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Murray-Davis B, Grenier LN, Mattison C, Malott AM, Cameron C, Li J, Darling E, Hutton EK. Mediating expectations and experiences that influence birth experiences in Canada's first Alongside Midwifery Unit. Birth 2023; 50:968-977. [PMID: 37485759 DOI: 10.1111/birt.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 10/28/2022] [Accepted: 06/24/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Globally, midwifery-led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of midwife-led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at Canada's first Alongside Midwifery Unit (AMU). METHODS We used a qualitative, grounded theory approach using semi-structured interviews with recipients of midwifery care at the AMU. FINDINGS Data were collected from twenty-eight participants between September 2018 and March 2020. Our generated theory explains how birth experiences and satisfaction were influenced by how well the AMU aligned with expectations or desired experiences related to the following four themes: (1) maintaining the midwifery model of care, (2) emphasizing control and choice, (3) facilitating interprofessional relationships, and (4) appreciating the unique AMU birthing environment. CONCLUSION Canada's first AMU met or exceeded service-user expectations, resulting in high levels of satisfaction with their birth experience. Maintaining core elements of the midwifery model of care, promoting high levels of autonomy, and facilitating positive interprofessional interactions are crucial elements contributing to childbirth satisfaction in the AMU environment.
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Affiliation(s)
- Beth Murray-Davis
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay N Grenier
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Cristina Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Anne M Malott
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
- Markham Stouffville Alongside Midwifery Unit, Markham, Ontario, Canada
| | - Carol Cameron
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
- Markham Stouffville Alongside Midwifery Unit, Markham, Ontario, Canada
| | - Jenifer Li
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Darling
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
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Spelten E, Gitsels J, Verhoeven C, Hutton EK, Martin L. The DELIVER study; the impact of research capacity building on research, education, and practice in Dutch midwifery. PLoS One 2023; 18:e0287834. [PMID: 37906553 PMCID: PMC10617737 DOI: 10.1371/journal.pone.0287834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 06/14/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Few examples exist of research capacity building (RCB) in midwifery. As in other jurisdictions, at the turn of this century midwives in the Netherlands lagged in research-based practice. Dutch professional and academic organisations recognised the need to proactively undertake RCB. This paper describes how a large national research project, the DELIVER study, contributed to RCB in Dutch midwifery. METHODS Applying Cooke's framework for RCB, we analysed the impact of the DELIVER study on RCB in midwifery with a document analysis comprising the following documents: annual reports on research output, websites of national organizations that might have implemented research findings, National Institute for Public Health and the Environment (RIVM)), midwifery guidelines concerning DELIVER research topics, publicly available career information of the PhD students and a google search using the main research topic and name of the researcher to look for articles in public papers. RESULTS The study provided an extensive database with nationally representative data on the quality and provision of midwifery-led care in the Netherlands. The DELIVER study resulted in 10 completed PhD projects and over 60 publications. Through close collaboration the study had direct impact on education of the next generation of primary, midwifery care practices and governmental and professional bodies. DISCUSSION The DELIVER study was intended to boost the research profile of primary care midwifery. This reflection on the research capacity building components of the study shows that the study also impacted on education, policy, and the midwifery profession. As such the study shows that this investment in RCB has had a profound positive impact on primary care midwifery in the Netherlands.
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Affiliation(s)
- Evelien Spelten
- Violet Marshman Centre for Rural Health Research, Rural Health School, La Trobe University, Melbourne, Australia
| | - Janneke Gitsels
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands
| | - Corine Verhoeven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands
- Department of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Eileen K. Hutton
- McMaster Midwifery Research Unit, McMaster University Hamilton, Canada
| | - Linda Martin
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, the Netherlands
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Hutton EK, Simioni JC, Thabane L, Morrison KM. Associations of intrapartum antibiotics and growth, atopy, gastrointestinal and sleep outcomes at one year of age. Pediatr Res 2023; 94:1026-1034. [PMID: 36807614 DOI: 10.1038/s41390-023-02525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Studies investigating neonatal outcomes following intrapartum antibiotic exposure show conflicting results. METHODS Data were collected prospectively in pregnancy to 1-year-of-age, from 212 mother-infant pairs. Adjusted multivariable regression models estimated relationships following exposure to intrapartum antibiotics among vaginally-born, full-term infants and outcomes related to growth, atopic disease, gastrointestinal symptoms, and sleep at 1-year. RESULTS Intrapartum antibiotic exposure (n = 40) was not associated with mass, ponderal index, BMI z-score (1- year), lean mass index (5-months) or height. Antibiotic exposure in labour ≥4-h was associated with increase in fat mass index at 5-months (β 0.42 [95% CI: 0.03, 0.80], p = 0.03). Intrapartum antibiotic was associated with atopy in the first year (OR: 2.93 [95% CI: 1.34, 6.43], p = 0.007). Antibiotic exposure during intrapartum or day 1-7 was associated with newborn fungal infection requiring antifungal therapy (OR 3.04 [95% CI: 1.14, 8.10], p = 0.026), and number of fungal infections (IRR: 2.90 [95% CI: 1.02, 8.27], p = 0.046). CONCLUSION Intrapartum and early life exposure to antibiotics were independently associated with measures of growth, atopy, and fungal infections suggesting that intrapartum and early neonatal antibiotics be used prudently following careful risk-benefit analysis. IMPACT This prospective study: Shows a shift in fat mass index at 5 months associated with antibiotic administration ≥4 h in labour; an earlier age than previously reported; Shows atopy reported less frequently among those not exposed to intrapartum antibiotics; Supports earlier research of increased likelihood of fungal infection following exposure to intrapartum or early-life antibiotics; Adds to growing evidence that antibiotics used intrapartum and in early neonatal periods influence longer-term outcomes for infants. Suggests that use of intrapartum and early neonatal antibiotics should be used prudently after careful consideration of risk and benefit.
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Affiliation(s)
- Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Julia C Simioni
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- Centre for Metabolism Obesity and Diabetes Research, Hamilton, ON, Canada.
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Hutton EK, Simioni JC, Thabane L, Morrison KM. Correction To: Associations of intrapartum antibiotics and growth, atopy, gastrointestinal and sleep outcomes at one year of age. Pediatr Res 2023; 94:1251. [PMID: 37296216 DOI: 10.1038/s41390-023-02613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Julia C Simioni
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- Centre for Metabolism Obesity and Diabetes Research, Hamilton, ON, Canada.
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Murray-Davis B, Grenier LN, Plett RA, Mattison CA, Ahmed M, Malott AM, Cameron C, Hutton EK, Darling EK. Making Space for Midwifery in a Hospital: Exploring the Built Birth Environment of Canada’s First Alongside Midwifery Unit. HERD 2022; 16:189-207. [PMID: 36384318 PMCID: PMC10133785 DOI: 10.1177/19375867221137099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Canada’s first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes. Objectives: To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people’s experiences. Methods: We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group. Results: Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where “making space” for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit. Conclusions: Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.
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Affiliation(s)
- Beth Murray-Davis
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Lindsay N. Grenier
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca A. Plett
- Department of Anthropology, McMaster University, McMaster University, Hamilton, Ontario, Canada
| | - Cristina A. Mattison
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Maisha Ahmed
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Anne M. Malott
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Carol Cameron
- Markham Stouffville Alongside Midwifery Unit, McMaster Midwifery Research Center
| | - Eileen K. Hutton
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth K. Darling
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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Guitor AK, Yousuf EI, Raphenya AR, Hutton EK, Morrison KM, McArthur AG, Wright GD, Stearns JC. Capturing the antibiotic resistome of preterm infants reveals new benefits of probiotic supplementation. Microbiome 2022; 10:136. [PMID: 36008821 PMCID: PMC9414150 DOI: 10.1186/s40168-022-01327-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/14/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Probiotic use in preterm infants can mitigate the impact of antibiotic exposure and reduce rates of certain illnesses; however, the benefit on the gut resistome, the collection of antibiotic resistance genes, requires further investigation. We hypothesized that probiotic supplementation of early preterm infants (born < 32-week gestation) while in hospital reduces the prevalence of antibiotic resistance genes associated with pathogenic bacteria in the gut. We used a targeted capture approach to compare the resistome from stool samples collected at the term corrected age of 40 weeks for two groups of preterm infants (those that routinely received a multi-strain probiotic during hospitalization and those that did not) with samples from full-term infants at 10 days of age to identify if preterm birth or probiotic supplementation impacted the resistome. We also compared the two groups of preterm infants up to 5 months of age to identify persistent antibiotic resistance genes. RESULTS At the term corrected age, or 10 days of age for the full-term infants, we found over 80 antibiotic resistance genes in the preterm infants that did not receive probiotics that were not identified in either the full-term or probiotic-supplemented preterm infants. More genes associated with antibiotic inactivation mechanisms were identified in preterm infants unexposed to probiotics at this collection time-point compared to the other infants. We further linked these genes to mobile genetic elements and Enterobacteriaceae, which were also abundant in their gut microbiomes. Various genes associated with aminoglycoside and beta-lactam resistance, commonly found in pathogenic bacteria, were retained for up to 5 months in the preterm infants that did not receive probiotics. CONCLUSIONS This pilot survey of preterm infants shows that probiotics administered after preterm birth during hospitalization reduced the diversity and prevented persistence of antibiotic resistance genes in the gut microbiome. The benefits of probiotic use on the microbiome and the resistome should be further explored in larger groups of infants. Due to its high sensitivity and lower sequencing cost, our targeted capture approach can facilitate these surveys to further address the implications of resistance genes persisting into infancy without the need for large-scale metagenomic sequencing. Video Abstract.
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Affiliation(s)
- Allison K Guitor
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Amogelang R Raphenya
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Canada
| | - Eileen K Hutton
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
- The Baby & Mi and the Baby & Pre-Mi Cohort Studies, Hamilton, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, Canada
- The Baby & Mi and the Baby & Pre-Mi Cohort Studies, Hamilton, Canada
| | - Andrew G McArthur
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Canada
| | - Gerard D Wright
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Canada
- David Braley Centre for Antibiotic Discovery, McMaster University, Hamilton, Canada
| | - Jennifer C Stearns
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada.
