New Zealand European Women Research Articles

Placental pathology findings amongst extremely preterm perinatal deaths in Aotearoa New Zealand

IntroductionWomen of South Asian ethnicity are overrepresented in adverse pregnancy outcomes across high-income countries, including placental dysfunction and antepartum haemorrhage. As the burden of mortality is highest for extremely preterm infants, we aimed to identify any differences in placental pathology among perinatal deaths from 20+0 to 27+6 weeks gestation between South Asian, Māori and New Zealand (NZ) European women in Aotearoa NZ, with a focus on women of South Asian ethnicity. MethodsPlacental pathology reports and clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, blinded and analysed by an experienced perinatal pathologist using the Amsterdam Placental Workshop Group Consensus Statement criteria. South Asian ethnicity was classified as Indian, Fijian Indian, South African Indian, Sri Lankan, Pakistani and Bangladeshi. Results886 of 1571 placental pathology reports met the inclusion criteria. Women of South Asian ethnicity were significantly more likely to show features of histologic chorioamnionitis (aOR 1.87, 95%CI 1.19–2.94) and chorionic vasculitis (aOR 1.92, 95%CI 1.13–3.29), than NZ European and Māori women respectively. 13 of 15 (87%) of South Asian mothers with a diabetic disorder were identified with chorioamnionitis, compared to 1 in 5 (20%) of Māori and 5 in 12 (41%) of NZ European women. Cord hyper-coiling was also more common among South Asian pregnancies, compared to NZ European (aOR 1.98, 95%CI 1.10–3.56). DiscussionDifferences in placental pathology by ethnicity were observed among extremely preterm perinatal deaths. Underlying metabolic disorders and an associated pro-inflammatory environment may play an important role in the causal pathway leading to these deaths in women of South Asian ethnicity.

Age, ethnicity, life events and wellbeing among New Zealand women

AbstractBy the year 2030, 19–21 per cent of the population of New Zealand (NZ) is projected to be aged 65 and over. Like many countries, life expectancy in NZ differs by gender but also ethnicity: in 2019, life expectancy for Māori (indigenous) women was 77.1 years compared with 84.4 years for non-Māori women. If Māori and NZ European women are to flourish in later life, examining the factors associated with their wellbeing is paramount. The current study draws on the Life Course Perspective to explore how wellbeing is associated with age-related life events among mid- to later-life NZ women. The women in this study (N = 19,624) are participants in the 2018 wave of the New Zealand Attitudes and Values Study, a national probabilistic 20-year longitudinal study (mean age = 55.62; Māori = 10.8%, NZ European = 89.2%). We found that stressful life events were negatively associated with life satisfaction but positively associated with meaning in life. Māori women exhibited lower levels of life satisfaction but there were no ethnic differences for meaning in life; however, Māori and NZ European women showed different patterns of significant correlates associated with meaning in life. Findings highlight the necessity of an intersectional approach to the study of mid- to later-life wellbeing and the utility of measuring wellbeing in more than one way within NZ's unique cultural-historical context.

Objectively Measured Physical Activity Is Associated With Body Composition and Metabolic Profiles of Pacific and New Zealand European Women With Different Metabolic Disease Risks.

Objective: To assess associations between physical activity (PA), body composition, and biomarkers of metabolic health in Pacific and New Zealand European (NZE) women who are known to have different metabolic disease risks.Methods: Pacific (n = 142) or NZE (n = 162) women aged 18–45 years with a self-reported body mass index (BMI) of either 18.5–25.0 kg⋅m–2 or ≥30.0 kg⋅m–2 were recruited and subsequently stratified as either low (<35%) or high (≥35%) BF%, with approximately half of each group in either category. Seven-day accelerometery was used to assess PA levels. Fasting blood was analysed for biomarkers of metabolic health, and whole body dual-energy X-ray absorptiometry (DXA) was used to estimate body composition.Results: Mean moderate-to-vigorous physical activity (MVPA; min⋅day–1) levels differed between BF% (p < 0.05) and ethnic (p < 0.05) groups: Pacific high- 19.1 (SD 15.2) and low-BF% 26.3 (SD 15.6) and NZE high- 30.5 (SD 19.1) and low-BF% 39.1 (SD 18.4). On average Pacific women in the low-BF% group engaged in significantly less total PA when compared to NZE women in the low-BF% group (133 cpm); no ethnic difference in mean total PA (cpm) between high-BF% groups were observed: Pacific high- 607 (SD 185) and low-BF% 598 (SD 168) and NZE high- 674 (SD 210) and low-BF% 731 (SD 179). Multiple linear regression analysis controlling for age and deprivation showed a significant inverse association between increasing total PA and fasting plasma insulin among Pacific women; every 100 cpm increase in total PA was associated with a 6% lower fasting plasma insulin; no significant association was observed in NZE women. For both Pacific and NZE women, there was an 8% reduction in fasting plasma insulin for every 10-min increase in MVPA (p ≤ 0.05).Conclusion: Increases in total PA and MVPA are associated with lower fasting plasma insulin, thus indicating a reduction in metabolic disease risk. Importantly, compared to NZE, the impact of increased total PA on fasting insulin may be greater in Pacific women. Considering Pacific women are a high metabolic disease risk population, these pre-clinical responses to PA may be important in this population; indicating promotion of PA in Pacific women should remain a priority.

