MHLU - Health Status Resource

Births are a key component of population growth and an indicator of the reproductive capacity of a population. In Middlesex-London, approximately 4500 to 4900 babies were born each year between 2006 and 2017. Most of these babies were born within a healthy range for birth weight, size and gestational age. The rate of babies born with a birth defect decreased significantly in Middlesex-London since 2013, to become similar to those seen across Ontario.

In general, women in Middlesex-London are having their first baby at an older age and having fewer babies, a trend also seen across Ontario. A woman’s fertility begins to decline in her early to mid thirties1, and increasing maternal age is significantly associated with negative birth outcomes for both the baby and mother.2 In Middlesex-London, the rates of preterm births and large for gestational age (LGA) babies were highest among mothers aged 40 to 49.

Stillbirth rates in Middlesex-London were consistently higher compared to Ontario from 2006 to 2017, although the differences were not always statistically significant. In Ontario, the death of a fetus of a certain weight or gestational age is classified as a stillbirth regardless of whether it occurred spontaneously or through the termination of a pregnancy.3 As a result, it is unclear what proportion of stillbirths in Middlesex-London (or across Ontario) have occurred spontaneously or due to pregnancy terminations, such as those that may occur after a birth defect is detected during pregnancy.

Exclusive breastfeeding is recommended for the first six months of life4, with continued breastfeeding recommended for up to two years and beyond.5 Some mothers may be unable to feed breast milk to their baby for medical reasons, or may choose to use a breast milk substitute for other reasons. Infant feeding supports are available to all families regardless of the type of feeding. From 2013 to 2017, most newborns in Middlesex-London were fed breast milk and the percent exclusively fed breast milk went up over time. Over 60% of infants were fed breast milk until six months of age, however, less than 15% were exclusively breastfed during this period.

Early childhood is considered to be the most important developmental phase throughout the lifespan.6 Identifying potential challenges at early stages allows steps to be taken to prevent, mitigate, or reverse its effects and set up children for greater success throughout life.

The Healthy Babies Healthy Children (HBHC) screen is used to identify families experiencing challenges who may benefit from the HBHC home-visiting program during the prenatal, postpartum, or early childhood periods. In 2017, a significantly higher percent of infants in Middlesex-London were identified as having a parent with a history of mental illness, in a family with concerns about money, and being with a family in need of newcomer supports, compared to Ontario.

At eighteen months of age—a milestone in a child’s development—a significantly higher percent of children in Middlesex-London saw a healthcare provider for an 18-month well-baby visit compared to Ontario. The visit promotes increased communication between parents and physicians (or other health professionals) on child development, parenting, early literacy, and local community resources that promote healthy learning, reading and age-appropriate play.7, 8

The Early Development Instrument (EDI) is a questionnaire used to assess children’s developmental health and well-being across five domains. For kindergarten age children in Middlesex-London, EDI results have shown that their ability to meet age-appropriate development expectations has been fairly comparable to others across Ontario. For each domain, more males fell into the “vulnerable” category—scoring below the 10th percentile cut-off—compared to females.

References:

1. The Society of Obstetricians and Gynaecologists of Canada (SOGC). Age and Fertility [Internet]. Ottawa, ON: The Society of Obstetricians and Gynaecologists of Canada; 2014 [cited 2019 Apr 26]. Available from: http://pregnancy.sogc.org/fertility-and-reproduction/age-and-fertility

2. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of Maternal Age on Obstetric Outcome. Obstet Gynecol [Internet]. 2005 [cited 2018 Nov 15];105(5 Pt 1):983-90. Available from: https://journals.lww.com/greenjournal/Fulltext

3. Provincial Council for Maternal and Child Health (PCMCH) and The Better Outcomes Registry & Network (BORN) Ontario Perinatal Record Working Group. A User Guide to the Ontario Perinatal Record [Internet]. Toronto, ON: Queen's Printer for Ontario, 2018 [cited 2019 Apr 26]. Available from: http://www.pcmch.on.ca/wp-content/uploads/2018/08/OPR_UserGuide_2018Update_Final_18-08-22.pdf

4. Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months [Internet]. Ottawa, ON: Government of Canada; 2012 [cited 2019 Mar 25]. Available from: https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html

5. Health Canada, Canadian Paediatric Society, Dietitians of Canada, Breastfeeding Committee for Canada. Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months [Internet]. Ottawa, ON: Government of Canada; 2014 [cited 2019 Mar 25]. Available from: https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months/6-24-months.html

6. Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health [Internet]. Geneva: World Health Organization, 2008 [cited 2019 Mar 25]. Available from: https://apps.who.int/iris/bitstream/handle/10665/43943/9789241563703_eng.pdf?sequence=1

7. Ministry of Children Community and Social Services. Ontario's Enhanced 18-Month Well-Baby Visit: Information for Physicians & Other Health Professionals [Internet]. Toronto: Queen's Printer for Ontario; 2015 [cited 2019 Mar 26]. Available from: http://www.children.gov.on.ca/htdocs/English/earlychildhood/health/enhanced_18-month.aspx

8. Guttman A, Cairney J, MacCon K, Kumar M. Uptake of Ontario's Enhanced 18-Month Well Baby Visit [Internet]. Toronto, ON: Institute for Clinical Evaluative Sciences, 2016 [cited 2019 Mar 26]. Available from: https://www.ices.on.ca/Publications/Atlases-and-Reports/2016/Well-Baby

Last modified on: May 7, 2019