Publications by authors named "Haim A Abenhaim"

95 Publications

Decreasing Incidence of Palatoplasty in the United States.

J Craniofac Surg 2021 Jul 7. Epub 2021 Jul 7.

Division of Plastic and Reconstructive Surgery, McGill University Health Center Center for Clinical Epidemiology and Community Studies, Jewish General Hospital Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC, Canada.

Introduction: Cleft palate is amongst the most common birth defect across the world. Although its etiology is multifactorial, including genetic and environmental contributors, the investigators were interested in exploring whether its incidence was changing over time.

Methods: The Nationwide Inpatient Sample database, the largest publically available healthcare database in the United States, was used to identify all primary palatoplasties performed under 2 years of age and births which occurred over a 17-year period from 1999 to 2015. The change in rate of palatoplasties and overall maternal demographics were assessed longitudinally using the chi-squared test. Significance level was set at P < 0.001.

Results: A total of 13,808,795 pregnancies were reviewed during the time period, from 1999 to 2015, inclusively. A total of 10,567 primary palatoplasties were performed in that period of time reflecting an overall rate of 7.7 palatoplasties per 10,000 deliveries. Palatoplasty rates decreased across the study period from 9.5 per 10,000 in 1999 to 7.1 per 10,000 died/delivered pregnancies in 2015 which corresponds to an average compounded year-to-year decrease of 1.76%, P < 0.001.

Conclusions: The rate of primary palatoplasties, as a proxy for the rate of cleft palate prevalence, has been significantly decreasing over the last 2 decades and may represent improvements in early diagnosis in pregnancy, changing genetic or racial demographics, and/or environmental factors such as decreased maternal smoking in the US population. Future research may be directed at better understanding the definitive etiology of this decreasing prevalence of children undergoing primary cleft palate repairs in the United States.
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http://dx.doi.org/10.1097/SCS.0000000000007799DOI Listing
July 2021

Maternal and neonatal outcomes in women with disorders of lipid metabolism.

J Perinat Med 2021 Jul 1. Epub 2021 Jul 1.

Department of Obstetrics & Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.

Objectives: The effects of lipid metabolism disorders (LMD) on pregnancy outcomes is not well known. The purpose of this study is to evaluate the impact of LMD on maternal and fetal outcomes.

Methods: Using the Healthcare Cost and Utilization Project - National Inpatient Sample from the United States, we carried out a retrospective cohort study of all births between 1999 and 2015 to determine the risks of complications in pregnant women known to have LMDs. All pregnant patients diagnosed with LMDs between 1999 and 2015 were identified using the International Classification of Disease-9 coding, which included all patients with pure hypercholesterolemia, pure hyperglyceridemia, mixed hyperlipidemia, hyperchylomicronemia, and other lipid metabolism disorders. Adjusted effects of LMDs on maternal and newborn outcomes were estimated using unconditional logistic regression analysis.

Results: A total of 13,792,544 births were included, 9,666 of which had an underlying diagnosis of LMDs for an overall prevalence of 7.0 per 10,000 births. Women with LMDs were more likely to have pregnancies complicated by diabetes, hypertension, and premature births, and to experience myocardial infarctions, venous thromboembolisms, postpartum hemorrhage, and maternal death. Their infants were at increased risk of congenital anomalies, fetal growth restriction, and fetal demise.

Conclusions: Women with LMDs are at significantly higher risk of adverse maternal and newborn outcomes. Prenatal counselling should take into consideration these risks and antenatal care in specialized centres should be considered.
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http://dx.doi.org/10.1515/jpm-2021-0028DOI Listing
July 2021

Association of timing of birth with mortality among preterm infants born in Canada.

J Perinatol 2021 May 28. Epub 2021 May 28.

Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.

Objective: To assess the association between time of birth and mortality among preterm infants.

Study Design: 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.

Result: Among infants 22-27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01-1.29). Among infants 28-32 weeks GA and 33-36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59-0.95; AOR 0.78, 95% CI 0.62-0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28-32 and 33-36 weeks GA decreased or were not statistically significant.

Conclusion: Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.
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http://dx.doi.org/10.1038/s41372-021-01092-9DOI Listing
May 2021

Obstetrical and Newborn Outcomes Among Patients With SARS-CoV-2 During Pregnancy.

J Obstet Gynaecol Can 2021 07 27;43(7):888-892.e1. Epub 2021 Mar 27.

Department of Obstetrics and Gynecology, McGill University, Montréal, QC; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jewish General Hospital, Montréal, QC. Electronic address:

We report on the perinatal outcomes of pregnant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 2 hospitals in Montréal, Québec. Outcomes of 45 patients with SARS-CoV-2 during pregnancy were compared with those of 225 patients without infection. Sixteen percent of patients with SARS-CoV-2 delivered preterm, compared with 9% of patients without (P = 0.28). Median gestational age at delivery (39.3 (interquartile range [IQR] 37.7-40.4) wk vs. 39.1 [IQR 38.3-40.1] wk) and median birth weight (3250 [IQR 2780-3530] g vs. 3340 [IQR 3025-3665] g) were similar between groups. The rate of cesarean delivery was 29% for patients with SARS-CoV-2. Therefore, we did not find important differences in outcomes associated with SARS-CoV-2. Our findings may be limited to women with mild COVID-19 diagnosed in the third trimester.
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http://dx.doi.org/10.1016/j.jogc.2021.03.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003454PMC
July 2021

Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing.

J Perinat Med 2021 May 18;49(4):448-454. Epub 2020 Dec 18.

Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada.

Objectives: We estimated the degree to which the association between race and spontaneous recurrent preterm delivery is mediated by the timing of the first prenatal care visit.

Methods: A retrospective population-based cohort study was conducted using the U.S. National Center for Health Statistics Natality Files. We identified 644,576 women with a prior PTB who delivered singleton live neonates between 2011 and 2017. A mediation analysis was conducted using log-binomial regression to evaluate the mediating effect of timing of first prenatal care visit.

