Data Analysis for Annual Report 2014-2016 December 2016 Disclaimer - - PowerPoint PPT Presentation

Data Analysis for Annual Report 2014-2016

December 2016

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Disclaimer

– Although significant effort has been made to ensure the accuracy of the information presented in this report, neither the authors nor BORN Ontario nor any other parties make any representation or warranties as to the accuracy, reliability or completeness of the information contained herein. – We may inaccurately estimate some indications including maternal health conditions due to incomplete data entry in a few hospitals prior to this report

• completion. Since LHIN of birth or residence were identified by postal codes,

there may be an issue of inaccuracy. – Permission is granted for the reproduction of these materials solely for non- commercial and educational purposes. Suggested citation: Better Outcomes Registry & Network (BORN) Ontario Annual Report 2014-2015 and 2015-2016. Ottawa, Ontario, 2016.

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Pregnancy Information

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Distribution of Conception Type

(Ontario, 2014-2015 to 2015-2016)

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Distribution of conception type, expressed as a percentage of the total number of women conceived from spontaneous conception or assisted reproductive technology (ART). Data analysis was based on aggregate pregnancy data in BORN Information System (BIS). 5.7% of records were excluded for missing data.

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Invitro Fertilization Treatments and Outcomes for Fresh Embryo Transfer Cycles

(Ontario cycles using own oocytes, 2014 – 2015)

11,252 10,596 6,514 2,376 2,190 1,851

2,000 4,000 6,000 8,000 10,000 12,000 14,000 Cycle starts (CS) Oocyte retrieval cycles (RET) Embryo transfer cycles (ET) Clinical pregnancies* Ongoing clinical pregnancies† Singleton pregnancies‡

656 cancelled: 5.8% per CS 19.5% per CS 20.7% per RET 33.6% per ET 16.5% per CS 17.5% per RET 28.4% per ET 21.1% per CS 22.4% per RET 36.5% per ET

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound ‡ Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

4,082 no ET: 38.5% per RET

84.5% of ongoing clinical pregnancies

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Invitro Fertilization Treatments and Outcomes for Frozen Embryo Transfer Cycles

(Ontario cycles using own oocytes, 2014 – 2015)

7,720 7,583 2,907 2,624 2,310

2,000 4,000 6,000 8,000 10,000 Embryo thaw cycles Embryo transfer cycles (ET) Clinical pregnancies* Ongoing clinical pregnancies† Singleton pregnancies‡

37.7% per thaw 38.3% per ET

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound ‡ Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

34.0% per thaw 34.6% per ET 29.9% per thaw 30.5% per ET 137 no ET: 1.8% per thaw

88.0% of ongoing clinical pregnancies

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Prenatal Screening Rates by LHIN of Residence

(Ontario, 2012-2013 to 2015-2016)

Prenatal screening rates are calculated using all available live births, still births, termination and pregnancy loss data in the BIS. However, not all terminations or pregnancy losses are captured completely in this data.

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Prenatal Screening Rates by LHIN of Residence

(Ontario, 2014-2016)

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Pre-Pregnancy Maternal Body Mass Index (BMI) and Giving Birth to an LGA Baby

(BORN Ontario, 2014-2015 to 2015-2016)

In 2014-2016, 17.6 % of women whose pre- pregnancy BMI was classified as obese gave birth to a large-for-gestational-age baby (a birth weight for sex and gestational age above the 90th percentile). Only 3.9% and 7.4% of women with underweight and normal weight pre-pregnancy BMI’s gave birth to large-for- gestational-age babies, respectively.

Did you know?

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Large-for-gestational-age (LGA) is defined as a birth weight (BW) greater than the 90th percentile for that gestational age (taking into account sex). Women giving birth singletons were included. BMI categories were defined as underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (30.0+ kg/m2).

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Maternal Pre-Pregnancy Body Mass Index (BMI) by Fiscal Year

(Ontario, 2012-2013 to 2015-2016)

Data source: BORN Ontario, 2012-2013 to 2015-2016 Definition of indicator: Trend of distribution of BMI categories, expressed as a percentage of the total number of women who had a live birth or still birth in each BMI category by fiscal year. BMI categories were defined according to the World Health Organization (WHO) Guidelines as: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (30.0+ kg/m2).

18.3% of records were excluded due to missing data.

Did you know?

In the latest year, in total, 42.1%

• f women were considered
• verweight or obese coming

into pregnancy.

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Mean Gestational Weight Gain (Kg) by Pre-pregnancy Maternal Body Mass (BMI) Categories

(Ontario, 2012-2013 to 2015-2016

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Mean gestational weight gain (Kg) by pre-pregnancy BMI Categories, expressed as average (mean ) gestational weight gain (Kg) among BMI categories. BMI categories were defined according to the World Health Organization (WHO) Guidelines as: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (30.0+ kg/m2).

27.9 % of records were excluded for missing data.

Recommended Range

• f Weight Gain

Underweight: 12.5-18 Kg Normal weight: 11.5-16 kg Overweight: 7-11.5 kg Obese: 5-9 kg

Reference: Institute of Medicine Weight Gain Recommendations for Pregnancy (2009).

