The rate of gestational diabetes mellitus (GDM) has increased over the past decades, but it’s unclear whether associations with maternal outcomes have changed. We aimed to describe rates of adverse maternal outcomes following deliveries with and without GDM over time and assess risks in these outcomes for GDM by delivery period. This population-based retrospective cohort study was conducted using provincial birth registry linked with health administrative databases in Ontario, Canada. All singleton hospital deliveries between April 1, 2012 and March 31, 2020 were included. We assessed the trends of adverse maternal outcomes among GDM and non-GDM pregnancies and used modified Poisson regression to estimate associations between GDM and adverse maternal outcomes, using crude and adjusted relative risk (aRR) and risk difference (aRD) with 95

First proposed in 1961, Taylor’s Power Law relates variance (S2) and mean (m), expressed as S2 = amb. While this relationship holds in ecology and other fields, it has seen less application in population health. Here, using Taylor’s Power Law, we assess the relationship between variance and mean body mass index across populations in low- and middle-income countries. We extracted adult body mass index data from 236 nationally representative, population-based samples of women aged 20–49 years and men aged 18 years and older, collected between 1994 and 2019 (n = 2,594,211 women, n = 455,479 men). We used log–log linear regression to estimate the scaling exponent (b) and intercept parameters. In women, Taylor’s Power Law showed a strong fit (b = 4.0, R2 = 0.72, n = 202 surveys), compared to b = 3.9 and R2 = 0.46 in men (n = 34 surveys). Across survey periods, intercepts increased, while scaling exponents remained stable or declined in some subpopulations, suggesting rising baseline variability in body mass index alongside a slowing of variance growth with continued mean increases. The strength of Taylor’s Power Law relationship varied by social and spatial context, including age, residence, socioeconomic status, and survey period. This approach may offer a useful framework for describing and monitoring population-level variability in body mass index.

Introduction Data on preventive care visits and long-term healthcare use patterns among children with prenatal opioid exposure remain limited. From a life course perspective, early impacts on health care engagement may shape patterns of health service use across childhood. Objective To characterise early and long-term healthcare service visits among children with prenatal opioid exposure using linked population-based health administrative databases from Ontario, Canada. Methods We conducted a population-based retrospective cohort study of live-born infants born between April 1, 2007, and March 31, 2018, who were born to mothers aged 15-50 years and who were eligible for provincial health insurance for at least 3 months before conception. Prenatal opioid use identified during routine prenatal care was extracted from clinical and perinatal health records. The primary outcome was the uptake of well-child visits until 24 months of age, an important early life preventive care period. Rates of all-cause inpatient, outpatient, and emergency department visits were examined and compared across the follow-up period and within specific time intervals up to 13 years of age. Results The final cohort totalled 1,343,653 live births, of whom 13,290 children (0.99%) had documented prenatal exposure to opioids. Prenatal opioid exposure was associated with reduced incidence of well-child visits (adjusted incidence rate ratio: 0.82 (95% CI: 0.81, 0.83)) from birth to 2 years. Exposed children were less likely to receive an enhanced 18-month well-child visit (adjusted risk ratio: 0.89 (95% CI: 0.88, 0.90)). Prenatal exposure was associated with increased rates of emergency department visits, specialist visits, hospitalisations and same-day surgery visits over the follow-up period. Differences in rates of health care visits were most pronounced in early childhood and attenuated for some services at older ages. Conclusions Prenatal opioid exposure was associated with reduced uptake of preventive health services and greater use of ambulatory care. This finding is consistent with a life course model, in which early gaps in preventive care may influence later-life care use patterns, and highlights the need for effective strategies to promote access to and engagement with preventive care services for opioid-exposed children.