- The Baby & Mi and the Baby & Pre-Mi Cohort Studies, Hamilton, Canada.
- Department of Medicine, McMaster University, Hamilton, Canada.
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.
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Murray-Davis B, Grenier LN, Mattison CA, Malott A, Cameron C, Hutton EK, Darling EK. Promoting safety and role clarity among health professionals on Canada's First Alongside Midwifery Unit (AMU): A mixed-methods evaluation. Midwifery 2022; 111:103366. [DOI: 10.1016/j.midw.2022.103366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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Atkinson SA, Maran A, Dempsey K, Perreault M, Vanniyasingam T, Phillips SM, Hutton EK, Mottola MF, Wahoush O, Xie F, Thabane L. Be Healthy in Pregnancy (BHIP): A Randomized Controlled Trial of Nutrition and Exercise Intervention from Early Pregnancy to Achieve Recommended Gestational Weight Gain. Nutrients 2022; 14:nu14040810. [PMID: 35215461 PMCID: PMC8879855 DOI: 10.3390/nu14040810] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023] Open
Abstract
A randomized two-arm prospective superiority trial tested the efficacy of a novel structured and monitored nutrition (bi-weekly counselling for individualized energy and high dairy protein diet) and exercise program (walking goal of 10,000 steps/day) (intervention) compared to usual care (control) in pregnant women to achieve gestational weight gain (GWG) within current recommendations. Women recruited in communities in southern Ontario, Canada were randomized at 12–17 weeks gestation with stratification by site and pre-pregnancy BMI to intervention (n = 119) or control (n = 122). The primary outcome was the proportion of women who achieved GWG within the Institute of Medicine recommendations. Although the intervention compared to control group was more likely to achieve GWG within recommendations (OR = 1.51; 95% CI (0.81, 2.80)) and total GWG was lower by 1.45 kg (95% CI: (−11.9, 8.88)) neither reached statistical significance. The intervention group achieved significantly higher protein intake at 26–28 week (mean difference (MD); 15.0 g/day; 95% CI (8.1, 21.9)) and 36–38 week gestation (MD = 15.2 g/day; 95% CI (9.4, 21.1)) and higher healthy diet scores (22.5 ± 6.9 vs. 18.7 ± 8.5, p < 0.005) but step counts were similar averaging 6335 steps/day. Pregnancy and infant birth outcomes were similar between groups. While the structured and monitored nutrition with counselling improved diet quality and protein intake and may have benefited GWG, the exercise goal of 10,000 steps/day was unachievable. The results can inform future recommendations for diet and physical activity in pregnancy.
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Affiliation(s)
- Stephanie A. Atkinson
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.M.); (K.D.); (M.P.)
- Correspondence: ; Tel.: +1-905-521-2100 (ext. 75644)
| | - Atherai Maran
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.M.); (K.D.); (M.P.)
| | - Kendra Dempsey
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.M.); (K.D.); (M.P.)
| | - Maude Perreault
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (A.M.); (K.D.); (M.P.)
| | - Thuva Vanniyasingam
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada; (T.V.); (L.T.)
| | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Eileen K. Hutton
- Midwifery Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Michelle F. Mottola
- Department of Anatomy & Cell Biology, School of Kinesiology, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Feng Xie
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada; (T.V.); (L.T.)
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Homann CM, Rossel CAJ, Dizzell S, Bervoets L, Simioni J, Li J, Gunn E, Surette MG, de Souza RJ, Mommers M, Hutton EK, Morrison KM, Penders J, van Best N, Stearns JC. Infants' First Solid Foods: Impact on Gut Microbiota Development in Two Intercontinental Cohorts. Nutrients 2021; 13:nu13082639. [PMID: 34444798 PMCID: PMC8400337 DOI: 10.3390/nu13082639] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022] Open
Abstract
The introduction of solid foods is an important dietary event during infancy that causes profound shifts in the gut microbial composition towards a more adult-like state. Infant gut bacterial dynamics, especially in relation to nutritional intake remain understudied. Over 2 weeks surrounding the time of solid food introduction, the day-to-day dynamics in the gut microbiomes of 24 healthy, full-term infants from the Baby, Food & Mi and LucKi-Gut cohort studies were investigated in relation to their dietary intake. Microbial richness (observed species) and diversity (Shannon index) increased over time and were positively associated with dietary diversity. Microbial community structure (Bray–Curtis dissimilarity) was determined predominantly by individual and age (days). The extent of change in community structure in the introductory period was negatively associated with daily dietary diversity. High daily dietary diversity stabilized the gut microbiome. Bifidobacterial taxa were positively associated, while taxa of the genus Veillonella, that may be the same species, were negatively associated with dietary diversity in both cohorts. This study furthers our understanding of the impact of solid food introduction on gut microbiome development in early life. Dietary diversity seems to have the greatest impact on the gut microbiome as solids are introduced.
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Affiliation(s)
- Chiara-Maria Homann
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (E.G.); (K.M.M.)
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Connor A. J. Rossel
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
| | - Sara Dizzell
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
| | - Liene Bervoets
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
| | - Julia Simioni
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada; (J.S.); (J.L.); (E.K.H.)
| | - Jenifer Li
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada; (J.S.); (J.L.); (E.K.H.)
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (E.G.); (K.M.M.)
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Michael G. Surette
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada
| | - Monique Mommers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Eileen K. Hutton
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada; (J.S.); (J.L.); (E.K.H.)
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Katherine M. Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (E.G.); (K.M.M.)
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - John Penders
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
- InVivo Planetary Health: An Affiliate of the World Universities Network (WUN), West New York, NJ 10704, USA
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands
| | - Niels van Best
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
- InVivo Planetary Health: An Affiliate of the World Universities Network (WUN), West New York, NJ 10704, USA
- Institute of Medical Microbiology, RWTH University Hospital Aachen, RWTH University, 52074 Aachen, Germany
- Correspondence: (N.v.B.); (J.C.S.)
| | - Jennifer C. Stearns
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence: (N.v.B.); (J.C.S.)
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10
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Ahmed RJ, Gafni A, Hutton EK, Hu ZJ, Sanchez JJ, Murphy HR, Feig DS. The cost implications of continuous glucose monitoring in pregnant women with type 1 diabetes in 3 Canadian provinces: a posthoc cost analysis of the CONCEPTT trial. CMAJ Open 2021; 9:E627-E634. [PMID: 34088734 PMCID: PMC8191590 DOI: 10.9778/cmajo.20200128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found improved health outcomes for mothers and their infants among those randomized to self-monitoring of blood glucose (SMBG) with continuous glucose monitoring (CGM) compared with SMBG alone. In this study, we evaluated whether CGM or standard SMBG was more or less costly from the perspective of a third-party payer. METHODS We conducted a posthoc analysis of data from the CONCEPTT trial (Mar. 25, 2013, to Mar. 22, 2016). Health care resource data from 215 pregnant women, randomized to CGM or SMBG, were collected from 31 hospitals in 7 countries. We determined resource costs posthoc based on prices from hospitals in 3 Canadian provinces (Ontario, British Columbia, Alberta). The primary outcome was the difference between groups in the mean total cost of care for mother and infant dyads, paid by each government (i.e., the third-party payer) from randomization to hospital discharge (time horizon). The secondary outcome included CGM and SMBG costs not paid by governments (e.g., glucose monitoring devices and supplies). RESULTS The mean total cost of care was lower in the CGM group compared with the SMBG group in each province (Ontario: $13 270.25 v. $18 465.21, difference in mean total cost [DMT] -$5194.96, 95% confidence interval [CI] -$9841 to -$1395; BC: $13 480.57 v. $18 762.17, DMT -$5281.60, 95% CI -$9964 to -$1382; Alberta: $13 294.39 v. $18 674.45, DMT -$5380.06, 95% CI -$10 216 to -$1490). There was no difference in the secondary outcome. INTERPRETATION Government health care costs are lower when CGM is paid by the patient, driven by lower costs from reduced use of the neonatal intensive care unit in the CGM group; however, when governments pay for CGM equipment, there is no overall cost difference between CGM and SMBG. Governments should consider paying for CGM, as it results in improved maternal and neonatal outcomes with no added overall cost. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01788527.
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Affiliation(s)
- Rashid J Ahmed
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont
| | - Amiram Gafni
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont.
| | - Zheng Jing Hu
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont
| | - J Johanna Sanchez
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont
| | - Helen R Murphy
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont
| | - Denice S Feig
- Department of Obstetrics and Gynecology, and McMaster Midwifery Research Centre (Ahmed, Hutton), and Centre for Health Economics and Policy Analysis, and the Department of Health Research Methods, Evidence and Impact (formerly, Clinical Epidemiology and Biostatistics) (Gafni), and Department of Health Research Methods, Evidence, and Impact (Hu), McMaster University, Hamilton, Ont.; Sunnybrook Research Institute (Sanchez), Sunnybrook Health Sciences Centre; School of Occupational and Public Health (Sanchez), Ryerson University, Toronto, Ont.; Department of Medicine (Murphy), University of East Anglia, Norwich, UK; Department of Medicine (Feig), University of Toronto, Toronto, Ont
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11
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Yousuf EI, Carvalho M, Dizzell SE, Kim S, Gunn E, Twiss J, Giglia L, Stuart C, Hutton EK, Morrison KM, Stearns JC. Persistence of Suspected Probiotic Organisms in Preterm Infant Gut Microbiota Weeks After Probiotic Supplementation in the NICU. Front Microbiol 2020; 11:574137. [PMID: 33117319 PMCID: PMC7552907 DOI: 10.3389/fmicb.2020.574137] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
Probiotics are becoming a prevalent supplement to prevent necrotizing enterocolitis in infants born preterm. However, little is known about the ability of these live bacterial supplements to colonize the gut or how they affect endogenous bacterial strains and the overall gut community. We capitalized on a natural experiment resulting from a policy change that introduced the use of probiotics to preterm infants in a single Neonatal Intensive Care Unit. We used amplicon sequence variants (ASVs) derived from the v3 region of the 16S rRNA gene to compare the prevalence and abundance of Bifidobacterium and Lactobacillus in the gut of preterm infants who were and were not exposed to a probiotic supplement in-hospital. Infants were followed to 5 months corrected age. In the probiotic-exposed infants, ASVs belonging to species of Bifidobacterium appeared at high relative abundance during probiotic supplementation and persisted for up to 5 months. In regression models that controlled for the confounding effects of age and antibiotic exposure, probiotic-exposed infants had a higher abundance of the suspected probiotic bifidobacteria than unexposed infants. Conversely, the relative abundance of Lactobacillus was similar between preterm groups over time. Lactobacillus abundance was inversely related to antibiotic exposure. Furthermore, the overall gut microbial community of the probiotic-exposed preterm infants at term corrected age clustered more closely to samples collected from 10-day old full-term infants than to samples from unexposed preterm infants at term age. In conclusion, routine in-hospital administration of probiotics to preterm infants resulted in the potential for colonization of the gut with probiotic organisms post-discharge and effects on the gut microbiome as a whole. Further research is needed to fully discriminate probiotic bacterial strains from endogenous strains and to explore their functional role in the gut microbiome and in infant health.
