ObjectivesAn obstetric comorbidity index has been developed recently with superior performance characteristics relative to general comorbidity measures in an obstetric population. This study aimed to externally validate this index and to examine the impact of including hospitalisation/delivery records only when estimating comorbidity prevalence and discriminative performance of the obstetric comorbidity index.DesignValidation study.SettingAlberta, Canada.PopulationPregnant women who delivered a live or stillborn infant in hospital (n = 5995).MethodsAdministrative databases were linked to create a population‐based cohort. Comorbid conditions were identified from diagnoses for the delivery hospitalisation, all hospitalisations and all healthcare contacts (i.e. hospitalisations, emergency room visits and physician visits) that occurred during pregnancy and 3 months pre‐conception. Logistic regression was used to test the discriminative performance of the comorbidity index.Main outcome measuresMaternal end‐organ damage and extended length of stay for delivery.ResultsAlthough prevalence estimates for comorbid conditions were consistently lower in delivery records and hospitalisation data than in data for all healthcare contacts, the discriminative performance of the comorbidity index was constant for maternal end‐organ damage [all healthcare contacts area under the receiver operating characteristic curve (AUC) = 0.70; hospitalisation data AUC = 0.67; delivery data AUC = 0.65] and extended length of stay for delivery (all healthcare contacts AUC = 0.60; hospitalisation data AUC = 0.58; delivery data AUC = 0.58).ConclusionsThe obstetric comorbidity index shows similar performance characteristics in an external population and is a valid measure of comorbidity in an obstetric population. Furthermore, the discriminative performance of the comorbidity index was similar for comorbidities ascertained at the time of delivery, in hospitalisation data or through all healthcare contacts.

BACKGROUND: Asthma can usually be controlled through allergen avoidance and/or appropriate medication. An emergency department visit for an acute exacerbation of asthma often represents a breakdown in asthma management. Emergency department treatment results in significant health care expenditures and reflects a compromised quality of life. OBJECTIVES: To identify risk factors associated with an emergency department visit for asthma. METHODS: This case-control study compared 299 people (76% of 390 cases contacted) who attended one of two emergency departments in Alberta in 1992 and 1993 for an acute exacerbation of asthma (cases) with 212 unmatched community controls with asthma who were located by random digit dialing. Cases and controls were asked to complete a mailed questionnaire to obtain data regarding severity, visits to doc-

Improved health outcomes occur with increased gestational age. Infants with BWT less than 1250 g born to women with HELLP syndrome were not at risk of increased neurodevelopmental disability compared to controls.

Background A significant association was found between cesarean section (CS) and obesity at adulthood in our previous study. Objective To assess the association between CS and obesity in schoolchildren. Methods We carried out two birth cohorts in Brazil: in Ribeirao Preto (RP) in 1994 and in São Luís (SL) in 1997. 2846 pairs of mothers-newborns were evaluated in RP and 2542 pairs in SL. Birth length and weight and variables were collected after delivery: gender, gestational age, type of delivery, maternal schooling and smoking. In 2004/2005 a random sample were reassessed with anthropometric measurements: 790 children aged 10-11 years in RP and 673 children aged 7-9 years in SL. The outcomes were BMI in Z score and obesity (>95 th percentile per age). A logistic model was used to investigate the association between CS and obesity. A multiple regression model was applied to investigate the association between CS and BMI. Results Obesity rate was 13% in RP and 2.0% in SL. In the logistic regression, the association between CS and obesity remained significant after adjustment only in RP [1.72 (CI95% 1.01-2.92)]. The linear coefficient after adjustment the association were 0.31 (95%CI 0.11-0.51) in SL and 0.25 (95%CI 0.05-0.46) in RP. Conclusion Cesarean section was associated to increased BMI in both cities, as previously found in adults. CS remained associated with obesity only in RP. We reinforce the previous hypothesis that intestinal flora related to type of delivery may play a role in the epidemic of obesity worldwide. Background and Aims To describe maternal perceptions of their child's BMI and maternal report of concerns about body weight raised by a health professional. Methods Data collection took place in 2010 when children were between 6 and 8 years of age and questionnaires were mailed to 706 mothers who were part of a longitudinal cohort that had been followed since pregnancy. Mothers reported the child's anthropometric measures, and BMI was categorized as underweight, healthy, overweight, or obese based on the child's age and sex according to the World Health Organization Growth Charts adapted for Canada. Results 450 participants completed the questionnaire (response rate 64%). 74% of children had a healthy BMI, 10% were underweight, 9% were overweight, and 7% were obese. 80% of parents whose child was underweight believed their child was about the right weight and only 13% recalled a health professional recently raising concerns about their child being underweight. 89% of parents whose child was overweight believed their child was about the right weight and only 6% recalled a health professional recently raising concerns about their child being overweight. 62% of parents whose children were obese believed their child was about the right weight and only 18% recalled a health professional recently raising concerns about their child being overweight. Conclusions The majority of parents whose children were not a healthy BMI misclassified their child's weight status, suggesting that there are opportunitie...

Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data metaanalysis. PLoS Med 16(2): e1002744.