Suzanne C Tough

• Doctor of Philosophy
• Professor at University of Calgary

Following up on previous findings from the All Our Families (AOF) cohort, the current study investigated the relationship between birthing parent history of adverse childhood experiences (ACEs) and child atopy, including asthma, allergy, and eczema, at five years of age. Potential indirect effects were explored. Participants completed the ACEs scal...

Previous studies have investigated whether inflammatory cytokines in maternal circulation are associated with preterm birth. However, many have reported inconsistent results, and few have investigated cytokine trends through gestation, particularly with respect to subtypes of preterm birth. We explored levels of 15 inflammatory cytokines and growth...

Background There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health. Objective The aims of this review were to evaluate positive psychological intervent...

Preterm birth (PTB) remains a significant global health challenge and a leading cause of neonatal mortality and morbidity. Despite advancements in neonatal care, the prediction of PTB remains elusive, in part due to complex etiologies and heterogeneous patient populations. This study aimed to validate and extend information on gene expression bioma...

Background The COVID-19 pandemic is associated with increases in child mental health problems, but the persistence of these changes in the post-pandemic era remains uncertain. Additionally, it is unclear whether changes in mental health problems during the pandemic exceed the anticipated increases as children age. This study controls for the linear...

Support has been found for the intergenerational transmission of risk from maternal adverse childhood experiences (ACEs) to child outcomes. Less research has focused on longitudinal psychosocial pathways that account for this transmission. In the current study, path analysis examined mediating pathways (i.e., maternal adult attachment insecurity, r...

Objective Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or...

Despite Canada’s strengths and widespread acknowledgment of the importance of children and youth, this country recently ranked 30th among 38 high-income countries on indicators of their well-being (UNICEF Innocenti 2020). While there are limited data readily available for monitoring within and across jurisdictions, Alberta compares worse than Canad...

Background Pediatric chronic pain (i.e., pain lasting ≥ 3 months) is prevalent, disabling, and costly. It spikes in adolescence, interrupts psychosocial development and functioning, and often co-occurs with mental health problems. Chronic pain often begins spontaneously without prior injuries and/or other disorders. Prospective longitudinal cohort...

Importance The digital phenomenon termed technoference refers to interruptions in routine social interactions due to technology use. Technoference may negatively affect parents’ attention to cues necessary for supporting children’s mental health. Objective To explore whether there are directional prospective associations between perceived parental...

Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37 weeks) and early term (≥ 37 and < 39 weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioura...

Background The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid traini...

Background Maternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine...

Objective: To examine a potential synergistic effect of history of childhood adversity and COVID-19 pandemic exposure on the association with mental health concerns in undergraduate students. Participants: We used U-Flourish Survey data from 2019 (pre-pandemic) and 2020 (during-pandemic) first-year cohorts (n = 3,149) identified at entry to a majo...

While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxie...

Postpartum depression (PPD) symptoms can negatively influence mother-infant interactions. Video-Feedback Interaction Guidance for Improving Interactions Between Depressed Mothers and their Infants (VID-KIDS) is a parenting intervention that allows mothers experiencing PPD symptoms to observe and improve their interactions with their infants. VID-KI...

BACKGROUND There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health. OBJECTIVE The aims of this review were to evaluate positive psychological intervent...

Preterm birth, defined as any birth before 37 weeks of completed gestation, poses adverse health risks to both mothers and infants. Despite preterm birth being associated with several risk factors, its relationship to maternal metabolism remains unclear, especially in first-time mothers. Aims of the present study were to identify maternal metabolic...

Objectives: Prenatal depression is a serious maternal-child health concern. Risk factors and health consequences appear more prevalent in Indigenous communities and ethnic minority groups; however, research on these populations is limited. We examined the following questions: (A) How do pregnant Indigenous women, ethnic minority women, and White w...

Introduction Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth a...