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Affiliation(s)
- Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Marilia Carvalho
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Sara E Dizzell
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Stephanie Kim
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Jennifer Twiss
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, ON, Canada
| | - Lucy Giglia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Connie Stuart
- Neonatal Follow Up Clinic, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Eileen K Hutton
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Jennifer C Stearns
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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12
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Grenier LN, Atkinson SA, Mottola MF, Wahoush O, Thabane L, Xie F, Vickers-Manzin J, Moore C, Hutton EK, Murray-Davis B. Be Healthy in Pregnancy: Exploring factors that impact pregnant women's nutrition and exercise behaviours. Matern Child Nutr 2020; 17:e13068. [PMID: 32705811 PMCID: PMC7729656 DOI: 10.1111/mcn.13068] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
Excess gestational weight gain is associated with short‐ and long‐term pregnancy complications. Although a healthy diet and physical activity during pregnancy are recommended and shown to reduce the risk of complications and improve outcomes, adherence to these recommendations is low. The aims of this study were to explore women's view of nutrition and physical activity during pregnancy and to describe barriers and facilitators experienced in implementing physical activity and nutrition recommendations. In a substudy of the Be Healthy in Pregnancy randomized trial, 20 semistructured focus groups were conducted with 66 women randomized to the control group when they were between 16 and 24 weeks gestation. Focus groups were recorded, transcribed verbatim, coded and thematically analysed. The results indicate that women felt motivated to be healthy for their baby, but competing priorities may take precedence. Participants described limited knowledge and access to information on safe physical activity in pregnancy and lacked the skills needed to operationalize both physical activity and dietary recommendations. Women's behaviours regarding diet and physical activity in pregnancy were highly influenced by their own and their peers' beliefs and values regarding how weight gain impacted their health during pregnancy. Pregnancy symptoms beyond women's control such as fatigue and nausea made physical activity and healthy eating more challenging. Counselling from care providers about nutrition and physical activity was perceived as minimal and ineffective. Future interventions should address improving counselling strategies and address individual's beliefs around nutrition and activity in pregnancy.
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Affiliation(s)
- Lindsay N Grenier
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | | | - Michelle F Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
| | - Olive Wahoush
- Global Health, McMaster University, Hamilton, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Vickers-Manzin
- Public Health Services-Healthy Families, Healthy & Safe Communities, Hamilton, Ontario, Canada
| | - Caroline Moore
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Beth Murray-Davis
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
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13
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Mattison CA, Lavis JN, Wilson MG, Hutton EK, Dion ML. A critical interpretive synthesis of the roles of midwives in health systems. Health Res Policy Syst 2020; 18:77. [PMID: 32641053 PMCID: PMC7346500 DOI: 10.1186/s12961-020-00590-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
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14
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Reitsma A, Simioni J, Brunton G, Kaufman K, Hutton EK. Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine 2020; 21:100319. [PMID: 32280941 PMCID: PMC7136633 DOI: 10.1016/j.eclinm.2020.100319] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We previously concluded that risk of stillbirth, neonatal mortality or morbidity is not different whether birth is intended at home or hospital. Here, we compare the occurrence of birth interventions and maternal outcomes among low-risk women who begin labour intending to birth at home compared to women intending to birth in hospital. METHODS We used our registered protocol (PROSPERO, http://www.crd.york.ac.uk, No.CRD42013004046) and searched five databases from 1990-2018. Using R, we obtained pooled estimates of effect (accounting for study design, study setting and parity). FINDINGS 16 studies provided data from ~500,000 intended home births for the meta-analyses. There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience: caesarean section OR 0.58(0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems. INTERPRETATION Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. These findings along with earlier work reporting neonatal outcomes inform families, health care providers and policy makers around the safety of intended home births. FUNDING Partial funding: Association of Ontario Midwives open peer reviewed grant.
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Affiliation(s)
- Angela Reitsma
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Julia Simioni
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa Canada
| | - Karyn Kaufman
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Corresponding author at: McMaster University, 1280 Main Street West, HSC 4H24, Hamilton, Ontario, Canada.
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15
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Mattison CA, Lavis JN, Hutton EK, Dion ML, Wilson MG. Understanding the conditions that influence the roles of midwives in Ontario, Canada's health system: an embedded single-case study. BMC Health Serv Res 2020; 20:197. [PMID: 32164698 PMCID: PMC7068956 DOI: 10.1186/s12913-020-5033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the significant variability in the role and integration of midwifery across provincial and territorial health systems, there has been limited scholarly inquiry into whether, how and under what conditions midwifery has been assigned roles and integrated into Canada's health systems. METHODS We use Yin's (2014) embedded single-case study design, which allows for an in-depth exploration to qualitatively assess how, since the regulation of midwives in 1994, the Ontario health system has assigned roles to and integrated midwives as a service delivery option. Kingdon's agenda setting and 3i + E theoretical frameworks are used to analyze two recent key policy directions (decision to fund freestanding midwifery-led birth centres and the Patients First primary care reform) that presented opportunities for the integration of midwives into the health system. Data were collected from key informant interviews and documents. RESULTS Nineteen key informant interviews were conducted, and 50 documents were reviewed in addition to field notes taken during the interviews. Our findings suggest that while midwifery was created as a self-regulated profession in 1994, health-system transformation initiatives have restricted the profession's integration into Ontario's health system. The policy legacies of how past decisions influence the decisions possible today have the most explanatory power to understand why midwives have had limited integration into interprofessional maternity care. The most important policy legacies to emerge from the analyses were related to payment mechanisms. In the medical model, payment mechanisms privilege physician-provided and hospital-based services, while payment mechanisms in the midwifery model have imposed unintended restrictions on the profession's ability to practice in interprofessional environments. CONCLUSIONS This is the first study to explain why midwives have not been fully integrated into the Ontario health system, as well as the limitations placed on their roles and scope of practice. The study also builds a theoretical understanding of the integration process of healthcare professions within health systems and how policy legacies shape service delivery options.
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Affiliation(s)
- Cristina A Mattison
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada.
| | - John N Lavis
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, 1280 Main St. West, HSC-4H26, Hamilton, ON, L8S 4K1, Canada
| | - Michelle L Dion
- Department of Political Science, McMaster University, 1280 Main St. West, KTH-533, Hamilton, ON, L8S 4M4, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main St West, MML-417, Hamilton, ON, L8S 4L6, Canada
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16
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Darling EK, Grenier L, Nussey L, Murray-Davis B, Hutton EK, Vanstone M. Access to midwifery care for people of low socio-economic status: a qualitative descriptive study. BMC Pregnancy Childbirth 2019; 19:416. [PMID: 31718569 PMCID: PMC6849230 DOI: 10.1186/s12884-019-2577-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background Despite public funding of midwifery care, people of low-socioeconomic status are less likely to access midwifery care in Ontario, Canada, but little is known about barriers that they experience in accessing midwifery care. The purpose of this study was to examine the barriers and facilitators to accessing midwifery care experienced by people of low-socioeconomic status. Methods A qualitative descriptive study design was used. Semi-structured interviews were conducted with 30 pregnant and post-partum people of low-socioeconomic status in Hamilton, Ontario from January to May 2018. Transcribed interviews were coded using open coding techniques and thematically analyzed. Results We interviewed 13 midwifery care recipients and 17 participants who had never received care from midwives. Four themes arose from the interviews: “I had no idea…”, “Babies are born in hospitals”, “Physicians as gateways into prenatal care”, and “Why change a good thing?”. Participants who had not experienced midwifery care had minimal knowledge of midwifery and often had misconceptions about midwives’ scope of practice and education. Prevailing beliefs about pregnancy and birth, particularly concerns about safety, drove participants to seek care from a physician. Physicians are the entry point into the health care system for many, yet few participants received information about midwifery care from physicians. Participants who had experienced midwifery care found it to be an appropriate match for the needs of people of low socioeconomic status. Word of mouth was a primary source of information about midwifery and the most common reason for people unfamiliar with midwifery to seek midwifery care. Conclusions Access to midwifery care is constrained for people of low-socioeconomic status because lack of awareness about midwifery limits the approachability of these services, and because information about midwifery care is often not provided by physicians when pregnant people first contact the health care system. For people of low-socioeconomic status, inequitable access to midwifery care may be exacerbated by lack of knowledge about midwifery within social networks and a tendency to move passively through the health care system which traditionally favours physician care. Targeted efforts to address this issue are necessary to reduce disparities in access to midwifery care.