Maternal cannabis use in pregnancy is reported to be associated with perinatal and neurodevelopmental outcomes in offspring. Such associations, however, may be biased by residual confounding by socioeconomic position (SEP). To assess confounding, we use paternal cannabis use in pregnancy as a negative control exposure. We use data from 15,013 mother–father–child trios from the ALSPAC birth cohort, with participants initially recruited between 1990 and 1992. Exposures were maternal and paternal cannabis use during pregnancy. Neonatal anthropometry, perinatal, cognitive, and neurodevelopmental outcomes were modelled as a function of maternal and paternal cannabis use in pregnancy, adjusting for household-level SEP markers and maternal and paternal tobacco, alcohol, and drug use in pregnancy. We compared the strength of the association between maternal and paternal cannabis on outcomes using Wald tests. 5 and 13

Objective:Cannabis use among expectant mothers has increased steadily over the past two decades. We compared the long-term health services use of offspring prenatally exposed to cannabis to that of matched, unexposed offspring. Study design:We conducted a retrospective cohort study using linked perinatal and health administrative databases of all live, singleton births in Ontario, Canada hospitals between April 1, 2007 and March 31, 2012. Infants were followed until March 31, 2017, with a primary outcome of primary care visits up to age 10. Secondary outcomes included rates of outpatient psychiatrist visits, emergency department visits and hospitalizations. We used adjusted Poisson regression to assess differences in rates of health service use between children with and without exposure to prenatal cannabis. Results:We included 508 025 infants, 3248 (0.6%) had cannabis exposure. Prenatal cannabis use was associated with a decreased rate of primary care physician visits (adjusted rate ratio [aRR]: 0.86, 95% confidence interval [CI]: 0.84-0.87) and an increase in the rate of outpatient psychiatrist visits (aRR: 1.29, 95% CI: 1.00-1.66), emergency department visits (aRR: 1.05, 95% CI: 1.03-1.08), and hospitalizations (aRR: 1.12, 95% CI: 1.04-1.20). Among preterm offspring, cannabis was associated with a decrease in primary care visits but no difference in other visits. Among those in the highest income quintiles, cannabis use was associated with a two-fold increase in the rate of outpatient psychiatrist visits. Conclusions:Offspring exposed to prenatal cannabis receive fewer primary care visits but have increased rates of visiting health care specialists past the neonatal period.

IntroductionAlthough chronic endometritis (CE) is strongly associated with infertility and adverse pregnancy outcomes, the specific microbiome of women with CE who can conceive remain unclear.MethodsThis study recruited 100 participants aged 18 to 45 years with spontaneously conceived pregnancy who opted for pregnancy termination, detected their endometrial microbiome by 16S rRNA, and made a diagnosis of CE.ResultsAmong them, 19 were diagnosed with CE. There was a comparable microbial composition within the endometrium between women with and without CE. The relative abundance of Sphingomonas (21%) and Pseudomonas (8%) were the same in both groups. Compared to women without CE, women with CE exhibited higher abundance of Faecalibacterium (6.5% vs 3.8%), Escherichia-Shigella (3.3% vs 2.6%), Akkermansia (1.65% vs 1.1%), and lower abundance of Lactobacillus (10% vs 14%), and Corynebacterium (1.35% vs 2.15%) at the genus level. Streptococcus, Escherichia-Shigella, Akkermansia and Finegoldia exhibited significant interactions with other microbiome in participants with CE.DiscussionIn women with CE, reproductive potential may be associated with the compositional stability of the endometrial microbiome, whereas an imbalance in the abundance of these microbes may be linked to their pregnancy outcomes.

Objectives Electronic cigarettes and other novel electronic nicotine delivery systems (ENDS) have grown rapidly in popularity and accessibility. In this study, we compiled a large sub-provincial dataset on smoking and vaping behaviour in Canada to inform targeted surveillance and prevention. Methods Twelve national-level survey datasets were concatenated. Multilevel models were used to derive precision-weighted estimates of census division-level smoking and ENDS use prevalence, adjusted for age, sex/gender, and data source. We developed visualizations of the geography of smoking and ENDS use across Canada and used Census Divisions for spatially explicit correlational analyses of community characteristics associated with vaping. Results The age- and sex-adjusted prevalence of past-month (i.e., current) ENDS use in Canada was 4%, with higher estimates observed in several Atlantic provinces: New Brunswick (5.6%), Prince Edward Island (4.8%), Nova Scotia (4.7%), and Newfoundland and Labrador (4.5%) followed by Manitoba (4.1%). Estimates for the remaining provinces were below 4%. The prevalence of ENDS use varied considerably across CDs, even in provinces where vaping was generally uncommon. Suburban and exurban communities in Ontario and Quebec demonstrated especially high ENDS use. Spatial analyses revealed select correlations with community factors such as economic composition. Conclusion Sub-provincial data revealed geographical variability in ENDS use across Canada. Localized surveillance and prevention efforts may be improved by considering the community features associated with high rates of use, and benchmarking regional regulations on the advertising and sales of ENDS products to communities with lower estimated rates of use.

