Birth Centre Evaluation

In 2014, two new birth centres funded by the Ontario Ministry of Health and Long-Term Care were opened in Ottawa and Toronto, providing individuals choosing midwifery care with a third option (in addition to home and hospital) for place of birth. These centres continue to provide prenatal and intrapartum services.

BORN Ontario led the evaluation of the first year of these two new birth centers to assess the maternal and newborn outcomes and to learn about the experiences of clients and health care providers. To date, there have been two publications from this evaluation:

Client Experience with the Ontario Birth Center Demonstration Project

Outcomes for the first year of Ontario's Birth Center demonstration project

Journal of Midwifery & Women's Health 2018;63(5):532-540

doi: 10.1111/jmwh.12884

This publication presents outcome data on the 495 individuals who accessed the two birth centres in the first year of operations, including data on obstetrical interventions used and maternal and newborn morbidity and mortality rates. Results suggest that birth centres are a safe option for low-risk individuals.

The integration of Ontario Birth Centres into existing maternal newborn services – care provider experiences

Journal of Midwifery & Women's Health 2018;63(5):541-549

doi: 10.1111/jmwh.12883

This publication presents the results of focus groups with health care providers in the two cities where the new birth centres opened, to learn about their perceptions of the integration of the centres and their experiences with transports and transfers of care. Results suggest that with the use of a collaborative approach, the centres were well integrated in the existing maternal newborn health system.

Canadian Assisted Reproductive Technologies Register (CARTR) Plus

The effect of the Ontario Fertility Program on IVF utilization and outcomes in women of advanced reproductive age. Reproductive BioMedicine Online 2023, 46(2), 410-416. doi:10.1016/j.rbmo.2022.05.014

Optimal endometrial thickness in fresh and frozen-thaw in vitro fertilization cycles: an analysis of live birth rates from 96,000 autologous embryo transfers. Fertility and Sterility 2022, 117(4), 792-800.

CARTR Plus: the creation of an ART registry in Canada

Comparing maternal serum screening markers among IVF and spontaneous conceptions in Ontario through registry data

Journal of Obstetrics and Gynecology in Canada 2018;40(12):1608-1617

doi: 10.1016/j.jogc.2018.02.024

This study included two years of data from all Ontario fertility clinics and prenatal screening data to compare maternal serum screening markers in in vitro fertilization (IVF) conceptions to spontaneous conceptions. The results suggest that alternate adjustment factors are needed to increase the accuracy of prenatal screening results in IVF conceptions

Cannabis

Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA. 2019;322(2):145-152. doi:10.1001/jama.2019.8734

Trends and correlates of cannabis use in pregnancy: a population-based study in Ontario, Canada from 2012 to 2017. Canadian Journal of Public Health. 2019; 110(1): 76-84.

Congenital Heart Disease

Associations of congenital heart disease with deprivation index by rural-urban maternal residence: a population-based retrospective cohort study in Ontario, Canada. BMC Pediatr 2022, 22(1), 476. doi: 10.1186/s12887-022-03498-6. PMID: 35931992; PMCID: PMC9356510.

Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease. BMC pregnancy and childbirth 2021, 21(1), 72–72. England: BioMed Central.

COVID-19

When the COVID-19 pandemic was declared in March 2020, BORN quickly realized that if the SARS-COV2 virus was like past respiratory virus pandemics, pregnant individuals and newborns could be adversely affected.  Consistent with our mandate to facilitate and improve care, we knew that health policy makers and funders and pregnant individual and their care providers would need good information to make decisions.  With Ontario’s large numbers of births/year, we knew we could add important information to the scientific literature.  We worked rapidly with hospital and midwifery clinic data providers and provincial and national research groups to develop data collection systems and data linkages to COVID-19 testing and the COVID-19 vaccination registries.  To-date, we have published a number of reports and manuscripts and have worked closely with the Canadian COVID-19 pregnancy group (CAN-COVID preg) to show patterns of illness and outcomes, vaccination usage and outcomes, and socio-demographic factors associated with both.  Data collection is winding down as of April 1, 2023, but the lessons learned continue to be shared. 

