Journal Articles

Please click on the headings below to expand the sections below to see the list of journal articles for that year.

Last updated: May 26th, 2023


1. Dewey, D, APrON Study Team, Barnieh, N., Deane, A., Giesbrecht, G., Jain, M., … & Letourneau, N. (2023). Fluoride exposure during pregnancy from a community water supply is associated with executive function in preschool children: A prospective ecological cohort study. Science of the Total Environment. Advance online publication.

2. Rouabhi, A., Husein, N., Dewey, D., Letourneau, N., Daboval, T., Oskoui, M., … & Dunbar, M.J. (accepted). Development of a bedside tool to predict the diagnosis of cerebral palsy in term-born neonates. JAMA Pediatrics. Advance online publication.

3. Irvine, N., England-Mason, G., Field, C.J., Letourneau, N., Bell, R.C., Giesbrecht, G., Kinniburgh, D.W., MacDonald, A.M., Martin, J.W., Dewey, D. and APrON Study Team. Associations between maternal folate status and choline intake during pregnancy and neurodevelopment at 3–4 years of age in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Journal of Developmental Origins of Health and Disease.

4. Donnici, C., Long, X., Reynolds, J., Giesbrecht, G.F., Dewey, D., Letourneau, N., … & Lebel, C. (2023). Prenatal depressive symptoms and childhood development of brain limbic and default mode network structure. Human Brain Mapping, 44, 2380-2394.

5. Schmidt, R.A., Wey, T.W., Harding, K.D., Fortier, I., Atkinson, S., Tough, S., … & Bocking, A. (2023). A harmonized analysis of five Canadian pregnancy cohort studies: exploring the characteristics and pregnancy outcomes associated with prenatal alcohol exposure. BMC Pregnancy and Childbirth, 23, 128.

6. Caffrey, A., Lamers, Y., Murphy, M.M., Letourneau, N., Irwin, R.E., Pentieva, K., … & McNulty, H. (2023). Epigenetic effects of folate and related B vitamins on brain health throughout life: Scientific substantiation and translation of the evidence for health improvement strategies. Nutrition Bulletin. Advance online publication. doi: 10.1111/nbu.12611


1. Pietrosanu M, Kong L, Yuan Y, Bell RC, Letourneau N, Jiang B. Associations between Longitudinal Gestational Weight Gain and Scalar Infant Birth Weight: A Bayesian Joint Modeling Approach. Entropy (Basel). 2022 Feb 2;24(2):232. doi: 10.3390/e24020232.

2. England-Mason, G., Merrill, S. M., Gladish, N., Moore, S. R., Giesbrecht, G. F., Letourneau, N., … & APrON Study Team. (2022). Prenatal exposure to phthalates and peripheral blood and buccal epithelial DNA methylation in infants: An epigenome-wide association study. Environment International163, 107183. doi: 10.1016/j.envint.2022.107183

3. Boehme, C., Moran, M., Do, V., Lasso-Mendez, J., Bell, R., Fruitman, D., & Hornberger, L. (2022). The Impact of Gestational Diabetes on the Cardiovascular Health of the Child. Canadian Journal of Cardiology38(10), S196-S197. THE TOP ABSTRACT AWARD AT THE 2022 CANADIAN CARDIOVASCULAR CONGRESS

4. Irvine, N., England-Mason, G., Field, C.J., Dewey, D., Aghajafari, F. Prenatal folate and choline levels and brain and cognitive development in children: A critical narrative review. Nutrients. 2022: 14(2):364.

5. Letourneau, N., Ali, E., Aghajafari, F., Bell, R., Deane, A., Dewey, D., … & APrON Study Team. The Alberta Pregnancy Outcomes and Nutrition Cohort Stud (APrON): Cohort profile and key findings from the first three years. BMJ Open. doi: 10.1136/bmjopen-2020-047503

6. Moore, S.R., Merrill, S.M., Sekhon, B., MacIsaac, J.L., Kobor, M.S., Giesbrecht, G.F., & Letourneau, N. (2022). Infant DNA methylation: An early indicator of intergenerational trauma? Early Human Development, 164, 105519.

