Background Reports on the adequacy of vitamin D status of pregnant women are not available in Can... more Background Reports on the adequacy of vitamin D status of pregnant women are not available in Canada. Objectives The objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada. Methods Pregnant women (≥18 years) from 6 provinces (2008–2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n = 1905) and third trimesters (n = 1649) and at delivery (n = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested...
To assess the association between time of birth and mortality among preterm infants. Population-b... more To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant. Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.
OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy... more OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and cl...
LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee ... more LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee proliferent depuis 20 ans. La plupart de ces recherches se font sous forme d’etudes par observation longitudinale, d’etudes par observation transversale et d’etudes cas–temoin. L’etude decrite par le Dr Michel Labrecque et ses collegues dans le present numero (page 797) allie une conception longitudinale et transversale et l’on examine minutieusement un vaste eventail de facteurs de confusion. Labrecque et ses collaborateurs concluent qu’il y a une association solide entre l’episiotomie mediale et des lacerations du perinee du troisieme et du quatrieme degres. Meme si des etudes controlees randomisees ont demontre que, pour chaque patiente, l’episiotomie accroit le risque de dechirure grave du perinee, l’adoption d’une politique de pratique restreinte n’a pas eu pour effet de reduire l’incidence des dechirures perineales. Comme les avantages de l’episiotomie n’ont pas ete demontres, on n...
Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees ... more Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees dans le cadre de la directive clinique redigee par le groupe de travail canadien sur les troubles hypertensifs de la grossesse et publiee dans Pregnancy Hypertension (http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext), en vue d'offrir une approche raisonnable envers le diagnostic, l'evaluation et la prise en charge des troubles hypertensifs de la grossesse. Resultats La litterature publiee a ete recuperee par l'intermediaire de recherches menees dans Medline, CINAHL et The Cochrane Library en mars 2012 au moyen d'un vocabulaire controle (p. ex. « pregnancy », « hypertension », « pre-eclampsia », « pregnancy toxemias ») et de mots cles (p. ex. « diagnosis », « evaluation », « classification », « prediction », « prevention », « prognosis », « treatment », « post-partum follow-up ») appropries. Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles rediges en anglais ou en francais entre janvier 2006 et fevrier 2012. Les recherches ont ete mises a jour de facon reguliere et integrees a la directive clinique jusqu'en septembre 2013. La litterature grise (non publiee) a ete identifiee par l'intermediaire de recherches menees dans les sites Web d'organismes s'interessant a l'evaluation des technologies dans le domaine de la sante et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et aupres de societes de specialite medicale nationales et internationales. Valeurs La qualite des resultats est evaluee au moyen des criteres decrits dans le rapport du Groupe d'etude canadien sur les soins de sante preventifs (Tableau).
Acta obstetricia et gynecologica Scandinavica, Jul 24, 2016
For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy... more For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48hr, or birthweight <10th centile) or maternal outcomes (severe hypertension, pre-eclampsia, or delivery at <34 or <37 weeks). A model containing all candidate predictors was used to start the stepwise regression process based on goodness of fit as measured by Akaike information criterion. For face validity, these variables were forced into the model: treatment group ('less tight' or 'tight'…
Background Reports on the adequacy of vitamin D status of pregnant women are not available in Can... more Background Reports on the adequacy of vitamin D status of pregnant women are not available in Canada. Objectives The objectives of this study were to examine vitamin D status across pregnancy and identify the correlates of vitamin D status of pregnant women in Canada. Methods Pregnant women (≥18 years) from 6 provinces (2008–2011) participating in a longitudinal cohort were studied. Sociodemographic data, obstetrical histories, and dietary and supplemental vitamin D intakes were surveyed. Plasma 25-hydroxyvitamin D (25OHD) was measured using an immunoassay standardized to LC-MS/MS from samples collected during the first (n = 1905) and third trimesters (n = 1649) and at delivery (n = 1543). The proportion of women with ≥40 nmol/L of plasma 25OHD (adequate status) was estimated at each time point, and factors related to achieving this cut point were identified using repeated-measures logistic regression. Differences in 25OHD concentrations across trimesters and at delivery were tested...
