Publications by authors named "Ri-Hua Xie"

33 Publications

Association between perceived birth trauma and postpartum depression: A prospective cohort study in China.

Int J Gynaecol Obstet 2021 Jul 29. Epub 2021 Jul 29.

Department of Nursing, The Seventh Affiliated Hospital of Southern Medical University, Foshan, Guangdong, China.

Objective: To assess the association between women's perceived birth trauma and risk of postpartum depression (PPD).

Methods: We conducted a prospective cohort study in China between December 2018 and November 2019. Women aged 18-45 years who had a singleton live birth at a university teaching hospital were enrolled after written consent was obtained. PPD was defined as a score of 13 or more on the Chinese version of the Edinburgh Postnatal Depression Scale. We used multiple log-binomial regression analysis to estimate the independent association between perceived birth trauma and PPD.

Results: A total of 650 eligible women were included in the final analysis. Of them, 245 (37.69%) had self-reported perceived birth trauma and 188 (28.92%) developed PPD. The PPD rate was 42.04% in women with perceived birth trauma, compared with 20.99% in women without perceived birth trauma (crude relative risk [RR] 2.46, 95% confidence interval [CI] 1.48-3.72). The increased risk of PPD for women with perceived birth trauma remained after adjustment for sociodemographic and obstetric factors (adjusted RR 2.13, 95% CI 1.69-3.28).

Conclusion: Perceived birth trauma may be an important risk factor for PPD in Chinese women. Supportive care for women who perceived childbirth as a trauma may help to reduce the risk of PPD.
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http://dx.doi.org/10.1002/ijgo.13845DOI Listing
July 2021

Maternal and neonatal outcomes in women undergoing Roux-en-Y gastric bypass: A systematic review and meta-analysis.

Eur J Obstet Gynecol Reprod Biol 2021 Sep 7;264:117-127. Epub 2021 Jul 7.

Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada; Department of Nursing, General Practice Center Nanhai Hospital, Southern Medical University, Guangzhou, PR China. Electronic address:

Background: To summarize evidence of benefits and risks of maternal and neonatal outcomes among pregnant women after Roux-en-Y gastric bypass surgery.

Methods: A systematic search was conducted in MEDLINE, EMBASE, Web of Science, Ovid and Cochrane Library until 24th May 2021. Inclusion criteria were randomized trails or observational studies including at least one of maternal or neonatal outcomes from pregnant women who had a history of Roux-en-Y gastric bypass surgery with a control group of pregnant women with no history of bariatric surgery. Non-English studies were excluded. Both fixed-effect and random-effect models were used in the meta-analyses. Newcastle-Ottawa Scale was used to assess quality of studies.

Results: Twelve retrospective articles were eligible including 13 848 pregnant women with a history of Roux-en-Y gastric bypass surgery and 255 008 pregnant women without a history of bariatric surgery. The results of meta-analysis showed a lower incidence of preterm premature rupture of membranes (OR 0.53, 95% CI [0.47, 0.60], p < 0.00001), large gestational age infants (OR 0.28, 95%CI [0.22, 0.37], p < 0.00001) or macrosomia (OR 0.26, 95%CI [0.23, 0.30], p < 0.00001) in women after Roux-en-Y gastric bypass surgery. On the other hand, infants born to mothers with a history of Roux-en-Y gastric bypass surgery had an increased risk of small gestational age (OR 2.24, 95% CI [1.55, 3.24], p < 0.00001).

Conclusion: Roux-en-Y gastric bypass surgery reduces significantly of risks of preterm premature rupture of membranes and large for gestational age/ macrosomia, but increase the risk of small for gestational age.
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http://dx.doi.org/10.1016/j.ejogrb.2021.07.006DOI Listing
September 2021

Treatment for grade 4 peripheral intravenous infiltration with type 3 skin tears: A case report and literature review.

Int Wound J 2021 Jun 15. Epub 2021 Jun 15.

Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada.

Grade 4 peripheral intravenous infiltration with skin tears has seldom been reported. On 4 August 2020, a 35-year-old female patient was admitted to the emergency department of our hospital because of postprandial abdominal pain for 2 hours. She was diagnosed with a severe acute pancreatitis with type II diabetes mellitus. On 7 August, a vein detained needle was inserted into the dorsal vein of her right foot to infuse drugs. On 9 August, a grade 4 infiltration, discoloured and bruised skin with a swollen area of 11 cm × 9 cm around the infusion part of her right foot, was discovered. The infusion was stopped immediately and the residual drug was aspirated at the infusion site. When removing the vein detained needle, the skin surrounding the infusion site on the right foot was torn by the adhesive dressing. The size of the skin tears was 6 cm × 3 cm (type 3). The patient was provided with appropriate dressing, manual lymphatic drainage, and surgical intervention. Two months later, she was fully recovered with no functional impairment of the affected foot. Timely local wound interventions could lead to a satisfactory outcome for severe peripheral intravenous infiltration with skin tears.
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http://dx.doi.org/10.1111/iwj.13624DOI Listing
June 2021

Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study.

J Obstet Gynaecol Can 2021 Sep 23;43(9):1076-1082. Epub 2021 Jan 23.

Department of Obstetrics and Gynecology, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan (Guangdong), China.

Objective: Comprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis.

Methods: We conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes.

Results: A total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed.

Conclusions: History of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.
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http://dx.doi.org/10.1016/j.jogc.2020.12.022DOI Listing
September 2021

The Effects of Traditional Chinese Medicine as an Auxiliary Treatment for COVID-19: A Systematic Review and Meta-Analysis.

J Altern Complement Med 2021 Mar 20;27(3):225-237. Epub 2020 Nov 20.

Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Coronavirus disease 2019 (COVID-19) has become a pandemic with no specific and widely accepted effective drug or vaccine. However, studies have shown that Traditional Chinese Medicine (TCM) may play a significant role as an auxiliary treatment for COVID-19. This study aimed to assess the effects of TCM as an auxiliary treatment for COVID-19 through a systematic review of randomized-controlled trials (RCTs). Four English and three Chinese language databases were searched from December 1, 2019, to June 30, 2020. RCTs comparing TCM in combination with Western medicine (WM) with the same WM therapies alone for confirmed COVID-19 patients were included. The outcome measures were cure rate, lowering of body temperature, cough relief, improvement in chest computed tomography (CT) images, deterioration of condition, and adverse effects. Methodological quality was assessed using the Cochrane risk-of-bias tool. A series of meta-analyses were conducted for selected outcomes using RevMan 5.3 software. The quality of evidence was appraised using the grading of recommendation, assessment, development, and evaluation (GRADE) recommendations. Ten RCTs with a total of 1,285 patients were included. Compared with WM alone in treating COVID-19, WM with auxiliary treatment by TCM appears to have increased the cure rate (risk ratio [RR] 1.15 [95% confidence interval (CI) 1.04-1.26]), relieved cough (RR 1.32 [95% CI 1.15-1.52]), improved chest CT images (RR 1.23 [95% CI 1.11-1.37]), and reduced the number of cases transitioning from a moderate to severe condition (RR 0.58 [95% CI 0.43-0.77]). The authors are uncertain whether TCM combined WM has effects on fever normalization (RR 1.10 [95% CI 0.94-1.29]) or adverse effects (RR 0.81 (95% CI 0.42-1.57]). Although they evaluated the certainty of evidence for lowering body temperature and adverse effects as very low, and low for cure rate, certainty was evaluated as moderate for improvement in chest CT images, cough relief, and deterioration of condition. TCM may be an effective auxiliary treatment for COVID-19 patients, which is likely to help improve the main symptoms and reduce disease progression. However, due to the limited number of studies and apparent heterogeneity among them, a more definitive conclusion on the effect of TCM on lowering body temperature and adverse effects cannot be drawn at this time.
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http://dx.doi.org/10.1089/acm.2020.0310DOI Listing
March 2021

The impact of pregnancy on postoperative outcomes among obese women who underwent bariatric surgery: A systematic review and meta-analysis.

Eur J Obstet Gynecol Reprod Biol 2020 Sep 23;252:239-245. Epub 2020 Jun 23.

School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada. Electronic address:

Objectives: Women who had a history of bariatric surgery are increasingly becoming pregnant. There is growing evidence showing that increased risk of postoperative complications may be associated with the gestation after bariatric surgery.The objective of this systematic review was to evaluate the potential impact of pregnancy on weight loss and postoperative complications in obese women after bariatric surgery.

Study Design: PubMed, Embase, Medline and Cochrane Central Register of Controlled Trails were searched from inception through October 2018. Selection criteria included observational or randomized trial examining weight loss and medical complications in pregnant compared to non-pregnant women after bariatric surgery. Two reviewers extracted information and performed quality appraisal of eligible articles. Meta-analysis was performed to ascertain the certainty of the evidence when possible.

Results: Seven observational cohort studies with a total of 27,369 obese women were included in the final analysis. The mean difference (95 % confidence interval) in percent excess weight loss between pregnant and non-pregnant subjects was -9.5 (-19.9, 0.9). The odds ratio (95 % confidence interval) for postoperative complications in pregnant relative to non-pregnant subjects was 0.85 (0.33, 2.18).

Conclusions: Pregnancy may have little or no effect on weight loss or postoperative complications in women who have undergone bariatric surgery.
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http://dx.doi.org/10.1016/j.ejogrb.2020.06.044DOI Listing
September 2020

Risk factors and consequences of undiagnosed cesarean scar pregnancy: a cohort study in China.

BMC Pregnancy Childbirth 2019 Oct 26;19(1):383. Epub 2019 Oct 26.

Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Background: The historically high cesarean section rate and the recent change in second-child policy could increase the risk of cesarean scar pregnancy (CSP) in China. This study aims to assess risk factors and consequences of undiagnosed CSP in China.

Methods: We conducted a retrospective cohort study between January 2013 and December 2017 in Qingyuan, Guangdong, China. Independent risk factors for undiagnosed CSP at the first contact with healthcare providers were assessed by log binomial regression analysis. Occurrence of serious complications was compared between undiagnosed and diagnosed CSP cases.

Results: A total of 195 women with CSP were included in the analysis. Of them, 81 (41.5%) women were undiagnosed at the first contact with healthcare providers. Women initially cared in primary or secondary hospitals were at increased risk for undiagnosed CSP: adjusted relative risks (95% confidence intervals) were 3.28 (2.06, 5.22) and 1.91 (1.16, 3.13), respectively, compared with women initially cared in the tertiary hospital. Undiagnosed CSP cases had higher incidences in serious complications (11 versus 0) and post-surgery anemia (23 (28.4%) versus 8 (7.0%)), stayed longer in hospital, and cost higher than diagnosed CSP cases.

Conclusions: Initial care provided at primary or secondary maternity care facilities is an important risk factor for undiagnosed CSP, with serious consequences to the affected women.
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http://dx.doi.org/10.1186/s12884-019-2523-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815460PMC
October 2019

Prevalence of Post-Traumatic Stress Disorder Following Caesarean Section: A Systematic Review and Meta-Analysis.

J Womens Health (Larchmt) 2020 02 18;29(2):200-209. Epub 2019 Sep 18.

Department of Nursing, General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China.

