Defining a shared research agenda to improve perinatal health through digital innovation

This project aims to bring together a multi-stakeholder group, composed of patient partners as well as research, government, and health care decision-makers to co-develop a research agenda for digital innovation in perinatal health. We believe this work to be both timely and relevant, as the Ministry of Health and Perinatal Services BC refresh provincial strategies for health care digital transformation, which include aims to expand technology to support patient and family care. With this grant, we will conduct a review of the literature to inform the design of a stakeholder engagement plan. We will also organize and implement stakeholder engagement activities, to collaborate on research priorities and identify digital health needs related to perinatal care. We will develop a research agenda outlining a summary of activity findings and three to five evidence-based priorities, which will be shared with key partners whose work can be informed by the findings, through presentations and social media engagement. Through this work, we hope to set the foundation for future research collaboration and innovation in perinatal care to enhance patient, infant, and family health.

Team members: Tibor van Rooij (BC Children’s Hospital Research Institute); Punit Virk (UBC); Marianne Vidler (University of British Columbia); Quynh Doan (BC Children’s Hospital Research Institute); May Tauson (Government of BC); Dominik Stoll (Provincial Health Services Authority); Kathryn Berry-Einarson (Perinatal Services BC); Jennifer Krempien (BC Children’s Hospital and BC Women’s Hospital + Health Centre); Candice Taguibao (Women’s Health Research Institute); Beth Payne (BC Children’s Hospital Research Institute).

Smart Discharges for Mom+Baby: Saving mother-newborn dyads by developing a predictive risk model to identify vulnerable dyads and guide delivery of post-discharge care

The risk of a mother or baby dying is highest in the first six weeks after birth. The World Health Organization (WHO) recommends regular follow-up visits for all mothers and their newborns. This is not always possible. In resource-constrained countries, a lack of money and nurses at hospitals and limited time and money at home often stops mothers from seeking care. In our study, we will build a score to identify mother-baby pairs that are most at risk of getting sick or dying in Uganda. The health of a mother impacts the health of their baby, and vice versa. Our risk score combines the risk of the mother and baby so that both can get care when they need it. A nurse can use this score to guide the number of follow-up visits recommended for the pair. In this way, mothers and babies at higher risk receive more visits. We will also talk to parents and nurses to determine what stops mothers and babies from receiving a follow-up visit. We will work with our Ugandan partners to remove these barriers so that improvements in care are long-lasting. In the future, we can use this approach to improve the health of mothers and babies in smaller, remote towns in BC, where specialized care for mothers and babies is not always readily available.

Study of early Health Outcomes in Neonates Exposed to COVID-19 in British Columbia (SHiNE-BC)

The long-term health challenges and needs of babies born in British Columbia during the COVID-19 pandemic are unknown. Babies can be exposed to the disease by their mother before birth or infected by the virus that causes COVID-19 after birth. The SHiNE-BC project will use information collected provincially to understand the health effects within the first year of life after exposure to COVID-19.

Health outcomes including diagnoses of infections and conditions affecting the lungs, visits to doctors or emergency departments, hospital stays, and prescription medications will be studied and compared among different geographical regions of BC. This vital information helps doctors improve care for these infants and assists decision-makers to address the changing needs within the health system.

All-cause and cause-specific mortality and acute morbidity attributable to COVID-19 and medical history associated with severe COVID-19 infection in BC.

Prediction models about the future course of the epidemic rely mainly on the trends in numbers of Covid-19 positive individuals, hospitalizations, and deaths. These estimates may not be accurate, however, due to a limited availability of the Covid-19 testing and its potential inaccuracies. There is an urgent need to evaluate the overall impact of the pandemic regardless of the accuracy of available data. Our research will provide an insight into who is most impacted by the pandemic in BC, including the primary effects and the secondary effects not directly caused by the virus. In addition, we will investigate the association between past medical history and the severity of symptoms among Covid-19 positive individuals. Our results will help to plan the next steps in the preventive efforts.

Optimal timing of delivery for high risk pregnancies

Early delivery (delivery before spontaneous labour by induced labour or caesarean birth) is often considered for high-risk pregnancies to prevent stillbirths and protect the mother from developing pregnancy complications. However, the optimal time for early delivery is often unclear. Although birth between 37 and 41 weeks of pregnancy was once considered ideal, babies delivered early at 37 to 38 weeks are more likely to have breathing complications than babies delivered later. Deciding when a higher-risk pregnancy should be delivered therefore involves balancing the risks to the baby from delivering too early against the risks to the mother and fetus from delaying delivery too long.

Dr. Jennifer Hutcheon's research focuses on better understanding the risks and benefits associated with early delivery and how they change on a week-by-week basis. She is studying the optimal timing of delivery for repeat caesarean surgeries (a caesarean scheduled after the caesarean delivery of a previous child). Delivery before 39 weeks is not recommended because it will increase the risk of breathing complications in the infant at birth. However, planning the surgery for a later week of pregnancy makes it more likely that the mother will go into spontaneous labour before her scheduled surgery. Early work has found that despite the risks to the baby, 62% of repeat caesarean births in British Columbia happen before 39 weeks.

Dr. Hutcheon will review the medical records from all pregnancies in BC between 2001 and 2010 stored in the BC Perinatal Database Registry to better understand the factors causing the high rate of early-term delivery in women having repeat caesareans and the potential risks associated with delaying delivery until 39 weeks or later. Using large population and clinical databases, she will also examine the week-by-week risks of delivery and delaying delivery in other higher-risk populations, such as twin pregnancies and older mothers.

