Pregnancy

Lawrence S. Bloomberg Faculty of Nursing

Leslie Dan Faculty of Pharmacy

We know that a person’s health during pregnancy impacts their child’s developmental trajectories, but what about parental health before conception?

A new study led by Cindy-Lee Dennis, a senior scientist at the Lunenfeld-Tanenbaum Research Institute at Sinai Healthand a professor in the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, found that a significant number of Canadian women have poor preconception health or interconception health, which refers to the period between two pregnancies.

Cindy-Lee Dennis

“What happens in utero can have a significant impact on a child’s health and well-being that continues into adulthood,” says Dennis, lead author of the study published in BMJ Family Medicine and Community Health. “There is now a growing body of evidence that suggests the health of parents prior to pregnancy is an important predictor of the long-term health of the child.”

Researchers surveyed 1,080 participants about a range of medical, behavioural and social risk factors. Fifty-five per cent of respondents reported risks in only one of 12 risk factor categories, most often related to reproductive health. Participants reported on average four risks each, with common factors including high body mass index, poor nutrition, low physical activity and poor mental health.

The study found that those with four or more risk factors were more likely to have a lower level of education or be born outside of Canada. For Dennis and her team, this signifies that there is a great opportunity to to improve preconception health through a public health and primary care response that targets these populations.

Of women surveyed in the current study, Dennis points out that more than 44 per cent were classified as having a BMI greater than 30, which would categorize them as obese according to World Health Organization criteria. Women who have a BMI greater than 25 are not only at risk for more severe pregnancy complications, she says, but meta-analytic data suggests it is also a significant risk factor for childhood obesity.

“These are considerable intergenerational health risks that we should not be ignoring,” says Dennis. “Today, preconception care is not readily delivered by health-care providers because most women do not seek care until they are well into their first trimester.”

In Ontario, the current standard of practice is for public health to provide preconception health care. A screening tool to identify a patient’s preconception health risks is available for physicians. However, there is a significant need to address preconception health risks with a more targeted approach, Dennis says.

“The good news,” Dennis says, “is that most of the common preconception risk factors identified in our study are modifiable and there is an opportunity for greater public awareness campaigns to educate individuals in their reproductive years about how these health behaviours can place not only parents but their future children at risk.”

Therefore, Dennis says policymakers must consider family-level interventions that focus on improving health behaviours such as adopting a healthy diet and becoming more physically active in addition to supporting positive mental health and reducing alcohol or cannabis use.

“Children mimic the behaviours of their parents,” she says. “Setting up parents to consider their own health before conception or just leading healthier lives will go a long way in changing the future health of generations to come.”

This study is part of The Healthy Life Trajectories Initiative (HeLTI) that was developed in partnership with funders from Canada, India, China and South Africa and in collaboration with the World Health Organization to address the increasing burden of non-communicable diseases – including obesity, diabetes, cardiovascular disease and poor mental health – around the world. There are four separate but harmonized randomized controlled trials being implemented in Soweto, Mysore, Shanghai and across Canada. All studies are focused on developing evidence-based interventions spanning preconception, pregnancy and the postnatal and early childhood periods, with the goal of improving parental and infant health – and ultimately the life-long well-being of the child.

Researcher focuses on essential, but often-ignored, organ in pregnancy

Christopher.Sorensen — Thu, 26 May 2022 18:29:23 +0000

Researcher focuses on essential, but often-ignored, organ in pregnancy

Christopher.Sorensen Thu, 05/26/2022 - 14:29

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(photo by JGI/Getty Images)

Topic

Dalla Lana School of Public Health

The placenta is an essential organ for the developing fetus, both protecting the fetus from potentially harmful components in the blood and transferring nutrients needed for growth and development. But it remains largely a mystery.

“For a long time, the placenta was ignored because it was seen only as a temporary organ, and that’s been to our detriment,” says Eliza McColl, a PhD student in the lab of Professor Micheline Piquette-Miller in U of T’s Leslie Dan Faculty of Pharmacy. “As much as we can describe changes that occur in the placenta and hypothesize about the effects they might have, we can’t really understand what those changes could mean if we don’t have a detailed understanding of the placenta’s baseline function.”

This lack of knowledge about the placenta is one of the major gaps in studying the health of pregnant people. Piquette-Miller and her team are helping to fill this knowledge gap. They are studying how the placenta functions by examining transport proteins that regulate how nutrients, drugs and other molecules cross the placenta to the fetus. Much of her research has focused on whether infection and inflammation during pregnancy alter these transporters, which may ultimately change a fetus’s exposure to these substances.

