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Background Prenatal exposure to ambient air pollution has been associated with adverse birth outcomes, but the potential modifying effect of maternal comorbidities remains understudied. Our objective was to investigate whether associations between prenatal air pollution exposures and birth outcomes differ by maternal comorbidities. Methods A total of 818,400 singleton live births were identified in the province of Ontario, Canada from 2005 to 2012. We assigned exposures to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ) and ozone (O 3 ) to maternal residences during pregnancy. We evaluated potential effect modification by maternal comorbidities (i.e. asthma, hypertension, pre-existing diabetes mellitus, heart disease, gestational diabetes and preeclampsia) on the associations between prenatal air pollution and preterm birth, term low birth weight and small for gestational age. Results Interquartile range (IQR) increases in PM 2.5 (2 μg/m 3 ), NO 2 (9 ppb) and O 3 (5 ppb) over the entire pregnancy were associated with a 4% (95% CI: 2.4–5.6%), 8.4% (95% CI: 5.5–10.3%) and 2% (95% CI: 0.5–4.1%) increase in the odds of preterm birth, respectively. Increases of 10.6% (95% CI: 0.2–2.1%) and 23.8% (95% CI: 5.5–44.8%) in the odds of preterm birth were observed among women with pre-existing diabetes while the increases were of 3.8% (95% CI: 2.2–5.4%) and 6.5% (95% CI: 3.7–8.4%) among women without this condition for pregnancy exposure to PM 2.5 and NO 2 , respectively ( P int <0.01). The increase in the odds of preterm birth for exposure to PM 2.5 during pregnancy was higher among women with preeclampsia (8.3%, 95% CI: 0.8–16.4%) than among women without (3.6%, 95% CI: 1.8–5.3%) ( P int =0.04). A stronger increase in the odds of preterm birth was found for exposure to O 3 during pregnancy among asthmatic women (12.0%, 95% CI: 3.5–21.1%) compared to non-asthmatic women (2.0%, 95% CI: 0.1–3.5%) ( P int <0.01). We did not find statistically significant effect modification for the other outcomes investigated. Conclusions Findings of this study suggest that associations of ambient air pollution with preterm birth are stronger among women with pre-existing diabetes, asthma, and preeclampsia. [ABSTRACT FROM AUTHOR]

Importance: RSV is a common illness among young children that causes significant morbidity and health care costs. Objective: Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario’s health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients. Study Design and Setting: A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children’s Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario’s administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression. Results: From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5–99.2%), specificity 99.6% (95%CI: 98.2–99.8%), PPV 96.9% (95%CI: 94.2–98.6%), NPV 99.4% (95%CI: 99.4–99.9%). Incidence of hospitalized RSV in Ontario from 2005–2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable increasing or decreasing linear trend in the incidence of hospitalized RSV, hospital length of stay and PICU admission rates. Among the Ontario RSV cohort, 16.3% had one or more major risk factors, with a decreasing trend observed over time. Conclusion: Children hospitalized for RSV-related disease can be accurately identified within population-based health administrative data. RSV is a major public health concern and incidence has not changed over time, suggesting a lack of progress in prevention. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy, safety, and maternal satisfaction of a newly established integrative postpartum community-based clinic providing comprehensive support for mothers during the first month after discharge from the hospital. Our primary interests were breastfeeding rates, readmission and patient satisfaction. Methods: A randomized controlled trial was conducted in Ottawa, Canada, where 472 mothers were randomized via a 1:2 ratio to either receive standard of care (n = 157) or to attend the postpartum breastfeeding clinic (n = 315). Outcome data were captured through questionnaires completed by the participants at 2, 4, 12 and 24 weeks postpartum. Unadjusted and adjusted logistic regression models were conducted to determine the effect of the intervention on exclusive breastfeeding at 12 weeks (primary outcome). Secondary outcomes included breastfeeding rate at 2, 4 and 24 weeks, breastfeeding self-efficacy scale, readmission rate, and satisfaction score. Results: More mothers in the intervention group (n = 195, 66.1%) were exclusively breastfeeding at 12 weeks compared to mothers in the control group (n = 81, 60.5%), however no statistically significant difference was observed (OR = 1.28; 95% CI:0.84–1.95)). The rate of emergency room visits at 2 weeks for the intervention group was 11.4% compared to the standard of care group (15.2%) (OR = 0.69; 95% CI: 0.39–1.23). The intervention group was significantly more satisfied with the overall care they received for breastfeeding compared to the control group (OR = 1.96; 95% CI: 3.50–6.88)). Conclusion: This new model of care did not significantly increase exclusive breastfeeding at 12 weeks. However, there were clinically meaningful improvements in the rate of postnatal problems and satisfaction that support this new service delivery model for postpartum care. A community-based multidisciplinary postpartum clinic is feasible to implement and can provide appropriate and highly satisfactory care to mother-baby dyads. This model of care may be more beneficial in a population that is not already predisposed to breastfeed. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background There are increasing concerns regarding the role of exposure to ambient air pollution during pregnancy in the development of early childhood cancers. Objective This population based study examined whether prenatal and early life (< 1 year of age) exposures to ambient air pollutants, including nitrogen dioxide (NO 2 ) and particulate matter with aerodynamic diameters ≤ 2.5 μm (PM 2.5 ), were associated with selected common early childhood cancers in Canada. Methods 2,350,898 singleton live births occurring between 1988 and 2012 were identified in the province of Ontario, Canada. We assigned temporally varying satellite-derived estimates of PM 2.5 and land-use regression model estimates of NO 2 to maternal residences during pregnancy. Incident cases of 13 subtypes of pediatric cancers among children up to age 6 until 2013 were ascertained through administrative health data linkages. Associations of trimester-specific, overall pregnancy and first year of life exposures were evaluated using Cox proportional hazards models, adjusting for potential confounders. Results A total of 2044 childhood cancers were identified. Exposure to PM 2.5 , per interquartile range increase, over the entire pregnancy, and during the first trimester was associated with an increased risk of astrocytoma (hazard ratio (HR) per 3.9 μg/m3 = 1.38 (95% CI: 1.01, 1.88) and, HR per 4.0 μg/m 3 = 1.40 (95% CI: 1.05–1.86), respectively). We also found a positive association between first trimester NO 2 and acute lymphoblastic leukemia (ALL) (HR = 1.20 (95% CI: 1.02–1.41) per IQR (13.3 ppb)). Conclusions In this population-based study in the largest province of Canada, results suggest an association between exposure to ambient air pollution during pregnancy, especially in the first trimester and an increased risk of astrocytoma and ALL. Further studies are required to replicate the findings of this study with adjustment for important individual-level confounders. [ABSTRACT FROM AUTHOR]