While caesarean section (CS) can be a lifesaving intervention when performed in a timely manner to overcome dystocia or other complications, it is a traumatic event and may increase the risk of post-traumatic stress disorder (PTSD). No attempt has been made to assess prevalence of PTSD after CS specifically. This study aimed to quantify pooled prevalence of PTSD after CS through a systematic review and meta-analysis. MEDLINE, PsycINFO, EMBASE, and CINAHL were searched using PTSD terms crossed with CS terms. Studies were included if they reported the prevalence of PTSD after CS using an instrument based on Diagnostic and Statistical Manual of Mental Disorders-criteria to identify PTSD. The pooled prevalence was then estimated by meta-analysis in overall eligible studies and in subgroups. Nine studies were included with a total of 1,134 postpartum women, of which 136 were identified as having PTSD. Pooled prevalence of PTSD after CS was 10.7% (95% confidence interval [CI]: 4.0-20.2). Pooled prevalence of PTSD after emergency CS (10.3% [95% CI: 1.7-24.9]) was higher than that after elective CS (7.1% [95% CI: 0.7-19.4]), but the difference was not statistically significant. Subgroup analysis showed that pooled prevalence of PTSD after CS differed according to study setting, time interval of PTSD assessment, and type of participants. Meta-regression analysis showed that study setting and type of study participants were significant sources of heterogeneity. Women with CS apparently have higher rates of PTSD as compared with women without CS. However, the susceptibility to PTSD appears to vary based on emergency/elective CS, study methodology, self-perceived traumatic birth, and country of study. Further targeted research is needed to elucidate the role of these factors in relationship between CS and PTSD.
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http://dx.doi.org/10.1089/jwh.2019.7750DOI Listing
February 2020

Using Video Feedback Through Smartphone Instant Messaging in Fundamental Nursing Skills Teaching: Observational Study.

JMIR Mhealth Uhealth 2019 09 5;7(9):15386. Epub 2019 Sep 5.

School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Background: Video feedback has been shown to be an effective teaching tool that can improve student learning when having them view their own performance. However, the literature on the effect of integrating smartphones with video feedback in fundamental nursing skills teaching is sparse.

Objective: This study aimed to explore the potential effects of video feedback through smartphone-based instant messaging on teaching undergraduate nursing students fundamental nursing skills.

Methods: We conducted a study on teaching fundamental nursing skills to 6 classes of second-year undergraduate nursing students. In 2 classes (the intervention group), the instructor elected to use smartphone-based video feedback to facilitate teaching; instructors in the other 4 classes (the control group) elected to use routine methods of teaching without video feedback. Scores from the final examination, in-class assignments, and the General Self-Efficacy Scale questionnaire were collected and compared between the two groups. Multiple linear regression analysis was performed to estimate the independent effect of video feedback after adjusting for gender, age, and prior experience in the use of WeChat/QQ in learning applications. An ad hoc questionnaire was used for student evaluation of the novel smartphone-based video feedback teaching method.

Results: A total of 195 nursing students (65 in the video feedback group and 130 in the control group) completed the study and were included in the final analysis. Mean and standard deviation of scores on the final examination, bed making, aseptic procedure, vital signs measurement, and oxygen therapy were 91.29 (SD 2.36), 90.52 (SD 3.18), 93.23 (SD 3.16), 91.65 (SD 4.21), and 92.06 (SD 3.58), respectively, in the video feedback group and 89.99 (SD 3.12), 81.71 (SD 8.63), 87.12 (SD 5.50), 87.45 (SD 8.00), and 90.37 (SD 6.36), respectively, in the control group (differences were statistically significant). The mean and standard deviation of scores for assignments in catheterization and enema and General Self-Efficacy Scale were 89.69 (SD 3.22), 91.14 (SD 3.15), and 24.52 (SD 5.35), respectively, in the video feedback group and 88.82 (SD 7.48), 90.79 (SD 6.08), and 24.50 (SD 6.16), respectively, in the control group (differences were not statistically significant). The majority (over 98%) of nursing students were satisfied with this smartphone-based video feedback teaching method.

Conclusions: Video feedback through smartphone-based instant messaging may be an effective way to improve nursing students' academic performance and professional skills.
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http://dx.doi.org/10.2196/15386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786856PMC
September 2019

Neighborhood Income and Cesarean Section Rates at a Tertiary Care Center in Canada.

J Womens Health (Larchmt) 2019 12 7;28(12):1721-1726. Epub 2019 Feb 7.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

With rising rates of cesarean sections (CSs) in Canada and worldwide, nonclinical factors for CS warrant consideration. To determine the association between a primigravid woman's neighborhood income and rates of CSs. A retrospective cohort study was conducted at an Ontario tertiary care center from January 2003 to December 2013. Rates of CSs were determined using data collected from the Discharge Abstract Database. Women with singleton live births were included. The main exposure variable was the neighborhood income quintile. A multivariable model was used to adjust for covariates and provide an estimate of the independent effect of neighborhood income on the CS rate. The study cohort comprised 32,714 women. Compared with the lowest quintile, women in the highest quintile had increased rates of CSs (relative risk, RR 1.06, 95% confidence interval, CI [1.02-1.11]). Following adjustment for important confounders, there was no longer an association between the neighborhood income and CS rate (adjusted RR 1.00, 95% CI [0.99-1.01]). Women in the highest quintile were more likely to have greater maternal age ( < 0.01). Although differences in CS rates are seen by the neighborhood income quintile, they appear to be mediated through a combination of maternal age and other clinical factors. Neighborhood income does not appear to be an independent predictor of CS.
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http://dx.doi.org/10.1089/jwh.2018.6971DOI Listing
December 2019

The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial.

JMIR Mhealth Uhealth 2018 Dec 19;6(12):e11213. Epub 2018 Dec 19.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

Background: In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse.

Objective: This study aimed to explore the impact of a maternal education program through text messaging.

Methods: We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes.

Results: A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant.

Conclusions: Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging-based maternal education program suggested by this trial.

Trial Registration: ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo).
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http://dx.doi.org/10.2196/11213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315224PMC
December 2018

Sweet Solutions for Analgesia in Neonates in China: A Systematic Review and Meta-Analysis.

Can J Nurs Res 2019 Jun 22;51(2):116-127. Epub 2018 Nov 22.

9 Nursing Care of Children, Youth and Families, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Introduction: High-quality synthesized evidence of sweet taste analgesia in neonates exists. However, Chinese databases have never been included in previous systematic reviews of sweet solutions for procedural pain.