Pertussis and influenza immunisation coverage of pregnant women in New Zealand

BackgroundImmunisation is an important public health policy and measuring coverage is imperative to identify gaps and monitor trends. New Zealand (NZ), like many countries, does not routinely publish coverage of immunisations given during pregnancy. Therefore, this study examined pregnancy immunisation coverage of all pregnant NZ women between 2013 and 2018, and what factors affected uptake. MethodsA retrospective cohort study of pregnant women who delivered between 2013 and 2018 was undertaken using administrative datasets. Maternity and immunisation data were linked to determine coverage of pertussis and influenza vaccinations in pregnancy. Generalised estimating equations were used to estimate the odds of receiving a vaccination during pregnancy. ResultsFrom 2013 to 2018 data were available for 323,622 pregnant women, of whom 21.7% received maternal influenza immunisations and 25.7% maternal pertussis immunisations. Coverage for both vaccines increased over time, pertussis increased from 10.2% to 43.6% and influenza from 11.2% to 30.8%. The odds of being vaccinated, with either vaccine, during pregnancy increased with increasing age and decreasing deprivation. Compared to NZ European or Other women, Māori and Pacific women had lower odds of receiving a maternal pertussis (OR:0.55, 95% CI: 0.54, 0.57; OR:0.60, 95% CI: 0.58, 0.62, respectively) and influenza (OR: 0.69, 95% CI: 0.67, 0.71; OR:0.90, 95% CI: 0.87, 0.94, respectively) immunisations during pregnancy. Women were also more likely to be vaccinated against pertussis if they received antenatal care from a General Practitioner or Obstetrician compared to a Midwife. A similar pattern was seen for influenza vaccination. ConclusionGaps in maternal coverage for pertussis and influenza exist and work is needed to reduce immunisation inequities.

Predictors Linking Obesity and the Gut Microbiome (the PROMISE Study): Protocol and Recruitment Strategy for a Cross-Sectional Study on Pathways That Affect the Gut Microbiome and Its Impact on Obesity.

