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Ahmed RJ, Gafni A, Hutton EK, Hu ZJ, Pullenayegum E, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE, Menzies J, Sanchez JJ, Ganzevoort W, Helewa M, Lee SK, Lee T, Logan AG, Moutquin JM, Singer J, Thornton JG, Welch R, Magee LA. The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial). Hypertension 2016; 68:1049-55. [PMID: 27550914 PMCID: PMC5008043 DOI: 10.1161/hypertensionaha.116.07466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
Abstract
UNLABELLED The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.
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Affiliation(s)
- Rashid J Ahmed
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Amiram Gafni
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Eileen K Hutton
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Zheng Jing Hu
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Eleanor Pullenayegum
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Peter von Dadelszen
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Evelyne Rey
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Susan Ross
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Elizabeth Asztalos
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Kellie E Murphy
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Jennifer Menzies
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - J Johanna Sanchez
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Wessel Ganzevoort
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Michael Helewa
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Shoo K Lee
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Terry Lee
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Alexander G Logan
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Jean-Marie Moutquin
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Joel Singer
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Jim G Thornton
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Ross Welch
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
| | - Laura A Magee
- From the Department of Obstetrics and Gynecology (R.J.A., E.K.H.), Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis (A.G.), and Department of Mathematics and Statistics (Z.J.H.), McMaster University, Hamilton, Ontario, Canada; Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Hospital for Sick Children, Ontario, Canada (E.P.); Department of Obstetrics and Gynaecology, St. George's University of London, United Kingdom (P.v.D.); Departments of Medicine (E.R.) and Obstetrics and Gynaecology (E.R.), University of Montreal, Quebec, Canada; Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada (S.R.); Departments of Paediatrics (E.A.) and Obstetrics and Gynecology (E.A.), University of Toronto, Sunnybrook Health Sciences Centre, Ontario, Canada; Departments of Obstetrics and Gynecology (K.E.M.) and Medicine (K.E.M., A.G.L.), University of Toronto, Mount Sinai Hospital, Ontario, Canada; Department of Obstetrics and Gynaecology (J.M.), Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute (T.L.), and School of Population and Public Health (J.S.), University of British Columbia, Vancouver, Canada; Clinical Trial Services, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, Toronto, Ontario, Canada (J.J.S.); Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands (W.G.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Women's Health, University of Manitoba, Winnipeg, Canada (M.H.); Division of Neonatology, Department of Paediatrics, University of Toronto, The Hospital for Sick Children, Ontario, Canada (S.K.L.); Department of Obstetrics and Gynecology, Université de Sherbrooke, Québec, Canada (J.-M.M.); Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham City Hospital, United Kingdom (J.G.T.); Department of Obstetr
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