For example, if a pregnant parent takes a drug considered safe in pregnancy but then experiences a viral infection or inflammatory condition such as preeclampsia, the expression of drug transporters in the placenta may change and alter the safety or efficacy of the drug. The research adds far more nuance to the discussion of what is safe and unsafe in pregnancy.

Piquette-Miller’s team has also contributed to a relatively new body of work suggesting that while the placenta itself is temporary, changes to it may lead to lifelong effects on offspring, including neurodevelopmental or metabolic disorders.

During McColl’s PhD research, she focused on transporters that allow amino acids essential for the fetus’s developing brain to cross the placenta – specifically whether infection or inflammation change the expression of these amino acid transporters and whether these changes are related to neurodevelopmental disorders in the offspring.

Using animal models, she found that amino acid transporters decreased after infection and that the offspring had altered levels of amino acids in the brain, and she identified that the cell signaling pathways that regulate these transporters are altered by infection. The results, which McColl is presenting at the American Society for Reproductive Immunology conference this week in Nashville, are the first step in understanding whether these changes could be targeted by therapeutics to reverse the nutrient deficits in the offspring.

“It's an interesting field of research that goes beyond describing the bare minimum of understanding the placenta, which is all that we’ve had for so long,” says McColl. “This is particularly important knowing that changes that occur in the placenta can actually impact the fetus after birth and throughout life.”

The COVID-19 pandemic has highlighted another key gap in pharmaceutical research: women and pregnant people have often been excluded from clinical trials and medical research. If conditions present differently between the sexes, diagnoses or differences in drug side effects or efficacy in understudied groups could be missed. And many drugs have not been tested for use during pregnancy at all.

“We can’t effectively treat or properly care for people if we don’t have the data about how they respond to medications or how they present with different conditions or diseases,” says McColl. “It’s definitely a risk to include pregnant people in clinical trials, but we also have to give people the tools they need to make decisions about their own health.”

In the case of the COVID-19 vaccine, pregnant people were excluded from many clinical trials, but they were allowed to decide for themselves whether to get the vaccine after it was approved. Many did choose to receive the vaccine, which provided the data to show that the vaccine is safe and effective in pregnancy – as reflected in current vaccine guidelines.

“I hope that the COVID-19 vaccine has been a turning point in showing the value of letting pregnant people exert agency and volunteering to receive drugs or vaccines in trials because that is currently a huge gap in the research,” says McColl.

First Exposure initiative provides critical resources for maternal, reproductive and child health in Ontario

Christopher.Sorensen — Thu, 19 May 2022 16:53:50 +0000

First Exposure initiative provides critical resources for maternal, reproductive and child health in Ontario

Christopher.Sorensen Thu, 05/19/2022 - 12:53

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A new information hub and research network at the Dalla Lana School of Public Health will fill crucial gaps in health care for mothers and infants (photo by Art_Photo/Shutterstock)

Topic

Meric Gertler

The University of Toronto’s Dalla Lana School of Public Health is launching a groundbreaking network dedicated to maternal, reproductive and early child health.

Supported by a $5-million investment from the Vohra Miller Foundation, First Exposure will support research, education and knowledge generation, as well as synthesis and translation activities – helping parents, children and their families.

First Exposure will remove barriers to access and provide parents with crucial health information. It will focus in particular on fetal, neonatal and infantile exposures to various medications, non-medicinal substances, maternal diseases, the rapidly changing ecosystem in our environment and the social determinants of health.

“First Exposure will draw from U of T’s world-leading expertise in public health to improve the health of parents, infants and children across Canada, especially those in marginalized, vulnerable and underserved populations,” says U of T President Meric Gertler. “On behalf of the University of Toronto, I would like to thank Sabina Vohra-Miller, Craig Miller, and the Vohra Miller Foundation for their vision, leadership and generosity in making this very hopeful initiative possible.”

As an information hub, First Exposure will provide easy-to-access and up-to-date information for families and health-care providers – with a focus on underserved and remote communities. It will also collect and provide secure, anonymous patient data to scientists who can translate research, fill relevant knowledge gaps and improve timely decision-making abilities for parents, health practitioners and the public health and health-care systems.

As an academic research network, First Exposure will support trainees in maternal health, reproductive health and early-life exposure research, and provide support to researchers undertaking important new studies and projects. It will also drive partnerships and innovations across U of T, the Toronto Academic Health Science Network, Black and Indigenous health organizations, as well as industry, hospital and government partners – all with a view to supporting communities in raising healthy, thriving children.

