Prenatal care of women who give birth to Children with Fetal Alcohol Spectrum Disorder in a universal health care system: A retrospective cohort study utilizing linkable administrative data

Introduction Fetal Alcohol Spectrum Disorder (FASD) is a significant public health concern. Prenatal care (PNC) settings are integral to preventing prenatal alcohol exposure as physicians delivering PNC services are in a unique position to reduce alcohol consumption during pregnancy. However, few studies have investigated PNC use among women who drink during Objectives and Approach Analysis was conducted of women with children born in Manitoba between April 1, 1984 and Mach 31, 2012, with follow up till 2013 using linkable administrative and novel clinic data. Study group included women whose child(ren) were diagnosed with FASD from 1999 to 2012 (n=702) at a centralised FASD diagnostic clinic. Comparison group included women from the general population whose children who did not have an FASD diagnosis (n=2097), matched on the index child’s birthdate, postal code, and SES. Adequacy of PNC utilization was defined using the revised Graduated Index of Prenatal Care Utilization. Results This is the first population-based study to investigate rates of PNC usage of women who have given birth to children with FASD. Rates of inadequate PNC were higher among the study group (adjusted RR 2.47, 95% CI 2.08 to 2.94), as well as no PNC (adjusted RR 3.55, CI 2.42 to 5.22). Among the study group 63% accessed PNC, with 59% receiving intermediate, adequate, or intensive PNC. Conclusion/Implications Results represent opportunity for screening and brief intervention programs to be delivered in PNC health care settings, as well as outreach programs to facilitate the uptake of PNC among high risk women

Prescription Opioid Use and Concurrent Psychotropic Drug Use During Pregnancy: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data

Introduction It is important to investigate the use of prescription opioids during pregnancy to gain insight into the potential impact of maternal opioid exposure during pregnancy on children. We report the prevalence of prescription opioid use and concurrent psychotropic drug use in a large, Canadian population-based cohort of pregnant women. Objectives and Approach Using population-level linked administrative data from a universal health care system, this study included all women with a live birth in Manitoba from 1996 to 2014. Dispensing of opioids was determined from prescription drug data. Patterns of prescription opioids dispensed to pregnant women were investigated by demographic characteristics, region of residence, and socioeconomic status. Concurrent psychotropic therapies were also measured. These data address limitations associated with re-call bias, cilitate longitudinal analaysis, and allow the investigation of rare outcomes, difficult to study using other data sources. Results In a large population level sample of pregnancies (N=245,784), 2.43% of pregnancies were exposed to 2+ dispensations of opioids. An additional 4.95% of pregnancies recorded at a single opioid dispensation. Compared to women who were not dispensed any opioid prescriptions, the proportion of opioid exposed pregnancies who were also prescribed anti-depressants (SSRI/SNRI) was sevenfold higher (22.5% vs 3.05%). The same pattern was found for anxiolytics (37.2% vs 1.5%) and antipsychotics (3.5% vs 0.34%). Conclusion/Implications These data demonstrate high proportions of women were dispensed opioids during pregnancy. Further research should be done on the short term and long term effects of these medications on infants and children. Moreover, these results highlight the need for further investigation into the effects of exposure to multiple psychotropic drug

In-Utero SSRI and SNRI Exposure and the Risk of Long Term Adverse Mental and Educational Outcomes in Children: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data

