World Heart Day 2018: An Interview with Dr. Karen Tran

September 29th is World Heart Day. Check out our Q&A with Dr. Karen Tran on her research on hypertensive disorders in pregnant women!

  1. What are hypertensive disorders? Do they affect pregnant women differently than non-pregnant women?

High blood pressure affects 1 in 4 Canadians and is the most common reason for Canadians to see their family doctors. Untreated high blood pressure is a major risk factor for heart attacks, strokes, heart failure, and kidney disease. Despite women being more likely than men to be treated for their high blood pressure, women are less likely to achieve blood pressure control.

In contrast, high blood pressure in pregnancy occurs in 5-10% of pregnant women, and accounts for a majority of maternal, fetal and neonatal morbidity and mortality. In BC alone, 1800 deliveries annually are complicated by hypertension and preeclampsia. Also, we know that pregnant women who having high blood pressure in their pregnancy are at increased risk of developing hypertension, cardiovascular disease, such as heart disease and stroke in the future.

2. In 2-3 sentences, could you briefly describe your research?

Together with Dr. Wee Shian Chan, we are interested in understanding how measuring blood pressure at home can improve how we care for pregnant women who develop hypertension during their pregnancies. We know that home blood pressure monitoring is more reliable than office blood pressure and associated with better outcomes in non-pregnant women, but we do not know if the same is true in pregnant women.

  1. What are some of the differences between how blood pressure is measured between pregnant women and non-pregnant women? Why are these processes different?

In non-pregnant women, home blood pressure monitoring leads to improved cardiovascular outcomes, adherence to medications, overall lower blood pressure, and increased patient satisfaction. There are also good recommendations on how often to measure blood pressure at home, as well as home blood pressure targets to achieve. This unfortunately is not the case for pregnant women. Currently, the diagnosis and management of high blood pressure in pregnant women rely on blood pressure measured in a doctor’s office, which can be inaccurate.

  1. How do these knowledge gaps currently impact pregnant women?

Even though, many doctors recommend that pregnant women measure their blood pressure at home, we are still not clear how often they should be doing this, what blood pressure they should achieve, how to use these blood pressure measurements to manage their care and whether or not this would reduce complications to mothers and their newborn babies.

  1. Why is this research important? How might it change clinical practice?

By measuring blood pressure at home, we hope to engage and empower women to take an active role in their health.  Many pregnant women already measure their blood pressure at home, but we require evidence to guide doctors on which home blood pressure thresholds to diagnose high blood pressure and what their home blood pressure targets should be to manage hypertension in pregnancy. Furthermore, we need to make sure that home blood pressures are measured accurately using validated blood pressure machines. In the future, we hope that clinicians will be able to rely on home blood pressure measurements to manage hypertension in pregnant women and improve the health of mothers and their new babies.

Maternal Microbiome Legacy Project Update

The Maternal Microbiome LEGACY Project team is excited to announce the launch of our second study site, being led by Dr. Sheona Mitchell-Foster at the University Hospital of Northern BC (UHNBC) in Prince George!

The goal of the Maternal Microbiome LEGACY Project, being led by Dr. Deborah Money, is to help clarify the link between the vaginal microbiome, mode of the delivery (vaginal or caesarean section delivery), and the development of the infant gut microbiome. Since its launch earlier this year at BC Women’s Hospital, the Maternal Microbiome LEGACY Project has recruited over 160 participants from the greater Vancouver area. The addition of our Prince George site will help in establishing a study population which is more representative of the British Columbia population.

This is a longitudinal study of women with term deliveries, with women and their infants being followed for 3 months after delivery. We are looking to recruit 920 women over the course of the study. To participate, women should be pregnant with a single or twin pregnancy, over 19 years of age, and be registered for hospital or home delivery at one of our study sites.

We thank the women who have participated so far and expressed interest in our study, and all of the nursing and clinical staff who have facilitated with in-hospital sample collection!

For more information, visit the study website, or follow MaternalLegacy on Facebook and Twitter.

