Hospitalizations due to self-poisoning at a Canadian paediatric hospital.

BACKGROUND: Adolescent self-harm by drug ingestion (i.e., self-poisoning) is a serious mental health issue. In Newfoundland and Labrador (NL), paediatricians suspected an increase in the number of adolescents hospitalized due to self-poisoning in the province. Our primary aim was to evaluate the number of hospital admissions of adolescents for self-poisoning between 2008 and 2013 to determine whether there was indeed an increase in hospitalizations. We also wanted to examine the characteristics of these admissions to better understand this patient population. METHOD: A retrospective chart review was conducted to identify cases of self-poisoning admitted to the only paediatric hospital in NL over a 6-year period. A data abstraction form was developed to collect patient demographic information and details about these incidences of self-poisoning. RESULTS: A total of 156 patient admissions were identified; 97 (62.2%) first time admissions and 59 (37.8%) recurrent admissions. The number of admissions for self-poisoning increased over the study period from 2.1% of total hospital admissions in 2008 to 6.5% in 2013. Mean (SD) age at the time of admission was 15.4 years, 122 patients (78.2%) were female and 86.5% had at least 1 previous mental health diagnosis. The most common drugs ingested were analgesics (38.0%) and antidepressants (32.2%), with 73 patients (48.7%) ingesting multiple drugs. CONCLUSIONS: The study contributes to the growing recognition of adolescent self-poisoning as a serious paediatric mental health issue. It also confirmed that an increase in adolescent hospitalizations due to self-poisoning has occurred in NL. Further research is warranted to identify effective prevention strategies for this serious problem.

High rates of International Code violations: a cross-sectional study in a region of Canada with low breastfeeding rates.

BACKGROUND: Exposure to marketing and promotion of commercial milk formula is associated with an increased likelihood of formula-feeding. In 1981, the International Code (IC) of Marketing of Breastmilk Substitutes was adopted by the 34th World Health Assembly to restrict the promotion, marketing and advertising of commercial milk formula and protect breastfeeding. RESEARCH AIM: The current study examines mothers' exposure to violations of the IC in Newfoundland and Labrador, a province of Canada with low breastfeeding rates. METHODS: A cross-sectional online survey measured exposure to IC violations (e.g., marketing, advertising and promotion of commercial milk formula) by mothers of infants less than two years old (n = 119). Data were collected on type, frequency, and location of violation. RESULTS: Most participants (87%, n = 104/119) reported exposure to at least one IC violation. Of this group (n = 104): 94% received coupons or discount codes for the purchase of commercial milk formula; 88% received free samples of commercial milk formula from manufacturers, and 79% were contacted directly by commercial milk formula companies via email, text message, mail or phone for advertising purposes. One-third (n = 28/104, 27%) observed commercial milk formula promotional materials in health care facilities. The most frequent locations were violations occurred were doctors' offices (79%), supermarkets(75%), and pharmacies (71%). CONCLUSION: The majority of mothers of young infants were exposed to violations of the IC involving the marketing, advertising and promotion of commercial milk formula. Companies producing commercial milk formula reached out directly to new mothers to offer unsolicited promotions and free samples of commercial milk formula.

A qualitative study exploring factors associated with mothers' decisions to formula-feed their infants in Newfoundland and Labrador, Canada.

BACKGROUND: Breastfeeding has numerous health benefits. In 2010, the province of Newfoundland and Labrador had the lowest breastfeeding initiation rate (64.0%) in Canada. Formula feeding is associated with well-known health risks. Exclusive formula feeding is the "cultural norm" in some regions of the province. Women appear resistant to changing their infant feeding behaviors and remain committed to their decision to formula-feed. The primary aim of this qualitative study was to examine individual factors that shaped mothers' decisions to formula-feed their infants. Nineteen mothers who were currently formula feeding their children participated in the study. METHODS: Qualitative research in the form of focus groups was conducted in three communities in the province in 2010. A thematic content analysis identified the main themes that influenced mothers' decisions to formula-feed their infants. RESULTS: The main themes included issues concerning the support needed to breastfeed, the convenience associated with formula feeding, and the embarrassment surrounding breastfeeding in public. CONCLUSIONS: These findings help to better understand why mothers choose formula feeding over breastfeeding and may help to inform the development of public health interventions targeted at this population of mothers.

Use of natural health products in children: experiences and attitudes of family physicians in Newfoundland and Labrador.