7. Grisbrook, M.A., Dewey, D., Cuthbert, C., McDonald, S., Ntanda, H., Giesbrecht, G.F., & Letourneau, N. (2022). Associations among caesarean section birth, post-traumatic stress, and postpartum depression symptoms. International Journal of Environmental Research and Public Health19, 4900.

8. Komanchuk, J., Dewey, D., Giesbrecht, G. F., Hart, M., Anis, L., Ntanda, H., … & Letourneau, N. (2022). Association between maternal reflective function and preschool children’s cognitive abilities. Frontiers in Psychology13, 995426.

9. Riis, J.L., Cook, S.H., Letourneau, N., Campbell, T., Granger, D. A., & Giesbrecht, G.F. (2022). Characterizing and Evaluating Diurnal Salivary Uric Acid Across Pregnancy Among Healthy Women. Frontiers in Endocrinology13, 813564.

10. Marefi, A., Husein, N., Dunbar, M., Dewey, D., Letourneau, N., Oskoui, M., … & Shevell, M. I. (2022). Risk factors for term-born periventricular white matter injury in children with cerebral palsy: A case-control study. Neurology99, e2485-e2493.

11. Riis, J.L., Cook, S.H., Letourneau, N., Campbell, T., Granger, D.A., & Giesbrecht, G.F. (2022). Characterizing and evaluating diurnal salivary uric acid across pregnancy among healthy women. Frontiers in Endocrinology13, 813564.

12. Lee, J.B., Ntanda, H., Ross, K., & Letourneau, N. (2022). Maternal mental health, child distress and family strain during the COVID-19 pandemic: Linking the provincial longitudinal cohort with the COVID-19 Impact Survey data in Canada. International Journal of Population Data Science, 1917.


1. Vitagliano, M., Dunbar, M., Dyck Holzinger, S., Letourneau, N., Dewey, D., Oskoui, M., … & Kirton, A. (2022). Perinatal arterial ischemic stroke and periventricular venous infarction in infants with unilateral cerebral palsy. Developmental Medicine & Child Neurology, 64, 56-62.

2. Vaghef-Mehrabany, E., Thomas-Argyriou, J.C., Lewis, E.D., Field, C.J., Wang, Y., Campbell, T., … & Giesbrecht, G.F. (2021). The role of maternal nutrition during pregnancy in the intergenerational transmission of childhood adversity. Psychoneuroendocrinology, 130, 105283.

3. Potter-Dickey, A., Letourneau, N., Silveira, P.P., Ntanda, H., Giesbrecht, G.F., Hart, M., … & de Koning, A.P. (2021). Associations among parental caregiving quality, cannabinoid receptor 1 expression-based polygenic scores, and infant-parent attachment: Evidence for differential genetic susceptibility? Frontiers in Neuroscience, 15, 704932.

4. Merrill, S.M., Moore, S.R., Gladish, N., Giesbrecht, G.F., Dewey, D., Konwar, C., … & Letourneau, N.L. (2021). Paternal adverse childhood experiences: Associations with infant DNA methylation. Developmental Psychobiology, 63, e22174.

5. Merrill, S.M., Gladish, N., Fu, M.P., Moore, S.R., Konwar, C., Giesbrecht, G.F., … & Letourneau, N.L. (2021). Associations of peripheral blood DNA methylation and estimated monocyte proportion differences during infancy with toddler attachment style. Attachment & Human Development, 1-30.

6. Vaghef-Mehrabany, E., Thomas-Argyriou, J.C., Lewis, E.D., Field, C.J., Wang, Y., Campbell, T., … & Giesbrecht, G.F. (2021). The role of maternal nutrition during pregnancy in the intergenerational transmission of childhood adversity. Psychoneuroendocrinology, 130, 105283.