Dr. Hutcheon will use the information she obtains to calculate the week-by-week risks for mother and infant associated with delivery and with delaying delivery, in order to highlight the time in pregnancy at which both risks are lowest. She anticipates that her work will help inform best practice in the province and will ultimately have a positive influence on the health of babies born in BC.

Reproductive trends among HIV-positive women in British Columbia's HAART era: Examining the interplay between pregnancy, antiretroviral adherence, and HIV disease progression

A growing proportion of new HIV infections, both locally and globally, are among women of childbearing age, and heterosexual contact is an increasingly important risk of HIV transmission. While it is clear that HIV-positive women continue to desire children, become pregnant, and give birth after knowing their HIV-positive status, the reproductive health concerns and rights of people living with and/or affected by HIV have received little attention. Highly active antiretroviral therapy (HAART), the standard of HIV treatment in BC, is reducing the health risks and barriers to reproduction for people living with HIV. With appropriate adherence to treatment, HAART increases life expectancy, decreases morbidity, and dramatically reduces the risks of HIV transmission from mother-to-child and to sero-discordant sexual partners. Angela Kaida’s research seeks to describe the reproductive trends of HIV-positive women in BC’s “”HAART era”” (roughly 1996 and onwards) and to investigate the complex interplay between pregnancy, antiretroviral adherence, and HIV disease progression. Owing to the structure of HIV-related services and population-level data capture methods, BC provides an entirely unique and highly valuable environment in which to investigate critical questions related to HIV, HAART, and pregnancy. Notably, no other jurisdiction in the world has published population level findings on this topic. This research will provide evidence to guide the development of effective and responsive reproductive and sexual health services and policies for HIV-positive women in BC and beyond. These services are intended to support the rights of HIV positive women to be sexually active and achieve their fertility goals, while minimizing associated risks to maternal, fetal, and partner health. The findings will contribute vital information to the development of provincial, national, and international guidelines that support reproductive decision making among HIV-affected couples and inform the use of antiretroviral therapy during pregnancy.

Optimal timing of delivery for pregnancies with pre-existing hypertension

Chronic high blood pressure in pregnant women is associated with serious maternal and fetal complications such as poor growth, early separation of the placenta, and stillbirth. Consequently, the recommendation has been made that all women with chronic high blood pressure be considered candidates for induced delivery to reduce the risk of complications that may occur with allowing pregnancies to continue to later gestational ages. However, the optimal gestational age at which the infants should be delivered is currently unknown: delivering too early may increase the risk of respiratory complications for the infant at birth, while delaying the induction of delivery increases the risk of stillbirth. Dr. Hutcheon’s research centres on the development of a methodology to help determine the optimal gestational week for delivery. Data on maternal characteristics and pregnancy outcomes obtained from the US population birth registry as well as Canadian Birth Registries will be reviewed with a focus on the occurrence of either a serious birth complication for the newborn (such as seizures or need for prolonged assisted ventilation), or stillbirth. Among women with pre-existing high blood pressure, the risks of a poor pregnancy outcome will be calculated for each week of gestation between 36 and 42 weeks of pregnancy. Statistical models will be used to determine the gestational age range for birth during which risks to the infants are lowest. These analyses will then be repeated to determine the timing of delivery that minimizes risks of serious complications for the mother. With childbearing at older maternal ages increasing in Canada, the number of pregnancies complicated by high blood pressure is expected to increase. The results of Dr. Hutcheon’s project will help provide guidance to physicians as to the best time to deliver pregnancies complicated by pre-existing high blood pressure and, as a result, help minimise the number of adverse pregnancy outcomes in the Canadian population.

Abnormal brain development in premature newborns

Many children who have been born prematurely experience long-term cognitive, visual and motor deficits. A number of interrelated factors that commonly follow preterm birth are believed to contribute to neurodevelopmental impairment, including newborn illness and exposure to medications, abnormal brain development in the months following birth, and a characteristic type of brain injury known as white matter injury. Currently, there is little research regarding how white matter injury and abnormal brain development lead to impaired motor and cognitive function. Dr. Steven Miller is researching brain development and injury in premature babies to understand how such injuries occur and why specific brain regions are affected. Using magnetic resonance imaging (MRI) techniques, Dr. Miller is measuring brain development and white matter injury in premature newborns shortly after birth and then again when the newborns reach term-equivalent age. Subsequent tests measuring gross and fine motor skills, language and cognition will be conducted at 18 and 36 months of age to evaluate neurodevelopmental outcome. The results of this study will provide a better understanding of the factors impacting brain growth and injury in newborns, and lead to improvements in preventing or treating brain injury in this population. Dr. Miller’s research group also studies brain development and white matter injury in other groups of newborns at high risk of neurodevelopmental impairments, such as those with heart birth defects.

Who has Epilepsy in British Columbia?

According to national surveys, an estimated 30 per cent of Canadian children between six and 18 years of age suffer from chronic conditions and/or disabilities, including seizure disorders. However, these surveys do not allow for provincial analysis, due to small sample sizes, and there is limited comparability between surveys because of differences in target groups, methodologies and conceptual frameworks. Currently, there are no comprehensive prevalence data on children with special health care needs in BC, such as children with epileptic seizures, who account for half the visits to specialists because of neurological disease. Veronica Schiariti is researching the influences of neighbourhood income, population density, health care availability and community resources on the treatment prevalence of epilepsy in BC children under the age of 19. She is examining both diagnosis and treatment patterns of pediatric patients with epilepsy. Veronica hopes that her research will contribute to improved treatment for epileptic children by identifying disparities in health service delivery, informing health care policy decisions, and enabling long-term tracking and study of health and development outcomes at the individual level and in the broader population.