If you would like to participate, or would like further information on participating, please fill out this survey.

For general study inquiries, please email the Study Manager, Zahra Pakzad at zahra.pakzad@cw.bc.ca.

Congratulations to Drs. Gina Ogilvie and Marette Lee, recipients of a MSFHR 2018 Implementation Science Team Project Grant!

Dr. Gina Ogilvie and Dr. Marette Lee have received the grant for the “At-Home Cervical Cancer Screening & Strategies To Enhance Engagement With The Care Pathway For Under-Screened Populations project”.

In this proposal we will use implementation science methodology to explore and address barriers to cervical cancer screening in BC to improve access to screening in under-served populations. Over the last decade in BC screening rates have remained at about 70%, which means there is a large proportion of the population who are under or never screened. Despite this, there are few interventions that have been successfully implemented to improve screening rates in priority populations.

Specifically we will use different implementation approaches for self-collected sampling for HPV (human papillomavirus) testing. This is a highly effective, validated tool for cervical screening that can be used to address many of the barriers women face to clinic-based pap testing, which is the current standard in BC. For example, embarrassment or discomfort with a pelvic exam, cultural taboos, or past trauma are reasons some women avoid screening, as well as inconvenient clinic hours, not having a family physician, or time and distance to travel for services. We anticipate that the use of self-screening can address many of these barriers. With this approach, women can collect their own sample in a simple and painless way, and it can be done in the privacy of women’s homes or wherever they are comfortable using it. 

To implement self-screening we are piloting two approaches, one being an online service called CervixCheck where women can order self-sampling kits for screening which are mailed to their home. After they have collected their sample the kit is mailed to the BC Public Health Laboratory for testing, and screening results become viewable online through their personal online account. In the second approach, self-collection based screening will be offered through community health centers.

Initially the program is being piloted in the urban clinics in Surrey with South Asian women, and in Northern BC with rural Indigenous communities. These populations are known to have some of the lowest screening rates in the province and face barriers to traditional screening approaches. This will also allow us to see how our interventions can be adapted to different contexts.

The program is embedded within the provincial health authority at BC Cancer, and will be examining health systems impact and cost-effectiveness to be used for future scale up planning of the program. The team is led by Dr Gina Ogilvie, Associate Director of the WHRI, UBC Professor, and Canada Research Chair in global control of HPV related diseases and cancer; Dr Marette Lee, Provincial Colposcopy Lead for the BC Cancer Cervix Screening Program; Dr Dirk van Niekerk, Medical Director of the BC Cancer Cervix Screening Program; along with an interdisciplinary team of researchers and research users in the Vancouver, Fraser, and Northern Regions of BC. Through health systems implementation research, our goal is that self-collection based screening and CervixCheck can be adopted within the BC Cancer Cervix Screening Program in the future, and serve as a model for other public health programs in BC.

Research spotlight: OVCARE

This Ovarian Cancer Awareness month we are recognizing the history of OVCARE and the strides they’ve made in the field of ovarian cancer research, impacting women’s health around the globe.

In December 2000 in the cafeteria at Vancouver General Hospital (VGH), Drs. David Huntsman, Dianne Miller, and Blake Gilks sat down to brainstorm how they might improve outcomes for women with ovarian cancer. 

Despite conventional research efforts in the field of ovarian cancer – both locally and internationally – there had not yet been a research breakthrough leading to significantly improved outcomes for women with the diagnosis. Most of these women died within five years of receiving the diagnosis, which motivated them to build a multidisciplinary team and core resources to facilitate research. At the time, it was unprecedented to have contrasting perspectives of a pathologist, geneticist, and clinically focused gynaecologic oncologist to tackle this disease.

They presented their plans to the BC Cancer Foundation and the VGH and UBC Hospital Foundation. From there, OVCARE was born.


