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Joel G. Ray - One of the best experts on this subject based on the ideXlab platform.

  • Impact of Diabetes, obesity and hypertension on preterm birth: Population-based study.
    PloS one, 2020
    Co-Authors: Howard Berger, Michael Geary, Nir Melamed, Karizma Mawjee, Jon Barrett, Sarah D. Mcdonald, Beth Murray Davis, Haroon Hasan, Joel G. Ray
    Abstract:

    Objective To determine the impact of pre-Pregnancy Diabetes Mellitus (D), obesity (O) and chronic hypertension (H) on preterm birth (PTB). Methods Retrospective population-based cohort study in Ontario, Canada between 2012–2016. Women who had a singleton livebirth or stillbirth at > 20 weeks gestation were included in the cohort. Exposures of interest were D, O and H, individually, and in various combinations. The primary outcome was PTB at 241/7 to 366/7 weeks. PTB was further analyzed by spontaneous or provider-initiated, early (< 34 weeks) or late (34–37 weeks), and the co-presence of preeclampsia, large for gestational age (LGA), and small for gestational age (SGA). Multivariable Poisson regression models with robust error variance were used to generate relative risks (RR), further adjusted for maternal age and parity (aRR). Population attributable fractions (PAF) were calculated for each of the outcomes by exposure state. Results 506,483 women were eligible for analysis. 30,139 pregnancies (6.0%) were complicated by PTB < 37 weeks, of which 7375 (24.5%) had D or O or H. Relative to women without D or O or H, the aRR for PTB < 37 weeks was higher for D (3.51; 95% CI 3.26–3.78) and H (3.81; 95% CI 3.55–4.10) than O (1.14; 95% CI 1.10–1.17). The combined state of DH was associated with a significantly higher aRR of PTB < 37 weeks (6.34; 95% CI 5.14–7.80) and < 34 weeks (aRR 10.33, 95% CI 6.96–15.33) than D alone. The risk of provider initiated PTB was generally higher than that for spontaneous PTB. Pre-Pregnancy hypertension was associated with the highest risk for PTB with preeclampsia (aRR 45.42, 95% CI 39.69–51.99) and PTB with SGA (aRR 9.78, 95% CI 7.81–12.26) while pre-Pregnancy Diabetes was associated with increased risk for PTB with LGA (aRR 28.85, 95% CI 24.65–33.76). Conclusion Combinations of DOH significantly magnify the risk of PTB, especially provider initiated PTB, and PTB with altered fetal growth or preeclampsia.

  • Timing of delivery in women with pre-Pregnancy Diabetes Mellitus: a population-based study
    BMJ Open Diabetes Research & Care, 2019
    Co-Authors: Meghan Brown, Joel G. Ray, Michael Geary, Nir Melamed, Beth Murray-davis, Haroon Hassan, Karizma Mawjee, Jon Barrett, Sarah D. Mcdonald, Howard Berger
    Abstract:

