Cohort Profile: The All Our Babies pregnancy cohort (AOB)

All Our Babies (AOB) is a community-based, longitudinal pregnancy cohort developed to investigate the relationships between the prenatal and early life periods and outcomes for infants, children and mothers. The design of AOB follows a life course perspective, whereby the influence of early events on long-term health and development of both mothers and children are investigated through examining factors across life stages.1 AOB spans pregnancy, birth and early postpartum through childhood, and therefore provides the unique opportunity to describe the relations between prenatal events and early life development and to examine key factors that influence child and mother well-being over time. AOB was originally designed to measure maternal and infant outcomes during the perinatal period, with a particular emphasis on barriers and facilitators to accessing health care services in Calgary, Alberta. Approximately 1 year after recruitment had started, an additional objective, to examine biological and environmental determinants of adverse birth outcomes, specifically spontaneous preterm birth, was added. Recognition of the opportunity to continue to collect relevant life course information on the AOB families, collaborations with content experts and securing additional funding has enabled ongoing follow-up of AOB mother-child dyads. The overall objective was to further investigate risk and protective factors for optimal child development, and to understand the trajectory and impact of poor maternal mental health over time. Mothers have completed questionnaires from pregnancy to 3 years postpartum, and consented to providing the research team with access to their obstetric medical records. Data collection for a 5-year follow-up questionnaire is ongoing. A subgroup within the cohort participated in the ‘prediction of preterm birth’ component and provided blood samples during pregnancy and an umbilical cord blood sample. The continuation of follow-up to 8 years is under way. A total of 3387 pregnant women (aged 19 to 47 years), residing in Calgary, Canada, were recruited between May 2008 and May 2011. Women were eligible if they were at less than 25 weeks of gestation at the time of recruitment, at least 18 years old, were accessing prenatal care in Calgary, Canada, and were able to complete written questionnaires in English. The AOB study was approved by the Conjoint Health Research Ethics Board at the University of Calgary (Ethics ID 20821 and 22821). Recruitment methods for the AOB study have been described previously.2,3 Briefly, a multi-method community-based recruitment strategy was developed involving active and passive recruitment strategies. Active recruitment occurred through a city-wide medical laboratory service where women undergoing prenatal viral serology testing were contacted by telephone by the laboratory staff, to request permission to release their contact information to AOB researchers. Women who consented were contacted to inform them of the study, determine eligibility, answer questions about the study and obtain informed consent. Using another active recruitment strategy, research staff were on site in primary health care waiting rooms to provide women with information about the study, assess eligibility and obtain informed consent. Passive recruitment occurred through posters advertising the study being displayed in places frequented by pregnant women, enabling them to self-identify to the study. Baseline questionnaire data were collected between 2008 and 2011. Table 1 describes the socio-demographic, pregnancy history, psychosocial health, delivery and birth outcomes of AOB participants. Participant characteristics EPDS, Edinburgh Postnatal Depression Scale; SSAI, Spielberger State Anxiety Inventory; PSS, Perceived Stress Scale; MOS-SSS, Medical Outcomes Study Social Support Survey. aN indicates the total sample with available data for each variable. bN = 3055 AOB participants, 36 of whom had twins, therefore total number of babies was 3091. Participant characteristics EPDS, Edinburgh Postnatal Depression Scale; SSAI, Spielberger State Anxiety Inventory; PSS, Perceived Stress Scale; MOS-SSS, Medical Outcomes Study Social Support Survey. aN indicates the total sample with available data for each variable. bN = 3055 AOB participants, 36 of whom had twins, therefore total number of babies was 3091. Socio-demographic data were unavailable for non-participating women. To assess the representativeness of the AOB sample, the socio-demographic characteristics of AOB participants at the time of recruitment were compared with those of parents of young children in Calgary, Alberta and Canada during the same period.4–6 A greater proportion of women in the AOB sample (82%) had annual household incomes > $60 000 compared with parenting women in Calgary (65%), Alberta (61%) and Canada (56%) (Figure 1). More AOB participants were married (83%) compared with parenting women in Calgary (73%), Alberta (70%) and Canada (60%) (Figure 1). The proportion of AOB participants who were at least 35 years old, who had completed post-secondary education and who were foreign born were similar to the proportions in Calgary, Alberta and Canada (Figure 1). Socio-demographic characteristics of women in AOB, Calgary, Alberta and Canada. Figure 2 shows the numbers of participants accrued and followed up to date. In total, 3387 women enrolled in the study and completed at least one questionnaire. Response rates for the first three questionnaires were 99%, 94% and 90%, respectively. Due to delays in securing funding and ethics approval processes, not all children were in the appropriate age range when each follow-up questionnaire was implemented. Among those eligible, response rates for the follow-up questionnaires were 81% at 1 year, 76% at 2 years and 69% at 3 years (Figure 2). AOB participant attrition from recruitment through three year follow-up. Participants who withdrew from the study (n = 938, 28%) included women who actively withdrew from the study, citing a loss of interest, time, comfort with the study or support from their partner, or declining to participate in follow-up research (n = 235, 7%). Participants who passively withdrew from the study included those lost to follow-up, geographical moves and unknown reasons (n = 669, 20%) and women who experienced a miscarriage, pregnancy termination, stillbirth or child death (n = 34, 1%) (Figure 2). Between 2009 and 2015, eligible AOB participants were asked to complete questionnaires when their child was 1, 2 and 3 years old (Figure 3). Data collection for the 5-year follow-up questionnaire began in 2013 and is ongoing; the 8-year follow-up is expected to begin in January 2017. AOB data collection timeline. The demographic characteristics of participants who have been retained in the AOB cohort compared with those who have discontinued are described in Table 2. Continuing participants were defined as those who completed at least one follow-up questionnaire when their child was 1, 2 or 3 years old. Discontinuing participants included those who actively withdrew from the study or those who were lost to follow-up (excluding pregnancy losses and child deaths). Continuing participants were more likely to be older, be in a stable relationship, have higher educational attainment, have higher family incomes, be born in Canada and primarily speak English in their home (Table 2). Comparison of demographic characteristics of continuing and discontinued participants aDenominator varies slightly due to missing data for some variables. Comparison of demographic characteristics of continuing and discontinued participants aDenominator varies slightly due to missing data for some variables. Figure 4 summarizes the broad categories of data collected in the AOB study, spanning pregnancy to 5 years postpartum. In order to understand trajectories of maternal psychosocial health and child development, attention has been paid to assessing the same constructs over time, using the same tools when appropriate. Future analyses, using longitudinal methods such as latent growth class analysis and path analysis, will be used to describe the course of maternal psychosocial health and child development over time. Constructs measured over time in the AOB study. Participants were asked to complete two questionnaires during pregnancy (at < 25 weeks and at 34–36 weeks of gestation) and one questionnaire at 4 months postpartum. Those who agreed to future contact were invited to complete follow-up questionnaires at 1, 2, 3 and 5 years postpartum. AOB questionnaires were developed in collaboration with researchers, health care providers, epidemiologists, decision makers and community programme experts. These questionnaires include standardized measures when available and questions created specifically for the study when standardized measures were not suitable. The first two questionnaires administered during pregnancy collected maternal data only, including socio-demographics, preconception history, pregnancy history, pregnancy experiences, access to prenatal care, health service utilization, psychosocial health, lifestyle and history of mental health disorders, and stressful life events. The third questionnaire, administered at 4 months postpartum, collected maternal and child data including questions about labour and delivery, birth outcomes, breastfeeding, child health, maternal mental health, lifestyle, parenting and the child care environment. The four follow-up questionnaires, administered when the AOB target child was 1, 2, 3 and 5 years old, collected maternal and child data including maternal physical and mental health, health care utilization, parenting, family well-being, childcare environment, community resource use, child health and child development. A detailed list of the data collected, including the measure used if applicable, as