Today this partnership has made OVCARE a global leader in ovarian cancer research. Their findings have had a profound impact not only in British Columbia, but throughout Canada and the world. Their achievements include discovering that ovarian cancer is not a single disease, but is made up of a number of subtypes of ovarian cancer; discovering driver mutations in several rare ovarian and uterine cancers which are now the diagnostic markers for these cancers; developing a prevention protocol adopted in numerous countries; and  leading Vancouver Coastal Health to become the first region in the world to offer patients presenting with ovarian cancer molecular risk assessment for the two common hereditary cancer syndromes.

Among their successes, their ovarian cancer educational campaign has had a huge impact on women’s health around the globe. The campaign was comprised of three key recommendations: 1) To remove the Fallopian tubes at the time of hysterectomy (opportunistic salpingectomy, a term coined by Dr. Dianne Miller); 2) For women who are undergoing tubal ligation for permanent contraception to undergo opportunistic salpingectomy; and 3) For any woman diagnosed with ovarian cancer to be tested for the BRCA mutations, and for her family members to be tested as well so they have the opportunity to undergo preventative surgery.

With these recommended changes in practice OVCARE predicts they can prevent ovarian cancer in up to 40% of cases. Dr. Gillian Hanley is currently using a population-based database in British Columbia to track the incidence of the disease, as well as to see how many women have undergone opportunistic salpingectomy based off of the recommendations. Preliminary findings show that the uptake of recommendations in 2014 rose 80% in British Columbia, which is the highest rate of growth in the country. While it is currently too early to tell if the incidence of ovarian cancer has been reduced, they anticipate that they may have enough data to analyze toward the end of 2019.

OVCARE encourages other researchers in fields outside of ovarian cancer research to take an interest in studying the disease by developing partnerships which provide access to their resources.  Since the start of OVCARE, the team has expanded and now has an active research program on endometrial cancer led by Drs. Jessica McAlpine and Aline Talhouk.

To learn more about OVCARE visit their site.

Further reading:

Study spotlight: “Pharmacokinetics and Safety of Commonly Used Drugs in Lactating Women and Breastfed Infants”

Dr. Wee-Shian Chan, Head of BC Women’s Department of Medicine, is leading a team based out of BC Women’s Hospital + Health Centre (BCWH) to further research on the transfer of commonly used drugs from mother to child via breastmilk.

The large-scale study, “Pharmacokinetics and Safety of Commonly Used Drugs in Lactating Women and Breastfed Infants”, is being funded by the National Institutes of Health (NIH) in the United States.

Dr. Chan, Site Principle Investigator, says that BCWH was contacted as a potential site for the study being led by the Pediatric Trials Network (PTN), and secured its position as one of four Canadian sites due to its adjacency to BC Children’s Hospital (BCCH), its impressive breastfeeding rate (72.4%), and the volume of pregnant women with medical disorders on medications who could be potentially eligible to participate.

“Often when women are pregnant and they have to be on medications for their medical conditions there’s this conflict [of] whether they should take it or not,” says Dr. Chan. “What [we’re] looking at specifically is more the breastfeeding piece, so that women can be better counselled with respect to those medications that they take for breastfeeding.”

When new medications are released to the market they are not tested in pregnant or breastfeeding women, despite the many medical conditions which require their use throughout pregnancy.  Currently safety information for these drugs’ use during pregnancy and breastfeeding is only obtained through observation of use across large cohorts.

This study will help to bridge this knowledge gap by looking at how much a drug is transferred from mother to child during breastfeeding to help assess the safety of a medication.  The team will begin focusing on ten drugs commonly used within the organization, including antihypertensives, antibiotics, commonly used antidepressants, diabetic medications, and drugs that are used to stop bleeding, and will continue to expand the list of drugs, so long as funding exists.

“To successfully recruit and participate in this study really requires cooperation across the whole organization,” Dr. Chan says. “Participation in this study will move us closer to developing a teratogen information service in BC, where women can call for drug safety information during pregnancy and breastfeeding.”

This study will be unique because it will require collaboration across BCWH and BCCH between obstetric medicine, pharmacists, pediatricians and NICU physicians, as well as the on-site lab and pathology department.

Recruitment is expected to begin within the next two or three months.

Read more about Dr. Chan here.

