Grant: Catalyst Gr: Disease Prev./Risk Factor Modification - Non-communicable diseases

In Canada, obese women, and women with pre-pregnancy diabetes, are each at higher risk of developing life-threatening conditions in pregnancy, or soon after birth -- what we call "severe maternal morbidity" (SMM). SMM offers a set of signals that a mother may be at high risk of dying. In screening for diabetes in women without diabetes, or for monitoring sugar control in women with existing diabetes, average blood sugar levels are measured using a test called "A1c." It is not known if an elevated A1c -- representing high average blood sugar -- can identify a woman at greater risk of SMM or death. Accordingly, the current study will use existing big healthcare data collected across all of Ontario. In our dataset, 25,000 births will have had an A1c before pregnancy, and 87,000 births an A1c done in pregnancy. We will determine if the preconception A1c, or early pregnancy A1c, are each associated with a higher risk of SMM or maternal death. This will be repeated among women from Sub-Saharan Africa and the Caribbean, two groups at especially high risk of SMM. We will also investigate whether a drop in A1c, from before pregnancy to that in early pregnancy, confers a lower risk of SMM or death. Working with national bodies in the fields of obstetrics and diabetes, we might adopt the use of a readily available and inexpensive blood test to identify a mother at high risk of SMM or death. Our research aims to save lives in susceptible women, including those of African and Caribbean heritage, to ensure a safe transition from pregnancy to a healthy motherhood.