    Objectives Controversy exists about the timing of delivery of women with pre-Pregnancy type 1 and 2 Diabetes Mellitus (PDM). This study aims to compare maternal and neonatal outcomes after induction of labor (IOL) at 38 weeks’ gestation versus expectant management from 39 weeks onward. Research design and methods This was a retrospective population-based cohort study using data from the Better Outcomes Registry and Network in Ontario Canada. Included were all women with PDM, who had a singleton hospital birth at ≥380/7 weeks’ gestation from 2012 to 2017. Maternal and perinatal outcomes were compared between 937 pregnancies that underwent IOL at 380/7–386/7 weeks (‘38-IOL group’) versus 1276 pregnancies expectantly managed resulting in a birth at ≥390/7 weeks (‘39-Exp group’). The primary outcome was all-cause cesarean delivery. Multivariable modified Poisson regression was performed to generate adjusted relative risks (aRR) and 95% CIs, adjusted for parity, maternal age, pre-Pregnancy body mass index and PDM type. Other outcomes included instrumental delivery, neonatal intensive care unit (NICU) admission, and newborn metabolic disturbances. Results Cesarean delivery occurred in 269 women (28.7%) in the 38-IOL group versus 333 women (26.1%) in the 39-Exp group—aRR 1.07 (95% CI 0.94 to 1.22). The respective rates of instrumental delivery were 11.2% and 10.2% (aRR 1.25, 95% CI 0.98 to 1.61). NICU admission was more common in the 38-IOL group (27.6%) than in the 39-Exp group (16.8%) (aRR 1.61, 95% CI 1.36 to 1.90), as were jaundice requiring phototherapy (12.4% vs 6.2%) (aRR 1.93, 95% CI 1.46 to 2.57) and newborn hypoglycemia (27.3% vs 14.7%) (aRR 1.74, 95% CI 1.46 to 2.07). Conclusion In pregnant women with PDM, IOL at 380/7–386/7 weeks was not associated with a higher risk of cesarean delivery, compared with expectant management, but was associated with a higher risk of certain adverse neonatal outcomes.

  • A simple clinical method to identify women at higher risk of preeclampsia.
    Pregnancy hypertension, 2017
    Co-Authors: Effie Viguiliouk, Alison L. Park, Howard Berger, Michael Geary, Joel G. Ray
    Abstract:

    Abstract An outstanding issue is how to efficiently identify women at high risk of preeclampsia. This retrospective cohort study included 8672 pregnancies at a single centre in Toronto. We tested our simple method – presence vs. absence of ≥1 major (pre-Pregnancy BMI > 30 kg/m2, chronic hypertension, pre-Pregnancy Diabetes Mellitus and assisted reproductive therapy) or ≥2 minor (prior stillbirth, age >40 years, nulliparity, multifetal Pregnancy, chronic kidney disease, and SLE) risk factors for PE. The RR of PE was 8.4 (95% CI 5.3–13.2) and the model C-statistic 0.74 (95% CI 0.69–0.79). Further testing of this method elsewhere is warranted.

  • Impact of pre-Pregnancy Diabetes Mellitus on congenital anomalies, Canada, 2002-2012.
    Health promotion and chronic disease prevention in Canada : research policy and practice, 2015
    Co-Authors: Shiliang Liu, Jocelyn Rouleau, Juan Andrés León, Reg Sauve, K.s. Joseph, Joel G. Ray
    Abstract:

    OBJECTIVE To examine the impact of pre-Pregnancy Diabetes Mellitus (DM) on the population birth prevalence of congenital anomalies in Canada. METHODS We carried out a population-based study of all women who delivered in Canadian hospitals (except those in the province of Quebec) between April 2002 and March 2013 and their live-born infants with a birth weight of 500 grams or more and/or a gestational age of 22 weeks or more. Pre-Pregnancy type 1 or type 2 DM was identified using ICD-10 diagnostic codes. The association between DM and all congenital anomalies as well as specific congenital anomaly categories was estimated using adjusted odds ratios; the impact was calculated as a population attributable risk percent (PAR%). RESULTS There were 118,892 infants with a congenital anomaly among 2,839,680 live births (41.9 per 1000). While the prevalence of any congenital anomaly declined from 50.7 per 1000 live births in 2002/03 to 41.5 per 1000 in 2012/13, the corresponding PAR% for a congenital anomaly related to pre-Pregnancy DM rose from 0.6% (95% confidence interval [CI]: 0.4-0.8) to 1.2% (95% CI: 0.9-1.4). Specifically, the PAR% for congenital cardiovascular defects increased from 2.3% (95% CI: 1.7-2.9) to 4.2% (95% CI: 3.5-4.9) and for gastrointestinal defects from 0.8% (95% CI: 0.2-1.9) to 1.4% (95% CI: 0.7-2.6) over the study period. CONCLUSION Although there has been a relative decline in the prevalence of congenital anomalies in Canada, the proportion of congenital anomalies due to maternal pre-Pregnancy DM has increased. Enhancement of preconception care initiatives for women with DM is recommended.