Read more about the study here.

Researcher spotlight: Meet Dr. Sarah Munro

Dr. Munro is a WHRI researcher and implementation scientist doing work on access to contraception and informed, shared decision-making. She holds a joint post-doctoral position between the Contraception and Abortion Research Team (CART) and the Dartmouth Institute for Health Policy and Clinical Practice (TDI).

Dr. Sarah Munro headshotChoosing the right form of contraception is not always an easy task. Misinformation, high costs, or familiarity with a particular method are all reasons a patient may not consider different options for contraception. This gap is what led Dr. Munro, principal investigator Dr. Rachel Thompson, and the team at Dartmouth to develop and evaluate a set of tools called Right For Me, which supports patients to make informed, shared decisions for contraceptive methods. The tools are comprised of a collection of decision aid handouts, a video and prompt card outlining three key questions to ask during clinic visits, and training for healthcare providers. The tools aim to aid patients in selecting the form of contraception that best matches their values and needs.

The Right for Me study was conducted with funding from the Patient Centered Outcomes Research Institute (PCORI), which focuses on research that directly involves and benefits patients. Patient partners from diverse backgrounds collaborated throughout the research process – from identifying which outcomes to measure, to creating a video summary of the study protocol. Dr. Munro recently completed the qualitative evaluation of the implementation of Right for Me. Stay posted for her publication in the coming months!

Moving forward Dr. Munro will be adapting the Right For Me tools for a Canadian audience. She will continue working with Dr. Wendy Norman and other researchers at WHRI and across the province to implement these successful tools to support shared decision-making for patients and providers involved in maternal, sexual, and reproductive healthcare.

Learn more about RightForMe.org.

World Contraception Day 2018

This year World Contraception Day falls in the middle of the inaugural Gender Equality Week in Canada. In honour of both these awareness initiatives, we are featuring the CART program and its research, and highlighting the impact access to contraception has on gender equality. Read our Q&A with the team here!

    1. What is the CART program?

The Contraception and Abortion Research Team (CART) is a national, interdisciplinary, cross-sectoral collaboration performing research to support health services and policies to ensure equitable access to high-quality family planning knowledge, methods and services for people throughout Canada. The overarching goal of the team is to support Canadians to plan and space their pregnancies. The team was founded and led by Dr. Wendy Norman, an Associate Professor at UBC Department of Family Practice and the CIHR-PHAC Chair in Family Planning Public Health Research. 

    1. Why is it important to continue research around contraception?

In Canada, approximately half of all pregnancies are unintended. Access to highly effective contraception is important to Canadians who typically spend 3 or fewer years pregnant or attempting to become pregnant and more than 30 years attempting to avoid pregnancy. Improving access to contraception, especially long-acting reversible contraception, has been acknowledged to be one of the top public health advances that can lead to population-level gains, and yet there are still many obstacles, such as knowledge, access, and affordability of highly effective contraception, that need to be studied, addressed and mitigated. 

    1. What are some of the ways that access to contraception contributes to gender equality?

Disadvantaged and vulnerable populations, particularly youth, those of low socio-economic status or those subjected to Adverse Childhood Experiences (ACES) and/or intimate partner violence, those living with substance use and mental health disorders, residents in rural and remote communities, and immigrants are over-represented among those with unintended pregnancy. Lack of knowledge of highly effective contraception, unaffordability and limited access to services all contribute to the societal inequalities of access to contraception, which in turn impact the health of Canadians. 

    1. How might the CART research impact women and their families?

One major theme of the CART research program is Health Policy Research. We aim to effectively translate research evidence to support health policy that will improve access to family planning knowledge, methods and services. 

One example is the BC wide Safe Methods at the Right Time program (SMART Program) providing free contraception at the time of abortion implemented in 2016. This policy decision was directly based on research provided by Dr. Norman and the CART collaborators to the BC Ministry of Health. The proposal used data from two CART RCTs in rigorous simulation modelling to demonstrate that subsidy for highly effective contraception at the time of abortion can save government costs and improve health outcomes. 