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Rates of Anxiety and Depression among Pregnant Women

(Ontario, 2014-2015 to 2015-2016)

Data source: BORN Ontario, 2012-2013 to 2015-2016 Definition of indicator: Rates of anxiety and depression, expressed as a percentage of women who reported anxiety or depression in mental health concerns during pregnancy by fiscal year. These two categories are not mutually exclusive. Mental health screening will be added in Ontario Perinatal Record in 2017.

Did you know?

5.7% of records were excluded for missing data.

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Distribution of Diabetes by Maternal Age

(Ontario, 2014-2015 to 2015-2016)

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Distributions of type II diabetes and gestational diabetes , expressed as a percentage of the total number of women who had type II diabetes and a percentage of the total number of women who had gestational diabetes . 0.6% of women in all age groups had type II diabetes 6.2% of women in all age groups had gestational diabetes

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Distribution of Hypertension by Maternal Age

Ontario, 2014-2015 to 2015-2016

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Distributions of pre-existing and gestational hypertension, expressed as a percentage of the total number of women who had pre-existing hypertension and a percentage of the total number of women who had gestational hypertension by age categories. 0.9% of women in all age groups had pre-existing hypertension 3.5% of women in all age groups had gestational hypertension

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BIRTH

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Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Distribution of maternal age categories, expressed as a percentage of the total number of women who had a live birth or still birth.

Distribution of Maternal Age at Birth

(Ontario, 2014-2015 to 2015-2016)

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Proportion of Women ≥ 35 years, by Parity

(Ontario, 2012-2013 to 2015-2016)

Data source: BORN Ontario, 2012-2013 to 2015-2016 Definition of indicator: Trend of distribution of maternal age categories, expressed as a percentage of the total number of women who had a live birth or still birth by fiscal years. 1.45% of records were excluded for missing data

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Distribution of Parity

(Ontario, 2014-2015 to 2015-2016)

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Distribution of parity, expressed as a percentage of the total number of women who had a live birth or stillbirth greater than or equal to 20 weeks’ gestation. Parity is defined as the number of previous live births or stillbirths (0, 1, 2, 3+), excluding the current pregnancy. 1.2% of records were excluded for missing data.

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Birth Volume in Hospitals by LHIN

(Ontario, 2015-2016)

Birth Volume in hospitals (Fiscal year 2015 – 2016)

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Number of Births by LHIN of Maternal Residence

(Ontario 2014-2015 to 2015-2016)

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Total number of live and stillbirths in Ontario by LHIN of residence.

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Number of Births by LHIN

(Ontario 2015-2016)

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Distribution of Type of Birth by LHIN

(Ontario, 2014-2015 to 2015-2016)

Data Source: BORN Ontario, 2014-2015 to 2015 -2016 Definition of Indicator: Distribution of type of birth by LHIN, expressed as a percentage of the total number of women who had a live birth or still birth.

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Induction Rate by LHIN among Low Risk Women

(Ontario, 2014-2015 to 2015-2016)

Definition of low risk women: hospital birth, nulliparous , full term (between 37 and 42 weeks of gestational age), singleton, live birth, cephalic presentation, without or minor complications of pregnancy, without or minor pre - existing maternal health conditions , no diabetes in pregnancy and no hypertension disorder in pregnancy and age at 35 years old or under.

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Cesarean Section Rate by LHIN among Low Risk Women

(Ontario, 2014-2015 to 2015-2016 )

Definition of low risk women: Hospital birth, nulliparous , full term (between 37 and 42 weeks of gestational age), singleton, live birth, cephalic presentation, without or minor complications of pregnancy, without or minor pre-existing maternal health conditions , no diabetes in pregnancy and no hypertension disorder in pregnancy and age at 35 years old or under.

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Rate of Attempted VBAC Among Eligible Women with 1-2 Previous Cesarean Sections, by LHIN

(Ontario, 2014-2015 to 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Rate of attempt by eligible women, expressed as a percentage of women with 1-2

previous cesarean sections who attempted a trial of labor. We excluded: 1. Women without previous CS; 2. Previous uterine rupture; 3. Women declined TOL with planned scheduled repeated CS; 4. Women with placenta previa or placenta abruption or mal-presentation; 5. Not eligible for VBAC is clearly identified in dataset

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Successful VBAC Rate by LHIN in Eligible Women with 1-2 Previous Cesarean Sections

Ontario 2014-2015 and 2015-2016

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Successful vaginal birth after attempted trial of labour following 1-2 previous cesarean sections among all women who attempted VBAC 2.1% of records were excluded for missing data

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The proportion of Women in Ontario with a Caesarean Section Performed from ≥ 37 to < 39 weeks’ Gestation among Low-risk Women having a Repeat Caesarean Section at Term

(Ontario, April 2014 to March 2016, by quarter)

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Distribution of Delivery Type for Singletons and Twins or Higher Order Multiples

(Ontario, 2014 – 2015 to 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Distribution of delivery type by singletons and twins or higher

• rder multiples, expressed as a percentage of the total number of women who delivered

live and still births.