Objective: To conduct a systematic review of Chinese literature evaluating analgesic effects of sweet solutions for neonates. Data sources: Wang Fang, China National Knowledge Infrastructure and Chinese Biomedical Literature Database. Data extraction and analysis: Two authors screened studies for inclusion and conducted risk of bias ratings and data extraction. A third author resolved any conflicts. Meta-analyses were performed using RevMan 5.2 software, on mean differences in pain outcomes using random effects models.

Results: Thirty-one trials (4999 neonates) were included; 26 trials used glucose, 4 used sucrose, and 1 trial evaluated both solutions. Sweet solutions reduced standardized mean pain scores (n = 21 studies; -1.68, 95% confidence interval -2.08, -1.27) and cry duration (n = 6 studies; -25.60, 95% confidence interval -36.47, -14.72 s) but not heart rate change (n = 7 studies; -17.64, 95% confidence interval -52.71, 17.43). No included studies cited the previously published systematic reviews of sweet solutions.

Conclusions: This systematic review of Chinese databases showed the same results as previously published systematic reviews. No trials included in this review cited the English systematic reviews, highlighting a parallel research agenda.
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http://dx.doi.org/10.1177/0844562118803756DOI Listing
June 2019

Clinical Characteristics Differentiating Uterine Sarcoma and Fibroids.

JSLS 2018 Jan-Mar;22(1)

Department of Obstetrics and Gynaecology, University of Ottawa and the Ottawa Hospital Research Institute.

Background And Objectives: Uterine fibroids are a common indication for laparoscopy. Unsuspected sarcoma can pose a serious risk if morcellation is used in the procedure. We sought to determine the clinical factors associated with uterine sarcoma compared with uterine fibroids.

Methods: We conducted a case-control study of 66 women who had hysterectomy for uterine sarcoma from April 1, 2007, to March 31, 2014. Sixty-six patients who had hysterectomy for fibroids were randomly selected as controls.

Results: Women with sarcoma vs women with fibroids, tended to be older (mean ± SD 62.1 ± 10.1 vs 46.5 ± 6.6; < .0001), were more likely to be postmenopausal (81.8% vs 9.2%; < .0001), and were more likely to have a history of another nonuterine malignancy (16.7% vs 4.6%; = .02). Women with sarcoma were more likely to have masses that were subserosal (69.4% vs 34.8%; < .0001), rather than intramural (11.1% vs 37.0%; = .01), and to have a solitary rather than multiple uterine mass (56.3% vs 18.5%; < .0001). They were also more likely to have a history of documented rapid growth (16.7% vs 4.6%; = .02).

Conclusion: Despite limitations in sample size related to infrequency of uterine sarcoma, our results suggest some preoperative clinical differences between women who have uterine sarcoma vs uterine fibroids. Further studies on such features may assist us in identifying patients who are at higher risk of having a uterine sarcoma among women with a uterine mass contemplating surgery.
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http://dx.doi.org/10.4293/JSLS.2017.00066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779798PMC
July 2018

Association between surgically diagnosed endometriosis and adverse pregnancy outcomes.

Fertil Steril 2018 01 29;109(1):142-147. Epub 2017 Nov 29.

Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Objective: To examine the association between surgically diagnosed endometriosis and pregnancy outcomes in subsequent pregnancies.

Design: Retrospective cohort study of women who delivered a singleton live birth from 2003 to 2013 in Ottawa, Ontario, Canada.

Setting: Tertiary level academic center.

Patient(s): Pregnant women with surgically diagnosed endometriosis were identified using International Classification of Diseases-10 codes from previous hospital admissions and were compared with pregnant women with no prior admission for endometriosis for the occurrences of adverse pregnancy outcomes.

Intervention(s): Observational study.

Main Outcome Measure(s): Gestational hypertension, preeclampsia, placenta previa, placental abruption, postpartum hemorrhage, preterm birth, low birth weight, small for gestational age, and neonatal intensive care unit admission.

Results: Among the 52,202 eligible mother-infant pairs, we identified 469 mothers with surgically diagnosed endometriosis from a previous hospital encounter. Compared with women without endometriosis, women with endometriosis were on average older and were more likely to be primiparous, have lower gravidity, have a history spontaneous abortion, conceive with assisted reproductive technology, and reside in areas with higher neighborhood income and lower proportion of immigrants. Women with endometriosis were found to have an elevated risk of placenta previa (relative risk [RR], 3.30; 95% confidence interval [CI], 1.65-5.40) and cesarean delivery (RR, 1.24; 95% CI, 1.10-1.40). After adjustment for potential confounding factors, women with endometriosis were found to have a significantly elevated risk of placenta previa compared with women without endometriosis (adjusted RR, 2.54; 95% CI, 1.39-4.64).

Conclusion(s): This study identifies baseline demographic differences between women with and without endometriosis and suggests that women affected by endometriosis have an independently elevated risk of placenta previa in pregnancy.
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http://dx.doi.org/10.1016/j.fertnstert.2017.09.028DOI Listing
January 2018

Pre-gravid predictors of new onset hypertension in pregnancy - Results from a pre-conception cohort study in China.

Eur J Obstet Gynecol Reprod Biol 2017 Jul 12;214:140-144. Epub 2017 May 12.

OMNI Research Group, Department of Obstetrics Gynecology, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada; School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Canada.

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http://dx.doi.org/10.1016/j.ejogrb.2017.05.008DOI Listing
July 2017

What is the Best Pain Management During Gastric Tube Insertion for Infants Aged 0-12months: A Systematic Review.

J Pediatr Nurs 2017 May - Jun;34:78-83. Epub 2016 Dec 24.

University of Ottawa and Children's Hospital of Eastern Ontario, Canada. Electronic address:

Problem: Synthesized evidence on the effectiveness of pain management for nasogastric tube (NGT) and orogastric tube (OGT) insertions in infants is lacking. This paper is a systematic review of the effectiveness of pain management for gastric tube (GT) insertion in infants.

Eligibility Criteria: Randomized control trial (RCT) or quasi-experimental studies published up to April 2016, on pain management strategies during GT insertions (either NGT or OGT) in infants up to 12months of age. Databases searched included seven English databases and three Chinese databases.

