Canadian Assisted Reproductive Technologies Register (CARTR) Plus

Perinatal and pediatric outcomes associated with the use of fertility treatment: a population-based retrospective cohort study in Ontario, Canada.

BMC Pregnancy Childbirth. 2023 23(1): 121. doi.org/10.1186/s12884-023-05446-3

The effect of the Ontario Fertility Program on IVF utilization and outcomes in women of advanced reproductive age.

Reproductive BioMedicine Online 2023, 46(2), 410-416. doi:10.1016/j.rbmo.2022.05.014

Optimal endometrial thickness in fresh and frozen-thaw in vitro fertilization cycles: an analysis of live birth rates from 96,000 autologous embryo transfers. 

Fertility and Sterility 2022, 117(4), 792-800.

CARTR Plus: the creation of an ART registry in Canada

Comparing maternal serum screening markers among IVF and spontaneous conceptions in Ontario through registry data

Journal of Obstetrics and Gynecology in Canada 2018;40(12):1608-1617

doi: 10.1016/j.jogc.2018.02.024

This study included two years of data from all Ontario fertility clinics and prenatal screening data to compare maternal serum screening markers in in vitro fertilization (IVF) conceptions to spontaneous conceptions. The results suggest that alternate adjustment factors are needed to increase the accuracy of prenatal screening results in IVF conceptions

Cannabis

Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes.

JAMA. 2019;322(2):145-152. doi:10.1001/jama.2019.8734

Trends and correlates of cannabis use in pregnancy: a population-based study in Ontario, Canada from 2012 to 2017.

Canadian Journal of Public Health. 2019; 110(1): 76-84.

Congenital Heart Disease

Associations between mental health conditions in pregnancy and maternal socioeconomic status: a population-based retrospective cohort study in Ontario, Canada.

BMC Womens Health. 2024 doi: 10.1186/s12905-024-03499-w.

Association between maternal marginalization and infants born with congenital heart disease in Ontario Canada.

BMC Public Health. 2023 23(1):790. doi: 10.1186/s12889-023-15660-5. 

Association of maternal socioeconomic status and race with risk of congenital heart disease: a population-based retrospective cohort study in Ontario, Canada. 

BMJ Open 2022, 12, 1-10. doi:10.1136/bmjopen-2021-051020.

Associations of congenital heart disease with deprivation index by rural-urban maternal residence: a population-based retrospective cohort study in Ontario, Canada. 

BMC Pediatr 2022, 22(1), 476. doi: 10.1186/s12887-022-03498-6. PMID: 35931992; PMCID: PMC9356510.

Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease. 

BMC pregnancy and childbirth 2021, 21(1), 72–72. England: BioMed Central.

COVID-19

When the COVID-19 pandemic was declared in March 2020, BORN quickly realized that if the SARS-COV2 virus was like past respiratory virus pandemics, pregnant individuals and newborns could be adversely affected.  Consistent with our mandate to facilitate and improve care, we knew that health policy makers and funders and pregnant individual and their care providers would need good information to make decisions.  With Ontario’s large numbers of births/year, we knew we could add important information to the scientific literature.  We worked rapidly with hospital and midwifery clinic data providers and provincial and national research groups to develop data collection systems and data linkages to COVID-19 testing and the COVID-19 vaccination registries.  To-date, we have published a number of reports and manuscripts and have worked closely with the Canadian COVID-19 pregnancy group (CAN-COVID preg) to show patterns of illness and outcomes, vaccination usage and outcomes, and socio-demographic factors associated with both.  Data collection is winding down as of April 1, 2023, but the lessons learned continue to be shared. 

Pregnancy, fetal, and neonatal outcomes after a first booster dose of covid-19 vaccine during pregnancy in Ontario, Canada: population based, retrospective cohort study.

BMJ Med. 2023 2(1):e000632. doi: 10.1136/bmjmed-2023-000632. 

Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study

Vaccine 2023; doi: 10.1016/j.vaccine.2023.01.073

This paper examines coverage estimates for COVID-19 vaccination before and during pregnancy in Ontario.  We found that COVID-19 vaccine coverage among pregnant individuals remained lower than in the general population, and there was lower vaccine initiation by multiple characteristics.

Maternal-Newborn Health System Changes and Outcomes in Ontario, Canada, During Wave 1 of the COVID-19 Pandemic-A Retrospective Study

Journal of Obstetrics and Gynaecology Canada 2022 Jun; 44(6): 664–674

doi: 10.1016/j.jogc.2021.12.006.

This paper looked at the population impact of Wave 1 of the COVID-19 pandemic on obstetric practices and the pregnancy and birth outcomes in Ontario. Key findings were that provincial health system changes implemented early in the pandemic did not result in significant increases in adverse outcomes.

Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study

BMJ 2022; 378 doi:10.1136/bmj-2022-071416 (Published 17 August 2022)

This paper assessed the risk of preterm birth, SGA and stillbirth after COVID-19 vaccination in pregnancy and found no association or higher risk of any of these outcomes.

Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes

JAMA 2022 327(20):1983-1991. doi: 10.1001/jama.2022.5906.

