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Introduction
Current institution
Additional affiliations
August 2019 - December 2019
Education
August 2017 - June 2020
September 2012 - February 2015
September 2007 - May 2011
Publications
Publications (50)
Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determin...
Objective:
Describe long-term breastfeeding initiation trends by prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and race/ethnicity.
Design:
Cross-sectional study of birth certificate data from 2009 to 2017 in 24 states that adopted the 2003 birth certificate revision by 2009.
Participants:...
Background
: In 2010, the Affordable Care Act (ACA) was enacted, with full provisions in effect by 2014, including expanded Medicaid coverage, changes to the marketplace, and contraceptive coverage, but its impact on birth trends are currently unknown, particularly adolescent births.
Objectives
: We sought to determine whether ACA implementation w...
Objectives
To describe long-term breastfeeding initiation trends by prenatal WIC participation and race/ethnicity among low-income women in the U.S.
Methods
We used birth certificate data (2009–2017) for 24 states that adopted the 2003 birth certificate revision by 2009. The analytic sample included term births with hospital costs covered by Medic...
Objective: To examine psychological symptoms (symptoms of depression, anger, anxiety) as potential mediators between discrimination and health outcomes among South Asian Americans. We hypothesized that psychological symptoms would be significant mediators in the pathways between discrimination and health.
Research design and methods: The Mediator...
Background
Low birthweight is associated with increased risk of neonatal mortality and adverse outcomes among survivors. As maternal sociodemographic factors do not explain all of the risk in low birthweight, exploring exposures occurring during critical periods, such as maternal food insecurity, should be considered from a life course perspective....
Objective: Suicide is the second leading cause of death in youth and is of public health importance. Characteristics and precipitating circumstances may differ by adolescent age groups. Understanding these differences may inform prevention efforts that are population-specific. Therefore, we sought to compare suicides between younger and older adole...
Background:
Several studies have examined the association between IPI and birth outcomes, but few have explored the association between interpregnancy interval (IPI) and postnatal outcomes.
Objective:
We examined the association between IPI and injury-related infant mortality, a leading cause of postneonatal mortality.
Methods:
We used 2011-20...
Background:
Severe maternal morbidity continues to be on the rise in the US. Short birth spacing is a modifiable risk factor associated with maternal morbidity, yet few studies have examined this association, possibly due to few available data sources to examine these rare events.
Objective:
To examine the association between interpregnancy inte...
Objective:
The objective is to provide guidelines for the use of antenatal magnesium sulphate for fetal neuroprotection of the preterm infant.
Options:
Antenatal magnesium sulphate administration should be considered for fetal neuroprotection when women present at ≤33 + 6 weeks with imminent preterm birth, defined as a high likelihood of birth b...
Objectif:
Fournir des directives sur l'administration prénatale de sulfate de magnésium visant à offrir une neuroprotection aux enfants prématurés.
Options:
L'administration prénatale de sulfate de magnésium aux fins de neuroprotection fœtale devrait être envisagée chez les femmes enceintes de 33+6 semaines ou moins étant sur le point d'accouche...
Background
Numerous studies use birth certificate data to examine the association between interpregnancy interval (IPI) and maternal and perinatal health outcomes. Substantive changes from the latest birth certificate revision have implications for examining this relationship.
Methods
We provide an overview of the National Vital Statistics System...
Background
Evidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32–34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (KT) strategy for this practice. Methods
The KT strategy includ...
Objective
Magnesium sulphate is recommended by international guidelines to prevent eclampsia among women with pre-eclampsia, especially when it is severe, but fewer than 70% of such women receive magnesium sulphate. We aimed to identify variables that prompt Canadian physicians to administer magnesium sulphate to women with pre-eclampsia.
Methods...
Table A. Definitions of adverse conditions and severe complications of pre-eclampsia in relevant SOGC guidelines.
Table B. Details of serious maternal complications according to severity of pre-eclampsia (SOGC definition) and use of magnesium sulphate or not.
Table C. Sensitivity analyses of determinants included in the final model for magnesium su...
CPN dataset for analysis.
(CSV)
Background:
The hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The ability to predict these complications using simple tests could aid in management and improve outcomes. We aimed to systematically review studies that reported on potential predictors of adverse maternal outcomes among wom...
Background
The efficacy of antenatal corticosteroid treatment for women with threatened preterm birth depends on timely administration within 7 days before delivery. We modelled the probability of delivery within 7 days of admission to hospital among women presenting with threatened preterm birth, using routinely collected clinical characteristics....
Objectives:
To compare the Multistix 10SG/visual-read with two automated methods (Multistix 10SG/Clinitek 50 and Chemstrip 10A/Urisys 1100) to detect significant proteinuria among high-risk pregnant women.
Study design:
Prospective cohort study at British Columbia Women's Hospital & Health Centre, Vancouver, Canada.
Main outcome measures:
Diag...
Background
Few studies have examined fetal, infant and maternal mortality and morbidity among pregnant women at very early gestation with an open cervix and prolapsed membranes. We carried out a study describing the outcomes of women hospitalized with prolapsed membranes at 22–28 weeks’ gestation.
Methods
We prospectively recruited women with sing...
Neonatal mortality and perinatal outcomes among NICU admitted infants of women with prolapsed membranes at 22–25 vs 26–28 weeks gestation (singleton pregnancies without congenital anomalies).
(DOCX)
Background:
Exclusive breastfeeding is strongly recommended by the World Health Organization. Given the low rate of exclusive breastfeeding in Canada and the increasing reports of a history of adverse childhood experiences, this study sought to investigate the association between a history of adverse childhood experiences and breastfeeding initiat...
