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2. Teen Pregnancy and Risk of Premature Mortality

Author

Ray, Joel G., primary, Fu, Longdi, additional, Austin, Peter C., additional, Park, Alison L., additional, Brown, Hilary K., additional, Grandi, Sonia M., additional, Vandermorris, Ashley, additional, Boblitz, Alexa, additional, and Cohen, Eyal, additional

Published
2024
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14. Prepregnancy renal function and risk of preterm birth and related outcomes

Author

Harel, Ziv, Park, Alison L., McArthur, Eric, Hladunewich, Michelle, Dirk, Jade S., Wald, Ron, Garg, Amit X., and Ray, Joel G.

Subjects
Premature infants, Blood tests, Pregnancy, Kidney diseases -- Risk factors, Pregnant women, Health
Abstract

BACKGROUND: Prepregnancy kidney dysfunction has been associated with preterm birth, which is the leading cause of neonatal morbidity and mortality; however, the relation is not well understood. We determined the risk of preterm birth in women with prepregnancy kidney dysfunction, defined using pregnancy-specific serum creatinine cut points. METHODS: This population-based cohort study in the province of Ontario, Canada, involved women aged 16 to 50 years who had a singleton birth between 2006 and 2016 and measurement of serum creatinine within 10 weeks preceding their estimated conception date. The exposure was abnormally elevated prepregnancy serum creatinine, defined as greater than the 95th percentile (> 77 [micro]mol/L), a value derived from a population-based sample of women without known kidney disease who became pregnant soon after the measurement was obtained. The main outcome was any preterm birth from 23 to 36 weeks' gestation. Secondary outcomes included provider-initiated preterm birth before 37 weeks' gestation and spontaneous preterm birth before 37 weeks. RESULTS: Among 55 946 pregnancies, preterm birth before 37 weeks' gestation occurred in 3956 women (7.1%). The risk of preterm birth before 37 weeks was higher among women with prepregnancy creatinine above the 95th percentile, relative to those with prepregnancy creatinine at or below the 95th percentile (9.1% v. 7.0%; adjusted relative risk [RR] 1.23, 95% confidence interval [CI] 1.09 to 1.38). The effect was significant for provider-initiated preterm birth (adjusted RR 1.30, 95% CI 1.11 to 1.52) but not for spontaneous preterm birth (adjusted RR 1.12, 95% CI 0.91 to 1.37). INTERPRETATION: Given that prepregnancy kidney dysfunction conferred an increased risk of preterm birth, measurement of serum creatinine (a relatively inexpensive blood test) may form part of the assessment of risk for preterm birth among those planning pregnancy., Prepregnancy kidney dysfunction may perturb the normal physiologic adaptations of pregnancy, predisposing a woman and her fetus to adversity, at least partly mediated by placental and endothelial dysfunction. (1) Complications [...]

Published
2020
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20. Infertility treatment and risk of severe maternal morbidity: a propensity score-matched cohort study

Author

Dayan, Natalie, Joseph, K.S., Fell, Deshayne B., Laskin, Carl A., Basso, Olga, Park, Alison L., Luo, Jin, Guan, Jun, and Ray, Joel G.

Subjects
Ontario. Ministry of Health and Long-Term Care, Maternal mortality -- Comparative analysis, Pregnant women -- Prognosis -- Comparative analysis, Infertility -- Prognosis -- Comparative analysis, Morbidity -- Prognosis -- Comparative analysis, Obstetrics -- Comparative analysis, Death, Fertilization in vitro, Sperm, Health
Abstract