To assess the association between time of birth and mortality among preterm infants. Population-b... more To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01–1.29). Among infants 28–32 weeks GA and 33–36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59–0.95; AOR 0.78, 95% CI 0.62–0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28–32 and 33–36 weeks GA decreased or were not statistically significant. Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.
OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy... more OBJECTIVES To provide Canadian physicians with a standard definition of hypertension in pregnancy, recommendations for laboratory investigations and tests for the assessment and management of hypertensive disorders in pregnancy, and a classification of such disorders. OPTIONS To improve or not improve Canadian uniformity and standardization in the investigation and classification of hypertensive disorders in pregnancy. OUTCOMES 1) Accuracy, reliability and practicality of diagnostic clinical criteria for hypertensive disorders in pregnancy. 2) Laboratory tests useful to determine severity and prognosis of disorders as measured by maternal and neonatal adverse outcomes. 3) A classification of disorders for use by Canadian physicians to facilitate uniformity and diffusion of research through a common language. EVIDENCE Articles on hypertensive disorders in pregnancy published from 1966 to 1996, retrieved through MEDLINE search, related to definitions, tests, diagnostic criteria and cl...
LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee ... more LES ETUDES CLINIQUES SUR L’EPISIOTOMIE comme facteur de risque de traumatismes graves du perinee proliferent depuis 20 ans. La plupart de ces recherches se font sous forme d’etudes par observation longitudinale, d’etudes par observation transversale et d’etudes cas–temoin. L’etude decrite par le Dr Michel Labrecque et ses collegues dans le present numero (page 797) allie une conception longitudinale et transversale et l’on examine minutieusement un vaste eventail de facteurs de confusion. Labrecque et ses collaborateurs concluent qu’il y a une association solide entre l’episiotomie mediale et des lacerations du perinee du troisieme et du quatrieme degres. Meme si des etudes controlees randomisees ont demontre que, pour chaque patiente, l’episiotomie accroit le risque de dechirure grave du perinee, l’adoption d’une politique de pratique restreinte n’a pas eu pour effet de reduire l’incidence des dechirures perineales. Comme les avantages de l’episiotomie n’ont pas ete demontres, on n...
Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees ... more Resume Objectif Le present resume directif presente un sommaire des donnees qui ont ete evaluees dans le cadre de la directive clinique redigee par le groupe de travail canadien sur les troubles hypertensifs de la grossesse et publiee dans Pregnancy Hypertension (http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext), en vue d'offrir une approche raisonnable envers le diagnostic, l'evaluation et la prise en charge des troubles hypertensifs de la grossesse. Resultats La litterature publiee a ete recuperee par l'intermediaire de recherches menees dans Medline, CINAHL et The Cochrane Library en mars 2012 au moyen d'un vocabulaire controle (p. ex. « pregnancy », « hypertension », « pre-eclampsia », « pregnancy toxemias ») et de mots cles (p. ex. « diagnosis », « evaluation », « classification », « prediction », « prevention », « prognosis », « treatment », « post-partum follow-up ») appropries. Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles rediges en anglais ou en francais entre janvier 2006 et fevrier 2012. Les recherches ont ete mises a jour de facon reguliere et integrees a la directive clinique jusqu'en septembre 2013. La litterature grise (non publiee) a ete identifiee par l'intermediaire de recherches menees dans les sites Web d'organismes s'interessant a l'evaluation des technologies dans le domaine de la sante et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et aupres de societes de specialite medicale nationales et internationales. Valeurs La qualite des resultats est evaluee au moyen des criteres decrits dans le rapport du Groupe d'etude canadien sur les soins de sante preventifs (Tableau).
Acta obstetricia et gynecologica Scandinavica, Jul 24, 2016
For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy... more For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48hr, or birthweight <10th centile) or maternal outcomes (severe hypertension, pre-eclampsia, or delivery at <34 or <37 weeks). A model containing all candidate predictors was used to start the stepwise regression process based on goodness of fit as measured by Akaike information criterion. For face validity, these variables were forced into the model: treatment group ('less tight' or 'tight'…
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