CIHR Analysis of Human Development, Child and Youth Health Data Using Existing Canadian Databases and Cohorts

Overcoming adversity

University of Manitoba researcher aims to identify protective factors to reduce substance use, build resilience and improve health outcomes among adolescents who have experienced adversity in childhood

"Studying childhood adversity is difficult, but I do it to produce evidence that can hopefully help to reduce violence so that fewer kids have these traumatic experiences. Our work aims to identify protective factors that may be effective in reducing substance use and fostering resilience among adolescents."

When children and adolescents experience adverse childhood experiences, they are more likely to use substances and have poor mental and physical health across the lifespan.

Dr. Tracie Afifi at the University of Manitoba studies child maltreatment and mental health with a focus on resilience, intervention, and prevention. Dr. Afifi and her team are conducting research and analyzing data to understand what factors might be protective and reduce the likelihood of substance use, including the use of alcohol, nicotine, and cannabis among adolescents who have experienced adversity. They also want to know how sexual or gender identity influences the relationship between substance use and mental health in these young people. The results of their first studies have shown that the likelihood of substance use becomes significantly greater if adolescents with a history of adverse childhood experiences also experiences peer victimization.

This work will help develop strategies and interventions that build resilience in adolescents and young adults and decrease substance use, mental health problems, and physical health conditions.

Further reading

• Dr. Tracie O. Afifi - University of Manitoba
• Dr. Tracie O. Afifi - Canada Research Chair in Childhood Adversity and Resilience

Is weight loss during pregnancy safe for women with obesity?

Over 52,000 Ontario women with pre-pregnancy obesity will help to guide weight management during pregnancy

"At the OMNI Research Group, we are committed to generating practice-changing research that will improve patient experience, quality of care, and clinical outcomes for pregnant women and their infants. Understanding the impact of gestational weight loss on adverse perinatal outcomes among women with obesity is important. Up to 15% of women with extreme obesity reported intentional weight loss during pregnancy while no clear guidelines are available for gestational weight management by severity of obesity."

Almost 20% of Canadian women enter pregnancy with an elevated body mass index (BMI). Appropriate gestational weight gain helps to improve maternal and fetal outcomes for individuals living with obesity. Due to limited and controversial findings of current studies, weight gain recommendations during pregnancy are not tailored for individuals with increasing BMI categories. The 2009 Institute of Medicine (IOM) guidelines for gestational weight gain recommend that individuals living with obesity should gain between 5 and 9 kg during pregnancy regardless of their obesity class.

Although weight loss during pregnancy is not indicated, it has been shown that 5-8% of women with obesity, and up to 15% of women with extreme obesity, reported intentional weight loss during pregnancy. Given that a clinical trial of gestational weight loss is not feasible, a high-quality observational study was greatly needed to explore potential harms of intentional weight loss during pregnancy.

Drs. Guo, Corsi and El-Chaâr and their team at the OMNI Research Group, based at the Ottawa Hospital Research Institute, are using data from BORN Ontario to study the impact of weight loss during pregnancy on a wide range of adverse maternal and infant outcomes for individuals with obesity.

As the largest and most robust provincial perinatal dataset, BORN Ontario captures all hospital births in the province, accounting for 40% of births across Canada. Using data from more than 52,000 charts, the team has already identified that intentional weight loss during pregnancy is associated with small-for-gestational-age babies for all obesity classes. This study overcomes limitations of previous research and fills gaps by investigating dose-response effects of gestational weight loss on perinatal outcomes.

Further reading

• OMNI Research Group
• Born Ontario

How does income inequality affect adolescent health?

It may be associated with deaths attributed to drug overdose among Canadian youth

"Growing income equality is not only unjust; it is a public health concern that will ultimately negatively impact Canada's social and economic conditions, which in turn may impact adolescent mental health. Addressing these conditions will benefit the health of Canadian youth and may prevent premature mortality."

Dr. Roman Pabayo is an Associate Professor in the University of Alberta’s School of Public Health and a Canada Research Chair in Social and Health Inequities. Dr. Pabayo leads the Emerge Research Lab where he supervises a team of researchers and students who are investigating the adverse relationship between income inequality and population health outcomes, particularly among Canadian youth.

In one population-based study, PhD candidate Claire Benny identified a harmful, significant association between income inequality within residential areas and an increased risk for all-cause mortality and deaths attributed to drug overdose among Canada's youth. These findings highlight the need to decrease inequities, which have a detrimental effect on the health of the youth population in Canada. They also present opportunities to target those at risk and to mitigate the harmful effects of income inequality, which include higher depressive and anxiety symptoms among adolescents as well as substance abuse.

