The epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.

Pregnant and parenting adolescents are more likely than adults to live with economic and social vulnerability, contributing to a higher risk of poorer maternal and newborn health outcomes. These same factors contribute to higher rates of postpartum child protection investigations among adolescents. This study describes an innovative approach to contextualize evidence on factors contributing to perinatal child protection involvement in the perspectives of pregnant and parenting adolescents. Using Weight of Evidence, an evidence-based participatory procedure, we conducted a conventional literature review and used fuzzy cognitive maps to contextualize evidence in the experiences of young mothers exposed to child protection investigations. Published evidence was contextualized through semi-structured mapping interviews with ten pregnant and parenting youth and subsequently shared with three child protection workers specialized in pre- and post-natal risk assessment. We developed and consolidated explanatory accounts describing how factors contribute to child protection involvement in the perinatal period among adolescent parents. We collaboratively designed and prioritized interventions strategies together with six adolescent parents. Young women highlighted mental health consequences of child protection involvement, including a reluctance to disclose their own health and social needs, challenges to their identity and self-confidence as parents, and social isolation. Women prioritized reducing the stigma they experience in accessing services, strengthening supportive relationships and greater understanding of their rights in child protection investigations as actionable intervention areas. Inputs of young women and service providers precipitated a reconceptualization of risk and identified how to support greater agency and self-determination among young parents experiencing child protection investigations.

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Background: The prevalence of cannabis use among pregnant individuals in Canada is increasing. In the design of new cohort studies to evaluate the patterns and outcomes of cannabis use in pregnancy, consideration must be given to the factors influencing participation, data sharing, and contribution of biological samples. Our objective was to assess the willingness of pregnant individuals to participate in prospective research during pregnancy. Methods: We surveyed pregnant individuals receiving obstetrical care through The Ottawa Hospital in Ottawa, Canada. The survey consisted of 23 dichotomous (yes/no), multiple-choice, Likert scale, and open-ended questions. Individuals were provided with a hypothetical research scenario and asked to report on the likelihood of their participation, use and storage of personal health information and contribution of maternal and newborn samples. Individuals provided motivating and deterring factors related to research participation. Descriptive statistics included frequencies (n) and percentages (%) for categorical variables. Continuous variables were described using means and standard deviations. Results: A total of 84 survey responses were collected. The mean age of respondents was 32.6(±5.3) years. Respondents were predominantly Caucasian (79%), college/university educated (85%) with a household income of ≥$100,000 (64%). There was a high degree of willingness to participate in prospective research by sharing data and biological samples. The most commonly cited motivating and deterring factors for participating in future research were a desire to contribute to science and health information (79%) and fear of privacy invasion (17%), respectively. Conclusions: Pregnant individuals receiving care at The Ottawa Hospital are willing to participate in prospective research studies, including those related to cannabis use. Survey respondents were predominantly of higher socioeconomic status, and few individuals reported cannabis use during pregnancy. Future studies should accommodate multiple recruitment strategies and flexible study designs to encourage enrollment from and retention across diverse sociodemographic communities.