Results: During the seven-year period, 349,293 (54.2%) White non-Hispanic women, 131,296 (20.4%) Black non-Hispanic women, 132,367 (20.5%) Hispanic women, and 31,620 (4.9%) Other women had a prior preterm delivery. The risk of late prenatal care initiation was higher in Black non-Hispanic women, Hispanic women, and Other women (women of other racial/ethnic backgrounds) compared to White non-Hispanic women, and the risk of preterm delivery was higher in women with late prenatal care initiation. Between 8 and 15% of the association between race and spontaneous recurrent preterm delivery acted through the delayed timing of the first prenatal care visit.

Conclusions: Racial disparities in spontaneous recurrent preterm delivery rates can be partly, but not primarily, attributed to timing of first prenatal care visit.
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http://dx.doi.org/10.1515/jpm-2020-0133DOI Listing
May 2021

Screening and Testing Pregnant Patients for SARS-CoV-2: First-Wave Experience of a Designated COVID-19 Hospitalization Centre in Montréal.

J Obstet Gynaecol Can 2021 05 5;43(5):571-575. Epub 2020 Nov 5.

Department of Obstetrics and Gynecology, McGill University, Montréal, QC; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jewish General Hospital, Montréal, QC. Electronic address:

Objective: Coronavirus disease 2019 (COVID-19) may present asymptomatically in a large proportion of cases in endemic areas. Accordingly, universal testing has been suggested as a potential strategy for reducing transmission in the obstetrical setting. We describe the clinical characteristics of patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy at a designated COVID-19 hospitalization centre in Montréal, Québec.

Methods: A single-centre retrospective cohort was constructed to include all pregnant patients who tested positive for SARS-CoV-2 between March 22 and July 31, 2020, and received care at the Jewish General Hospital. Initially, testing was restricted to at-risk patients, identified through the use of a screening questionnaire. Beginning on May 15, 2020, universal testing was implemented, and all pregnant patients admitted to the hospital were tested. Data were collected through chart review.

Results: Of 803 patients tested for SARS-CoV-2 during the study period, 41 (5%) tested positive. Among those patients who were symptomatic, the most commonly reported symptoms were cough (53%), fever (37%), dyspnea (30%), and anosmia and/or ageusia (20%). Before the implementation of universal testing, 13% (3 of 24) of patients with SARS-CoV-2 were asymptomatic. After implementation of universal testing, 80% (8 of 10) of patients with SARS-CoV-2 were asymptomatic.

Conclusion: Our findings suggest that most pregnant patients with SARS-CoV-2 are asymptomatic or have mild symptoms of COVID-19. Particularly in endemic areas, universal testing of pregnant patients presenting to the hospital should be strongly considered as an important measure to prevent in-hospital and community transmission of COVID-19.
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http://dx.doi.org/10.1016/j.jogc.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642740PMC
May 2021

Maternal vitamin D, oxidative stress, and pre-eclampsia.

Int J Gynaecol Obstet 2020 Dec 22. Epub 2020 Dec 22.

Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.

Objective: To examine the associations between risk of pre-eclampsia and pregnancy levels of maternal 25-hydroxyvitamin D (25[OH]D) and oxidative stress biomarkers.

Methods: A nested case-control study (n = 99; 34 cases; 65 controls) within a prospective pregnancy cohort. Maternal 25(OH)D and oxidative stress markers (six isomers of F -isoprostanes; F -isoPs) were measured in plasma at 12-18 and 24-26 gestational weeks. Vitamin D deficiency was defined as 25[OH]D less than 50 nmol/L.

Results: Maternal vitamin D deficiency was associated with increased 8-iso-PGF (P = 0.037), 15(R)-PGF (P = 0.004), (±)5-iPF -VI (P = 0.026) at 12-18 weeks. Vitamin D deficiency was inversely associated with 8-iso-PGF (P = 0.019) and (±)5-iPF -VI isomer (P = 0.010) at 24-26 weeks. Both maternal vitamin D deficiency (adjusted odds ratio [aOR], 4.79; 95% confidence interval [CI], 1.67-13.75) and increased (±)5-iPF -VI (aOR, 2.46; 95% CI, 1.16-5.22) at 24-26 weeks were associated with risk of pre-eclampsia. However, the interaction test between 25(OH)D and (±)5-iPF -VI was not significant (P = 0.143).

Conclusion: Plasma 25(OH)D below 50 nmol/L was associated with increased oxidative stress levels during pregnancy as measured by two F -isoP isomers, including the well-studied marker 8-iso-PGF . Whether vitamin D-induced oxidative stress mediates the risk of pre-eclampsia warrants future study.
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http://dx.doi.org/10.1002/ijgo.13559DOI Listing
December 2020

Extracorporeal membrane oxygenation in pregnant and postpartum patients: a systematic review.

J Matern Fetal Neonatal Med 2020 Dec 20:1-11. Epub 2020 Dec 20.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

Purpose: Information on the use of extracorporeal membrane oxygenation (ECMO) in obstetric patients is scarce. The objective was to conduct a systematic review examining ECMO use in pregnant and postpartum patients in order to identify indications leading to ECMO use and to assess mortality rates.

Materials And Methods: PubMed, EMBASE, Cochrane Library, and SCOPUS were searched using the terms "extracorporeal membrane oxygenation" and "pregnancy" up to 1 November 2020. Case reports and case series reporting the use of ECMO in pregnancy were eligible. Data about maternal age, gestational age, diagnosis, type of ECMO, time on ECMO, pregnancy outcomes, and maternal survival were extracted from studies.

