4 million pregnancies and over 20 years of data

With the Canadian Mother-Child Cohort (CAMCCO), we’re aiming to put in place standardized and harmonized longitudinal pregnancy cohorts in five provinces: Quebec, Ontario, Manitoba, Saskatchewan and Alberta. Based on the Quebec Pregnancy Cohort model, these cohorts will include billing, medical, hospital, birth certificate and sociodemographic data on approximately four million pregnant women, mothers and children. Having these data will be essential for studying rare adverse pregnancy outcomes such as birth defects.

The universal health care system in Canada, which is mostly administered by the provinces, gives a wealth of real-world data that can be used for research and policymaking. But these data are not now readily organized for the purposes of research; before they can be used, they need to be standardized and harmonized. That’s where CAMCCO comes in: once it’s completed, researchers will finally be able to carry out truly pioneering research on the use of medications during pregnancy and do so in a timely manner. As well, by standardizing and harmonizing the various cohorts we’ll be able to set up an online surveillance platform to identify signals that will help policymakers better evaluate all the attendant risks and benefits.

CAMCCO includes investigators from six institutions: UdeM, with myself as principal investigator; McGill University, with Sasha Bernatsky and Évelyne Vinet; University of Ottawa, with Mark Walker, Steven Hawken and Anne Sprague; the University of Manitoba (Sherif Eltonsy and Dan Chateau); the University of Saskatchewan (Brandy Winquist); and the University of Alberta (Padma Kaul). We also have collaborators from Health Canada and from the U.S. Food & Drug Administration’s Sentinel Initiative, through Judith Maro of Harvard Medical School. With five provincial mother-child cohorts to be standardized and harmonized, investigators in each province will be responsible for the accuracy, confidentiality and privacy of their data. All CAMCCO investigators will be involved in harmonization and research, and collaborators will provide expertise in perinatal epidemiology. Coordination and the surveillance platform will be based in Montreal at CHU Sainte-Justine.

Although such data are not systematically collected in the provincial databases we’re accessing, CAMCCO does plan to collect data on lifestyle, smoking, alcohol use and folic acid use in representative samples of pregnant women within each province in order to estimate their impact on the research overall. Our main focus now is medications and pregnancy, but by building pregnancy cohorts dating back almost a quarter-century we’ll also be able to study other medical interventions and uses as well as longer-term outcomes such as metabolic and rheumatic diseases and asthma, to name a few.

We started CAMCCO in the spring of 2019 with seed funding from the Canadian Institutes of Health Research and Health Canada, and very soon we will be submitting the description of the infrastructure and our baseline results for publication. As for standardizing and harmonizing the five provincial mother-child cohorts, that will take three years, including the time needed for training personnel, research fellows and graduate students. The online surveillance platform will be put in place faster – we expect it to go live sometime this fall – and this summer we’ll start to see results regarding the risks and benefits of using opioids during pregnancy, maybe even of COVID-19 medications and vaccines.