  • Serious Preeclampsia Among Different Immigrant Groups
    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2012
    Co-Authors: Marcelo L. Urquia, Howard Berger, Ivan Ying, Richard H. Glazier, Leanne R. De Souza, Joel G. Ray
    Abstract:

    Abstract Objective Research conducted outside Canada suggests that preeclampsia (PET) may be more common among certain ethnic groups. A limitation to prior studies is that they did not distinguish between immigrant and non-immigrant women; they also included women with mild PET arising near term, the clinical importance of which is debatable. We created the term "serious PET" to describe a diagnosis of severe PET, eclampsia, or any degree of PET with concomitant preterm delivery, fetal death, or maternal hospitalization of seven days or more, and evaluated its risk in association with world region of origin among recent immigrants to Ontario. Methods Using the federal Landed Immigrant Data System database (LIDS), we completed a population-based study of 18 849 women who immigrated to Ontario between 1985 and 2000. The LIDS was linked to the Canadian Institute for Health Information's Discharge Abstracts Database, thereby capturing all hospitalizations with subsequent delivery in Ontario between April 1, 2002, and March 31, 2009. Rates for serious PET were determined according to maternal world region of birth, and odds ratios were adjusted for maternal age, number of live births, multifetal Pregnancy, Diabetes Mellitus status, level of formal education, place of residence, neighbourhood income quintile, duration of residence in Canada, and fiscal year of delivery. Results Immigrant women from the Caribbean (6.8 per 1000; OR 3.34; 95% CI 2.25 to 4.96), Sub-Saharan Africa (6.8 per 1000; OR 3.14; 95% CI 2.04 to 4.83) and Hispanic America (5.9 per 1000; OR 3.11; 95% CI 1.97 to 4.88) were at highest risk of serious PET relative to immigrant women from industrialized nations. The ORs were either unchanged or higher when restricted to women without a prior live birth. Conclusion We identified immigrant groups at higher risk of serious PET, whose consequences would presumably include greater financial costs for hospital care and a negative impact on maternal and newborn well-being.

David E. C. Cole - One of the best experts on this subject based on the ideXlab platform.

  • Metabolic syndrome features and risk of neural tube defects.
    BMC pregnancy and childbirth, 2007
    Co-Authors: Joel G. Ray, Anne Summers, Philip Wyatt, Miles D. Thompson, Marian J. Vermeulen, Chris Meier, Pui-yuen Wong, Sandra A. Farrell, David E. C. Cole
    Abstract:

    Background Maternal obesity and pre-Pregnancy Diabetes Mellitus, features of the metabolic syndrome (MetSyn), are individual risk factors for neural tube defects (NTD). Whether they, in combination with additional features of MetSyn, alter this risk is not known. We evaluated the risk of NTD in association with maternal features of the MetSyn.

  • Metabolic Syndrome features and risk of neural tube defects
    BMC Pregnancy and Childbirth, 2007
    Co-Authors: Joel G. Ray, Miles D. Thompson, Marian J. Vermeulen, Chris Meier, Pui-yuen Wong, Sandra A. Farrell, Philip R Wyatt, Anne M Summers, David E. C. Cole
    Abstract:

    Background Maternal obesity and pre-Pregnancy Diabetes Mellitus, features of the metabolic syndrome (MetSyn), are individual risk factors for neural tube defects (NTD). Whether they, in combination with additional features of MetSyn, alter this risk is not known. We evaluated the risk of NTD in association with maternal features of the MetSyn. Methods We used a population-based case-control study design in the province of Ontario, Canada. Cases and controls were derived from women who underwent antenatal maternal screening (MSS) at 15 to 20 weeks' gestation. There were 89 maternal cases with, and 434 controls without, an NTD-affected singleton Pregnancy. Maternal features of MetSyn were defined by the presence of pre-Pregnancy Diabetes Mellitus, body weight ≥ 90th centile among controls, non-white ethnicity and/or serum highly sensitive C-reactive protein (hsCRP) ≥ 75th centile of controls. Since hsCRP naturally increases in Pregnancy, analyses were performed with, and without, the inclusion of hsCRP in the model. Results Mean hsCRP concentrations were exceptionally high among study cases and controls (6.1 and 6.4 mg/L, respectively). When hsCRP was excluded from the model, the adjusted odds ratios for NTD were 1.9 (95% confidence interval 1.1–3.4) in the presence 1 feature of MetSyn, and 6.1 (1.1–32.9) in the presence of 2 or more features. When hsCRP was included, the respective risk estimates were attenuated to 1.6 (0.88–2.8) and 3.1 (1.2–8.3). Conclusion We found about 2-fold and 6-fold higher risk for NTD in the presence 1, and 2 or more features, of the metabolic syndrome, respectively. It is not clear whether this risk is altered by the presence of a high serum hsCRP concentration.

Shaun T. O'keeffe - One of the best experts on this subject based on the ideXlab platform.

  • Restless Legs Syndrome: A Review
    Archives of internal medicine, 1996
    Co-Authors: Shaun T. O'keeffe
    Abstract:

    Restless legs syndrome is characterized by unpleasant, deep-seated paresthesias in the legs and sometimes the arms. These sensations occur at rest and are relieved by movement. Sleep disturbance is common. Many patients also have periodic movements of sleep. Mild symptoms of restless legs occur in up to 5% of the population. Restless legs syndrome is idiopathic in most patients, but it may be the presenting feature of iron deficiency and is also common in uremia, Pregnancy, Diabetes Mellitus, rheumatoid arthritis, and polyneuropathy. Treatment of the underlying cause, when possible, usually relieves the symptoms. For patients with severe symptoms, levodopa, bromocriptine mesylate, opioids, carbamazepine, clonazepam, and clonidine hydrochloride have proved to be effective. (Arch Intern Med. 1996;156:243-248)

Pui-yuen Wong - One of the best experts on this subject based on the ideXlab platform.

  • Metabolic syndrome features and risk of neural tube defects.
    BMC pregnancy and childbirth, 2007
    Co-Authors: Joel G. Ray, Anne Summers, Philip Wyatt, Miles D. Thompson, Marian J. Vermeulen, Chris Meier, Pui-yuen Wong, Sandra A. Farrell, David E. C. Cole
    Abstract:

    Background Maternal obesity and pre-Pregnancy Diabetes Mellitus, features of the metabolic syndrome (MetSyn), are individual risk factors for neural tube defects (NTD). Whether they, in combination with additional features of MetSyn, alter this risk is not known. We evaluated the risk of NTD in association with maternal features of the MetSyn.

  • Metabolic Syndrome features and risk of neural tube defects
    BMC Pregnancy and Childbirth, 2007
    Co-Authors: Joel G. Ray, Miles D. Thompson, Marian J. Vermeulen, Chris Meier, Pui-yuen Wong, Sandra A. Farrell, Philip R Wyatt, Anne M Summers, David E. C. Cole
    Abstract:

    Background Maternal obesity and pre-Pregnancy Diabetes Mellitus, features of the metabolic syndrome (MetSyn), are individual risk factors for neural tube defects (NTD). Whether they, in combination with additional features of MetSyn, alter this risk is not known. We evaluated the risk of NTD in association with maternal features of the MetSyn. Methods We used a population-based case-control study design in the province of Ontario, Canada. Cases and controls were derived from women who underwent antenatal maternal screening (MSS) at 15 to 20 weeks' gestation. There were 89 maternal cases with, and 434 controls without, an NTD-affected singleton Pregnancy. Maternal features of MetSyn were defined by the presence of pre-Pregnancy Diabetes Mellitus, body weight ≥ 90th centile among controls, non-white ethnicity and/or serum highly sensitive C-reactive protein (hsCRP) ≥ 75th centile of controls. Since hsCRP naturally increases in Pregnancy, analyses were performed with, and without, the inclusion of hsCRP in the model. Results Mean hsCRP concentrations were exceptionally high among study cases and controls (6.1 and 6.4 mg/L, respectively). When hsCRP was excluded from the model, the adjusted odds ratios for NTD were 1.9 (95% confidence interval 1.1–3.4) in the presence 1 feature of MetSyn, and 6.1 (1.1–32.9) in the presence of 2 or more features. When hsCRP was included, the respective risk estimates were attenuated to 1.6 (0.88–2.8) and 3.1 (1.2–8.3). Conclusion We found about 2-fold and 6-fold higher risk for NTD in the presence 1, and 2 or more features, of the metabolic syndrome, respectively. It is not clear whether this risk is altered by the presence of a high serum hsCRP concentration.

Marian J. Vermeulen - One of the best experts on this subject based on the ideXlab platform.

  • Metabolic syndrome features and risk of neural tube defects.
    BMC pregnancy and childbirth, 2007
    Co-Authors: Joel G. Ray, Anne Summers, Philip Wyatt, Miles D. Thompson, Marian J. Vermeulen, Chris Meier, Pui-yuen Wong, Sandra A. Farrell, David E. C. Cole
    Abstract:

    Background Maternal obesity and pre-Pregnancy Diabetes Mellitus, features of the metabolic syndrome (MetSyn), are individual risk factors for neural tube defects (NTD). Whether they, in combination with additional features of MetSyn, alter this risk is not known. We evaluated the risk of NTD in association with maternal features of the MetSyn.

  • Metabolic Syndrome features and risk of neural tube defects
    BMC Pregnancy and Childbirth, 2007
    Co-Authors: Joel G. Ray, Miles D. Thompson, Marian J. Vermeulen, Chris Meier, Pui-yuen Wong, Sandra A. Farrell, Philip R Wyatt, Anne M Summers, David E. C. Cole
    Abstract:

    Background Maternal obesity and pre-Pregnancy Diabetes Mellitus, features of the metabolic syndrome (MetSyn), are individual risk factors for neural tube defects (NTD). Whether they, in combination with additional features of MetSyn, alter this risk is not known. We evaluated the risk of NTD in association with maternal features of the MetSyn. Methods We used a population-based case-control study design in the province of Ontario, Canada. Cases and controls were derived from women who underwent antenatal maternal screening (MSS) at 15 to 20 weeks' gestation. There were 89 maternal cases with, and 434 controls without, an NTD-affected singleton Pregnancy. Maternal features of MetSyn were defined by the presence of pre-Pregnancy Diabetes Mellitus, body weight ≥ 90th centile among controls, non-white ethnicity and/or serum highly sensitive C-reactive protein (hsCRP) ≥ 75th centile of controls. Since hsCRP naturally increases in Pregnancy, analyses were performed with, and without, the inclusion of hsCRP in the model. Results Mean hsCRP concentrations were exceptionally high among study cases and controls (6.1 and 6.4 mg/L, respectively). When hsCRP was excluded from the model, the adjusted odds ratios for NTD were 1.9 (95% confidence interval 1.1–3.4) in the presence 1 feature of MetSyn, and 6.1 (1.1–32.9) in the presence of 2 or more features. When hsCRP was included, the respective risk estimates were attenuated to 1.6 (0.88–2.8) and 3.1 (1.2–8.3). Conclusion We found about 2-fold and 6-fold higher risk for NTD in the presence 1, and 2 or more features, of the metabolic syndrome, respectively. It is not clear whether this risk is altered by the presence of a high serum hsCRP concentration.