Results: The search yielded 1696 citations, of which 125 were included. There were 213 obstetric patients treated with ECMO over a 30-year period. The frequency of reports increased considerably over the last decade. The majority of patients were treated in their third trimester (28.2%) or postpartum (32.9%). Most common etiologies included influenza-induced ARDS (27.7%), pulmonary embolism (13.6%), peripartum cardiomyopathy (11.7%), and infection (11.7%). Pregnancy outcomes ended with live births, either on ECMO (15.5%, 95% CI 10.6-20.4) or not on ECMO (58.3%, 95% CI 51.7-64.9), in fetal demise (8.9%, 95% CI 5.1-12.7), or in spontaneous or induced abortion on ECMO (4.2%, 95% CI 1.5-6.9) or not on ECMO (4.2%, 95% CI 1.5-6.9). Maternal survival was 79.3%.

Conclusion: Although women placed on ECMO had a high mortality rate, this is likely an indication of the severity of illness. Overall, ECMO appears to be a valid therapy for the temporary support of vital organs in severely ill pregnant women.
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http://dx.doi.org/10.1080/14767058.2020.1860932DOI Listing
December 2020

Association Between First-Trimester Bleeding and Retained Placenta Requiring Dilatation and Curettage.

J Obstet Gynaecol Can 2021 Apr 25;43(4):463-468. Epub 2020 Aug 25.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC. Electronic address:

Objective: Early subchorionic hemorrhage may lead to a disruption in the placental-uterine matrix, which may result in an adherence of the placenta to the endometrium. We evaluated the effect of a first-trimester bleed on the need for a post-vaginal delivery dilatation and curettage (D&C) for removal of retained placenta.

Methods: We conducted a case-control study at a tertiary care centre between 2012 and 2016. Patients identified through medical records as having required a post-vaginal delivery D&C for retained placenta were considered cases and were matched 1:5 with patients delivering vaginally within 1 week who did not require a D&C. History of first-trimester bleeding and subchorionic hemorrhage were identified through chart review. Conditional logistic regression analyses estimated the effect of a first-trimester bleed on the requirement for D&C for retained placenta. Models were adjusted for maternal age and previous uterine surgery.

Results: There were 68 cases of retained placenta requiring D&C, for an estimated 3 in 1000 deliveries. Patients requiring D&C were slightly older than controls but were otherwise comparable with respect to baseline demographic characteristics. In adjusted analyses, patients who required a postpartum D&C were more likely than controls to have had a first-trimester bleed at 11.8% and 0.6%, respectively (OR 25.3; 95% CI 4.7-135.4, P < 0.001). Postpartum D&C for retained placenta was associated with postpartum hemorrhage, need for blood transfusion, and manual removal of placenta.

Conclusion: First-trimester bleeding should be considered a high-risk determinant for post-vaginal delivery D&C for retained placenta and for severe postpartum hemorrhage.
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http://dx.doi.org/10.1016/j.jogc.2020.07.012DOI Listing
April 2021

Use of extracorporeal membrane oxygenation in obstetric patients: a retrospective cohort study.

Arch Gynecol Obstet 2020 06 3;301(6):1377-1382. Epub 2020 May 3.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.

Purpose: There is little information on the use of extracorporeal membrane oxygenation (ECMO) in pregnant women. Our objectives are to estimate the use of ECMO in pregnant patients, identify clinical conditions associated with ECMO use, and assess survival rates by the associated condition.

Methods: Using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we carried out a retrospective cohort study of all delivery admissions in the United States from January 1, 1999, to October 1, 2015. Within the cohort, women who received ECMO therapy were identified using ICD-9 codes and then survival rates among these women were calculated.

Results: There were 83 women who underwent ECMO therapy in our cohort of 15,335,205 births, for an overall ECMO use rate of 0.54/100,000 pregnancies. The incidence of ECMO use increased from 0.23/100,000 in 1999 to 2.57/100,000 in 2015. Patients on ECMO were more likely to be older, have a lower income, and have pre-existing medical conditions when compared with the patients not on ECMO. The overall survival rate for the ECMO group was 62.7%. The most common reason for ECMO use was acute respiratory failure. Etiologies associated with the highest survival in those on ECMO were pneumonia and venous thromboembolism, which were found to have survival rates of 75.0% and 81.0%, respectively.

Conclusion: The incidence of ECMO use in the obstetric population increased over the last decade and a half. Although it carries a limited survival rate within this population, it has proven life-saving for many suffering from complications of pregnancy and delivery.
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http://dx.doi.org/10.1007/s00404-020-05530-5DOI Listing
June 2020

To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort.

Am J Epidemiol 2020 11;189(11):1360-1368

Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011-2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.
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http://dx.doi.org/10.1093/aje/kwaa054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604519PMC
November 2020

Evaluating the Quality and Reliability of Online Information on Social Fertility Preservation.

J Obstet Gynaecol Can 2020 05 26;42(5):561-567. Epub 2019 Dec 26.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montréal, QC. Electronic address:

Objective: With the rising trend of postponing motherhood, there has been an increasing rate of infertility. Social fertility preservation offers the potential to overcome this age-related infertility, and many women are turning to the Internet to seek medical information. The aim of this study was to evaluate online information on social fertility preservation.

Methods: This study used five search terms-"egg freezing," "fertility preservation," "social egg freezing," "social fertility preservation," and "oocyte cryopreservation"-to identify the most popular sites as rated by Google. Accuracy of information and quality of websites were rated on the basis of four categories: Silberg's accountability criteria, Abbott's aesthetic criteria, Flesch-Kincaid readability score, and the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommendations (Canadian Task Force classification III).

Results: Study investigators identified the 21 most used websites. The average Silberg score was 6.57, with 85.7% of websites meeting the criteria for adequate accountability. Only one website (4.8%) did not meet the criteria for appropriate aesthetic appeal. The average Flesch-Kincaid readability score was 11.39, equivalent to a grade 11 reading level, which is significantly higher than the reading level of the general population. A total of 57% of websites contained less than half of the evidence-based recommendations provided in CFAS and SOGC recommendations.

Conclusion: Online information on social fertility preservation is easily accessible and aesthetically pleasing, but information is not easily readable and does not reflect evidence-based recommendations. Hence, health care professionals must fill the knowledge gaps and adequately counsel their patients to optimize a woman's chance at a successful pregnancy.
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http://dx.doi.org/10.1016/j.jogc.2019.10.029DOI Listing
May 2020

Maternal and fetal outcomes in pregnancies with long-term corticosteroid use.

