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

Data Analysis for Annual Report 2014-2016 December 2016

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. 2

Pregnancy Information 3

Distribution of Conception Type (Ontario, 2014-2015 to 2015-2016) 5.7% of records were excluded for missing data. 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 4 (ART). Data analysis was based on aggregate pregnancy data in BORN Information System (BIS).

Invitro Fertilization Treatments and Outcomes for Fresh Embryo Transfer Cycles (Ontario cycles using own oocytes, 2014 – 2015) 14,000 12,000 11,252 10,596 10,000 8,000 6,514 6,000 84.5% of ongoing clinical pregnancies 4,000 2,376 2,190 1,851 2,000 0 Cycle starts (CS) Oocyte retrieval Embryo transfer Clinical Ongoing clinical Singleton cycles (RET) cycles (ET) pregnancies* pregnancies† pregnancies‡ 656 cancelled: 4,082 no ET: 21.1% per CS 19.5% per CS 16.5% per CS 5.8% per CS 38.5% per RET 22.4% per RET 20.7% per RET 17.5% per RET 36.5% per ET 33.6% per ET 28.4% per ET * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy 5 † 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

Invitro Fertilization Treatments and Outcomes for Frozen Embryo Transfer Cycles (Ontario cycles using own oocytes, 2014 – 2015) 10,000 7,720 7,583 8,000 6,000 88.0% of ongoing 4,000 clinical pregnancies 2,907 2,624 2,310 2,000 0 Embryo thaw cycles Embryo transfer cycles Clinical pregnancies* Ongoing clinical Singleton pregnancies‡ (ET) pregnancies† 137 no ET: 37.7% per thaw 34.0% per thaw 29.9% per thaw 1.8% per thaw 38.3% per ET 34.6% per ET 30.5% per ET * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy 6 † 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

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. 7

Prenatal Screening Rates by LHIN of Residence (Ontario, 2014-2016) 8

Pre-Pregnancy Maternal Body Mass Index (BMI) and Giving Birth to an LGA Baby (BORN Ontario, 2014-2015 to 2015-2016) Did you know? 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 90 th 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. 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 9 singletons were included. BMI categories were defined as underweight (<18.5 kg/m 2 ), normal weight (18.5-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (30.0+ kg/m 2 ).

Maternal Pre-Pregnancy Body Mass Index (BMI) by Fiscal Year (Ontario, 2012-2013 to 2015-2016) Did you know? In the latest year, in total, 42.1% of women were considered overweight or obese coming into pregnancy. 18.3% of records were excluded due to missing data. 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. 10 BMI categories were defined according to the World Health Organization (WHO) Guidelines as: underweight (<18.5 kg/m 2 ), normal weight (18.5-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (30.0+ kg/m 2 ).

Mean Gestational Weight Gain (Kg) by Pre-pregnancy Maternal Body Mass (BMI) Categories (Ontario, 2012-2013 to 2015-2016 Recommended Range of 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). 27.9 % of records were excluded for missing data. 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 11 Organization (WHO) Guidelines as: underweight (<18.5 kg/m 2 ), normal weight (18.5-24.9 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ), and obese (30.0+ kg/m 2 ).

Rates of Anxiety and Depression among Pregnant Women (Ontario, 2014-2015 to 2015-2016) Did you know? Mental health screening will be added in Ontario Perinatal Record in 2017. 5.7% of records were excluded for missing data. 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 12 pregnancy by fiscal year. These two categories are not mutually exclusive.

Distribution of Diabetes by Maternal Age (Ontario, 2014-2015 to 2015-2016) 6.2% of women in all age groups had gestational diabetes 0.6% of women in all age groups had type II diabetes 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 13 percentage of the total number of women who had gestational diabetes .

Distribution of Hypertension by Maternal Age Ontario, 2014-2015 to 2015-2016 3.5% of women in all age groups had gestational hypertension 0.9% of women in all age groups had pre-existing hypertension 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 14 the total number of women who had gestational hypertension by age categories.

BIRTH 15

Distribution of Maternal Age at Birth (Ontario, 2014-2015 to 2015-2016) Data source: BORN Ontario, 2014-2015 to 2015-2016 Definition of indicator: Distribution of maternal age categories, expressed as a 16 percentage of the total number of women who had a live birth or still birth.

Proportion of Women ≥ 35 years, by Parity (Ontario, 2012-2013 to 2015-2016) 1.45% of records were excluded for missing data 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 17 fiscal years.

Distribution of Parity (Ontario, 2014-2015 to 2015-2016) 1.2% of records were excluded for missing data. 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 18 pregnancy.

Birth Volume in Hospitals by LHIN (Ontario, 2015-2016) Birth Volume in hospitals (Fiscal year 2015 – 2016) 19

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. 20

Number of Births by LHIN (Ontario 2015-2016) 21

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 22 total number of women who had a live birth or still birth.