Similar CART studies have been undertaken to support decision making on the cost-effectiveness of government subsidy to provide free contraception for all women.

Gender Equality Week 2018

September 23rd, 2018 marks the start of the inaugural Gender Equality Week in Canada.

take action for changeThe week was first introduced earlier this year by the Honourable Maryam Monsef, Minister of Status of Women “to celebrate the legacy of our progress while reflecting on the necessary work that remains to ensure all Canadians can reach their full potential, regardless of gender.” (Status of Women Canada)

While the Canadian Government’s campaign aims to shed light on the ways which #EveryoneBenefits from gender equality, the Women’s Health Research Institute (WHRI) will use this week as an opportunity to reflect on gender inequalities existing within health research.

Around the world women are more likely to die from largely preventable illnesses, like lung cancer, or HPV-related cancer. They also bear a higher burden of chronic illness than men, experience higher levels of disability, and are twice as likely to suffer from anxiety and depression. However, despite these alarming disparities, until recently, much research aimed at understanding women’s conditions did not include only women in research trials. Women’s health research projects are necessary in order to understand differences between women, across sexes, and across the lifespans.

Our recent publication, The BC Women’s Health Research Agenda provides insight into the core challenges perpetuating these inequalities, and details tangible steps that researchers can take to help address them.

Throughout the week we will be discussing gender inequalities in health research across our social media, and encourage you to join the conversation. Follow us @womensresearch on Twitter and Instagram, and let us know how you will #TakeActionForChange to move the needle on women’s health research.

World Alzheimer’s Day

World Alzheimer’s Day takes place every September 21st to raise greater awareness of Alzheimer’s Disease.

By Paula Duarte-Guterman and Liisa Galea

Alzheimer’s Disease is a degenerative disease that results in cognitive decline, a progressive loss of brain cells, and the addition of pathological features in the brain. One of the areas first affected by Alzheimer’s Disease is the hippocampus, a brain area important for the formation of new memories. Women are disproportionately affected by Alzheimer’s Disease compared to men, with two-thirds of Alzheimer’s Disease patients being women, although this demographic may be changing with recent studies indicating that the sex disparity is more evident in European compared to North American populations. More importantly, women with Alzheimer’s Disease also show greater neuropathology and cognitive decline than men with Alzheimer’s Disease and women caregivers share a greater burden care than men caregivers. Women’s health researchers in this area are interested in understanding why Alzheimer’s Disease impacts women more so than men. They investigate how unique female experiences such as pregnancy, motherhood, and menopause may be important for brain health and disease. There is increasing evidence that women are more likely to develop Alzheimer’s Disease when they have a previous history of multiple pregnancies. In addition, hormone levels decline around menopause and this has been proposed as an important factor in cognitive decline with aging and developing Alzheimer’s Disease. Certain hormone therapies have been associated with a reduced risk of Alzheimer’s Disease but unfortunately, this research is controversial as some studies have not found any beneficial effects of hormone therapies.

Work at UBC, with WHRI members, is exploring the effects of estrogens and reproductive experience (motherhood) on the hippocampus, the brain area that is implicated in Alzheimer’s Disease. For example, estrogens increase the production of new neurons in the hippocampus in females with a history of past pregnancies but not in females with no history of pregnancies. In their latest work, Liisa Galea and her team tested the idea whether hormone therapy would have different effects on cognition and brain function in females depending on their reproductive history. In middle aged rats, Premarin (a very commonly prescribed hormone therapy for women) improved spatial memory and reduced inflammation in females that had never mothered before but Premarin had the opposite effect in females with history of one pregnancy. This work demonstrates that hormone therapies have different effects on cognition and brain function later in life depending on reproductive history. The laboratory is continuing to assess the long term impacts of pregnancy and motherhood on the brain in both animal models and humans. Work by Teresa Liu-Ambrose indicates that women with mild cognitive impairment may have a greater benefit from physical activity on memory than men, and work is ongoing to determine what mechanisms may explain this greater benefit. These studies indicate why it is so important to fund and research the influence of Alzheimer’s Disease in both men and women to determine whether different treatments may be necessary between the sexes in order to afford the best treatments to offset this devastating disease. Research in this area will help determine what makes women more vulnerable to the impact of to Alzheimer’s Disease as they age and which treatments or combination of treatments (exercise and hormone therapies) might be beneficial depending on your reproductive history.