Further reading

• Emerge Research Lab

Risk of asthma in children diagnosed with bronchiolitis during infancy: A longitudinal study linking emergency department-based clinical data to provincial health administrative databases

Names:
Amy Plint and Kawsari Abdullah (Co-PIs)
Deshayne Fell
Dhenuka Radhakrishnan
Steven Hawken
David W Johnson
Piush Mandhane
Teresa To
Gary Joubert (Co-Is)

Institution:
Children’s Hospital of Eastern Ontario, Ottawa, ON

Bronchiolitis is a viral illness that affects infants during winter months causing fever, cough, wheezing and difficulty breathing. It is the most common disease of the lungs during the first year of life. Asthma is the most common pediatric lung disorder in North America with one in five children being diagnosed with asthma by age 10. Evidence has suggested that bronchiolitis during infancy is associated with development of asthma in later life. Better understanding of the relationship between bronchiolitis and future asthma is needed. We propose a study that will link clinical data from two emergency department-based (ED) bronchiolitis studies to provincial health administrative databases. Through linkage of ED-based clinical data to health administrative datasets, we will have a rich source of data from which to enhance our understanding of the long-term respiratory effects of interventions used to treat bronchiolitis and also identify risk factors (such as child’s clinical course, demographic and maternal factors and health service utilization related risk factors) associated with future development of asthma. Our goal is to generate evidence on the long-term respiratory outcome of children after bronchiolitis, specifically the development of asthma at a later stage of childhood. Identification of risk factors associated with development of asthma may prevent progression of disease, help maintain a good quality of life and reduce healthcare costs.

Depression Trajectories in Pregnant and Postpartum Women: An Individual Participant Data Meta-Analysis

Names:
Andrea Benedetti
Brett D Thombs

Institution:
Research Institute of the McGill University Health Centre

Missed opportunities for early intervention: Determinants of prevalence and characteristics of children with impairments unrecognized in health systems by kindergarten age among the 2009 birth cohort of Ontario children

Names:
Magdalena Janus, PI
Astrid Guttmann, co-PI

Institution:
McMaster University and ICES, Toronto

Early identification and subsequent intervention can have a beneficial impact on the lives of young children with developmental delays. The percentage of children who enter kindergarten with an impairment or a special health need (ISHN) has been increasing in the last decade. In Ontario, education and health data are kept separate, which means we know very little about these children, and even less whether - and why - they have or have not been identified prior to school entry by any health professional. How many of these children have been identified early? Who are the children who have not? What predicts early identification? We bring the health and education population-level data together for children born in 2009 who attended kindergarten in publicly-funded schools in Ontario in 2014/2015. We matched kindergarten teachers’ reports of children’s development and their ISHN using the Early Development Instrument (EDI), collected in the second half of the 2014/2015 school year, with health data from ICES (formerly called the Institute for Clinical Evaluative Sciences). In this study we try to understand why some children with early health problems start school without being flagged in the healthcare system, thus missing an opportunity to benefit from early intervention.

Twitter:
@EDI_OCCS
@OffordCentre
@ICESOntario

Websites:
Early Development Instrument
Offord Centre for Child Studies
Institute for Clinical Evaluative Sciences (ICES)

Health and developmental trajectories of infants born with Neonatal Abstinence Syndrome: sex differences and implications for harm reduction

Name:
Sarka Lisonkova

Institution:
University of British Columbia

Exposure to opioids during pregnancy can have negative effects on baby’s development, including preterm birth, slow fetal growth, and neonatal abstinence syndrome. Neonatal abstinence syndrome is a drug withdrawal syndrome occurring shortly after birth and affecting baby’s sleep, feeding and nervous system function.

Our previous research shows that neonatal abstinence syndrome increased in Canada from 2.0 to 5.1 per 1000 live births between 2005 and 2015, and that the affected babies have high occurrence of severe neonatal morbidity. However, very little is known about long-term effects of neonatal abstinence syndrome on childhood health and development.

Our first objective is to examine health trajectories among children born with neonatal abstinence syndrome in British Columbia between 2001/02 and 2017/18 in a follow-up period up to 18 years. Secondly, we will assess developmental vulnerability among these children and thirdly, we will look at potential differences in these outcomes and risk factors between boys and girls.

In the light of the ongoing opioid crisis, our goal is to provide information on determinants of early childhood morbidity and adverse developmental outcomes among children born with neonatal abstinence syndrome. Our results will help to create optimal targets for harm reduction and prevention.

Twitter:
@sarkalis

Asking the Right Questions: Understanding Social and Emotional Determinants of Child Health in Pediatric Primary Care

Names:
Sheri Madigan
Nicole Racine
Brae Anne McArthur
Sheila McDonald
Andre Plamondon
Sarah Edwards
Suzanne Tough

Institution:
University of Calgary and Alberta Children’s Hospital Research Institute

Children’s mental health difficulties are a pressing public health concern in Canada. Children who experience mental health difficulties such as anxiety, depression, aggression, and conduct problems in childhood, are at risk of poor health and mental health across the lifespan. Thus, identifying the origins of children’s mental health difficulties will provide opportunities to implement targeted prevention and intervention strategies to reduce the impact of mental health difficulties on Canadian society. Many of the risk factors that lead to mental health difficulties in childhood are present early in life. The objectives of this study are to: 1) identify the individual, family, and social-environmental risk factors that are most predictive of poor child mental health at 8 years of age, and 2) identify risk clusters that predict poor mental health symptoms and diagnoses at 8 years of age. We will answer these research questions by leveraging a longitudinal cohort of over 3,000 mother-child dyads from the All Our Families study which we will link to administrative health data to determine what risk factors are the most salient predictors of children’s mental health symptoms and diagnoses at 8 years of age. The AOF study collected data twice in pregnancy, and at 4, 12, 24, 36, and 60 months postpartum. Extensive demographic, mental health, and information on early risk factors were collected using standardized tools. Children’s mental health diagnoses will be obtained from their health record. The research team is composed of experts in children’s mental health, child development, data linkage, and longitudinal statistical analyses. The potential for impact at both a practice and policy level to improve the mental health of Canadian children is significant.

