Background
Methods
Overview
Ethical approval
Recruitment
Data collection (perinatal period)
Maternal history |
---|
Smoking, drug dependent |
Pre-existing diabetes, heart disease, hypertension |
Chronic renal disease, other chronic disorder, auto immune conditions |
Maternal past pregnancy history
|
Previous term births, past preterm birth, previous preterm deliveries |
Number of previous c-sections |
Abortion, stillbirth(s), neonatal death, major congenital anomaly |
History of intrauterine growth restriction, SGA, LGA |
Indicated pregnancy
|
Smoking, drinking |
Date admitted to labour and delivery |
Assisted conception |
Gravidity, parity |
Maternal height <=152cm, maternal weight (<=45Kg, >=91Kg), poor weight gain |
Antepartum risk score |
Pregnancy complications/problems
|
Infection in pregnancy (GBS, HIV, HepB, other), fever, UTI |
Poly/oligo, ROM <37 wks, bleeding |
Pregnancy induced hypertension, gestational diabetes |
Proteinuria, anemia |
Cerclage, pre-eclampsia, eclampsia, abruption, prolonged premature rupture of membranes, placenta previa, |
Intrauterine growth restriction, polyhydramnios, chorioamnionitis |
Delivery
|
Site, type of delivery provider |
Multiple pregnancy, maternal age at delivery, gestation, pregnancy >=41 weeks |
Admitted for elect c-section, reason for operative delivery |
Indication for induction, cervical dilatation at presentation, type of delivery, delivery mode |
(Fetal) presentation in labour, trial of labour |
Method of induction (oxytocin, artificial rupture of membranes, other) |
Narcotics in labour, epidural in labour, Antenatal steroids, use of intrapartum antibiotics |
Second stage (minutes), third stage (minutes) |
Fetal
|
Neonatal gender, birth weight, date/time, disposition |
5 minute Apgar score |
Meconium, resuscitation |
NICU admission, congenital anomaly |
Maternal
|
Maternal discharge date, maternal discharge disposition, length of stay |
Breastfeeding at discharge |
Data collection (early childhood)
Results
Characteristics of the AOB participants
Maternal age at delivery (n=2670) | |
---|---|
Characteristic | n(%) |
19-24 | 153 (5.7) |
25-29 | 716 (26.8) |
30-34 | 1156 (43.3) |
35-39 | 553 (20.7) |
40+ | 92 (3.4) |
Marital status (n=3354)
| |
Married/Common Law | 3165 (94.4) |
Other | 189 (5.6) |
Education (n=3356)
| |
High school or less | 370 (11) |
Some or completed university/college | 2458 (73.2) |
Some or completed grad school | 528 (15.7) |
Ethnicity (n=3354)
| |
Caucasian | 2636 (78.6) |
Non-Caucasian | 718 (21.4) |
Income (n=3252)
| |
< $40,000 | 299 (9.2) |
$40,000 - $79,000 | 717 (22) |
≥$80,000 | 2236 (68.8) |
Born in Canada (n=3360)
| |
Yes | 2623 (78.1) |
No | 737 (21.9) |
Pregnancy intention (n=3355) | |
---|---|
Characteristic | n(%) |
Trying to get pregnant | 2698 (80.4) |
Not trying to get pregnant | 657 (19.6) |
Feelings about pregnancy (n=3348)
| |
Happy | 2913 (87) |
Unhappy/not sure | 435 (13) |
Gravidity (n=3338)
| |
Nulligravida | 1192 (35.7) |
Primi/Multigravida | 2141 (64.3) |
Parity (n=3340)
| |
Nulliparous | 1637 (49) |
Primi/Multiparous | 1703 (51) |
Weight gain during pregnancy
a
(n=3002)
| |
Inadequate | 895 (29.8) |
Adequate | 1239 (41.3) |
Excessive | 868 (28.9) |
Method of delivery (n=3055)
| |
Vaginal | 2297 (75.2) |
Caesarean section | 758 (24.8) |
Gestational age (n=3032)
| |
<34wks | 51 (1.7) |
34-36 wks | 190 (6.2) |
37+ wks | 2791 (92.1) |
Small for Gestational Age (singletons; n=2836)
| |
SGA | 300 (10.6) |
Not SGA | 2536 (89.4) |
Large for Gestational Age (singletons; n=2836)
| |
LGA | 251 (8.9) |
Not LGA | 2585 (91.1) |
Breastfeeding initiation (n=3057)
| |
Yes | 2993 (97.9) |
No | 64 (2.1) |
Exclusive breastfeeding at 1 wk (n=2969)
b
| |
Yes | 1786 (60.2) |
No | 1183 (39.8) |
Exclusive breastfeeding at 4-months (n=2976)