BackgroundThe prevalence of obesity has increased substantially over recent decades and is associated with considerable health inequalities. Although the causes of obesity are complex, key drivers include overconsumption of highly palatable, energy-dense, and nutrient-poor foods, which have a profound impact on the composition and function of the gut microbiome. Alterations to the microbiome may play a critical role in obesity by affecting energy extraction from food and subsequent energy metabolism and fat storage.ObjectiveWe report the study protocol and recruitment strategy of the PRedictors linking Obesity and the gut MIcrobiomE (PROMISE) study, which characterizes the gut microbiome in 2 populations with different metabolic disease risk (Pacific and European women) and different body fat profiles (normal and obese). It investigates (1) the role of gut microbiome composition and functionality in obesity and (2) the interactions between dietary intake; eating behavior; sweet, fat, and bitter taste perception; and sleep and physical activity; and their impact on the gut microbiome, metabolic and endocrine regulation, and body fat profiles.MethodsHealthy Pacific and New Zealand (NZ) European women aged between 18 and 45 years from the Auckland region were recruited for this cross-sectional study. Participants were recruited such that half in each group had either a normal weight (body mass index [BMI] 18.5-24.9 kg/m2) or were obese (BMI ≥30.0 kg/m2). In addition to anthropometric measurements and assessment of the body fat content using dual-energy x-ray absorptiometry, participants completed sweet, fat, and bitter taste perception tests; food records; and sleep diaries; and they wore accelerometers to assess physical activity and sleep. Fasting blood samples were analyzed for metabolic and endocrine biomarkers and DNA extracted from fecal samples was analyzed by shotgun sequencing. Participants completed questionnaires on dietary intake, eating behavior, sleep, and physical activity. Data were analyzed using descriptive and multivariate regression methods to assess the associations between dietary intake, taste perception, sleep, physical activity, gut microbiome complexity and functionality, and host metabolic and body fat profiles.ResultsOf the initial 351 women enrolled, 142 Pacific women and 162 NZ European women completed the study protocol. A partnership with a Pacific primary health and social services provider facilitated the recruitment of Pacific women, involving direct contact methods and networking within the Pacific communities. NZ European women were primarily recruited through Web-based methods and special interest Facebook pages.ConclusionsThis cross-sectional study will provide a wealth of data enabling the identification of distinct roles for diet, taste perception, sleep, and physical activity in women with different body fat profiles in modifying the gut microbiome and its impact on obesity and metabolic health. It will advance our understanding of the etiology of obesity and guide future intervention studies involving specific dietary approaches and microbiota-based therapies.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618000432213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370874International Registered Report Identifier (IRRID)RR1-10.2196/14529

Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

In New Zealand (NZ), Maori and Pacific women are less likely to complete prenatal screening for Down syndrome and other aneuploidies than other ethnic groups. Young women <20 have low rates of completed screening compared with women >20years. Women living in deprived areas have lower completed screen rates than women living in more affluent areas. Combined first trimester screening has a superior sensitivity (85%) compared with second trimester screening (75%) for trisomy 21. The relative contribution of demographic factors to timing of screening uptake (first vs second trimester) has not previously been examined. To evaluate the association of ethnicity, deprivation, District Health Board (DHB) of domicile and maternal age with timing of prenatal screening (first vs second trimester) in pregnant women screened in NZ from 2010 to 2013. Univariate logistic regression analyses were used to explore the association between timing of completed screening and each of ethnicity, deprivation index, DHB of domicile and maternal age. Multivariate logistic regression models were developed to calculate odds ratios (OR) and 95% confidence intervals (CI). Statistical analyses were performed using SAS v9.3 RESULTS: Of completed prenatal screens, 88% were completed in the first trimester. Ethnicity, age, deprivation and DHB were all significant predictors of completed first versus second trimester screening. Maori women were almost 60% less likely (adjusted OR 0.37, CI 0.35-0.39) and Pacific women almost 80% less likely (adjusted OR 0.23, CI 0.21-0.24) than NZ European women to have completed first versus second trimester screening. Women <30years were less likely to have completed first trimester screening, as were more deprived women. Variation was also seen by DHB with women living in Whanganui DHB less likely to have completed first versus second trimester screening than women living in Auckland (adjusted OR 0.76, CI 0.71-0.81). Women living in Bay of Plenty DHB were more likely to be screened in the first versus second trimester compared with women living in Auckland (adjusted OR 1.55, CI 1.38-1.74). Within Auckland itself, women living in Counties Manukau DHB were less likely to be screened in the first versus second trimester than women living in Auckland DHB even after adjusting for ethnicity, deprivation and maternal age. Maori and Pacific women have the lowest uptake of completed first versus second trimester screening after adjusting for age, deprivation and DHB. Research is required to understand if this relates to characteristics of the carer making the offer of screening, language and/or cultural barriers to care or specific collective cultural or religious views held by women from these ethnicities. The lower completed first trimester versus second trimester prenatal screening in deprived areas, as well as variation by DHB, may relate to the availability of ultrasound and/or laboratory services in specific regions. Cost may be a contributing factor to inequity in timing of completed prenatal screening uptake, as first trimester screening incurs a part-charge to the individual, while second trimester screening is fully funded. Systemic factors within the NZ maternity model of care may also be contributory with a potential disconnect occurring for the woman between primary medical care and later registration with a Lead Maternity Carer in the first trimester.