Twitter:
@sherimadigan
@racinen2
@swmcdona
@allourfamilies

Quality population-based studies of outcomes of extremely preterm infants born by cesarean section compared to vaginal birth

Names:
Sarah D McDonald
KS Joseph
Prakesh Shah

Institution:
McMaster University

Preterm birth is the main cause of infant death and longterm disability. For extremely preterm infants born before 28 weeks of pregnancy who were presenting bottom-first, not head-first, Caesarean section may be associated with 40% lower odds of death for the infant but not all predictors were accounted for (studies did not account for other factors, like growth restriction). For extremely preterm infants presenting head-first, Caesarean section appears to reduce death by approximately 40% with.

Although we summarized all available published literature, there were key gaps in the data regarding extremely preterm infants delivered by Caesarean section compared with vaginal birth:

1. There is a lack of data adequately accounting for other factors besides Caesarean section and
2. no studies have evaluated infant neurodevelopmental outcomes within the last 10 years.

We have gathered a team of experts in obstetrics, neonatology, methodology and statistics, national organizations and parents to study short term infant outcomes using established databases. We will also study neurological development in infants at 18-21 months after their expected due date. We will use sophisticated analysis to understand the impact of Caesarean section alone compared to vaginal birth and convey our results using articles and social media.

Twitter:
@DrSDMcDonald

Short interpregnancy interval and risk of subsequent adverse pregnancy outcomes: modifiers and mediators

Name:
Wendy V Norman

Institution:
University of British Columbia

Factors of Mothers and Infants in Longitudinal Years (FAMILY)

Names: Teresa To
Cornelia Borkhoff

Institution: The Hospital for Sick Children, Research Institute

Funding partners:
CIHR Institute of Human Development, Child and Youth Health (IHDCYH) and the Institute of Infection and Immunity (III)

Today, questions on how biological, prenatal, maternal risk factors, early life social and environmental determinants interact and influence later childhood lung health and developmental outcomes remain largely unanswered.

For this project, we will use health administrative data to link mothers and children from three existing Ontario pediatric cohorts (TCHEQ, CHILD, and TARGetKids!) to create a birth cohort of infants, their siblings, and mothers. Using this cohort, we will conduct two studies to: 1) determine whether the risk of common childhood respiratory diseases, atopic and allergic conditions (e.g. asthma, allergic rhinitis and eczema), and poor child development is increased with early life exposures; and 2) examine whether poor delivery, common childhood respiratory diseases, atopic allergic conditions, and poor child development are associated with mothers’ patterns of health care use and lifestyle during pregnancy.

Considering the high health burden of asthma in children, the high incidence of asthma exacerbation during pregnancy, and the significant economic burden of poorly controlled asthma on the health care system, it is paramount to examine the short- and long-term impacts of this highly prevalent and dangerous health condition on children and mothers.

Twitter:
@OASIS_Ontario
@TeresaTo8

Websites:
Ontario Asthma Surveillance Information System (OASIS)
CHILD Study
TARGetKids! Study

Neighbourhood environments and weight management outcomes in the Canadian Pediatric Weight Management Registry (CANPWR)

Names:
Andraea Van Hulst and Katherine Morrison (co-PIs)
Nancy Ross and Lehana Thabane (co-Is)
Geoff Ball
Annick Buchholz
Josephine Ho
Laurent Legault
Rajibul Mian and Ian Zenlea (collaborators)

Institution:
McGill University and McMaster University

The ways in which neighbourhoods are designed influence children’s lifestyle behaviours such as physical activity and diet, which in turn influence body weight and chronic diseases. However, there is almost no research on whether neighbourhood characteristics can support the adoption of healthy lifestyle behaviours and improve health and body weight specifically among children who are seeking clinical care for obesity. With more than 1 in 4 children who have an excess in body weight, a growing number of children and families are being followed in pediatric weight management centres across Canada.

This study builds on two existing research infrastructures: 1) CANPWR, a study of Canadian children with overweight or obesity who are followed in pediatric weight management programs across Canada, and 2) CANUE which facilitates the use of neighbourhood environment data in health research. We are doing analyses to understand which neighbourhood characteristics influence weight management outcomes, and which combinations of neighbourhood, program, family and child characteristics are linked to improved weight management outcomes. The results of this research will provide new information about the role of neighbourhoods on childhood obesity prevention and management, and on how to tailor weight management interventions to the places where children live.