OBJECTIVE: To determine the experiences of family physicians in Newfoundland and Labrador with parents' use of natural health products (NHPs) for their children and to assess physicians' attitudes toward use of NHPs in children. DESIGN: A survey using the Dillman approach. SETTING: Newfoundland and Labrador. PARTICIPANTS: All family physicians in the province. MAIN OUTCOME MEASURES: Physician demographic characteristics; whether physicians inquire about the use of NHPs in children; the degree to which they think patients disclose use of NHPs in children; whether they counsel parents about the potential benefits or harms of NHPs; their own opinions about the usefulness of NHPs; whether they recommend NHPs in children and for what reasons; and the particular NHPs they have seen used in children and for what reasons. RESULTS: A total of 159 (33.1%) family physicians responded; 65.4% were men, 71.7% were Canadian medical graduates, and 46.5% practised in rural areas. Overall, 18.8% of family physicians said they regularly or frequently asked about NHP use; 24.7% counseled patients about potential harms. Only 1.9% of physicians believed NHPs were usually beneficial, but a similarly small number (8.4%) thought they were usually harmful. Most respondents were somewhat neutral; 59.7% said they never recommend NHPs for children, and a further 37.0% said they would only "sometimes" recommend NHPs. CONCLUSION: Most physicians believed that NHPs were probably of little benefit but not likely to be harmful. Most NHPs used were vitamins and minerals. Physicians recognized that NHPs were often used by parents for children, but in general they believed NHPs had little effect on their day-to-day medical practices. Thirty-eight (24.7%) of the 154 physicians had at least once recommended an NHP (including vitamins) for their pediatric patients. Physicians believed that parents did not often disclose use of NHPs for their children, but at the same time physicians generally did not actively inquire.

Use of natural health products in children: survey of parents in waiting rooms.

OBJECTIVE: To determine how common it is for parents to give natural health products (NHPs) to their children, which NHPs are being used, why they are being used, and parents' assessments of the benefits and side effects of NHPs. DESIGN: Survey. SETTING: Newfoundland and Labrador. PARTICIPANTS: Parents waiting in their family doctors' offices. MAIN OUTCOME MEASURES: Parent and child demographic characteristics; pediatric chronic medical conditions affecting the children; prescribed medications, over-the-counter medications, and NHPs used by the children; why the medications and NHPs were being used, the dose, and parents' assessments of the effectiveness and side effects; and where parents had heard about the NHPs, whether they had told their physicians that the children were taking the products, and where they had obtained the products. RESULTS: A total of 202 (53.4%) of the 378 eligible adults who were approached completed the survey. This represented 333 children. Mean (SD) age of the children was 5.1 (3.3) years. Overall, 28.7% of parents reported using nonvitamin NHPs for their children. A total of 137 children (41.1%) had taken NHPs (including vitamins); 61.1% of the NHPs being used were vitamins. The remainder fell under teas (primarily chamomile and green teas), echinacea, fish or omega-3 oils, and a large category of "other" products. These NHPs were most commonly used to improve general health, improve immunity, and prevent colds and infections. Approximately half of the parents (51.7%) believed their children had benefited from taking NHPs, and 4.4% believed their children had experienced adverse side effects. Slightly less than half of the parents (45.0%) had informed their physicians that their children were taking NHPs. CONCLUSION: Overall, 45.5% of parents attending physicians' offices reported using NHPs in their children. If vitamins are not included in the definition of NHPs, this rate drops to 28.7%. Parents most commonly use NHPs to maintain the general health of their children, to prevent colds, and to boost children's immune systems. About half of the parents believed the NHPs helped, very few had noticed any side effects, and approximately half had informed their physicians that they were giving their children NHPs.

Use of natural health products in children: qualitative analysis of parents' experiences.

OBJECTIVE: To gain a more thorough understanding of why parents choose to give their children natural health products (NHPs), parents' sources of information about NHPs, and the extent of disclosure and conversation with family doctors about the use of NHPs. DESIGN: Qualitative study. SETTING: Newfoundland and Labrador. PARTICIPANTS: Parents of children who were using NHPs (N = 20). METHODS: Individual, semistructured interviews were carried out with parents to obtain a better understanding of the reasoning behind the use of NHPs. Key themes emerging from the qualitative data were identified according to a number of criteria, including relevance to the research objectives, frequency with which a theme was mentioned, relative importance of the themes based on the amount of text taken up to address an issue, and emphasis (eg, emphatic or emotional speech). MAIN FINDINGS: The types of NHPs used by parents participating in this study varied, except for the use of multivitamins. In addition, use of the products themselves was variable and inconsistent. Parents reported few concerns about the use of NHPs. The most commonly reported source of information about NHPs was family and friends. Most participants had not spoken to their family doctors about the use of NHPs. CONCLUSION: Participants considered NHPs to be "natural" and seemed to equate this assessment with safety. This might explain why these parents sought advice and information from family and friends rather than from their family doctors and often failed to disclose the use of NHPs to their children's family doctors.