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Affiliation(s)
- Elizabeth K Darling
- McMaster Midwifery Research Centre, McMaster University, HSC 4H24, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
| | - Lindsay Grenier
- McMaster Midwifery Research Centre, McMaster University, HSC 4H24, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Lisa Nussey
- McMaster Midwifery Research Centre, McMaster University, HSC 4H24, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Beth Murray-Davis
- McMaster Midwifery Research Centre, McMaster University, HSC 4H24, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Eileen K Hutton
- McMaster Midwifery Research Centre, McMaster University, HSC 4H24, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Centre for Health Economics and Policy Analysis McMaster FHS Education Research, Innovation & Theory (MERIT) program, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada
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17
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Hutton EK, Reitsma A, Simioni J, Brunton G, Kaufman K. Caution is needed when assessing results of home birth-Authors' reply. EClinicalMedicine 2019; 16:17. [PMID: 31832615 PMCID: PMC6890941 DOI: 10.1016/j.eclinm.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Eileen K Hutton
- McMaster University, Department of Obstetrics and Gynecology, Faculty of Health Sciences, Hamilton, Canada
| | - Angela Reitsma
- McMaster University, Department of Family Medicine, Faculty of Health Sciences, Hamilton, Canada
| | - Julia Simioni
- McMaster University, Midwifery Education Program, Faculty of Health Sciences, Hamilton, Canada
| | - Ginny Brunton
- University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa Canada
| | - Karyn Kaufman
- McMaster University, Department of Family Medicine, Faculty of Health Sciences, Hamilton, Canada
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Murray-Davis B, Grenier L, Atkinson SA, Mottola MF, Wahoush O, Thabane L, Xie F, Vickers-Manzin J, Moore C, Hutton EK. Experiences regarding nutrition and exercise among women during early postpartum: a qualitative grounded theory study. BMC Pregnancy Childbirth 2019; 19:368. [PMID: 31638920 PMCID: PMC6805669 DOI: 10.1186/s12884-019-2508-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Excess gestational weight gain has long- and short-term implications for women and children, and postpartum weight retention is associated with an increased risk of long-term obesity. Despite the existence of dietary and exercise guidelines, many women struggle to return to pre-pregnancy weight. Experiences of women in tackling postpartum weight loss are poorly understood. We undertook this study to explore experiences related to nutrition, exercise and weight in the postpartum in women in Ontario, Canada. METHODS This was a nested qualitative study within The Be Healthy in Pregnancy Study, a randomized controlled trial. Women randomized to the control group were invited to participate. Semi-structured focus groups were conducted at 4-6 months postpartum. Focus groups were audio recorded, transcribed verbatim, coded and analyzed thematically using a constructivist grounded theory approach. RESULTS Women experienced a complex relationship with their body image, due to unrealistic expectations related to their postpartum body. Participants identified barriers and enablers to healthy habits during pregnancy and postpartum. Gestational weight gain guidelines were regarded as unhelpful and unrealistic. A lack of guidance and information about weight management, healthy eating, and exercise in the postpartum period was highlighted. CONCLUSION Strategies for weight management that target the unique characteristics of the postpartum period have been neglected in research and in patient counselling. Postpartum women may begin preparing for their next pregnancy and support during this period could improve their health for subsequent pregnancies. TRIAL REGISTRATION NCT01689961 registered September 21, 2012.
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Affiliation(s)
- Beth Murray-Davis
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
| | - Lindsay Grenier
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
| | | | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation- Exercise and Pregnancy Lab, School of Kinesiology, The University of Western Ontario, London, ON Canada
| | - Olive Wahoush
- Global Health, McMaster University, Hamilton, ON Canada
- School of Nursing, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Jennifer Vickers-Manzin
- Public Health Services-Healthy Families, Healthy & Safe Communities, City of Hamilton, Hamilton, ON Canada
| | - Caroline Moore
- Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - Eileen K. Hutton
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
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Elderhorst E, Ahmed RJ, Hutton EK, Darling EK. Birth Outcomes for Midwifery Clients Who Begin Postdates Induction of Labour Under Midwifery Care Compared With Those Who Are Transferred to Obstetrical Care. Journal of Obstetrics and Gynaecology Canada 2019; 41:1444-1452. [DOI: 10.1016/j.jogc.2018.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/15/2018] [Indexed: 10/27/2022]
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20
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Hutton EK, Reitsma A, Simioni J, Brunton G, Kaufman K. Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine 2019; 14:59-70. [PMID: 31709403 PMCID: PMC6833447 DOI: 10.1016/j.eclinm.2019.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 07/16/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND More women are choosing to birth at home in well-resourced countries. Concerns persist that out-of-hospital birth contributes to higher perinatal and neonatal mortality. This systematic review and meta-analyses determines if risk of fetal or neonatal loss differs among low-risk women who begin labour intending to give birth at home compared to low-risk women intending to give birth in hospital. METHODS In April 2018 we searched five databases from 1990 onward and used R to obtain pooled estimates of effect. We stratified by study design, study settings and parity. The primary outcome is any perinatal or neonatal death after the onset of labour. The study protocol is peer-reviewed, published and registered (PROSPERO No.CRD42013004046). FINDINGS We identified 14 studies eligible for meta-analysis including ~ 500,000 intended home births. Among nulliparous women intending a home birth in settings where midwives attending home birth are well-integrated in health services, the odds ratio (OR) of perinatal or neonatal mortality compared to those intending hospital birth was 1.07 (95% Confidence Interval [CI], 0.70 to 1.65); and in less integrated settings 3.17 (95% CI, 0.73 to 13.76). Among multiparous women intending a home birth in well-integrated settings, the estimated OR compared to those intending a hospital birth was 1.08 (95% CI, 0.84 to 1.38); and in less integrated settings was 1.58 (95% CI, 0.50 to 5.03). INTERPRETATION The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital. FUNDING Partial funding: Association of Ontario Midwives open peer reviewed grant. RESEARCH IN CONTEXT Evidence before this study Although there is increasing acceptance for intended home birth as a choice for birthing women, controversy about its safety persists. The varying responses of obstetrical societies to intended home birth provide evidence of contrasting views. A Cochrane review of randomised controlled trials addressing this topic included one small trial and noted that in the absence of adequately sized randomised controlled trials on the topic of intended home compared to intended hospital birth, a peer reviewed protocol be published to guide a systematic review and meta-analysis including observational studies. Reviews to date have been limited by design or methodological issues and none has used a protocol published a priori.Added value of this study Individual studies are underpowered to detect small but potentially important differences in rare outcomes. This study uses a published peer-reviewed protocol and is the largest and most comprehensive meta-analysis comparing outcomes of intended home and hospital birth. We take study design, parity and jurisdictional support for home birth into account. Our study provides much needed information to policy makers, care providers and women and families when planning for birth.Implications of all the available evidence Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth in hospital.
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Affiliation(s)
- Eileen K. Hutton
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Angela Reitsma
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Julia Simioni
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ginny Brunton
- EPPI-Centre, Department of Social Science, UCL Institute of Education, University College London, United Kingdom
| | - Karyn Kaufman
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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21
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Hutton EK, Hannah ME, Willan A, Ross S, Armson A, Gafni A, Joseph KS, Mangoff K, Ohlsson A, Sanchez J, Asztalos E, Barrett J. Authors' reply re: Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial. BJOG 2019; 126:547. [PMID: 30729657 DOI: 10.1111/1471-0528.15582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Mary E Hannah
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andy Willan
- Hospital for Sick Children, Toronto, ON, Canada
| | - Sue Ross
- University of Alberta, Edmonton, AB, Canada
| | | | | | - K S Joseph
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Jon Barrett
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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22
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Perreault M, Atkinson SA, Mottola MF, Phillips SM, Bracken K, Hutton EK, Xie F, Meyre D, Morassut RE, Prapavessis H, Thabane L. Structured diet and exercise guidance in pregnancy to improve health in women and their offspring: study protocol for the Be Healthy in Pregnancy (BHIP) randomized controlled trial. Trials 2018; 19:691. [PMID: 30567604 PMCID: PMC6299965 DOI: 10.1186/s13063-018-3065-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 11/21/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence from epidemiological and animal studies support the concept of programming fetal, neonatal, and adult health in response to in utero exposures such as maternal obesity and lifestyle variables. Excess gestational weight gain (GWG), maternal physical activity, and sub-optimal and excess nutrition during pregnancy may program the offspring's risk of obesity. Maternal intake of dairy foods rich in high-quality proteins, calcium, and vitamin D may influence later bone health status. Current clinical practice guidelines for managing GWG are not founded on randomized trials and lack specific "active intervention ingredients." The Be Healthy in Pregnancy (BHIP) study is a randomized controlled trial (RCT) designed to test the effectiveness of a novel structured and monitored Nutrition + Exercise intervention in pregnant women of all pre-pregnancy weight categories (except extreme obesity), delivered through prenatal care in community settings (rather than in hospital settings), on the likelihood of women achieving recommended GWG and a benefit to bone status of offspring and mother at birth and six months postpartum. METHODS The BHIP study is a two-site RCT that will recruit up to 242 participants aged > 18 years at 12-17 weeks of gestation. After baseline measures, participants are randomized to either a structured and monitored Nutrition + Exercise (intervention) or usual care (control) program for the duration of their pregnancy. The primary outcome of the study is the percent of women who achieve GWG within the Institute of Medicine (IOM) guidelines. The secondary outcomes include: (1) maternal bone status via blood bone biomarkers during pregnancy; (2) infant bone status in cord blood; (3) mother and infant bone status measured by dual-energy absorptiometry scanning (DXA scan) at six months postpartum; (4) other measures including maternal blood pressure, blood glucose and lipid profiles, % body fat, and postpartum weight retention; and (5) infant weight z-scores and fat mass at six months of age. DISCUSSION If effective, this RCT will generate high-quality evidence to refine the nutrition guidelines during pregnancy to improve the likelihood of women achieving recommended GWG. It will also demonstrate the importance of early nutrition on bone health in the offspring. TRIAL REGISTRATION ClinicalTrials.gov, NCT01689961 Registered on 21 September 2012.