Introduction Few studies are capable of investigating the impact of untreated maternal depression versus in-utero antidepressant exposure on long-term effects on children. Previous studies are limited by confounding by indication and are unable to follow children over time to accurately investigate long term outcomes present in childhood and adolescence. Objectives and Approach We utilize linkable administrative data to facilitate longitudinal analysis to investigate mental and educational outcomes in children exposed to in utero antidepressants. Using population-level linked administrative data from a universal health system, this study included all mother-newborn dyads in Manitoba (born 1996 to 2009, with follow-up through 2014). High Dimensional Propensity Scores and inverse probability treatment weighting were used to address confounding by indication and disease severity.Cox Proportional Hazard Regression models were used to estimate risk of mood and anxiety disorder in children and educational outcomes. Results Asymmetric trimming of the study cohort resulted in a total of 4998 mother-child dyads; 4159 children whose mothers did not use SSRIs/SNRIs during pregnancy and 839 children who were exposed to 2+ prescriptions in-utero. Use of SSRIs/SNRIs during pregnancy was not associated with an increased risk of mood/anxiety disorder in children HR 1.32 (95% CI 0.67 to 2.62). Initial results on the association between in-utero antidepressant use and early childhood development index (EDI) scores indicate no impact on school readiness (31.9% vs 29.3%), or scores on standardized tests of literacy and numeracy in Grade 3 (28.4% meeting expectation versus 31.4%) and in Grade 7 (68.8% versus 70.0%). Conclusion/Implications Administrative data facilitate investigation into an important clinical concern. These data provide robust evidence demonstrating in a large population based sample, in utero exposure to serotonergic antidepressants compared with no exposure does not increase risk of the onset of mood and anxiety disorders and adverse educational outcomes in children

In-Utero SSRI and SNRI Exposure and the Risk of Neurodevelopmental Disorders in Children: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data

Introduction Many studies demonstrating an association between in utero exposure to serotonergic antidepressants and higher risk of neurodevelopmental disorders in children are confounded by history of maternal depression and disease severity. We conducted a population-based analysis of women diagnosed with mood/anxiety disorder, a patient population for whom pharmacotherapy is clearly indicated. Objectives and Approach Using linked population-based administrative data, we identified all mother-newborn pairs in Manitoba (born 1996 to 2009, with follow-up through 2014). High dimensional propensity scores and inverse probability treatment weighting were used to address confounding by indication and disease severity. The final trimmed cohort consisted of mothers who were diagnosed with a mood/anxiety disorder from 90 days prior to conception until delivery (n=4995). Cox Proportional Hazard Regression models were used to estimate risk of Autism Spectrum Disorder, epilepsy and attention deficit hyperactivity disorder (ADHD) in offspring. In addition to clinical data, we used novel education data to define outcomes in children. Results Among the cohort of mothers diagnosed with a mood/anxiety disorder during pregnancy or up to 90 days before, 16.8% received at least two dispensations of an SSRI or SNRI during pregnancy. We did not observe an association between use of SSRIs/SNRIs during pregnancy and increased risk of Autism Spectrum Disorder (hazard ratio 0.92; 95% CI 0.42 to 2.03), epilepsy (hazard ratio 1.21; 95% CI 0.48 to 3.05), or ADHD (hazard ratio 1.13, 95% CI 0.78 to 1.64) among offspring. Conclusion/Implications In the absence of randomized control trials, large observation studies using sophisticated data analysis are the gold standard of evidence to help patients and clinicians making the decision to continue antidepressant use during pregnancy. Results of this study reassure women for whom the medication is clinically indicated

Children\u27s Sleep during COVID-19: How Sleep Influences Surviving and Thriving in Families

Objective The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents and children s needs to support sleep during the pandemic. Methods Eighty-five Canadian parents with children aged 4 14 years participated in this explanatory sequential, mixed-methods study using an online survey of children s and parents sleep, with a subset of 16 parents, selected based on changes in their children s sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. Results While some parents perceived their child s sleep quality improved during the COVID-19 pandemic (14.1%, n 12), many parents perceived their child s sleep had worsened (40.0%, n 34). Parents attributed children s worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children s and parents sleep. Conclusions The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children s sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges

Understanding and Managing Sleep Disruption in Children with FASD

Accumulating evidence has revealed high rates of sleep disruption among children with Fetal Alcohol Spectrum Disorder (FASD). Multiple animal and clinical studies have found a clear association between sleep problems and prenatal alcohol exposure (PAE), and recent research is beginning to characterize the types and extent of sleep disruption in FASD. Nevertheless, sleep disruption in children with FASD often goes unrecognized or is treated without referring to an evidence base. Childrenâ s disrupted sleep interferes with parental sleep and increases caregiver burden, which is of particular importance for families raising children with FASD, a group with very high levels of caregiving stress. The literature supporting an association between sleep problems and deficits in emotional, behavioral and cognitive function in children is compelling, but needs further investigation in children with FASD. This paper will review the current state of knowledge on sleep in FASD, and recommend a rational approach to sleep interventions for affected children and their families.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Translating to the Community (T2C): A protocol paper describing the development of Canada's first social epigenetic FASD Biobank

Translating to the Community (T2C) is a social bio-repository designed to advance new diagnostic tools and realign community-clinical processes, with the aim to mitigate the short-and-long term impacts of Fetal Alcohol Spectrum Disorder (FASD), prenatal alcohol exposure, and its co-morbidities and behaviors. In this paper, we describe the evolution of this repository as a new translational partnership to advance a precision medicine approach to FASD. Key to its evolution was a partnership between academic researchers, Indigenous communities, families and a regional diagnostic clinic. We further describe the rationale for social biobanking, the type of banking, ethical engagement of families, communities and clinics, their role in repository design, governance, translation and research activities, types of data collected from families, and how the study data is managed, reported and accessed. The repository design includes biological samples, social-contextual-health survey data, and clinical data (which are linkable to administrative data) from community and clinical cohorts of diagnosed children, children prenatally exposed but not diagnosed, children suspected to have had a prenatal exposure, and related siblings, biological parents, and unrelated children and their parents. From these cohorts and families, potential studies drawing on this data will shed light on various risk factors, social and biological pathways, and service utilization issues, with the aim to implement primary and secondary prevention and intervention strategies.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Comorbidities Affecting Children with Autism Spectrum Disorder: A Retrospective Chart Review

Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction/communication, restricted interests, and repetitive behaviors. Recent discussions have emerged worldwide regarding the heterogeneity around presentation/etiology and comorbidities. This study aimed to determine the frequency and characteristics of comorbidities among children diagnosed with ASD in Manitoba and to evaluate differences in presentation between those with and without medical comorbidities. We conducted a retrospective chart review of >1900 electronic charts at the only publicly funded referral site for children ≤6 years requiring evaluation for ASD in Manitoba. All children aged 0–6 years diagnosed with ASD at this site between May 2016 and September 2021 were identified. χ2 and t-tests were used to compare groups. Of the total of 1858 children identified, 1452 (78.1%) were boys, 251 (13.5%) were prematurely born, and 539 (29.0%) had ≥1 medical comorbidity. Global developmental delay (GDD) was diagnosed in 428 (23.0%). The age of referral and diagnosis did not differ between groups. Comorbidities were more common among premature children (16.0% vs. 12.5%, p: 0.005) and children with comorbid GDD (34.9% vs. 18.2%, p p: 0.518); however, girls had a higher incidence of neurological comorbidities, e.g., cerebral palsy, seizures, hypotonia (14.8% vs. 9.64%, p: 0.009), as well as genetic comorbidities (4.92% vs. 2.75%, p: 0.04). The high rates of associated neurological conditions, GDD, and prematurity add heterogeneity to this group leading to potential difficulties with prognosis and service allocation. Primary vs. secondary ASD can be a way of separating individuals based on relevant medical comorbidities

Integrating Care for Individuals with FASD: Results from a Multi-Stakeholder Symposium

BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals’ lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes. METHODS: We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified ‘Nominal Group Technique’. RESULTS: FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities. CONCLUSIONS: There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and supporting increased integration. Research is needed to better address best practices (e.g., interventions, supports and programs) and long-term individual and family outcomes following a diagnosis of FASD