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Introduction Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time. Material and methods This study was a register‐based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005–2018 resulting in live‐born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics. Results The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02–0.04) and 0.06 (95% CI 0.05–0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19–0.21) and 0.44 (95% CI 0.42–0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely. Conclusions The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long‐term follow up and care will amplify the existing pressure on healthcare systems. The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely.

Epilepsy management during pregnancy is crucial for both the mother and fetus. The use of antiseizure medications (ASMs) during pregnancy requires careful consideration due to their potential effects on maternal and fetal health. This study analyzed trends in ASMs use among pregnant people in four Canadian provinces over 20 years (Manitoba, Saskatchewan, Alberta, and Quebec). Descriptive statistics were utilized to examine the characteristics of the population, with the frequency and patterns of ASM use estimated throughout each trimester. Linear regression models were developed to analyze yearly patterns of ASM utilization for the overall study population, as well as for people with and without epilepsy. Among 1,317,141 pregnant individuals across four provinces, 0.7% had epilepsy. Of the total pregnancies, 1.7% (n = 22,783) were exposed to ASMs, comprising 4,392 from pregnant people with epilepsy (PPWE) and 18,391 from those without epilepsy (PPWOE). Results demonstrated varying trends in ASM usage between provinces, with an overall increase in usage among people without epilepsy in Manitoba, Saskatchewan, and Alberta. ASM use among PPWOE surged significantly in Manitoba (24.2-149.1 per 10,000 pregnant people), Saskatchewan (29.4-107.0 per 10,000), and Alberta (65.7-241.7 per 10,000) ( < 0.05). In Alberta, PPWE's ASM exposure also rose, from 23.6 in 2008 to 43.0 per 10,000 pregnant people in 2021, while Quebec witnessed a decrease from 59.2 in 1998 to 45.5 per 10,000 pregnancies in 2015. Analysis of ASM use by trimester illustrated a substantial decline among PPWOE from 365 days pre-pregnancy to the third trimester in all provinces. ASM utilization by drug class showcased significant shifts, with second-generation ASMs experiencing a notable rise. Carbamazepine, once prominent, declined, making way for lamotrigine. Regional variations underscore diverse preferences, such as clonazepam's sustained popularity in Manitoba and Quebec. The study identified increasing trends in ASM use, particularly the increased use of second-generation ASMs, and differences in prescription patterns for pregnant individuals with and without epilepsy. These findings reveal changing ASM use patterns, including increased second-generation ASM use and regional disparities, providing valuable insights into real-world prescription practices.

Relatively few studies have examined the association between the entire spectrum of adverse birth outcomes [stillbirth, preterm birth (PTB), term births that are low birth weight (LBW) or high birth weight (HBW)] and long-term risk of CVD in the mother. Our objective was to examine the association between birth outcomes and risk of premature CVD or death in a contemporary cohort of pregnant women. We conducted a retrospective population-based cohort study of women in Alberta, Canada, between 01/01/2005 and 01/01/2023. The primary endpoint was a composite of CVD-related hospitalization, CVD-related emergency department visit, or death. Cox proportional hazard modelling was used to examine the independent association between birth outcomes and the risk of CVD or death in the mother, after accounting for other socio-demographic, clinical and pregnancy-related complications. Among 502,383 mothers, 0.51% had stillbirth, 7.11% had PTB, 86.11% had normal birth weight (NBW), 2.11% had LBW, and 4.15% had HBW. During a median follow-up of 3612 days (∼10 years), compared the NBW group, the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for maternal CVD or death associated with stillbirth was 1.63 (1.33, 1.99); 1.45 (1.36, 1.55) for PTB; 1.22 (1.06, 1.41) for LBW, and 1.13 (1.03, 1.23) for HBW. In addition to birth outcomes, pre-existing diabetes (aHR: 1.61, 95% CI: 1.47, 1.76), gestational hypertension (aHR: 1.47, 95% CI: 1.38, 1.57), and pre-existing hypertension (aHR: 3.28, 95% CI: 2.66, 4.04) carried a higher risk for premature CVD and death in the mother. Adverse birth outcomes of stillbirth and preterm birth, and to a lesser degree term births that result in LBW or HBW, are markers of increased risk of premature CVD and death in the mother. Coordinated effort between obstetricians, family physicians, and cardiologists are needed to design and implement effective risk reduction programs tailored for these high-risk women.