Twitter:
@MacMODR
@PHRIresearch
@McGillNursing
@GeoSDH_Group

Websites:
CANPWR: Canadian Pediatric Weight Management Registry
The CANadian Pediatric Weight management Registry (CANPWR): lessons learned from developing and initiating a national, multi-centre study embedded in pediatric clinical practice

Prenatal maternal physical activity and brain structure and function in young children

Names:
Catherine Lebel
Jessica Reynolds
Deborah Dewey
Rhonda Bell

Academic institution:
University of Calgary

Funding partners:
Previous data collection was funded by Alberta innovates – health solutions, CIHR, and the Alberta Children’s Hospital Research Institute

Exercise during pregnancy can be good for mothers and babies. Yet less than 2 in 10 pregnant women meet the Canadian guidelines of at least 150 minutes of moderate activity per week. Children of mothers who were more active during pregnancy appear to have better learning and memory, but we do not know why. Studies in mice show that prenatal exercise changes the brain, particularly in the hippocampus, an area involved in memory. This study will investigate how prenatal physical activity is related to young children’s brains. We will use data from an existing study that enrolled women during pregnancy and has followed their children since. Women reported physical activity in each trimester of pregnancy. Children received a magnetic resonance imaging (MRI) scan and memory test between the ages of 2-5 years. We will measure the structure and function of the hippocampus from the MRI scans and compare that to mothers’ activity during pregnancy. We will also look at whether our findings help explain memory function in the children. Evidence showing the impact of prenatal exercise on children’s brains is necessary for developing appropriate guidelines that will ultimately improve child health.

Twitter:
@CatherineALebel
@Jess_E_Reynolds

Adolescent injury, substance use, and mental health: An exploration of rates, determinants, and comorbidities in Canadian survey data

Name: Mark Asbridge
Institution: Dalhousie University

Adolescents; Comorbid Conditions; Injury; Mental Health; Social Determinants; Substance Abuse; Vulnerable Populations

Artificial sweeteners during pregnancy: Do they alter the baby’s microbiome?
Secondary analysis of the CHILD birth cohort to assess the impact of maternal non-nutritive sweetener consumption on the fecal metagenome and urinary metabolome of infant offspring

Name: Meghan Azad and Marie-Claire Arrieta (co-PIs), Laura Sycuro (Co-I) and Isabel Laforest Lapointe (Postdoctoral Fellow)
Institution: University of Calgary and University of Manitoba

In the CHILD Study, we have already found that maternal consumption of non-nutritive sweeteners (NNS) during pregnancy is associated with infant obesity, but we don’t know why. In this project, using stool samples from infants in the CHILD cohort, we found that gut bacteria might play a role in this relationship. We are doing more in-depth analyses to understand which specific bacteria are involved, how these bacteria affect infant metabolism and weight gain, and which mothers and infants are most affected by NNS. The results of this research will provide new information about the development of childhood obesity, and help guide nutrition recommendations for pregnant women.

Twitter:

• @MeghanAzad
• @arrietalab
• @sycurol
• @isabel_Laforest
• @UCalgaryMed
• @CHRIManitoba
• @UM_Research
• @CHILDStudy

Websites:

• Association Between Artificially Sweetened Beverage Consumption During Pregnancy and Infant Body Mass Index
• The Case Against Artificial Sweeteners Is Getting Stronger

Artificial Sweeteners; Childhood Obesity; Developmental Origins Of Health And Disease; Infants; Metabolomics; Metagenomics; Microbiome; Non-Nutritive Sweeteners; Pregnancy; Prenatal Nutrition

Impact of asthma diagnosed during pregnancy on perinatal outcomes

Name: Lucie Blais
Institution: Faculty of Pharmacy, Université de Montréal

Asthma firstly diagnosed during pregnancy may be of a different nature than asthma diagnosed during pregnancy, maybe more difficult to treat, and may have stronger consequences on the newborn.

We compared the risk of prematurity and low birth weight between women who were diagnosed with asthma in the two years prior to pregnancy and those who developed asthma during pregnancy. We observed that women who developed asthma during pregnancy were at increased risks of having a premature delivery and a baby with a low birth weight. Further research is needed to know whether this increased risk is due to the nature of asthma itself being more severe when developed during pregnancy or it is due to the fact that physicians and women are more reluctant to start the required treatment when asthma is diagnosed during pregnancy.

Twitter:

• @FacPharmUdeM

Administrative Databases; Asthma; Cohort Design; Low Birth Weight; Perinatal Epidemiology; Pharmacoepidemiology; Pregnancy; Prematurity

Mining the gap: Establishment of pregnancy-specific laboratory reference intervals using provincial laboratory data

Name: Vilte Barakauskas
Institution: B.C. Women’s Hospital

Clinical Biochemistry; Data Mining; Laboratory Testing; Pregnancy; Quality Improvement; Reference Intervals

Perinatal exposure to perfluoroalkyl substances (PFASs) and polybrominated diphenyl ethers (PBDEs) and weight gain trajectory in children: Data from the maternal-infant research on environmental chemicals (MIREC) cohort

Name: Maryse Bouchard
Institution: Centre hospitalier universitaire Sainte-Justine

Children; Environmental Contaminants; Obesity; Perfluoroalkyl Substances (Pfass); Polybrominated Diphenyl Ethers (Pbde); Pregnancy Cohort; Prenatal; Sensitive Window Of Exposure; Weight

Depressive symptoms in adolescence: Do genetics and physical activity play a role?