J Matern Fetal Neonatal Med 2021 Jun 20;34(11):1797-1804. Epub 2019 Aug 20.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.

Purpose: Long-term corticosteroids are administered in pregnant patients with an array of autoimmune and inflammatory disorders. Our objective is to determine whether long-term corticosteroid use is associated with increased maternal and neonatal adverse outcomes.

Materials And Methods: We performed a retrospective cohort study using the Healthcare Cost and Utilization Project-national Inpatient Sample from the USA. All pregnant patients on long-term corticosteroids were identified using International Classification of Disease-9 coding from 2003 to 2015. The effect of long-term corticosteroid use on maternal and neonatal outcomes was evaluated using multivariate logistic regression.

Results: Out of the 10,491,798 births included in our study, 3999 were among women with long-term use of steroids, for an overall prevalence of 38 per 100,000 births. There was a steady increase in chronic steroid use from 2 to 81 per 100,000 births over the 13-year study period ( < .0001). Women on long-term steroids were more likely to have pregnancies complicated by preeclampsia, 1.72 (1.30-2.29) and were at greater risk of preterm premature rupture of membranes, 1.63 (1.01-2.44), pyelonephritis, 4.81 (1.18-19.61), and venous thromboembolisms, 2.50 (1.32-4.73). Neonates born from mothers on long-term steroids were more likely to suffer from prematurity, 1.51 (1.13-2.05), and lower weight for gestational age, 2.10 (1.34-3.30).

Conclusion: Long-term corticosteroids use in pregnancy is associated with maternal and fetal adverse outcomes. These patients would benefit from close follow-up throughout their pregnancy to minimize complications.
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http://dx.doi.org/10.1080/14767058.2019.1649392DOI Listing
June 2021

Influence of intrauterine growth restriction on caesarean delivery risk among preterm pregnancies undergoing induction of labor for hypertensive disease.

J Obstet Gynaecol Res 2019 Sep 9;45(9):1860-1865. Epub 2019 Jul 9.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

Aim: To evaluate the effect of intrauterine growth restriction (IUGR) on the success rate of labor induction of preterm pregnancies complicated by hypertensive disorders.

Methods: A retrospective cohort study conducted using data from the Centers for Disease Control and Prevention's Linked Birth-Infant Death File in the United States from 2009 to 2013. Our cohort included live normal singleton cephalic pregnancies complicated by hypertensive disorders that underwent induction of labor and delivered between 24 and 35.6 weeks' gestation. Study subjects were categorized by the presence or absence of IUGR. Multivariate logistic regression was used to estimate the adjusted effect of IUGR on risk of caesarean deliveries.

Results: Of 41 640 births meeting study criteria, 39 890 had no IUGR and 1750 had IUGR infants. The overall caesarean delivery rate was 22.2%, with caesarean delivery risk being higher among pregnancies complicated by IUGR versus those not complicated by IUGR (33.2% vs 21.7%, respectively) (odds ratio 2.00, 95% confidence interval 1.78-2.25). The effect of IUGR on risk of caesarean sections was most pronounced for gestational ages between 28 and 36 weeks. The effect of IUGR was highest among obese women, with the risk of caesarean in IUGR vs non-IUGR pregnancies being 62.8% vs 41.4%, respectively (odds ratio 2.53, 95% confidence interval 1.98-3.24).

Conclusion: Induction of labor of preterm pregnancy complicated by hypertensive disorders should be considered a reasonable option for delivery; however, in the context of IUGR, women should be informed of the considerable higher risk of caesarean delivery.
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http://dx.doi.org/10.1111/jog.14062DOI Listing
September 2019

The effect of rural vs. urban setting on the management and outcomes of surgery for endometrial cancer.

J Gynecol Obstet Hum Reprod 2019 Nov 5;48(9):745-749. Epub 2019 Jun 5.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada. Electronic address:

Introduction: To evaluate the proportion of endometrial cancers surgically managed in rural centers, and to compare the surgical management and perioperative morbidity of hysterectomies for endometrial cancer performed in rural settings with those performed in urban settings.

Materials And Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from 2003 to 2010. We included all patients diagnosed with endometrial cancer who underwent a hysterectomy and compared surgical approaches, lymph node dissection rates, perioperative complication rates, and lengths of stay according to location of care provided (rural versus urban centers), using multivariate logistic regression models.

Results: Of the 52,299 women who underwent surgery for endometrial cancer, 6% were performed in rural centers-a proportion that trended down over the study period. A disparity in surgical management was noted between rural versus urban settings, with rural centers having lower rates of laparoscopy and robotics (6.9% vs. 18.5%; OR 0.35, CI 0.30-0.40), and lower rates of lymph node dissection both overall (39.4% vs. 67.0%; OR 0.32, CI 0.30-0.35) and for early (37.2% vs. 66.2%; OR 0.30, 95%CI 0.28-0.33) and advanced (57.7% vs. 71.7%; OR 0.56, 95% CI 0.44-0.70) stage disease. Perioperative morbidity was comparable in both settings, with lower rates of transfusion, sepsis, wound infection, ileus, and prolonged hospitalization in rural settings.

Conclusions: Although women obtaining care for endometrial cancer in rural centers receive differential surgical management than women cared for in urban centers, perioperative morbidity appears to be overall comparable.
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http://dx.doi.org/10.1016/j.jogoh.2019.06.001DOI Listing
November 2019

Effect of Hospital Choice on the Risk of Caesarean Delivery.

J Obstet Gynaecol Can 2019 Sep 14;41(9):1302-1310. Epub 2019 Mar 14.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC. Electronic address:

Objective: This study aimed to evaluate the variation in Caesarean delivery rate (CDR) among hospitals across the United States, its effect on maternal and neonatal outcomes, and whether differences in pregnancy and hospital characteristics can explain the higher CDRs seen in certain hospitals.

