Women In Quebec Research Articles

Early predictors of Guillain-Barré syndrome in the life course of women.

We sought to determine if immune disorders early in life were associated with the later risk of Guillain-Barré syndrome, a neurological disorder thought to be infection-related. We conducted a longitudinal cohort study with 16 108 819 person-years of follow-up for a population of 1 108 541 parous women in Quebec, Canada (1989-2014). The outcome was Guillain-Barré syndrome. We identified women with potential risk factors for future Guillain-Barré syndrome, including immune-mediated and rheumatological diseases, cancer, transfusion, surgical procedures and pregnancy-specific disorders. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of risk factors with later onset of Guillain-Barré syndrome, adjusted for personal characteristics of women. The overall incidence of Guillain-Barré syndrome was 1.42 per 100 000 person-years. Incidence was higher for women with immune-mediated (8.79 per 100 000 person-years) and rheumatological disorders (9.84 per 100 000 person-years), transfusion (4.41 per 100 000 person-years), and preeclampsia (2.62 per 100 000 person-years). Immune-mediated disorders were associated with six times the risk of Guillain-Barré syndrome (HR 6.57, 95% CI 3.58 to 12.04), rheumatological disorders with seven times the risk (HR 7.23, 95% CI 3.21 to 16.28), transfusion three times the risk (HR 3.58, 95% CI 1.83 to 6.98) and preeclampsia two times the risk (HR 2.01, 95% CI 1.29 to 3.12). Women with other potential risk factors did not have an increased risk of Guillain-Barré syndrome. Immune-related conditions that occur early in life are associated with an increased risk of Guillain-Barré syndrome. The pathophysiology of Guillain-Barré syndrome may extend beyond infectious triggers.

Cell-Free DNA–Based Non-invasive Prenatal Screening for Common Aneuploidies in a Canadian Province: A Cost-Effectiveness Analysis

ObjectiveYearly, 450 000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness of NIPT strategies compared with conventional strategies. MethodsThis study used a decision analytic model to estimate the cost-effectiveness of 13 prenatal screening strategies for fetal aneuploidies: six frequently used strategies, universal NIPT, and six strategies incorporating NIPT as a second-tier test. The study considered a virtual cohort of pregnant women of similar size and age as women in Quebec. Model data were obtained from published sources and government databases. The study predicted the number of chromosomal anomalies detected (trisomies 21, 13, and 18), invasive procedures and euploid fetal losses, direct costs, and incremental cost-effectiveness ratios. ResultsOf the 13 strategies compared, eight identified fewer cases at a higher cost than at least one of the remaining five strategies. Integrated serum screening with conditional NIPT had the lowest cost, and the cost per case detected was $63 139, with a 90% reduction of invasive procedures. The number of cases identified was improved with four other screening strategies, but with increasing of incremental costs per case (from $61 623 to $1 553 615). Results remained robust, except when NIPT costs and risk cut-offs varied. ConclusionNIPT as a second-tier test for high-risk women is likely to be cost-effective as compared with screening algorithms not involving NIPT.

Maternal Vitamin D Insufficiency Early in Pregnancy Is Associated with Increased Risk of Preterm Birth in Ethnic Minority Women in Canada