Name: Jennifer Brunet
Institution: University of Ottawa

Although depression can occur at any age, the average age of onset of depression is decreasing and between 2-9% of adolescents are affected by major depressive disorder. These individuals have poorer educational, behavioural and health outcomes than do asymptomatic adolescents underscoring the critical need to identify and understand factors involved in the development and alleviation of depressive symptoms in this age demographic. Dr. Brunet’s research focuses on identifying genetic variants contributing to depressive symptoms in adolescence, and determining whether physical activity plays a role in moderating this relationship while also exploring sex differences and investigating the role of timing and intensity of physical activity.

Findings from this study will lead to a better understanding of the etiology of depression in adolescence, and shed light on which subgroups may benefit most from physical activity interventions. Further, the study of physical activity and depressive symptoms over time will inform optimal age windows for intervention delivery, and help us to understand what patterns of physical activity lead to decreases in depressive symptoms.

Twitter:

• @Brunet_Jen
• @uOttawa

Websites:

• PA Health Promo
• Jennifer Brunet

Adolescents; Depression; Gene By Environment Interactions; Genetics; Longitudinal Study; Mixed Models; Physical Activity; Sedentary Time

Impacts of Canada’s minimum age for tobacco sales (MATS) laws on youth smoking behaviour, 2000-2014

Name: Russell C. Callaghan
Institution: University of Northern British Columbia, Northern Medical Program

Recently, the US Institute of Medicine and Health Canada have proposed that raising the minimum age for tobacco purchasing /sales to 21 years would likely lead to reductions in smoking behavior among young people. Surprisingly few studies, however, have assessed the potential impacts of minimum-age tobacco restrictions on youth smoking. As such, the current study aimed to evaluate the impacts of Canadian minimum age for tobacco sales (MATS) laws on youth smoking behavior. Study results demonstrated that Canadian MATS laws were associated with a significant impact on smoking behaviour among young people. In comparison to persons slightly younger than the MATS, age groups just older had sharply higher prevalence of current smoking and daily smoking, as well as higher rates of past-month cigarette consumption. Given these findings, it seems reasonable to argue that raising Canada’s MATS laws would likely attenuate young people’s initiation to current-smoker or daily-smoker status and total cigarette volume consumption in newly restricted age groups.

Twitter:

• @UBCNMP_unbc

Website:

• Impacts of Canada’s minimum age for tobacco sales (MATS) laws on youth smoking behaviour, 2000-2014

Minimum Age Of Tobacco Sales Laws; Policy Simulation Modeling; Population-Based Surveys; Smoking Frequency; Smoking Initiation; Smoking Intensity; Smoking Prevalence; Tobacco Control Policy; Types Of Smokers; Youth Smoking

In through the out door: Do increasing pediatric emergency mental health presentations reflect poorer access to primary and outpatient mental health care?

Name: Leslie Campbell
Institution: Dalhousie University

Access To Care; Child And Youth Mental Health; Community Mental Health Services; Emergency Department; Health Services Research; Pediatric Mental Health Emergencies; Primary Care; Small Area Rate Variation

Can parenting behaviours influence adolescent mental health?

Name: Ian Colman
Institution: University of Ottawa

Our research sought to clarify how parenting practices influence adolescent mental health. We used data from a long-running study of several thousand Canadian children. When the children were young, parents reported on positive behaviours (e.g., frequently praising the child) and the use of harsh discipline (e.g., yelling at the child). When the children reached age 12, they completed structured assessments of their mental health, including symptoms of depression, hyperactivity, conduct disorder, and suicidal thought. We found that positive parenting was linked to better adolescent mental health, particularly among girls, while harsh discipline was linked to worse adolescent mental health, particularly among boys. These results held after accounting for numerous other factors associated with parenting behaviours and mental health, such as poverty, parental education, and parental mental health. This suggests that programs aimed at supporting parents may have beneficial effects on their children’s mental health.

Twitter:

• @APEAL_Lab
• @uOttawa_SEPH
• @uOttawaMed
• @uOttawa

Website:

• APEAL Research Lab – Applied Psychiatric Epidemiology Across the Lifecourse

Depression; Epidemiology; Parenting; Suicidality

Infertility treatment and severe maternal morbidity

Name: Natalie Dayan
Institution: McGill University, McGill University Health Centre

Infertility Treatment (IT) is increasingly used in Canada to achieve pregnancy and in some cases is publicly funded. Research strongly suggests that obstetric complications are more common in IT than non-IT pregnancies but fewer studies have examined maternal complications specifically. In this study, we measured the link between IT and severe maternal morbidity (life-threatening complications occurring to a woman during pregnancy or up to 42 days after delivery) in Ontario.