Methods: This retrospective population-based cohort study was conducted using the 2014 Healthcare and Utilization Project Nationwide Inpatient Sample. The investigators identified all hospitals with birth admissions and compared hospitals with high CDRs with hospitals with low/mid CDRs, in terms of hospital characteristics, maternal characteristics, and maternal and neonatal outcomes. Regression analyses within multiple hospital and patient characteristic strata were used to evaluate the adjusted independent effect of the hospital on the risk of Caesarean delivery (Canadian Task Force Classification II-2).

Results: In this study population, 96% of U.S. hospitals had a CDR above 20%, and 5% had a CDR >40%. High-CDR hospitals (>40%) were more often privately owned, non-teaching hospitals with an older patient population. When adjusting for baseline obstetrical and hospital characteristics, high-CDR hospitals remained independently associated with an elevated risk of Caesarean delivery. These findings persisted in stratified analyses of each hospital and patient-level characteristic. Obstetrical and neonatal outcomes were comparable in all hospitals irrespective of CDR.

Conclusion: Hospital characteristics and case mix do not account for the significant variation in CDRs across U.S. hospitals. Individual hospitals are in themselves independent risk factors for Caesarean delivery. Choosing to give birth in a certain hospital may put women at an increased risk of having a Caesarean delivery, without maternal or neonatal benefit.
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http://dx.doi.org/10.1016/j.jogc.2018.11.013DOI Listing
September 2019

Cannabis Abuse or Dependence During Pregnancy: A Population-Based Cohort Study on 12 Million Births.

J Obstet Gynaecol Can 2019 May 15;41(5):623-630. Epub 2018 Nov 15.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC. Electronic address:

Objective: Cannabis is the most commonly used recreational drug during pregnancy in the United States. This study aimed to describe the rate of cannabis dependence or abuse use during pregnancy and its effect on obstetrical and neonatal outcomes.

Methods: A retrospective population-based cohort of births in the United States between 1999 and 2013 was created using data from the National Inpatient Sample. Births to mothers who reported cannabis dependence or abuse were identified using ICD-9 codes, and the effect on various obstetrical and neonatal outcomes was assessed using logistic regression, adjusting for relevant confounders (Canadian Task Force Classification II-2).

Results: A total of 12 578 557 births were included in our analysis. The incidence of cannabis abuse or dependence rose from 3.22 in 1000 births in 1999 to 8.55 in 1000 births in 2013 (P < 0.0001). Women reporting cannabis dependence or abuse were more likely to have a preterm premature rupture of membranes (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.35-1.58), a hospital stay of >7 days (OR 1.17; 95% CI 1.11-1.23), and an intrauterine fetal demise (OR 1.50; 95% CI 1.39-1.62). Neonates born to exposed mothers had a higher risk of prematurity (OR 1.40; 95% CI 1.36-1.43) and growth restriction (OR 1.35; 95% CI 1.30-1.41).

Conclusion: Cannabis use during pregnancy steadily increased over the study period. Users of cannabis during gestation were more likely to have adverse outcomes during delivery and require longer periods of hospitalization. Neonates born to exposed mothers were more likely to be born preterm and underweight.
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http://dx.doi.org/10.1016/j.jogc.2018.09.009DOI Listing
May 2019

Pregnancy outcomes in women with rheumatoid arthritis: a retrospective population-based cohort study.

J Matern Fetal Neonatal Med 2020 Feb 6;33(4):618-624. Epub 2018 Sep 6.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University Montreal, Montreal, Canada.

To assess if pregnancies in women with rheumatoid arthritis (RA) are at a higher risk for adverse maternal and neonatal outcomes. A retrospective cohort study was carried out using the Healthcare Cost and Utilization Project - National Inpatient Sample (HCUP-NIS) from the USA. All births that took place from 2004 to 2013 were identified and women were classified as having RA or not on the basis of ICD-9 coding. Unconditional logistic regression was used to evaluate the adjusted effect of RA on maternal and neonatal outcomes. Of the total 8,417,607 births in our cohort, 6068 were among women with RA for an overall prevalence of 72 per 100,000 births. There was a steady increase in reported RA in pregnancy from 47 to 100 per 100,000 over the 10-year study period. Compared with women without RA, women with RA were more likely to develop pre-eclampsia/eclampsia, gestational diabetes, to present with preterm premature rupture of membranes(PPROM), to experience placental abruption and placenta previa, and to deliver by caesarean section. Postpartum, RA-complicated pregnancies were associated with wound complications and thromboembolisms. Congenital anomalies, small for gestational age and preterm birth were more common in neonates of women with RA. RA in pregnancy is associated with a greater likelihood of adverse maternal and neonatal outcomes. Women with RA should be made aware of these risks and be followed as a high risk pregnancy.
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http://dx.doi.org/10.1080/14767058.2018.1498835DOI Listing
February 2020

Large-for-Gestational-Age May Be Associated With Lower Fetal Insulin Sensitivity and β-Cell Function Linked to Leptin.

J Clin Endocrinol Metab 2018 10;103(10):3837-3844

Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Quebec, Canada.

Context: Fetal overgrowth is associated with increased risk for type 2 diabetes in adulthood. It is unclear whether there are alterations in insulin sensitivity and β-cell function in early life.

Objective: To determine whether large-for-gestational-age (LGA) (birth weight > 90th percentile), an indicator of fetal overgrowth, is associated with altered fetal insulin sensitivity and β-cell function.

Study Design, Population, And Outcomes: In the Design, Development, and Discover birth cohort in Canada, we studied 106 pairs of LGA and optimal-for-gestational-age (OGA; birth weight, 25th to 75th percentiles) infants matched by maternal ethnicity, smoking status, and gestational age. Cord plasma glucose-to-insulin ratio was used as an indicator of fetal insulin sensitivity, and proinsulin-to-insulin ratio was used as an indicator of β-cell function. Cord plasma leptin and high-molecular-weight (HMW) adiponectin concentrations were measured.

