2018 CIHR Early Career Investigators in Maternal, Reproductive, Child and Youth Health Grant Profiles
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Endometriosis Microenvironment: influence of "cancer-driver" mutationsName: Michael S. Anglesio Endometriosis is the presence of tissue from the lining of the uterus (womb) found outside the uterus. 10% of women will be affected by endometriosis during their childbearing years with ~1 million Canadian women affected in any given year. Symptoms can include daily pelvic pain, pain during menstruation or sexual activity, infertility and, in rare circumstances, development of ovarian cancer. The economic impact of endometriosis is ~$2 billion/yr in Canada and over $50 billion/yr in the USA, attributed to lost productivity and management of chronic disease. Nonetheless, it remains vastly understudied, leaving women with unanswered questions on how to deal with their disease and whether any treatment may be successful. Historically thought of as an inflammatory condition, endometriosis is classified based on where it presents: (1) on the ovary (endometrioma), (2) on the surface of peritoneal organs (superficial), or (3) invading into organs (deep endometriosis). Staging of endometriosis estimates the amount of disease present. Neither anatomical classes, nor staging, are reliable for predicting success of treatments or alleviation of symptoms. In 2017, my group reported a world-first discovery that 25% of endometriosis carry cancer-driver mutations despite having no risk of becoming cancer. We have since discovered that different types of endometriosis have similar mutations and some women with multiple types of endometriosis may have the exact same mutations across all lesions. Endometriosis symptoms and behavior must therefore depend on both mutations and interactions with normal cells in the body, e.g. organs and immune system. To accelerate research and drive development of new management strategies we propose to examine how mutations and anatomical presentation of endometriosis influence its interaction with normal cells in the body and the immune system (the microenvironment). This study will form the basis for a new molecular-classification of endometriosis. Twitter: |
Optimizing resource allocation in the NICU to improve outcomes of very preterm infantsName: Marc Beltempo Each year, more than 4000 infants are born very preterm (<33 weeks) in Canada and are admitted in a neonatal intensive care unit NICU. These infants are at high risk of death and short-term hospital morbidity and the cost of care of these infants is estimated at $378 million annually in Canada. The structure of care including resource allocation (nurse-to-patient ratios, physician provision and other healthcare providers) and how they are organized within each unit significantly contributes to costs and quality of care. The objective of our research is to determine the effects of resource organization and allocation on outcomes (death or major morbidity) of very preterm infants in Canada born < 33 weeks. To carry out this program of research, we are collecting organizational and resource allocation data with surveys and administrative databases and evaluate how these factors affect patient outcomes. We will study variations in resource allocation to identify more efficient models of care to reduce costs and improve outcomes of very preterm infants. I am a pediatrician sub-specialized in neonatology. I work at the Montreal Children's Hospital Neonatal Intensive Care Unit where I also do my research. I have a Masters in Health Administration (health systems analysis) and have spent two years with the Canadian Neonatal Network doing a research fellowship in neonatal outcomes research and studying variations in practice. My research focuses on evaluating how the organization of work and resource allocation affects outcomes of infants in the NICU. Twitter: @HopitalChildren Website: Child Health Investigators in the Department of Pediatrics Publications: Marc Beltempo: Publications |
A clinical decision rule to identify young children at risk for iron deficiencyName: Cornelia Borkhoff Iron deficiency is a very common nutrition-related disorder among children 1 to 3 years of age (12%), which can affect brain development and lead to developmental delays. Our team has studied iron deficiency in young children for several years and identified several important risk factors including the consumption of cow's milk over 500 mL per day, breastfeeding beyond 12 to 15 months without iron supplementation, and a high body mass index. As there is no iron deficiency screening recommendation in Canada, most Canadian children do not have any blood tests at their regularly scheduled health supervision visits with their primary care physician at 15 and 18 months of age. We are developing a clinical decision rule based on known risk factors to help primary care physicians identify young children at risk for iron deficiency and know which children to screen for iron deficiency using a ferritin blood test. A blood test for ferritin is highly sensitive and specific in its early identification of iron deficiency. If the child's ferritin is low, parents can discuss strategies with their child's physician to increase iron in the diet and whether oral iron supplements may be needed. Our current project is embedded within the TARGet Kids! platform, the largest primary care childhood research network in Canada involving 10 primary care practices and over 10,000 young children and their families. As a clinical epidemiologist with research interests in child health equity and measurement, my goal is to advance early childhood screening in primary care to inform practice and policy. My research focuses on contributing to the current evidence-to-care gap for secondary prevention in primary care, namely high-quality screening tools that perform well in ‘real world' primary care practice settings. Twitter: Websites: |
