Gilles Paradis

Summary: We assessed the pregnancy outcomes of patients with sickle cell crises. We carried out a retrospective study of 2 698 556 pregnancies in Quebec, Canada between 1989 and 2022. The primary exposure was sickle cell anaemia with crisis during or outside of pregnancy. Outcomes included severe maternal morbidity and other pregnancy complications. We used log‐binomial regression models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for the association between sickle cell crises and pregnancy outcomes. We found that patients with sickle cell crises were particularly at risk of severe maternal morbidity (RR 8.50, 95% CI 6.93–10.41), especially peripartum sepsis (RR 12.64, 95% CI 7.20–22.18) and acute renal failure (RR 32.37, 95% CI 16.99–61.67) compared with no sickling disorder. Patients with crises during pregnancy that required delivery (RR 15.58, 95% CI 11.92–25.33) or that resolved without requiring delivery (RR 7.39, 95% CI 4.64–11.78) were at risk of severe maternal morbidity. Sickle cell crises were associated with a range of other pregnancy complications, such as preterm birth and caesarean delivery. The findings suggest that sickle cell crises, including crises during or outside pregnancy, are associated with severe maternal morbidity and other pregnancy complications.

Background: Assisted reproductive technology has been linked to an increased risk of pregnancy-related cardiovascular complications, but the long-term cardiovascular outcome is poorly understood. This study aimed to assess whether women who use ART have an elevated long-term risk of adverse cardiovascular outcomes. Methods: We conducted a systematic review and meta-analysis to examine the association between ART and long-term cardiovascular outcomes after pregnancy. We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published by January 2026. We evaluated the methodological quality of included studies using the Newcastle-Ottawa Scale. We used random effects models to calculate pooled adjusted risk ratios (aRR) with 95% confidence intervals (CI) for the association of ART with cardiovascular outcomes. Results: We included thirteen studies comprising 553,331 patients who used ART and 37,826,591 patients who conceived spontaneously. All women achieved a live birth. Mean duration of follow-up after delivery was 8.4 ± 8.3 years. In models adjusted for age, parity, and comorbidity, ART was associated with a small increase in the risk of cardiovascular disease compared with spontaneous conception (aRR 1.18, 95% CI 1.03–1.35), but the association was attenuated when studies that had only 42 days of follow-up were excluded (aRR 1.13, 95% CI 0.99–1.29). ART was not associated with cardiac complications (aRR 0.94, 95% CI 0.82–1.08), stroke (aRR 1.20; 95% CI 0.93–1.55), hypertension (aRR 1.02; 95% CI 0.72–1.44), or venous thrombosis (aRR 1.27, 95% CI 0.97–1.67). Conclusions: Our findings suggest that women who achieve a live birth following ART do not appear to have an increased long-term risk of adverse cardiovascular outcomes. These results provide reassuring evidence for patient counseling regarding the long-term cardiovascular safety of ART among women with successful pregnancies. Further research that includes women who do not achieve a live birth is warranted to more fully characterize the potential long-term cardiovascular effects of ART across the entire spectrum of treatment outcomes.

Background: Severe maternal morbidity is rising, yet the association with cardiovascular disease is not clear. We examined the risk of cardiovascular hospitalization up to 3 decades after having a pregnancy complicated by severe maternal morbidity. Methods: We analyzed a longitudinal cohort of 1 336 846 women who were pregnant between 1989 and 2019 in Quebec, Canada. The main exposure measure was severe maternal morbidity in any pregnancy, including severe preeclampsia, acute renal failure, sepsis, and other life-threatening conditions. Using time-varying Cox regression models, we compared the adjusted risk of hospitalization for cardiovascular disease up to 3 decades after pregnancy for women with severe maternal morbidity relative to women without severe morbidity. Results: Five percent of women had severe maternal morbidity. Overall, there were 68 287 cardiovascular hospitalizations during 21 725 672 person-years of follow-up in the cohort. Compared with no morbidity, women with any severe morbidity had a greater risk of cardiovascular hospitalization (hazard ratio [HR], 1.77 [95% CI, 1.72–1.82]). The association was the greatest within the first year of delivery (HR, 4.42 [95% CI, 3.77–5.19]) but persisted beyond 15 years (HR, 1.44 [95% CI, 1.37–1.51]). Having a cardiac complication (HR, 5.37 [95% CI, 4.65–6.20]), cerebrovascular accident (HR, 3.82 [95% CI, 2.94–4.96]), or acute renal failure (HR, 2.60 [95% CI, 2.15–3.14]) during pregnancy was strongly associated with future cardiovascular hospitalization. Conclusions: Women with severe maternal morbidity have a greater risk of cardiovascular disease after pregnancy, both in the short and long term. These women may benefit from active surveillance for cardiovascular disease.

Background/Objective Adiposity may mediate the effect of dietary glycemic load (GL) on lipid profiles in children, as studies have shown an association between dietary GL and adiposity and between adiposity and lipid profiles. Our objective was to evaluate the role of adiposity as a mediator in the association between dietary GL and lipid profiles after 2 years. Subjects/Methods The Quebec Adipose and Lifestyle InvesTigation in Youth study included 630 children, 8–10 years old at recruitment with at least one parent with overweight or obesity with 2-year follow-up. Three baseline 24-h dietary recalls were administered by a dietitian at baseline. Child and parent characteristics were obtained through direct measurement (blood lipids, anthropometrics) or questionnaires (socio-economic characteristics). Indicators of adiposity, including body mass index (BMI) z-score and percent body fat, were the mediators of interest. A conventional approach using the Baron and Kenny method was used. A causal approach using marginal structural models (MSM) was used to estimate the controlled direct effect. Results Mean age at baseline was 9.6 years and 33% were overweight or obese. Both methods revealed that the effect of GL on blood lipids was mediated by adiposity. The weighted MSM did not show evidence of a direct effect (TG: β =;0.01, 95% CI = −0.01,0.02; HDL: β = 0.005, 95%CI = −0.002,0.01), whereas the conventional method did for TG but not HDL (TG:β = 0.04, 95%CI = 0.01,0.07; HDL: β = −0.01, 95%CI = −0.03,0.01). Conclusion Adiposity contributes substantially to the association between GL and blood lipids. The choice of approach for mediation analysis should be based on the fulfilment of conditions of each method.