Infant-feeding among low-income women: the social context that shapes their perspectives and experiences.

This article explores the perspectives of low-income women in order to better understand the social context that shapes their infant-feeding perspectives and experiences. The authors used purposive sampling to conduct 3 focus groups with 19 women who were formula-feeding their infants in 1 urban and 2 rural communities in the eastern region of the island of Newfoundland in Canada. Elements of the social context for infant-feeding included the prevalence of myths and misinformation about breastfeeding; cultural expectations about infant behaviour; the postnatal experience, including the medicalization of birth and breastfeeding; partner support and child-care workload; cultural stigma of breastfeeding; and a moralizing ideology that equates breastfeeding with "good mothering. "The authors discuss the implications of the findings from a nursing and public health perspective, offering 7 recommendations for how nurses and health professionals might better support women and their families.

The prevalence of pediatric asthma hospitalizations at different stages of the COVID-19 pandemic: A systematic review and meta-analysis study protocol.

BACKGROUND: Asthma is a highly prevalent chronic inflammatory lung disease and is a frequent cause of hospitalization in children. The COVID-19 pandemic has introduced several challenges that have impacted the delivery of care for vulnerable patients, including asthmatic children. Asthmatic children without immediate access to healthcare services can face severe and fatal consequences. Furthermore, various governmental restrictions and viral mutants have been introduced throughout the pandemic, affecting COVID-19 cases and hospitalization rates. OBJECTIVES: To investigate the impact of the COVID-19 pandemic on the prevalence of asthma hospitalizations during various stages of the pandemic. We also aim to compare asthma hospital admissions during the pandemic to pre-pandemic periods. METHODS AND ANALYSIS: The databases PubMed (MEDLINE), EMBASE, CINAHL, and the Cochrane library will be used to identify relevant articles between the start of the pandemic and the date of the search strategy. Studies will be included if they examine hospital admissions for pediatric (0 to 18 years) asthma patients, regardless of asthma severity, sex, ethnicity or race. Observational retrospective cohort, prospective cohort, and cross-sectional studies will be included. A meta-analysis will be conducted if there are ≥2 articles. Else, a narrative review will be used to report our results. TRIAL REGISTRATION: PROSPERO registration number: CRD42022337606.

Adverse events among children in Canadian hospitals: the Canadian Paediatric Adverse Events Study.

BACKGROUND: Limited data are available on adverse events among children admitted to hospital. The Canadian Paediatric Adverse Events Study was done to describe the epidemiology of adverse events among children in hospital in Canada. METHODS: We performed a 2-stage medical record review at 8 academic pediatric centres and 14 community hospitals in Canada. We reviewed charts from patients admitted from April 2008 through March 2009, evenly distributed across 4 age groups (0 to 28 d; 29 to 365 d; > 1 to 5 yr and > 5 to 18 yr). In stage 1, nurses and health records personnel who had received training in the use of the Canadian Paediatric Trigger Tool reviewed medical records to detect triggers for possible adverse events. In stage 2, physicians reviewed the charts identified as having triggers and described the adverse events. RESULTS: A total of 3669 children were admitted to hospital during the study period. The weighted rate of adverse events was 9.2%. Adverse events were more frequent in academic pediatric centres than in community hospitals (adjusted odds ratio [OR] 2.98, 95% confidence interval [CI] 1.65-5.39). The incidence of preventable adverse events was not significantly different between types of hospital, but nonpreventable adverse events were more common in academic pediatric centres (adjusted OR 4.39, 95% CI 2.08-9.27). Surgical events predominated overall and occurred more frequently in academic pediatric centres than in community hospitals (37.2% v. 21.5%, relative risk [RR] 1.7, 95% CI 1.0-3.1), whereas events associated with diagnostic errors were significantly less frequent (11.1% v. 23.1%, RR 0.5, 95% CI 0.2-0.9). INTERPRETATION: More children have adverse events in academic pediatric centres than in community hospitals; however, adverse events in the former are less likely to be preventable. There are many opportunities to reduce harm affecting children in hospital in Canada, particularly related to surgery, intensive care and diagnostic error.

