Diabetes during pregnancy among Métis people in Alberta: a retrospective cohort study.

BACKGROUND: Diabetes in pregnancy is an important public health concern for Indigenous populations. We sought to evaluate the prevalence and outcomes of pre-existing and gestational diabetes among Métis pregnancies compared with other pregnancies in Alberta, Canada. METHODS: We conducted a retrospective cohort study using administrative health data from 2006 to 2016 and the Métis Nation of Alberta Identification Registry to compare the prevalence of pre-existing and gestational diabetes among all singleton Métis births with non-Métis births. We compared 10 maternal and neonatal outcomes using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in multivariable analyses. RESULTS: The study population included 7902 Métis and 471 886 non-Métis births. The age-standardized prevalence of pre-existing diabetes was 1.7% (95% CI 1.4%-2.1%) for Métis and 1.1% (95% CI 1.1%-1.2%) for non-Métis pregnancies. For gestational diabetes, the age-standardized prevalence was 6.3% (95% CI 5.6%-6.9%) for Métis and 5.4% (95% CI 5.3%-5.4%) for non-Métis pregnancies. After adjusting for parity, maternal weight, age, smoking during pregnancy and material and social deprivation, Métis pregnancies had 1.72 times higher prevalence of preexisting diabetes (adjusted OR 1.72, 95% CI 1.15-2.56) and 1.30 times higher prevalence of gestational diabetes (adjusted OR 1.30, 95% CI 1.08-1.57) than non-Métis pregnancies. Métis pregnancies with pre-existing diabetes had nearly 3 times the odds of developing preeclampsia (adjusted OR 2.96, 95% CI 1.27-6.90), while those with gestational diabetes had 48% higher odds of large-for-gestational-age infants (adjusted OR 1.48, 95% CI 1.00-2.19). INTERPRETATION: Métis pregnancies have an increased prevalence of pre-existing and gestational diabetes than non-Métis pregnancies and an elevated risk of some perinatal outcomes. Interventions to tackle these health inequities should address both physiologic and cultural dimensions of health, informed by Métis perspectives.

Commonly used medications and endometrial cancer survival: a population-based cohort study.

BACKGROUND: Increasing incidence and new indications for existing drugs make it important to identify new adjuvant therapies for endometrial cancer (EC). METHODS: This is a prospective cohort study of 3058 newly diagnosed EC cases from 1998 to 2010, identified through record linkages between the UK Clinical Practice Research Datalink, the National Cancer Research Datalink and death registrations from the Office of National Statistics. Using Cox regression models, unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for EC-specific survival. RESULTS: Over a mean 6.1 (range 1-16) years of follow-up, there were 394 EC-specific deaths. There was no evidence of a significant association between post-diagnostic use of statins (adjusted HR 0.83, 95% CI 0.64, 1.08), ß-blockers (adjusted HR 0.86, 95% CI 0.65, 1.13) or low-dose aspirin (adjusted HR 0.91, 95% CI 0.69, 1.20) and EC survival before or after adjustment for confounders. There were also no evidence of a dose-response association between these drug groups and EC survival. CONCLUSIONS: In this large UK population-based study, no significant associations were observed for post-diagnostic use of statins, ß-blockers or low-dose aspirin and EC survival.

Climate Change and African Migrant Health.

INTRODUCTION: Climate change exacerbates existing sociopolitical and economic vulnerabilities, undermining livelihoods, inflating the risk of conflict, and making it difficult for people to remain stable. In 2019, around 25 million new displacements occurred due to natural disasters. This review aims to summarize the existing evidence regarding the impact of climate change on the health of African immigrants. METHODS: Nine databases were systematically searched using a strategy developed in collaboration with a subject librarian. Potentially relevant articles were identified, screened, and reviewed by at least two reviewers, with a third reviewer resolving conflicts where necessary. Data were extracted from relevant articles using a standardized form. RESULTS: Seven studies (three cross-sectional, two qualitative, one cohort, and one need assessment report) were identified; they included different categories of African migrants and reported on various aspects of health. The included articles report on climate change, e.g., flooding, drought, and excess heat, resulting in respiratory illness, mental health issues, malnutrition, and premature mortality among African immigrants. CONCLUSION: This review suggests climate change adversely affects the physical, mental, and social health of African immigrants. It also highlights a knowledge gap in evidence related to the impact of climate change on the health of African immigrants.

Immigrant child health in Canada: a scoping review.