BackgroundMaternal vitamin D insufficiency (plasma 25-hydroxyvitamin D [25(OH)D] <75 nmol/L) may play a role in ethnic disparities in rates of preterm and spontaneous preterm births. ObjectiveWe explored the relation between maternal plasma 25(OH)D concentration in the first trimester (8–14 wk of gestation) and the risk of preterm and spontaneous preterm births (<37 wk of gestation) by ethnicity. MethodsWe designed a case-control study that included 120 cases of preterm birth (<37 wk of gestation) and 360 term controls (≥37 wk of gestation) of singleton pregnancies from the 3D cohort, a multicenter study in 2456 pregnant women in Quebec, Canada. Plasma 25(OH)D was measured by LC–mass spectrometry. We compared the distribution of vitamin D status between cases and controls for 8 ethnic minority subgroups. We explored the association between maternal plasma 25(OH)D concentration and preterm and spontaneous preterm births with the use of splines in logistic regression by ethnicity. ResultsThe distributions of maternal vitamin D status (<50, 50–75, and >75 nmol/L) were different in preterm and spontaneous preterm birth cases compared with controls but only in women of ethnic minority (P-trend = 0.003 and 0.024, respectively). Among ethnic subgroups, sub-Saharan Africans (P-trend = 0.030) and Arab-West Asians (P-trend = 0.045) showed an inverse relation between maternal vitamin D status and the risk of preterm birth. Maternal plasma 25(OH)D concentrations of 30 nmol/L were associated with 4.05 times the risk of preterm birth in the total ethnic minority population (95% CI: 1.16, 14.12; P = 0.028) relative to participants with a concentration of 75 nmol/L. In contrast, there was no such association among nonethnic women (OR: 0.94; 95% CI: 0.48, 1.82; P = 0.85). There was no association when we considered only spontaneous preterm births in the total ethnic minority population (OR: 1.75; 95% CI: 0.39, 7.79; P = 0.46). ConclusionVitamin D insufficiency is associated with an increased risk of preterm birth in ethnic minority women in Canada.

Escherichia coli antimicrobial susceptibility profile and cumulative antibiogram to guide empirical treatment of uncomplicated urinary tract infections in women in the province of Québec, 2010-15.

Empirical treatment of uncomplicated urinary tract infections (UTIs) in women should be based on local susceptibility data. We aimed to generate regional and provincial cumulative antibiograms combining data from different laboratory information systems and determine the impact of basic patient characteristics on susceptibility results. All positive urine samples for Escherichia coli obtained from women aged 18-65 years old in outpatient settings between 1 April 2010 and 31 March 2015 from four hospitals in Quebec, Canada, were included. The cumulative antibiogram for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was calculated. A clinically significant difference in susceptibility profile was defined as factor(s) that lowered the susceptibility proportion below 80%. A total of 36 293 positive urine cultures were analysed. In the last year of the study, the proportion of susceptibility for ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole was 90.3%, 95.4% and 81.9%, respectively. The susceptibility proportion was <80% for trimethoprim/sulfamethoxazole in the Montreal region (73.4%; 95% CI 71.1%-75.9%), whereas it remained >80% for the other regions. A significant decrease in susceptibility with time was identified for ciprofloxacin (92.1%-90.3%, P < 0.001) and nitrofurantoin (97.1%-95.4%, P < 0.001). Increasing age, recent hospitalization and site of collection were associated with an increase in resistance for certain antibiotics. Overall, all first-line antimicrobials remain acceptable choices for empirical treatment of uncomplicated UTIs in women in Quebec. The regional variability in susceptibility data within a single province emphasizes the importance of local susceptibility data to inform the development of empirical treatment guidelines for UTIs.

A Brief History of Women in Quebec by Denyse Baillargeon

<i>A Brief History of Women in Quebec</i> by Denyse Baillargeon

Relationships between physical activity across lifetime and health outcomes in older adults: Results from the NuAge cohort

This study aims to (1) describe participation in four physical activity (PA) domains across life and (2) examine the influence of PA during adolescence, early, middle, and later adulthood on health variables at older age.This observational study was conducted in 1378 generally healthy older adults (age 67–84 at baseline in 2003–2005; 52% women) in Quebec, Canada. Using a modified version of the interviewer-administered Lifetime Total Physical Activity Questionnaire (LTPAQ) and life events calendar to facilitate the recall, participants reported the frequency, duration, and intensity of occupational (OPA), commuting (CPA), household (HPA), and leisure time (LTPA) they participated in at age 15, 25, 45, and 65, and at the first follow-up (age 68–85 in 2005–2006). Fat mass, lean body mass, body mass index, waist-to-hip ratio, fasting glucose, systolic and diastolic blood pressures, self-reported chronic diseases, and socio-demographic data were assessed at baseline.Changes in PA over time differed by sex in each domain. However, there was a general decline in all PA domains in both sexes after age 65. In multiple regression analyses, LTPA at first-follow-up was associated with more favourable waist-to-hip ratio in both sexes, fat mass in women and fat mass percentage in men, whereas CPA, OPA, and HPA across life were not consistently associated with health variables.Older adults' LTPA at first follow-up was related to health variables, but PA recalled during adolescence, early adulthood, and mid-life was not. Results support the idea that current PA is positively related to better health outcomes.