Results: Six English studies out of 1236 screened met the eligibility criteria and were included in the review. Two studied OGT insertion and four studies focused on NGT insertion. All six studies evaluated oral sweet solutions (24%-30% sucrose and 25% glucose) compared to placebo (water) or no treatment and all focused on newborn infants. Data from four studies which used the Premature Infant Pain Profile (PIPP) were pooled for meta-analysis. Results showed a significant reduction in PIPP scores during or immediately after the procedure for sweet solution interventions (MD=-2.18, 95% CI (-3.86, -0.51), P=0.01), compared to no intervention or placebo.

Conclusions: Small volumes of oral sweet solutions reduce pain during GT insertion procedure in newborn infants.

Implications: Oral sweet solutions can be recommended before GT insertion for newborns in clinical practice. Further studies determining the effect of sweet solution beyond the newborn period, different concentrations of sweet solution and comparison with other pain management strategies are warranted. Systematic review registration number: CRD42016038535. http://www.crd.york.ac.uk/prospero/.
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http://dx.doi.org/10.1016/j.pedn.2016.12.015DOI Listing
April 2018

New Perspective on Impact of Folic Acid Supplementation during Pregnancy on Neurodevelopment/Autism in the Offspring Children - A Systematic Review.

PLoS One 2016 22;11(11):e0165626. Epub 2016 Nov 22.

OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada.

It has been conclusively established that folic acid supplementation prior to and during early pregnancy (up to 12 weeks of gestation) can prevent neural tube defects (NTDs). We hypothesized that folate effects may extend from neuro-structural defects to alterations in neuro-behavioural and emotional skills including autism spectrum disorders (ASDs) and other developmental disorders. The objective of this review was to comprehensively evaluate evidence on the impact of folic acid on neurodevelopment other than NTDs. We conducted an online search of relevant literature compiled by the National Library of Medicine from Medline and EMBASE (searched on Dec 31, 2014: http://www.ncbi.nlm.nih.gov/entrez/query/fcgi and http://www.elsevier.com/online-tools/embase). We first created 3 files (search restricted to English literature) using the following key words: 1) folate or folic acid (171322 papers identified by this search); 2) maternal or pregnancy or pregnant or gestation or gestational or prenatal or antenatal or periconception or periconceptional (1349219 papers identified by this search); and 3) autism or autism spectrum disorders or developmental delay or development or neurodevelopment or mental or cognitive or language or personal-social or gross motor or fine motor or behaviour or intellectual or intelligence or Bayley Scale (8268145 papers identified by this search). We then merged the 3 files and reviewed the papers that addressed these three issues simultaneously. A total of 22 original papers that examined the association between folic acid supplementation in human pregnancy and neurodevelopment/autism were identified after the screening, with 15 studies showing a beneficial effect of folic acid supplementation on neurodevelopment/autism, 6 studies showed no statistically significant difference, while one study showed a harmful effect in > 5 mg folic acid supplementation/day during pregnancy. Folic acid supplementation in pregnancy may have beneficial effects on the neurodevelopment of children beyond its proven effect on NTDs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165626PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5119728PMC
June 2017

[Efficacy of sweet solutions in relieving pain caused by vaccination in infants aged 1 to 12 months: a systematic review].

Zhongguo Dang Dai Er Ke Za Zhi 2016 Jun;18(6):534-40

School of Nursing, Hunan University of Medicine, Huaihua, Hunan 418000, China.

Objective: To investigate the efficacy of oral sweet solutions in relieving pain caused by vaccination in infants aged 1 to 12 months.

Methods: Related databases were searched to find related randomized control trails (RCTs). The quality of these RCTs was evaluated. The Meta analysis was performed using RevMan 5.3.

Results: A total of 20 RCTs involving 2 376 infants were included, and quality assessment showed that 6 RCTs had grade A quality and 14 had grade B quality. The Meta analysis showed that compared with sterile water, 25%-75% oral sweet solution significantly reduced crying time (WMD=-21.16, 95%CI -39.66 to -2.77, P<0.05) and the proportion of crying time (the duration of crying /3-minute periods after the injection) (WMD=-13.83, 95%CI -20.88 to -6.78, P<0.01), while the crying time showed no significant difference between the group treated with oral administration of 12% sucrose solution and non-intervention group. Co

Onclusions: Oral sweet solution (25%-75%; 2 mL) given 2 minutes before vaccination can effectively relieve the pain caused by vaccination in infants aged 1-12 months.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7389092PMC
June 2016

Higher cesarean delivery rates are associated with higher infant mortality rates in industrialized countries.

Birth 2015 Mar 17;42(1):62-9. Epub 2015 Jan 17.

Department of Nursing at the Hunan University of Medicine, Huaihua, China; McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, ON, Canada.

Background: Recent data indicate that more than half of high-income industrialized countries have a cesarean delivery rate of  > 25 percent, which is higher than the appropriate level considered by most health professionals worldwide.

Methods: Data for 31 high-income industrialized countries in 2010 (or the nearest year) obtained from the World Health Organization, Organization for Economic Cooperation and Development, World Bank, and individual countries were analyzed in this study. We examined the correlation between cesarean delivery rate and infant mortality rate with Pearson correlation coefficient analysis, and examined the independent effect of cesarean delivery on infant mortality with multiple linear regression analyses.

Results: The cesarean delivery and infant mortality rates varied substantially among the included countries: from 15.6 to 50.0 percent and from 1.9 per to 6.8 per 1,000 live births, respectively. Cesarean delivery rates were positively correlated with infant mortality rates (Pearson correlation coefficient: 0.41, p < 0.05). The association remained after adjustment for maternal age, infant sex, per capita GDP, and the Gini index (p < 0.03), but disappeared after further adjustment for preterm birth (p = 0.07). In a sensitivity analysis, the results were not appreciably affected by excluding births at < 22 weeks of gestation, by weighting the data by the number of births in each country, or by excluding data from particular countries with possible measurement issues (USA, Greece).