INTRODUCTION: Understanding the health of immigrant children from birth to 18 years of age is important given the significance of the early childhood years and complexity of factors that may influence the health status of immigrant populations. Thus, the purpose of this review was to understand the extent and nature of the literature on the health of immigrant children in Canada. METHODS: We conducted a scoping review of the literature. The review was focused on studies of first-generation and second-generation immigrant children aged 0-18 years. We completed standardised data extraction of immigration status, immigration route, age of children, data source, health or clinical focus, country of origin and major findings. RESULTS: In total, 250 published papers representing data from 237 studies met the inclusion criteria for this study. A total of 178 articles used quantitative methodologies (mostly survey and cross-sectional study designs), 54 used qualitative methodologies and 18 used mixed methodologies. The articles considered in this review included 147 (59%) focusing on physical health, 76 (30%) focusing on mental health and 37 (15%) focusing on the social aspects of health for refugee and first-generation and second-generation immigrant children across the provinces and territories of Canada. CONCLUSIONS: Several literature gaps exist with respect to child immigrant health in Canada. For instance, there are no exclusive studies on immigrant boys and limited studies on children of international students.

Effectiveness of Probiotic, Prebiotic, and Synbiotic Supplementation to Improve Perinatal Mental Health in Mothers: A Systematic Review and Meta-Analysis.

Introduction: There is an emerging interest in modulating the gut microbiota to target the gut-brain axis and improve maternal mental health in the perinatal period. This systematic review evaluated the effectiveness of prebiotics, probiotics, and synbiotics supplementation during pregnancy to reduce the risk of maternal mental health problems in the perinatal period. Methods: Electronic biomedical databases and clinical trial registries were searched from database inception through August 2020 to identify randomized controlled clinical trials (RCTs) evaluating the effect of probiotic, prebiotic, or synbiotic supplements administered to women during pregnancy on measures of perinatal depression, anxiety, and other mental health outcomes. Study selection, risk of bias appraisal, and data extraction were independently performed by two reviewers. Pooled mean differences (MD) and odds ratios (pOR) with 95% confidence intervals (CI) were calculated in random-effects meta-analyses for the outcomes of interest in the review. Results: From 3,868 studies identified through the search strategy, three RCTs of low risk of bias involving 713 participants were included, all three testing probiotics. There were no differences between probiotics and control groups in the mean depression scores (MD -0.46; 95% CI -2.16, 1.25) at end of follow-up. Although statistical significance was not achieved, probiotics showed an advantage in the proportion of participants scoring below an established cut-off for depression (pOR 0.68; 95% CI 0.43, 1.07). Compared to placebo, probiotics in pregnancy reduced anxiety symptoms (MD -0.99; 95% CI -1.80, -0.18); however, this advantage was not translated in a reduction in the proportion of participants scoring above an established cut-off for anxiety (pOR 0.65; 95% CI 0.23, 1.85). There were no differences between probiotics and control groups in global mental health scores at end of follow-up (MD 1.09; 95% CI -2.04, 4.22). Conclusion: There is limited but promising evidence about the effectiveness of probiotics during pregnancy to reduce anxiety symptoms and reduce the proportion of women scoring ABOVE a cut-off depression score. There is a lack of RCT evidence supporting prebiotics and synbiotics supplementation for similar purposes in the perinatal period. More research is needed before prebiotics, probiotics, and synbiotics are recommended to support maternal mental health and well-being in the perinatal period. Systematic Review Registration: PROSPERO, CRD42019137158.

Public health measures to reduce the risk of SARS-CoV-2 transmission in Canada during the early days of the COVID-19 pandemic: a scoping review.

OBJECTIVE: The main objectives of this study were to synthesise and compare pandemic preparedness strategies issued by the federal and provincial/territorial (P/T) governments in Canada and to assess whether COVID-19 public health (PH) measures were tailored towards priority populations, as defined by relevant social determinants of health. METHODS: This scoping review searched federal and P/T websites on daily COVID-19 pandemic preparedness strategies between 30 January and 30 April 2020. The PROGRESS-Plus equity-lens framework was used to define priority populations. All definitions, policies and guidelines of PH strategies implemented by the federal and P/T governments to reduce risk of SARS-CoV-2 transmission were included. PH measures were classified using a modified Public Health Agency of Canada Framework for Canadian Pandemic Influenza Preparedness. RESULTS: A total of 722 COVID-19 PH measures were issued during the study period. Of these, home quarantine (voluntary) (n=13.0%; 94/722) and retail/commerce restrictions (10.9%; n=79/722) were the most common measures introduced. Many of the PH orders, including physical distancing, cancellation of mass gatherings, school closures or retail/commerce restrictions began to be introduced after 11 March 2020. Lifting of some of the PH orders in phases to reopen the economy began in April 2020 (6.5%; n=47/722). The majority (68%, n=491/722) of COVID-19 PH announcements were deemed mandatory, while 32% (n=231/722) were recommendations. Several PH measures (28.0%, n=202/722) targeted a variety of groups at risk of socially produced health inequalities, such as age, religion, occupation and migration status. CONCLUSIONS: Most PH measures centred on limiting contact between people who were not from the same household. PH measures were evolutionary in nature, reflecting new evidence that emerged throughout the pandemic. Although ~30% of all implemented COVID-19 PH measures were tailored towards priority groups, there were still unintended consequences on these populations.

Prevalence of diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand, and the USA: a systematic review and meta-analysis.