7. Donnici, C., Long, X., Dewey, D., Letourneau, N., Landman, B., Huo, Y., & Lebel, C. (2021). Prenatal and postnatal maternal anxiety and amygdala structure and function in young children. Scientific Reports, 11, 1-12.

8. Adhikari, K., Patten, S.B., Patel, A.B., Premji, S., Tough, S., Letourneau, N., … & Metcalfe, A. (2021). Data harmonization and data pooling from cohort studies: A practical approach for data management. International Journal of Population data Science, 6, 21.

9. Letourneau, N., McDonald, S., MacKay, L.J., Bell, R.C., Hetherington, E., Deane, A., … & Tough. S.C. (2021). Cross-sectional study protocol for the COVID-19 Impact Survey of mothers and their 7-11 year old children in Alberta, Canada. Frontiers in Psychiatry, 12, 597759.

10. Donnici, C., Long, X., Dewey, D., Letourneau, N., Landman, B., Huo, Y., & Lebel, C. (2021). Prenatal and postnatal maternal anxiety and amygdala structure and function in young children. Scientific reports, 11, 1-12. doi:10.1038/s41598-021-83249-2

11. Kar, P., Reynolds, J.E., Grohs, M.N., Bell, R.C., Jarman, M., Dewey, D., & Lebel, C. (2021). Association between breastfeeding during infancy and white matter microstructure in early childhood. bioRxiv. [Epub ahead of print]. doi:10.1101/2021.01.05.425482

12. Letourneau, N., Ntanda, H., Jong, V. L., Mahinpey, N., Giesbrecht, G., Ross, K. M., & APrON Team. (2021). Prenatal maternal distress and immune cell epigenetic profiles at 3‐months of age. Developmental Psychobiology. doi:10.1002/dev.22103

13. Liu, J., Martin, L. J., Dinu, I., Field, C. J., Dewey, D., & Martin, J. W. (2021). Interaction of prenatal bisphenols, maternal nutrients, and toxic metal exposures on neurodevelopment of 2-year-olds in the APrON cohort. Environment International, 155, 106601.

14. Scott, H. D., Buchan, M., Chadwick, C., Field, C. J., Letourneau, N., Montina, T., … & Metz, G. A. (2021). Metabolic dysfunction in pregnancy: Fingerprinting the maternal metabolome using proton nuclear magnetic resonance spectroscopy. Endocrinology, Diabetes & Metabolism, 4, e00201.


1. Khil, J., Picardo, S., Seow, C. H., Leung, Y., Metcalfe, A., Afshar, E.E., … & APrON Study Team. (2020). Physiological and psychological stress in pregnant women with quiescent inflammatory bowel disease: A pilot study using salivary biomarkers. JGH Open, 4, 692-697.

2. Giesbrecht, G.F., Letourneau, N., Dewey, D., & APrON Study Team. (2020). Latent class trajectories of infant temperament and associations with problem behavior at two years of age. Development and Psychopathology, 1-16.

3. Benischek A., Rohr C., Long X., Bray S., Dewey D., Lebel C. (2020). Pre-reading language abilities and the brain’s functional reading network in pre-schoolers. NeuroImage, 217, 116903.

4. Paniukov, D., Lebel, R. M., Giesbrecht, G., & Lebel, C. (2020). Cerebral blood flow increases across early childhood. NeuroImage, 204, 116224.

Summary coming soon!

5. Hay, R. E., Reynolds, J. E., Grohs, M. N., Paniukov, D., Giesbrecht, G. F., Letourneau, N., Dewey, D., & Lebel, C. (2020). Amygdala-Prefrontal Structural Connectivity Mediates the Relationship between Prenatal Depression and Behavior in Preschool Boys. The Journal of Neuroscience, 40(36), 6969–6977.