Using telerehabilitation to support families of children with motor difficulties aged 3-8 years old. A patient-centred, mixed-method innovative pragmatic trialName: Chantal Camden About 1 child out of 20 have motor delays that are not immediately explained by a specific diagnosis. These children are often underserved by existing health and rehabilitation services even though we know that they are at risk of developing important negative outcomes in the long run. The most recent scientific evidence indicates that motor delays can be effectively addressed via early interventions supporting families and stimulating the child's development. The goal of this study is to determine whether an online intervention can support families of children with motor delay. We will determine whether the online intervention can improve the child's motor skills and the family's well-being, while exploring the factors that may influence the way the intervention could be included into existing health services. We will recruit 100 families of children with motor delay in Quebec, 3 to 8 years of age, who are not yet receiving public rehabilitation services. Families will either receive usual health care or have access to health professionals via webinars, group and private discussions, and regular one-on-one virtual meetings. This study will evaluate an innovative, convenient and accessible intervention providing assistance for an important yet underserved population of children and their families. Chantal is an Assistant Professor at the school of Physical and Occupational Therapy at Sherbrooke University. Her research focuses on developing, implementing and evaluating evidence-based interventions and service delivery models for children with disabilities or at risk of developmental delays. Twitter: @USherbrooke Website: Publication: |
Identification of biomarkers for antenatal depression in early pregnancy and associations with Child developmental milestone achievement at 12 and 24 months of age in the All Our Families prospective cohortName: Kathleen Chaput Antenatal depression (depression in pregnancy) is a common and debilitating disease that impacts pregnant women's daily living, and increases the risk of developmental problems for their infants. With a growing body of knowledge about the links between depression and inflammation, and the known links between inflammation during pregnancy and sub-optimal infant brain development, our study seeks to identify the possible biological mechanisms underlying the sub-optimal infant development that often accompany antenatal depression. We have two aims: 1) to identify the patterns of inflammatory biomarkers that are unique to antenatal depression, using emerging advanced analysis techniques; and 2) to assess whether these biomarkers (and which ones) are linked to sub-optimal infant development at 12 and 24 months of age. Our study will capitalize on the All Our Families Cohort data, a large dataset from a long-term study that follows over 3000 women and children from pregnancy through late childhood, which represents an unprecedented opportunity to examine the biological pathways in antenatal depression, using a very rich data set, which requires a relatively small investment of resources. Our study may inform future exploration and development of treatments for antenatal depression and its associated inflammation, improving the health of mothers and their babies. Dr. Chaput is a Perinatal Epidemiologist and Assistant Professor of Obstetrics and Gynecology at the University of Calgary's Cumming School of Medicine. Her program of research explores modifiable risk factors for perinatal mental health and addictions, and infant development, and the optimization of health education, services and supports to improve maternal and infant health outcomes. Twitter: Websites: |