We found that while severe maternal morbidity or death was thankfully rare, occurring in overall 1.5% of women, those who had undergone IT were 40% more likely to experience one of these serious outcomes even after accounting for maternal factors more common in IT users. This risk was particularly concentrated among women who had undergone more invasive forms of IT such as in vitro fertilization (IVF).

We are currently developing a risk score to identify women at risk for severe maternal morbidity. This work will help in the pre-conception counseling of all women, including those who use IT. Future planned studies will evaluate different IVF protocols and their relative contribution to severe maternal morbidity.

Twitter:

• @cusm_muhc

Websites:

• Infertility treatment and risk of severe maternal morbidity: a propensity score-matched cohort study
• A Closer Look at Infertility Treatment and Risk for Severe Maternal Morbidity
• IVF linked to slightly higher risk of maternal complications: study

Healthy Pregnancy; Reproductive, Child, And Maternal Health

Perinatal use of immunosuppressant therapies and risk of infections in mothers and babies

Name: Mary De Vera
Institution: University of British Columbia

Autoimmune Diseases; Biologics; Disease Modifying Antirheumatic Drugs; Glucocorticosteroids; Immunosuppressant Therapies; Infections; Perinatal Pharmacoepidemiology; Pregnancy; Reproduction

Flu shots during pregnancy
Influenza vaccination during pregnancy and child health

Name: Deshayne Fell
Institution: Children’s Hospital of Eastern Ontario Research Institute and University of Ottawa

Influenza –– also known as the flu –– is an infectious illness caused by a virus that affects the nose, throat and lungs. Most people who get the flu become mildly ill and recover quickly; but others, such as pregnant women, may develop more serious illness. For this reason, pregnant women are advised to get the influenza vaccination (flu shot) each year. Despite this advice, Canadian research indicates that less than a third of pregnant women actually received a flu shot in recent years.

One important reason that pregnant women might decide not to get a flu shot is due to their concerns about safety for their children. Many research studies done over the past several years have examined the health of newborns whose mothers received a flu shot during pregnancy, and have found that it is safe and also helps to prevent the flu in young infants. Our study in Ontario extended this research by examining health outcomes of children up to five years of age in order to provide a more comprehensive understanding of the long-term safety of flu shots during pregnancy. We did not find any link between receiving a flu shot during pregnancy and child health outcomes such as respiratory infections, ear infections, or complex chronic illnesses including cancer. Although there was a small reduction in gastro-intestinal infections and a small increase in reported asthma among children born to mothers who received a flu shot during pregnancy, these associations were minor and should be assessed by other studies. 

Our study results have been accepted for publication in the British Medical Journal and we are currently finishing a similar study in Nova Scotia to look at different flu seasons. Our study findings to-date support the safety of flu shots during pregnancy, and will provide valuable information to pregnant women well as to health care providers working to ensure that mothers and their children are in the best possible health.

Twitter:

• @CHEOhospital

Website:

• Health outcomes of young children born to mothers who received 2009 pandemic H1N1 influenza vaccination during pregnancy: retrospective cohort study

Immunization; Influenza; Maternal And Child Health; Population Health

Mothers' well-being in pregnancy and associations with biological measures of stress in mothers, the placenta and newborns

Name: Catherine Herba
Institution: Université du Québec à Montréal and Centre de Recherche du CHU Sainte-Justine

Mothers' stress, depression and/or anxiety (SDA) in pregnancy have been associated with poorer child neurobehavioural outcomes, even after accounting for postnatal SDA and inherited influences. Elevated SDA may render the placenta less able to protect the fetus against harmful physiological effects of stress, increasing the child's vulnerability to stress. Using the 3D pregnancy cohort and biobank, we examine how SDA in pregnancy affects the child by studying stress markers in the glucocorticoid and serotonin signaling pathways. Our study is unique in its ability to assess associations among stress markers in mothers, placenta and newborns in relation to prenatal maternal SDA. At birth, placenta samples and mother and newborn hair samples were obtained. Hair cortisol concentration (HCC) can capture biological stress response in mothers and fetuses over the last pregnancy months. Placental glucocorticoid and serotonin gene expression was measured. First analyses suggest elevated mothers' HCC may be associated with altered placental glucocorticoid gene expression, whereas elevated newborn HCC may be associated with alterations in serotonin gene expression. Sexual dimorphism was observed in placental glucocorticoid and serotonin signaling pathways. Once completed, results from this study will help improve our understanding of how maternal SDA links to stress markers in the mother, fetus and placenta.

Twitter:

• @CR_CHUSJ

Websites:

• Research Center of the Sainte-Justine University Hospital
• Profile: Catherine M. Herba, Ph.D.

Cortisol; Glucocorticoid; Longitudinal; Maternal Depression; Mechanisms; Perinatal Mental Health; Placenta; Pregnancy Cohort; Prenatal Maternal Mental Health; Stress Biomarkers

Parenting and children’s BMI

Name: Lisa Kakinami
Institution: Concordia University

Our research aimed to investigate whether general parent-child interactions might predict children’s future body mass index (BMI). A secondary objective was to investigate whether the child’s behaviours or BMI would affect the way the parents interacted with them.