The role of self-construal in resisting tobacco smoking

We interpreted depth interviews and personal observations of 29 Tongan and New Zealand European (NZE) women who self-identified as non-smokers to examine the role of self-construal in the creation and maintenance of their smoking-resistant identities. Our research offers substantive contributions to the smoking prevention literature because most prior work has been situated wholly within Western cultural contexts. We contribute methodologically by showing how a multicultural team-based approach can reap the advantages of interviewer–participant congruity whilst overcoming its limitations, thus paving the way for more fruitful qualitative research with minority groups. Our research also contributes theoretically to the self-construal literature by comparing the role of self-construal not just within the two groups but also across them. Our findings show that independent self-construal played a significant role in NZE women's resistance to smoking. However, for Tongan women, both independent and interdependent self-construals played important roles in their smoking resistance. Our findings both confirm and extend the current view that there are marked differences between collectivist and independent societies. We extend this view because our findings contradict the notion that Tongan women are likely to only use an interdependent self-concept when deciding to resist smoking, suggesting instead that Tongan women negotiate their self-construals in ways that allow them to employ the positives from both Tongan values and Western world views. We suggest that future appeals to Pacific women to resist smoking should draw on both traditional Pacific values and modern Western independence.

Risk factors associated with mortality from breast cancer in Waikato, New Zealand: a case-control study

ObjectivesThe aim of this study is to identify key characteristics associated with mortality from breast cancer among women with newly diagnosed breast cancer in New Zealand (NZ). Study designCase-control study. MethodsAll primary breast cancers diagnosed between 01/01/2002 and 31/12/2010 in Waikato, NZ, were identified from the Waikato Breast Cancer Register. A total of 258 breast cancer deaths were identified from 1767 invasive cancers diagnosed over this period. ResultsBreast cancer deaths (n = 246) were compared with an age and year of diagnosis matched control group (n = 652) who were alive at the time of the death of the corresponding case and subsequently did not die from breast cancer. Diagnosis through symptomatic presentation, advanced stage, higher grade, absent hormone receptors (i.e. oestrogen and progesterone) and HER-2 amplification were associated with significantly higher risks of breast cancer mortality in bivariate analysis. Tumour stage, grade and hormone receptor status remained significant in the multivariable model, while mode of detection and HER-2 status were non-significant. In the bivariate analysis, Māori women had a higher risk of breast cancer mortality compared to NZ European women (OR 1.34) which was statistically non-significant. However in the adjusted model, risk of mortality was lower for Māori compared to NZ European women, although this was not significant statistically (OR 0.85). ConclusionsMortality pattern from breast cancer in this study were associated with established risk factors. Ethnic inequity in breast cancer mortality in NZ appears to be largely attributable to delay in diagnosis and tumour related factors. Further research in a larger cohort is needed to identify the full impact of these factors on ethnic inequity in breast cancer mortality.