Impact of maternal pertussis immunization on pregnancy outcome and child healthName: Deshayne B. Fell Pertussis (also known as whooping cough) is a highly contagious infectious illness that mainly affects the lungs. The highest risk of severe pertussis illness occurs in babies under the age of two months, and can lead to breathing difficulties, hospitalization, and even death. In order to prevent these early cases, women are sometimes vaccinated against pertussis during their pregnancy, which provides protection to the babies before they are fully vaccinated themselves in the early months of life. However, even in countries where pertussis vaccination is recommended and provided for free, not all pregnant women become vaccinated possibly due to ongoing concern about the benefits and safety of vaccination during pregnancy for their children. As there is limited information on possible benefits or concerns of pertussis vaccination during pregnancy on longer-term health, our study will examine important health outcomes among children up to six years of age. Our findings will provide valuable information to pregnant women and their families, as well as to health care providers working to ensure that mothers and their children are in the best possible health. Dr. Deshayne Fell is an Assistant Professor of Epidemiology at the University of Ottawa, Scientist at the CHEO Research Institute, and Adjunct Scientist with ICES. Her research uses large, linked population databases and registries to improve our understanding of factors affecting maternal and infant population health, with a focus on infection and immunization during pregnancy. Twitter: |
Investigating the keys to spermatogenic niches among men with non-obstructive azoospermiaName: Ryan Flannigan Infertility affects 15% of couples world-wide, and male factors contribute to half of cases. The most severe form of male infertility, termed non-obstructive azoospermia (NOA) occurs where no sperm are produced due to defective spermatogenesis. An overwhelming 70% of these cases have no known cause. Treatment options are limited to surgical sperm retrieval which is only successful in approximately half of cases; therefore, research is desperately needed to understand the mechanisms underlying these severely infertile men to progress care. This study will investigate the genetic and molecular mechanisms that distinguish active and defective spermatogenesis with the aim to identify novel therapeutic targets. To do this, we will compare testis tissue from men with severe infertility to those with normal sperm production. We will use state-of-the-art single cell sequencing which allows us to study the precise genetic expression within each individual cell and use computational modeling to understand abnormalities in cell differentiation. Using specialized 3-D organoid cultures, we will investigate the regulatory differences in cell interactions. Results from this study will contribute to our understanding of the mechanisms and identification of novel therapeutic targets among severely infertile men with no presently available treatments. Dr. Flannigan is an Assistant Professor at the University of British Columbia in the Department of Urologic Sciences. He is a surgeon-scientist interested in translational research investigating the molecular and genetic mechanisms contributing to male infertility. His goal is to identify novel therapeutic targets and treatment strategies for couples with infertility. Twitter: |
Developmental outcome of preterm infants enrolled in a randomized clinical trial of a parent administered sensorimotor intervention in the NICUName: Sandra Fucile Approximately 7.8% of all live births are preterm in Canada, representing an annual rate of 29, 716 of infants who are born preterm. Children who are born prematurely are at risk of developing developmental delays, with significant impact on their occupational performances and quality of life. Early intervention strategies in the neonatal intensive care unit (NICU), among them sensorimotor programs, can influence developmental outcomes. What remains unknown is the potential to further enhance the efficacy of early intervention strategies by active involvement of the parents. Parental engagement in the NICU is vital and can significantly improve outcomes. The aim of this research project is to evaluate the efficacy of parent driven sensorimotor intervention programs on infants' development. Results from this study will provide new knowledge on the impact of sensorimotor interventions as well as the mediating effect of active parental involvement on infants' development. Provision of a parent administered sensorimotor program is a safe and low cost effective intervention that may increase the development and quality of life of preterm born children and their family. If this is achieved, such programs may be implemented across NICUs in Canada with potential for similar improvements in this high-risk population. Dr. Fucile's research interests focus on developmental and functional outcomes of children born prematurely, and early intervention strategies to circumvent sequelae. Dr. Fucile is an occupational therapist with graduate training in Rehabilitation Science from McGill University. She is currently an assistant professor in the Department of Paediatrics, at Queen's University. Twitter: @Queenspeds Website: Sandra Fucile |