To answer these objectives, we used data from the Quebec Longitudinal Study of Child Development (QLSCD), a representative cohort of singleton births born in Quebec in 1998. Data from when the children were six to 12 years of age were utilized.

Although preliminary, two different sets of analyses (a linear mixed model, and a structural equation model utilizing path analysis) suggest that children with parents who were more permissive toward them (eg: not disciplining them for misbehaving) were more likely to have higher BMIs than children with parents who set expectations and enforced boundaries. We found no evidence that the BMI of the child, or the child’s behaviours (eg: if they were more withdrawn, or more aggressive) affected the way the parents interacted with them.

Website:

• Profile: Lisa Kakinami, PhD

Children And Adolescents; Longitudinal; Obesity; Parenting Style

Mental health outcomes in pediatric survivors of traumatic injury compared to matched controls: A population based, retrospective study

Name: Sarvesh Logsetty
Institution: University of Manitoba

Administrative Data; Children's Health; Epidemiology; Long Term Outcomes; Longitudinal Health Outcomes; Mental Health; Population Health; Traumatic Injury

Innovation prediction models for risk assessment of preterm birth: A key step to improve care and outcomes

Name: Sarah McDonald
Institution: McMaster University

Preterm birth is a heterogeneous syndrome resulting from the interaction of numerous genetic and environmental factors. Given the heterogeneity of preterm birth, developing a comprehensive and uniform classification approach to examine clinical subtypes of preterm birth was seen as a priority by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), to improve preterm surveillance, reporting and ultimately management. We used the GAPPS classification approach to study the following research question:

What are the prevalences of preterm birth phenotypes and their association with cesarean section and adverse neonatal outcomes for singleton births in multiparous women?

In this population-based cohort study of 8775 preterm births of multiparous women, two-thirds met criteria for at least one predefined phenotype. The distribution of preterm birth phenotypes varied in first and recurrent preterm births, although their associations with maternal and neonatal outcomes were similar.

Meaning: The consistency of the associations between preterm birth clinical conditions and adverse outcomes in the different levels of exposures provides validation for the phenotypic classification model.

Twitter:

• @DrSDMcDonald

Website:

• For Women’s and Infants’ Health

Big Data; Ensemble Model; Epidemiology; Machine Learning; Prediction Models; Preterm Birth

Intergenerational transmission of maternal ACEs on child behaviour at age 5: Risk and resilience factors

Name: Sheila Mcdonald
Institution: University of Calgary

Adverse Childhood Experiences; Child Behavior; Cohort; Intergenerational; Mechanisms; Parenting; Resilience

Prenatal biochemical screening and the long-term risk of cardiovascular disease and cancer

Name: Joel Ray
Institution: Unity Health Toronto

Breast Cancer; Cancer; Cardiovascular Disease; Heart Disease; Maternal Serum Screening; Mortality; Prediction; Prenatal Biochemical Screening; Stroke; Uterine Cancer

Do we preferentially prescribe insulin pumps to wealthier kids?: The Quebec and Manitoba experience

Name: Celia Rodd
Institution: University of Manitoba

All Canadian provinces have invested in programs to fund insulin pumps for children with Type 1 (juvenile) diabetes mellitus. The initial cost for the pump is approximately $7000 with ongoing annual costs of about $4000 for supplies. Intensive teaching is also required to ensure that the cutting edge technology is used safely and effectively.

Although Quebec provides funding to cover all pump-related costs, this is not true in Manitoba or Ontario, and an Ontario study has shown that wealthier and more educated families were more likely to receive pumps than disadvantaged families. By comparing data from Manitoba and Quebec, we hoped to answer the question of whether funding support and other program differences might lead to differences in access to pump therapy or complication rates due to diabetes or pump failures based on family income and education levels.

To date, our work has shown that wealthier and more educated families in both provinces were more likely to move to the pump than those with less income or education. We are currently comparing emergency room visits and hospital admissions to assess the impact of different program models on diabetes control and complications.

Acute Diabetes-Related Complications; Continuous Subcutaneous Insulin Infusion; Insulin Pump; Ses; Type 1 Diabetes Mellitus

Copy number variation and mental illness in a pediatric community sample

Name: Russell Schachar

Attention Deficit Hyperactivity Disorder; Mental Health; Obsessive Compulsive Disorder

Adults born at extremely low birth weight (ELBW): Evidence of premature aging?