part of each questionnaire is provided in Table 3. Variables collected in all questionnaires X refers to investigator-derived variables. The full versions of standardized measures were used, unless the number of items used for a modified version of a measure is noted. SF-12, Short Form Health Survey-12; MCH Feeding Scale, Montreal Children’s Hospital Feeding Scale; GLTE, Godin Leisure-Time Exercise Questionnaire; EPD, Edinburgh Postnatal Depression Scale; CES-D, Center for Epidemiologic Studies Depression Scale; SSAI, Spielberger State Anxiety Inventory; STAI, Spielberger Trait Anxiety Inventory; PSS, Perceived Stress Scale; MOS SSS, Medical Outcomes Study Social Support Survey; NLSCY SSS, National Longitudinal Survey of Children and Youth Social Support Scale; LOT-R, Life Orientation Test – Revised; ECR (short form), Experiences in Close Relationships Scale (short form); ACEs, Adverse Childhood Experiences Checklist; NutriSTEP, Nutrition Screening Tool for Every Preschooler; ASQ, Ages and Stages Questionnaire; CDI Words and Gestures, MacArthur-Bates Communicative Development Inventories: Words and Gestures; CDI Words and Sentences, MacArthur-Bates Communicative Development Inventories: Words and Sentences; CCC-2, Child Communication Checklist-2; CBQ-SF, Rothbart Child Temperament Scale; BITSEA, Brief Infant Toddler Social Emotional Assessment; NLSCY CBCL, National Longitudinal Survey of Children and Youth Child Behaviour Checklist; BASC, Behaviour Assessment System for Children; M-CHAT, Modified Checklist for Autism in Toddlers; PMI, Parenting Morale Index; BPCIS, Brigance Parent Child Interaction Scale; PACOTIS, Parental Cognitions and Conduct Toward the Infant Scale - Parental Hostile-Reactive Behaviors subscale; NLSCY Parenting Scales, National Longitudinal Survey of Children and Youth Parenting Scales; PACOTIS Parental Self-Efficacy subscale, Parental Cognitions and Conduct Toward the Infant Scales - Parental Self-Efficacy subscale; MSAS, Maternal Separation Anxiety Scale; DAS, Dyadic Adjustment Scale; PRBI, Parent Reading Belief Inventory. Variables collected in all questionnaires X refers to investigator-derived variables. The full versions of standardized measures were used, unless the number of items used for a modified version of a measure is noted. SF-12, Short Form Health Survey-12; MCH Feeding Scale, Montreal Children’s Hospital Feeding Scale; GLTE, Godin Leisure-Time Exercise Questionnaire; EPD, Edinburgh Postnatal Depression Scale; CES-D, Center for Epidemiologic Studies Depression Scale; SSAI, Spielberger State Anxiety Inventory; STAI, Spielberger Trait Anxiety Inventory; PSS, Perceived Stress Scale; MOS SSS, Medical Outcomes Study Social Support Survey; NLSCY SSS, National Longitudinal Survey of Children and Youth Social Support Scale; LOT-R, Life Orientation Test – Revised; ECR (short form), Experiences in Close Relationships Scale (short form); ACEs, Adverse Childhood Experiences Checklist; NutriSTEP, Nutrition Screening Tool for Every Preschooler; ASQ, Ages and Stages Questionnaire; CDI Words and Gestures, MacArthur-Bates Communicative Development Inventories: Words and Gestures; CDI Words and Sentences, MacArthur-Bates Communicative Development Inventories: Words and Sentences; CCC-2, Child Communication Checklist-2; CBQ-SF, Rothbart Child Temperament Scale; BITSEA, Brief Infant Toddler Social Emotional Assessment; NLSCY CBCL, National Longitudinal Survey of Children and Youth Child Behaviour Checklist; BASC, Behaviour Assessment System for Children; M-CHAT, Modified Checklist for Autism in Toddlers; PMI, Parenting Morale Index; BPCIS, Brigance Parent Child Interaction Scale; PACOTIS, Parental Cognitions and Conduct Toward the Infant Scale - Parental Hostile-Reactive Behaviors subscale; NLSCY Parenting Scales, National Longitudinal Survey of Children and Youth Parenting Scales; PACOTIS Parental Self-Efficacy subscale, Parental Cognitions and Conduct Toward the Infant Scales - Parental Self-Efficacy subscale; MSAS, Maternal Separation Anxiety Scale; DAS, Dyadic Adjustment Scale; PRBI, Parent Reading Belief Inventory. Obstetric and birth data were obtained through data linkages to mothers’ and children’s prenatal and birth medical records from the Alberta Health electronic database, and have been previously described.2,3 The medical records contributed obstetric and birth data not captured in the questionnaires (e.g. pregnancy complications, antepartum risk score, Apgar score etc.) and some data elements that were also collected in the 4-month postpartum questionnaire (type of delivery, gestational age, birthweight etc.). A validation study comparing the two sources found maternal recall of infant characteristics and labour and delivery outcomes was valid (sensitivity and specificity > 85%).7 Both versions of these common data elements have been retained in the dataset, providing the option to utilize either source depending on the research question and analysis being