Relevant papers for further reading

  1. Galea LAM et al. Beyond sex differences: short and long-term implications of motherhood on women’s health. Curr Opin Physiol 06:82 (2018)
  2. Prince MJ et al. Reproductive period, endogenous estrogen exposure and dementia incidence among women in Latin America and China; A 10/66 population-based cohort study. PLoS ONE 13:e0192889 (2018)
  3. Jang H et al. Differential effects of completed and incomplete pregnancies on the risk of Alzheimer disease. Neurology 91:e643 (2018)
  4. Barha CK, Galea LAM. Motherhood alters the cellular response to estrogens in the hippocampus later in life Neurobiol Aging 32:2091 (2011)
  5. Galea LAM et al. Premarin has opposing effects on spatial learning, neural activation, and serum cytokine levels in middle-aged female rats depending on reproductive history. Neurobiol Aging 70:291 (2018)
  6. Barha CK et al. Sex difference in aerobic exercise efficacy to improve cognition in older adults with vascular cognitive impairment: secondary analysis of a randomized controlled trial. J Alzheimers Dis. 60:1397 (2017)

MSFHR 2018 Reach Award project: “Developing and disseminating an interactive menstruation (info)graphic (I’M IN)”

  1. Briefly, what research will you be disseminating with the MSFHR Reach Award?

Our WHRI study explored the meaning of wellness for women with congenital adrenal hyperplasia (CAH). We learned about many aspects of wellness by engaging with these women. Early findings from both the literature and women’s narratives highlighted, that menstrual wellness for women with CAH is constrained by ongoing menstrual taboos, similar for all women. Additional stressors include the impact of metabolic processes on menstruation, cycle variation, and the impact these have across the life course. Introducing health concepts linked to menstrual wellness (for all women who may face health challenges) as early as possible can help to reduce stigma and isolation as well as promote early body wellness conversations.

  1. How will you be disseminating it?

Specifically, we aim to build on ‘standard’ menstrual information to design a simple infographic that also lays out the important factors of concern for women with CAH. In addition, we have to begin to look at how to situate such information since across Canada we do not have clearly defined support networks for individuals with CAH. We will launch the infographic in conjunction with provincial events for example Women’s Day 2019 and use a range of interactive media approaches. Since our team is geographically dispersed, we will connect with wider audiences globally in order to receive feedback, update, and refresh out infographic.

  1. Research users are expected to play a key role in Reach Award-funded projects. How did your patient partner get involved with the project and what will their role look like within your team?

Our patient partner(s) were crucial in generating the primary study questions and also giving perspective, insight, and sharing their knowledge. They became involved via clinical networks, support and advocacy groups. Moving forward, as our partners, there is opportunity to disseminate information, co-write and update the infographic, present to a range of audiences as well as learn more about patient engagement research as active team members.

  1. Why is it important to share this research?

As the knowledge to action cycle acts as a framework, both iterative and informative, we have recognized the barriers to knowledge translation within this area. This has resulted in a range of communication challenges, complex and perhaps misjudged decision-making, and overlooked opportunities to direct research towards areas important to women with CAH. In recognizing and beginning to develop knowledge translation approaches that openly address menstrual taboo linked to gender we can energize wider community support to begin to have informal (and clinical) dialogues about the situation of menstrual experiences in diverse bodies.

  1. When/where can we expect to see your research disseminated?

You can expect to see our infographic in the public space, we aim to use multi-media, key provincial events and the powerful voice of the Public to help share our messaging. We hope, over time, the infographic will have a place in health care dialogues and our aim is to freely share with our global networks, advocacy groups, and key Canadian organizations.