Temporal trends and determinants of COVID-19 vaccine coverage and series initiation during pregnancy in Ontario, Canada, December 2020 to December 2021: A population-based retrospective cohort study

Vaccine 2023;

doi: 10.1016/j.vaccine.2023.01.073

This paper examines coverage estimates for COVID-19 vaccination before and during pregnancy in Ontario.  We found that COVID-19 vaccine coverage among pregnant individuals remained lower than in the general population, and there was lower vaccine initiation by multiple characteristics.

Maternal-Newborn Health System Changes and Outcomes in Ontario, Canada, During Wave 1 of the COVID-19 Pandemic-A Retrospective Study

Journal of Obstetrics and Gynaecology Canada 2022 Jun; 44(6): 664–674

doi: 10.1016/j.jogc.2021.12.006.

This paper looked at the population impact of Wave 1 of the COVID-19 pandemic on obstetric practices and the pregnancy and birth outcomes in Ontario. Key findings were that provincial health system changes implemented early in the pandemic did not result in significant increases in adverse outcomes.

Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study

BMJ 2022; 378 doi:10.1136/bmj-2022-071416 (Published 17 August 2022)

This paper assessed the risk of preterm birth, SGA and stillbirth after COVID-19 vaccination in pregnancy and found no association or higher risk of any of these outcomes.

Association of SARS-CoV-2 Infection During Pregnancy With Maternal and Perinatal Outcomes

JAMA 2022 May 24;327(20):1983-1991.

doi: 10.1001/jama.2022.5906.

This paper explored whether Is SARS-CoV-2 infection during pregnancy was associated with increased risk of adverse maternal and perinatal outcomes.  This pan-Canadian study found that among over 6000 cases of COVID-19 infection in pregnant individuals there was increased risk of SARS-CoV-2–related hospitalization (relative risk, 2.65) and intensive care unit admission (relative risk, 5.46). Among cases of infection during pregnancy compared with pregnant individuals without SARS-CoV-2 infection, there was a significantly increased risk of preterm birth (relative risk, 1.63).

Association of COVID-19 Vaccination in Pregnancy With Adverse Peripartum Outcomes

doi: 10.1001/jama.2022.4255.

Looking at almost 100,000 pregnant individuals we found no significant association with an increased risk of adverse peripartum outcomes associated with the COVID-19 vaccination in pregnancy.  

Maternal Newborn Dashboard Evaluation

BORN Ontario developed the Maternal Newborn Dashboard, an electronic audit and feedback system for all maternal-newborn hospitals in Ontario.

The BORN group led a provincial mixed-methods evaluation of the Maternal Newborn Dashboard, to assess the effect of the system on clinical practice improvement on 6 key performance indicators across Ontario. To date, there have been three publications from this evaluation:

A mixed methods evaluation of the maternal dashboard in Ontario: dashboard attributes contextual factors & facilitators and barriers to use: a study protocol

Implementation Science 2016; 11:59

doi: 10.1186/s13012-016-0427-1

This is the published protocol for the mixed-methods evaluation of the BORN Ontario Maternal newborn Dashboard, and details the objectives and planned methods for the study.

Effect of a population-level performance dashboard intervention on maternal-newborn outcomes: an interrupted time series study

BMJ Quality & Safety 2018;27(6):425-436

doi: 10.1136/bmjqs-2017-007361

This study used an interrupted time series analysis to assess the effect of the BORN Maternal Newborn Dashboard 2.5 years after implementation in Ontario on six key performance indicators. Results showed an improvement in four out of six key performance indicators at the provincial level.

Use of a maternal newborn audit and feedback system in Ontario: A collective case study

BMJ Quality & Safety 2019; e-pub ahead of print

doi:10.1136/bmjqs-2018-008354

This study used a qualitative case study design with over 100 people at 14 diverse Ontario hospitals to learn about their experiences using the BORN Maternal Newborn Dashboard for clinical practice change in their settings. The identified barriers and facilitators to using the Dashboard suggest that additional interventions may be needed to further optimize the effect of audit and feedback.

MOREOB Evaluation

Since 2002, most maternal-newborn hospitals in Ontario have participated in the MORE^OB (Managing Obstetrical Risk Efficiently) program, an obstetrical safety program for health care providers that aims to create a culture of safety and improve maternal and newborn outcomes in obstetric units.