“We’ve long known that positive long-term health outcomes are influenced by maternal health – and throughout the very first months of life,” says Adalsteinn Brown, dean of the Dalla Lana School of Public Health. “The Vohra Miller Foundation recognized the expertise and capacity at the Dalla Lana School of Public Health to make a real difference and, with this visionary investment, will help our researchers and clinicians strengthen maternal, reproductive and child health for Canadians.

“First Exposure is an innovative new resource that will have a tremendous impact on both the short- and long-term health of Canadians. On behalf of the Dalla Lana School, and the thousands of beneficiaries of this investment, our deepest thanks to Sabina and Craig, and the Vohra Miller Foundation, for its leadership.”

Vohra-Miller, who holds two U of T degrees, and her husband Craig co-founded the Vohra Miller Foundation in January 2020 with a philanthropic mission to improve the health of people and the planet. Shortly thereafter, the world was plunged into a global pandemic and the Vohra Miller Foundation responded by helping establish U of T’s Institute for Pandemics with a $1-million investment. This was followed the next year by its $5-million investment in First Exposure.

Vohra-Miller has a background in clinical pharmacology and runs a popular science blog.

“Our goal has always been to strengthen the planet and its people,” she says. “First Exposure will equip families and health providers with evidence-based information about the risks and impacts of early-life exposure to medications, environmental pollutants and other substances during pregnancy and lactation. We’re proud to have partnered with U of T for this important new initiative.”

The investment from the Vohra Miller Foundation also funds a range of scholarships and fellowships, as well as research, engagement, resource and outreach activities that will build long-term health and resilience for generations of families. Through strategic knowledge translation, synthesis and generation, First Exposure will build on its own outreach and research successes, growing over the years to become a key resource for maternal health in Canada.

“The Vohra Miller Foundation continues to take its place as a powerful and positive force for social impact and public health,” says David Palmer, U of T’s vice-president, advancement. “As an entrepreneurial and philanthropic leader, the foundation is making a huge difference for the health and resilience of generations of families. Their current investment represents a long-term vision for healthy children and families – and a stronger health-care system for people in vulnerable and marginalized communities, which in turn builds a stronger society for everyone.”

Iron deficiency affects half of pregnancies, yet many women aren’t screened: U of T study

Christopher.Sorensen — Tue, 31 Aug 2021 18:33:00 +0000

Iron deficiency affects half of pregnancies, yet many women aren’t screened: U of T study

Christopher.Sorensen Tue, 08/31/2021 - 14:33

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(Photo by PeopleImages via Getty Images)

Leah Enser

Topic

Temerty Faculty of Medicine

Temerty Faculty of Medicine

One in two women in Ontario have low iron levels during pregnancy, but more than one-third of pregnant women are not tested for iron deficiency, University of Toronto researchers have found.

The researchers said the findings underscore the need to revisit clinical guidelines to ensure that testing for ferritin, a blood protein that stores iron and provides a standard measure of iron deficiency, is a routine part of maternal care and pregnancy health screenings.

Jennifer Teichman

“Despite the very high prevalence of iron deficiency in pregnancy, and how easy it is to treat, we are not doing a very good job of checking for it,” said Jennifer Teichman, lead author on the study and a hematology resident in the department of medicine at U of T’s Temerty Faculty of Medicine. “It’s not top of mind, in part, because of inconsistent recommendations for ferritin testing across clinical guidelines.”

The results were published in the journal Blood Advances.

The study included 44,552 pregnant women who received prenatal testing at community laboratories in Ontario between 2013 and 2018. The researchers also found that one in four women had severe iron deficiency, and that women of lower socio-economic status were less likely to get tested.

Iron deficiency is the most common cause of anemia during pregnancy and iron deficiency anemia has been linked to poorer outcomes for both mother and baby, including a higher risk of premature delivery, low birth weight and post-partum depression.

Anemia early in pregnancy has also been associated with neurodevelopmental delays in offspring – even as the child approaches school age and beyond – which points to potentially long-lasting effects.

Low levels of iron can also cause fatigue, weakness and brain fog during pregnancy.

Almost three-quarters of ferritin testing in the study occurred at or near the first prenatal visit, when risk of iron deficiency is lowest. Patients’ iron levels were often checked only once during their pregnancy.

“Iron deficiency becomes more common as women progress through pregnancy,” said Teichman. “If we don’t re-evaluate iron stores later in pregnancy, we miss a lot of women who are becoming iron deficient in later trimesters.”

Teichman emphasized that the women in the study received care in Canada’s publicly funded health-care system, which means patients didn’t incur the cost of ferritin testing.

