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

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.

Congratulations to the recipients of the UBC 2018 Faculty of Medicine Awards!

Congratulations to WHRI members Drs. Joanne Weinberg and Jehannine Austin, who were recently awarded for their work in the UBC 2018 Faculty of Medicine Awards.

The Bill and Marilyn Webber Lifetime Achievement award was given to Joanne Weinberg for a distinguished career at UBC in the areas of research, training and/or service, and Jehannine Austin was awarded for Excellence in Education and given a UBC Killam Teaching Prize.

Read the full announcement here.

MSFHR 2018 Reach Award project: #LifeAndLoveWithHIV: A social media initiative to support the sexual health needs of women living with HIV

WHRI members Drs. Angela Kaida, Lori Brotto, and Ali Carter and Margarite Sanchez are working together to create an online space for women living with HIV to reclaim their sexuality and shift the narrative from risk to pleasure. Read our Q&A with the team to learn more about this amazing project!

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

The overall purpose of our project, #LifeAndLoveWithHIV: A social media initiative to support the sexual health needs of women living with HIV, is to move research evidence, along with lived experience perspectives, about sexuality and relationships in the context of HIV directly into the hands of women living with HIV and those who love and support them. Desire, pleasure, abstinence, and love are just a few of the topics we’ll be disseminating with the MSFHR Reach Award. Much of this information comes from our own research on Women’s Sexuality, as well as women’s personal essays on the subject.

  1. How will you be disseminating it?

We believe storytelling has the potential to improve sexual health—be it knowledge, attitudes, feelings, or behaviors. We also believe in the power of stories for positive social change. To achieve this, we created a feminist magazine and blog, dedicated to building conversation and community around sexuality and relationships with HIV.

  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?

Research users came up with the idea! A group of us (some women living with HIV, some researchers) had been working together for a number of years on the Canadian HIV Women’s Sexual and Reproductive Health Study (CHIWOS). In 2018, we co-founded and launched Life and Love with HIV. Our community features six women-identifying writers from all around the world who live with HIV (USA, Canada, UK, South Africa, Kenya, and New Zealand). They are supported by three Editors, Florence Anam, Margarite Sanchez, and Dr. Allie Carter, as well as a team of resident researchers who provide the statistics and information we need to further our cause.

  1. Why is it important to share this research?

For decades, HIV research and support has focused solely on preventing disease and saving lives. Frankly, not many people have cared much about the quality of women’s sexual lives. More than 17 million women are currently living with HIV. With treatment, women can live just as long, and just as well, as those without the disease. They also have effectively no risk of sexually transmitting the virus, if they’re stable on their meds and have an undetectable viral load. In this era of amazing medical progress, we saw an opportunity to change the outdated narrative of AIDS, sickness, despair, and death, and share positive, pleasure-focused stories on life, love, and everything in between. Ultimately, the goal of our platform is to de-stigmatize and de-marginalize sexuality and relationships in the context of HIV and better support women, partners, and couples who are living with disease globally.

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

Visit and share There is a lot of content already on our website and much, much more to come!

Meet the researcher: Dr. Gillian Hanley

Dr. Hanley headshotWHRI member Dr. Gillian Hanley is a health services and health economics researcher with OVCARE.

Recently her work has involved evaluating a knowledge translation initiative which asked gynaecologists across British Columbia to consider changing their practice to include opportunistic salpingectomy to help prevent ovarian cancer.

What is your role at OVCARE, and what led you to ovarian cancer research?

I’m an Assistant Professor in Obstetrics & Gyencology and a PI with OVCARE. I became interested in ovarian cancer research after hearing about the opportunistic salpingectomy (OS) campaign that OVCARE ran and the possibilities for preventing ovarian cancer, which is a terrible disease with a very low survival rate. As it is not possible to screen for ovarian cancer, and we have made little progress in the way of treatment, prevention is our best hope!

Briefly, what is opportunistic salpingectomy and who is it for?

Opportunistic salpingectomy refers to the removal of both fallopian tubes at the time of hysterectomy or instead of tubal ligation in women seeking permanent irreversible contraception. It should be discussed with any woman who is already undergoing one of those surgeries, and involves simply removing the entirety of her fallopian tubes (the tissue or origin for most ovarian cancers).

What was the biggest challenge in evaluating a knowledge translation initiative?

The biggest challenge with evaluation has been that we really need to study this on a population-level, as ovarian cancer is a very rare disease (thankfully). Luckily we have excellent data resources in BC, but they do not always contain data on all the things we would like to know about women who have undergone OS, so we have had to find some creative solutions.

Was there anything that surprised you during the initiative or evaluation?

The incredible success of the educational campaign that Dianne Miller, Sarah Finlayson and others at OVCARE ran in 2010 was remarkable. It usually takes 17 years for a recommendation to significantly change practice. In BC, rates of OS with hysterectomy went from 8% to 75% in and rates of OS for sterilization went from 0.5% to 50% less than 5 years following the campaign. That is really remarkable.

How may these findings impact patient care?

We hope that we will soon be able to show that by implementing OS in British Columbia, we have dramatically decreased the incidence of ovarian cancer in the province. If we have successfully decreased new cases of ovarian cancer, then we know we will have saved lives.

If there was one thing you wish everyone knew about ovarian cancer, what would it be?

That we think we can prevent it.

Sex & Gender Considerations in Research

The Women’s Health Research Institute strives to create new knowledge that can inform and transform the health of women and their families. This is why we are thrilled that the Canadian Institute for Health Research (CIHR) now requires all research applicants to include considerations for sex & gender into their projects where appropriate.

But what exactly does that mean?

We attended the CIHR Sex & Gender workshop, and this is what we learned!

What is the difference between sex & gender?

  • Sex = biological characteristics
  • Gender = cultural attitudes and behaviours

Why should you include considerations for sex & gender in your research?

  • Sex and gender affect everyone
  • Women are historically under-represented in health research
  • Men’s health is not a proxy for women’s health
  • It results in better science

How can you include sex & gender considerations in your research?

  • Discuss the differences in disease prevalence
  • Discuss relevant sex & gender research gaps
  • If the objective includes both men & women, make that explicit
  • Increase the sample size to allow for reporting of sex & gender differences
  • Discuss gendered considerations in recruitment strategies
  • Add a sex & gender question on your questionnaire
  • Include sex & gender in your analysis strategy
  • Customize your KT plan by sex & gender

There are many reasons why sex & gender considerations may not be applicable to your research question, such as when studying diseases that affect only one sex, addressing a significant gender gap in research, or when the data just isn’t available.  However, a clear justification is necessary and creativity is encouraged.


By Heather Noga, Research Coordinator