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2. The impact of isolated obesity compared with obesity and other risk factors on risk of stillbirth: a retrospective cohort study

Author

Ramji, Naila, Corsi, Daniel J., Gad, Monica, Dimanlig-Cruz, Sheryll, Miao, Qun, Guo, Yanfang, Rybak, Natalie, White, Ruth Rennicks, Wen, Shi Wu, Walker, Mark C., and Gaudet, Laura M.

Subjects
Obesity -- Risk factors, Still-birth -- Risk factors, Mediation, Body mass index, Health
Abstract

Background: Maternal obesity is associated with stillbirth, but uncertainty persists around the effects of higher obesity classes. We sought to compare the risk of stillbirth associated with maternal obesity alone versus maternal obesity and additional or undiagnosed factors contributing to high-risk pregnancy. Methods: We conducted a retrospective cohort study using the Better Outcomes Registry and Network (BORN) for singleton hospital births in Ontario between 2012 and 2018. We used multivariable Cox proportional hazard regression and logistic regression to evaluate the relationship between prepregnancy maternal body mass index (BMI) class and stillbirth (reference was normal BMI). We treated maternal characteristics and obstetrical complications as independent covariates. We performed mediator analyses to measure the direct and indirect effects of BMI on stillbirth through major common-pathway complications. We used fully adjusted and partially adjusted models, representing the impact of maternal obesity alone and maternal obesity with other risk factors on stillbirth, respectively. Results: We analyzed data on 681 178 births between 2012 and 2018, of which 1956 were stillbirths. Class I obesity was associated with an increased incidence of stillbirth (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.35-1.78). This association was stronger for class III obesity (adjusted HR 1.80, 95% CI 1.44-2.24), and strongest for class II obesity (adjusted HR 2.17, 95% CI 1.83-2.57). Plotting point estimates for odds ratios, stratified by gestational age, showed a marked increase in the relative odds for stillbirth beyond 37 weeks' gestation for those with obesity with and without other risk factors, compared with those with normal BMI. The impact of potential mediators was minimal. Interpretation: Maternal obesity alone and obesity with other risk factors are associated with an increased risk of stillbirth. This risk increases with gestational age, especially at term., The relationship between maternal obesity and stillbirth has been well established. (1-3) Compared with pregnant people with normal body mass index (BMI), those with obesity (BMI [greater than or equal [...]

Published
2024
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19. Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

Author

Andruschak, John, Dale, Sheryll, Der, Kenny, Pacheco, Terri, Vida, Karen, Frick, Corrine, Bott, Nancy, Carr, Lee-Ann, Bedard, Daniel, Robert, Nicole, Sprague, Ann, Berthiaume, Maryse, Beaudoin, Richard, Attenborough, Rebecca, Fahey, John, Gagnon, Irene, Murphy, Phil, Allen, Victoria, Bocking, Alan, Bottomley, Jim, Bujold, Emmanuel, Campbell, Karen, Christilaw, Jan, Crane, Joan, Dodds, Linda, Donner, Allan, Dumont, Alexandre, Dzakpasu, Susie, Forson, Abigail, Fraser, Bill, Gagnon, Anita, Joseph, K.S., Klein, Michael, Kramer, Michael, LaFrance, Martine, Lemay, Karine, Liu, Shiliang, Moutquin, Jean-Marie, Nimrod, Carl, Platt, Robert, O’Brien, Beverley, Ohlsson, Arne, Wen, Shi Wu, Gulmezoghu, Metin, Shah, Archana, Villar, Jose, Yang, Jie, Armson, B. Anthony, Carson, George D., da Silva, Orlando, Heaman, Maureen, Janssen, Patricia, Murphy, Phil A., Pasquier, Jean Charles, Sauve, Reg, Von Dadelszen, Peter, Walker, Mark, and Lee, Shoo K.

Published
2022
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26. Interventions for intimate partner violence during the perinatal period: A scoping review.