Conclusions: A higher cesarean delivery rate is associated with higher infant mortality rate among these high-income industrialized countries. One of the mechanisms by which cesarean delivery affects infant mortality is through iatrogenic prematurity.
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http://dx.doi.org/10.1111/birt.12153DOI Listing
March 2015

Maternal exposure to the production of fireworks and reduced rate of new onset hypertension in pregnancy.

Hypertens Pregnancy 2014 Nov 28;33(4):457-66. Epub 2014 Jul 28.

School of Public Health, Central South University , Changsha , China .

Background: Carbon monoxide (CO) is one of the main substances contained in fireworks. Previous studies suggested that CO may have protective effect on the development of hypertension of pregnancy.

Method: The authors conducted a prospective cohort study in Liuyang, Hunan, China between January 2010 and December 2011. Demographic and life-style variables of the participating pregnant women were obtained through structured interview with the women and clinical data were retrieved from antenatal medical records. Density of fireworks factories was defined as the number of fireworks factories per 1000 residents in the township where the mothers resided during pregnancy. Multiple logistic regression analysis was used to analyze the independent association between maternal exposure to the production of fireworks and new onset hypertension in pregnancy.

Results: A total of 5976 pregnant women were included in the final analysis. Density of fireworks factories was inversely correlated with incidence of new onset hypertension in pregnancy (Pearson correlation coefficient = -0.29, p < 0.001). Multiple logistic regression analysis showed that, compared with women who resided during pregnancy in a township with 0-0.25 fireworks factories per 1000 residents, the rates of new onset hypertension in pregnancy in women who resided in a township with 0.26-1.00 fireworks factories per 1000 residents (Odds Ratio = 0.66, 95% confidence interval: 0.46, 0.96) and >1.5 fireworks factories per 1000 residents (Odds Ratio = 0.65, 95% confidence interval: 0.44, 0.97) were reduced by more than 30%.

Conclusion: Maternal exposure to the high density of fireworks factories is associated with reduced risk of developing new onset hypertension in pregnancy.
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http://dx.doi.org/10.3109/10641955.2014.938752DOI Listing
November 2014

Association between labetalol use for hypertension in pregnancy and adverse infant outcomes.

Eur J Obstet Gynecol Reprod Biol 2014 Apr 19;175:124-8. Epub 2014 Jan 19.

OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6; Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5; School of Public Health, Central South University, 110 Xiang Ya Road, Changsha, Hunan 410078, China. Electronic address:

Objective: Labetalol and methyldopa are the two antihypertensive drugs most frequently used to control blood pressure for hypertensive disorders of pregnancy. The objective of this study was to assess if labetalol is associated with poor infant outcomes.

Study Design: Retrospective population-based cohort study using the linked maternal/infant databases in the Province of Saskatchewan. Women with a diagnosis of a hypertensive disorder of pregnancy who delivered a singleton in Saskatchewan from January 1, 1990 to December 31, 2005 and who were dispensed only labetalol or only methyldopa were included in the study. Occurrences of small for gestational age (SGA)<10th percentile, SGA<3rd percentile, preterm birth, stillbirth, hospitalization for respiratory distress syndrome (RDS), sepsis, and seizure during infancy, and infant death were compared. Multiple logistic regression analysis was performed to adjust for potential confounding.

Results: A total of 1223 eligible women were included in the final analysis. Among them, 300 received labetalol only and 923 received methyldopa only during pregnancy. For women with chronic hypertension, the rate of hospitalization for RDS, sepsis, and seizure during infancy was significantly higher for infants born to mothers who were dispensed labetalol only as compared with infants born to mothers who were dispensed methyldopa only (adjusted odds ratio (OR) 1.51, 95% confidence interval (CI) 1.02-2.22).

Conclusion: Compared with methyldopa, the use of labetalol for chronic hypertension of pregnancy may be associated with increased rate of hospitalization during infancy.
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http://dx.doi.org/10.1016/j.ejogrb.2014.01.019DOI Listing
April 2014

Trends in using beta-blockers and methyldopa for hypertensive disorders during pregnancy in a Canadian population.

Eur J Obstet Gynecol Reprod Biol 2013 Dec 1;171(2):281-5. Epub 2013 Oct 1.

Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Road, Guangzhou 510515, China; OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Canada K1H 8L6.

Objective: To describe trends in and patterns of antihypertensive drug use in a general obstetric population.

Study Design: Historical cohort study. A total of 18,117 women who gave birth in a Saskatchewan hospital between January 1, 1980 and December 31, 2005 with a diagnosis of hypertensive disorders in pregnancy were identified and included in the analysis.

Results: The rate of treatment with antihypertensive drugs for pregnant women with chronic hypertension rose from 19.94% in 1980-1984 to 37.63% in 2000-2005. There were similar increases in antihypertensive drug use from 1.51% to 14.47% for gestational hypertension/non-severe preeclampsia, and from 1.56% to 20.86% for severe preeclampsia/eclampsia. Methyldopa was the most frequently used drug, followed by beta-blockers, with other antihypertensive drugs accounting for about 18.43% of total uses. The use of both methyldopa and labetalol has increased in recent years while the use of other antihypertensive drugs has decreased. Other antihypertensive drugs were more commonly prescribed in earlier gestation, while methyldopa and labetalol were generally prescribed in later gestation.

Conclusion: The use of antihypertensive drugs in pregnancy is relatively common and is increasing, with the liberal use of methyldopa and (especially) labetalol contributing appreciably to this increase.
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http://dx.doi.org/10.1016/j.ejogrb.2013.09.032DOI Listing
December 2013

Occurrence and predictors of vacuum and forceps used sequentially for vaginal birth.

J Obstet Gynaecol Can 2013 Apr;35(4):317-322

OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa ON; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa ON.

Background: Sequential use of vacuum and obstetric forceps for vaginal delivery is associated with increased risks of adverse maternal and infant outcomes.