conducted. Maternal blood at 17–23 and 27–33 weeks of gestation and umbilical cord blood, when retrievable, was collected at birth for participants in the ‘prediction of preterm birth’ group (n = 1871). Maternal blood samples were collected into PAXgene™ tubes (PreAnalytix/BD Canada, Mississauga, ON, Canada) for RNA extraction, EDTA tubes for DNA extraction, a heparin tube to isolate plasma and a serum collection tube. Umbilical cord blood (3–5 ml) is routinely collected at all hospital births to establish red blood cell antigens. The research team accessed the unused portion of these umbilical cord blood samples from consenting participants and them to study All samples have been at The biological collection and provide blood, plasma and serum samples from and be and RNA and DNA be for total RNA has been and has been on maternal blood samples by the for Hospital for ON, Data were into the National Center for A subgroup of AOB participants (n = who the questionnaire between 18 2009 and were asked about their of the and during the year, the Health had the of the a A questionnaire, created specifically for study, was to eligible participants with the AOB questionnaire. were asked about of the and of of both of of of and they had time due to during their A was to understand the impact of that occurred in Calgary, in 2013 on and their and to a of being of over 000 and across the All AOB participants who were in Calgary at the time and who agreed to be contacted for additional research were a impact questionnaire in the of The questionnaire asked women about their during the and provided and such as and Participants who not a questionnaire were asked to answer three questions from the impact questionnaire by telephone or In total, women participated in the impact study, of whom participants completed the questionnaire and participants to the three questions by telephone or A subgroup of AOB participants mother-child have been recruited to participate in a study early of describes a to and the of and is one of the and of In were in during a laboratory on measures of using the Test of and on and using the of and the and Scale of were administered to the to Data were collected from mothers on and environmental home and maternal and as part of the AOB are ongoing. A complete list of from AOB be found at to have been by 1 1 blood and factors were with spontaneous preterm birth in women. data and data in a in the of with and specificity in women. Anxiety during pregnancy with psychosocial risk of preterm birth weeks of gestation) when for medical and lifestyle A of data collected from maternal on 4-month postpartum questionnaires and medical records that maternal of delivery and birth is valid (sensitivity and specificity > A total of of children experienced development at 1 year of preterm birth, postpartum community and less were as risk factors for development at age 1 In of children were with a at age 2 factors included and a family history of factors included providing and and care at a child care The of during pregnancy in the or third was of women experienced on at least one during defined as during both the and third occurred for less than of women. was experienced by of women. factors for included history of poor mental health, poor physical health, pregnancy and factors for included history of poor mental health, support and women will with and early and of mental health of women some during pregnancy, including they they were to pregnancy of women at least one of defined as or more on one pregnancy of women some all at to factors for in early pregnancy included educational attainment, pregnancy, in the year pregnancy, in the year pregnancy and is defined as a that more than will in the of after pregnancy included pregnancy, < in the year pregnancy and in the year risk factors were pregnancy and pregnancy and with blood and factors were with spontaneous preterm birth in and with were in women with compared with women who had In women with had RNA RNA and cell compared with women who had factors with included during pregnancy, history of preterm birth, history of during pregnancy and during A data and data was found to with and specificity in psychosocial as the of during pregnancy on the State Anxiety and at least one history of mental health history of or their was a risk for preterm birth weeks of for medical and lifestyle is with and with the of psychosocial was an risk for preterm birth weeks of gestation) women with of either support or not women with higher of these These that a history of psychosocial with in pregnancy the risk for preterm The proportion of children with development at 1 year of age, defined as in the on at least two of the of the Ages and Stages was risk factors for development at 1 year included maternal prenatal preterm birth, community and Child development be by poor maternal mental and of the Among children with these protective factors for include higher parenting higher community