Results: Comparisons of infants who were born LGA vs OGA, adjusted for maternal and newborn characteristics, showed that cord blood insulin, proinsulin, and leptin concentrations were significantly higher, whereas HWM adiponectin concentrations were similar. Glucose-to-insulin ratios were significantly lower (15.4 ± 28.1 vs 22.0 ± 24.9; P = 0.004), and proinsulin-to-insulin ratios significantly higher (0.73 ± 0.82 vs 0.60 ± 0.78; P = 0.005) in LGA vs OGA newborns, indicating lower insulin sensitivity and β-cell function in LGA newborns. These significant differences were almost unchanged after further adjustment for cord blood adiponectin levels but disappeared upon additional adjustment for cord blood leptin levels.

Conclusions: This study demonstrates that LGA may be associated with decreases in both fetal insulin sensitivity and β-cell function. The alterations appear to be linked to elevated leptin levels.
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http://dx.doi.org/10.1210/jc.2018-00917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179169PMC
October 2018

Obstetrical, maternal and neonatal outcomes in pregnancies affected by muscular dystrophy.

J Perinat Med 2018 Sep;46(7):791-796

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1515/jpm-2017-0299DOI Listing
September 2018

Maternal Circulating Placental Growth Factor and Neonatal Metabolic Health Biomarkers in Small for Gestational Age Infants.

Front Endocrinol (Lausanne) 2018 25;9:198. Epub 2018 Apr 25.

Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, QC, Canada.

Small for gestational age (SGA) infants are at increased risk of type 2 diabetes in adulthood. It is unknown whether any prenatal biomarkers are helpful for identifying SGA infants with altered metabolic health profile at birth or later life. In a nested study of 162 SGA (birth weight < 10th percentile) and 161 optimal birth weight (25th-75th percentiles) control infants in the 3D (design, develop and discover) birth cohort in Canada, we assessed whether maternal circulating placental growth factor (PlGF), a biomarker of placental function, is associated with metabolic health biomarkers in SGA infants. Main outcomes were cord plasma insulin, proinsulin, insulin-like growth factor-I (IGF-I), leptin, and high-molecular weight (HMW) adiponectin concentrations. Maternal PlGF concentrations at 32-35 weeks of gestation were substantially lower in SGA versus control infants ( < 0.001), so as were cord plasma proinsulin ( = 0.005), IGF-I ( < 0.001), leptin ( < 0.001), and HMW adiponectin ( = 0.002) concentrations. In SGA infants with both low (<25th percentile) and normal maternal PlGF concentrations, cord plasma IGF-I and leptin concentrations were lower than control infants, but the decreases were to a greater extent in SGA infants with low maternal PlGF. Cord blood leptin levels were lower comparing SGA infants with low vs. normal maternal PlGF levels ( = 0.01). SGA infants with low maternal circulating PlGF levels at late gestation were characterized by greater decreases in cord blood IGF-I and leptin concentrations. Maternal circulating PlGF appears to be associated with neonatal metabolic health profile in SGA infants.
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http://dx.doi.org/10.3389/fendo.2018.00198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996905PMC
April 2018

Effect of pre-pregnancy body mass index on respiratory-related neonatal outcomes in women undergoing elective cesarean prior to 39 weeks.

J Perinat Med 2018 Oct;46(8):905-912

Center for Clinical Epidemiology and Community Studies, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.

Objective To examine the association between pre-pregnancy body mass index (BMI) and neonatal respiratory-related outcomes among women who underwent an elective cesarean section (CS). Methods A retrospective cohort study was conducted using the Centers for Disease Control and Prevention (CDC)'s 2009-2013 period linked birth/infant death dataset. Women who had elective CSs at term were categorized by their pre-pregnancy BMI as normal, overweight, obese or morbidly obese. Odds ratios (OR) and 95% confidence intervals (CIs), adjusted for baseline characteristics, were calculated using multivariate logistic regression to estimate the neonatal risks in relation to maternal pre-pregnancy BMI. Results Our cohort consisted of 717,080 women, of whom 39.9% had normal BMI, 27.0% were overweight, 25.7% obese and 7.4% morbidly obese. A dose-dependent relationship between maternal pre-pregnancy BMI and assisted ventilation was seen. Furthermore, infants born to morbidly obese women were at significantly increased risk for assisted ventilation over 6 h (OR 1.24, 95% CI 1.15-1.35) and admission to intensive care units (OR 1.17, 95% CI 1.13-1.21). Infant mortality rates were 4.2/1000 births for normal weight women, and 5.5/1000 births among the morbidly obese group (OR 1.43, 95% CI 1.25-1.64). Risk for adverse outcomes was increased with elective SC performed at earlier gestational age, and this effect was not modified by use of corticosteroids. Conclusion Overweight and obese women are at particularly greater risk of adverse newborn outcomes when elective CSs are done before 39 weeks. In these women, elective CSs should be delayed until 39 weeks, as corticosteroid use did not eliminate this association.
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http://dx.doi.org/10.1515/jpm-2017-0384DOI Listing
October 2018

Diabetic ketoacidosis among pregnant and non-pregnant women: a comparison of morbidity and mortality.

J Matern Fetal Neonatal Med 2019 Aug 27;32(16):2649-2652. Epub 2018 Feb 27.

a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Canada.

Purpose: Diabetic ketoacidosis (DKA) is a critical diagnosis that can cause severe morbidity and mortality in the diabetic population. Although it is rare in pregnancy, the aim of this study is to compare DKA in pregnant women with age-matched non-pregnant women to determine if outcomes are influenced by pregnancy.

Materials And Methods: A population-based age-matched retrospective cohort was carried out using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2013. Pregnant patients with DKA were age-matched with non-pregnant controls also admitted with DKA at a ratio of 1:10. Severe morbidities and mortality were compared among the two groups. Logistic regression was used to adjust for baseline characteristics and comorbidities.