Yet, the researchers found that women of lower socio-economic status were still less likely to be tested for iron deficiency, which further underscores differences in access to care and how clinicians may treat patients differently.

Most tests were ordered by general practitioners (48 per cent) and obstetricians/gynecologists (32 per cent).

Teichman urged pregnant women – and those who plan to become pregnant – to ask about their iron levels before and during their pregnancy.

“Iron deficiency is very common, and there can be poor outcomes for both mom and baby if it isn’t identified and treated,” she said. “The good news is that it’s easily found with a simple blood test and completely correctable with iron supplements.”

She is quick to caution that standard prenatal vitamins by themselves cannot treat iron deficiency.

“Prenatal vitamins contain only a sprinkling of iron and many combine iron with calcium, which can inhibit the absorption of iron,” Teichman said. “The way to address the problem is by identifying iron deficiency early on and then supplementing women with therapeutic doses of iron, which has 10 times the amount found in most prenatal vitamins.”

Pregnancy and mental health: U of T expert offers tips, resources during COVID-19

Christopher.Sorensen — Mon, 17 May 2021 16:36:39 +0000

Pregnancy and mental health: U of T expert offers tips, resources during COVID-19

Christopher.Sorensen Mon, 05/17/2021 - 12:36

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(photo by Dann Tardif/Getty Images)

Blake Eligh

Topic

Our Community

Mental Health

Mount Sinai Hospital

An estimated 15 to 20 per cent of expectant and new mothers experience mental health issues such as anxiety or postpartum depression – and the global pandemic has only served to heighten stress.

That’s according to Ariel Dalfen, a perinatal mental health expert and assistant professor in the University of Toronto department psychiatry in the Temerty Faculty of Medicine. Over the past 12 years, Dalfen headed the perinatal mental health program and telemedicine program at Mount Sinai Hospital. With the largest program of its kind in Canada, the hospital provides assessment and treatment to women through pregnancy planning, pregnancy and up to a year postpartum.

Dalfen recently stepped down from her role at the hospital, but she continues her psychiatric practice with the program and her advocacy for mental health and access to perinatal mental health care.

She recently spoke with writer Blake Eligh about supports for expectant and new mothers and offered tips to manage the stress and isolation of a pandemic pregnancy.

The COVID-19 pandemic has been stressful for everyone. What are expectant and new parents dealing with right now?

This situation hits people in so many ways. In the spring, intensive care units experienced a wave of pregnant patients with severe COVID-19 symptoms. People are extremely anxious and nervous about the new variants. They’re not going out because they’re worried about getting COVID-19. We also see people coping with severe illness or the loss of loved ones.

Many pulled their other children from school or daycare, which adds to everyday challenges like trying to work from home. A recent study in The Lancet highlighted job losses and income among the biggest stressors for parents right now.

How do these stressors impact perinatal mental health?

The pandemic has added extra stress, with huge implications for women. They may be cut off from in-person visits with family or community support workers who come to their homes, or be unable to attend support groups for new mothers. New moms rely on these supports and may experience increased physical, logistical and emotional burdens as a result.

We also see more sadness or anxiety. This could lead to a worsening of existing mental health issues or a recurrence of previous mental health problems. For some, we see an increase in problematic ways of coping such as increased substance abuse or disordered eating.

When do common worries cross over into something that might require mental health supports? Are there signs to watch for?

People may notice they can't turn off their mind or they aren’t sleeping. When health and well-being are significantly impacted, it’s important to reach out for help, because it could be more than just normal anxiety.

What’s the first step in seeking support?

Just speaking about it is an important first step. People often find when they start to speak out, they find that others are in the same boat and struggling, too.

Family doctors are often a good point of contact to get an initial assessment and can help provide a connection to a therapist or a referral to see a psychiatrist. Other care team members, such as an obstetrician or midwife, can also help women connect with social workers, mental health care providers and therapists.

What supports are available when it’s safer to be apart?

Our population has traditionally had a lot of barriers to in-person care. Specialized perinatal mental health services are concentrated in downtown Toronto, so factors like traffic, parking fees, getting time off work or having to find childcare can make it hard for people to get to in-person appointments even if they live in the Greater Toronto Area. Access can also be complicated by medical or mobility considerations related to pregnancy.

Through Mount Sinai’s perinatal mental health telemedicine program, we offer specialized care to women across the province so they can get help when and where they need it. Since the world shut down in March 2020, we’ve been able to continue to offer timely individual care to people in the comfort of their own environments through telemedicine and to expand the program to include group care, as well.