BACKGROUND: The extent to which infertility treatment predicts severe maternal morbidity is not well known. We examined the association between infertility treatment and severe maternal morbidity in pregnancy and the postpartum period.METHODS: We conducted a cohort study using population-based registries from Ontario between 2006 and 2012. Pregnancies achieved using infertility treatment (ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) were compared with unassisted pregnancies using propensity score matching, based on demographic, reproductive and obstetric factors. The primary outcome was a validated composite of severe maternal morbidity or maternal death from 20 weeks' gestation to 42 days postpartum. We also calculated the odds ratio of a woman having 1, 2, or 3 or more severe maternal morbidity indicators in relation to invasive (e.g., in vitro fertilization) or noninvasive (e.g., intrauterine insemination) infertility treatment.RESULTS: We matched 11546 infertility treatment pregnancies with 47 553 untreated pregnancies. Severe maternal morbidity or maternal death occurred in 356 infertility-treated pregnancies (30.8 per 1000 deliveries) versus 1054 untreated pregnancies (22.2 per 1000 deliveries); relative risk 1.39 (95% confidence interval [CI] 1.231.56). The likelihood of a woman having 3 or more severe maternal morbidity indicators was increased in women who received invasive infertility treatment (odds ratio [OR] 2.28, 95% CI 1.56-3.33) but not in those who received noninvasive infertility treatment (OR 0.99, 95% CI 0.57-1.72).INTERPRETATION: Women who undergo infertility treatment, particularly in vitro fertilization, are at somewhat higher risk of severe maternal morbidity or death. Efforts are needed to identify patient- and treatment-specific predictors of severe maternal morbidity that may influence the type of treatment a woman is offered., Infertility affects 1 in 6 Canadian couples, many of whom turn to infertility treatment. These include pharmacologic ovulation induction, intrauterine insemination, and more invasive assisted reproductive technologies, such as in [...]

Published
2019
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28. Risk of severe maternal morbidity or death in relation to elevated hemoglobin A1c preconception, and in early pregnancy: A population-based cohort study

Author

Davidson, Alexander J. F., Park, Alison L., Berger, Howard, Aoyama, Kazuyoshi, Harel, Ziv, Cook, Jocelynn L., and Ray, Joel G.

Subjects
Maternal mortality, Diabetes mellitus, Glucose, Morbidity, Glycosylated hemoglobin, Pregnant women, Biological sciences
Abstract

Background The relation between prepregnancy average glucose concentration and a woman's risk of severe maternal morbidity (SMM) is unknown. The current study evaluated whether an elevated preconception hemoglobin A1c (A1c) is associated with SMM or maternal death among women with and without known prepregnancy diabetes mellitus (DM). Methods and findings A population-based cohort study was completed in Ontario, Canada, where there is universal healthcare. The main cohort included 31,225 women aged 16-50 years with a hospital live birth or stillbirth from 2007 to 2015, and who had an A1c measured within 90 days before conception, including 28,075 women (90%) without known prepregnancy DM. The main outcome was SMM or maternal mortality from 23 weeks' gestation up to 42 days postpartum. Relative risks (RRs) were generated using modified Poisson regression, adjusting for the main covariates of maternal age, multifetal pregnancy, world region of origin, and tobacco/drug dependence. The mean maternal age was 31.1 years. Overall, SMM or death arose among 682 births (2.2%). The RR of SMM or death was 1.16 (95% CI 1.14-1.19; p < 0.001) per 0.5% increase in A1c and 1.16 (95% CI 1.13-1.18; p < 0.001) after adjusting for the main covariates. The adjusted relative risk (aRR) was increased among those with (1.11, 95% CI 1.07-1.14; p < 0.001) and without (1.15, 95% CI 1.02-1.29; p < 0.001) known prepregnancy diabetes, and upon further adjusting for body mass index (BMI) (1.15, 95% CI 1.11-1.20; p < 0.001), or chronic hypertension and prepregnancy serum creatinine (1.11, 95% CI 1.04-1.18; p = 0.002). The aRR of SMM or death was 1.31 (95% CI 1.06-1.62; p = 0.01) in those with a preconception A1c of 5.8%-6.4%, and 2.84 (95% CI 2.31-3.49; p 6.4%, each relative to an A1c 6.4%, the aRR of SMM or death was 3.25 (95% CI 1.76-6.00; p < 0.001). Study limitations include that selection bias may have incorporated less healthy women tested for A1c, and BMI was unknown for many women. Conclusions Our findings indicate that women with an elevated A1c preconception may be at higher risk of SMM or death in pregnancy or postpartum, including those without known prepregnancy DM., Author(s): Alexander J. F. Davidson 1, Alison L. Park 1,2, Howard Berger 1,3,4, Kazuyoshi Aoyama 1,5, Ziv Harel 1,2,3, Jocelynn L. Cook 6,7, Joel G. Ray 1,2,3,4,* Introduction The prevalence [...]

