CHU Sainte-Justine Université de Montréal

Research projects

Caffeine intake before and during pregnancy and the risk of adverse pregnancy outcomes.

Caffeine is the most consumed psychoactive substance in the world. Caffeine has the particularity of being completely absorbed by the gastro-intestinal tract and to cross easily encephalic and placental membranes. Furthermore, caffeine elimination during pregnancy is delayed due to the increased estrogens concentration induced by gestation. Experimental studies conducted in animal models suggested an association between caffeine intake and adverse pregnancy outcomes including growth restriction.

Our previous study on the prevalence of caffeine intake among canadian women showed that 87.3 % of women involved in our study reported consuming caffeine before pregnancy and 71.4 % of them continued during pregnancy.

The objective of this study was to quantify the association between caffeine intake during pregnancy and the risk of small for gestational age (SGA) using data from the  Quebec Pregnancy Cohort.

Determinants of periconceptional folic acid supplementation and consistency with the Canadian Guidelines.

Neural-tube defects (NTDs) are congenital malformations of the central nervous system that are among the most common and serious of all congenital anomalies. In North America, they are the second cause of infant mortality, among congenital malformations. Etiology of neural-tube defects remains unknown, but epidemiologic studies suggested that they are the result of a combination of environmental influences and genetic predispositions.

Folate deficiency during embryogenesis is the predominant environmental factor that has been associated with NTDs. Results of previous studies has shown a 72% reduction of the prevalence of neural tube defects after maternal periconceptional folate supplementation. In order to reduce the incidence of neural tube defects, Canadian health authorities recommend, since 1993, that women of childbearing age should be advised about the benefits of folic acid and should take a multivitamin containing 0.4 mg to 1.0 mg of folic acid daily before conception and during first trimester of pregnancy.

The objectives of this study were: 1) to evaluate the concordance between the new guidelines and vitamin/folic acid use in real life according to the risk factors identified by the canadien recommendations; and 2) to identify variables associated with appropriate folic acid supplementation in women of childbearing age. The data for this project was obtained by a self-adminstrated questionnaire and women enrolled in this study were recruited at the department of obstetrics and gynecology of the CHU Sainte-Justine.

Use of antihypertensive drugs during pregnancy: Risks and benefits to mother and child.

Hypertension is one of the most frequently reported medical disorders of pregnancy and often needs to be managed using antihypertensive drugs. In fact, antihypertensive drugs are among the most commonly used medications in pregnancy. However, there is still no strong evidence regarding the appropriate use of these drugs for the management of hypertension during pregnancy and the impact of these drugs on pregnant women and on the developing fetus.

The aims of this study were to: 1) determine the prevalence and trends of the use of antihypertensive drugs during pregnancy; 2) identify predictors associated with the use of antihypertensive drugs during pregnancy; and 3) evaluate the association between fetal exposure to antihypertensive drugs and preterm birth, low birth weight, and major congenital malformations. This study was conducted using data from the  Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

Antibiotics use during pregnancy: Risks and benefits for mother and child.

Despite the fact that antibiotics are among the most frequently used drugs during pregnancy, there is no agreement on the risks and benefits for pregnant women and their children.

The objectives of this research project are to: 1) determine the prevalence and trends of antibiotics use before, during and after pregnancy; 2) identify predictors associated with antibiotics use during pregnancy; and 3) evaluate the association between fetal exposure to antibiotics and preterm birth, low birth weight, and major congenital malformations, according to trimester of exposure. These different aspects of antibiotics use during pregnancy are studied using data from the Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

Antiepileptic drug use during pregnancy: Risks and benefits to mother and child.

The main concern associated with the use of antiepileptic drugs in pregnancy consists of maternal and fetal risk. There is still uncertainty regarding the risk of fetal malformations associated with the use of the various antiepileptic drugs, especially the newer agents. Through this study, we aim to determine the prevalence and trends of antiepileptic drug use during pregnancy and to assess whether any of these agents is associated with major congenital malformations. Dosage, type of medication and drug combinations are considered. The study is conducted using data from the Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

Tobacco use during pregnancy: Prevalence, risks, and interventions.

Smoking during pregnancy is a well established risk to fetal development. Cigarette smoking during pregnancy is the single largest modifiable risk for pregnancy-related morbidity and mortality. As of now, studies have not compared the effect of interventions (nicotine replacement therapy vs. bupropion) with regards to infant risks/benefits.

 

With this study, we aimed to determine and compare the effects of gestational use of bupropion and nicotine replacement therapy on the rate of: 1) preterm birth; 2) low birth weight; and 3) small for gestational age (SGA). The study was conducted using data from the  Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants, National Cancer Institute of Canada.

Oral contraceptive use before pregnancy and the risk of gestational hypertension, pre-eclampsia and eclampsia.

The literature suggests that oral contraceptive use increases blood pressure. Hence, there is reason to believe that oral contraceptive use before pregnancy might increase the risk of gestational hypertension, pre-eclampsia, and eclampsia.

We sought to investigate the association between oral contraceptive use before pregnancy and the risk of: 1) gestational hypertension, 2) pre-eclampsia, and 3) eclampsia. This study was conducted using data from the  Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

Medication use during pregnancy and lactation: Data from the IMAGe Center for information on teratogenic risk.

Few clinical trials have studied medications, prior to their market approval, for risks and benefits when used during pregnancy and lactation. The IMAGe Center, based at CHU Sainte-Justine in Montreal, Quebec, Canada, is a teratogen information service that counsels Quebec healthcare professionals on the risks and benefits of exposure to various medications during pregnancy and lactation. This study was conducted using data from the  IMAGe Center database. The first phase of this research project was to determine the content of telephone calls (medication classes most frequently asked about, their indications for use) and the predictors of these calls (according to medication class). To be included, calls had to be received between 2004 and 2007 and had to pertain to women exposed during pregnancy or lactation. The second phase of the research project was to determine whether Health Canada advisories and warnings had any impact on the number of calls received at IMAGe.