There are many other good online resources, like the Pandemic Pregnancy Guide on Instagram, Mind Beacon, AbilitiCBT and COVID-19 mental health information from the Centre for Addiction and Mental Health.

What can women do to manage their own stress right now?

First, it’s normal to feel stress because the world feels like a stressful place. Pretending it doesn’t exist won’t make it go away, so it’s important to acknowledge and validate that anxiety.

Turn off the news or social media so you’re not continuously bombarded by COVID-19 news. I know that's easier said than done, but it is so helpful.

Find time to be with people. Whether virtually or safely in person, talking to friends and having time to just laugh and relax can help turn our minds to something else.

I also encourage people to talk to their partners, if they have one, or to family members and friends. It can feel better to know you're not alone – even if there aren't concrete things people can do to help.

What is your advice for women worried about variants, vaccines and going out in public?

First, everyone needs to follow local advice and guidance from public health experts. Then, within those rules, people can determine what they need to do to keep themselves and their families safe. For example, some parents choose to keep their children in daycare services, while others feel it isn’t right for them.

Clinics like the UHN clinic on the St. George campus offer vaccinations to pregnant women. The early data is reassuring, and health-care providers who care for pregnant individuals encourage patients to get vaccinated as soon as possible. This is a reassuring step to reduce COVID illness and transmission.

How can family and friends lend support?

Stigma sometimes makes people nervous to talk about mental health issues, but most of us wouldn’t think twice about telling someone they should get help for a physical injury. It’s important to raise concerns about mental health changes you may notice in others in a clear, caring and supportive way.

Open the door to conversation. Starting with a fact-based observation or question like, “I notice you don’t seem like yourself lately.” Or “How are you sleeping these days?” It can help demonstrate that you care and want to be helpful and supportive.

U of T study highlights health-care barriers women with disabilities face during pregnancy

Christopher.Sorensen — Mon, 08 Feb 2021 19:30:19 +0000

U of T study highlights health-care barriers women with disabilities face during pregnancy

Christopher.Sorensen Mon, 02/08/2021 - 14:30

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A study led by U of T Scarborough researcher Hilary Brown found that women with disabilities are nearly twice as likely to experience life-threatening pregnancy complications or maternal death (photo by Ken Jones)

Don Campbell

Topic

Dalla Lana School of Public Health

Accessibility

Dalla Lana School of Public Health

U of T Scarborough

Women's College Hospital

Women with disabilities are nearly twice as likely to experience life-threatening pregnancy complications or maternal death compared to their peers, a study by University of Toronto researchers has found.

The finding, published recently in the journal JAMA Network Open, is the result of the largest study of maternal outcomes for women with disabilities in Canadian history, highlighting the need for better access to medical care in this population of women.

“We need to make health care more accessible, but this also raises awareness that women with disabilities have a right to quality health care and good pregnancy outcomes,” says lead author Hilary Brown, an assistant professor in the department of health and society at U of T Scarborough and an adjunct scientist at Women’s College Research Institute and Institute for Clinical Evaluative Sciences (ICES).

While life-threatening pregnancy complications and maternal death are relatively rare, Brown says both are on the rise in North America – and that the effect on families is devastating. She notes that pregnancy rates among women with disabilities have also been rising over the past 20 years, and that women with disabilities now account for nearly one in eight births.

“At the same time, health-care guidelines in Canada on how to best provide pregnancy-related care to these women has not improved,” says Brown, who is cross-appointed to the Dalla Lana School of Public Health and Temerty Faculty of Medicine. “Women with disabilities are more likely than their peers to experience social and medical risk factors, but until now rates of life-threatening pregnancy complications or maternal death among this group have been relatively unknown.”

The U of T study looked at Ontario health record data from 222,000 women with physical, sensory and intellectual or developmental disabilities, as well as 1.6 million women without disabilities, who gave birth between 2003-2018. Brown and her colleagues found that life-threatening pregnancy complications or maternal death happened at a higher rate for women with disabilities. Women with multiple disabilities were also at double the risk (3.4 per cent) for negative pregnancy outcomes compared to women without disabilities (1.7 per cent).

They also found there were 14 maternal deaths per 100,000 births among women with disabilities compared to just eight deaths per 100,000 births among women without disabilities.

Brown says social factors faced by women with disabilities – including barriers to employment, education, stable housing and access to health care – as well as medical factors such as a higher incidence of chronic disease can result in negative pregnancy outcomes. But even after accounting for these factors, she says there were still disparities between pregnancy outcomes for women with and without disabilities.