OBJECTIVE:To assess the impact of high-dose folic acid supplementation (4.0-5.1 mg), started between 8+0 and 16+6 weeks of gestation and continued until delivery, on social impairments associated with Autism Spectrum Disorders, deficiencies in executive function, and emotional and behavioural problems in children. DESIGN:FACT 4 Child is a follow-up of mothers and their children born during the Folic Acid Clinical Trial (FACT), an international multi-centre double-blinded randomised trial to assess the effect of high-dose folic acid supplementation on preventing preeclampsia in women with increased risk. SETTING:Multi-centre international follow-up study. POPULATION:Mothers and their children enrolled in FACT, among them 664 completed the follow-up. METHODS:Mothers reported on social and executive function and emotional and behavioural problems in their children aged 4-9 years using standardised, validated questionnaires. MAIN OUTCOME:The proportion of children with at least one score > 1.5 SD above expected mean. RESULTS:Among 319 children in the intervention group, 43 (13.5%) had a score in the elevated range, compared with 51/345 (14.8%) in the placebo group (RR = 0.91; 95% CI: 0.63 to 1.33; p = 0.63). CONCLUSION:In children born to women at risk for preeclampsia, rates of neurodevelopmental outcomes were not different between high-dose folic acid and control groups in this study. Our finding suggests that a high dose of folic acid supplementation may not be needed in pregnant women with increased risk. A larger-scale study is needed to determine neurodevelopmental outcomes associated with different dosages and timing of folic acid supplementation during pregnancy.

Cannabis use is on the rise, driven by relaxing legal regulations and declining perceptions of harm. This trend, coupled with the increasing reliance on social media for health-related information, has sparked interest in cannabis use during pregnancy (CanPreg). This study examines online discourse about CanPreg on Twitter, analyzing 53,183 unique tweets from 32,744 users in the USA and Canada between 2012 and 2021. We investigate the spatio-temporal distribution of CanPreg discussions, key topical contexts within these conversations, and their correlations with socioeconomic and health indicators. The analysis reveals regional differences, with a relatively higher interest in CanPreg discussions in Canada compared to the USA. The online discourse is primarily focused on research, alongside criticism, personal experiences, queries, news sharing, and advertisements. Additionally, correlations between CanPreg tweet activity, poverty rates, and mental health metrics suggest a connection between online discussions and real-world behaviors. This study highlights the role of social media in health communication and provides insights to inform targeted intervention strategies.

BACKGROUND:Research on the impact of the COVID-19 pandemic on mothers/childbearing parents has mainly been cross-sectional and focused on psychological symptoms. This study examined the impact on function using ongoing, systematic screening of a representative Ontario sample. METHODS:An interrupted time series analysis of repeated cross-sectional data from a province-wide screening program using the Healthy Babies Healthy Children (HBHC) tool assessed changes associated with the pandemic at the time of postpartum discharge from hospital. Postal codes were used to link to neighborhood-level data. The ability to parent or care for the baby/child and other psychosocial and behavioral outcomes were assessed. RESULTS:The co-primary outcomes of inability to parent or care for the baby/child were infrequently observed in the pre-pandemic (March 9, 2019-March 15, 2020) and initial pandemic periods (March 16, 2020-March 23, 2021) (parent 209/63,006 (0.33%)-177/56,117 (0.32%), care 537/62,955 (0.85%)-324/56,086 (0.58%)). Changes after pandemic onset were not observed for either outcome although a significant (p = 0.02) increase in slope was observed for inability to parent (with questionable clinical significance). For secondary outcomes, worsening was only seen for reported complications during labor/delivery. Significant improvements were observed in the likelihood of being unable to identify a support person to assist with care, need of newcomer support, and concerns about money over time. CONCLUSIONS:There were no substantive changes in concerns about ability to parent or care for children. Adverse impacts of the pandemic may have been mitigated by accommodations for remote work and social safety net policies.