and child These that such as those at mental health, support parenting of community and parents to in and with their influence child development at 1 preterm to 36 weeks of gestation) were more likely to risk of in and on the at months compared with weeks of age was used for preterm Both preterm and who care were at greater risk of compared with who were not after for maternal and infant These preterm and to care be used to at risk of at 1 of risk provides an opportunity for and to early The of as < on the MacArthur-Bates Communicative Development Inventories: Words and in between and months of age was factors for included and a family history of or protective factors included providing and and care at a child care as compared with of care were not The protective factors in study describe for with a of to risk for early of the All Our Babies (AOB) study include the recruitment and of a community-based pregnancy cohort with lifestyle and biological data spanning pregnancy to early The AOB study used standardized measures or for the of including those to mental health and child development. data collection on and in to data provides the opportunity to from an the of factors on child development and maternal mental The longitudinal with early follow-up, the of to inform and The representativeness of the sample in of and is a the AOB pregnancy cohort is with the of Health and a of research that environmental factors with to the of an being to and to across the life The collection of biological and environmental data from women during the prenatal and early postpartum provides the opportunity to longitudinal research that early as on risk for and AOB of including the and a providing data that be to To the AOB study is the pregnancy cohort of with such prenatal data to lifestyle, maternal mental health, health service utilization, community child care and with collection of child development measures over time. A of study is the of measures to psychosocial health and child development outcomes as an to or from the outcomes are on standardized tools and on mental health and child development the for be when the rates of mental health and are in with the of is AOB and has retained women and those with higher incomes and who are to those maternal age, and be with additional was the collection of maternal and child data data have been collected from to examine to child development outcomes as The participant questionnaires were detailed and to the collection of socio-demographic, health, and child on participants completed the questionnaires in the emphasis on child development in questionnaires, time for in follow-up as is that participant during questionnaire have contributed to attrition across time for some women. have been to participants over time, that the longitudinal design and to of funding and development of follow-up questionnaires has on study attrition over time and be a source of for the follow-up questionnaires at 1, 2 and 3 The in the demographic characteristics of continuing participants maternal age, stable relationship, higher higher compared with discontinued participants be into when the The All Our Babies questionnaire and medical data are at for a data by the Alberta for and for data and collaborations are Those in collaborations contact at the University of Calgary at further access study at in a AOB is a community-based longitudinal pregnancy cohort of mother-child birth and child development A total of 3387 pregnant women (aged 19 to 47 years), residing in Calgary, Canada, enrolled and completed at least one questionnaire between May 2008 and May 2011. The were had annual household incomes > $60 000 and were born in Canada. Mothers have completed questionnaires spanning pregnancy to 3 years postpartum and provided access to their medical records. A subgroup of participants provided two maternal blood samples during pregnancy and an umbilical cord blood sample at mother-child eligible for future follow-up. The AOB psychosocial data spanning pregnancy to 3 years postpartum, to medical records and maternal and umbilical cord blood samples for a subgroup of the 5-year follow-up questionnaire data will be and an 8-year follow-up is for data and collaborations are Those in collaborations contact at the University of Calgary at funding to investigate maternal and infant outcomes during the perinatal was provided by for the Alberta Health of the to include collection of biological to determinants of adverse birth outcomes, was by Alberta Health and the to and collaborations on the trajectories of AOB children have been by including the Social and Research Alberta Health the Alberta Children’s Hospital the Alberta for and the of Calgary, Women and Children’s Health Research the for Research and the The the and support of AOB team and participants. are to all the who part in study and the All Our Babies are to the research and staff and of

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