“Pregnancy guidelines specific to the needs of Canadian women with disabilities do not currently exist, and there are few obstetric programs created with the needs of women with disabilities in mind,” says Brown, who is an expert on reproductive, maternal and child health.

She points to a lack of pre-conception programs tailored to meet the needs of women with disabilities and inadequate or non-existent disability-related training for obstetrical health-care providers as examples.

One example of pregnancy-related care developed with accessibility in mind is the Accessible Care Pregnancy Clinic at Toronto’s Sunnybrook Hospital, which is one of the first of its kind in North America.

Brown says it should be a model for more health-care providers.

She also says the findings of the study, which used data from ICES, a non-profit research institute that uses population-based health information to study health care issues, highlights the need to tackle the stigma faced by pregnant women with disabilities.

“Many of the mothers with disabilities that we talk to have faced discriminatory attitudes about their pregnancies, and it needs to change,” she says.

“Society is shifting to better allow women with disabilities to become pregnant and be mothers. It’s time for us to address how disability shapes access to health care and how it interacts with other risk factors like poverty to ensure that these life-threatening pregnancy complications and maternal death rates are reduced.”

The research was supported by the U.S. National Institutes of Health and the Canada Research Chairs program, among others.

U of T students, faculty help expectant parents navigate COVID-19 with Pandemic Pregnancy Guide

Christopher.Sorensen — Wed, 06 May 2020 15:58:30 +0000

U of T students, faculty help expectant parents navigate COVID-19 with Pandemic Pregnancy Guide

Christopher.Sorensen Wed, 05/06/2020 - 11:58

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Created by U of T experts, it's hoped the Pandemic Pregnancy Guide's evidence-based approach will ease the worries of expectant and postpartum parents during COVID-19 (photo by damircudic via Getty Images)

St. Michael's Hospital

Women's College Hospital

Experts from the University of Toronto are helping expectant parents navigate pregnancy and the postpartum period during the COVID-19 pandemic.

Doctors Tali Bogler, Eliane Shore and Sheila Wijayasinghe, as well as medical students Sepand Alavifard and Sarah Freeman, have come together to create the Pandemic Pregnancy Guide (PPG), a virtual hub focused on pregnancy and COVID-19 related information on Instagram.

With less in-person time with maternity care providers, pregnant patients are finding themselves with many unanswered questions, says Bogler, who is a family physician and chair of the family medicine obstetrics program at St. Michael’s Hospital. She hopes that the platform’s multidisciplinary and evidence-based approach will ease the worries of expectant and postpartum parents and empower them with information.

Faculty of Medicine writer Ciara Parsons recently spoke with Bogler, a lecturer in the department of family and community medicine, about why the team was motivated to create the Pandemic Pregnancy Guide, how the pandemic has impacted expecting parents, and the type of content the team has planned for the future.

What was the motive behind creating the Pandemic Pregnancy Guide?

As COVID-19 began to surface, I realized there was an obvious need in my practice to answer questions about how the pandemic may affect pregnancies, especially because I care for a lot of expectant parents in my family practice obstetrics practice.

Expecting parents can feel overwhelmed during normal circumstances, especially first-time parents – but with the added stress of the COVID-19 pandemic and all the uncertainties that come with it, these individuals are all feeling a lot more anxiety.

Our group decided to create the Pregnancy Pandemic Guide because COVID-19 has led to expectant parents having fewer one-on-one sessions with their maternity-care providers, and an increase in virtual care appointments. There’s also been the cancellation of in-person supports like prenatal classes, hospital tours and breastfeeding classes. We wanted to make sure that patients seeking information had a place to go where they could learn more.

The Pandemic Pregnancy Guide uses social media, specifically Instagram, to operate as a virtual hub of information about pregnancy, and a place where people can ask questions. It’s kind of like a virtual prenatal class, but with a focus on COVID-19 and pregnancy.

The team behind the Pandemic Pregnancy Guide. From left to right: Sheila Wijayasinghe, Sepand Alavifard, Tali Bogler, Sarah Freeman and Eliane Shore.

What types of care are being converted to virtual care?

We are limiting in-person appointments to keep patients and their families safe. For example, for low-risk pregnancies, we’re trying to have every other appointment completed by virtual care, either by phone or video call.

During these virtual appointments, we ask about things like the baby’s movements, which is a great way to assess fetal viability, or if the patient has signs or symptoms of high blood pressure. Additionally, we might ask about the parent’s weight, blood pressure and if they can measure the size of their growing uterus from home.