Cross-training to work better together with women in Quebec who use substances: care providers' perceptions.

Some authors have called attention to the lack of service integration related to evaluation and treatment of parental substance abuse, an ongoing challenge for service providers. A cross-training project involving exchanges (immersion sessions) among clinical teams was established to improve the integration, effectiveness and coherence of interventions for pregnant women and mothers with problematic substance use, and to prevent negative impacts of substance abuse on parenting skills and on foetal and child development. The research goal was to understand, from the perspectives of care providers, how cross-training either fosters or fails to foster changes in the practices of care providers who work with young pregnant women and mothers whose use of psychotropic drugs puts them at risk of neglecting their children. The cross-training project was carried out between 2009 and 2013. During the last phase of the project, focus group data were collected from 14 different clinical teams (N=121) from the fields of substance abuse, child protection, perinatality and early childhood. The responses of each focus group yielded data for thematic analysis, performed using a mixed coding approach that included predefined and emerging themes. Points of convergence and divergence were identified by comparing what was said in different groups and types of clinical settings. At the conclusion of the project, the care providers said they knew their clinical partners better, communicated more with each other and made more referrals to those partners, and were better able to express themselves clearly about the effects of psychotropic drug use on the foetus, the child and the parenting role. In conclusion, the project helped create a culture of co-operation and partnership that has direct effects on services for pregnant women and young mothers who use substances.

A Brief History of Women in Quebec

A Brief History of Women in Quebec

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 4: criminal recidivism.

To examine criminal recidivism rates of a large sample of people found not criminally responsible on account of mental disorder (NCRMD) in Canada's 3 most populous provinces, British Columbia, Ontario, and Quebec. Public concern about the dangerousness of people found NCRMD has been fed by media attention on high-profile cases. However, little research is available on the rate of reoffending among people found NCRMD across Canadian provinces. Using data from the National Trajectory Project, this study examined 1800 men and women in British Columbia (n = 222), Ontario (n = 484), and Quebec (n = 1094) who were found NCRMD between May 2000 and April 2005 and followed until December 2008. Recidivism was relatively low after 3 years (17%). There were interprovincial differences after controlling for number of prior criminal offences, diagnosis, seriousness of the index offence, and supervision by the review boards. British Columbia (10%) and Ontario (9%) were similar, whereas Quebec had almost twice the recidivism (22%). People who had committed severe violent index offences were less likely to reoffend than those who had committed less severe offences. People from the sample were less likely to reoffend when under the purview of review boards, across all 3 provinces. The results of this study, along with other research on processing differences, suggest systemic differences in the trajectories and outcomes of persons found NCRMD need to be better understood to guide national policies and practices.

A brief history of women in Quebec

A brief history of women in Quebec

Projection scenarios of body mass index (2013-2030) for Public Health Planning in Quebec.