Methods: We conducted a retrospective cohort study to estimate the frequency of sequential use of vacuum and forceps for planned vaginal delivery and to identify predictors, using data collected in Ontario between 2004 and 2007. Multivariate logistic regression models were used to estimate the adjusted odds ratios and 95% confidence intervals of predictors of sequential use of vacuum and forceps.

Results: Of 186 988 pregnant women with a singleton, vertex presentation at term and a planned vaginal birth, 1062 (0.57%) required the sequential use of vacuum and forceps for delivery. The major predictors for sequential use of vacuum and forceps were mother's primary language being other than English or French, nulliparity, a history of Caesarean section, dystocia, use of epidural or other pain relief, labour induction, labour augmentation, fetal macrosomia, and advanced gestational age.

Conclusion: In this population-based study we found that 0.57% of planned vaginal births were delivered with sequential use of vacuum and obstetric forceps. Abnormal labour, fetal macrosomia, language barriers, and advanced gestational age are significant predictors of requiring this sequential use.
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http://dx.doi.org/10.1016/S1701-2163(15)30958-0DOI Listing
April 2013

Infant outcomes among pregnant women who used oseltamivir for treatment of influenza during the H1N1 epidemic.

Am J Obstet Gynecol 2013 Apr 17;208(4):293.e1-7. Epub 2013 Jan 17.

OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada.

Objective: This study was undertaken to examine the association between maternal oseltamivir treatment for influenza and infant outcomes during the 2009 HINI influenza pandemic.

Study Design: This was a retrospective cohort study using a population-based maternal newborn database including women who gave birth to a singleton infant in the Canadian province of Ontario from November 2009 through April 2010. Risks of small for gestational age (SGA) (10th percentile and 3rd percentile), preterm birth (<37 weeks of gestation), very preterm birth (<32 weeks of gestation), and 5-minute Apgar score <7 associated with maternal exposure to oseltamivir were analyzed by multivariable regression.

Results: A total of 55,355 women with a singleton birth were included in this study. Among them, 1237 (2.2%) women received oseltamivir for treatment or prevention of influenza during pregnancy. Women who took oseltamivir during pregnancy were less likely to have a SGA infant based on the 10th percentile for growth (adjusted risk ratio, 0.77; 95% confidence interval, 0.60-0.98). No association between maternal use of oseltamivir with SGA on 3rd percentile, preterm birth, very preterm birth, and low Apgar score was observed.

Conclusion: There is no evidence of an association between maternal use of oseltamivir for influenza and early birth, low Apgar at birth, and poor fetal growth.
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http://dx.doi.org/10.1016/j.ajog.2013.01.015DOI Listing
April 2013

Cesarean section and postpartum depression in a cohort of Chinese women with a high cesarean delivery rate.

J Womens Health (Larchmt) 2011 Dec 30;20(12):1881-6. Epub 2011 Aug 30.

OMNI Research Group, Department of Obstetrics & Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, Canada.

Background: Whether or not cesarean delivery is associated with increased risk of postpartum depression (PPD) remains unclear.

Methods: We carried out a prospective cohort study between February and September 2007 in Hunan Maternal and Infant Hospital and the First Affiliated and Third Affiliated Hospitals of the Central South University in Changsha, Hunan, People's Republic of China. The Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) was used at 2 weeks postpartum to assess PPD, with a score of ≥13 as the cutoff for PPD.

Results: A total of 534 women were included in the final analysis, with 415 (77.7%) delivering by cesarean section (the majority of them with no medical indication). The rate of PPD was 21.7% in women who had a cesarean delivery and 10.9% in women who delivered vaginally. The increased risk of PPD in women who had cesarean sections was maintained after we adjusted for potential confounding factors or considered cesarean delivery by social indications.

Conclusions: Cesarean section is associated with increased risk of PPD in Chinese women with a high cesarean delivery rate.
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http://dx.doi.org/10.1089/jwh.2011.2842DOI Listing
December 2011

[Age-specific reference ranges for prostate specific antigen in 16 222 Chinese men].

Beijing Da Xue Xue Bao Yi Xue Ban 2011 Aug;43(4):586-90

Department of Urology, McGill University, Montreal H9X 3V9, Canada.

Objective: To investigate the PSA level of 16 222 asymptematic men in Shenzhen who came from different areas of China, in order to find out the PSA levels of Chinese men.

Methods: Serum samples of 16 222 men who came to Peking University Shenzhen Hospital for health examination were collected, all of whom had no symptoms. Their serum PSA levels were measured with MEIA with ILMA instrument.

Results: The mean PSA level of the 16 222 men in our research was 0.986 μg/L, and the standard deviation was 1.190. The 95% percentile was 2.375 μg/L. Of all the cases ,the 95% percentile of 15 498 was lower than 2.5 μg/L, about 95.472%;that of 699 was between 2.5-10.0 μg/L, about 4.306%;And if took 4.0 μg/L as reference value,that of 15 948 cases was below 4.0 μg/L, about 98.244%;that of 249 was between 4.0-10.0 μg/L, about 1.534%;That of only 36 cases was greater than 10.0 μg/L, about 0.222%;The 95% percentiles of the different age groups were: 10-19 years 0-1.067 μg/L;20-29 years 0-1.818 μg/L;30-39 years 0-1.914 μg/L;40-49 years 0-2.001 μg/L;50-59 years 0-2.900 μg/L;60-69 years 0-5.862 μg/L;70-79 years 0-8.536 μg/L;elder than 80 years 0-12.869 μg/L;There were statistic differences between thedifferent age groups.

Conclusion: Our data demonstrate that the mean value of PSA levels of Chinese men is 0.986 μg/L at present stage, and the 95% percentile is 2.375 g/L. Our PSA levels of each age group are different from Oesterling's reference values which are commonly accepted in the world. The PSA level of Chinese men who are under 60 years is lower than that of Euramericans, while the PSA level of Chinese men who are above 60 years is higher than that of Euramericans. This shows that for the men who are under 60 the reference value should be 2.5 μg/L, while for the men who are above 60, we could still use 4 μg/L as reference value.
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August 2011

Exposure to trimethoprim/sulfamethoxazole but not other FDA category C and D anti-infectives is associated with increased risks of preterm birth and low birth weight.

