BACKGROUND: Smoking cessation is recommended to improve the prognosis after acute coronary syndro... more BACKGROUND: Smoking cessation is recommended to improve the prognosis after acute coronary syndrome (ACS). Smoking habit, largely influenced by psychosocial aspects, is high prevalent (50%) among younger patients. However,
We present a case of persistent postpartum hypertension found to be secondary to primary aldoster... more We present a case of persistent postpartum hypertension found to be secondary to primary aldosteronism in a patient with a history of recurrent hypertensive disorders of pregnancy and associated fetal complications. Informed written consent was obtained verbally from the patient to be included in this case report. Our systematic review revealed only 18 cases of primary aldosteronism diagnosed in women with postpartum hypertension, suggesting that this disorder is under-studied in the postpartum period. A review of these cases suggests that women with primary aldosteronism commonly present with hypertensive disorders of pregnancy, but may only be identified de novo postpartum. However, a high index of suspicion is needed to diagnose primary aldosteronism in the postpartum period, guided by a woman's obstetric history.
Women with prior pregnancy complications are younger at the time of premature acute coronary synd... more Women with prior pregnancy complications are younger at the time of premature acute coronary syndrome, have a higher burden of atherosclerotic risk factors and a tendency towards worse clinical outcomes.
Journal of obstetrics and gynaecology Canada, Jun 1, 2014
P art of the growing demand for assisted reproductive technologies (ART), including in vitro fert... more P art of the growing demand for assisted reproductive technologies (ART), including in vitro fertilization, intrauterine insemination, and ovulation induction, is related to delayed childbearing and the increasing proportion of obese reproductive-aged women with ovulatory dysfunction. 1 ART is associated with adverse health events in singleton pregnancies, including hypertensive disorders of pregnancy, preterm birth, low birth weight, and perinatal mortality. 2 It remains uncertain whether access to ART should be universal or based on selection criteria that consider risks to the woman and her offspring. In particular, obese women (BMI > 30 kg/m 2) experience more complicated pregnancies. 3 Nearly one quarter of the adult Canadian female population is obese, 4 and infertility in this subgroup is common. 1 We discuss here the medical and economic aspects of balancing the goals of assisting pregnancy and mitigating risk in obese infertile women.
Journal of obstetrics and gynaecology Canada, Dec 1, 2020
Pulmonary embolism (PE) complicates 5.4 per 10 000 pregnancies and remains a significant cause of... more Pulmonary embolism (PE) complicates 5.4 per 10 000 pregnancies and remains a significant cause of maternal mortality. Prompt diagnosis and treatment of PE are key to ensuring optimal outcomes, but are not without risks associated with over-testing. Given the paucity of evidence informing PE diagnosis in pregnancy, marked heterogeneity exists among different societies in their recommendations.
Aims We assessed the impact of Covid-19 on gestational diabetes rates in Quebec, the pandemic epi... more Aims We assessed the impact of Covid-19 on gestational diabetes rates in Quebec, the pandemic epicenter of Canada.
BackgroundTime‐related biases, such as immortal time and time‐window bias, frequently occur in ph... more BackgroundTime‐related biases, such as immortal time and time‐window bias, frequently occur in pharmacoepidemiologic research. However, the prevalence of these biases in perinatal pharmacoepidemiology is not well understood.ObjectiveTo describe the frequency of time‐related biases in observational studies of medications commonly used during pregnancy (antibiotic, antifungal, and antiemetic drugs) via systematic review.MethodWe searched Medline and EMBASE for observational studies published between January 2013 and September 2020 and examining the association between antibiotic, antifungal, or antiemetic drugs and adverse pregnancy outcomes, including spontaneous abortion, stillbirth, preterm delivery, small‐for‐gestational age, pre‐eclampsia, and gestational diabetes. The proportion of studies with time‐related biases was estimated overall and by type (immortal time bias, time‐window bias).ResultsOur systematic review included 20 studies (16 cohort studies, 3 nested case–control stu...
Circulation: Cardiovascular Quality and Outcomes, 2022
Background: Severe maternal morbidity is rising, yet the association with cardiovascular disease ... more Background: Severe maternal morbidity is rising, yet the association with cardiovascular disease is not clear. We examined the risk of cardiovascular hospitalization up to 3 decades after having a pregnancy complicated by severe maternal morbidity. Methods: We analyzed a longitudinal cohort of 1 336 846 women who were pregnant between 1989 and 2019 in Quebec, Canada. The main exposure measure was severe maternal morbidity in any pregnancy, including severe preeclampsia, acute renal failure, sepsis, and other life-threatening conditions. Using time-varying Cox regression models, we compared the adjusted risk of hospitalization for cardiovascular disease up to 3 decades after pregnancy for women with severe maternal morbidity relative to women without severe morbidity. Results: Five percent of women had severe maternal morbidity. Overall, there were 68 287 cardiovascular hospitalizations during 21 725 672 person-years of follow-up in the cohort. Compared with no morbidity, women with ...