Published
2020
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33. Differences in growth of Canadian children compared to the WHO 2006 Child Growth Standards

Author

Park, Alison L., Tu, Karen, Ray, Joel G., Babaran‐Henfrey, Kathlyn, Bartsch, Emily, Berger, Howard, Campbell, Douglas, Chiu, Maria, De Souza, Leanne R., Guttmann, Astrid, Handa, Manavi, Longo, Christopher, Maguire, Jonathon, Meloche, James, Melamed, Nir, Mousmanis, Patricia, Roukema, Henry, Roy, Jennifer, Sgro, Michael, Smith, Graeme N., Urquia, Marcelo, Vanderkooy, Pat, Watson, William, Watts, Nancy, and Young, Jacqueline

Published
2017
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34. Severity of obstructive coronary artery stenosis after pre-eclampsia.

Author

Ray, Joel G., Austin, Peter C., Park, Alison L., Cohen, Eyal, Jiming Fang, and Chu, Anna

Subjects
ECLAMPSIA, CORONARY artery stenosis, PREECLAMPSIA, ARTERIAL dissections, AMBULATORY blood pressure monitoring, CARDIOGRAPHIC tomography, CORONARY artery calcification, SPONTANEOUS coronary artery dissection
Published
2023
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35. Influence of environmental temperature on risk of gestational diabetes

Author

Booth, Gillian L., Luo, Jin, Park, Alison L., Feig, Denice S., Moineddin, Rahim, and Ray, Joel G.

Subjects
Ontario. Ministry of Health and Long-Term Care, Health screening, Global warming, Algorithms, Medical records, Online databases, Gestational diabetes -- Risk factors, Pregnant women, Online database, Algorithm, Health, Mount Sinai Hospital
Abstract

BACKGROUND: Cold-induced thermogenesis is known to improve insulin sensitivity, which may become increasingly relevant in the face of global warming. The aim of this study was to examine the relation between outdoor air temperature and the risk of gestational diabetes mellitus. METHODS: We identified all births in the Greater Toronto Area from 2002 to 2014 using administrative health databases. Generalized estimating equations were used to examine the relation between the mean 30-day outdoor air temperature before the time of gestational diabetes mellitus screening and the likelihood of diagnosis of gestational diabetes mellitus based on a validated algorithm using hospital records and physician service claims. RESULTS: Over the 12-year period, there were 555911 births among 396828 women. Prevalence of gestational diabetes mellitus was 4.6% among women exposed to extremely cold mean outdoor air temperatures ([less than or equal to]-10[degrees]C) in the 30-day period before screening and increased to 7.7% among those exposed to hot mean 30-day temperatures ([greater than or equal to] 24[degrees]C). Each 10[degrees]C increase in mean 30-day temperature was associated with a 1.06 (95% confidence interval [CI] 1.04-1.07) times higher odds of gestational diabetes mellitus, after adjusting for maternal age, parity, neighbourhood income quintile, world region and year. A similar effect was seen for each 10[degrees]C rise in outdoor air temperature difference between 2 consecutive pregnancies for the same woman (adjusted odds ratio 1.06, 95% CI 1.03-1.08). INTERPRETATION: In our setting, there was a direct relation between outdoor air temperature and the likelihood of gestational diabetes mellitus. Future climate patterns may substantially affect global variations in the prevalence of diabetes, which also has important implications for the prevention and treatment of gestational diabetes mellitus., The impact of climate variability on health has become increasingly relevant given the global rise in air temperatures over the past century. (1,2) Extreme weather patterns can adversely influence health--directly, [...]

Published
2017
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38. Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial

Author

Acartürk, Ceren, Uygun, Ersin, İlkkurşun, Zeynep, Yurtbakan, Taylan, Kurt, Gülşah, Adam Troian, Jais, Şenay, İbrahim, Bryant, R., Cuijpers, P., Kiselev, N., Mcdaid, D., Morina, Njomeza, Nişancı, Zehra Nuray, Park, Alison L., Sijbrandij, M., Ventevogel, Peter, Fuhr, Daniela C., Acartürk, Zeynep Ceren (ORCID 0000-0001-7093-1554 & YÖK ID 39271), İlkkurşun, Zeynep, Kurt, Gülşah, Uygun, E., Yurtbakan, T., Adam Troian, J., Şenay, I, Bryant, R., Cuijpers, P., Kiselev, N., McDaid, D., Morina, N., Nişancı, Z., Park, A. L., Sijbrandij, M., Ventevogel, P., Fuhr, D. C., College of Social Sciences and Humanities, Graduate School of Social Sciences and Humanities, Department of Psychology, Clinical Psychology, World Health Organization (WHO) Collaborating Center, APH - Global Health, and APH - Mental Health

