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. 2022 Sep 20;17(9):e0274355.
doi: 10.1371/journal.pone.0274355. eCollection 2022.

The Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO): Comparisons between Quebec, Manitoba, Saskatchewan, and Alberta

Anick Bérard  1   2   3 , Padma Kaul  4   5 , Sherif Eltonsy  6 , Brandace Winquist  7 , Dan Chateau  6   8 , Steven Hawken  9   10   11 , Ann Sprague  12 , Mark Walker  9   10   11   12   13 , Sasha Bernatsky  14 , Michal Abrahamowicz  15 , Cristiano Soares de Moura  16 , Évelyne Vinet  14 , Bruce Carleton  17 , Gillian Hanley  18 , Tim Oberlander  19 , Odile Sheehy  2 , Yessica Haydee Gomez  2 , Jessica Gorgui  1   2 , Anamaria Savu  5
Affiliations

The Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO): Comparisons between Quebec, Manitoba, Saskatchewan, and Alberta

Anick Bérard et al. PLoS One. .

Abstract

Background: Given that pregnant women taking medications are excluded from clinical trials, real-world evidence is essential. We aimed to build a Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO) and compare frequency of prematurity, low-birth-weight (LBW), major malformations, multiplicity, and gestational medication use across four provinces.

Methods: CAMCCO is a collaborative research infrastructure that uses real-world data from large provincial health care databases in Canada; developed with standardized methods to similarly construct population-based pregnancy/child cohorts with longitudinal follow-up by linking administrative/hospital/birth databases. CAMCCO also includes a common repository to i) share algorithms and case definitions based on diagnostic and procedural codes for research/training purpose, and ii) download aggregate data relevant to primary care providers, researchers, and decision makers. For this study, data from Quebec (1998-2015), Manitoba (1995-2019), Saskatchewan (1996-2020), and Alberta (2005-2018) are compared (Chi-square tests, p-values), and trends are calculated using Cochran-Armitage trend tests.

Results: Almost two-thirds (61%) of women took medications during pregnancy, mostly antibiotics (26%), asthma drugs (8%), and antidepressants (4%). Differences in the prevalence of prematurity (5.9-6.8%), LBW (4.0-5.2%), and multiplicity (1.0-2.5%) were statistically significant between provinces (p<0.001). Frequency of major malformations increased over time in Quebec (7-11%; p<0.001), Saskatchewan (5-11%; p<0.001), and Alberta (from 7-8%; p<0.001), and decreased in Manitoba (5-3%; p<0.001). Cardiovascular and musculoskeletal malformations were the most prevalent.

Interpretation: Medications are often used among Canadian pregnancies but adverse pregnancy outcomes vary across provinces. Digitized health data may help researchers and care providers understand the risk-benefit ratios related to gestational medication use, as well as province-specific trends.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Annual rates of prematurity and low birth weight (LBW).
Annual rates of prematurity and LBW during the study period in Quebec, Manitoba, Saskatchewan, and Alberta. Note: Data on preterm births were missing from SK’s birth abstracts for the years 1996–2000; and birthweight was missing for the years 1996–98 for live births.
Fig 2
Fig 2. CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Overall prevalence of categories of prematurity.
Note: Data on preterm births were missing from SK’s birth abstracts for the years 1996–2000.
Fig 3
Fig 3. CAMCCO—Quebec, Manitoba, Saskatchewan, and Alberta—Annual rates of major malformations in the first year of life with trends for each province.
Note: Trend comparisons between provinces p < 0.0001.
Fig 4
Fig 4. CAMCCO—Quebec, Manitoba, Saskatchewan and Alberta—Prevalence of major malformations in the first year of life by organ system.
Note: All major malformation organ system prevalences between provinces were statistically significant (p < 0.0001).
See this image and copyright information in PMC

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