Disparities in congenital heart disease burden by maternal socioeconomic status and ethnicityName: Grace (Qun) Miao Congenital heart diseases (CHD) are a type of heart problem that babies are born with. They are a major cause of babies' death in Canada. CHDs can cause severe disability. Patients with CHD may require life time cardiac care. Previous studies have shown that the chance to have babies with CHD among poor families and certain minority groups is higher than that among rich families or other ethnic groups. However, results are vague and inconsistent. There are substantial limitations in previous studies, which make the results biased and difficult to interpret. In Canada, at least 50,000 children are born into poverty, and one in every 100 infants are born with CHD. Considering that Ontario consists of 39% of Canada's population and one third of Ontarians are visual minorities, health inequity would be a major concern in prenatal health if pregnant women from poor and vulnerable families or a minority group have an increased risk of CHD in offspring. Therefore, we plan to study if moms from a minority group or who live in poor, less educated, or socially deprived neighbourhoods increase the chance to have babies with CHD. We are going to link several big data sources, including the BORN Information System (BIS) birth registry data, the CIHI data, and the Census data collected by different organizations and equity index scores developed by experienced Canadian researchers. All databases are available. Therefore, no extra cost on data collection is needed. Findings from this study will help us better understand the causes of CHD and further develop strategies for the CHD prevention. The results of this study could have important recommendations for health policy to improve the health inequality in Canada. Dr. Miao received training in Epidemiology and Biostatistics at Queen's University Kingston and Clinical Medicine in China. She is a Clinical Investigator at the CHEO RI, and an Epidemiologist at BORN Ontario. She is interested in maternal and perinatal health, congenital anomalies, cancer, environmental exposures and social determinants of health. Twitter: Website: Grace (Qun) Miao |
Effects of Canadian smoking policies on children’s use of e-cigarettes and exposure to second-hand smoke in carsName: Hai Van Nguyen This research program aims to investigate the impacts of two recent anti-smoking policies adopted across Canadian provinces: 1) Prohibition of smoking inside cars in the presence of children; 2) Prohibition of sale of e-cigarettes to children. The research will shed light on several questions including: Does a ban on smoking in cars reduce children's risks of second-hand smoke exposure and respiratory exacerbations? Can prohibiting the sale of e-cigarettes to children make them smoke fewer e-cigarettes? Do children switch to combustible cigarettes as a result of limited access to e-cigarettes? These important public health policies have attracted considerable attention and debate in Canada and other countries, but evidence on their effects is still limited. This research program aims to fill this evidence gap and provide timely evidence to inform the public and policy makers, both in Canada and internationally, on the effectiveness of these policies. Dr. Nguyen is an Assistant professor and Canada Research Chair (Tier 2) at the School of Pharmacy, Memorial University Newfoundland. As an applied health economist, Dr. Nguyen's research focuses on evaluating effectiveness and cost-effectiveness of health policies and healthcare interventions. He has published in leading health economics and medical journals. Twitter: Website: Dr. Hai Van Nguyen |
Accuracy of general paediatrician diagnosis of autism spectrum disorder compared to multi-disciplinary team assessmentName: Melanie Penner Increasing rates of autism spectrum disorder (ASD) have contributed to lengthy waits for expert diagnostic assessment that negatively impact ASD outcomes. Many ASD diagnostic guidelines state that an expert team is needed to make the diagnosis; although some children currently receive their diagnosis from a community-based clinician, e.g. a general paediatrician (GP). There are no studies of the accuracy of GPs in diagnosing ASD. Project aims: The aims of this project are to: 1) determine accuracy of GP ASD diagnosis compared to an expert team assessment; 2) to determine child features associated with accurate diagnosis by GPs. Possible features include: child's age; sex; cultural background; ASD severity; developmental delays; and having a sibling with ASD. Methods: We will recruit 26 GPs from across Ontario, as well as 260 of their patients (10 per GP) who have been referred with possible ASD. The GP will complete their assessment and decide on a diagnosis, but will not tell the family. The ASD expert team, consisting of a developmental paediatrician and a psychologist, will also perform a diagnostic assessment without knowing the GP's opinion. The team will inform the family of their diagnostic opinion. We will determine the diagnostic agreement between the two assessments. We will then determine which of the child's characteristics (age, sex, cultural background, ASD severity, developmental delays, having a sibling with ASD) predict agreement in diagnosis. Expected Results: Results from this study will determine whether GPs can independently and accurately diagnose ASD. Future activities include refinement of educational workshops for GPs on ASD diagnosis and development of pathways to identify which children can be diagnosed in a community setting. Twitter: |