Background We described longitudinal trends in the incidence of episodes of care (EOC) and follow-up care for pediatric concussion in relation to age, sex, rurality of patient residence, point of care, and area-based socioeconomic status (SES) in Alberta, Canada. Methods A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age who received a diagnosis of concussion, other specified injuries of head, unspecified injury of head, or post-concussion syndrome between April 1, 2004 and March 31, 2018. Data were geospatially mapped. Results Concussion EOCs increased 2.2-fold over the study period, follow-up visits 5.1-fold. Care was increasingly received in physician office (PO) settings. Concussion diagnoses in rural and remote areas occurred in emergency department (ED) settings more often than in metro centres or urban areas (76%/75% vs. 52%/60%). Proportion of concussion diagnoses was positively related to SES and age. Diagnosis and point of care varied geographically. Conclusions The shift in care to PO settings, increased incidence of all diagnoses, and the higher use of the ED by some segments of the population all have important implications for appropriate clinical management and the efficient provision of health care for pediatric concussion. Impact This is the first study to use EOC to describe longitudinal trends in incidence and follow-up care for pediatric concussion in relation to age, sex, rurality, point of care, and area-based SES. We report increased incidence of concussion in both emergency and outpatient settings and the proportion of diagnoses was positively related to SES and age. Patients increasingly received care for concussion in PO over time. Geospatial mapping indicated that the incidence of concussion and unspecified injury of head varied geographically and temporally. Results have important implications for appropriate clinical management and efficient provision of health care following pediatric concussion.

Over 100 million pregnant people worldwide remain at risk of COVID-19. We compared the prevalence of severe COVID-19 in pregnancy and in people of reproductive age, and the risk of adverse pregnancy/neonatal outcomes in those with/without COVID-19 during gestation. In the Canadian Mother–Child Cohort, two sub-cohorts were identified using medical services, prescription medication fillings, hospitalizations, and COVID-19 surveillance testing programs data (28 February 2020–2021). The first included all pregnant people with at least one completed trimester of pregnancy during the study period, stratified on COVID-19 status. The second included all non-pregnant people (aged 15–45) with a positive COVID-19 test during the same period. COVID-19 severity was categorized based on hospital admissions before the end of pregnancy. Associations between COVID-19 during pregnancy and adverse perinatal outcomes were quantified using log-binomial regressions. A total of 150,345 pregnant people (3464 (2.3%) had COVID-19), and 112,073 non-pregnant people with COVID-19 were included. Maternal age at the time of COVID-19 diagnosis/positive test was statistically significantly lower among pregnant individuals compared to those who were not pregnant (96% had less than 40 years vs. 80%, p < 0.001). In pregnancy, COVID-19 was associated with the risk of spontaneous abortions (adjRR 1.76, 95%CI 1.37, 2.25), gestational diabetes (adjRR 1.52, 95%CI 1.18, 1.97), prematurity (adjRR 1.30, 95%CI 1.01, 1.67), and NICU (adjRR 1.32, 95%CI 1.10, 1.59); COVID-19 treatment with medications reduced risks. Severe COVID-19 was more prevalent in pregnancy and was associated with higher risks of adverse maternal/neonatal outcomes. As some countries are pulling back preventive strategies for COVID-19, this study highlights the importance of continued surveillance during pregnancy to prevent adverse pregnancy outcomes.

Objectives To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. Methods Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care. Results A total of 2878 unique patients (1164 female, 1713 male) aged 5–17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change − 23.76 min, 95% CI − 37.99, − 9.52). Total physician claims increased significantly at only 1 of 5 sites. Conclusions Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient. Trial registration ClinicalTrials.gov NCT05095012.

PurposeThe Calgary Transition Cohort was created to examine health service utilisation by adolescents affected by chronic health conditions seen in a tertiary paediatric hospital in the province of Alberta, Canada. The cohort includes adolescents who received care before the implementation of a hospital-wide intervention to improve transitions to adult care.ParticipantsUsing hospital records, a stepwise methodology involving a series of algorithms based on adolescents’ visit frequency to a hospital ambulatory chronic care clinic (CCC) was used to identify the cohort. A visit frequency of ≥4 visits in any 24-month window, during the ages of 12–17 years old, was used to identify eligible adolescents, as agreed on by key stakeholders and chronic disease clinical providers, and reflects the usual practice at the hospital for routine care of children with chronic disease.Findings to dateAdolescents with ≥4 visits to the same CCC in any 2-year period (n=1344) with a median of 8.7 years of follow-up data collected (range 1.4–9.1). The median age at study entry was 14 years (range 12–17) and 22 years (range 14–24) at study exit. The cohort was linked (97% successful match proportion) to their population-level health records that allowed for examination of occurrence of chronic disease codes in health utilisation encounters (ie, physician claims, hospital admissions and emergency room visits). At least one encounter with a chronic disease code (International Classification of Diseases, 9th/10th Revisions) was observed during the entire study window in 87.9% of the cohort.Future plansThe Calgary Transition Cohort will be used to address existing knowledge gaps about health service utilisation by adolescents, seen at a tertiary care hospital, affected by a broad group of chronic health conditions. These adolescents will require transition to adult-oriented care. Longitudinal analysis of health service use patterns over a 9-year window (2008–2016) will be conducted.