Objectives
To compare the Multistix 10SG/visual-read with two automated methods (Multistix 10SG/Clinitek50 and Chemstrip 10A/Urisys1100) to detect significant proteinuria among high-risk pregnant women.
Study design
Prospective cohort study at British Columbia Women’s Hospital & Health Centre, Vancouver, Canada.
Main outcome measures
Diagnostic a...
Background
Administration of magnesium sulphate (MgSO4) to women with imminent preterm birth at <34 weeks is an evidence-based antenatal neuroprotective strategy to prevent cerebral palsy. Although a Society of Obstetricians and Gynaecologists of Canada (SOGC) national guideline with practice recommendations based on relevant clinical evidence exis...
Background:
Magnesium sulphate (MgSO4) has been recommended for fetal neuroprotection to prevent cerebral palsy, with national societies adopting new guidelines for its use. A knowledge translation project to implement Canadian guidelines is ongoing. Discussion about MgSO4 for fetal neuroprotection could not occur distinct from MgSO4 for eclampsia...
Introduction: Antenatal corticosteroid treatment is the standard of care to prevent serious neonatal morbidity among women with threatened preterm labour. However, there are increasing concerns about the sequelae of corticosteroid treatment, particularly among infants delivered at term. As the efficacy of antenatal corticosteroid treatment is optim...
Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks’ gestation.
Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 w...
Objective:
To examine the potential effects of intravenous magnesium sulphate (MgSO4) administration on antepartum and intrapartum fetal heart rate (FHR) parameters measured by cardiotocography (CTG) or electronic fetal monitoring (EFM).
Methods:
We undertook a systematic review of randomized controlled trials, observational studies, and case se...
Objectives: Although routine use of prophylactic MgSO4 is recommended for all women with pre-eclampsia, MgSO4 is underutilized. We explored the causal variables that explain MgSO4 use in women with severe or non-severe pre-eclampsia following admission to Canadian tertiary perinatal centers at <29 weeks.
Methods: Data were used from the Canadian P...
Pre-eclampsia definitions beyond gestational hypertension (GH) plus proteinuria remain controversial. Four international clinical practice guidelines (CPGs) allow pre-eclampsia to be defined by adverse conditions [maternal symptoms/signs/abnormal lab tests/fetal signs]. For women with GH admitted to tertiary perinatal centers of the Canadian Perina...
Objectives: Gestational hypertension (GH) with onset at <34 weeks (compared with later onset) is associated with poorer maternal and perinatal outcomes. For women with GH without proteinuria admitted to tertiary perinatal centers of the Canadian Perinatal Network at <29 weeks (2005–11), we describe the natural history of the GH and whether or not m...
Objectives: Proteinuria assessment is key in management of many clinical conditions in adults and children. Previously, we demonstrated false positive proteinuria measurements, and falsely elevated protein:creatinine ratio (PrCr) results in dilute urine using a pyrocatechol violet red-based assay. Thus, we sought to compare random urine PrCr result...
Objectives: Dipstick urinalysis is widely used for screening of proteinuria in pregnancy. Conflicting results have been reported for diagnostic accuracy between visual and automated methods. We compared semi-quantitative visual and automated dipstick methods with protein:creatinine ratio (PrCr, ⩾30 mg/mmol defined as elevated) in high risk pregnanc...
Objective: To compare the diagnostic test properties of automated and visually read urine dipstick screening for detection of a random protein:creatinine ratio (PrCr) ≥ 30mg/mmol.
Methods: Urine samples were collected prospectively from 160 women attending high-risk maternity clinics at a tertiary care facility. Samples were divided into two aliquo...
Objective:
To review systematically the magnesium sulphate (MgSO4) dosing regimens tested in low and middle income countries (LMICs) for women with preeclampsia (prevention) and/or eclampsia (treatment).
Data sources:
We searched Medline, EMBASE, IPA, CINAHL, CDSR, and CENTRAL databases for relevant English language publications.
Study selectio...
For clinicians, it is important to rely on accurate laboratory results for patient care and optimal use of health care resources. We sought to explore our observations that urine protein:creatinine ratios (PrCr) >=30 mg/mmol are seen not infrequently associated with normal pregnancy outcome.
Urine samples were collected prospectively from 160 pregn...
We evaluated the frequency of measurable albuminuria (⩾6.00mg/L) for albumin:creatinine ratios (ACr) among 160 consecutive women attending high-risk clinics. Of last urine samples before delivery, 76 had measurable albuminuria and 41/76 (53.9%) had ACr ⩾2mg/mmol of which 7.3% had normal pregnancy outcome. 84 samples had albuminuria <6.00mg/L and 43...
The visual urinary test strip is widely accepted for screening for proteinuria in pregnancy, given the convenience of the method and its low cost. However, test strips are known to lack sensitivity and specificity. The 2010 NICE (National Institute for Health and Clinical Excellence) guidelines for management of pregnancy hypertension have recommen...
The albumin:creatinine ratio (ACr) is the newest of available methods of proteinuria assessment in pregnancy. Published cut-offs for detection of ⩾0.3g/d proteinuria vary from 2mg/mmol to 8mg/mmol. Up to 20% of women have an elevated ACr in pregnancy but normal outcome. In addition, it is our impression that the urine albumin component of the ACr i...
Proteinuria assessment is important in pregnancy, particularly in determining whether or not a woman has pre-eclampsia. The random protein to creatinine ratio (PrCr) has been recommended as a confirmatory test for dipstick proteinuria in pregnancy, defined as random PrCr ⩾30mg/mmol. However, it has been our clinical impression that women with norma...
