Healthcare Utilization in Women With and Without Inflammatory Bowel Diseases From Preconception to Postpartum and Their Infants Up To Five Years of Life
Bibliographic record
Abstract
Women with inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes compared to those without IBD. Their infants may also be at risk of developing complications in early life due to genetic susceptibilities and in utero exposure to maternal inflammation. Understanding how women with IBD navigate the healthcare system during periods such as pregnancy, and their infants during the first few years of life, offers a unique opportunity to identify risk factors for adverse pregnancy and neonatal outcomes and disparities in access to high-quality ambulatory care. Furthermore, identifying these disparities in vulnerable populations such as new immigrants with IBD may lead to a clearer understanding of major health delivery problems. The availability of large healthcare administrative databases at ICES in Ontario, Canada allowed us the opportunity to achieve these goals. In Aim # 1, we found that compared to those without IBD, women with IBD were significantly more likely to visit the emergency department (ED) and be hospitalized during pregnancy and postpartum, particularly for venous thromboembolic reasons. Women with IBD were also more likely to receive adequate prenatal care. In Aim # 2, we found that recent immigrants (within 5 years of conception) with IBD had increased ambulatory and endoscopy visits during preconception and postpartum but were much less likely to receive adequate prenatal care. Those immigrating from the South Americas were the least likely to receive adequate prenatal care. In Aim # 3, we found that compared to those born to women without IBD, infants born to women with IBD had increased risk of hospitalizations, ED visits, and increased rates of mental health related ambulatory visits such as those for neurodevelopmental concerns in the first 5 years of life. There remains disparity in healthcare use between women with and without IBD from preconception to postpartum, and infants born to these women in the first few years of life. These thesis findings provide critical evidence for Canadian policymakers to further allocate resources towards the development of healthcare programs that aim to provide equitable, timely, and high-quality care to all women living with IBD during pregnancy, and their infants during the first few years of life.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".