6. England-Mason, G., Martin, J. W., MacDonald, A., Kinniburgh, D., Giesbrecht, G. F., Letourneau, N., & Dewey, D. (2020). Similar names, different results: Consistency of the associations between prenatal exposure to phthalates and parent-ratings of behavior problems in preschool children. Environment International, 142, 105892.

7. England-Mason, G., *Liu, J., Martin, J.W., Giesbrecht, G.F., Letourneau, N., Dewey, D. the APrON Study Team. Postnatal BPA is associated with increasing executive function difficulties in preschool children. Pediatric Res, 2021. 89, 686-693. 


Bisphenols are commonly used in the manufacture of plastic products. In North America, over 90% of children and adults have detectable levels of urinary bisphenol A (BPA). Environmental health research reports that early exposure to BPA may be related to difficulties in executive function in young children, but less is known about the effects of bisphenol S (BPS). Additionally, it is not well understood if early exposure to bisphenols has different effects on executive functioning in girls and boys. The current study examined whether early bisphenol exposures were associated with changes in executive functioning in girls and boys.

Analyses showed that child sex modified the associations between maternal postnatal BPA concentrations and changes in executive function. Higher maternal postnatal BPA concentrations were related to increasing difficulties from age 2 to 4 in the executive function domains of inhibitory self-control and emergent metacognition in girls, but not boys. The other bisphenol concentrations were not associated with changes in executive functioning in girls or boys. Due to the ubiquity of BPA exposure among breastfeeding women, further research on the effects of postnatal bisphenol exposure on child cognitive development is recommended. Additional precautions to protect mothers from BPA during the postnatal period may help to reduce infants’ exposure to BPA through indirect sources, such as through breastmilk.

Abstract coming soon!

8. England-Mason, G., Grohs, M.N., Reynolds, J.E., MacDonald, A., Kinniburgh, D., Liu, J., … & APrON Study Team. (2020). White matter microstructure mediates the association between prenatal exposure to phthalates and behavior problems in preschool children. Environmental Research182, 1-12.

9. Thomas-Argyriou, J.C., Letourneau, N., Dewey, D., Campbell, T.S., Giesbrecht, G.F., & the APrON Study Team. (2020) The role of HPA-axis function during pregnancy in the intergenerational transmission of maternal adverse childhood experiences to child behaviour problems. Development and Psychopathology, 33(1), 284–300.

10. Giesbrecht, G.F., Letourneau, N., Campbell, T., Hart, M., Thomas, J.C., Tomfohr-Madsen, L., & the APrON Study Team. (2020) Parental Use of “Cry Out” in a Community Sample During the First Year of Infant Life. Journal of Developmental and Behavioural Pediatrics, 41(5), 379–387.

11. Jarman, M., Vashi, N., Angus, A., Bell, R.C., Giesbrecht, G.F., & the APrON Study Team. (2020) Development of a diet quality index to assess adherence to Canadian dietary recommendations in 3-year-old children. Public Health Nutrition, 23(3), 385-393.

12. Adhikari, K., Batten, S.B., Williamson, T., Patel, A.B., Premji, S., Tough, S., Letourneau, N., Giesbrecht, G., and Metcalfe, A. (2020) Neighbourhood socioeconomic status modifies the association between anxiety and depression during pregnancy and preterm birth: a Community-based Canadian cohort study. BMJ Open, 10(2), e031035.

Summary coming soon!

13. Adhikari, K., Batten, S.B., Williamson, T., Patel, A.B., Premji, S., Tough, S., Letourneau, N., Giesbrecht, G., and Metcalfe, A. (2020) Assessment of anxiety during pregnancy: are existing multiple anxiety scales suitable and comparable in measuring anxiety during pregnancy? Journal of Psychosomatic Obstetrics & Gynecology, 1–7.

14. Reynolds, J. E., Long, X., Paniukov, D., Bagshawe, M., & Lebel, C. (2020). Calgary Preschool magnetic resonance imaging (MRI) dataset. Data in Brief, 29, 105224.