Funding

Canadian Foundation for Innovation (CFI).

Medications in pregnancy: Risks of preterm birth, congenital malformations, and associated healthcare costs.

Our objectives were to conduct a series of retrospective studies using data available from the  Quebec Pregnancy Cohort. We completed studies investigating the association between the use of medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and statins in early pregnancy and the risk of congenital malformations. Other objectives of our research project were to identify and quantify the risk factors associated with preterm birth and to evaluate the healthcare costs of late preterm and full-term births during the early years of child development.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

Use of antidepressants in pregnancy: associated risks and benefits in terms of infant health and healthcare costs.

The use of antidepressants in pregnancy remains a controversial topic. Starting, continuing, or discontinuing treatment remains a difficult decision.

Our objectives were to: 1) determine the prevalence of antidepressant use before, during, and after pregnancy, including switches, doses, and classes of antidepressants used; 2) identify factors associated with antidepressant use at the beginning and end of pregnancy; 3) determine whether duration of antidepressant use during the first trimester of pregnancy increases the risk of major congenital malformations; and 4) quantify the association between antidepressant use and infants born small for gestational age (SGA). This study was conducted using data from the  Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

The use of herbal products during pregnancy: Prevalence, predictors, and risk of preterm birth.

An increase in the use of natural health products, particularly herbal products (HPs), is noticed all over the world. Previous studies conducted among pregnant women in the United States and elsewhere showed that up to 55% of women used at least one HP during pregnancy. However, in Canada, the population of women who use HPs during pregnancy has not been studied. Moreover, the effect of HP use during pregnancy on pregnancy outcomes remains largely unknown.

With this research project, we aimed to: 1) measure the frequency of HP use among pregnant women in Canada; 2) identify the most frequently consumed HPs during gestation; 3) estimate the frequency of concomitant use of HPs and prescribed medications during pregnancy; 4) determine predictors of HP use among women at the beginning of pregnancy and during the third trimester; and 5) quantify the association between HP use in the second and third trimesters of pregnancy and the risk of preterm birth. This study was conducted using data from the Quebec Pregnancy Cohort.

Funding

Fonds de la recherche en santé du Québec (FRSQ), Réseau québécois de recherche sur l'usage des médicaments (RQRUM), Réseau FRSQ pour le bien-être des enfants.

Quality of life during pregnancy: Impact and management of nausea and vomiting of pregnancy.

Most pregnant women (50% to 90%) experience nausea and vomiting of pregnancy (NVP) during their first trimester. NVP can have a significant impact on quality of life (QOL) of pregnant women. However, given that NVP is common and generally not life-threatening, healthcare professionals and pregnant women often tend to minimize its impact. As a result, it is believed that management of NVP is less than optimal.

With this research project, we sought to identify determinants of the presence and severity of NVP during the first and second trimesters of pregnancy, with special emphasis on the effect of race/ethnicity. We also aimed to determine the impact of NVP on quality of life in the first trimester of pregnancy and to evaluate the management of NVP at the first prenatal visit. A prospective cohort study, including pregnant women attending the CHU Sainte-Justine or René-Laennec Obstetrics and Gynaecology Clinics for prenatal care, was conducted from 2004 to 2006. Ethics approval was obtained from the CHU Sainte-Justine ethics committee.

Funding

Fonds de la recherche en santé du Québec (FRSQ).

Metoclopramide and diphenhydramine in the treatment of hyperemesis gravidarum: Effectiveness, safety and predictors of rehospitalisation.

Hyperemesis gravidarum (HG) is the second most common reason for hospitalisation during pregnancy. Since 2002, a new HG treatment protocol consisting of metoclopramide plus diphenhydramine was put in place at CHU Sainte-Justine.

A retrospective cohort study was conducted from 2002 to 2006 on the cohort of pregnant women diagnosed with HG and treated at CHU Sainte-Justine with the new protocol (consisting of intravenous metoclopramide 1.2-1.8 mg/h plus diphenhydramine 50 mg every six hours). These women were compared to a historical control group consisting of women diagnosed with HG between 1998 and 2001 and treated in the same institution with intravenous droperidol 0.5-1 mg/h plus diphenhydramine 25-50 mg every six hours.

The objective of this study was to evaluate the effectiveness of the new protocol with respect to length of hospitalisation for HG, rate of rehospitalisation for HG, progression of NVP symptoms, and rate of adverse events. A second objective was to identify predictors of rehospitalisation for HG in the group of women treated with the new protocol.

Funding

Researcher's funds

Isotretinoin and the risk of depression in patients with severe acne vulgaris.

Isotretinoin is the most effective medication in the treatment of severe recalcitrant nodular acne. However, case reports have suggested a controversial association between isotretinoin and depression. Although several observational studies have investigated this association, none has produced significant results. These studies either involved small sample sizes or had no appropriate control groups.

The primary objective of this research project was to determine whether isotretinoin increases the risk of depression in patients with acne vulgaris. The study was conducted from 1984 through 2003 in the province of Quebec. Moreover, we sought to: 1) describe the patterns and trends of isotretinoin utilization; 2) describe the characteristics of isotretinoin users within that same time period; 3) identify and quantify predictors of isotretinoin use; 4) identify and quantify predictors of acne relapses; and 5) describe the impact of guidelines on isotretinoin utilization. This study was conducted using data from the  Isotretinoin users cohort.

Funding

Canadian Institutes of Health Research (CIHR).