Name: Louis Schmidt
Institution: McMaster University

Aging; Cognition; Developmental Origins Of Health And Disease (Dohad); Epigenetic Effects; Extremely Low Birth Weight (Elbw); Mental Health; Physical Health; Prematurity

The nutritional vulnerability associated with food insecurity in Canada

Name: Valerie Tarasuk
Institution: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto

Food insecurity, the inadequate access to food due to financial constraints, is a serious social and public health problem in our country, affecting more than 4 million Canadians. Drawing on data from the 2004 and 2015 Nutrition-focused Canadian Community Health Surveys, we examined the nutritional implications of food insecurity for children and adults in Canada. We found a clear gradient whereby the more severe the household food insecurity, the poorer dietary intakes, with people in severely food insecure households having substantially lower intakes of essential nutrients and lower intakes of the foods recommended by the 2019 Canada’s Food Guide (i.e., fruits and vegetables, protein foods, and whole grains). Our results are consistent with other Canadian research showing greater budgetary compromises and higher rates of morbidity and mortality with more severe food insecurity. A comparison of the dietary intakes of adults in food insecure households in 2015 with the intakes of those in similarly food-insecure households in 2004 suggests that the dietary compromises associated with food insecurity have worsened over time. Our findings highlight the need for more effective policy interventions to reduce the prevalence and severity of food insecurity in Canada.

Twitter:

• @proofcanada

Website:

• PROOF - Food Insecurity Policy Research

Anthropometry; Child Health; Household Food Insecurity; Nutritional Status; Public Health

Do the patterns of health care use in early life predict subsequent risks of childhood respiratory conditions?
Early detection of childhood respiratory conditions

Name: Teresa To
Institution: The Hospital for Sick Children, Research Institute

Our study answered the question: What are the unique patterns of respiratory-related healthcare resource use in early childhood?  And, are they indications of later risks of childhood respiratory conditions such as asthma?

We found that in this birth cohort study with linked health administrative data, while most children had low and stable utilization of respiratory-related health resources, one in ten had high respiratory-related resource use between birth and 3 years of age. Those young children who experienced early wheezing, continued to incur higher all-cause healthcare costs from 3 to 5 years of age. However, they do not have a higher risk of developing asthma. Longer follow-up of these high-risk children is important to monitor their long-term risks of respiratory diseases.

The early-life patterns of respiratory-related resource use can be mapped to the children population to identify high-risk children and monitor their respiratory health burden and economic burden to the healthcare system. Early-life disease has a robust and economically meaningful impact on lifetime well-being, identifying children with a high demand for respiratory care early in life may facilitate prevention and intervention strategies to minimize their long-term morbidity.

Twitter:

• @OASIS_Ontario
• @TeresaTo8

Websites:

• Ontario Asthma Surveillance Information System (OASIS)

Asthma; Case Validation; Disease Burden And Management; Early Detection; Health Services Utilization; Population Surveillance; Pre-School Children; Prediction Rule

What works best for children with autism?
Understanding the breadth of services used by children with autism from age 3 to 11

Name: Wendy J. Unger
Institution: Hospital for Sick Children Research Institute

With autism becoming more common, it’s critical to understand how services offered in the health, education and community sectors confer benefit to children with autism. Using data from the national Pathways Study, the research explored whether pre-school behavioural interventions (BI) contribute to better outcomes and which combination of health, behavioural, educational and community services are associated with better functioning. The analysis revealed no significant improvement in social and communication functioning for children receiving a BI in the pre-school years. Similarly, no significant improvement in IQ or symptom severity was observed. Similar results were found for speech & language and group-based services. A significant improvement in social functioning was found in children who received a combination of speech and language and BI during the pre-school years. Children who were continually mainstreamed from pre-school through age 11 also demonstrated better social functioning. Children with autism receive a wide variety of services with unknown evidence of effectiveness. Understanding which types of services are most effective is an area of active investigation. These findings are important for provincial policy makers grappling with how to design and pay for effective ASD programs that can achieve long lasting benefits.

Twitter:

• @SickKidsNews

Websites:

• Technology Assessment at SickKids
• Pathways in Autism Spectrum Disorder

Adaptive Functioning; Autism Spectrum Disorder; Developmental Health; Longitudinal Cohort; Mixed Effects Multi-Variate Model; Parent Perceptions; Retrospective; Service Integration; Service Use; Trajectory Analysis

Providing end-of-life care to children – We can do better!

Name: Kimberley Widger
Institution: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto

Children with life-threatening conditions deserve the highest quality of care aimed at maximizing quality of life and ensuring a good death in the preferred location Unfortunately, research with bereaved parents highlights the use of intensive medical treatments (e.g., intensive care unit admissions, ventilator support) at end-of-life with a high degree of associated suffering. In this study we aimed to improve our understanding of how many children with life-threatening conditions died in hospital and received intensive treatments as well as the specific patient characteristics associated with differences in the care provided. We found that 89% of children with a life-threatening condition died in hospital and 40% received high intensity healthcare at the end of life. Not surprisingly, age and diagnosis were associated with differences in location of death and high intensity health care use, however, differences based on province, distance from tertiary care center and living in rural areas are concerning indicators of potential inequities in the ability to access high quality care at end-of life.

Twitter:

• @WidgerKim
• @UofTNursing

Website:

• End of Life Health Care Use for Children with Life Threatening Conditions: A National Population Based Study

End-Of-Life Care; Health Services Research; Pediatrics; Surveillance