Grant: Operating Grant

We have previously carried out research that has been instrumental in advancing knowledge related to the health of mothers and babies. We propose to use this knowledge to further expand clinical understanding and improve outcomes related to a) Fetal growth: There has been a large reduction in babies born abnormally small in recent decades. We hypothesize that this improvement followed increased early delivery by obstetricians of pregnancies with complications. b) Breathing difficulties: There are 2 age peaks in the frequency of breathing difficulties among newborns and this suggests that 2 distinct diseases are involved. c) Timing of delivery: Currently, the optimal time to deliver a baby is determined by minimizing the risk of stillbirth and the risk of infant death. However, this method needs refinement as it does not address serious illness in the newborn baby. d) The effects of recent policies regarding the timing of labour induction and cesarean delivery have not been adequately studied. Methods We propose to address these issues with studies using data from perinatal databases in British Columbia, Canada and the United States. Studies on fetal growth will use the Kitagawa decomposition method, which will quantify improvements in fetal growth due to earlier delivery vs that due to reductions in maternal smoking, etc. Methods for determining the optimal timing of delivery will integrate serious illnesses among newborns into the risk-benefit equation. We will attempt to show that babies with breathing problems at 34-36 weeks have a different disease from those with breathing problems at 42 weeks. Studies will also quantify the effect of policies on timing of induction and cesarean delivery. Significance Our research will improve the health of mothers and babies by increasing knowledge of fetal growth, by optimizing timing of delivery in complicated pregnancies and by individualizing care of babies with breathing problems.