3D Cohort Study: The Integrated Research Network in Perinatology of Quebec and Eastern Ontario.

BACKGROUND: The 3D Cohort Study (Design, Develop, Discover) was established to help bridge knowledge gaps about the links between various adverse exposures during pregnancy with birth outcomes and later health outcomes in children. METHODS: Pregnant women and their partners were recruited during the first trimester from nine sites in Quebec and followed along with their children through to 2 years of age. Questionnaires were administered during pregnancy and post-delivery to collect information on demographics, mental health and life style, medical history, psychosocial measures, diet, infant growth, and neurodevelopment. Information on the delivery and newborn outcomes were abstracted from medical charts. Biological specimens were collected from mothers during each trimester, fathers (once during the pregnancy), and infants (at delivery and 2 years of age) for storage in a biological specimen bank. RESULTS: Of the 9864 women screened, 6348 met the eligibility criteria and 2366 women participated in the study (37% of eligible women). Among women in the 3D cohort, 1721 of their partners (1704 biological fathers) agreed to participate (73%). Two thousand two hundred and nineteen participants had a live singleton birth (94%). Prenatal blood and urine samples as well as vaginal secretions were collected for ≥98% of participants, cord blood for 81% of livebirths, and placental tissue for 89% of livebirths. CONCLUSIONS: The 3D Cohort Study combines a rich bank of multiple biological specimens with extensive clinical, life style, and psychosocial data. This data set is a valuable resource for studying the developmental etiology of birth and early childhood neurodevelopmental outcomes.

Obstetrician or family physician: are vaginal deliveries managed differently?

BACKGROUND: In Canada, obstetricians and family physicians both provide obstetrical care. However, the effect of specialty training on obstetrical outcomes of low-risk pregnancies has not recently been evaluated. In this study we examine the role of specialty training on the management of vaginal deliveries. METHODS: We conducted a cohort study on all vaginal deliveries that took place at Sacré-Coeur Hospital between July 2000 and June 2006. We compared baseline characteristics of obstetricians and family physicians and used an unconditional logistic regression model to estimate the adjusted relative risk of undergoing different obstetrical interventions. RESULTS: Of a total 8807 vaginal deliveries, 1915 were conducted by eight obstetricians and 6892 were conducted by 21 family physicians. Apart from a higher rate of induction of labour in patients of obstetricians, baseline characteristics were comparable between the two groups. Overall rates of use of instruments were similar in the two groups; however, family physicians were less likely than obstetricians to perform an episiotomy (odds ratio [OR] 0.47; 95% confidence intervals [CI] 0.41-0.55) but more likely to have patients who sustained a perineal injury (OR 1.51; 95% CI 1.36-1.68). There were no differences in the incidence of third- and fourth-degree tears, and 5-minute Apgar scores were similar in both groups. CONCLUSION: Obstetricians and family physicians differ in the performance of episiotomies, and their patients differ in the resulting type of perineal injury. Instrument use and neonatal outcomes were similar in both groups. Major maternal and neonatal morbidity are unlikely to differ whether women with low-risk pregnancies are delivered by an obstetrician or a family physician.