Objective To describe developmental domain-specific trajectories from ages 1 through 5 years and to estimate the association of trajectory group membership with gestational age for children born between ≥34 and <41 weeks gestation. Methods Using data from the All Our Families cohort, trajectories of the domain-specific Ages & Stages Questionnaire...

Background Prospective cohorts may be vulnerable to bias due to attrition. Inverse probability weights have been proposed as a method to help mitigate this bias. The current study used the “All Our Families” longitudinal pregnancy cohort of 3351 maternal-infant pairs and aimed to develop inverse probability weights using logistic regression models...

BACKGROUND The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. OBJECTIVE The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid traini...

Background The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a repre...

Background: Overweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm. Objective: The objective of the study was to assess the association between small for gestational age (S...

Objective: Attempts by governments around the world to mitigate the spread of COVID-19 have substantially altered the early rearing environment, raising concerns about potential negative consequences for babies born during this time. The objective of this study was to determine whether infants born during the COVID-19 pandemic were at greater risk...

Longitudinal changes in maternal depressive and anxiety symptoms and predictors of symptom variation among a group of middle-to-upper income Canadian women (n = 2152) were examined prior to the pandemic (2017-2019) and at three pandemic timepoints (May-July 2020, March-April 2021, November-December 2021). Mean maternal depression and anxiety scores...

Objective The study examined the association between specific childhood adversities and rate of all-cause hospitalization in adulthood in a large sample of the general population and assessed whether adult socioeconomic and health-related factors mediate those associations. Methods We used linked data available from Statistics Canada i.e., the Can...

Objective: We examined whether changes in illness perceptions from preconception to pregnancy were associated with intentions to exclusively breastfeed to 6 months postpartum among women with chronic physical health conditions. Methods: We analyzed self-reported cross-sectional questionnaire data collected in the third trimester from 361 women w...

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This cohort study compared children’s recreational screen time with screen time before the COVID-19 pandemic and during 3 pandemic waves to examine whether changes in screen time were greater than those associated with age.

Background Antenatal depression (AD) is the most common complication of pregnancy in developed countries and increases the risk of preterm birth (PTB). Many pregnant individuals with AD do not obtain treatment due in part to risks associated with antidepressant medications, the expense and wait times for psychological services, and perceived stigma...

Background Like infants born very preterm (<32 weeks), late preterm (≥34 and <37 weeks) and early term (≥37 and <39 weeks) births have been associated with increased risk of developmental delay (DD); yet, the evidence remains heterogeneous across the continuum of gestational ages, hindering early identification and intervention. Objective To est...

Background As a teratogen, alcohol exposure during pregnancy can impact fetal development and result in adverse birth outcomes. Despite the clinical and social importance of prenatal alcohol use, limited routinely collected information or epidemiological data exists in Canada. The aim of this study was to pool data from multiple Canadian cohort stu...

Background Breastfeeding difficulties frequently exacerbate one another and are common reasons for curtailed breastfeeding. Women with chronic conditions are at high risk of early breastfeeding cessation, yet limited evidence exists on the breastfeeding difficulties that co-occur in these mothers. The objective of this study was to explore clusters...

Introduction Use of medications is a common concern for breastfeeding women, particularly when they are strongly needed or unavoidable to manage maternal chronic conditions. Yet the influence of medication usage patterns on breastfeeding duration in mothers with chronic conditions is unclear. The objective of this study was to examine whether postp...

Background Preterm birth is the leading cause of perinatal morbidity and mortality and is associated with adverse developmental and long-term health outcomes, including several cardiometabolic risk factors and outcomes. However, evidence about the association of preterm birth with later body size derives mainly from studies using birth weight as a...

Background: Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. Objectives: To assess the association be...

Background Neighbourhood characteristics have been found to influence child development, but little is known about lifestyle factors that may moderate this relationship, which can provide modifiable targets for policies and programing. This study investigated the association between neighbourhood characteristics (e.g., deprivation, disorder) during...