BORN Ontario led a provincial mixed-methods evaluation of the MORE^OB program, to assess the effect of the program on maternal and newborn adverse outcomes, health care provider knowledge, unit culture, and to learn about health care provider experiences participating in and implementing the program. To date, there have been two publications from this evaluation:

Effect of implementation of the MORE^OB program on adverse maternal and neonatal birth outcomes in Ontario, Canada: A retrospective cohort study

BMC Pregnancy & Childbirth 2019; 19:151

doi: 10.1186/s12884-019-2296-5

This retrospective cohort study of 67 Ontario hospitals that implemented the MORE^OB program between 2002 and 2012, demonstrated no reduction in the incidence of maternal and neonatal adverse outcomes.

A mixed-methods evaluation of the MORE^OB program in Ontario hospitals: Participant knowledge, organizational culture, and experiences

BMC Health Services Research. 2019; in press

doi: 10.1186/s12913-019-4224-9

This study used surveys and semi-structured interviews with health care providers and administrators who participated in the MORE^OB program at 26 Ontario hospitals since 2013, to learn about changes in obstetrical knowledge, unit culture, and experiences with the program. The MORE^OB program contributed to increasing health care provider knowledge and unit culture, and participants reported positive experiences in the program.

Prenatal Screening Ontario (PSO)

Prenatal Screening Ontario (PSO) was created as a provincial resource to enhance access to prenatal screening, provide education supports, facilitate ongoing quality assurance and support the incorporation of evolving technology or screening options.  For more information about PSO activities, or to access educational or ordering resources, please visit the PSO website.

Key to the work of the program is the understanding of how screening is utilized and performs in our population, and PSO has produced a number of publications to widely disseminate our findings. Selected publications are below:

Cytogenetic outcomes following a failed cell-free DNA screen: a population-based retrospective cohort study of 35,146 singleton pregnancies.

AJOG 2023. DOI: 10.1016/j.ajog.2023.01.007 

The main goal of this study was to assess the association between a failed cell-free DNA test and common aneuploidies. The study showed that cell-free DNA screening test failures are relatively common. Although repeat testing improves the likelihood of an informative result, pregnancies with a failed cell-free DNA screen upon first attempt remain at increased risk for common autosomal aneuploidies, but not sex chromosome aneuploidies.

Infographic

The impact of maternal and geographical factors on the uptake of NIPT: A retrospective cohort study

Prenat Diagn 2022; 42(13): 1594-1605; doi: 10.1002/pd.6257

The objectives of this study were to investigate recent trends in non-invasive prenatal testing (NIPT) utilisation. The study found there was substantial variation in NIPT uptake between regions within the province. The highest uptake was found in urban areas, highest quintile of neighbourhood income and education, for those who were ≥40 years of age and had a history of previous aneuploidy, for those with a prenatal care visit in the first trimester, multiple pregnancy, multigravidity and body mass index within the normal range.

Performance of a universal prenatal screening program incorporating cell-free fetal DNA analysis in Ontario

CMAJ 2021;193(30):E1156-E1163; doi: 10.1503/cmaj.202456.

This study described the population-based performance of Ontario's prenatal screening program, which incorporates publicly funded cfDNA screening for specific indications, and the effect of cfDNA testing on the screening and diagnostic choices made by pregnant people. This publicly funded screening program showed robust performance, a substantial reduction in prenatal diagnostic testing and that pregnant people exercise autonomy in their choices about prenatal screening and diagnosis.

Infographic

Trends in the use of prenatal testing services for fetal aneuploidy in Ontario: a descriptive study

CMAJ Open 2018;6(4):E436-E444; doi: 10.9778/cmajo.20180046

This study examined the trends in use of different modalities of prenatal screening (multiple-marker screening, cell-free DNA screening [cfDNA]) and diagnostic testing before and after the implementation of provincial funding for cfDNA screening in Ontario. Results demonstrated that since the implementation of publicly funded cfDNA, cfDNA screening increased and prenatal diagnostic testing decreased.

Enhanced first trimester screening for trisomy 21 with contingent cell-free fetal DNA: a comparative performance and cost analysis

JOGC 2017;39(9):742-749; doi: 10.1016/j.jogc.2017.01.025

This study compared four prenatal screening strategies to integrate cell-free DNA screening into a publicly funded prenatal screening algorithm. The results suggest that using enhanced first trimester screening (eFTS) with contingent cfDNA screening following a positive eFTS result is a cost-effective system that doesn't compromise screening performance.