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Affiliation(s)
- Maude Perreault
- Department Pediatrics, HSC 3A44, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Stephanie A Atkinson
- Department Pediatrics, HSC 3A44, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
| | | | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Keyna Bracken
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - David Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pathology & Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Rita E Morassut
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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23
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Magee LA, Synnes AR, von Dadelszen P, Hutfield AM, Chanoine JP, Côté AM, Devlin AM, Dorling J, Gafni A, Ganzevoort W, Helewa ME, Hutton EK, Koren G, Lee SK, Mcarthur D, Rey E, Robinson WP, Roseboom TJ, Singer J, Wilson S, Moutquin JM. CHIPS-Child: Testing the developmental programming hypothesis in the offspring of the CHIPS trial. Pregnancy Hypertens 2018; 14:15-22. [PMID: 30527103 DOI: 10.1016/j.preghy.2018.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES As a follow-up to the CHIPS trial (Control of Hypertension In Pregnancy Study) of 'less tight' (versus 'tight') control of maternal blood pressure in pregnancy, CHIPS-Child investigated potential developmental programming of maternal blood pressure control in pregnancy, by examining measures of postnatal growth rate and hypothalamic-pituitary adrenal (HPA) axis activation. METHODS CHIPS follow-up was extended to 12 ± 2 months corrected post-gestational age for anthropometry (weight, length, head/waist circumference). For eligible children with consent for a study visit, we collected biological samples (hair/buccal samples) to evaluate HPA axis function (hair cortisol levels) and epigenetic change (DNA methylation analysis of buccal cells). The primary outcome was 'change in z-score for weight' between birth and 12 ± 2 mos. Secondary outcomes were hair cortisol and genome-wide DNA methylation status. RESULTS Of 683 eligible babies, 183 (26.8%) were lost to follow-up, 83 (12.2%) declined, 3 (0.4%) agreed only to ongoing contact, and 414 (60.6%) consented. 372/414 (89.9%) had weight measured at 12mos. In 'less tight' (vs. 'tight') control, the primary outcome was similar [-0.26 (-0.53, +0.01); p = 0.14, padjusted = 0.06]; median (95% confidence interval) hair cortisol (N = 35 samples) was lower [-496 (-892, -100) ng/g; p = 0.02], and buccal swab DNA methylation (N = 16 samples) was similar. No differences in growth rate could be demonstrated up to 5 years. CONCLUSIONS Results demonstrate no compelling evidence for developmental programming of growth or the HPA axis. Clinicians should look to the clinical findings of CHIPS to guide practice. Researchers should seek to replicate these findings and extend outcomes to paediatric blood pressure and neurodevelopment.
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, King's College London, UK; School of Life Course Sciences, King's College London, UK.
| | - Anne R Synnes
- Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, UK; School of Life Course Sciences, King's College London, UK.
| | - Anna M Hutfield
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
| | - Jean-Pierre Chanoine
- Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | | | - Angela M Devlin
- Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | | | - Amiram Gafni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Wessel Ganzevoort
- Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Netherlands.
| | | | - Eileen K Hutton
- Obstetrics and Gynaecology, McMaster University, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Gideon Koren
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Shoo K Lee
- Pediatrics, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Canada.
| | - Dawn Mcarthur
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
| | - Evelyne Rey
- Medicine and Obstetrics and Gynaecology, University of Montreal, Canada.
| | - Wendy P Robinson
- Department of Medical Genetics, University of British Columbia, Canada.
| | - Tessa J Roseboom
- Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Netherlands.
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Canada
| | - Samantha Wilson
- Department of Medical Genetics, University of British Columbia, Canada.
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24
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Mattison CA, Dion ML, Lavis JN, Hutton EK, Wilson MG. Midwifery and obstetrics: Factors influencing mothers' satisfaction with the birth experience. Birth 2018; 45:322-327. [PMID: 29687481 DOI: 10.1111/birt.12352] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Satisfaction is a key component of the care experience and part of the health system "triple aim," along with improving population health and reducing per capita health care costs, the other two parts of the "triple aim." The objectives of the study were to examine birth-experience satisfaction among women in Ontario, Canada, who received care from midwives, family physicians, and obstetricians. METHODS We used Statistics Canada's 2006 national Maternity Experiences Survey. The sample includes 1900 Ontario women and is, with appropriate weighting, representative of an estimated population of 29 700 women who gave birth in Ontario to a singleton baby during the study period. Information was collected on respondents' satisfaction with their health care providers, demographic characteristics, and a range of pregnancy, labor, birth, and postpartum experiences. We used logistic regression analysis to assess differences in patient/client satisfaction by type of health care provider. RESULTS Women cared for by midwives were three times more likely to be satisfied with their care (OR 3.32 [95% CI 2.26-4.86]) when compared with obstetrician-led care. Depression symptoms, having to travel outside the respondents' community to give birth, and being born in an East Asian country were associated with lower levels of satisfaction. CONCLUSION Given recent health system reforms emphasizing the importance of shifting from expensive acute hospital-based care to community-based care, our findings support empirically the importance of supporting women's access to midwifery services within their communities. Findings of ethnocultural differences in satisfaction with care can inform policy makers as health systems move to provide culturally appropriate care to increasingly diverse populations.
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Affiliation(s)
| | - Michelle L Dion
- Department of Political Science, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- Department of Political Science, McMaster University, Hamilton, ON, Canada.,Department of Health Evidence and Impact, McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Michael G Wilson
- Department of Health Evidence and Impact, McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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25
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Comeau A, Hutton EK, Simioni J, Anvari E, Bowen M, Kruegar S, Darling EK. Home birth integration into the health care systems of eleven international jurisdictions. Birth 2018; 45:311-321. [PMID: 29436048 DOI: 10.1111/birt.12339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. METHODS An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. RESULTS Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. CONCLUSIONS This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences.
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Affiliation(s)
- Amanda Comeau
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Julia Simioni
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Ella Anvari
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Megan Bowen
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Kruegar
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth K Darling
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
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26
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Hutton EK, Hannah ME, Willan AR, Ross S, Allen AC, Armson BA, Gafni A, Joseph KS, Mangoff K, Ohlsson A, Sanchez JJ, Asztalos EV, Barrett J. Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial. BJOG 2018; 125:1682-1690. [PMID: 30007113 PMCID: PMC6282843 DOI: 10.1111/1471-0528.15407] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, faecal, or flatal incontinence? DESIGN Women between 320/7 and 386/7 weeks of gestation with a twin pregnancy were randomised to planned caesarean or planned vaginal birth. SETTING The trial took place at 106 centres in 25 countries. POPULATION A total of 2305 of the 2804 women enrolled in the study completed questionnaires at 2 years (82.2% follow-up): 1155 in the planned caesarean group and 1150 in the planned vaginal birth group. METHODS A structured self-administered questionnaire completed at 2 years postpartum. MAIN OUTCOME MEASURES The primary maternal outcome of the Twin Birth Study was problematic urinary stress, or fecal, or flatal incontinence at 2 years RESULTS: Women in the planned caesarean group had lower problematic urinary stress incontinence rates compared with women in the planned vaginal birth group [93/1147 (8.11%) versus 140/1143 (12.25%); odds ratio, 0.63; 95% confidence interval, 0.47-0.83; P = 0.001]. Among those with problematic urinary stress incontinence, quality of life (measured using the Incontinence Impact Questionnaire, IIQ-7) was not different for planned caesarean versus planned vaginal birth groups [mean (SD): 18.4 (21.0) versus 19.1 (21.5); P = 0.82]. There were no differences in problematic faecal or flatal incontinence, or in other maternal outcomes. CONCLUSIONS Among women with a twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces the risk of problematic urinary stress incontinence at 2 years postpartum. Our findings show that the prevalence but not the severity of urinary stress incontinence was associated with mode of birth. FUNDING Canadian Institutes of Health Research (CIHR) (grant no. MCT-63164). TWEETABLE ABSTRACT For women with twins, planned caesarean compared with planned vaginal birth is associated with decreased prevalence but not severity of urinary stress incontinence at 2 years.
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Affiliation(s)
- E K Hutton
- Division of Midwifery, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - M E Hannah
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - A R Willan
- Program in Child Health Evaluative Sciences, Sick Kids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - S Ross
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada
| | - A C Allen
- Department of Paediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - B A Armson
- Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - A Gafni
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K Mangoff
- The Centre for Mother, Infant, and Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Ohlsson
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J J Sanchez
- The Centre for Mother, Infant, and Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E V Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jfr Barrett
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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27
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Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, Asztalos E, Barrett JFR, Sanchez JJ, de Leiva A, Hod M, Jovanovic L, Keely E, McManus R, Hutton EK, Meek CL, Stewart ZA, Wysocki T, O'Brien R, Ruedy K, Kollman C, Tomlinson G, Murphy HR. Continuous Glucose Monitoring in Pregnant Women With Type 1 Diabetes (CONCEPTT): A Multicenter International Randomised Controlled Trial. Obstet Gynecol Surv 2018. [DOI: 10.1097/01.ogx.0000532199.80944.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Baron R, Te Velde SJ, Heymans MW, Klomp T, Hutton EK, Brug J. The Relationships of Health Behaviour and Psychological Characteristics with Spontaneous Preterm Birth in Nulliparous Women. Matern Child Health J 2018; 21:873-882. [PMID: 27581004 PMCID: PMC5378731 DOI: 10.1007/s10995-016-2160-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives Preterm birth is the leading pregnancy outcome associated with perinatal morbidity and mortality and remains difficult to prevent. There is evidence that some modifiable maternal health characteristics may influence the risk of preterm birth. Our aim was to investigate the relationships of self-reported maternal health behaviour and psychological characteristics in nulliparous women with spontaneous preterm birth in prenatal primary care. Methods The data of our prospective study was obtained from the nationwide DELIVER multicentre cohort study (September 2009–March 2011), which was designed to examine perinatal primary care in the Netherlands. In our study, consisting of 2768 nulliparous women, we estimated the relationships of various self-reported health behaviours (smoking, alcohol consumption, folic acid supplementation, daily fruit, daily fresh vegetables, daily hot meal and daily breakfast consumption) and psychological characteristics (anxious/depressed mood and health control beliefs) with spontaneous preterm birth as a dichotomous outcome. Due to the clustering of clients within midwife practices, Generalized Estimating Equations was used for these analyses. Results Low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth (odds ratio 2.26; 95 % confidence interval 1.51, 3.39) after being adjusted for socio-demographics, anthropometrics and the remaining health behaviour and psychological characteristics. The other characteristics were not significantly associated with spontaneous preterm birth. Conclusions for Practice Maternal low health control beliefs need to be explored further as a possible marker for women at risk for preterm birth, and as a potentially modifiable characteristic to be used in interventions which are designed to reduce the risk of spontaneous preterm birth.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Saskia J Te Velde
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Methodology and Applied Biostatistics, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Trudy Klomp
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, L8S 4K1, Canada
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Mårtensson LB, Hutton EK, Lee N, Kildea S, Gao Y, Bergh I. Sterile water injections for childbirth pain: An evidenced based guide to practice. Women Birth 2017; 31:380-385. [PMID: 29241699 DOI: 10.1016/j.wombi.2017.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND About 30% of women in labour suffer from lower back pain. Studies of sterile water injections for management of low back pain have consistently shown this approach to be effective. The objective of this evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower back pain in labouring women. METHODS To identify relevant publications our search strategy was based on computerised literature searches in scientific databases. The methodological quality of each study was assessed using the modified version of the Jadad scale, 12 studies were included. FINDINGS Recommendations regarding the clinical use of sterile water injections for pain relief in labour are reported in terms of the location of injection administration, various injection techniques, number of injections used, amount of sterile water in each injection and adverse effects. DISCUSSION Both injection techniques provide good pain relief for lower back pain during labour. The subcutaneous injection technique is possibly less painful than the intracutaneous technique administered, but we are unsure if this impacts on effectiveness. The effect seems to be related to the number of injections and the amount of sterile water in each injection. CONCLUSION The recommendation at present, based on the current state of knowledge, is to give four injections. Notwithstanding the differences in injection technique and number of injections the method appears to provide significant levels of pain relief and can be repeated as often as required with no adverse effect (apart from the administration pain) on the woman or her foetus.