Approximately 25% of individuals report poor mental health during their pregnancy or postpartum period, which may impact fetal neurodevelopment, birth outcomes, and maternal behaviors. In the present study, maternal serum samples were collected from pregnancies at 28–32 weeks gestation from the All Our Families (Alberta, Canada) cohort and assessed...

Healthy pregnancy requires a coordinated immune response, yet complications can arise, putting both the mother’s and child’s health at risk. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are pregnancy-related complications that account for most maternal morbidity and mortality. Cytokines are proteins released as...

Objective This study examined the prevalence of elevated maternal anxiety and/or depression symptoms up to eight years after childbirth and the association between role and relationship strains during parenting and mental health challenges from three to eight years after childbirth. Methods This study used data from the All Our Families longitudin...

Background: Antenatal depression (AD) is the most common complication of pregnancy in developed countries and increases risk of preterm birth (PTB). Many pregnant individuals with AD do not obtain treatment due in part to risks associated with antidepressant medications, the expense and wait times for psychological services, and perceived stigma. A...

Background Persons with disability (PWD) experience disproportionately high poverty rates in Canada. This trend is apparent especially among youth compared to those who develop disabilities later in life. PWD in poverty have additional needs that increase barriers to full participation in society and translate to higher basic costs for daily living...

Importance: People conceived using assisted reproductive technology (ART) make up an increasing proportion of the world's population. Objective: To investigate the association of ART conception with offspring growth and adiposity from infancy to early adulthood in a large multicohort study. Design, setting, and participants: This cohort study...

Background Preterm birth is the leading cause of perinatal morbidity and mortality, and is associated with adverse developmental and long-term health outcomes, including several cardio-metabolic risk factors. However, evidence about the association of preterm birth with later body size derives mainly from studies using birth weight as proxy of prem...

Introduction Hypertensive disorders of pregnancy occur in approximately 7%–10% of pregnancies and are associated with adverse maternal cardiovascular health outcomes across the lifespan. In contrast, breastfeeding has been associated with a reduction in cardiovascular risk factors in a dose‐dependent manner. Despite the potential protective effects...

Aim Combination vaccines decrease the number of needles required, addressing a common concern of parents. However, some parents are hesitant about combination vaccines and/or want to opt out of certain vaccine components. This study assessed whether introduction of the combination MMRV vaccine influenced coverage levels for measles- and varicella-c...

Youth in special education have complex needs that are supported across multiple systems. Our research investigates the use of adult income assistance, as one structure that supports youth as they transition to adulthood. We created a cohort of youth (5–22 years old) using linked administrative data from British Columbia government ministries from...

Introduction: South Africa's evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception...

Importance People conceived using assisted reproductive technology (ART) make up an increasing proportion of the world’s population, and their numbers are expected to continue rising. Objective Investigate association of ART conception with growth and adiposity outcomes from infancy to early adulthood in offspring from a large multinational multi-...

With social isolation and physical distancing protocols implemented as a result of the COVID-19 pandemic, there is a need for strategies that promote social connections to "build back better" post-pandemic. A "natural supports" approach will enable the development of supportive relationships and environments. Natural supports are informal give-and-...

Language ability is strongly related to important child developmental outcomes. Family-level socioeconomic status influences child language ability; it is unclear if, and through which mechanisms, neighborhood-level factors impact child language. The current study investigated the association between neighborhood factors (deprivation and disorder)...

The COVID-19 pandemic has resulted in substantial and widespread changes to many prenatal (e.g., maternal stress) and postnatal (e.g., socialization) factors contributing to early child development. We compared developmental screening of 1-year old infants born between April 17, 2020-November 11, 2020 to data from infants born pre-pandemic. We aime...

Socio-demographic risks are associated with higher child screen time and higher screen time is associated with poor socioemotional and developmental health. Existing studies have not examined children’s screen time as a mechanism through which distal risks may be associated with child outcomes. In the current study, we examined whether two proximal...