How do you choose what information you’ll include on your social media accounts?

We create content based on the types of questions we are hearing from our patients and Instagram followers. The content is also based around current emerging research related to pregnancy and COVID-19 and includes Q&A interviews with experts from different specialties. For instance, Dr. Wijayasinghe recently interviewed Dr. Mark Yudin, an obstetrician who specializes in infectious disease and pregnancy.

We have also had interviews with our pediatrician, midwifery and pelvic floor physiotherapist colleagues, as well as prenatal mindfulness movement classes with a doula and yoga instructor. In the future, we plan to include insights from lactation consultants, psychiatry and social workers in our upcoming Q&A interviews.

Do you think that having resources like this helps to fight misinformation about pregnancy during the COVID-19 pandemic?

There is so much misinformation out there about COVID-19 and how it may affect pregnancies. With so many different articles and resources available, expectant parents don’t know which resources to trust or where to turn for guidance. It can be overwhelming to try and sift through the information to determine what is legitimate.

From the feedback we’ve received on our social media page and from our patients in the clinic, it seems that our audience is thankful to have a fact-checked, evidence-based information source to turn to. We spend a lot of time curating our content before we post anything to make sure it is as up-to-date and accurate as possible.

What are some of the biggest impacts or disruptions pregnant patients may face during this pandemic?

Patients are being impacted by COVID-19 at all stages of their fertility journey, including pregnancy-planning, pregnancy and postpartum period. Many hospitals and clinics are restricting partners from attending ultrasounds and routine visits, which is typically an exciting time for patients and their families. Limitations around support persons during labour are a huge concern for many expectant parents, as many sites have restrictions in place limiting visitors (primarily only one support person if labouring individual and partner screen negative for COVID-19) to optimize patient and provider safety.

As physicians and health-care providers, all we can do at this time is provide the best care we can under these exceptional circumstances and make the process feel as supportive as possible for patients.

The perinatal time is one that often builds community for individuals. During the pandemic, many have voiced that they feel isolated. Beyond the medical information we are sharing, we hope that this virtual platform will also allow for a sense of community and sharing of stories to help people feel less alone during this incredibly important time in their lives.

More studies needed on use of acetaminophen prior to pregnancy, U of T researchers say

Christopher.Sorensen — Mon, 27 Jan 2020 15:52:36 +0000

More studies needed on use of acetaminophen prior to pregnancy, U of T researchers say

Christopher.Sorensen Mon, 01/27/2020 - 10:52

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A U of T study found an 82 per cent higher risk of having a baby born small for its gestational age among women who took acetaminophen more than once per week in the three months before pregnancy (photo by damircudic via Getty Images)

Françoise Makanda

Topic

Our Community

Mount Sinai Hospital

Using the popular painkiller acetaminophen just before pregnancy could lead to babies born smaller than usual for their gestational age or with a lower birth weight, a new study by University of Toronto researchers suggests.

The researchers’ findings, published recently in the journal Pediatric Research, could potentially have implications for women who are trying to get pregnant.

“Nobody has examined acetaminophen use in the three months prior to pregnancy before,” says Jasleen Arneja, the study’s lead author and a researcher at the Dalla Lana School of Public Health.

“We found that the more frequently a woman was taking acetaminophen in the three months prior to pregnancy, the greater her risk was of having a baby born small for gestational age or with low birth weight.”

Acetaminophen, the active ingredient in well-known brands like Tylenol, is the only physician-recommended pain medication available to pregnant women to help address inflammation, pain and fever. But some recent studies have found an association between acetaminophen-use during pregnancy and neurological disorders including cerebral palsy, ADHD and other behavioural problems.

Arneja says that systematic reviews have so far found these relationships inconclusive, and that her recent study’s results requires additional research as well.

“We cannot say conclusively that there’s a causal relationship,” she says. “It’s important not to overstate the study’s results because we don’t want to burden pregnant women or those planning for pregnancy.

“However, we do think that clinicians who are taking care of women who are planning to get pregnant should take the study into consideration.”

Jasleen Arneja, a researcher at U of T’s Dalla Lana School of Health, says that her study should be taken into account by clinicians even if it does not conclusively prove a causal relationship between acetaminophen use prior to pregnancy and babies born small for their gestational age or with low birth weight (photo by Françoise Makanda)

The authors, who included Assistant Professor Jennifer Brooks and Associate Professor Rayjean Hung, used data from 1,200 women participating in the Ontario Birth Study at Mount Sinai Hospital. They examined three outcomes: pre-term birth, low birth weight and small-for-gestational-age. Current medical literature suggests that these birth outcomes are linked to an increased risk of various neurodevelopmental disorders in early childhood.