15. Anis, L., Perez, G., Benzies, K. M., Ewashen, C., Hart, M., & Letourneau, N. (2020). Convergent validity of three measures of reflective function: Parent Development Interview, Parental Reflective Function Questionnaire, and Reflective Function Questionnaire. Frontiers in Psychology, 11, 574719.

16. Mujica, M., Lewis, E., Jacobs, R., Letourneau, N., Bell, R., Field, C., & Lamers, Y. (2020). Plasma Free Choline Concentration Did Not Reflect Dietary Choline Intake in Early and Late Pregnancy: Findings from the APrON Study. Current Developments in Nutrition, 4(Supplement_2), 1825-1825.

17. Ross, K.M., Letourneau, N., Climie, E., Giesbrecht, G., & Dewey, D. (2020). Perinatal maternal anxiety and depressive symptoms and child executive function and attention at two-years of age. Developmental Neuropsychology, 45, 380-395.

18. Manny, E., Carroll, A., Charlton, C., Robinson, J., Subbarao, P., Azad, M.B., … & Mandhane, P.J. (2020). Increased mask use and fewer gatherings associated with lower SARS-CoV-2 seropositivity among young school-age children. The Lancet. Pre-print article.


1. Long, X., Kar, P., Gibbard, B., Tortorelli, C., & Lebel, C. (2019). The brain’s functional connectome in young children with prenatal alcohol exposure. NeuroImage: Clinical, 24, 102082.

2. Ali, E., Letourneau, N., Benzies, K., Ntanda, H., Dewey, D., Campbell, T., & Giesbrecht, G. (2019). Maternal prenatal anxiety and children’s externalizing and internalizing behavioral problems: The moderating roles of maternal-child attachment security and child sex. Canadian Journal of Nursing Research. Advance online publication.

Summary coming soon!

3. Tomfohr-Madsen, L., Cameron, E. E., Dunkel Schetter, C., Campbell, T., O’Beirne, M., Letourneau, N., & Giesbrecht, G. F. (2019). Pregnancy anxiety and preterm birth: The moderating role of sleep. Health Psychology38, 1025-1035.

Summary coming soon!

4. Grohs, M.N., Reynolds J., Liu, J., Martin, J., Pollock, T., Lebel, C., Dewey, D. (2019). Prenatal and childhood bisphenol A exposure and brain structure of young children. Environmental Health, 18(1), 85.

Summary coming soon!

5. Letourneau, N., Leung, B., Ntanda, H., Dewey, D., Deane, A.J., Giesbrecht, G.F., & the APrON Study Team. (2019). Maternal and paternal perinatal depressive symptoms associate with 2- and 3-year-old children’s behaviour: findings from the APrON longitudinal study. BMC Pediatrics.

Summary coming soon!

6. Letourneau, N., Dewey, D., Kaplan, B.J., Ntanda, H., Novick, J., Thomas, J.C., Deane, A.J., Leung, B., Pon, K., Giesbrecht, G.F., & the APrON Study Team. (2019). Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex. Journal of Developmental Origins of Health and Disease 10: 88–99.

Summary coming soon!

7. Letourneau, N. L., de Koning, A. P. J., Sekhon, B., Ntanda, H. N., Kobor, M., Deane, A. J., Morin A. M., Dewey, D., Campbell, T.S., Giesbrecht, G. F. APrON Study Team. (2019). Parenting Interacts with Plasticity Genes in Predicting Behavioral Outcomes in Preschoolers. Canadian Journal of Nursing Research.

Summary coming soon!

8. McEwen, L., O’Donnell, K., McGill, M., Edgar, R., Jones, M., MacIsaac, J., . . . Reynolds. (2019). The PedBE clock accurately estimates DNA methylation age in pediatric buccal cells. Proceedings of the National Academy of Sciences of the United States of America., Proceedings of the National Academy of Sciences of the United States of America.

Summary coming soon!

