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Background: Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the contribution of prenatal smoking, a recognized perinatal risk factor. Methods: We analyzed data from the Canadian Maternity Experiences Survey. A sample of 5,930 women who had a singleton live birth in 2005-2006 was weighted to a nationally representative population of 71,200 women. From adjusted odds ratios, we calculated population attributable fractions to estimate the contribution of BMI, GWG and prenatal smoking to PTB, SGA and LGA infants overall and across four obstetric groups. Results: Overall, 6% of women were underweight (<18.5 kg/m2) and 34.4% were overweight or obese (⩾25.0 kg/m2). More than half (59.4%) gained above the recommended weight for their BMI, 18.6% gained less than the recommended weight and 10.4% smoked prenatally. Excess GWG contributed more to adverse outcomes than BMI, contributing to 18.2% of PTB and 15.9% of LGA. Although the distribution of BMI and GWG was similar across obstetric groups, their impact was greater among primigravid women and multigravid women without a previous PTB or pregnancy loss. The contributions of BMI and GWG to PTB and SGA exceeded that of prenatal smoking. Conclusions: Maternal weight, and GWG in particular, contributes significantly to the occurrence of adverse neonatal outcomes in Canada. Indeed, this contribution exceeds that of prenatal smoking for PTB and SGA, highlighting its public health importance. [ABSTRACT FROM AUTHOR]

Objective: To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.Methods: We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 2009. The data were obtained from the Canadian Institute for Health Information. Logistic models were used to examine the association with potential determinants and consequences of eclampsia.Results: The incidence of eclampsia declined dramatically from 12.4 per 10,000 deliveries in 2003 to 5.9 in 2009. Among singleton deliveries, nulliparity (adjusted odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0-2.6), anemia (adjusted OR 2.4; 95% CI 2.0-3.0), and existing heart disease (adjusted OR 4.8; 95% CI 2.9-7.3) increased the risk of eclampsia. The declining trend in eclampsia remained unchanged after accounting for changes in potential determinants and risk factors during the study period. Eclampsia was associated with increased risks of maternal death (adjusted OR 26.8; 95% CI 9.7-73.8), assisted ventilation (adjusted OR 102.3; 95% CI 78.2-133.8), respiratory distress syndrome (adjusted OR 36.2; 95% CI 15.3-85.3), acute renal failure (adjusted OR 20.9; 95% CI 11.4-38.3), obstetric embolism (adjusted OR 9.1; 95% CI 4.1-19.9), and other complications. Adverse neonatal outcomes associated with eclampsia included neonatal death (adjusted OR 2.9; 95% CI 1.6-5.5), respiratory distress syndrome (adjusted OR 5.1; 95% CI 4.1-6.3), and small-for-gestational age birth (adjusted OR 2.6; 95% CI 2.3-3.0).Conclusion: Despite declining incidence and improved care of women with eclampsia, the condition remains strongly associated with serious adverse consequences. [ABSTRACT FROM AUTHOR]

Background: Overweight and obese women are known to be at increased risk of caesarean birth. This study estimates the contribution of prepregnancy body mass index (BMI) and gestational weight gain (GWG) to caesarean births in Canada., Methods: We analyzed data from women in the Canadian Maternity Experiences Survey who had a singleton term live birth in 2005-2006. Adjusted odds ratios for caesarean birth across BMI and GWG groups were derived, separately for nulliparous women and parous women with and without a prior caesarean. Population attributable fractions of caesarean births associated with above normal BMI and excess GWG were calculated., Results: The overall caesarean birth rate was 25.7%. Among nulliparous and parous women without a previous caesarean birth, rates in obese women were 45.1% and 9.7% respectively, and rates in women who gained above their recommended GWG were 33.5% and 8.0% respectively. Caesarean birth was more strongly associated with BMI than with GWG. However, due to the high prevalence of excess GWG (48.8%), the proportion of caesareans associated with above normal BMI and excess GWG was similar [10.1% (95% CI: 9.9-10.2) and 10.9% (95% CI: 10.7-11.1) respectively]. Overall, one in five (20.2%, 95% CI: 20.0-20.4) caesarean births was associated with above normal BMI or excess GWG., Conclusions: Overweight and obese BMI and above recommended GWG are significantly associated with caesarean birth in singleton term pregnancies in Canada. Strategies to reduce caesarean births must include measures to prevent overweight and obese BMI prior to conception and promote recommended weight gain throughout pregnancy.

Objective: To examine the feasibility of using routine labour and delivery hospitalization data and international classification of diseases (ICD-10CA) codes for carrying out surveillance of severe maternal morbidity in Canada., Methods: We identified ICD-10CA diagnosis codes and Canadian Classification of Interventions (CCI) procedure codes associated with severe maternal illness. Severe maternal morbidity rates in Canada (excluding Quebec) for the period 2003 to 2007 were estimated using the Discharge Abstract Database of the Canadian Institute for Health Information. Rates were compared across maternal age, parity, plurality, labour induction, delivery by Caesarean section, and other factors. Case fatality rates and length of hospitalization were also estimated., Results: Among the 1 336 356 women who delivered between 2003 and 2007, the rate of severe maternal morbidity was 13.8 per 1000 deliveries. The mean length of hospital stay for women with and without a severe illness was 5.4 days vs. 2.5 days, while the frequency of prolonged hospital stay (>or=7 days) was 19.8% vs. 1.8%, respectively (rate ratio 9.3; 95% CI 9.0 to 9.6). Case fatality rates differed significantly between women with and without a severe illness at 2.98 vs. 0.008 per 1000, respectively (rate ratio 392.8; 95% CI 200.3 to 700.4). Rates of severe maternal morbidity were higher among deliveries to older and nulliparous women and to those delivering twins or triplets., Conclusion: Disease frequency, case fatality, and length of hospitalization patterns suggest that comprehensive and timely surveillance of severe maternal morbidity in Canada is feasible using the Canadian Institute for Health Information hospitalization data and ICD-10CA/CCI codes.