The Effectiveness of Virtual Lactation Support: A Systematic Review and Meta-Analysis.

BACKGROUND: The World Health Organization recommends lactation support to enhance the rates of exclusive breastfeeding. Access to in person lactation support may be limited due to scarcity of resources (e.g., healthcare professionals) and geography. Advances in technology have allowed lactation supports to be offered virtually through information and communication technologies (i.e., telephone, internet, and social media). RESEARCH AIMS: To (1) critically review and (2) statistically analyze the effectiveness of virtual lactation support for postpartum mothers' exclusive breastfeeding for up to 6 months. METHODS: A systematic review and meta-analysis were conducted using PRISMA guidelines. Studies were included if they were (a) randomized controlled trials, (b) with a virtual lactation support intervention during the postpartum period, (c) reported on exclusive breastfeeding outcomes. Two reviewers independently assessed the risk of bias and extracted data. The prevalence of exclusive breastfeeding in each group and the total number of participants randomized for each group were entered into random-effects meta-analyses to calculate a pooled relative risk (RR) at three different time points (1, 4, and 6 months). The sample size was 19 randomized control trials. RESULTS: Of the 19 studies, 16 (84.2%) were included in the meta-analysis (n = 5,254). Virtual lactation support was found to be effective at increasing exclusive breastfeeding at 1 month (RR, 1.21; 95% CI [1.09, 1.35]; p < .001) and 6 months (RR, 1.87; 95% CI [1.30, 2.68]; p < .001). CONCLUSION: In this meta-analysis of randomized controlled trials comparing virtual lactation support with other postnatal maternity care, virtual lactation support was associated with increasing exclusive breastfeeding rates at 1 month and 6 months postpartum.The study protocol was registered (CRD42021256433) with PROSPERO.

The Use of Patient Engagement to Gather Perceptions on the Cost of Infant Feeding.

Purpose: Patient-oriented research (POR) and patient engagement (PE) has highlighted the value of incorporating patients' ideas and priorities in health research. Using the guiding principles of POR and PE, the current study conducted PE sessions to gain insight on the perceptions of mothers regarding the costs of infant feeding. Methods: Four patient engagement sessions were held with mothers residing in Newfoundland and Labrador between November 2019 and January 2020. Mothers were targeted through the Brighter Futures Coalition of St. John's, a not-for-profit community organization. PE sessions were designed in a two-hour format, allowing the research team to engage mothers and identify costs of infant feeding from a mothers' perspective. Results: Through the guiding principles of patient-oriented research and patient engagement, our research team successful engaged with mothers in discussions surrounding the costs of infant feeding. The sessions allowed for an in-depth discussion surrounding monetary costs (eg, incidentals of breast or formula feeding), the associated costs of infant feeding and the workplace (eg, perceived productivity) and environment impacts (eg, single use plastics). During each session, evaluations were provided to solicit feedback on whether the goals and expectations of mothers had been met, and whether they felt their opinions were heard and understood. Conclusion: By conducting patient engagement sessions, informed by patient-oriented research guiding principles, we were able to successfully recruit and engage mothers in discussions that led to a better understanding of their perspectives on the costs of infant feeding.

A Multi-Intervention Campaign Lowers Pediatric and Young Adult Diabetic Ketoacidosis Hospitalizations in a Canadian Province.

OBJECTIVES: The Newfoundland and Labrador diabetic ketoacidosis Project (NLdkaP) is a multi-intervention, province-wide project aimed at lowering rates of diabetic ketoacidosis (DKA) within the pediatric and young adult populations. METHODS: The NLdkaP interventions were first selected, developed and implemented. We then conducted a retrospective study of hospitalization data over three 2-year periods: pre-, during and post-NLdkaP. Data included demographic factors, DKA hospitalizations and length of hospital stay. RESULTS: There were 412 DKA hospitalizations over the study period. Before the NLdkaP, the provincial hospitalization rate of DKA for patients <25 years of age was 55.61 per 100,000. During the NLdkaP, the rate dropped to 38.48 per 100,000 (p<0.001). After the NLdkaP, the rate rose to 54.53 per 100,000 (p<0.001). Hospitalization rates were highest for females (p<0.001) and for those in the 19- to 24-year age group (p<0.001). CONCLUSIONS: The NLdkaP was associated with decreased rates of DKA hospitalizations, but the rates remained relatively stable in both the pre- and postintervention periods. Although the approach and resources developed in the NLdkaP appear effective, continuous preventive efforts are needed to sustain reductions in DKA hospitalizations.