Background: Maternal obesity is associated with stillbirth, but uncertainty persists around the effects of higher obesity classes. We sought to compare the risk of stillbirth associated with maternal obesity alone versus maternal obesity and additional or undiagnosed factors contributing to high-risk pregnancy.Methods: We conducted a retrospective cohort study using the Better Outcomes Registry and Network (BORN) for singleton hospital births in Ontario between 2012 and 2018. We used multivariable Cox proportional hazard regression and logistic regression to evaluate the relationship between prepregnancy maternal body mass index (BMI) class and stillbirth (reference was normal BMI). We treated maternal characteristics and obstetrical complications as independent covariates. We performed mediator analyses to measure the direct and indirect effects of BMI on stillbirth through major common-pathway complications. We used fully adjusted and partially adjusted models, representing the impact of maternal obesity alone and maternal obesity with other risk factors on stillbirth, respectively.Results: We analyzed data on 681 178 births between 2012 and 2018, of which 1956 were stillbirths. Class I obesity was associated with an increased incidence of stillbirth (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.35-1.78). This association was stronger for class III obesity (adjusted HR 1.80, 95% CI 1.44-2.24), and strongest for class II obesity (adjusted HR 2.17, 95% CI 1.83-2.57). Plotting point estimates for odds ratios, stratified by gestational age, showed a marked increase in the relative odds for stillbirth beyond 37 weeks' gestation for those with obesity with and without other risk factors, compared with those with normal BMI. The impact of potential mediators was minimal.Interpretation: Maternal obesity alone and obesity with other risk factors are associated with an increased risk of stillbirth. This risk increases with gestational age, especially at term.

BackgroundThis study was designed to investigate patterns and risk factors for substance use among obstetrical patients who gave birth during the early period of the pandemic, and their partners.MethodsCross-sectional survey of obstetrical patients between March 17th and June 16th, 2020, at The Ottawa Hospital, Ottawa, Canada. Substance use was a composite measure of any alcohol, tobacco, or cannabis use since COVID-19 began. Four outcomes included: any participant substance use or increase in substance use, any partner substance use or increase in substance use. Adjusted risk ratios (ARR) and 95% confidence intervals (CI) are presented.FindingsOf 216 participants, 113 (52.3%) and 15 (6.9%) obstetrical patients reported substance use and increased use, respectively. Those born in Canada (ARR: 2.03; 95% CI: 1.27-3.23) and those with lower household income (ARR: 1.38; 95% CI: 1.04-1.85) had higher risk of substance use. Those with postpartum depression (ARR: 5.78; 95%CI: 2.22-15.05) had the highest risk of increased substance use. Families affected by school/daycare closure reported a higher risk of increased partner substance use (ARR: 2.46; 95% CI:1.38-4.39).ConclusionThis study found that risk factors for substance use included demographics (i.e., being born in Canada, income), mental health (postpartum depression), and school/childcare closures.

Introduction Early mid-life is marked by accumulating risks for cardiometabolic illness linked to health-risk behaviors like nicotine use. Identifying polygenic indices (PGI) has enriched scientific understanding of the cumulative genetic contributions to behavioral and cardiometabolic health, though few studies have assessed these associations alongside socioeconomic (SES) and lifestyle factors.Aims and Methods Drawing on data from 2337 individuals from the United States participating in the National Longitudinal Study of Adolescent to Adult Health, the current study assesses the fraction of variance in five related outcomes-use of conventional and electronic cigarettes, body mass index (BMI), waist circumference, and glycosylated hemoglobin (A1c)-explained by PGI, SES, and lifestyle.Results Regression models on African ancestry (AA) and European ancestry (EA) subsamples reveal that the fraction of variance explained by PGI ranges across outcomes. While adjusting for sex and age, PGI explained 3.5%, 2.2%, and 0% in the AA subsample of variability in BMI, waist circumference, and A1c, respectively (in the EA subsample these figures were 7.7%, 9.4%, and 1.3%). The proportion of variance explained by PGI in nicotine-use outcomes is also variable. Results further indicate that PGI and SES are generally complementary, accounting for more variance in the outcomes when modeled together versus separately.Conclusions PGI are gaining attention in population health surveillance, but polygenic variability might not align clearly with health differences in populations or surpass SES as a fundamental cause of health disparities. We discuss future steps in integrating PGI and SES to refine population health prediction rules.Implications Study findings point to the complementary relationship of PGI and socioeconomic indicators in explaining population variance in nicotine outcomes and cardiometabolic wellness. Population health surveillance and prediction rules would benefit from the combination of information from both polygenic and socioeconomic risks. Additionally, the risk for electronic cigarette use among users of conventional cigarettes may have a genetic component tied to the cumulative genetic propensity for heavy smoking. Further research on PGI for vaping is needed.