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Affiliation(s)
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada; Vrije Universiteit, Amsterdam, The Netherlands
| | - Nigel Lee
- Mater Research Institute University of Queensland, Brisbane, Australia; School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia
| | - Sue Kildea
- Mater Research Institute University of Queensland, Brisbane, Australia; School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia
| | - Yu Gao
- Mater Research Institute University of Queensland, Brisbane, Australia; School of Nursing, Midwifery and Social Work University of Queensland, St Lucia, Australia
| | - Ingrid Bergh
- School of Health and Education, University of Skövde, Sweden
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Stearns JC, Simioni J, Gunn E, McDonald H, Holloway AC, Thabane L, Mousseau A, Schertzer JD, Ratcliffe EM, Rossi L, Surette MG, Morrison KM, Hutton EK. Intrapartum antibiotics for GBS prophylaxis alter colonization patterns in the early infant gut microbiome of low risk infants. Sci Rep 2017; 7:16527. [PMID: 29184093 PMCID: PMC5705725 DOI: 10.1038/s41598-017-16606-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/10/2017] [Indexed: 01/15/2023] Open
Abstract
Early life microbial colonization and succession is critically important to healthy development with impacts on metabolic and immunologic processes throughout life. A longitudinal prospective cohort was recruited from midwifery practices to include infants born at full term gestation to women with uncomplicated pregnancies. Here we compare bacterial community succession in infants born vaginally, with no exposure to antibiotics (n = 53), with infants who were exposed to intrapartum antibiotic prophylaxis (IAP) for Group B Streptococcus (GBS; n = 14), and infants born by C-section (n = 7). Molecular profiles of the 16 S rRNA genes indicate that there is a delay in the expansion of Bifidobacterium, which was the dominate infant gut colonizer, over the first 12 weeks and a persistence of Escherichia when IAP for GBS exposure is present during vaginal labour. Longer duration of IAP exposure increased the magnitude of the effect on Bifidobacterium populations, suggesting a longer delay in microbial community maturation. As with prior studies, we found altered gut colonisation following C-section that included a notable lack of Bacteroidetes. This study found that exposure of infants to IAP for GBS during vaginal birth affected aspects of gut microbial ecology that, although dramatic at early time points, disappeared by 12 weeks of age in most infants.
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Affiliation(s)
- Jennifer C Stearns
- Department of Medicine, McMaster University, Hamilton, Canada. .,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.
| | - Julia Simioni
- Midwifery Education Program, McMaster University, Hamilton, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Helen McDonald
- Midwifery Education Program, McMaster University, Hamilton, Canada
| | - Alison C Holloway
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Andrea Mousseau
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
| | - Jonathan D Schertzer
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.,Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Elyanne M Ratcliffe
- Department of Pediatrics, McMaster University, Hamilton, Canada.,Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Laura Rossi
- Department of Medicine, McMaster University, Hamilton, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada
| | - Michael G Surette
- Department of Medicine, McMaster University, Hamilton, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.,Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Canada
| | | | - Eileen K Hutton
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
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Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, Asztalos E, Barrett JFR, Sanchez JJ, de Leiva A, Hod M, Jovanovic L, Keely E, McManus R, Hutton EK, Meek CL, Stewart ZA, Wysocki T, O'Brien R, Ruedy K, Kollman C, Tomlinson G, Murphy HR. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet 2017; 390:2347-2359. [PMID: 28923465 PMCID: PMC5713979 DOI: 10.1016/s0140-6736(17)32400-5] [Citation(s) in RCA: 382] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/31/2017] [Accepted: 08/08/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. FINDINGS Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). INTERPRETATION Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. FUNDING Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.
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Affiliation(s)
- Denice S Feig
- Department of Medicine, Sinai Health System, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lois E Donovan
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rosa Corcoy
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau CIBER-BBN, Barcelona, Spain
| | - Kellie E Murphy
- Department of Obstetrics & Gynecology, Sinai Health System, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie A Amiel
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK; Diabetes Service, Devision of Urgent Care, Planned Care and Allied Critical Services, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Alberto de Leiva
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau CIBER-BBN, Barcelona, Spain
| | - Moshe Hod
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah, Tikvah, Israel
| | - Lois Jovanovic
- Division of Endocrinology, University of Southern California, Los Angeles, CA, USA; Department of Chemistry, University of California, Santa Barbara, CA, USA
| | - Erin Keely
- Department of Medicine, University of Ottawa, and The Ottawa Hospital, Ottawa, ON, Canada
| | - Ruth McManus
- Department of Medicine, St Joseph Health Care London, ON, Canada; Department of Medicine, University of Western ON, London, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics & Gynecology, McMaster University Hamilton, ON, Canada
| | - Claire L Meek
- Wolfson Diabetes and Endocrine Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zoe A Stewart
- Wolfson Diabetes and Endocrine Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tim Wysocki
- Nemours Children's Health System, Jacksonville, FL, USA
| | | | | | | | - George Tomlinson
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Helen R Murphy
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK; Wolfson Diabetes and Endocrine Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Medicine, University of East Anglia, Norwich, UK
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Warmelink JC, Wiegers TA, de Cock TP, Klomp T, Hutton EK. Collaboration of midwives in primary care midwifery practices with other maternity care providers. Midwifery 2017; 55:45-52. [PMID: 28926751 DOI: 10.1016/j.midw.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. METHODS Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. RESULTS Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with interactions with physicians (GPs, obstetricians and paediatricians). Midwives with more work experience were more satisfied with their collaboration with GPs. Midwives from the southern region of the Netherlands were more satisfied with collaboration with GPs and obstetricians. Compared to the urban areas, in the rural or mixed areas the midwives were more satisfied regarding their collaboration with MCA(O)s and clinical midwives. Midwives from non-Dutch origin were less satisfied with the collaboration with paediatricians. No relations were found between the overall mean satisfaction of collaboration and work-related and personal characteristics and attitude towards work. CONCLUSIONS Inter-professionals relations in maternity care in the Netherlands can be enhanced, especially the primary care midwives' interactions with physicians and with maternity care providers in the northern and central part of the Netherlands, and in urban areas. Future exploratory or deductive research may provide additional insight in the collaborative practice in everyday work setting.
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Affiliation(s)
- J Catja Warmelink
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Midwifery Academy Amsterdam Groningen, The Netherlands.
| | - Therese A Wiegers
- Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands
| | - T Paul de Cock
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Midwifery Academy Amsterdam Groningen, The Netherlands; The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Coleraine, United Kingdom
| | - Trudy Klomp
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Midwifery Academy Amsterdam Groningen, The Netherlands
| | - Eileen K Hutton
- Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Shoemaker ES, Bourgeault IL, Cameron C, Graham ID, Hutton EK. Results of implementation of a hospital-based strategy to reduce cesarean delivery among low-risk women in Canada. Int J Gynaecol Obstet 2017; 139:239-244. [DOI: 10.1002/ijgo.12263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/28/2017] [Accepted: 07/10/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Esther S. Shoemaker
- C.T. Lamont Primary Health Care Research Centre; Bruyère Research Institute; Ottawa ON Canada
| | | | - Carol Cameron
- Faculty of Health Sciences; McMaster University; Hamilton ON Canada
| | - Ian D. Graham
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON Canada
| | - Eileen K. Hutton
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
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Baron R, Martin L, Gitsels-van der Wal JT, Noordman J, Heymans MW, Spelten ER, Brug J, Hutton EK. Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses. Midwifery 2017; 54:7-17. [PMID: 28780476 DOI: 10.1016/j.midw.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. DESIGN quantitative video analyses. SETTING AND PARTICIPANTS 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. FINDINGS our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Linda Martin
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Methodology and Applied Biostatistics, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Evelien R Spelten
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Public Health, Rural Health School, La Trobe University, Melbourne, VIC 3086, Australia
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, Canada L8S 4K1
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Klomp T, Witteveen AB, de Jonge A, Hutton EK, Lagro-Janssen ALM. A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands. J Psychosom Obstet Gynaecol 2017; 38:94-102. [PMID: 27778527 DOI: 10.1080/0167482x.2016.1244522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain. METHODS Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010. RESULTS Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time. DISCUSSION It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.