Development of functional antibody assays to assess the immunogenicity of pertussis-containing vaccine (Tdap) for HIV-infected and HIV-uninfected pregnant women and their newbornsName: Manish Sadarangani Young babies are at high risk of severe disease from whooping cough - some babies will die. Whooping cough vaccine (Tdap) has recently been recommended in Canada to be given to all pregnant women to prevent whooping cough in their babies, before they are immunized themselves. However we do not fully understand how Tdap works. This project is linked to a trial we are doing of Tdap vaccine in pregnant women in Uganda. In that study pregnant women with HIV will receive Tdap. Their immune response will be compared to pregnant women with HIV given tetanus vaccine and also to pregnant women without HIV given Tdap. We will use the blood samples collected from the women in the trial, and their newborn babies, to help us to understand how Tdap vaccine works during pregnancy. We will use these samples to examine the amount of antibody produced after Tdap in pregnancy and also test exactly how this antibody interacts with the bacterium which causes whooping cough, called Bordetella pertussis. This will help us to understand how Tdap vaccine works in pregnancy, which will help to ensure we use it in the best way possible to prevent whooping cough in babies. Dr. Manish Sadarangani is Director of the Vaccine Evaluation Center at the BC Children's Hospital Research Institute and an Assistant Professor in the Division of Infectious Diseases, UBC Department of Pediatrics. He has worked in pediatrics throughout the world, including in sub-Saharan Africa, Asia, Australia, North America and Europe. His research links clinical trials with basic microbiology, immunology and epidemiology to address clinically relevant problems related to immunization and vaccine-preventable diseases. Twitter: Websites: Publications:
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Social competence in children diagnosed with sickle cell disease: An examination of risk factorsName: Fiona Schulte Sickle cell disease (SCD) is a severe, genetic form of anemia that causes distorted red blood cells. The distorted red blood cells can impact almost every tissue in the body causing difficulties including pain, stroke, decreased quality of life, learning and social difficulties. Children who have a diagnosis of SCD do not have as many friends as their peers. Yet, we do not understand who is most at risk of experiencing social difficulties. We need to understand this in order to find the best way to treat these children. In this study we aim to identify some of the factors that might be contributing to social difficulties in children diagnosed with SCD. Children diagnosed with SCD and their healthy peers will be invited to participate and complete some tests assessing social function. They will also undergo imaging of their brain (MRI) to see whether there may be brain abnormalities caused by their disease that can be linked to social difficulties. Parents, teachers and classroom peers will also complete measures designed to assess the social function of these children. This will help us learn to better identify which children may be at greatest risk of social difficulties and to design better treatments to help these children. Dr. Fiona Schulte is an Assistant Professor in the Department of Oncology, Cumming School of Medicine, University of Calgary and a psychologist in the Haematology, Oncology, Transplant Program at the Alberta Children's Hospital. Her research is interested in enhancing the patient and family experience for children diagnosed with haematological and oncological conditions. She has received the International Psycho-Oncology Society Young Investigator Award and Calgary's Top 40 Under 40. Twitter: Websites: |
Understanding fibre fermentation within the 1-year-old infant gut microbiomeName: Jennifer Stearns Infant nutrition is an important factor in healthy development and impacts life-long risk of metabolic disease. The human gastrointestinal tract is home to bacteria that can process undigested parts of the diet, such as fibre. This process is called “fermentation” and creates metabolites such as short chain fatty acids and lactic acid that are beneficial for the host and the microbial communities. The health benefits of breastfeeding are clear, however, the impact of the solid food diet on gut bacterial metabolism and support a healthy microbial community in infancy is unknown. We will study how bacteria in the 1-year-old infant gut break down different kinds of fibre and which metabolites they produce. This research is important to our understanding of how an infant's diet might be modified by the bacteria in his or her gut and how to best leverage the infant diet to promote a healthy gut microbiota for health long-term. Dr. Jennifer Stearns is the Farncombe Chair in Microbial Ecology and Bioinformatics and an Assistant Professor in the Department of Medicine at McMaster University. She studies how infants are colonized with microorganisms after birth and the role of the gut microbiome in healthy infant development. Twitter: Websites: |