Objective: Research suggests that children's screen use during the COVID-19 pandemic has doubled. There is a need to understand factors associated with increased use to more adequately inform COVID-19 pandemic recovery efforts aimed at promoting healthy device habits. The objective of this multi-informant study of children aged 9 to 11 years was t...

Hypertensive disorders in pregnancy (HDP) are associated with increased risk of offspring neurodevelopmental disorders, suggesting long-term adverse impacts on fetal brain development. However, the relationship between HDP and deficits in general child development is unclear. Our objective was to assess the association between HDP and motor and cog...

Data pooling from pre-existing multiple datasets can be useful to increase study sample size and statistical power to answer a research question. However, individual datasets may contain variables that measure the same construct differently, posing challenges for data pooling. Variable harmonization, an approach that can generate comparable dataset...

To assess the association between time of birth and mortality among preterm infants. Population-based study of infants born 22–36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. Among infants 22–27 weeks GA, evening birth was associ...

Background Mothers have experienced a near doubling of depression and anxiety symptoms pre- to during the COVID-19 pandemic. The identification of mechanisms that account for this increase can help inform specific targets for mental health recovery efforts. The current study examined whether women with higher levels of depression and anxiety sympto...

Background Extensive literature has shown an association of Adverse Childhood Experiences (ACEs) with adverse health outcomes; however, its ability to predict events or stratify risks is less known. Individuals with mental illness and ACE exposure have been shown to visit emergency departments (ED) more often than those in the general population. T...

Background Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of thi...

Objectives It is critical to understand what children, and in which context, are at risk for high levels of screen use. This study examines whether child temperament interacts with cumulative social risk to predict young children’s screen use and if the results are consistent with differential susceptibility or diathesis-stress models. Methods Dat...

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financi...

Objectives: Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We wil...

Strategies used to restrict the spread of COVID-19, such as school closures and limited extracurricular activities, have resulted in shifts in children’s sedentary behaviors¹ and increases in screen time have largely been assumed. One limitation of the existing research is that it is either cross-sectional¹ or uses national norms as a comparison²....

The current study examined the interaction between maternal depressive symptoms and child temperament in predicting subsequent child language skills. Participants were 252 mother-child dyads recruited from the All Our Families longitudinal cohort, a primarily middle-class sample (62.9% completed postsecondary education) from Alberta, Canada (90.5%...

Background: Births between 34-38 weeks gestational age (GA) account for 30% of all live births, and unlike infants born <34 weeks they do not receive routine developmental follow-up. It is not feasible to routinely follow up 30% of all live births, thus it must be determined who among this group would benefit most from additional support to reduce...

Background and objectives: The home literacy environment has been identified as a key predictor of children's language, school readiness, academic achievement, and behavioral outcomes. With the increased accessibility and consumption of digital media, it is important to understand whether screen use impacts off-line enrichment activities such as r...

Research on the effects of adversity has led to mounting interest in examining the differential impact of adversity as a function of its timing and type. The current study examines whether the effects of different types (i.e., physical, sexual, and emotional abuse) and timing (i.e., early, middle childhood, adolescence, or adulthood) of adversity o...

One pressing question in the field of pediatrics is whether a dose–response relation is observed between hours of screen time and child outcomes. This study examined the association between hours of screen time (≤1 vs 2 vs ≥3 h/day) and children’s developmental and behavioral outcomes. This study included data from 1994 mothers and children in Calg...

Objectives Given stress, anxiety, and depression affect 15–25% of women during pregnancy and are associated with adverse outcomes for maternal and child health if untreated, a randomized controlled trial evaluated the effectiveness of an 8-week modified Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD) intervention for psycholo...

Background Children with disabilities often face limitations that cross support sectors. Objective: Our aim was to measure cross-ministry service use, outcomes, and functional limitations faced by children who qualified for special education. Methods We used longitudinal British Columbia ministry data linked to children (0-18y) registered in K-12...

