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168 My pioneering research project on calcium in pregnancy led to a significant finding that calcium supplementation in pregnancy prevents pre-eclampsiaeclampsia which is a leading cause of maternal mortality and morbidity in the world. Furthermore calcium was found to be superior to low-dose aspirin as prophy- laxis against hypertensive disorders of pregnancy. Since this research which resulted in much wider administration of calcium to pregnant womenthere has been a marked decline in maternal deaths from hypertensive disorders of pregnancy in Trinidad and Tobago. This research culminated in the award of the Master of Philosophy MPhil in Obstetrics and Gynaecology by The University of the West Indies.The findings of this research are documented as part of a thesis as well as a publication in the peer-reviewed journal Journal of Obstetrics and Gynaecology UK. It is noteworthy that the reviewer of that article Professor Michael de Sweit a leading authority in Medical Disorders of Pregnancy commented that this research was the first documented study which compared calcium and low-dose aspirin as prophylaxis against pre-eclampsiaeclampsia. I continue to lead the research agenda in The University of the West Indies in the field of Maternal Disorders of Pregnancy. The Caribbean is plagued with one of the highest incidence of diabetes mellitus in the world. As evident elsewhere we are also experiencing an epidemic of obesity in our population which is a precursor for diabetes mellitus. Similarly the incidence of gestational diabetes mellitus GDM a predisposing factor for diabetes mellitus type 2is also common in our population. Prior to my research on GDM screening for this condition in Trinidad and Tobago was primarily via testing for glycosuria although it is recognised that glycosuria is not a reliable screening tool with a low sensitivity and specificity for GDM. I have demonstrated that use of a lime-flavoured glucose drink is a suitable and effective method for screening for GDM.The addition of the lime juice makes the glucose drink much more palatable especially in pregnancy where many women experience nausea and vomit- ing which may be worsened by a highly concentrated glucose drink. We noted that these gastrointestinal upsets were eliminated with the addition of the lime juice to the glucose drink. I remain a firm advocate for universal screening for GDM in the Caribbean.With the introduction of universal screening over selective screening based on risk factors we have shown that selective screening misses as much as 50 of cases. We have already noted a much better outcome in pregnancy compli- cated by GDM with universal screening with the lime-flavoured glucose drink and early treatment.One such outcome is the fall in perinatal mortality from GDM from about 200 to less than 50 per 1000 total such births at the Mt. Hope Maternity Hospital since this research. Currently my postgraduate trainees and I are conducting a prospective study on the optimal time of delivery for women in their forties a condition that is well-recognised as high-risk in terms of outcome for both mothers and their offspring. A rising trend of pregnancy among women in the latter part of their reproductive age has been observed in Trinidad and Tobago. This trend is also evident internationally. We are also studying the outcome among 900 pregnant women with gestational diabetes who were treated with insulin andor oral hypoglycae- mic agents. We hope that the findings of this study may be instructive in assisting us to determine the best option to achieve glycaemic control among gestational diabetics. My research agenda also includes uterine fibroids which are the most common gynaecological tumours. These tumours are said to occur in 50-80 of Caucasian women and are even more common in West Indian women. We have been studying approaches to minimise intra-operative haemorrhage during myomectomy surgical removal of fibroids. This procedure is associated with severe blood loss and sometimes the only recourse to save the womens life is hysterectomy.My recent work in the field showed that the 3-month course of GnRH analogue was only effective in reducing associated blood loss in myomec- tomy for small