Maternal and neonatal health in Canada's Black communities: A scoping review of epidemiologic studies.

Objectives: Black-White disparities in maternal and neonatal morbidity and mortality highlight health inequities in several settings, yet such racial disparities in Canada are not well defined. Our objective was to conduct a scoping review to identify the extent of epidemiologic evidence assessing Black-White disparities in maternal and neonatal health in Canada.

Methods: We included peer-reviewed epidemiologic studies which measured maternal or neonatal outcomes in Black versus White individuals in Canada.

Identifying research priorities for pregnant South Asian immigrants in Canada: A James Lind Alliance approach.

Background: Pregnant South Asian immigrants (PSAI) make up a significant portion of immigrants to Canada and face a higher risk of adverse pregnancy outcomes compared to other ethnic groups. This disparity is largely due to cultural and linguistic barriers to maternity care, including language difficulties, limited cultural sensitivity in healthcare services, and a lack of awareness about culturally tailored educational resources. Despite the growing number of PSAI in Canada, there is limited understanding of how to best support their healthcare and well-being.

Severe Neonatal Morbidity in Forceps versus Vacuum Birth among Individuals with Previous Cesarean Birth: A Population-Based Retrospective Cohort Study.

We sought to compare severe neonatal morbidity associated with forceps versus vacuum birth among individuals with prior cesarean birth.We conducted a population-based retrospective cohort study using data on all full term, singleton, cephalic vaginal births among individuals with prior cesarean birth in the United States (2014-2021). The exposure was operative vaginal birth (forceps vs.

Core Outcome Set for Studies on Cardiac Disease in Pregnancy (COSCarP): An International Delphi Consensus Study.

Background: Outcome reporting in cardio-obstetrics studies is inconsistent. The objective of the COSCarP study (Core Outcome Set on Cardiac Diseases in Pregnancy) was to develop a core outcome set through international consensus and harmonize outcome reporting in cardio-obstetrics studies.

Methods: We conducted a multimethod study between February 2021 and April 2023 that included an online 2-round Delphi survey, 3 small group discussions and a consensus meeting with health service users (people with lived experience of pregnancy and heart disease) and health care professionals.

Core GRADE 7: principles for moving from evidence to recommendations and decisions.

This seventh article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for moving from evidence to recommendations or policy decisions. Core GRADE users make strong recommendations for an intervention versus a comparator when the desirable consequences clearly outweigh the undesirable consequences, and a conditional (weak) recommendation when the balance is less clear. Primary considerations in deciding on recommendations considering an individual patient perspective include balance of benefits, harms, and burdens; the certainty of evidence; and values and preferences.

Risk predictors of severe adverse maternal outcomes in pre-eclampsia: a systematic review and meta-analysis protocol.

Introduction: Pre-eclampsia (PE) remains a major contributor to maternal morbidity and mortality globally. Early identification of risk factors and evaluation of prognostic models for severe adverse maternal outcomes are essential for improving management and reducing complications. While numerous studies have explored potential risk markers, there is still no consensus on the most reliable factors and models to use in clinical practice.

Core GRADE 3: rating certainty of evidence-assessing inconsistency.

This third article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to deciding whether to rate down certainty of evidence due to inconsistency—that is, unexplained variability in results across studies. For binary outcomes in which relative effects are consistent across baseline risks while absolute effects are not, Core Grade users assess consistency in relative effects. For continuous outcomes, they assess consistency in the absolute effects.

Core GRADE 1: overview of the Core GRADE approach.

This first article in a seven part series presents an overview of the essential elements of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach that has proved extremely useful in systematic reviews, health technology assessment reports, and clinical practice guidelines. GRADE guidance has appeared in many articles dealing with both core issues and more specialised and complex guidance, and it has evolved over time. This series of articles presents GRADE essentials, Core GRADE, focusing on the core judgments necessary to summarise the comparative evidence about alternative care options and to make recommendations that apply to the care of individual patients.

Health care experiences and expectations of individuals with severe maternal morbidity in high-income countries: a qualitative systematic review protocol.

Objective: The objective of this review is to describe the health care experiences and expectations of people living in high-income countries who have had severe maternal morbidity (SMM). It will expand on findings from 2 earlier reviews highlighting structural and systemic factors influencing care to inform health care recommendations.

Introduction: Severe maternal morbidity describes conditions and complications during pregnancy, birth, and postpartum associated with severe illness, debilitation, prolonged hospitalization, and high fatality rates.

Conducting a High-Quality Systematic Review.

Systematic reviews (SRs) are a structured means of knowledge synthesis used by a variety of healthcare practitioners to aid in medical decision making. The SR, if conducted rigorously, is considered to be at the top of the hierarchy for research studies. In addition to synthesizing evidence, SRs identify research priorities, address questions that may not be answerable by individual studies, and identify gaps to be addressed in future primary research.