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Affiliation(s)
- Trudy Klomp
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Anke B Witteveen
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Ank de Jonge
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Eileen K Hutton
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands.,c Midwifery Education Program , McMaster University Hamilton , Ontario , Canada
| | - Antoine L M Lagro-Janssen
- b Department of Primary Care and Community Care, Women's Studies Medicine , Radboud University Medical Center Nijmegen , the Netherlands
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Hutton EK, Simioni JC, Thabane L. Predictors of success of external cephalic version and cephalic presentation at birth among 1253 women with non-cephalic presentation using logistic regression and classification tree analyses. Acta Obstet Gynecol Scand 2017; 96:1012-1020. [DOI: 10.1111/aogs.13161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Eileen K. Hutton
- Department of Obstetrics and Gynecology; McMaster University; Hamilton Ontario Canada
| | - Julia C. Simioni
- Midwifery Education Program; McMaster University; Hamilton Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods; Evidence, and Impact (HEI); McMaster University; Hamilton Ontario Canada
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Poole KL, McDonald SD, Griffith LE, Hutton EK. Association of external cephalic version before term with late preterm birth. Acta Obstet Gynecol Scand 2017; 96:998-1005. [PMID: 28414857 DOI: 10.1111/aogs.13153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While evidence suggests that beginning an external cephalic version (ECV) before term (340/7 to 366/7 weeks) compared with after term may be associated with an increase in late preterm birth (340/7 to 366/7 weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birth. MATERIAL AND METHODS Secondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (340/7 to 366/7 weeks), as well as whether additional risk factors for preterm birth (such as maternal age, height, body mass index, parity, placental location, and perinatal mortality rate) moderated this relation. Generalized linear mixed methods were used to account for center effect and adjust for covariates. RESULT Among 1765 women with breech pregnancies and without a prior preterm birth, 749 (42.4%) received at least one ECV before term. Exposure to an ECV before term was not associated significantly independently with odds of preterm birth. However, placenta location moderated the association between early ECV exposure and late preterm birth. The odds of preterm birth in women who were exposed to an ECV before term and who also had an anterior placenta were doubled (OR 2.05; 95% CI 1.12-3.71; p = 0.02). CONCLUSION In a large cohort of women without known risks for preterm birth, those with an anterior placenta who undergo an ECV before term constitute a subgroup at particular risk for late preterm birth.
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Affiliation(s)
- Kristie L Poole
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sarah D McDonald
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Lauren E Griffith
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
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Baas CI, Wiegers TA, de Cock TP, Erwich JJHM, Spelten ER, de Boer MR, Hutton EK. Client-Related Factors Associated with a "Less than Good" Experience of Midwifery Care during Childbirth in the Netherlands. Birth 2017; 44:58-67. [PMID: 27905662 DOI: 10.1111/birt.12266] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND A "less than good" experience during childbirth can affect a mother's early interaction with her child and may significantly influence a woman's emotional well-being. In this study, we focus on clients who experienced midwifery care provided during childbirth as "less than good" care. The aim of this study was to understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve this care. METHODS This study was part of the "DELIVER study" where mothers report on the care they received. We used generalized estimation equations to control for correlations within midwife practices. Forward multivariate logistic regression analyses were conducted to model the client-related factors associated with the experienced midwifery care during childbirth. RESULTS We included the responses of 2,377 women. In the multivariable logistic regression model, odds of reporting "less than good care" were significantly higher for women who experienced an unplanned cesarean birth (OR 2.21 [CI 1.19-4.09]), an instrumental birth (OR 1.55 [CI 1.08-2.23]), and less control during the dilation phase (OR 0.98 [CI 0.97-0.99]) and pushing phase (OR 0.98 [CI 0.97-0.99]). DISCUSSION Birth-related factors were more likely than maternal characteristics to be associated with the experience of midwifery care during childbirth. We conclude that there is room for midwives to improve their care for women during childbirth particularly in improving the patient centeredness of the care provider, using strategies to enhance sense of control, and focusing on the particular needs of those who experience instrumental vaginal or unplanned cesarean births.
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Affiliation(s)
- Carien I Baas
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Therese A Wiegers
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - T Paul de Cock
- Department of Midwifery Science, EMGO+VUMc, Amsterdam, the Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynaecology, University of Groningen, Groningen, the Netherlands.,University Medical Centre Groningen, Groningen, the Netherlands
| | - Evelien R Spelten
- Department of Public Health, Rural Health School, La Trobe University, Melbourne, Vic., 3086, Australia
| | | | - Eileen K Hutton
- Department of Midwifery Science, EMGO+VUMc, Amsterdam, the Netherlands.,Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
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Baron R, Heesterbeek Q, Manniën J, Hutton EK, Brug J, Westerman MJ. Exploring health education with midwives, as perceived by pregnant women in primary care: A qualitative study in the Netherlands. Midwifery 2017; 46:37-44. [PMID: 28161688 DOI: 10.1016/j.midw.2017.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 12/30/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE to explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives. DESIGN qualitative semi-structured interview study, using thematic analysis and constant comparison. SETTING AND PARTICIPANTS twenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013. FINDINGS women considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives' assessments of the extent of their knowledge, as well as by the questions they asked themselves. A few were concerned that midwives may make incorrect assumptions about the extent of their knowledge. Women also varied in how comfortable they felt about contacting their midwives for questions between antenatal visits. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE health education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasise their availability for questions between antenatal visits.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Querine Heesterbeek
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Judith Manniën
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG) and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, Canada L8S 4K1
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Warmelink JC, de Cock TP, Combee Y, Rongen M, Wiegers TA, Hutton EK. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study. BMC Pregnancy Childbirth 2017; 17:24. [PMID: 28077073 PMCID: PMC5225585 DOI: 10.1186/s12884-016-1185-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. METHODS This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. RESULTS Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. CONCLUSIONS Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating midwives are motivated to undertake an expanded intrapartum skill set. It can be important to involve students' views in the discussion, because they are the future maternity care providers.
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Affiliation(s)
- J Catja Warmelink
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. .,Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands.
| | - T Paul de Cock
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands.,The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Coleraine, UK
| | - Yvonne Combee
- Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands
| | - Marloes Rongen
- Midwifery Academy Amsterdam Groningen, Amsterdam/Groningen, The Netherlands
| | - Therese A Wiegers
- Netherlands institute for health services research (NIVEL), Utrecht, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Faculty of Health Sciences, McMaster University, Hamilton, Canada
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41
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Murray-Davis B, McVittie J, Barrett JF, Hutton EK. Exploring Women's Preferences for the Mode of Delivery in Twin Gestations: Results of the Twin Birth Study. Birth 2016; 43:285-292. [PMID: 27321272 DOI: 10.1111/birt.12238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Twin Birth Study, an international, multi-center randomized controlled trial was conducted to compare the risks of planned cesarean with planned vaginal delivery for twin pregnancies. The aim of this component of the trial was to understand participants' perspectives of study participation and preferences for the mode of delivery. METHODS A mixed-methods questionnaire was distributed to study participants 3 months after giving birth. The questionnaire contained Likert scales and open-ended questions about the experience of being enrolled in a clinical trial and of childbirth, including the mode of delivery. Quantitative data were analyzed using SAS to generate descriptive statistics. Qualitative data were analyzed to identify categories and themes. RESULTS Ninety-one percent of trial participants completed the questionnaire. Across all groups, the majority of women would participate in a study like this one again if given the opportunity. Main benefits of participating were as follows: benefits to one and one's babies, altruism, and receiving quality care. Randomization for the mode of delivery was challenging for women because of the desire to be involved in decision-making. Findings related to childbirth experience and the mode of delivery demonstrated a preference for vaginal birth across all groups. Those who had a vaginal birth were more satisfied with their birth experience. CONCLUSIONS This study provides evidence to inform practitioners about what women who have twin pregnancies like or dislike about birth and their desire for involvement in decision-making. Vaginal birth was preferred across all study groups and was associated with greater satisfaction with childbirth experience.
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Affiliation(s)
| | | | - Jon F Barrett
- Department of Obstetrics and Gynaecology, University of Toronto, Hamilton, ON, Canada
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42
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Simioni J, Hutton EK, Gunn E, Holloway AC, Stearns JC, McDonald H, Mousseau A, Schertzer JD, Ratcliffe EM, Thabane L, Surette MG, Morrison KM. A comparison of intestinal microbiota in a population of low-risk infants exposed and not exposed to intrapartum antibiotics: The Baby & Microbiota of the Intestine cohort study protocol. BMC Pediatr 2016; 16:183. [PMID: 27832763 PMCID: PMC5103394 DOI: 10.1186/s12887-016-0724-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023] Open
Abstract
Background The intestinal microbiota influences metabolic, nutritional, and immunologic processes and has been associated with a broad range of adverse health outcomes including asthma, obesity and Type 2 diabetes. Early life exposures may alter the course of gut microbial colonization leading to differences in metabolic and immune regulation throughout life. Although approximately 50 % of low-risk full-term infants born in Canada are exposed to intrapartum antibiotics, little is known about the influence of this common prophylactic treatment on the developing neonatal intestinal microbiota. The purpose of this study is to describe the intestinal microbiome over the first 3 years of life among healthy, breastfed infants born to women with low-risk pregnancies at full term gestation and to determine if at 1 year of age, the intestinal microbiome of infants exposed to intrapartum antibiotics differs in type and quantity from the infants that are not exposed. Methods A prospectively followed cohort of 240 mother-infant pairs will be formed by enrolling eligible pregnant women from midwifery practices in the City of Hamilton and surrounding area in Ontario, Canada. Participants will be followed until the age of 3 years. Women are eligible to participate in the study if they are considered to be low-risk, planning a vaginal birth and able to communicate in English. Women are excluded if they have a multiple pregnancy or a preterm birth. Study questionnaires are completed, anthropometric measures are taken and biological samples are acquired including eight infant stool samples between 3 days and 3 years of age. Discussion Our experience to date indicates that midwifery practices and clients are keen to participate in this research. The midwifery client population is likely to have high rates of breastfeeding and low rates of intervention, allowing us to examine the comparative development of the microbiome in a relatively healthy and homogenous population. Results from this study will make an important contribution to the growing understanding of the patterns of intestinal microbiome colonization in the early years of life and may have implications for best practices to support the establishment of the microbiome at birth. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0724-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Simioni
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jennifer C Stearns
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Helen McDonald
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - Andrea Mousseau
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jonathan D Schertzer
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada.,Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Elyanne M Ratcliffe
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Michael G Surette
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada.