Resolving mechanisms and biomarkers of ascending infections to prevent preterm birthName: Laura Sycuro Millions of genes are carried by complex communities of microbes inhabiting our bodies – together these microbes and genes form the microbiome, an integral component of normal human physiology. My research seeks to understand how the maternal microbiome influences the success of human reproduction – both by supporting human development, and by sometimes causing it harm. As we discover which bacterial species and functions are linked to pregnancy complications, we hope to harness the maternal microbiome to prevent preterm birth. The proposed research project will determine how select members of vaginal microbiome are able to access the amniotic fluid and cause infections of the fetus. We will focus on poorly understood groups of bacteria, including vaginal Sneathia and Prevotella species, which are among the most common types of bacteria infecting the womb. Our preliminary findings suggest these diverse microbes exhibit some of the same functional traits as well known obstetrical pathogens such as Group B Streptococcus and Fusobacterium nucleatum. By characterizing bacterial functions that are conserved amongst ascending pathogens and critical for their ability to cause infection, we hope to identify new ways of screening women to predict and stop maternal infections before they trigger premature labour. I began my independent research career in 2016 as a founding member of the International Microbiome Centre. In addition to serving as a platform lead for the CIHR Pan-Canadian Microbiome Core, I am spearheading a major birth cohort initiative called Alberta BLOOM, which seeks to understand the role of the maternal and early life microbiome in child health. Twitter: Website: Alberta Bloom |
Sleeping for Two: A randomized controlled trial of cognitive behavior therapy for insomnia experienced during pregnancyName: Lianne Tomfohr-Madsen Experiencing difficulty sleeping during pregnancy is a common and psychologically difficult experience. Sleep problems tend to worsen as pregnancy progresses, and are associated with increased birth complications, higher rates of postpartum depression and worse infant sleep. Although there are medications for short-term treatment of insomnia the majority of pregnant women say that they will not take them due to fears about the potential impact on the developing baby, leaving women without any evidence-based treatment options. Our research group has shown that a psychological intervention called cognitive behavioural therapy for insomnia (CBT-I) reduces insomnia symptoms in pregnancy. This project is a larger trial of the intervention, "Sleeping for Two: CBT-I for treatment of insomnia during pregnancy", which is a six-week psychological therapy aimed at both positively changing behaviours and thoughts related to sleep. The main goals of the project are to investigate if CBT-I reduces symptoms of insomnia in pregnancy and if those gains are maintained in the postpartum. Dr. Tomfohr-Madsen's research interests focus on psychological and social factors that promote or detract from optimal health trajectories. The main focus of her research is the transition to parenthood and the development of interventions that prevent the onset of physical and mental health problems in parents and their children. Twitter: Website: Healthy Families Lab |
Closing the gap: Identifying risk and resilience factors influencing mental health and wellness among First Nations children and youthName: Amy Bombay Indigenous children and youth experience poorer health and wellness compared to those in the general population. These health gaps have been attributed to the intergenerational consequences of harmful colonization practices, continued systemic discrimination, and social determinants of health that further disadvantage Indigenous Peoples. In this regard, within First Nations communities in Canada very young children and youth are disproportionately dying by suicide, highlighting the importance of early identification and intervention. However, empirical evidence elucidating the factors contributing to Indigenous children and youth mental health is lacking. To address this gap, we propose a mixed methods approach to obtain an in-depth understanding of the pathways influencing the mental health of First Nations children and youth. We will examine the risk factors, such as historical and current community stressors, as well as the resiliency factors, such as community belonging, that lead to or protect against First Nations children and youth suicide and comorbid conditions. This will begin with the analyses of nationally representative surveys to examine First Nations children and youth living in reserve communities and those living in urban regions of Canada. Additionally, we will conduct a qualitative study with mental health service providers who work directly with Indigenous youth to gather a richer understanding and story of Indigenous child and youth mental health. It is expected that this work will provide an in-depth understanding of factors contributing to the mental health disparities that exist for Indigenous children and youth, with a view to inform evidence-based strategies for prevention, identification and treatment. Twitter: |
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