Bibliographic record
Abstract
This thesis uses administrative health data to examine temporal trends in postpartum opioid prescribing in Ontario, Canada, as well as the maternal and neonatal risks associated with maternal postpartum opioid therapy. In the first study, I conducted a cross-sectional time series analysis examining whether a highly-publicized 2006 case report questioning the safety of codeine during lactation was associated with changes in postpartum opioid prescribing. I found that postpartum opioid prescribing changed significantly in Ontario following publication of the case report and subsequent safety warnings, including a 30% relative decline in opioid initiation, a reduction in the proportion of prescriptions issued for codeine, and significant increases in the prescribing of more potent opioids. In the second study, I examined whether initiation of oxycodone following delivery was associated with an increased risk of persistent maternal opioid use relative to initiation of codeine. I found that 2.1% of postpartum women had evidence of new persistent opioid use in the year after delivery and compared to women who filled an initial prescription for codeine, receipt of oxycodone was not associated with persistent opioid use (RR 1.04; 95% CI 0.91 to 1.20). In subgroup analyses, I found an association between a prescription of oxycodone and persistent use relative to codeine after vaginal delivery (RR 1.63; 95% CI 1.31 to 2.03), but not after cesarean delivery (RR 0.85; 95% CI 0.73 to 1.00). In the third study, I examined whether postpartum maternal opioid therapy was associated with an increased risk of adverse neonatal outcomes. I found that children born to mothers who filled an opioid prescription were no more likely to be hospitalized for any reason compared to children born to mothers who did not (HR 0.98; 95% CI 0.93 to 1.03). The studies that comprise this thesis found substantial shifts in the types of opioids prescribed to postpartum women temporally associated with a faulty narrative regarding the dangers of codeine during lactation. In addition, our findings help clarify that providers should emphasize the potential risks of postpartum opioid use as they relate to mothers, rather than their infants.
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.008 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".