ObjectivesInvestigations about cesarean delivery (CD) on maternal request (CDMR) and infant infection risk frequently rely on administrative data with poorly defined indications for CD. We sought to determine the association between CDMR and infant infection using an intent-to-treat approach.MethodsThis was a population-based cohort study of low-risk singleton pregnancies with a term livebirth in Ontario, Canada between April 2012 and March 2018. Subjects with prior CD were excluded. Outcomes included upper and lower respiratory tract infections, gastrointestinal infections, otitis media, and a composite of these 4. Relative risks (RR) and 95% confidence intervals (CI) were calculated for component and composite outcomes up to 1 year following planned CDMR versus planned vaginal deliveries (VD). Sub-group and sensitivity analyses included age at infection (≤28 vs. >28 days), type of care (ambulatory vs. hospitalization), restricting the cohort to nulliparous pregnancies, and including individuals with previous CD. Last, we re-examined outcome risk on an as-treated basis (actual CD vs. actual VD).ResultsOf 422 134 pregnancies, 0.4% (1827) resulted in a planned CDMR. After adjusting for covariates, planned CDMR was not associated with a risk of composite infant infections (aRR 1.02, 95% CI 0.92–1.11). Findings for component infection outcomes, sub-group, and sensitivity analyses were similar. However, the as-treated analysis of the role of delivery mode on infant risk for infection demonstrated that actual CD (planned and unplanned) was associated with an increased risk for infant infections compared to actual VD.ConclusionsPlanned CDMR is not associated with increased risk for neonatal or infant infections compared with planned VD. Study design must be carefully considered when investigating the impact of CDMR on infant infection outcomes.

Introduction Up to 30% of newborns with in-utero selective serotonin reuptake inhibitor (SSRI) exposure experience withdrawal symptoms. The impact of newborn feeding method on alleviating withdrawal has not been investigated. We examined the effect of newborn feeding method (breastfeeding versus formula) among a cohort of Neonates With In-utero SSRI Exposure (NeoWISE). Methods This population-based retrospective cohort study included newborns born in Ontario hospitals between April 1, 2012, and March 31, 2020 to Ontario Drug Benefit Program beneficiaries who filled at least one SSRI prenatal prescription. Linked administrative health and registry data were used. Method of newborn feeding was available from birth to hospital discharge. The primary outcome was newborn withdrawal. The secondary outcome was transfer to the Neonatal Intensive Care Unit (NICU). Adjusted risk ratios (adjRR) in breast- versus formula-fed newborns and our outcomes were estimated using generalized linear models. Propensity scores based on antepartum and intrapartum characteristics and inverse probability of treatment weighting were used to balance differences in maternal-newborn characteristics by treatment. Results Overall, 5,079 newborns were included in the NeoWISE Cohort, with 3,321 (65.4%) exclusively breastfeeding from birth to hospital discharge. Among the breastfed newborns, 50 (1.5%) had neonatal withdrawal versus 41 (2.3%) in the formula-fed newborns. There was no difference in risk of withdrawal in breast versus formula-fed newborns (adjRR 0.86, 95% CI 0.56, 1.34). Breastfed newborns had a reduced risk of transfer to the NICU compared to formula-fed newborns (adjRR 0.80, 95% CI 0.66, 0.97); however, this finding did not persist in sensitivity analysis. Conclusion The rate of newborn withdrawal was low in this cohort of SSRI-exposed neonates and was not associated with feeding method in the hospital. The results of this study inform shared decision-making around newborn feeding for perinatal women who take SSRI medications.

BACKGROUND:The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. METHODS:Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m2) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. FINDINGS:Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010). INTERPRETATION:Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health. FUNDING:Population Health Research Institute, Hamilton Health Sciences Research Institute, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research's Strategy for Patient Oriented Research, Ontario Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline.