9. Reardon A. J .F., Khodayari Moez E., Dinu I.,  Goruk S., Field C. J., Kinniburgh D. W.,  MacDonald A. M., Martin J. W., & the APrON Study. (2019). Longitudinal analysis reveals early-pregnancy associations between perfluoroalkyl sulfonates and thyroid hormone status in a Canadian prospective birth cohort. Environment International, Volume 129, 389-399.

Summary coming soon!

10. Reynolds, J., Grohs, M.N., Dewey, D., Lebel, C. (2019). Global and regional white matter development in early childhood. NeuroImage, 196, 49-58.

Summary coming soon!

11. Reynolds, J., Long, X., Grohs, M.N., Dewey, D., Lebel C. (2019). Structural and functional asymmetry of the language network emerge in early childhood. Dev. Cogn. Neurosci. 39, 100682.

Summary coming soon!

12. Ross, K., Thomas, J., Campbell, T., Letourneau, N., & Giesbrecht, G. (2019). Partner social support during pregnancy and the postpartum period and inflammation in 3-month-old infants. Biological Psychology, 144, 11-19.

Summary coming soon!

13. Subhan F. B., Shulman L., Yuan Y., the APrON Study Team and ENRICH, et al. (2019). Association of pre-pregnancy BMI and gestational weight gain with fat mass distribution and accretion during pregnancy and early postpartum: a prospective study of Albertan women. BMJ Open 2019;9:e026908.

Summary coming soon!

14. Thieba, C., Long, X., Dewey, D., Lebel, C. (2019). Young children in different linguistic environments: a multimodal neuroimaging study of the inferior frontal gyrus. Brain and Cognition 134, 71-79.

Summary coming soon!

15. Adhikari, K., Patten, S.B., Williamson, T., Patel, A.B., Premji, S., Tough, S., … & Metcalfe, A. (2019). Does neighborhood socioeconomic status predict the risk of preterm birth? A community-based Canadian cohort study. BMJ Open, 20, e025341.


1. Grohs, M.N., Reynolds, J., Dewey, D., Lebel C. (2018). Corpus callosum microstructure is associated with motor functioning in preschool children. NeuroImage 183 (2018) 828-735.

Summary coming soon!

2. Forbes, L.E., Graham, J.E., Berglund, C., and Bell, R.C. (2018). Dietary Change during Pregnancy and Women’s Reasons for Change. Nutrients, 10(8),1032.

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3. Jarman, M., Mathe, N., Ramazani, F., Pakseresht, M., Robson, P.J., Johnson, S.T., Bell, R.C., & the APrON and ENRICH Study Teams. (2018). Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications. Nutrients, 10(7), 914.

Summary coming soon!

4. Thomas, J.C., Magel, C., Tomfohr-Madsen, L., Madigan, S.L., Letourneau, N.L., Campbell, T.S., … & APrON Study Team. (2018). Adverse childhood experiences and HPA axis function in pregnant women. Hormones and Behavior, 102, 10-22.

Summary coming soon!

Abstract coming soon!

5. Manhas, K.P., Dodd, S.X., Page, S., Letourneau, N., Adair, C.E., Cui, X., & Tough, S. C. (2018). Sharing longitudinal, non-biological birth cohort data: A cross-sectional analysis of parent consent preferences. BMC Medical Informatics and Decision Making18, 1-11.

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6. Thieba, C., Frayne, A., Walton, M., Mah, A., Benischek, A., Dewey, D., Lebel C. (2018). Factors associated with successful MRI scanning in unsedated young children. Front Pediatr 6: 126.

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7. Walton, M., Dewey, D., Lebel, C. (2018). Brain white matter structure and language ability in preschool-aged children. Brain and language 176, 19-25.

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8. Aghajafari, F., Field, C., Weinberg, A., Letourneau, N., & the APrON Study Team. (2018). Both mother and infant require a vitamin D supplement to ensure that infants’ vitamin D status meets current guidelines. Nutrients, 10(4), E429.

Summary coming soon!