This paper explored whether Is SARS-CoV-2 infection during pregnancy was associated with increased risk of adverse maternal and perinatal outcomes.  This pan-Canadian study found that among over 6000 cases of COVID-19 infection in pregnant individuals there was increased risk of SARS-CoV-2–related hospitalization (relative risk, 2.65) and intensive care unit admission (relative risk, 5.46). Among cases of infection during pregnancy compared with pregnant individuals without SARS-CoV-2 infection, there was a significantly increased risk of preterm birth (relative risk, 1.63).

Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes

Looking at almost 100,000 pregnant individuals we found no significant association with an increased risk of adverse peripartum outcomes associated with the COVID-19 vaccination in pregnancy.  

 Maternal Mortality and Morbidity

Mortality Following Childbirth in Ontario - A Twenty-Year Analysis of Temporal Trends and Causes.

Journal of Obstetrics and Gynaecology Canada  2024 46, no. 12: 102689.doi: 10.1016/j.jogc.2024.102689. 

Prenatal Screening Ontario (PSO)

Prenatal Screening Ontario (PSO) was created as a provincial resource to enhance access to prenatal screening, provide education supports, facilitate ongoing quality assurance and support the incorporation of evolving technology or screening options.  For more information about PSO activities, or to access educational or ordering resources, please visit the PSO website.

Key to the work of the program is the understanding of how screening is utilized and performs in our population, and PSO has produced a number of publications to widely disseminate our findings. Selected publications are below:

Outcomes of pregnancies with varying levels of nuchal translucency measurements: A population-based retrospective study in Ontario, Canada.

Acta Obstet Gynecol Scand. 2024 doi: 10.1111/aogs.14965. 

Ultrasonographic Fetal Nuchal Translucency Measurements and Cytogenetic Outcomes.

JAMA 7(3):e243689 doi:10.1001/jamanetworkopen.2024.3689.

Pregnancies with 'double-positive' multiple marker screening results: a population-based study in Ontario, Canada.

BMC Pregnancy Childbirth. 2024  6;24(1):584. doi: 10.1186/s12884-024-06774-8. 

Cytogenetic outcomes following a failed cell-free DNA screen: a population-based retrospective cohort study of 35,146 singleton pregnancies.

American Journal of Obsetrics & Gynecology. 2023 S0002-9378(23)00010-8.doi: 10.1016/j.ajog.2023.01.007

First and second trimester maternal serum markers for prenatal aneuploidy screening: An update on the adjustment factors for race, smoking, and insulin dependent diabetes mellitus.

Clin Biochem. 2023 118:110596. doi: 10.1016/j.clinbiochem.2023.110596. 

Cytogenetic outcomes following a failed cell-free DNA screen: a population-based retrospective cohort study of 35,146 singleton pregnancies.

AJOG 2023. DOI: 10.1016/j.ajog.2023.01.007 

The main goal of this study was to assess the association between a failed cell-free DNA test and common aneuploidies. The study showed that cell-free DNA screening test failures are relatively common. Although repeat testing improves the likelihood of an informative result, pregnancies with a failed cell-free DNA screen upon first attempt remain at increased risk for common autosomal aneuploidies, but not sex chromosome aneuploidies.

Infographic

The impact of maternal and geographical factors on the uptake of NIPT: A retrospective cohort study

Prenat Diagn 2022; 42(13): 1594-1605; doi: 10.1002/pd.6257

The objectives of this study were to investigate recent trends in non-invasive prenatal testing (NIPT) utilisation. The study found there was substantial variation in NIPT uptake between regions within the province. The highest uptake was found in urban areas, highest quintile of neighbourhood income and education, for those who were ≥40 years of age and had a history of previous aneuploidy, for those with a prenatal care visit in the first trimester, multiple pregnancy, multigravidity and body mass index within the normal range.

Performance of a universal prenatal screening program incorporating cell-free fetal DNA analysis in Ontario

CMAJ 2021;193(30):E1156-E1163; doi: 10.1503/cmaj.202456.

This study described the population-based performance of Ontario's prenatal screening program, which incorporates publicly funded cfDNA screening for specific indications, and the effect of cfDNA testing on the screening and diagnostic choices made by pregnant people. This publicly funded screening program showed robust performance, a substantial reduction in prenatal diagnostic testing and that pregnant people exercise autonomy in their choices about prenatal screening and diagnosis.

Infographic

Trends in the use of prenatal testing services for fetal aneuploidy in Ontario: a descriptive study

CMAJ Open 2018;6(4):E436-E444; doi: 10.9778/cmajo.20180046

This study examined the trends in use of different modalities of prenatal screening (multiple-marker screening, cell-free DNA screening [cfDNA]) and diagnostic testing before and after the implementation of provincial funding for cfDNA screening in Ontario. Results demonstrated that since the implementation of publicly funded cfDNA, cfDNA screening increased and prenatal diagnostic testing decreased.

Enhanced first trimester screening for trisomy 21 with contingent cell-free fetal DNA: a comparative performance and cost analysis

JOGC 2017;39(9):742-749; doi: 10.1016/j.jogc.2017.01.025

This study compared four prenatal screening strategies to integrate cell-free DNA screening into a publicly funded prenatal screening algorithm. The results suggest that using enhanced first trimester screening (eFTS) with contingent cfDNA screening following a positive eFTS result is a cost-effective system that doesn't compromise screening performance.