Canadian Survey on the Diagnosis and Clinical Management of Preterm Premature Rupture of Membranes in Tertiary Centres.

This study examines diagnostic and management practices for preterm premature rupture of membranes before 34 weeks in Canada. Between August and November 2023, obstetricians from the Canadian Preterm Birth Network (28 sites) completed an online survey. The response rate was 79% (n = 22).

Core Outcome Set and Reporting Checklist for Studies on Vasa Previa.

Importance: Vasa previa, although a rare condition affecting 0.46 per 1000 pregnancies, results in high rates of fetal and neonatal mortality and morbidity. Widespread use of a core outcome set and reporting checklist may enable data harmonization, enhance evidence synthesis, and ensure prioritization of patient-important outcomes in clinical practice, future research, and clinical practice guidelines.

Patterns of non-fatal overdose and injection-related bacterial infections during pregnancy and the postpartum year among New York State residents.

Objectives: Overdoses are a leading cause of maternal mortality in the US, but limited evidence exists about patterns of nonfatal overdose, a key risk factor for subsequent fatal overdose, or of other drug-related harms. Here, we estimate prevalences of nonfatal overdose and injection-related endocarditis and abscesses/cellulitis across the 21 months spanning pregnancy and the postpartum year.

Methods: Among people who experienced an in-hospital birth in New York State between 9/1/2016 and 1/1/2018 (N=330,872), we estimated the prevalences of hospital-based diagnoses of nonfatal overdose and of injection-related bacterial infections (i.

Estimating the Association Between Outdoor Temperature and Acute Kidney Injury Using Alternative Case Definitions.

Objective: This study aimed to improve estimates of the association between acute kidney injury (AKI) and ambient heat exposure through better case ascertainment and by isolating community-acquired AKI.

Methods: We conducted a case-crossover study using data on AKI-related emergency department (ED) visits in Atlanta. Daymet meteorology was used to assess exposure.

Dust Storms and Emergency Department Visits in 3 Southwestern States Using NWS Storm Reports.

Importance: Dust storms are projected to increase with climate change. The short-term health outcomes associated with dust storms in the US are not well characterized, especially for morbidity outcomes.

Objective: To estimate associations between dust storms and diagnosis-specific emergency department (ED) visits during 2005 to 2018.

Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.

There are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pregnancy clinical encounters. Sixteen patients and 19 HCPs participated in in-depth, semi-structured interviews.

Acceptance and attitudes towards COVID-19 vaccination during pregnancy in Canada.

The COVID-19 pandemic posed a unique set of risks to pregnant women and pregnant people. SARS-CoV-2 infection in pregnancy is associated with increased risk of severe illness and adverse perinatal outcomes. However, evidence regarding the use of COVID-19 vaccines in pregnancy shows safety and efficacy.

Global Disparities in Outcomes of Pregnant Individuals With Rheumatic Heart Disease: A Scoping Review.

Background: Rheumatic heart disease (RHD) remains as 1 of the major contributors to indirect pregnancy-related mortality and morbidity worldwide and disproportionately affects marginalized populations.

Objectives: In this scoping review, the authors sought to explore the socioeconomic, cultural, and health care access-related causes of global disparities in outcomes of pregnancy among individuals with RHD.

Methods: We performed a literature search of all studies published between January 1, 1990, and January 1, 2022, that investigated causes for disparate outcomes in pregnant individuals with RHD.

Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016-2019.

Introduction: There are limited data regarding the associations between public transportation reliance, availability, and diabetic foot ulcer (DFU)-related amputations.

Research Design And Methods: We used visit-level data from the Georgia 2016-2019 Healthcare Cost and Utilization Project database and obtained transportation variables from open sources. Using Bayesian spatial-temporal models, we assessed the associations between transportation and DFU-related amputations within each quartile of poverty status indicators at the ZIP code tabulation area (ZCTA) level.

Outcome reporting in studies on critically ill obstetric patients: A systematic review.

Introduction: This systematic review is the first step in the process of standardizing outcome reporting through the development of a core outcome set for research on critically ill obstetric patients (COSCO).

Methods: A five-database search was performed to identify randomized and non-randomized studies published before November 2017, on patients admitted to intensive care or high-dependency units during or immediately after pregnancy. Reported outcomes were categorized into domains and definitions were documented.

Influenza Activity and Preterm Birth in the Atlanta Metropolitan Area: A Time-Series Analysis from 2010 to 2017.

Background: Annual influenza epidemics lead to a substantial public health burden, and pregnant people are vulnerable to severe outcomes. Influenza during pregnancy is hypothesized to increase the risk of adverse birth outcomes, but population-based epidemiologic evidence remains limited and inconsistent.

Methods: We conducted a time-series analysis to estimate short-term associations between community-level seasonal influenza activity and daily counts of preterm births in Atlanta, United States from October 17, 2010 to July 10, 2017.