BackgroundProjection analyses can provide estimates of the future health burden of increasing BMI and represent a relevant and useful tool for public health planning. Our study presents long-term (2013–2030) projections of the prevalence and numbers of individuals by BMI category for adult men and women in Quebec. Three applications of projections to estimate outcomes more directly pertinent to public health planning, as well as an in-depth discussion of limits, are provided with the aim of encouraging greater use of projection analyses by public health officers.MethodsThe weighted compositional regression method is applied to prevalence time series derived from sixteen cross-sectional survey cycles, for scenarios of linear change and deceleration. Estimation of the component of projected change potentially amenable to intervention, future health targets and the projected impact on type 2 diabetes, were done.ResultsObesity prevalence in Quebec is projected to rise steadily from 2013 to 2030 in both men (from 18.0-19.4% to 22.2-30.4%) and women (from 15.5-16.3% to 18.2-22.4%). Corresponding projected numbers of obese individuals are (579,000-625,000 to 790,000-1,084,000) in men and (514,000-543,000 to 661,000-816,000) in women. These projected increases are found to be primarily an ‘epidemiologic’ rather than ‘demographic’ phenomenon and thus potentially amenable to public health intervention. Assessment of obesity targets for 2020 illustrates the necessity of using projected rather than current prevalence; for example a targeted 2% drop in obesity prevalence relative to 2013 translates into a 3.6-5.4% drop relative to 2020 projected levels. Type 2 diabetes is projected to increase from 6.9% to 9.2-10.1% in men and from 5.7% to 7.1-7.5% in women, from 2011–2012 to 2030. A substantial proportion of this change (25-44% for men, and 27-43% for women) is attributable to the changing BMI distribution.ConclusionsObesity in Quebec is projected to increase and should therefore continue to be a public health priority. Application of projections to estimate the proportion of change potentially amenable to intervention, feasible health targets, and future chronic disease prevalence are demonstrated. Projection analyses have limitations, but represent a pertinent tool for public health planning.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-996) contains supplementary material, which is available to authorized users.

Cost-Effectiveness of the Management of Rh-Negative Pregnant Women

ObjectiveThe purpose of this study was to determine the most cost-effective option to prevent alloimmunization against the Rh factor. MethodsA virtual population of Rh-negative pregnant women in Quebec was built to simulate the cost-effectiveness of preventing alloimmunization. The model considered four options: (1) systematic use of anti-D immunoglobulin; (2) fetal Rh(D) genotyping; (3) immunological determination of the father’s Rh type; (4) mixed screening: immunological determination of the father’s Rh type, followed if positive by fetal Rh(D) genotyping. Two outcomes were considered, in addition to the estimated costs: (1) the number of babies without hemolytic disease, and (2) the number of surviving infants. ResultsIn a first pregnancy, two options emerged as the most cost-effective options: systematic prophylaxis and immunological Rh typing of the father, with overlapping confidence intervals between them. In a second pregnancy, the results were similar. In all cases (first or second pregnancy or a combination of the two) fetal genotyping was not found to be a cost-effective option. ConclusionRoutine prophylaxis and immunological Rh typing of the father are the most cost-effective options for the prevention of Rh alloimmunization. Considering that immunological typing of the father would probably not be carried out by the majority of clinicians, routine prophylaxis remains the preferred option. However, this could change if the cost of Rh(D) fetal genotyping fell below $140 per sample.

Validation of a Prediction Model for Predicting the Probability of Morbidity Related to a Trial of Labour in Quebec