Results: We identified 4661 cases of DKA in pregnancy during our study period, which were age-matched to 46,610 non-pregnant controls. Pregnant women with DKA were more likely to stay in hospital for >3 d (odds ratios (OR) 2.15, 95% CI 2.06-2.25) and had more associated renal failure (OR 2.86, 95% CI 1.76-4.55); however, they were less likely to require ventilation (OR 0.70, 95% CI 0.62-0.79), experience systemic inflammatory response syndrome (OR 0.53, 95% CI 0.38-0.73), or seizures (OR 0.49, 95% CI 0.42-0.57). Among pregnant women, rates of coma (0.04%) and death (0.17%, OR 0.23, 95% CI 0.14-0.39) were lower than previously reported and lower than non-pregnant women.

Conclusion: Pregnant women with DKA are admitted to hospital for longer periods than non-pregnant controls and are at higher risk for renal failure but otherwise have better outcomes and less mortality than non-pregnant controls.
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http://dx.doi.org/10.1080/14767058.2018.1443071DOI Listing
August 2019

Effect of Cesarean Delivery on Long-term Risk of Small Bowel Obstruction.

Obstet Gynecol 2018 02;131(2):354-359

Department of Obstetrics & Gynecology, Jewish General Hospital, the Center for Clinical Epidemiology, Lady Davis Institute, the Department of Family Medicine, and the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

Objective: To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction.

Methods: We formed a population-based cohort of all women with a first live birth between 1998 and 2007 using the U.K. Clinical Practice Research Datalink. Women were followed until 2015, the occurrence of a small bowel obstruction, or loss to follow-up. Cesarean delivery was identified from the Hospital Episode Statistics and small bowel obstruction events were identified using the Classification of Interventions and Procedures and International Classification of Diseases, 10th Revision codes. Cox proportional hazard models, with cesarean delivery defined as a time-dependent exposure, estimated the adjusted hazard ratios and 95% CIs of small bowel obstruction associated with cesarean delivery.

Results: The cohort included 81,480 women with a median follow-up of 8.0 years (range 6 months to 16.6 years), during which 575 new small bowel obstructions occurred (incidence 9.1/10,000 person-years). Risk of small bowel obstruction was higher among women with a cesarean delivery compared with women without (16.3 vs 6.4 patients/10,000 person-years, odds ratio [OR] 2.54, 95% CI 2.15-3.00). Increasing number of cesarean deliveries was associated with an increasing risk of small bowel obstruction (OR 1.61, 95% CI 1.46-1.78, per additional cesarean delivery). Repeated small bowel obstructions were more common among women with a cesarean delivery and the association remained when restricting to small bowel obstruction requiring surgical management.

Conclusion: Although rare, small bowel obstructions are increased among women who have undergone a cesarean delivery. With increasing rates of cesarean deliveries worldwide, small bowel obstructions and related morbidities may become a more prevalent women's health concern.
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http://dx.doi.org/10.1097/AOG.0000000000002440DOI Listing
February 2018

Inter-institutional Variation in Use of Caesarean Delivery for Labour Dystocia.

J Obstet Gynaecol Can 2017 Nov 12;39(11):988-995. Epub 2017 Sep 12.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC.

Objective: To establish the degree of variation across hospitals in the use of Caesarean delivery for the indication of labour dystocia before and after accounting for maternal, fetal, and hospital characteristics.

Methods: This study was a retrospective, population-based cohort study of nulliparous women delivering term singletons in cephalic position following labour. Delivery visits were extracted from three provincial perinatal registries in the Canadian provinces of Ontario, Alberta, and British Columbia, from 2008-2012. Crude hospital-specific rates of Caesarean delivery for labour dystocia were reported, and these rates were then stabilized to account for hospitals with low delivery volumes. Rates were then adjusted for maternal, fetal, and hospital characteristics using hierarchical logistic regression.

Results: Among 403 205 women delivering at 170 hospitals, the overall Caesarean delivery rate was 21.0%, and the rate of Caesarean delivery for labour dystocia was 12.7%, indicating that 60% of all Caesarean deliveries were performed in part for this indication. The middle 95% of hospitals had Caesarean delivery rates for labour dystocia ranging from 4.5% to 24.7%. Differences in maternal case mix and hospital characteristics explained only a small proportion of this variation (95% central range 6.3%-21.7%).

Conclusion: Considerable inter-hospital variation in rates of Caesarean delivery for labour dystocia remained after accounting for differences in maternal and hospital factors. Reporting systems that monitor variation in inter-institutional rates should incorporate stabilization and adjustment for case-mix differences and consider indication-specific rates of Caesarean delivery to more fairly compare hospital performance and better target interventions to reduce Caesarean delivery for specific indications.
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http://dx.doi.org/10.1016/j.jogc.2017.05.003DOI Listing
November 2017

Obstetrical and perinatal morbidity and mortality among in-vitro fertilization pregnancies: a population-based study.

Arch Gynecol Obstet 2017 Jul 25;296(1):107-113. Epub 2017 May 25.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.

Purpose: To compare patient characteristics and obstetrical/neonatal outcomes of in-vitro fertilization (IVF) and spontaneously conceived pregnancies.

Methods: Using the Nationwide Inpatient Sample, we conducted a retrospective cohort study from 2008 to 2011 comparing IVF conceptions to spontaneous ones. Patient characteristics were descriptively compared, and after adjusting for baseline characteristics with logistic regression, obstetrical/neonatal outcomes were also compared.