Int J Infect Dis 2011 May 22;15(5):e336-41. Epub 2011 Feb 22.

Department of Preventive Medicine, Changzhi Medical College, Changzhi, China.

Objective: To examine the association between trimethoprim/sulfamethoxazole, other US Food and Drug Administration (FDA) C and D anti-infectives, and non anti-infective FDA C, D, and X drugs used during pregnancy with preterm birth and low birth weight.

Methods: We carried out a retrospective cohort study based on a 50% random sample of women who gave birth in the Canadian province of Saskatchewan from 1997 to 2000. The association between trimethoprim/sulfamethoxazole, other FDA C and D anti-infectives (fluconazole, clarithromycin, doxycycline, and tetracycline), and non anti-infective FDA C, D, and X drugs used during pregnancy with preterm birth and low birth weight was evaluated using multiple logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) as association measures.

Results: A total of 17 939 women were included in the final analysis. Trimethoprim/sulfamethoxazole was associated with significantly increased risks for preterm birth (aOR 1.51, 95% CI 1.10, 2.08) and low birth weight (aOR 1.67, 95% CI 1.14, 2.46). Exposure to non anti-infective FDA category C, D and X drugs was also associated with increased risks for preterm birth (aOR 1.17, 95% CI 1.09, 1.31) and low birth weight (aOR 1.14, 95% CI 0.92, 1.42), but to a lesser degree. Other FDA C and D anti-infectives were not (statistically) significantly associated with increased risks for preterm birth (aOR 0.93, 95% CI 0.49, 1.77) or low birth weight (aOR 0.65, 95% CI 0.27, 1.60).

Conclusions: Among FDA C, D and X drugs, trimethoprim/sulfamethoxazole, a folic acid antagonist, has the strongest association with preterm birth and low birth weight.
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http://dx.doi.org/10.1016/j.ijid.2011.01.007DOI Listing
May 2011

Prenatal family support, postnatal family support and postpartum depression.

Aust N Z J Obstet Gynaecol 2010 Aug;50(4):340-5

Department of Obstetrics & Gynecology, University of Ottawa, Canada.

Background: Inadequate social support is an important determinant of postpartum depression (PPD). Social support for pregnant women consists of supports from various sources and can be measured at different gestation periods. Differentiating the effects of social support from different sources and measured at different gestation periods may have important implications in the prevention of PPD. In the family centred Chinese culture, family support is likely to be one of the most important components in social support.

Aims: The aim of this study was to assess the association of prenatal family support and postnatal family support with PPD.

Methods: A prospective cohort study was conducted between February and September 2007 in Hunan, China. Family support was measured with social support rating scale at 30-32 weeks of gestation (prenatal support) and again at 2 weeks of postpartum visit (postnatal support). PPD was defined as Edinburgh Postnatal Depression Scale (EPDS) score > or =13.

Results: A total of 534 pregnant women were included, and among them, 103 (19.3%) scored 13 or more on the EPDS. PPD was 19.4% in the lowest tertile versus 18.4% in the highest quartile (adjusted odds ratio: 1.04, 95% confidence interval 0.60, 1.80) for prenatal support from all family members, and PPD was 39.8% in the lowest tertile versus 9.6% in the highest tertile (adjusted odds ratio: 4.4, 95% confidence interval 2.3, 8.4) for postnatal support from all family members. Among family members, support from husband had the largest impact on the risk of developing PPD.

Conclusions: Lack of postnatal family support, especially the support from husband, is an important risk factor of PPD.
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http://dx.doi.org/10.1111/j.1479-828X.2010.01185.xDOI Listing
August 2010

Maternal and congenital syphilis in Shanghai, China, 2002 to 2006.

Int J Infect Dis 2010 Sep 6;14 Suppl 3:e45-8. Epub 2010 Feb 6.

Shanghai First Maternity and Infant Hospital/Tongji University, Shanghai Women's Health Institute, Shanghai, China.

Objective: To assess the trends and determinants of maternal and congenital syphilis in Shanghai, China.

Methods: We conducted a prospective cohort study of maternal and congenital syphilis from 2002 to 2006 in Shanghai, China. We presented the trends of maternal syphilis and congenital syphilis rates and compared outcomes in infants born to mothers with complete versus incomplete treatment for maternal syphilis. We also assessed the determinants of compliance to treatment of maternal syphilis and examined the associations of initial maternal RPR antibody level and gestational age at initiation of treatment with occurrence of congenital syphilis.

Results: A total of 535 537 pregnant women were included in the analysis. During this period of time, 1471 maternal syphilis cases (298.7 per 100 000 live births) and 334 congenital syphilis cases (62.4 per 100 000 live births) were identified. Both maternal and congenital syphilis rates increased from 2002 until 2005, with a slight decrease in 2006. The rate of maternal syphilis was 156.2 per 100 000 live births in Shanghai residents and 371.7 per 100 000 live births in the migrating population (p<0.001). The compliance to treatment for maternal syphilis was poorer in women with a lower level of education. The rate of congenital syphilis in infants born to mothers with incomplete treatment (50.8%) was much higher than in infants born to mothers with complete treatment (12.5%). Rates of fetal death, neonatal death, and major birth defects were 30.4%, 11.0%, and 3.8%, respectively, in the incomplete treatment group; the corresponding figures were 5.5%, 0.56%, and 0.46%, respectively, in the complete treatment group. Infant outcome was also affected by initial maternal RPR antibody level and time of treatment, with much better outcomes in mothers with low antibody levels and earlier treatment.

Conclusion: There has been a resurgence of congenital syphilis in Shanghai, China, especially in the migrating population and other populations with a lower socioeconomic status.
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http://dx.doi.org/10.1016/j.ijid.2009.09.009DOI Listing
September 2010
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