Between 2000 and 2006, births by cesarean section (CS) increased from 21.2% to 26.3% in Canada and reached greater than 30% in the United States. A prior CS is the primary indication for greater than 30% of all CS procedures in Canada. The number of CSs could be decreased if more women who could undergo a trial of labor after CS (TOLAC) chose this option. The decision to attempt a TOLAC or to have an elective repeat CS (ERCS) is often made by considering the fear of a repeat failed labor or the odds of developing maternal and neonatal complications with either delivery mode. Grobman’s model, which allows an estimation of the probability of vaginal delivery for women with 1 prior CS undergoing a TOLAC, was developed from 9616 American women experiencing a TOLAC and validated using an independent cohort. Maternal and neonatal morbidity decreased as the predicted chance of vaginal birth after cesarean (VBAC) increased. Morbidity was similar between TOLAC and ERCS when the probability of successful VBAC was 70% or greater. Because the Grobman model has not been validated in a Canadian population and because American and Canadian populations and clinical practices may differ, validation is needed before the prediction model can be used in Canada. The present study was performed to determine whether Grobman’s model for predicting TOLAC success in an American population can predict the probability of morbidity associated with TOLAC in a Canadian population. A perinatal database with 185,437 deliveries from 32 obstetric centers in Quebec was used, and women with 1 prior CS who were eligible for a TOLAC were selected. The probability of VBAC was calculated from the Grobman model, using maternal age, body mass index, history of vaginal delivery, timing of vaginal delivery in relation to the CS, and indication for the prior CS. Major and minor maternal morbidities and newborn morbidities were determined. Women were then categorized by deciles of their predicted probability of VBAC, and the frequencies of maternal and neonatal morbidities between those who underwent TOLAC and those who had ERCS were compared using either the Fisher exact or χ2 analysis. Statistical significance was defined as P < 0.05. Of 8508 women with 1 prior CS, 3113 had a TOLAC (36.6%) and 5395 underwent an ERCS (63.4%). Minor and major maternal morbidity occurred in 1.9% and 1.1%, respectively; the frequency of neonatal morbidity was 5.1%. Maternal and neonatal morbidities became less frequent as the predicted chance of VBAC increased among women who underwent TOLAC (P < 0.05). No comparable trend was apparent among women who had ERCS. When the predicted chance of VBAC was less than 60%, women undergoing a TOLAC were more likely to have morbidity than women who underwent an ERCS (P < 0.05). When the probability of VBAC success reached 60%, this difference was not present. Neonatal morbidities showed a similar pattern, but they became equivalent between TOLAC and ERCS only when the probability of VBAC was 70% or greater. All women were grouped according to predicted probabilities of VBAC success of either 60% or 70%. When the predicted chance of VBAC was less than 60%, women undergoing a TOLAC were more likely to have maternal morbidity (RR 2.3; 95% confidence interval [CI], 1.4–4.0) than those who underwent an ERCS. However, when the predicted chance of VBAC was 60% or greater, maternal morbidity did not differ between the groups (RR, 0.8; 95% CI, 0.6–1.1). Neonatal morbidity was similar between groups when the probability of VBAC reached 70% (RR, 1.2; 95% CI, 0.9–1.5). This prediction model for VBAC success as validated in the United States is also predictive for Canadian women in Quebec. Maternal and neonatal morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOLAC. The findings of this study confirm that individual assessment of the probability of VBAC success allows health care providers to refine and improve counseling to inform women with a prior CS about their chance of successful VBAC and their level of risk, to enable them to make an informed choice regarding their mode of delivery.

Cohort profile of the CARTaGENE study: Quebec’s population-based biobank for public health and personalized genomics

The CARTaGENE (CaG) study is both a population-based biobank and the largest ongoing prospective health study of men and women in Quebec. In population-based cohorts, participants are not recruited for a particular disease but represent a random selection among the population, minimizing the need to correct for bias in measured phenotypes. CaG targeted the segment of the population that is most at risk of developing chronic disorders, that is 40-69 years of age, from four metropolitan areas in Quebec. Over 20,000 participants consented to visiting 1 of 12 assessment sites where detailed health and socio-demographic information, physiological measures and biological samples (blood, serum and urine) were captured for a total of 650 variables. Significant correlations of diseases and chronic conditions are observed across these regions, implicating complex interactions, some of which we describe for major chronic conditions. The CaG study is one of the few population-based cohorts in the world where blood is stored not only for DNA and protein based science but also for gene expression analyses, opening the door for multiple systems genomics approaches that identify genetic and environmental factors associated with disease-related quantitative traits. Interested researchers are encouraged to submit project proposals on the study website (www.cartagene.qc.ca).

Antenatal depressive symptoms among Canadian-born and immigrant women in Quebec: differential exposure and vulnerability to contextual risk factors