Results: Among 3,315,764 pregnancies, 5773 (0.17%) were a result of IVF. These patients were more often older, wealthier, Caucasian, non-smokers, and more likely to carry a higher order pregnancy. IVF was strongly associated with pre-eclampsia (OR 1.48, 95% CI 1.32-1.62), gestational diabetes (OR 1.27, 95% CI 1.17-1.38), antepartum hemorrhage (OR 2.04, 95% CI 1.79-2.32), placenta previa (OR 3.14, 95% CI 2.71-3.64), pre-term premature rupture of membranes (OR 1.49, 95% CI 1.30-1.70), chorioamnionitis (OR 1.52, 1.29-1.79), and cesarean section (OR 1.60, 95% CI 1.51-1.70). There was a significantly increased risk of post-partum hemorrhage (OR 2.95, 95% CI 2.29-3.80) and hysterectomy (OR 1.73, 95% CI 1.12-2.69), as well as disseminated intravascular coagulopathy (OR 2.23, 95% CI 1.24-3.99), transfusion (OR 1.78, 95% CI 1.53-2.07), prolonged hospitalization (OR 1.96, 95% CI 1.80-2.14), intrauterine growth restriction (OR 1.81, 95% CI 1.63-2.02), and pre-term birth (OR 1.31, 95% CI 1.22-1.41).

Conclusion: IVF is still primarily used by only a subset of the population, and is associated with increased obstetrical and perinatal morbidity and mortality. These patients may benefit from more vigilant antenatal surveillance and delivery in a tertiary care center.
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http://dx.doi.org/10.1007/s00404-017-4379-8DOI Listing
July 2017

Prise en charge des femmes présentant un col de l’utérus court.

Authors:
Haim A Abenhaim

J Obstet Gynaecol Can 2017 05;39(5):319-320

Obstétricien et gynécologue, spécialiste en médecine fœto-maternelle, directeur de recherche périnatale, Hôpital général juif, Université McGill, Montréal (Québec).

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http://dx.doi.org/10.1016/j.jogc.2017.03.117DOI Listing
May 2017

Management of Women with Short Cervix.

Authors:
Haim A Abenhaim

J Obstet Gynaecol Can 2017 05;39(5):317-318

Obstetrician & Gynecologist/Maternal Fetal Medicine Specialist, Director of Perinatal Research, Jewish General Hospital, McGill University, Montréal, QC.

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http://dx.doi.org/10.1016/j.jogc.2017.03.084DOI Listing
May 2017

Prolactin-Elevating Antipsychotics and the Risk of Endometrial Cancer.

J Clin Psychiatry 2017 Jun;78(6):714-719

Jewish General Hospital, Lady Davis Institute, Centre for Clinical Epidemiology, 3755 Côte Sainte-Catherine, Montreal, Quebec, H3T 1E2, Canada.

Background: The use of antipsychotics may increase the risk of endometrial cancer through elevation of prolactin levels. We investigated the association between antipsychotics that are known to cause prolactin elevation and the risk of endometrial cancer.

Methods: In data from the United Kingdom Clinical Practice Research Datalink, all women who were newly treated with antipsychotics from 1990-2013 were identified and followed until 2014. Within this cohort of antipsychotic users, a nested case-control analysis was conducted. Main exposure was nonsporadic use of prolactin-elevating antipsychotics, and the active comparator was prolactin-sparing antipsychotics. Cases were women newly diagnosed with endometrial cancer (ICD-10) matched with up to 20 controls on age, calendar year of cohort entry, linkability to the Hospital Episode Statistics repository, and duration of follow-up. Conditional logistic regression models were used to determine the association of prolactin-elevating antipsychotics and endometrial cancer compared with prolactin-sparing antipsychotics. All analyses were adjusted for relevant potential confounders, including smoking, obesity, and diabetes mellitus.

Results: The cohort included 65,930 women. During 366,112 person-years of follow-up, there were 139 cases of endometrial cancer (incidence rate: 38/100,000 person-years), which were matched to 1,603 controls. Compared with the use of prolactin-sparing antipsychotics, the use of prolactin-elevating antipsychotics was not associated with an increased risk of endometrial cancer (adjusted odds ratio [aOR] = 1.00; 95% CI, 0.68-1.48). These findings remained similar with different durations of use (≤ 1 year, aOR = 1.07; 95% CI, 0.64-1.78, and > 1 year, aOR = 0.95; 95% CI, 0.58-1.54) and were robust to various sensitivity analyses.

Conclusions: Prolactin-elevating antipsychotics were not associated with an increased risk of endometrial cancer.
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http://dx.doi.org/10.4088/JCP.15m10532DOI Listing
June 2017

Pregnancy outcomes in HIV-positive women: a retrospective cohort study.

Arch Gynecol Obstet 2017 Mar 17;295(3):599-606. Epub 2017 Jan 17.

Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada.

Purpose: In the United States, an estimated 8500 HIV (human immunodeficiency virus) positive women gave birth in 2014. This rate appears to be increasing annually. Our objective is to examine obstetrical outcomes of pregnancy among HIV-positive women.

Methods: A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003-2011) from the United States. Pregnant HIV-positive women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical and neonatal outcomes.

Results: Among 7,772,999 births over the study period, 1997 were in HIV-positive women (an incidence of 25.7/100,000 births). HIV-infected patients had greater frequency of pre-existing diabetes and chronic hypertension, and use of cigarettes, drugs, and alcohol during pregnancy (p < 0.001). Upon adjustment for baseline characteristics, HIV-infected women had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.35, 95% CI 1.14-1.60) and urinary tract infections (OR 3.02, 95% CI 2.40-3.81). Delivery and postpartum complications were also increased among HIV-infected women: cesarean delivery (OR 3.06, 95% CI 2.79-3.36), postpartum sepsis (OR 8.05, 95% CI 5.44-11.90), venous thromboembolism (OR 2.21, 95% CI 1.46-3.33), blood transfusions (OR 3.67, 95% CI 3.01-4.49), postpartum infection (OR 3.00, 95% CI 2.37-3.80), and maternal mortality (OR 21.52, 95% CI 12.96-35.72). Neonates born to these mothers were at higher risk of prematurity and intrauterine growth restriction.

Conclusion: Pregnancy in HIV-infected women is associated with adverse maternal and newborn complications. Pregnant HIV-positive women should be followed in high-risk healthcare centers.
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http://dx.doi.org/10.1007/s00404-016-4271-yDOI Listing
March 2017
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