Michelle Rotermann

Pre-conceptional Folic Acid Supplement Use According to Maternal Country of Birth

BACKGROUND Supplementation with folic acid tablets in the pre-conceptional period reduces the risk of neural tube defects (NTD). In Canada, the risk of NTD may differ across certain ethnic groups. It is not known whether pre-conceptional folic acid supplement use varies according to a womans country of birth or her duration of residency in Canada. METHODS We included 6349 Canadian women who gave birth between January 2005 and December 2006, and who had participated in the nationally representative Maternity Experiences Survey. Reported use of a supplement containing folic acid in the three months prior to conception was evaluated in association with maternal place of birth, categorized by nine regions of the world. Odds ratios (OR) were adjusted for maternal age, gravidity, income, education level, gestational age at first prenatal care visit, and number of years living in Canada. RESULTS Relative to a rate of 61% among Canadian-born mothers, the adjusted OR for pre-conceptional use of supplements containing folic acid was significantly lower among those who emigrated from the Caribbean and Latin America (OR 0.46; 95% confidence interval [CI] 0.31-0.70), Northern Africa and the Middle East (OR 0.33; 95% CI 0.20-0.57), and China and the South Pacific (OR 0.55; 95% CI 0.40-0.78). CONCLUSION Certain groups of women who are immigrants to Canada take pre-conceptional folic acid supplements at rates much lower than Canadian-born women. Interventions aimed at increasing folic acid use might focus on these women, perhaps around their time of arrival in Canada.

Elevated Risk Factors for Adverse Pregnancy Outcomes Among Filipina-Canadian Women

OBJECTIVES Filipina immigrant women have higher than expected rates of preeclampsia and perinatal morbidity. Since obesity, diabetes mellitus (DM), and chronic hypertension are established risk factors for adverse pregnancy outcomes, we sought to determine whether they are more prevalent among Filipina women than other East Asian and Caucasian women. METHODS We pooled data from the 2000-01, 2003, 2005, and 2007 cycles of the nationally administered Canadian Community Health Survey. We generated data representative of 115,842 Filipina, 394,357 other East Asian, and 5,812 851 Caucasian women aged 18 to 49 years and living in Canada. Crude and adjusted odds ratios and 95% confidence intervals expressed the association between ethnicity and the risk of overweight (BMI >or= 25.0 kg/m(2)), obesity (BMI >or= 30.0 kg/m(2)), DM, and chronic hypertension. RESULTS The respective rates of obesity were approximately 5% for Filipinas, 2% for other East Asian women, and 14% for Caucasian women. The adjusted OR of obesity was 0.28 (95% CI 0.16 to 0.47) among Filipina women and 0.14 (95% CI 0.10 to 0.20) among other East Asians. The risk of DM was not significantly lower in Filipina women or other East Asian women than in Caucasians. Relative to a rate of 4.8% among Caucasians, chronic hypertension was significantly more prevalent among Filipinas (7.1%; adjusted OR 2.14, 95% CI 1.51 to 3.03), but not other East Asians (3.9%; adjusted OR 1.27, 95% CI 0.96 to 1.70). Post-hoc analyses showed that Filipina women were more likely to be hypertensive (adjusted OR 1.79, 95% CI 1.12 to 2.85) than other East Asian women; for obesity the adjusted OR was 1.88 (95% CI 0.97 to 3.66), and for DM it was 1.62 (95% CI 0.65 to 4.02). CONCLUSION Filipina women have higher than expected rates of excess weight and chronic hypertension, underlining the need to consider Filipina and other East Asian women separately.

Multiple Births Associated With Assisted Human Reproduction in Canada

OBJECTIVE Assisted human reproduction has been associated with increased rates of multiple births. Data suggest that twins and higher order multiple pregnancies are at risk for pre- and postnatal health complications that contribute to stress on both the family and the Canadian health care system. No published Canadian data estimate the contribution of assisted human reproduction to multiple birth rates. This study was designed to determine the contributions of age and assisted human reproduction to multiple birth rates in Canada. METHODS We performed analyses of existing Canadian databases, using a mathematical model from the Centers for Disease Control and Prevention. More specifically, data from the Canadian Vital Statistics: Births and Stillbirths database were combined with data from the Canadian Assisted Reproductive Technologies Register collected by the Canadian Fertility and Andrology Society. Datasets were standardized to age distributions of mothers in 1978. RESULTS RESULTS suggest that in vitro fertilization, ovulation induction, and age each contribute more to the rates of triplets than to twins. As expected, the contribution of natural factors was higher to twins than to triplets. CONCLUSION These are the first Canadian data analyzed to separate and measure the contributions of age and assisted reproductive technologies to multiple birth rates. Our findings are important for guiding physician and patient education and informing the development of treatment protocols that will result in lower-risk pregnancies and improved long-term health for women and their offspring.