To examine the distribution of contextual risk factors for antenatal depression according to immigrant status and the length of stay in Canada, to assess the association between these risk factors and antenatal depression (AD) for Canadian-born and immigrant women, and to compare the vulnerability of Canadian-born and immigrant women to risk factors in relation to antenatal depression. Women were recruited at routine ultrasound examinations (16-20 weeks), at antenatal blood sampling (8-12 weeks), or in antenatal care clinics. Cross-sectional analysis was performed on the baseline sample consisting of 5,162 pregnant women. CES-D scale was used to investigate depression. Levels of exposure to the selected risk factors according to immigrant status and length of stay were assessed using Chi-square-test or the t test. All measures of association were assessed using logistic regression. Multiplicative interaction terms were constructed between each of the risk factors and immigrant status to reveal differential vulnerability between Canadian-born and immigrant women. Prevalence of AD (CES-D ≥16 points) was higher in immigrants (32% [29.6-34.4]) than in Canadian-born women (22.8% IC 95% [21.4-24.1]). Immigrant women were significantly more exposed than Canadian-born women to adverse contextual risk factors such as high marital strain, lack of social support, poverty, and crowding. At the same level of exposure to risk factors, Canadian-born women presented higher vulnerability to AD when lacking social support (OR = 4.14 IC 95% [2.69; 6.37]) while immigrant women presented higher vulnerability to AD when lacking money for basic needs (OR = 2.98 IC 95% [2.06; 4.32]). Important risk factor exposure inequalities exist between Canadian-born and immigrant pregnant women. Interventions should target poverty and social isolation. The observed high frequency of AD highlights the need to evaluate the effectiveness of preventive interventions of antenatal depression.

Virus du papillome humain : connaissances, croyances et comportements des femmes québécoises

Objective: A program providing free immunization against human papillomavirus (HPV) was launched in the province of Quebec in 2008. A survey was conducted to describe the knowledge, attitudes and behaviours of young women in Quebec regarding HPV infections. Method: In 2009, a questionnaire was sent by mail to 2,400 women, 24 years of age, randomly selected from the Quebec provincial health insurance database (RAMQ). Results: The overall response rate was 56%. More than 80% of participants had heard of HPV and HPV vaccine. Less than half knew the mode of transmission of HPV. More than 80% of participants knew the causes of cervical cancer. Most women said they were dissatisfied with the information received on HPV. Only 5% of participants had received the HPV vaccine. The average age at first sexual intercourse was 17 years. More than 80% of participants had been screened for cervical cancer with an average age for screening initiation of 18 years. Conclusion: This study provided basic data from a representative sample of women, 24 years of age, in Quebec. Although most women surveyed had heard of HPV and the vaccine, gaps remained in their knowledge in addition to a dissatisfaction about the information they received. A better way to inform the young adult population should be developed. Key words: Health knowledge/attitudes/practices; papillomavirus infections; papillomavirus vaccine

Human papilloma virus: knowledge, beliefs and behavior of Quebec women

A program providing free immunization against human papillomavirus (HPV) was launched in the province of Quebec in 2008. A survey was conducted to describe the knowledge, attitudes and behaviours of young women in Quebec regarding HPV infections. In 2009, a questionnaire was sent by mail to 2,400 women, 24 years of age, randomly selected from the Quebec provincial health insurance database (RAMQ). The overall response rate was 56%. More than 80% of participants had heard of HPV and HPV vaccine. Less than half knew the mode of transmission of HPV. More than 80% of participants knew the causes of cervical cancer. Most women said they were dissatisfied with the information received on HPV. Only 5% of participants had received the HPV vaccine. The average age at first sexual intercourse was 17 years. More than 80% of participants had been screened for cervical cancer with an average age for screening initiation of 18 years. This study provided basic data from a representative sample of women, 24 years of age, in Quebec. Although most women surveyed had heard of HPV and the vaccine, gaps remained in their knowledge in addition to a dissatisfaction about the information they received. A better way to inform the young adult population should be developed.