Author

Mercier, Olivia, Fu, Sarah Yu, Filler, Rachel, Leclerc, Alexie, Sampsel, Kari, Fournier, Karine, Walker, Mark, Wen, Shi Wu, and Muldoon, Katherine

Subjects
MEDICAL information storage & retrieval systems, PATIENT education, VICTIMS, INTIMATE partner violence, MATERNAL health services, MENTAL health, CINAHL database, PREGNANT women, FAMILY relations, SYSTEMATIC reviews, MEDLINE, LITERATURE reviews, MEDICAL databases, COUNSELING, PREGNANCY complications, PERINATAL period, PSYCHOLOGY information storage & retrieval systems, DISEASE risk factors
Abstract

Background: Intimate partner violence (IPV) is a prevalent global health problem. IPV that occurs before pregnancy often continues during the perinatal period, resulting in ongoing violence and many adverse maternal, obstetrical, and neonatal outcomes. Objectives: This scoping review is designed to broadly capture all potential interventions for perinatal IPV and describe their core components and measured outcomes. Search Methods: We conducted a search for empirical studies describing IPV interventions in the perinatal population in June 2022. The search was conducted in MEDLINE, EMBASE, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, Applied Social Sciences Index & Abstracts, ClinicalTrials.gov and MedRxiv. Hand searching of references from select articles was also performed. Selection Criteria: Included studies described an intervention for those experiencing IPV during the perinatal period, including 12 months before pregnancy, while pregnant or in the 12 months post‐partum. The search encompassed January 2000 to June 2022 and only peer‐reviewed studies written in either English or French were included. Included interventions focused on the survivor exposed to IPV, rather than healthcare professionals administering the intervention. Interventions designed to reduce IPV revictimization or any adverse maternal, obstetrical, or neonatal health outcomes as well as social outcomes related to IPV victimization were included. Data Collections and Analysis: We used standard methodological procedures expected by The Campbell Collaboration. Main Results: In total, 10,079 titles and abstracts were screened and 226 proceeded to full text screening. A total of 67 studies included perinatal IPV interventions and were included in the final sample. These studies included a total of 27,327 participants. Included studies originated from 19 countries, and the majority were randomized controlled trials (n = 43). Most studies were of moderate or low quality. Interventions included home visitation, educational modules, counseling, and cash transfer programs and occurred primarily in community obstetrician and gynecologist clinics, hospitals, or in participants' homes. Most interventions focused on reducing revictimization of IPV (n = 38), improving survivor knowledge or acceptance of violence, knowledge of community resources, and actions to reduce violence (n = 28), and improving maternal mental health outcomes (n = 26). Few studies evaluated the effect of perinatal IPV interventions on obstetrical, neonatal or child health outcomes. Authors' Conclusion(s): The majority of intervention studies for perinatal IPV focus on reducing revictimization and improving mental health outcomes, very few included obstetrical, neonatal, and other physical health outcomes. Future interventions should place a larger emphasis on targeting maternal and neonatal outcomes to have the largest possible impact on the lives and families of IPV survivors and their infants. [ABSTRACT FROM AUTHOR]

Published
2024
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33. The COVID-19 pandemic and parental substance use: a cross-sectional survey of substance use among pregnant and post-partum individuals and their partners.

Author

Frank, Olivia, Murphy, Malia S. Q, Talarico, Robert, Denize, Kathryn M., Boisvert, Carlie, Harvey, Alysha L. J Dingwall, Rennicks White, Ruth, Corsi, Daniel J, Sampsel, Kari, Wen, Shi Wu, Walker, Mark C., El-Chaâr, Darine, and Muldoon, Katherine A.

