The Good GP

In this episode of The Good GP, Dr Julia Rawlinson speaks with Dr Florence Martin, an epidemiologist specialising in pregnancy pharmacoepidemiology. Dr Martin discusses her recent study examining the relationship between first trimester antidepressant use and miscarriage risk, using UK primary care data from the CPRD GOLD database.

Dr Martin explains the definitions used for trimesters and miscarriage, and highlights the understanding confounding by indication; how underlying depression, rather than the use of antidepressants, may skew observed associations in raw data. After adjusting for confounding factors, her research found only a modest increase in miscarriage risk for women using antidepressants in the first trimester, with the absolute risk rising slightly from 13.1% to 13.6%.

She further outlines the difference in risk between women who were already taking antidepressants when becoming pregnant and those who started during the first trimester. The findings suggest no increased miscarriage risk for continuing users, while those newly starting medication may show a slight increase, potentially due to residual confounding or early pregnancy detection bias.

Dr Martin encourages GPs to communicate absolute risk clearly and to consider each patient’s context when discussing antidepressant use in pregnancy.

Link & Resources:
https://bjgp.org/content/75/761/e843

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode of the Good GP, Dr Julia Rawlinson speaks with Dr Julia Feutrill, consultant psychiatrist at King Edward Memorial Hospital and co-director of the Elizabeth Clinic. They discuss the complexities of antidepressant use during pregnancy, providing GPs with practical advice for navigating these conversations.

Covering key assessment considerations, such as the severity of illness, history of hormonal sensitivity, trauma, and family psychiatric history. Dr Feutrill stresses the need to treat symptoms to remission rather than opting for subtherapeutic dosing, highlighting the low absolute risk of congenital malformations from antidepressant medications, especially compared to other modifiable risk factors.

Sertraline is identified as the antidepressant with the most robust safety data for pregnancy. Examining neonatal adaptation syndrome and outlines current understanding regarding dose adjustments during pregnancy. Guidance is provided on managing abrupt discontinuation and when GP referral to psychiatry is appropriate.

Dr Feutrill also draws attention to the growing recognition of hormonal sensitivity’s impact on mental health and encourages GPs to consider hormonal and neurobiological factors in their assessment and management.

Link & Resources:
Mothersafe NSW - https://www.seslhd.health.nsw.gov.au/royal-hospital-for-women/services-clinics/directory/mothersafe
TGA - Obstetric drug information services - https://www.tga.gov.au/resources/health-professional-information-and-resources/australian-categorisation-system-prescribing-medicines-pregnancy/prescribing-medicines-pregnancy-database/obstetric-drug-information-services
Perinatal Mental Health Guidelines - https://www.cope.org.au/uploads/images/Health-professionals/COPE_2023_Perinatal_Mental_Health_Practice_Guideline.pdf

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode of the Good GP, Dr Julia Rawlinson speaks with Dr Paul Effler, Senior Medical Advisor at the WA Department of Health and expert in communicable diseases, about H5N1 avian influenza and pertussis.

They review the current status of H5N1 in Australia, where the virus has been detected in wild birds but no human cases have been reported. Dr Effler highlights the very low risk of transmission to the general public, based on international experience, and outlines which groups may be at relatively higher risk. He provides practical advice for GPs on risk assessment, testing, and when to involve public health units, as well as the importance of not causing unnecessary alarm.

They also addressed the recent increase in pertussis cases in Western Australia. Dr Effler discusses the contribution of natural epidemic cycles and the importance of improving pertussis vaccination rates, especially for pregnant women, to protect infants.

Links & Resources:
Australian Centre for Disease Control - https://www.cdc.gov.au/diseases/bird-flu-avian-influenza
Light for Riley Foundation - https://www.ifa.org.au/lightforriley
Sharing Knowledge about immunisation - https://skai.org.au/healthcare-professionals/talking-parents-who-have-questions
Melbourne Vaccine education centre - https://mvec.mcri.edu.au/references/vaccine-confidence/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network
If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode, Dr Julia Rawlinson is once again joined by Dr Emma Turner, Paediatric Gastroenterologist and Hepatologist at Perth Children’s Hospital, and Dr Erin Horsley, GP Anaesthetist with a special interest in gastroenterology and lived experience parenting a child with coeliac disease. For the second part of their discussion on coeliac disease in children.

Dr Emma outlines key aspects of long-term management following a coeliac disease diagnosis. She highlights the necessity of early dietitian involvement for gluten-free diet education and stresses the importance of annual monitoring, including coeliac serology, full blood count, liver function, iron studies, thyroid function, and vitamin D. Covering the risk of ongoing small bowel inflammation and malignancy associated with continued gluten exposure, even in children without acute symptoms, and provides practical tips on identifying hidden sources of gluten.

Dr Erin shares her lived experience as a parent, emphasising family education, membership in Coeliac Australia, and engaging with schools and peer families for support. The unique challenges faced by adolescents with coeliac disease are also addressed, with a recommendation for ongoing dietetic input during periods of increasing independence.

Links & Resources:
https://coeliac.org.au/health-professionals/gluten-challenge/
Health professionals - Coeliac Australia
Ongoing management - Coeliac Australia
https://coeliac.org.au/health-professionals/ongoing-management/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!

In this episode, Dr Julia Rawlinson is joined in this two-part series by Dr Emma Turner, Paediatric Gastroenterologist and Hepatologist at Perth Children’s Hospital, and Dr Erin Horsley, GP Anaesthetist with a special interest in gastroenterology and lived experience parenting a child with coeliac disease.

Providing practical advice for GPs on recognising and investigating coeliac disease in Australian children.

Key points discussed:
Prevalence and Risk: Coeliac disease affects about 1 in 70 Australians, with 80% undiagnosed. First-degree relatives have a 10-20% risk depending on family history.
Clinical Presentation: Symptoms can include iron deficiency, growth failure, pubertal delay, abdominal pain, and altered bowel habits. Less obvious presentations might be behavioural issues, sleep problems, mild elevation of liver enzymes, dental enamel defects, and recurrent mouth ulcers. Diagnosis should still be considered in children who are growing normally or are obese.
Testing Approach: The recommended initial tests are tissue transglutaminase IgA (TTG-IgA) and total IgA. Gluten intake must be adequate for accurate results. There is no current recommendation for population screening, but GPs are encouraged to maintain a low threshold for testing symptomatic children.
Diagnosis and Specialist Involvement: Non-biopsy diagnosis can be considered for children with TTG-IgA >10× upper limit of normal plus confirmatory endomysial antibody testing, but all cases require confirmation by a paediatric gastroenterologist. Early gluten-free diets before testing complicate diagnosis and may require a supervised gluten challenge.
Screening Relatives and Genetic Testing: All first-degree relatives should be screened, ideally at the time of index case diagnosis, and re-tested every 2–3 years if negative. HLA genetic testing is useful only to exclude coeliac disease, not to confirm it.

Part 2 will focus on managing coeliac disease long term and practical advice for GPs and families.

Links & Resources:
https://coeliac.org.au/health-professionals/gluten-challenge/
Health professionals - Coeliac Australia
Ongoing management - Coeliac Australia
https://coeliac.org.au/health-professionals/ongoing-management/

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information. You can also find us on our Instagram page: @thegoodgppodcast. Follow us for more updates!