9. Lee, S., Metcalfe, A., Raman, M., Leung, Y., Aghajafari, F., Letourneau, N., … & Seow, C.H. (2018). Pregnant women with inflammatory bowel disease are at increased risk of Vitamin D insufficiency: A cross-sectional study. Journal of Crohn’s and Colitis12, 702-709.

Summary coming soon!

10. Liu, J., Wattar, N., Field, C.J., Dinu I., Dewey, D., Martin, J., & APrON Study Team. (2018). Exposure and dietary sources of bisphenol A (BPA) and BPA-alternatives among mothers in the APrON cohort study. Environment International, 119, 319-326.

Summary coming soon!

11. Aghajafari F, Letourneau N, Mahinpey N, et al. (2018). Vitamin D deficiency and antenatal and postpartum depression: a systematic review. Nutrients, 10(4): 478.

12. Thomas, J.C., Letourneau, N., Campbell, T.S., Giesbrecht, G.F., & Apron Study Team (2018). Social buffering of the maternal and infant HPA axes: Mediation and moderation in the intergenerational transmission of adverse childhood experiences. Development and Psychopathology, 30, 921-939.


1. Giesbrecht, G., Letourneau, N., & Campbell, T. (2017). Sexually dimorphic and interactive effects of prenatal maternal cortisol and psychological distress on infant cortisol reactivity. Development and Psychopathology, 29(3), 805-818.

2. Jarman, M., Bell, R.C., Nerenberg, K., Robson, P.J., & the APrON and ENRICH Study Teams. (2017). Adherence to Canada’s Food Guide Recommendations during Pregnancy. Current Developments in Nutrition,1(7):e000356.


1630 women with term, singleton pregnancies who had complete dietary, demographic, and pre pregnancy weight data were included in the analysis. Dietary assessment was done via 24 hour recalls in the second trimester using the multi pass method.

  • Adherence to CFG (Canada’s Food Guide) recommendations during the second trimester of pregnancy was low. On average women only met 3 of the 9 daily food-based recommendations specified in CFG.
  • Women who had higher levels of education and income tended to have higher CFG scores.
  • Higher LH diet scores were associated with being younger and having a higher income.
  • Women with better adherence to CFG, as represented by higher CFG scores, tended to report a lower consumption of LH foods.
  • Women who were obese pre-pregnancy had lower CFG scores and higher LH scores than did those who were normal weight.

Conclusion: Adherence to national dietary recommendations during pregnancy is low and further research is needed to determine whether low adherence is due to a lack of awareness, or if other factors are at play. In a healthcare system in which GWG guidelines are based on prepregnancy BMI, it may be necessary to tailor dietary guidelines as well.

Click here to view the full project summary poster.

3. Aghajafari, F., Field, C. J., Kaplan, B. J., Maggiore, J. A., O’Beirne, M., Hanley, D. A., & APrON Study Team. (2017). The High Prevalence of Vitamin D Insufficiency in Cord Blood in Calgary, Alberta (APrON-D Study). Journal of Obstetrics and Gynaecology Canada, 39(5), 347-353.

4. Begum Subhan, F., Colman, I., McCargar, L., Bell, R.C., & the APrON Study Team. (2017). Higher pre-pregnancy BMI and Excessive Gestational Weight Gain are Risk Factors for Rapid Weight Gain in Infants. Maternal and Child Health Journal (e-pub ahead of print, January).

5. Clayborne, Z., Giesbrecht, G.F., Bell, R., Tomfohr-Madsen, L., & the APrON Study Team. (2017). Relations between Neighbourhood Socioeconomic Status and Birth Outcomes are Mediated by Maternal Weight. Social Science & Medicine, 175 (February), 143–151.

6. Cole, L., Dewey, D., Letourneau, N., Kaplan, B. J., Chaput, K., Gallagher, C., … & Kirton, A. (2017). Clinical characteristics, risk factors, and outcomes associated with neonatal hemorrhagic stroke: a population-based case-control study. JAMA pediatrics, 171(3), 230-238.