A province wide review of transition practices for young adult patients with type 1 diabetes.

RATIONALE, AIMS, AND OBJECTIVES: Many studies on the transition from paediatric to adult care focus on practices within a single institution or program. We examine the transition for young adults with type 1 diabetes across an entire Canadian province with a small, mostly rural population and high rates of type 1 diabetes: Newfoundland and Labrador (NL). Our aim is to determine how transition is occurring across the jurisdiction and identify methods for improving clinical services for paediatric patients with a chronic condition during their move into adult care. METHODS: A provincial diabetes database and hospital admission data were reviewed for a cohort of young adults with type 1 diabetes who transitioned into adult care. Semi-structured interviews were conducted with paediatric and adult diabetes providers. RESULTS: Between 2008 and 2013, 93 patients with type 1 diabetes transitioned into adult care. Rates of diabetes-related hospitalizations increased from 15.6/100 person-years in the 3 years before their 18th birthday to 16.7/100 person-years in the three-year period after. Between 2017 and 2019, 15 interviews were conducted across the province's four regional health authorities. Various models of transition care are being employed, reflecting staff and resource availability in different centres. While no formal transition program was identified in either region, some providers, particularly in rural areas, reported being comfortable with their current transition practices. Suggested improvements included more structured processes, shared educational resources, expanding the role played by primary care physicians, and a dedicated transfer clinic. CONCLUSIONS: We found different approaches for transitioning patients with diabetes into adult care across NL. Yet this variation may not negatively impact patient outcomes, particularly in rural areas. The approach we employed of combining reviews of administration data with a detailed analysis of current processes could be employed in other jurisdictions to identify appropriate quality improvement initiatives.

Can exclusive breastfeeding reduce the likelihood of childhood obesity in some regions of Canada?

OBJECTIVES: The prevalence of childhood obesity in Canada is a major concern. Studies report a small but significant inverse relationship between exclusive breastfeeding and childhood obesity. The study objectives were to determine the prevalence of overweight and obesity in a preschool population living in Newfoundland and Labrador (NL) and to examine the relationship between exclusive breastfeeding and preschool obesity. METHODS: This was a cross-sectional analysis of 1,026 children born in 2001 who participated in the Pre Kindergarten Health Fairs in 2005. Heights and weights were collected and body mass index (BMI) calculated. The BMI-for-age references used by the Centers for Disease Control (CDC) in the United States were used to classify the weight status of children. Infant feeding information was collected through a survey. The relationship between breastfeeding and childhood obesity was examined using logistic regression models controlling for child's age and gender, mother's education and smoking status, and whether the baby was preterm or full-term. RESULTS: In 2005, 65%, 19% and 16% of preschool children were normal, overweight and obese, respectively. 74% of women initiated breastfeeding and 43% exclusively breastfed to 3 months. Exclusive breastfeeding to 3 months was protective of preschool obesity (adjusted odds ratio (AOR) 0.65, 95% CI 0.45-0.96). CONCLUSION: Obesity is prevalent in preschool children in NL. Exclusive breastfeeding appeared to be a protective factor for obesity in preschoolers. Given the known benefits of breastfeeding and the adverse health consequences of obesity, efforts should be made to increase exclusive breastfeeding which may help to prevent the development of obesity in young children.

Improving the transitioning of pediatric patients with type 1 diabetes into adult care by initiating a dedicated single session transfer clinic.

BACKGROUND: Young adults with type 1 diabetes face potential health problems and disruptions in accessing care related to their move from pediatrics into adult care. At a medium-sized pediatric hospital with no formal transition support program, we developed and evaluated the use of a single-session transfer clinic as an initial quality improvement intervention to improve patient satisfaction, clinic attendance, and knowledge of transition related issues. METHODS: Following a jurisdictional scan of other diabetes programs, the pediatric diabetes program developed a half-day transfer clinic. After the first transfer clinic was held, evaluation surveys were completed by patients, parents, and healthcare providers. Based on the feedback received, we altered the structure and evaluated the revised clinic by surveying patients and parents. RESULTS: All patients and parents who attended reported high levels of satisfaction with the clinic. Providers were also mostly positive regarding their participation. Feedback from the first clinic was used to modify the structure of the second clinic to better meet the needs of participants and to allow the clinic to run more efficiently. The use of group sessions and adapting resources developed by other diabetes programs were viewed favourably by participants and lessened the burden on staff who delivered the clinic. CONCLUSIONS: A half-day transfer clinic is a viable step towards improving patient and parent satisfaction during the transition into adult care without requiring additional staff or significant expenditures of new resources. This type of clinic can also be incorporated into a larger program of transition supports or be adopted by programs serving young adults with other chronic diseases.