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disor... more Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness. Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between meas...
Fifty-eight women (DH¼30, C¼28) completed baseline and 3-month testing. At baseline there were no... more Fifty-eight women (DH¼30, C¼28) completed baseline and 3-month testing. At baseline there were no differences in hypertension (52%), fasting glucose impairment (29%), or smoking history (31%). However, DH women were younger than C (52 vs 59 years, p¼0.007), and had lower 10-year ASCVD risk scores (6.2AE5.1% vs 3.7AE3.7, p¼0.042). Upon LEARN program completion, mean weight loss (2.9AE4.1 kg), was similar in both groups (p¼0.773), and there was no change in SBP or ASCVD risk scores for either group. Lipid profile parameters showed favorable trends for both groups. A significant reduction was seen only for triglycerides in DH group (119AE40 at baseline vs 98AE26 at 3 months, p¼0.0009). Similarly, NMR lipoprofile analysis showed a significant reduction in large VLDL particles for DH group (5.3AE3.6 at baseline vs 3.4AE2.2 at 3 months, p¼0.0188). CONCLUSION: In women with ASCVD risk completing a 3 month LEARN program, Digital Health administration resulted in similar decreases in weight loss as traditional methods, but more favorable cardiometabolic results. This study demonstrates the feasibility and effectiveness of novel Digital Health methods for a weight loss program with immediate beneficial impact on weight loss and triglyceride levels.
BACKGROUND: Smoking cessation is recommended to improve the prognosis after acute coronary syndro... more BACKGROUND: Smoking cessation is recommended to improve the prognosis after acute coronary syndrome (ACS). Smoking habit, largely influenced by psychosocial aspects, is high prevalent (50%) among younger patients. However,
We present a case of persistent postpartum hypertension found to be secondary to primary aldoster... more We present a case of persistent postpartum hypertension found to be secondary to primary aldosteronism in a patient with a history of recurrent hypertensive disorders of pregnancy and associated fetal complications. Informed written consent was obtained verbally from the patient to be included in this case report. Our systematic review revealed only 18 cases of primary aldosteronism diagnosed in women with postpartum hypertension, suggesting that this disorder is under-studied in the postpartum period. A review of these cases suggests that women with primary aldosteronism commonly present with hypertensive disorders of pregnancy, but may only be identified de novo postpartum. However, a high index of suspicion is needed to diagnose primary aldosteronism in the postpartum period, guided by a woman's obstetric history.
Women with prior pregnancy complications are younger at the time of premature acute coronary synd... more Women with prior pregnancy complications are younger at the time of premature acute coronary syndrome, have a higher burden of atherosclerotic risk factors and a tendency towards worse clinical outcomes.
Journal of obstetrics and gynaecology Canada, Jun 1, 2014
P art of the growing demand for assisted reproductive technologies (ART), including in vitro fert... more P art of the growing demand for assisted reproductive technologies (ART), including in vitro fertilization, intrauterine insemination, and ovulation induction, is related to delayed childbearing and the increasing proportion of obese reproductive-aged women with ovulatory dysfunction. 1 ART is associated with adverse health events in singleton pregnancies, including hypertensive disorders of pregnancy, preterm birth, low birth weight, and perinatal mortality. 2 It remains uncertain whether access to ART should be universal or based on selection criteria that consider risks to the woman and her offspring. In particular, obese women (BMI > 30 kg/m 2) experience more complicated pregnancies. 3 Nearly one quarter of the adult Canadian female population is obese, 4 and infertility in this subgroup is common. 1 We discuss here the medical and economic aspects of balancing the goals of assisting pregnancy and mitigating risk in obese infertile women.
Journal of obstetrics and gynaecology Canada, Dec 1, 2020
Pulmonary embolism (PE) complicates 5.4 per 10 000 pregnancies and remains a significant cause of... more Pulmonary embolism (PE) complicates 5.4 per 10 000 pregnancies and remains a significant cause of maternal mortality. Prompt diagnosis and treatment of PE are key to ensuring optimal outcomes, but are not without risks associated with over-testing. Given the paucity of evidence informing PE diagnosis in pregnancy, marked heterogeneity exists among different societies in their recommendations.