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43
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Affiliation(s)
- Eileen K Hutton
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton ON
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44
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Ahmed RJ, Gafni A, Hutton EK, Hu ZJ, Pullenayegum E, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez JJ, Ganzevoort W, Helewa M, Lee SK, Lee T, Logan AG, Moutquin JM, Singer J, Thornton JG, Welch R, Magee LA. The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial). Hypertension 2016; 68:1049-55. [PMID: 27550914 PMCID: PMC5008043 DOI: 10.1161/hypertensionaha.116.07466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
Abstract
UNLABELLED The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.
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Affiliation(s)
- Rashid J Ahmed
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Amiram Gafni
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Eileen K Hutton
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Zheng Jing Hu
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Eleanor Pullenayegum
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Peter von Dadelszen
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Evelyne Rey
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Susan Ross
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Elizabeth Asztalos
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Kellie E Murphy
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Jennifer Menzies
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - J Johanna Sanchez
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Wessel Ganzevoort
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Michael Helewa
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Shoo K Lee
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Terry Lee
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Alexander G Logan
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Jean-Marie Moutquin
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Joel Singer
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Jim G Thornton
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Ross Welch
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Laura A Magee
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
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Hutton EK, Hannah ME, Ross S, Joseph KS, Ohlsson A, Asztalos E, Willan AR, Allen AC, Armson BA, Gafni A, Mangoff K, Sanchez JJ, Barrett JF. Re: Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial: Counselling is difficult when outcomes are associated with mode of delivery and not the plan of mode of delivery. BJOG 2016; 123:644. [PMID: 26914900 DOI: 10.1111/1471-0528.13769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Eileen K Hutton
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mary E Hannah
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Susan Ross
- Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - K S Joseph
- Obstetrics and Gynaecology and School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Arne Ohlsson
- Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Asztalos
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Andrew R Willan
- Ontario Child Health Support Unit, Sickkids Research Institute and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alexander C Allen
- Pediatrics, IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - B Anthony Armson
- Obstetrics and Gynecology, IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Amiram Gafni
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kathryn Mangoff
- Center for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Johanna J Sanchez
- Center for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Jon F Barrett
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
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Ahmed RJ, Gafni A, Hutton EK. The Cost Implications in Ontario, Alberta, and British Columbia of Early Versus Delayed External Cephalic Version in the Early External Cephalic Version 2 (EECV2) Trial. J Obstet Gynaecol Can 2016; 38:235-245.e3. [PMID: 27106193 DOI: 10.1016/j.jogc.2015.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE According to the Early External Cephalic Version (EECV2) Trial, planning external cephalic version (ECV) early in pregnancy results in fewer breech presentations at delivery compared with delayed external cephalic version. A Cochrane review conducted after the EECV2 Trial identified an increase in preterm birth associated with early ECV. We examined whether a policy of routine early ECV (i.e., before 37 weeks' gestation) is more or less costly than a policy of delayed ECV. METHODS We undertook this analysis from the perspective of a third-party payer (Ministry of Health). We applied data, using resources reported in the EECV2 Trial, to the Canadian context using 10 hospital unit costs and 17 physician service/procedure unit costs. The data were derived from the provincial health insurance plan schedule of medical benefits in three Canadian provinces (Ontario, Alberta, and British Columbia). The difference in mean total costs between study groups was tested for each province separately. RESULTS We found that planning early ECV results in higher costs than planning delayed ECV. The mean costs of all physician services/procedures and hospital units for planned ECV compared with delayed ECV were $7997.32 versus $7263.04 in Ontario (P < 0.001), $8162.82 versus $7410.55 in Alberta (P < 0.001), and $8178.92 versus $7417.04 in British Columbia (P < 0.001), respectively. CONCLUSION From the perspective of overall cost, our analyses do not support a policy of routinely planning ECV before 37 weeks' gestation.
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Affiliation(s)
- Rashid J Ahmed
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton ON
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology (Midwifery), Faculty of Health Sciences, McMaster University, Hamilton ON
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Asztalos EV, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, Gafni A, Joseph K, Ohlsson A, Ross S, Sanchez JJ, Mangoff K, Barrett JF. Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy. Am J Obstet Gynecol 2016; 214:371.e1-371.e19. [PMID: 26830380 DOI: 10.1016/j.ajog.2015.12.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/13/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Twin Birth Study randomized women with uncomplicated pregnancies, between 32(0/7)-38(6/7) weeks' gestation where the first twin was in cephalic presentation, to a policy of either a planned cesarean or planned vaginal delivery. The primary analysis showed that planned cesarean delivery did not increase or decrease the risk of fetal/neonatal death or serious neonatal morbidity as compared with planned vaginal delivery. OBJECTIVE This study presents the secondary outcome of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN A total of 4603 children from the initial cohort of 5565 fetuses/infants (83%) contributed to the outcome of death or neurodevelopmental delay. Surviving children were screened using the Ages and Stages Questionnaire with abnormal scores validated by a clinical neurodevelopmental assessment. The effect of planned cesarean vs planned vaginal delivery on death or neurodevelopmental delay was quantified using a logistic model to control for stratification variables and using generalized estimating equations to account for the nonindependence of twin births. RESULTS Baseline maternal, pregnancy, and infant characteristics were similar. Mean age at assessment was 26 months. There was no significant difference in the outcome of death or neurodevelopmental delay: 5.99% in the planned cesarean vs 5.83% in the planned vaginal delivery group (odds ratio, 1.04; 95% confidence interval, 0.77-1.41; P = .79). CONCLUSION A policy of planned cesarean delivery provides no benefit to children at 2 years of age compared with a policy of planned vaginal delivery in uncomplicated twin pregnancies between 32(0/7)-38(6/7)weeks' gestation where the first twin is in cephalic presentation.
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Beuckens ARM, Rijnders M, Verburgt-Doeleman T, Rijninks-van Driel GC, Thorpe J, Hutton EK. Authors' reply re: An observational study of the success and complications of 2546 external cephalic versions in low-risk pregnant women performed by trained midwives. BJOG 2016; 123:478. [PMID: 26810684 DOI: 10.1111/1471-0528.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Julia Thorpe
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada.,Department of Midwifery, VU University, Amsterdam, The Netherlands
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Martin L, Gitsels-van der Wal JT, Pereboom MTR, Spelten ER, Hutton EK, van Dulmen S. Clients' psychosocial communication and midwives' verbal and nonverbal communication during prenatal counseling for anomaly screening. Patient Educ Couns 2016; 99:85-91. [PMID: 26298217 DOI: 10.1016/j.pec.2015.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study focuses on facilitation of clients' psychosocial communication during prenatal counseling for fetal anomaly screening. We assessed how psychosocial communication by clients is related to midwives' psychosocial and affective communication, client-directed gaze and counseling duration. METHODS During 184 videotaped prenatal counseling consultations with 20 Dutch midwives, verbal psychosocial and affective behavior was measured by the Roter Interaction Analysis System (RIAS). We rated the duration of client-directed gaze. We performed multilevel analyses to assess the relation between clients' psychosocial communication and midwives' psychosocial and affective communication, client-directed gaze and counseling duration. RESULTS Clients' psychosocial communication was higher if midwives' asked more psychosocial questions and showed more affective behavior (β=0.90; CI: 0.45-1.35; p<0.00 and β=1.32; CI: 0.18-2.47; p=0.025, respectively). Clients "psychosocial communication was not related to midwives" client-directed gaze. Additionally, psychosocial communication by clients was directly, positively related to the counseling duration (β=0.59; CI: 0.20-099; p=0.004). CONCLUSIONS In contrast with our expectations, midwives' client-directed gaze was not related with psychosocial communication of clients. PRACTICE IMPLICATIONS In addition to asking psychosocial questions, our study shows that midwives' affective behavior and counseling duration is likely to encourage client's psychosocial communication, known to be especially important for facilitating decision-making.
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Affiliation(s)
- Linda Martin
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands.
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands; Faculty of Theology, VU University, Amsterdam, Netherlands
| | - Monique T R Pereboom
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands
| | - Evelien R Spelten
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands; Obstetrics & Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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Hutton EK, Cappelletti A, Reitsma AH, Simioni J, Horne J, McGregor C, Ahmed RJ. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ 2015; 188:E80-E90. [PMID: 26696622 DOI: 10.1503/cmaj.150564] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Previous studies have shown that planned home birth is associated with a decreased likelihood of intrapartum intervention with no difference in neonatal outcomes compared with planned hospital birth. The purpose of our study was to evaluate different birth settings by comparing neonatal mortality, morbidity and rates of birth interventions between planned home and planned hospital births in Ontario, Canada. METHODS We used a provincial database of all midwifery-booked pregnancies between 2006 and 2009 to compare women who planned home birth at the onset of labour to a matched cohort of women with low-risk pregnancies who had planned hospital births attended by midwives. We conducted subgroup analyses by parity. Our primary outcome was stillbirth, neonatal death (< 28 d) or serious morbidity (Apgar score < 4 at 5 min or resuscitation with positive pressure ventilation and cardiac compressions). RESULTS We compared 11 493 planned home births and 11 493 planned hospital births. The risk of our primary outcome did not differ significantly by planned place of birth (relative risk [RR] 1.03, 95% confidence interval [CI] 0.68-1.55). These findings held true for both nulliparous (RR 1.04, 95% CI 0.62-1.73) and multiparous women (RR 1.00, 95% CI 0.49-2.05). All intrapartum interventions were lower among planned home births. INTERPRETATION Compared with planned hospital birth, planned home birth attended by midwives in a jurisdiction where home birth is well-integrated into the health care system was not associated with a difference in serious adverse neonatal outcomes but was associated with fewer intrapartum interventions.
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Affiliation(s)
- Eileen K Hutton
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
| | - Adriana Cappelletti
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Angela H Reitsma
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Julia Simioni
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Jordyn Horne
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Caroline McGregor
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Rashid J Ahmed
- Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont
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