Factors predicting the nodal involvement in early breast cancer

s / The Breast 23 (2014) S1eS6 S5 FACTORS PREDICTING THE NODAL INVOLVEMENT IN EARLY BREAST CANCER A. Elmadahm, P. Gill , G. Farshid , V. Gebski , M. Bilous , S. Lord , L. Chee , N. Wetzig . University of Adelaide, North Terrace, Adelaide, SA, Australia; NHRMC Clinical trial Centre, University of Sydney, Sydney, NSW, Australia; 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Wesley Medical Centre, Brisbane, QLd, Australia Background: The nodal status is an important prognostic factor in early breast cancer. This study assessed association between clinicopathological factors and involvement of Sentinel Lymph Node (SLN) and Non Sentinel Lymph Node (NSLN) in the SNAC 1 trial. Accurate statistical models can assist surgical counselling and potentially avoid axillary surgery in selected cases. Method: This is a retrospective analysis of 1088 patients. Lymphoscintigraphy, blue dye injection and gamma probe were used for SLN mapping and retrieved nodes were examined with HE 16:266-75. TREATMENT DELAY FOR M AORI WOMEN WITH BREAST CANCER IN NEW ZEALAND S.A. Seneviratne, I.D. Campbell, N. Scott, R. Lawrenson. Waikato Clinical School, University of Auckland, New Zealand Background: Delays in diagnosis and treatment of breast cancer are associated with lower survival rates 1. Indigenous M aori women have 60% higher overall and 32% higher stage adjusted breast cancer mortality compared to European women in New Zealand (NZ) 2. We sought to evaluate factors associated with delays of >31 and >90 days for surgical treatment of breast cancer among NZ womenwith newly diagnosed breast cancer. Methods: A retrospective analysis of prospectively collected data included in the Waikato Breast Cancer Register from 01/01/2005 through 31/12/ 2010 was performed. Results: 1449 (out of 1510, 96%) breast cancers diagnosed within Waikato, over the study period were included. Out of women undergoing primary surgery (n1⁄41264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among M aori (mean 36.9, p with NZ European women, higher proportions of M aori and Pacific Island women (statistically non-significant) experienced delays longer than 31 days (40.2% vs. 47.8% and 52.1%, P>0.05) and 90 days (1.6% vs. 2.7% and 4.3%, p>0.05). Multivariate analysis identified public sector treatment (OR 5.93 and 8.14), DCIS (OR 1.53 and 3.17), mastectomy as treatment (OR 1.75 and 6.60) and earlier year of diagnosis (1.21 and 1.03) as factors significantly associated with delays longer than 31 and 90 days. Conclusions: A high proportion of women not initiating surgical treat- ment of breast cancer within the stipulated guideline limit of 31 days and significantly longer delays experienced by ethnic minority women were highlighted in this study. Urgent steps are needed to improve performance and to shorten treatment delays in public sector to minimize delays overall, and to reduce ethnic inequities in breast cancer treatment in NZ.

Treatment delay for Māori women with breast cancer in New Zealand

Objectives. To identify differences in delay for surgical treatment of breast cancer between ethnic groups and to evaluate the role of health system, sociodemographic and tumour factors in ethnic inequities in breast cancer treatment.Methods. A retrospective analysis of prospectively collected data from the Waikato Breast Cancer Register for cancers diagnosed in the Waikato region in New Zealand (NZ) from 1 January 2005 to 31 December 2010.Results. Approximately 95% (1449 out of 1514) of women with breast cancer diagnosed in the Waikato over the study period were included. Of women undergoing primary surgery (n = 1264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis, respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among Māori (mean = 37.1 days, p = 0.005) and Pacific women (mean = 42.8 days, p = 0.005). Māori women were more likely to experience delays longer than 31 (p = 0.048) and 90 days (p = 0.286) compared with NZ European women. Factors predicting delays longer than 31 and 90 days in the multivariable model included public sector treatment (OR 5.93, 8.14), DCIS (OR 1.53, 3.17), mastectomy (OR 1.75, 6.60), higher co-morbidity score (OR 2.02, 1.02) and earlier year of diagnosis (OR 1.21, 1.03). Inequities in delay between Māori and NZ European women were greatest for women under 50 years and those older than 70 years.Conclusion. This study shows that significant inequities in timely access to surgical treatment for breast cancer exist in NZ, with Māori and Pacific women having to wait longer to access treatment than NZ European women. Overall, a high proportion of women did not receive surgical treatment for breast cancer within the guideline limit of 31 days. Urgent steps are needed to reduce ethnic inequities in timely access to breast cancer treatment, and to shorten treatment delays in the public sector for all women.

Disparities in edentulism and tooth loss between Māori and non‐Māori New Zealand women

Tooth loss and edentulism are important negative health outcomes; however, there is little current information about the prevalence of these conditions among adults in New Zealand (NZ). This study describes the dentate status of Maori and non-Maori NZ women with regard to tooth loss, edentulism and denture-wearing, and investigates ethnic and sociodemographic disparities within the sample. Associations between dentate status, socio-demographic and health-related factors are described. Participants were 1,817 women who were screened for participation in a randomised controlled trial. 9.0% of women were edentulous and 30.3% wore a denture (partial or complete). The mean number of teeth present was 24.2, and older women had fewer teeth on average. Socio-demographic and ethnic disparities in tooth loss and edentulism were observed. Maori ethnicity was strongly associated with edentulism and tooth loss, with Maori women five times more likely than NZ European women to be edentulous. These associations held after controlling for age, education, smoking, diabetes, cardiovascular disease history, and BMI. Marked ethnic disparities in edentulism and tooth loss exist in New Zealand. Effective targeted programmes are needed to reduce the public health impact of poor oral health among Maori.