ObjectiveThere is no clear evidence on the risk of gestational weight loss (GWL) for individuals with obesity. Our study aimed to assess the association between GWL and adverse perinatal outcomes among individuals with obesity.MethodsThis population-based retrospective cohort study examined individuals with prepregnancy BMI >= 30 kg/m2 who had a singleton pregnancy, using Ontario, Canada, birth registry data from 2012 to 2020. The primary outcome was a composite of adverse outcomes, including perinatal death and neonatal morbidity. The association between GWL and risk of adverse perinatal outcomes was estimated using generalized estimating equation models and restricted cubic spline regression analysis. Stratified analysis was conducted by obesity class.ResultsOf the 157,205 individuals with obesity, 6.1% experienced GWL. Compared with adequate gestational weight gain, GWL was associated with an increased risk of a composite of adverse perinatal outcomes (adjusted risk ratio: 1.31; 95% CI: 1.22-1.39). Similar results were observed in the stratified analysis. Restricted cubic spline regression analysis revealed that average weekly gestational weight changes displayed a nonlinear U-shaped association, with a higher risk of a composite of adverse perinatal outcomes noted in the extremities, particularly toward GWL and excessive weight gain.ConclusionsOur findings suggest that GWL may increase the risk of adverse perinatal outcomes across all obesity classes.

Objectives: The prevalence of gestational diabetes mellitus (GDM) has been increasing globally over recent decades; however, underlying reasons for the increase remain unclear. We analyzed trends in GDM rates and evaluated risk factors associated with the observed trends in Ontario, Canada. Methods: We conducted a retrospective population -based cohort study using the Better Outcomes Registry and Network Ontario, linked with the Canadian Institute for Health Information Discharge Abstract Database. All pregnant individuals who had a singleton hospital delivery from 1 April 2012 to 31 March 2020 were included. We calculated rates and 95% CIs for GDM by year of delivery and contrasted fiscal year 2019/20 with 2012/13. Temporal trends in GDM were quantified using crude and adjusted risk ratios by modified Poisson regression. We further quantified the temporal increase attributable to changes in maternal characteristics by decomposition analysis. Results: Among 1 044 258 pregnant individuals, 82 896 (7.9%) were diagnosed with GDM over the 8 years. GDM rate rose from 6.1 to 10.4 per 100 deliveries between fiscal years 2012/13 and 2019/20. The risk of GDM in 2019/20 was 1.53 times (95% CI 1.50-1.56) higher compared with 2012/13. 27% of the increase in GDM was due to changes in maternal age, 8 BMI, and Asian ethnicity. Conclusions: The GDM rate has been consistently increasing in Ontario, Canada. The contribution of increasing maternal age, prepregnancy obesity, and Asian ethnicity to the recent increase in GDM is notable. Further investigation is required to better understand the contributors to increasing GDM.

IntroductionFirst responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. MethodsWe conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. ResultsThe most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF’s 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. ConclusionThe results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.

Objective The impact of gestational weight loss (GWL) on fetal growth among women with obesity remains unclear. This study aimed to examine the association between weight loss during pregnancy among women with body mass index (BMI) ≥ 30 kg/m 2 and the risk of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) neonates. Methods We conducted a retrospective, population-based cohort study of women with pre-pregnancy obesity that resulted in a singleton live birth in 2012-2017, using birth registry data in Ontario, Canada. Women with pregnancy complications or health conditions which could cause weight loss were excluded. GWL is defined as negative gestational weight change (≤0 kg). The association between GWL and fetal growth was estimated using generalized estimating equation models and restricted cubic spline regression analysis. Stratified analysis was conducted by obesity class (I:30–34.9 kg/m 2 , II:35–39.9 kg/m 2 , and III + : ≥40 kg/m 2 ). Results Of the 52,153 eligible women who entered pregnancy with a BMI ≥ 30 kg/m 2 , 5.3% had GWL. Compared to adequate gestational weight gain, GWL was associated with an increased risk of SGA neonates (aRR:1.45, 95% CI: 1.30–1.60) and a decreased risk of LGA neonates (aRR: 0.81, 95% CI:0.73–0.93). Non-linear L-shaped associations were observed between gestational weight change and SGA neonates, with an increased risk of SGA observed with increased GWL. On the contrary, non-linear S-shaped associations were observed between gestational weight change and LGA neonates, with a decreased risk of LGA observed with increased GWL. Similar findings were observed from the stratified analysis by obesity class. Conclusion These findings highlight that GWL in women with obesity may increase the risk of SGA neonates but reduce the risk of LGA neonates. Recommendations of GWL for women with obesity should be interpreted with caution.