Using data from the All Our Families study, a longitudinal study of 1992 mother‐child dyads in Canada (47.7% female; 81.9% White), we examined the developmental pathways between infant gestures and symbolic actions and communicative skills at age 5. Communicative gestures at age 12 months (e.g., pointing, nodding head “yes”), obtained via parental...

Background: Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination. Methods: Participants from the All Our Families pregnancy longitudinal cohort whose children...

Background Parents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes...

Background : An intergenerational association between maternal depression and child emotional problems is well established. However, the underlying processes underpinning this association are still unclear, with relatively little attention paid to potential child-driven effects. This study adds to existing research by examining the bidirectional pr...

Background Adverse childhood experiences (ACEs) are associated with illicit drug use among pregnant women who are socioeconomically vulnerable. While it is assumed that the impact of ACEs on illicit drug use in pregnancy is reduced among women with higher socioeconomic status (SES), this assumption is not well tested in the literature. The objectiv...

Background: Exposure to adverse childhood experiences (ACEs) is a risk factor for maternal substance use in pregnancy, however, mechanisms by which maternal ACEs may influence substance use in pregnancy have not been fully explored. The current study examines the association between maternal ACEs and substance use in pregnancy (i.e., alcohol, smoki...

Initiatives have been implemented to provide training to health care providers (HCPs) on the adverse health outcomes associated with alcohol use during pregnancy, including the risk of fetal alcohol spectrum disorder (FASD). The purpose of this exploratory study was to compare two cross-sectional data sets of HCP perspectives over 15 years. In 2002...

Using data from the All Our Families study, a longitudinal study of 1992 mother-child dyads in Canada (47.7% female; 81.9% White), we examined the developmental pathways between infant gestures and symbolic actions and communicative skills at age 5. Communicative gestures at age 12 months (e.g., pointing, nodding head “yes”), obtained via parental...

Substance use in pregnancy, including alcohol use, drug use, or smoking, is associated with poor health outcomes for both the mother and her unborn child. Building on previous research that has examined the cumulative impact of Adverse Childhood Experiences (ACEs) on maternal binge drinking and alcohol use in pregnancy, the current study sought to...

Background The All Our Families (AOF) cohort study is a longitudinal population-based study which collected biological samples from 1948 pregnant women between May 2008 and December 2010. As the quality of samples can decline over time, the objective of the current study was to assess the association between storage time and RNA (ribonucleic acid)...

Background Acceptance of a COVID-19 vaccine is critical to achieving high levels of immunization. The objective of this study is to understand factors associated with COVID-19 vaccine intentions among parents and explore reasons underlying decision making. Methods Participants from a longitudinal cohort were invited to participate in a COVID-19 im...

Objective Rapid repeat pregnancy (RRP), a birth occurring within 33 months of a previous birth, is associated with adverse neonatal outcomes. RRP occurs among 25%–35% of adolescents who become pregnant. The current study examines trends in and outcomes of adolescent RRP in the Canadian context. Methods Using population-based data from the Discharg...

Self-regulation is the ability to manage emotions, modulate behaviors, and focus attention. This critical skill begins to develop in infancy, improves substantially in early childhood and continues through adolescence, and has been linked to long-term health and well-being. The objectives of this study were to determine risk factors and moderators...

Background: Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnanc...

Little is known about the development of early screen use patterns. Using data from 1949 families in Calgary, Alberta, drawn from the XXX cohort, this study examined patterns of screen use across 3 time points (24, 36, 60 months) to identify trajectories of screen use, socio-demographic factors that predict trajectory membership, and whether high u...

Background Sleep health is important for development and improves overall health. There are large socioeconomic gradients in sleep health, from childhood through adulthood. Recent findings suggest that children from neighborhoods with poorer socioeconomic conditions have more sleep problems. The current study aimed to investigate the associations b...

Background: Adverse childhood experiences (ACEs) are associated with illicit drug use among pregnant women who are socioeconomically vulnerable. While it is assumed that the impact of ACEs on illicit drug use is reduced among pregnant women who are well educated and have higher socioeconomic status, this assumption has not been well tested in the l...