BACKGROUND: Indigenous peoples in countries with similar colonial histories have disproportionate burdens of disease compared with non-Indigenous peoples. We aimed to systematically identify and collate studies describing the prevalence of pre-existing diabetes and gestational diabetes, and compare the prevalence of these conditions between Indigenous and non-Indigenous pregnant women in Australia, Canada, New Zealand, and the USA. METHODS: For this systematic review and meta-analysis, an information specialist did a comprehensive search of eight databases (Ovid MEDLINE, Ovid Embase, Ovid Global Health, CINAHL [EBSCO], Scopus, ProQuest Dissertations and Theses Global, PROSPERO, and the Wiley Cochrane Library) in June, 2019, for studies published between inception and June 25, 2019, without restrictions on language, publication type, or year of publication. Database searches were supplemented by grey literature searches of the Bielefield Academic Search Engine and Google Scholar, and the reference lists of relevant articles were also manually searched. We included observational epidemiological studies comparing the prevalence of pre-existing diabetes or gestational diabetes in Indigenous and non-Indigenous pregnant women in Australia, Canada, New Zealand, and the USA. Two independent reviewers assessed study eligibility and risk of bias. We used a standardised data extraction form to collect information from the published reports of eligible studies, and, if needed, we contacted authors for further information. We did a Mantel-Haenszel random-effects meta-analysis to obtain the pooled unadjusted prevalence odds ratios (PORs) of pre-existing diabetes and gestational diabetes in Indigenous women compared with non-Indigenous women. We stratified meta-analyses by country and type of diabetes. The study is registered with PROSPERO, number CRD42018095971. FINDINGS: Our search identified 1348 studies, of which 43 studies with 32 952 441 participants from Australia, Canada, New Zealand, and the USA were included in the systematic review, and 39 of these studies were included in the meta-analysis. 40 of the included studies used a cohort design. Pre-existing diabetes was more prevalent in Indigenous women than in non-Indigenous women, with pooled PORs ranging from 1·81 (95% CI 1·53-2·13) for women in the USA to 3·63 (2·35-5·62) for women in Australia. Similarly, gestational diabetes was more prevalent in Indigenous women than in non-Indigenous women, with PORs ranging from 1·42 (1·24-1·63) for women in Australia to 2·04 (1·46-2·84) for women in Canada. Risk of bias was low in 37·2% of studies, unclear in 34·8% of studies, and high in 27·9% of studies. Heterogeneity between studies was predominantly high (I2=97-100%), with one exception of moderate heterogeneity (I2=48%); however, the magnitude and direction of the PORs from individual studies indicated an association between pre-existing diabetes or gestational diabetes and indigeneity among pregnant women. INTERPRETATION: The prevalence of pre-existing diabetes and gestational diabetes was higher in Indigenous pregnant women than in non-Indigenous pregnant women in four countries (Australia, Canada, New Zealand and the USA) with similar histories of colonialism. These findings have implications for prenatal care services and the monitoring of Indigenous women in industrialised countries. FUNDING: Canadian Institute of Health Research and the Women's and Children's Health Research Institute.

A systematic review and meta-analysis of the correlation between maternal and neonatal iron status and haematologic indices.

BACKGROUND: Iron deficiency (ID) is the leading single-nutrient deficiency in the world. Anaemia is a common outcome of ID that affects half of pregnancies worldwide with serious consequences for child development. Whether haematologic indices and biomarkers of iron status in pregnant women correlate with those of their neonates is unclear. This systematic review evaluated studies comparing haematologic and iron status indices in pregnant women and their newborns/neonates. METHODS: We searched MEDLINE, EMBASE, CINAHL, and Web of Science from database inception until March 2020 for primary studies comparing haematologic and iron status indices between women and their newborns up to 48 h after birth. We summarized the results descriptively and calculated pooled correlation coefficients in mothers and newborns/neonates using the Schmidt-Hunter method. The protocol was registered at PROSPERO International Prospective Register of Systematic Reviews (Registration number: CRD42018093094). FINDINGS: Sixty-five studies were included. Pooled correlation coefficients for biomarkers of iron status in mothers and newborns/neonates were 0.13 (ferritin), 0.42 (hepcidin), 0.30 (serum/plasma iron), 0.09 (transferrin), 0.20 (transferrin saturation), and 0.16 (total iron binding capacity). Pooled correlation coefficients for haematological indices in mothers and newborns/neonates were 0.15 (haemoglobin), 0.15 (haematocrit), 0.25 (mean cell/corpuscular haemoglobin), 0.22 (mean cell/corpuscular volume). INTERPRETATION: Maternal biomarkers of iron and haematologic status correlate poorly with those in newborns/neonates. These results underscore a need for alternative approaches to estimate foetal/neonatal iron status and haematological indices. FUNDING: MBO and SLB hold Canada Research Chairs, and grants from the Women and Children's Health Research Institute and Canadian Institutes of Health Research.

Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis.

BACKGROUND: To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. METHODS: We identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). RESULTS: A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). CONCLUSIONS: Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients to better inform treatment strategies.