Aims We assessed the impact of Covid-19 on gestational diabetes rates in Quebec, the pandemic epi... more Aims We assessed the impact of Covid-19 on gestational diabetes rates in Quebec, the pandemic epicenter of Canada.
BackgroundTime‐related biases, such as immortal time and time‐window bias, frequently occur in ph... more BackgroundTime‐related biases, such as immortal time and time‐window bias, frequently occur in pharmacoepidemiologic research. However, the prevalence of these biases in perinatal pharmacoepidemiology is not well understood.ObjectiveTo describe the frequency of time‐related biases in observational studies of medications commonly used during pregnancy (antibiotic, antifungal, and antiemetic drugs) via systematic review.MethodWe searched Medline and EMBASE for observational studies published between January 2013 and September 2020 and examining the association between antibiotic, antifungal, or antiemetic drugs and adverse pregnancy outcomes, including spontaneous abortion, stillbirth, preterm delivery, small‐for‐gestational age, pre‐eclampsia, and gestational diabetes. The proportion of studies with time‐related biases was estimated overall and by type (immortal time bias, time‐window bias).ResultsOur systematic review included 20 studies (16 cohort studies, 3 nested case–control stu...
Circulation: Cardiovascular Quality and Outcomes, 2022
Background: Severe maternal morbidity is rising, yet the association with cardiovascular disease ... more Background: Severe maternal morbidity is rising, yet the association with cardiovascular disease is not clear. We examined the risk of cardiovascular hospitalization up to 3 decades after having a pregnancy complicated by severe maternal morbidity. Methods: We analyzed a longitudinal cohort of 1 336 846 women who were pregnant between 1989 and 2019 in Quebec, Canada. The main exposure measure was severe maternal morbidity in any pregnancy, including severe preeclampsia, acute renal failure, sepsis, and other life-threatening conditions. Using time-varying Cox regression models, we compared the adjusted risk of hospitalization for cardiovascular disease up to 3 decades after pregnancy for women with severe maternal morbidity relative to women without severe morbidity. Results: Five percent of women had severe maternal morbidity. Overall, there were 68 287 cardiovascular hospitalizations during 21 725 672 person-years of follow-up in the cohort. Compared with no morbidity, women with ...
Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disor... more Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). Attenuation of the normal nocturnal blood pressure (BP) decline (non-dipping) is associated with adverse pregnancy outcomes. OSAH is associated with nocturnal non-dipping in the general population, but this has not been studied in pregnancy. We therefore analyzed baseline data from an ongoing RCT (NCT03309826) assessing the impact of OSAH treatment on HDP outcomes, to evaluate the relationship of OSAH to 24-h BP profile, in particular nocturnal BP dipping, and measures of arterial stiffness. Methods: Women with a singleton pregnancy and HDP underwent level II polysomnography. Patients with OSAH (apnea-hypopnea index (AHI) ≥ 5 events/h) then underwent 24-h ambulatory BP monitoring and arterial stiffness measurements (applanation tonometry, SphygmoCor). Positive dipping was defined as nocturnal systolic blood pressure (SBP) dip ≥ 10%. The relationships between meas...
Fifty-eight women (DH¼30, C¼28) completed baseline and 3-month testing. At baseline there were no... more Fifty-eight women (DH¼30, C¼28) completed baseline and 3-month testing. At baseline there were no differences in hypertension (52%), fasting glucose impairment (29%), or smoking history (31%). However, DH women were younger than C (52 vs 59 years, p¼0.007), and had lower 10-year ASCVD risk scores (6.2AE5.1% vs 3.7AE3.7, p¼0.042). Upon LEARN program completion, mean weight loss (2.9AE4.1 kg), was similar in both groups (p¼0.773), and there was no change in SBP or ASCVD risk scores for either group. Lipid profile parameters showed favorable trends for both groups. A significant reduction was seen only for triglycerides in DH group (119AE40 at baseline vs 98AE26 at 3 months, p¼0.0009). Similarly, NMR lipoprofile analysis showed a significant reduction in large VLDL particles for DH group (5.3AE3.6 at baseline vs 3.4AE2.2 at 3 months, p¼0.0188). CONCLUSION: In women with ASCVD risk completing a 3 month LEARN program, Digital Health administration resulted in similar decreases in weight loss as traditional methods, but more favorable cardiometabolic results. This study demonstrates the feasibility and effectiveness of novel Digital Health methods for a weight loss program with immediate beneficial impact on weight loss and triglyceride levels.
Uploads
Papers by Natalie Dayan