Women who took acetaminophen more than once a week in the three months before pregnancy had an 82 per cent higher risk of having a baby born small for gestational age and approximately two-fold risk of the baby having low birth weight, compared to women who never took the drug. Moreover, even women who took acetaminophen less than once a week in the three months before pregnancy had a 46 per cent higher risk of having a baby born small for gestational age, compared to women who never took it.

About 60 per cent of the cohort reported using acetaminophen at any point during the study period, according to Arneja.

Research to assess childhood developmental health outcomes in the Ontario Birth Study is still ongoing.

The U of T researchers were supported by the Canadian Institutes of Health Research, among others.

Women with chronic physical conditions more likely to experience mental illness in pregnancy: U of T study

noreen.rasbach — Mon, 26 Aug 2019 14:01:35 +0000

Women with chronic physical conditions more likely to experience mental illness in pregnancy: U of T study

noreen.rasbach Mon, 08/26/2019 - 10:01

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“It’s important to look at pregnancy because chronic disease isn’t commonly a factor that physicians use to screen for perinatal mental illness risk,” says U of T Scarborough's Hilary Brown (photo by Ken Jones)

Don Campbell

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Interdisciplinary Centre for Health & Society

Mental Health

U of T Scarborough

A new study led by a University of Toronto researcher has found that women with chronic physical conditions are more likely to experience mental illness during pregnancy or shortly after giving birth.

“Women with a chronic physical condition like diabetes, hypertension and asthma may benefit from targeted strategies to reduce their risk of mental illness,” says Hilary Brown, an assistant professor at the Interdisciplinary Centre for Health & Society at U of T Scarborough.

Brown and her colleagues used data from ICES, a non-profit research institute where she’s also an adjunct scientist. ICES uses population-based health information to study a broad range of health-care issues.

The study looked at more than 850,000 women in Ontario aged 15 to 49 during their perinatal period, which extends from conception to one year after birth. It found that those with a chronic physical condition (20.4 per cent) were more likely than those without (15.6 per cent) to experience mental illness during pregnancy or postpartum.

The researchers defined a perinatal mental illness as diagnosis of a psychotic disorder, mood or anxiety disorder, substance use disorder or an addiction from conception to one year after giving birth.

Brown, the study's lead author, notes that they looked at any physical condition that lasts more than one year and has an impact on functioning – including diabetes, arthritis, heart disease, hypertension and asthma.

Women with a chronic physical condition may be at an increased risk of mental illness for a number of biological and social reasons, Brown says.

For one, research suggests that a lot of chronic physical conditions are characterized by chronic inflammation, and that mental illness could be triggered by similar biological mechanisms. There’s also the possibility that both could have genetic links.

“The social reasons include the stress of managing a chronic disease, managing pain, fatigue or sleeplessness – these are all things that come with many chronic physical conditions,” she says.

This study builds on previous research that shows chronic physical conditions increase the risk of mental illness in the general population, but this has rarely been studied in pregnant women.

“It’s a real missed opportunity,” says Brown, an expert on reproductive as well as maternal and child health.

“It’s important to look at pregnancy because chronic disease isn’t commonly a factor that physicians use to screen for perinatal mental illness risk.”

The study, which is published in the journal PLOS Medicine, received funding from a Canadian Institutes of Health Research (CIHR) grant.

Brown says the findings highlight the need to better identify and help treat women in this group. She says targeted strategies should include those that help support chronic disease management and improve coping.

While mental illness negatively affects mothers, infants and families, only about one-third of women with perinatal mental illness get the care they need. These women don’t receive care for a variety of reasons, notes Brown.

“There remains a stigma attached to mental illness, there may be transportation and child care challenges for new mothers, not to mention significant systemic barriers as well.

“We have an overstressed health-care system that often lacks resources for women to receive timely diagnosis and care. Identification of high-risk groups, like women with chronic physical conditions, could make the health system more efficient.”

Women with intellectual, developmental challenges have double the rate of rapid, repeat pregnancy: U of T study

noreen.rasbach — Mon, 13 Aug 2018 17:01:51 +0000

Women with intellectual, developmental challenges have double the rate of rapid, repeat pregnancy: U of T study

noreen.rasbach Mon, 08/13/2018 - 13:01

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“This is a cause for concern because rapid, repeat pregnancies are associated with a higher risk of complications, including stillbirth and premature birth,” says lead author Hilary Brown (photo by Ken Jones)

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