Effects of Delayed Newborn Bathing on Breastfeeding, Hypothermia, and Hypoglycemia.

OBJECTIVE: To determine whether delaying the newborn bath by 24 hours increases the prevalence of breastfeeding initiation and exclusive breastfeeding at discharge in healthy full-term and late preterm newborns (34 0/7-36 6/7 weeks gestation) and to examine the effect of delayed newborn bathing on the incidences of hypothermia and hypoglycemia. DESIGN: Pre-post implementation, retrospective, cohort study. SETTING: Provincial children's hospital with an average of 2,500 births per year. PARTICIPANTS: Healthy newborns (N = 1,225) born at 34 0/7 weeks or more gestation who were admitted to the mother-baby unit. METHODS: We compared newborns who were bathed before 24 hours (n = 680, preimplementation group) to newborns who were bathed after 24 hours (n = 545, postimplementation group). RESULTS: After adjustment for confounders, the odds of exclusive breastfeeding at discharge were 33% greater in the postimplementation group than in the preimplementation group (adjusted odds ratio = 1.334; 95% confidence interval [1.049,1.698]; p = .019). Delayed bathing was associated with decreased incidence of hypothermia and hypoglycemia (p = .007 and p = .003, respectively). We observed no difference in breastfeeding initiation between groups. CONCLUSION: Delaying the newborn bath for 24 hours was associated with an increased likelihood of exclusive breastfeeding at discharge and a decreased incidence of hypothermia and hypoglycemia in healthy newborns. The implementation of a delayed bathing policy has the potential to improve breastfeeding rates and reduce the incidence of hypothermia and hypoglycemia.

Infant feeding mode predicts the costs of healthcare services in one region of Canada: a data linkage pilot study.

OBJECTIVE: The aim is to perform a pilot study evaluating the differences in healthcare service use and its associated costs by infant feeding mode in an infant's first year of life. Data from a prospective cohort study and administrative databases were linked to examine healthcare use in healthy full term infants (N = 160). Exposure was categorized as exclusively breastfed, mixed fed and exclusively formula fed. Outcomes included hospitalizations, emergency room and physician visits. Descriptive statistics and generalized linear modelling were performed. RESULTS: Overall $315,235 was spent on healthcare service use for the sample of infants during their first year of life. When compared to exclusive breastfeeding, mixed feeding and exclusive formula feeding were found to be significant predictors of total healthcare service use costs (p < 0.05), driven by costs of hospital admissions. Due to the human and economic burden associated with not breastfeeding, policies and programs that support and encourage breastfeeding should be priority.

Seasonal variation of maternal serum vitamin D in Newfoundland and Labrador.

BACKGROUND: Research has suggested that vitamin D insufficiency and deficiency is common at northern latitudes, and that vitamin D insufficiency and deficiency may be common during pregnancy. We measured the serum 25-hydroxyvitamin D (25-[OH]D) status of pregnant women across the province of Newfoundland and Labrador in both summer and winter to investigate seasonal differences, age associations, and differences in geospatial distribution across the province. METHODS: We uniformly and randomly sampled blood from pregnant women in each of 79 census consolidated subdivisions across Newfoundland and Labrador from January to March 2007 and from July to September 2007. RESULTS: We obtained 304 samples from the end of winter (March) and 289 samples from the end of summer (September). Mean serum 25-(OH)D concentration was 52.1 nmol/L in winter and 68.6 nmol/L in summer (P < 0.001); 89% were vitamin D insufficient in the winter and 64% in the summer (P < 0.001); 6.6% were vitamin D deficient in winter and 1.7% in summer (P = 0.003), and younger women tended to be more vitamin D insufficient in the winter than older women. The geospatial distribution of vitamin D insufficiency tends to follow a north-south distribution in the winter. CONCLUSIONS: A significant proportion of pregnant women in Newfoundland and Labrador are vitamin D insufficient. Vitamin D insufficiency may have important adverse health consequences for both the mother and the fetus. Further study is necessary to address health outcomes and effects of vitamin D supplementation and lifestyle changes in this population.