Subjects
Psychiatry, Randomised controlled trial, Refugees, Syria, Turkey, BF Psychology, Research, RC435-571, Common mental health problems, Pilot Projects, Pilot, Feasibility, Group intervention, Task sharing, Psychological Distress, JV Colonies and colonization. Emigration and immigration. International migration, Psychiatry and Mental health, RA Public aspects of medicine, Humans, Single-Blind Method
Abstract

Background: Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul,Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. Methods: refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0> 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results: there were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions: gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT., European Union (EU); Horizon 2020; Research and Innovation Programme Societal Challenges

Published
2022

48. Additional file 1 of Development and internal validation of a model predicting severe maternal morbidity using pre-conception and early pregnancy variables: a population-based study in Ontario, Canada

Author

Dayan, Natalie, Shapiro, Gabriel D., Luo, Jin, Guan, Jun, Fell, Deshayne B., Laskin, Carl A., Basso, Olga, Park, Alison L., and Ray, Joel G.

Abstract

Additional file 1: Table S1. Variables used to define cohort entry and exclusion criteria, primary outcome, and variables considered for each clinical prediction model. Table S2. List of countries used to define World region of origin among immigrant women included in the study. Table S3. Adjusted odds ratio of maternal end-organ injury or death arising between 20 weeks’ gestation and up to 42 days after birth, in association with variables measured pre-pregnancy and in the index pregnancy prior to 20 weeks’ gestation. Table S4. Adjusted odds ratio of all-cause maternal death arising between birth and up to 365 days after birth, in association with variables measured pre-pregnancy and in the index pregnancy prior to 20 weeks’ gestation. Table S5. Adjusted odds ratio of maternal end-organ injury or death arising between 20 weeks’ gestation and up to 42 days after birth in association with variables measured in the index pregnancy prior to 20 weeks’ gestation. Table S6. Adjusted odds ratio of maternal end-organ injury or death arising between 20 weeks’ gestation and up to 42 days after birth in association with variables measured in the index pregnancy prior to 20 weeks’ gestation and pre-pregnancy. Table S7. Adjusted odds ratio of maternal end-organ injury or death arising between 20 weeks’ gestation and up to 42 days after birth in association with variables measured in the index pregnancy prior to 20 weeks’ gestation, pre-pregnancy, and in any previous pregnancy. Table S8. Baseline characteristics of the study population, according to missing BMI vs. non-missing BMI. Figure S1. Flow diagram of the creation of the study cohort. Figure S2. Receiver operating characteristic curve showing discrimination of the clinical prediction model for all-cause maternal death. Figure S3. a. Calibration plot of predicted (x-axis) and observed (y-axis) deciles of probability of acute end organ injury or death, entire cohort of 634,290 births. b. Calibration plot of predicted (x-axis) and observed (y-axis) deciles of probability of all-cause maternal death, entire cohort of 634,290 births. c. Calibration plot of predicted (x-axis) and observed (y-axis) deciles of probability of acute end organ injury or death, early index pregnancy factors, sub-cohort of 333,435 births among parous women. d. Calibration plot of predicted (x-axis) and observed (y-axis) deciles of probability of acute end organ injury or death, pre-pregnancy and early index pregnancy factors, sub-cohort of 333,435 births among parous women. e. Calibration plot of predicted (x-axis) and observed (y-axis) deciles of probability of acute end organ injury or death, pre-pregnancy, previous pregnancy, and early index pregnancy factors, sub-cohort of 333,435 births among parous women.

Published
2021
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49. Supplemental Material, sj-pdf-1-cat-10.1177_10760296211008986 - ABO Blood Group, SARS-CoV-2 Infection, and Risk of Venous Thromboembolism: Population-Based Cohort Study

Author

Ray, Joel G., Vermeulen, Marian J., Schull, Michael J., and Park, Alison L.