b
| |
Yes | 1809 (60.8) |
No | 1167 (39.2) |
Prenatal | |
---|---|
Characteristic | n(%) |
Depression, EPDSa ≥13 (n=3384) | |
Yes | 405 (12) |
No | 2979 (88) |
Anxiety, SAIb≥ 40 (n=3363) | |
Yes | 924 (27.5) |
No | 2439 (72.5) |
Stress, PSSc 80th percentile (n=3376) | |
Yes | 1041 (30.8) |
No | 2335 (69.2) |
Social support, MOSd total ≤ 69 (n=3379) | |
Inadequate | 645 (19.1) |
Adequate | 2734 (80.9) |
Optimism, LOT-Re 20th percentile (n=2925) | |
Low optimism | 582 (19.9) |
High optimism | 2343 (80.1) |
4 months postpartum
| |
Depression, EPDSa≥13 (n=3041) | |
Yes | 152 (5) |
No | 2889 (95) |
Anxiety, SAIb ≥ 40 (n=2942) | |
Yes | 440 (15) |
No | 2502 (85) |
Stress, PSSc 80th percentile (n=3004) | |
Yes | 714 (23.8) |
No | 2290 (76.2) |
Social support, MOSd total ≤ 69 (n=3012) | |
Inadequate | 412 (13.7) |
Adequate | 2600 (86.3) |
Parenting Morale Index, PMIf 20th percentile (n=2931) | |
Low parenting morale | 491 (16.8) |
High parenting morale | 2440 (83.2) |
Characteristics of discontinued participants
Characteristic | Drop-outs (n=123) | Continuers (n=3208) | p-value |
---|---|---|---|
Maternal age | |||
<30 years | 56 (49.1) | 1094 (36.5) | 0.006 |
30+ years | 58 (50.9) | 1904 (63.5) | |
Marital status | |||
Married/common-law | 102 (83.6) | 3030 (94.8) | <0.001 |
Other | 20 (16.4) | 166 (5.2) | |
Education | |||
High school or less | 32 (26.0) | 336 (10.5) | <0.001 |
More than high school | 91 (74.0) | 2861 (89.5) | |
Ethnicity | |||
Caucasian | 85 (69.7) | 671 (21.0) | 0.014 |
Non-Caucasian | 37 (30.3) | 2525 (79.0) | |
Income | |||
<$40K | 29 (24.4) | 266 (8.6) | <0.001 |
$40+K | 90 (75.6) | 2833 (91.4) | |
Gravidity | |||
Nulligravida | 43 (35.0) | 1138 (35.8) | 0.85 |
Primi/Multigravida | 80 (65.0) | 2041 (64.2) | |
Born in Canada | |||
Yes | 87 (70.7) | 2508 (78.4) | 0.045 |
No | 36 (29.3) | 693 (21.6) | |
Depression in early pregnancy | |||
Yes | 27 (22.1) | 239 (7.5) | <0.001 |
No | 95 (77.9) | 2952 (92.5) | |
Anxiety in early pregnancy | |||
Yes | 37 (32.2) | 506 (16.3) | <0.001 |
No | 78 (67.8) | 2589 (83.7) | |
Stress in early pregnancy | |||
Yes | 50 (41.3) | 660 (20.9) | <0.001 |
No | 71 (58.7) | 2505 (79.1) | |
Social support in early pregnancy | |||
Inadequate | 25 (20.8) | 412 (13.0) | 0.013 |
Adequate | 95 (79.2) | 2762 (87.0) | |
Feelings about pregnancy | |||
Happy | 100 (81.3) | 2783 (87.2) | 0.057 |
Unhappy/not sure | 23 (18.7) | 409 (12.8) |
Comparison to the target population
Characteristic | AOB % | Alberta % | Canada % |
---|---|---|---|
Demographic characteristics | |||
≥35 years | 24.1 | 15.6 | 17.5 |
Postsecondary completed | 76.3 | 69.5 | 72.1 |
>$40K | 92.3 | 77.8 | 72.6 |
Primiparousb | 48.9 | 46.0 | 44.7 |
Pre-pregnancy BMI (mean) | 24.3 | 24.4 | 24.4 |
Pregnancy characteristicsc | |||
Number of prenatal care visits (mean) | 12.8 | 13.0 | 12.9 |
Gestational age at first prenatal care visit (mean) | 9.1 | 7.2 | 7.5 |
Initiated prenatal care in first trimester (<14 weeks) | 93.1 | 94.9 | 94.9 |
First ultrasound <18weeks | 85.6 | 63.4 | 66.8 |
Attended prenatal or childbirth education classes | 41.2 | 33.4 | 32.7 |
Satisfied with timing of pregnancy | 52.6 | 50.9 | 49.5 |
Feeling happyd upon realization of pregnancy | 87.0 | 90.8 | 93.0 |
Intended to breastfeed | 96.2 | 93.8 | 90.0 |
Delivery and postpartum experiences | |||
Preterm birth rate | 7.3 | 6.3 | 6.2 |
Caesarean section delivery | 24.5 | 27.3 | 26.3 |
Short length of maternal stay in hospital | |||
Vaginal (<2 days) | 66.8 | 60.7 | 33.6 |
Caesarean section (<4 days) | 79.9 | 59.1 | 53.0 |
Initiated breastfeeding | 97.8 | 94.6 | 90.3 |
Scoring ≥13 on Edinburgh Postnatal Depression Scale | 5.1 | 6.5 | 7.5 |
Rated postpartum health as very good or excellent | 53.9 | 73.6 | 72.5 |
Postpartum BMI (mean) | 25.6 | 25.5 | 25.4 |