Kuhle, Stefan
Permanent URI for this collectionhttps://hdl.handle.net/10222/80518
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Item Open Access Cesarean Delivery and Healthcare Utilization and Costs in the Offspring: A Retrospective Cohort Study(Elsevier, 2019) MacLellan, Alexander Nikolas; Woolcott, Christy Gwen; Brown, Mary Margaret; Dodds, Linda; McDonald, Sarah Diana; Kuhle, StefanObjective: To examine the association between Caesarean section (CS) and health care utilization and costs in offspring from birth until age 7 years. Methods: A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age seven years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (CS vs. vaginal birth (VB)); the outcome was health care utilization and costs during the first seven years of life. Associations were modeled using multiple regression adjusting for maternal pre- pregnancy weight and socio-demographic factors. Results: 32,464 births were included in the analysis. Compared to VB children, children born by CS had more physician visits (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI] 1.05-1.08) and longer hospital stays (IRR 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (odds ratio 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by CS compared to VB. Conclusion: CS compared to VB is associated with small but statistically significant increases in health care utilization and costs in during the first seven years of life.Item Open Access Maternal pre-pregnancy weight status and health care use for mental health conditions in the offspring(Springer, 2019) Grudzinski, Alexa; Campbell, Leslie Anne; Liu, Lihui; Brown, Mary Margaret; Dodds, Linda; Kuhle, StefanObjectives: The objective of this study was to examine the relationship between pre-pregnancy maternal weight status and offspring physician visits for mental health conditions in childhood and adolescence. Methods: We conducted a population-based retrospective cohort study of singleton infants born between the years of 1989 and 1993 using a linkage of the Nova Scotia Atlee Perinatal Database with administrative health data. Offspring were followed from birth to age 18 years. Maternal weight status was categorized according to WHO body mass index cutoffs. The number of physician visits for any mental health condition, mood, anxiety, and adjustment disorders, conduct disorder, and attention deficit hyperactivity disorder (ADHD) from age 0-18 years was determined from ICD codes in physician billings and hospital discharge abstract data. Compound Poisson regression adjusting for sociodemographics, maternal psychiatric disorders and smoking was used to model the association. Results: In total, 38,211 mother-offspring pairs were included in the cohort. Within the first 18 years of life, offspring of mothers with obesity had significantly more physician visits for any mental health condition (adjusted incidence rate ratio [IRR] 1.21, 95% CI 1.14-1.28), mood, anxiety, and adjustment disorders (IRR 1.13, 95% CI 1.04-1.23), conduct disorder (IRR 1.16, 95% CI 1.17-2.11), and ADHD (IRR 1.44, 95% CI 1.19-1.74) compared to mothers of normal weight. Associations for mood, anxiety, and adjustment disorders and conduct disorder were strongest at 13-18 years. Conclusions: Offspring of mothers with obesity appear to use health care for mental health conditions more frequently than offspring of normal weight mothers.Item Open Access Birth weight for gestational age and the risk of asthma in childhood and adolescence: a retrospective cohort study(BMJ, 2019) Carter, Jillian Hansen; Woolcott, Christy Gwen; Liu, Lihui; Kuhle, StefanObjective: To examine the association between birthweight for gestational age and asthma in childhood and adolescence while controlling for potential confounders and considering smoking as an effect modifier. Methods: A retrospective cohort of all singleton term births in Nova Scotia, Canada between 1989 and 1993 was identified in the provincial perinatal database and followed through 2014 by linking with administrative health data. The outcome, asthma, was defined as having one hospitalization or two physician visits with an ICD code for asthma in a 2-year period. Birthweight was categorized as small (SGA), large (LGA), or appropriate (AGA) for gestational age. Multivariable-adjusted Cox proportional hazards models were used to examine the association between the birthweight for gestational age and asthma and to test for effect modification by maternal smoking in pregnancy. Results: Of the 40,724 cohort children, 10.5% and 11.7% were born SGA and LGA, respectively, and the risk of developing asthma to age 18 years was 30.2%. The adjusted hazard ratios (HR) for SGA and LGA (relative to AGA) and asthma were 1.07 [95% CI 1.02, 1.14], and 0.96 [95% CI 0.91, 1.02], respectively. Relative to AGA children born to non-smoking mothers, SGA children were not at increased risk of asthma (HR 1.02), whereas both AGA and SGA children born to smoking mothers were at significantly increased risk (HR 1.14 and 1.29, respectively). Conclusions: Our findings suggest that SGA in term infants is not associated with asthma in childhood in the absence of smoking in pregnancy.