Subjects
body regions, FOS: Clinical medicine, fungi, Cardiology, 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified
Abstract

Supplemental Material, sj-pdf-1-cat-10.1177_10760296211008986 for ABO Blood Group, SARS-CoV-2 Infection, and Risk of Venous Thromboembolism: Population-Based Cohort Study by Joel G. Ray, Marian J. Vermeulen, Michael J. Schull and Alison L. Park in Clinical and Applied Thrombosis/Hemostasis

Published
2021
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50. Educational inequality in stillbirth: temporal trends in Quebec from 1981 to 2009

Author

Savard, Noemie, Auger, Nathalie, Park, Alison L., Lo, Ernest, and Martinez, Jerome

Subjects
Educational equalization -- Demographic aspects, Still-birth -- Causes of, Pregnant women -- Education, Government, Health, Health care industry
Abstract

OBJECTIVE: Educational inequality in stillbirth has been documented in high-income countries and the province of Quebec, Canada, but temporal trends are poorly understood. Our objective was to determine time trends in inequality related to maternal education for all-cause and cause-specific stillbirth over the past three decades in Quebec. METHODS: We included 2,397,971 live births and 9,983 stillbirths from 1981 through 2009 using Quebec vital statistics. For each decade, we computed measures of inequality capturing relative (relative index of inequality, RII) and absolute (slope index of inequality, SII) differences between the least- and most-educated mothers for all-cause and cause-specific stillbirth, adjusting for maternal characteristics. RESULTS: Stillbirth rates decreased over time for all education levels. Absolute educational inequality (SII 2.5 per 1000 births, 95% CI 2.1-2.8; all periods combined) was stable over time, whereas relative inequality increased ([RII.sub.1981-1989] 1.8 vs. [RII.sub.2000-2009] 2.3). Absolute inequality decreased for stillbirths caused by placental abruption ([SII.sub.1981-1989] 0.6 vs. [SII.sub.2000-2009] 0.3), but increased for unspecified causes ([SII.sub.1981-1989] 0.2 vs. [SII.sub.2000-2009] 0.7). CONCLUSIONS: Absolute educational inequality in stillbirth persisted and relative inequality increased over the past three decades, despite an overall decrease in stillbirth rates. The decrease in absolute inequality for placental abruption was countered by an increase for unspecified causes. A better understanding of the underlying components of unspecified causes is needed to further address educational inequality in stillbirth. KEY WORDS: Cause of death; educational status; fetal death; socioeconomic factors; stillbirth; trend, temporal OBJECTIF: Des inegalites de scolarite maternelle pour les mortinaissances ont ete documentees dans plusieurs pays industrialises, mais leurs tendances temporelles sont moins connues. Notre objectif etait d'etudier les tendances temporelles des inegalites de scolarite pour les mortinaissances, toutes causes et par cause, pour les trois dernieres decennies au Quebec, Canada. METHODES: Nous avons inclus 2 397 971 naissances vivantes et 9 983 mortinaissances du Quebec de 1981 a 2009. Pour chaque decennie, nous avons obtenu un indice d'inegalite relatif (<< relative index of inequality >>, RII) et un indice d'inegalite absolu (<< slope index of inequality >>, SII) pour l'association entre la scolarite maternelle et les mortinaissances, toutes causes et par cause, en ajustant pour les caracteristiques maternelles. RESULTATS: Les taux de mortinaissance ont diminue pour tous les niveaux de scolarite. L'inegalite absolue de scolarite est demeuree stable (SII 2,5 pour 1 000 naissances, intervalle de confiance a 95 % 2,1-2,8; periodes combinees), tandis que l'inegalite relative a augmente (RII 1,8 a 2,3). L'inegalite absolue a diminue pour les mortinaissances causees par un decollement placentaire (SII 0,6 a 0,3), mais a augmente pour les causes non-specifiees (SII 0,2 a 0,7). CONCLUSIONS: L'inegalite absolue de scolarite pour les mortinaissances a persiste et l'inegalite relative a augmente au cours des trois dernieres decennies, malgre une diminution des taux de mortinaissance. Malgre une diminution de l'inegalite pour les decollements placentaires, on observe une augmentation pour les causes non-specifiees. Une meilleure comprehension des composantes contribuant a ces dernieres est necessaire pour mieux apprehender les inegalites de scolarite pour les mortinaissances. MOTS CLES: cause de deces; facteurs socioeconomiques; mort foetale; mortinaissance; scolarite; tendances temporelles, Stillbirth, an important contributor to perinatal mortality, (1) is unequally distributed across socio-economic groups. (2) Educational inequality in stillbirth has been documented in many high-income countries (2-4) and the province [...]

Published
2013

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