Did you know?

In 2013-2014 to 2015-2016, 3.4% of live

• r stillborn infants in Ontario were twins
• r higher order multiples. The rate was

slightly decreased from 3.7% in 2012- 2014. The numbers of infants from a multiple gestation pregnancy has been steadily decreasing : 5,263 in 2012/13, 5,185 in 2013/14, 4,784 in 2014/15, 4,730 in 2015/16. We excluded birth records with pregnancy outcome of termination and/or gestational age at birth < 20 weeks.

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Distribution of Gestational Age at Birth for Singletons and Twins or Higher Order Multiples

(Ontario, 2014 - 2015 to 2015 -2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Distribution of gestational age at birth in weeks, expressed separately for singletons and twins or higher order multiples from gestation pregnancies as a percentage of the total number of infants with live and still births.

Did you know?

In 2013-2014 to 2015-2016, 92.3%

• f live births in Ontario occurred at

≥ 37 weeks’ gestation. This rate increased slightly from 92.0% in 2012-2013 to 2013-2014.

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Distribution of Delivery Types by BMI Categories

(Ontario, 2014 – 2015 to 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Distribution of delivery types by BMI categories, expressed as a percentage of the total number of women in each BMI category. BMI categories were defined according to the World Health Organization (WHO) Guidelines as: underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (30.0+ kg/m2).

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Distribution of Health Care Provider Attending Births

(Ontario, 2014-2015 to 2015-2016)

In 2014-2016, obstetricians attended the births

• f almost 80% of Ontario women; this rate

decreased slightly compared with 81.7% in 2012–2014. The proportion of births attended by a midwife has steadily increased to 10.1% from 8.9% in 2012–2014.

Did you know?

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Distribution of type of health care provider who attended the birth, expressed as a percentage of the total number of women who gave birth. The calculation was based on the element of ‘health care provider who caught baby’, not the element of ‘billable course of care midwifery’ in BORN data.

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Babies

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Breastfeeding Initiation- Supplementation Rate with No Medical Indications by LHIN

(Ontario, 2014-2015 to 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: The overall supplementation rate was expressed as the percentage of breastfed infants who received at least one feed other than human milk (human milk substitute, water, or other fluids with the exception of medications, or vitamins or mineral drops) in the hospital without any documented medical reason(s) among all live births by the index hospital LHIN

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Breastfeeding Initiation- Supplementation Rate with Medical Indications by LHIN

(Ontario, 2014-2015 to 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: The supplementation rate with medical indications was expressed as the percentage of breastfed infants who received at least one feed other than human milk (human milk substitute, water, or other fluids with the exception of medications, or vitamins or mineral drops) in the hospital with documented medical reason(s) among all live births by the index hospital LHIN

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Breastfeeding Initiation-Overall Supplementation Rates by LHIN (Ontario 2014-2015, 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: The overall supplementation rate was expressed as the percentage of breastfed infants who received at least one feed other than human milk (human milk substitute, water, or other fluids with the exception of medications, or vitamins or mineral drops) in the hospital with or without any documented medical reason(s) among all live births by the index hospital LHIN or in Ontario. Overall rate is the sum of supplementation rate with medical indications and supplementation rate without medical indications.

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Pain Relief Measures used During Newborn Screening or Bilirubin Sampling

(Ontario 2014-2015, 2015-2016)

Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Pain relief measures used during newborn screening or bilirubin sampling is expressed as a percentage of newborn babies receiving any one or more pain relief measures among all newborn babies undergoing newborn screening or bilirubin sampling. The categories of breastfeeding, skin to skin, sucrose and other pain relief measures are not mutually exclusive. The rates in this graph reflect out of all the pain relief measures used how often was a specific measure used. Therefore, data from a single child could be counted in more than one measure.

Did you know?

Blood sampling for newborn screening and bilirubin testing causes pain, distress and physiological changes in babies. Repeated painful procedures put infants at increased risk of long-term developmental

• delays. Breastfeeding, holding babies skin-to-skin,
• r giving a few drops of sugar water (sucrose),

reduces procedural pain and is recommended during painful procedures. In 2014-2016, only 62.9% of babies received pain relief via these measures. No pain relief measures were used for 30.4% of newborns and there is still about 30% of records with missing data for this important variable. Types of pain relief used No pain relief measures used

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Proportion of Infants Born at < 32 Weeks Gestation Outside of a Level 3 Facility

(Ontario, 2012-2013 to 2015-2016)

About 35.3% of infants born less than 32 weeks gestation in Ontario were born

• utside of a level 3 facility in 2012. In

2013, the rates dropped to 33.6% and 33.4% in 2013- 2014 and 2014 – 2015 respectively, and then increased again slightly to 35.3% in 2015-2016.

Did you know?

Data source: BORN Ontario, 2012-2013 to 2015-2016 Definition of indicator: Proportion of infants born at less than 32 weeks gestation outside of a level 3 facility by fiscal year, among all infants born less than 32 weeks gestation by fiscal year 2012-2013 to 2015 to 2016. Hospital birth, live birth and Ontario residents were included.