Association of macrosomia with perinatal and postneonatal mortality among First Nations people in Quebec

High prevalence of infant macrosomia (up to 36%, the highest in the world) has been reported in some First Nations communities in the Canadian province of Quebec and the eastern area of the province of Ontario. We aimed to assess whether infant macrosomia was associated with elevated risks of perinatal and postneonatal mortality among First Nations people in Quebec. We calculated risk ratios (RRs) of perinatal and postneonatal mortality by birthweight for gestational age, comparing births to First Nations women (n = 5193) versus women whose mother tongue is French (n = 653 424, the majority reference group) in Quebec 1991-2000. The prevalence of infant macrosomia (birthweight for gestational age > 90th percentile) was 27.5% among births to First Nations women, which was 3.3 times (confidence interval [CI] 3.2-3.5) higher than the prevalence (8.3%) among births to women whose mother tongue is French. Risk ratios for perinatal mortality among births to First Nations women were 1.8 (95% CI 1.3-2.5) for births with weight appropriate for gestational age, 4.1 (95% CI 2.4-7.0) for small-for-gestational-age (< 10th percentile) births and < 1 (not significant) for macrosomic births compared to births among women whose mother tongue is French. The RRs for postneonatal mortality were 4.3 (95% CI 2.7-6.7) for infants with appropriate-for-gestational-age birthweight and 8.3 (95% CI 4.0-17.0) for infants with macrosomia. Macrosomia was associated with a generally protective effect against perinatal death, but substantially greater risks of postneonatal death among births to First Nations women in Quebec versus women whose mother tongue is French.

Determinants of A (H1N1) vaccination: Cross-sectional study in a population of pregnant women in Quebec

Background Because of the risk of complication, pregnant women were a priority target for vaccination during the A (H1N1) pandemic influenza. In Quebec, 63% of pregnant women were vaccinated, which is a higher rate than vaccination against seasonal influenza. However, the behaviour of pregnant women relative to the vaccination during the H1N1 pandemic is unknown. The present study was aimed at identifying factors influencing the decision-making of pregnant women regarding H1N1 vaccination. Methods A cross-sectional survey was conducted in February 2010 in pregnant women or in early postpartum at the Sherbrooke University Hospital Centre using a self-administered questionnaire based on the Health Belief Model (HBM). Data items collected were: socio-demographic data, vaccination status, information sources consulted, knowledge on vaccination, and the HBM dimensions: effectiveness and risks of vaccination, severity and vulnerability towards the influenza. The associations between questionnaire variables and vaccination status were assessed by univariate and multivariate analysis. Results Of the 250 women interviewed, 95% knew that the vaccination was recommended, but only 76% received the vaccine. Variables positively associated with vaccination were late vaccination during pregnancy (OR = 7.3, 95% CI 2.1–25.3), belief in the efficacy of the vaccine (OR = 7, 95% CI 2–23.4), and consultation of the Pandémie-Québec website (OR = 4.5, 95% CI 1.5–13.4). However, the belief that the vaccine had not been adequately tested (OR = 0.08, 95% CI 0.02–0.35) and consultation of mainstream websites (OR = 0.22, 95% CI 0.06–0.81) were associated with lower vaccination rates. Conclusions The vast majority of pregnant women were aware of the recommendations relative to A (H1N1) vaccination. Internet media played an important role in their decision to get vaccinated. Better information on the safety of the vaccine must be prepared for future pandemics.

Tea consumption during pregnancy and the risk of pre-eclampsia

Objective To examine the effects of tea consumption during pregnancy on the risk of pre-eclampsia. Methods A case-control study was carried out among nulliparous pregnant women in Quebec between January 2003 and March 2006. Data were collected using a structured study questionnaire. A total of 92 women with pre-eclampsia and 245 controls were analyzed. Univariate analysis and multivariate regression were performed to examine the association between tea consumption and pre-eclampsia. Results Compared with non-tea drinking during pregnancy, the crude odds ratio (OR) and adjusted OR (aOR) of pre-eclampsia for tea drinking were 1.34 (95% CI, 0.80–2.25) and 1.39 (95% CI, 0.81-2.41), respectively. The OR and aOR of severe pre-eclampsia for tea drinking were 1.39 (95% CI, 0.78–2.46) and 2.14 (95% CI, 1.01–4.54), respectively. The aORs for persistent tea consumption in pre-eclampsia and severe pre-eclampsia were 1.88 (95% CI, 1.01–3.51) and 1.95 (95% CI, 1.06–3.57), respectively. Conclusion Persistent tea drinking during pregnancy may be associated with an increased risk of pre-eclampsia.