Subjects
SUBSTANCE abuse risk factors, SUBSTANCE abuse, RISK assessment, CROSS-sectional method, POISSON distribution, INCOME, MENTAL health, RESEARCH funding, PUERPERIUM, SPOUSES, MULTIPLE regression analysis, PREGNANT women, PARENTING, DESCRIPTIVE statistics, POSTPARTUM depression, SURVEYS, SOCIODEMOGRAPHIC factors, ALCOHOLISM, TOBACCO products, CANNABIS (Genus), COMPARATIVE studies, CONFIDENCE intervals, DATA analysis software, COVID-19 pandemic, PREGNANCY
Abstract

This study was designed to investigate patterns and risk factors for substance use among obstetrical patients who gave birth during the early period of the pandemic, and their partners. Cross-sectional survey of obstetrical patients between March 17th and June 16th, 2020, at The Ottawa Hospital, Ottawa, Canada. Substance use was a composite measure of any alcohol, tobacco, or cannabis use since COVID-19 began. Four outcomes included: any participant substance use or increase in substance use, any partner substance use or increase in substance use. Adjusted risk ratios (ARR) and 95% confidence intervals (CI) are presented. Of 216 participants, 113 (52.3%) and 15 (6.9%) obstetrical patients reported substance use and increased use, respectively. Those born in Canada (ARR: 2.03; 95% CI: 1.27–3.23) and those with lower household income (ARR: 1.38; 95% CI: 1.04–1.85) had higher risk of substance use. Those with postpartum depression (ARR: 5.78; 95%CI: 2.22–15.05) had the highest risk of increased substance use. Families affected by school/daycare closure reported a higher risk of increased partner substance use (ARR: 2.46; 95% CI:1.38–4.39). This study found that risk factors for substance use included demographics (i.e., being born in Canada, income), mental health (postpartum depression), and school/childcare closures. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Birth outcomes following cesarean delivery on maternal request: a population-based cohort study

Author

Guo, Yanfang, Murphy, Malia S.Q., Erwin, Erica, Fakhraei, Romina, Corsi, Daniel J., White, Ruth Rennicks, Harvey, Alysha L.J., Gaudet, Laura M., Walker, Mark C., Wen, Shi Wu, and El-Chaar, Darine

Subjects
Cesarean section -- Patient outcomes, Health
Abstract

BACKGROUND: Data on the effect of cesarean delivery on maternal request (CDMR) on maternal and neonatal outcomes are inconsistent and often limited by inadequate case definitions and other methodological issues. Our objective was to evaluate the trends, determinants and outcomes of CDMR using an intent-to-treat approach. METHODS: We designed a population-based retrospective cohort study using data on low-risk pregnancies in Ontario, Canada (April 2012-March 2018). We assessed temporal trends and determinants of CDMR. We estimated the relative risks for component and composite outcomes used in the Adverse Outcome Index (AOI) related to planned CDMR compared with planned vaginal delivery using generalized estimating equation models. We compared the Weighted Adverse Outcome Score (WAOS) and the Severity Index (SI) across planned modes of delivery using analysis of variance. RESULTS: Of 422 210 women, 0.4% (n = 1827) had a planned CDMR and 99.6% (n = 420 383) had a planned vaginal delivery. The prevalence of CDMR remained stable over time at 3.9% of all cesarean deliveries. Factors associated with CDMR included late maternal age, higher education, conception via in vitro fertilization, anxiety, nulliparity, being White, delivery at a hospital providing higher levels of maternal care and obstetrician-based antenatal care. Women who planned CDMR had a lower risk of adverse outcomes than women who planned vaginal delivery (adjusted relative risk 0.42, 95% confidence interval [CI] 0.33 to 0.53). The WAOS was lower for planned CDMR than planned vaginal delivery (mean difference -1.28, 95% CI -2.02 to -0.55). The SI was not statistically different between groups (mean difference 3.6, 95% CI -7.4 to 14.5). Interpretation: Rates of CDMR have not increased in Ontario. Planned CDMR is associated with a decreased risk of short-term adverse outcomes compared with planned vaginal delivery. Investigation into the long-term implications of CDMR is warranted., Cesarean delivery is the most common inpatient surgical procedure in North America, (1,2) where rates often exceed World Health Organization recommendations (10%-15% of deliveries). (3) Given the financial and resource [...]

Published
2021
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