Objective: To determine the characteristics, determinants, and persistent use for prescription opioid episodes initiated postpartum in British Columbia (BC), Canada. Design: Population-based cohort, 2008-2015. Setting: Linked administrative databases including outpatient and inpatient visits and outpatient prescription dispensations for all individuals in BC tested for hepatitis C or HIV. Population: Opioid-naïve individuals aged 13-49 with a delivery hospitalization record. Methods: We used modified Poisson regression to estimate risk ratios (RR) for pre-pregnancy characteristics and adjusted RR (aRR) for delivery characteristics adjusted for potential confounders. Main Outcome Measures: All and persistent (≥90 days) prescription opioid episodes initiated postpartum. Results: Among 292,684 eligible deliveries, 8.8% (95% CI: 8.7% to 8.9%) initiated a postpartum prescription opioid episode and 0.4% (0.4%- 0.5%) had a persistent episode. Persistent prescription opioid episodes were more frequent among cesarean vs. vaginal deliveries (1.0% vs. 0.2%, aRR 5.1 [4.6-5.8]). Opioid episodes varied regionally and declined from 12.8% in 2008 to 7% in 2012-2015. Persistent prescription opioid episodes were associated with pre-pregnancy: mental illness history (RR 2.4 [1.9-3.1]), psychotropic medication use (RRs 3.6-4.9), chronic pain (RR 2.7 [1.8-3.9]) and alcohol misuse (4.6 [2.2-9.7]), and delivery complications: intensive care unit admission (aRR 5.4 [3.3-8.9]), postpartum hospital readmission (aRR 3.9 [3.2-4.8]), and vaginal deliveries with hysterectomy (aRR 23.7 [6.1-91.8]) or tubal ligation/salpingectomy (aRR 14.6 [5.4-39.4]). Conclusions: Persistent prescription opioid episodes were initiated following 0.4% of deliveries. Postpartum pain management strategies should consider the strong associations between pre-pregnancy and delivery characteristics and persistent prescription opioid episodes initiated postpartum.

Objectives: To estimate the association between estimated fetal weight (EFW) percentiles on the INTERGROWTH-21st and WHO fetal growth charts and kindergarten-age childhood development, and identify the charts’ percentile cut-offs that best predict kindergarten-age developmental challenges. Design: Retrospective cohort linkage study. Setting: Obstetrical ultrasound department of BC Women’s Hospital, Vancouver, Canada. Population or Sample: Non-anomalous, singleton fetuses scanned ≥ 28 weeks’ gestation, 2000-2011 (n=3418). Methods: We classified EFWs into percentiles using the INTERGROWTH-21st and WHO charts. We used generalized additive modelling to link EFW percentile with routine province-wide kindergarten readiness test results. We calculated the AUC, as well as other measures of diagnostic accuracy with 95% confidence intervals (CI) at select percentile cut-points of the charts. Main Outcome Measures: Total Early Development Instrument (EDI) score (/50). Secondary outcomes: EDI sub-domain scores for language and cognitive development, and for communication skills and general knowledge; designation of ‘developmentally vulnerable’ or ‘special needs’. Results: Fetuses with lower EFW percentiles had systematically lower EDI scores and increased risks of developmental vulnerability. However, the clinical significance of differences was modest in magnitude: e.g., total EDI score -2.8 [95% CI: -5.1, -0.5] in children with an EFW 3-9th percentile of INTERGROWTH chart (vs. reference of 31-90th). The charts’ predictive abilities for adverse child development were limited (e.g., AUC<0.53 for both charts). Conclusions: Lower EFW percentiles on the INTERGROWTH-21st and WHO charts indicate increased risks of adverse kindergarten-age child development at the population level, but are not accurate individual-level predictors of adverse child development.

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