7. Giesbrecht, G.F., Ejaredar, M., Liu, J., Thomas, J., Letourneau, N., Campbell, T., Martin, J., Dewey, D. & the APrON Study Team. (2017). Prenatal bisphenol A exposure and dysregulation of infant hypothalamic-pituitary-adrenal axis function: Findings from the APrON cohort study. Environmental Health, 16:47 (May), 1-11.

8. Letourneau, N, Kozyrskyj, A.L., Cosic, N., Ntanda, H.N., Anis, L., Hart, M.J., Campbell, T., & Giesbrecht, G.F. (2017). Maternal Sensitivity and Social Support Protect Against Childhood Atopic Dermatitis. Allergy, Asthma & Clinical Immunology, 13:26 (May), 1-14.

9. Leung, B., Letourneau, L., Bright, K., Giesbrecht, G.F., Ntanda, H., Gagnon, L. & the APrON Study Team. (2017). Appraisal of the Psychiatric Diagnostic Screening Questionnaire in a Perinatal Cohort: The APrON Study. Scandinavian Journal of Public Health, 45 (Aug), 658-665

10. Leung, B. M., Letourneau, N. L., Giesbrecht, G. F., Ntanda, H., & Hart, M. (2017). Predictors of postpartum depression in partnered mothers and fathers from a longitudinal cohort. Community mental health journal, 53(4), 420-431.

11. Long X, Benischek A, Dewey D, Lebel C. (2017) Age-related functional brain changes in preschool children. NeuroImage 155, 322-330.

12. Thomas, J.C., Letourneau, N., Bryce, C.I., Campbell, T.S., Giesbrecht, G.F. & the APrON Study Team. (2017). Biological embedding of perinatal social relationships in infant stress reactivity. Developmental Psychobiology, 59 (May), 425-435.

13. Thomas, J. C., Letourneau, N., Campbell, T. S., Tomfohr-Madsen, L., & Giesbrecht, G. F. (2017). Developmental origins of infant emotion regulation: Mediation by temperamental negativity and moderation by maternal sensitivity. Developmental psychology, 53(4), 611.


1. Aghajafari, F., Field, C.J., Kaplan, B.J., Rabi, D., Maggiore, J.A., O’Beirne, M., Hanley, D.A., Eliasziw, M., Dewey, D., Weinberg, A., Ross, S. & the APrON study Team (Giesbrecht, G.F. member). (2016). The current recommended vitamin D intake guidelines for diet and supplements during pregnancy is not adequate to achieve vitamin D sufficiency for most pregnant women, PLOS One, July, (1-14).

2. Aghajafari, F., Field, C.J., Rabi, D., Kaplan, B.J., Maggiore, J.A., O’Beirne, M., Hanley, D.A., Eliasziw, M., Dewey, D., Ross, S., & the APrON Study Team. (2016). Plasma 3-Epi-25-Hydroxycholecalciferol Can Alter the Assessment of Vitamin D Status Using the Current Reference Ranges for Pregnant Women and Their Newborns. The Journal of Nutrition.

3. Ejaredar, M., Lee, Y., Roberts, D.J., Sauve, R., Dewey, D. (2016). Bisphenol A exposure and children’s behavior:  A systematic review. J Expo Sci Environ Epidemiol. [Epub ahead of print].

4. Giesbrecht, G.F., Liu, J., Ejaredar, M., Dewey, D., Letourneau, N., Campbell, T., Martin, J., & the APrON Study Team. (2016). Urinary bisphenol A is associated with dysregulation of HPA axis function in pregnant women: Findings from the APrON cohort study. Environmental Health, 151 (November), 689-697.

5. Jarman, M., Yuan, Y., Pakseresht, M., Shi, Q., Robson, P. J., & Bell, R. C. (2016). Patterns and trajectories of gestational weight gain: a prospective cohort study. CMAJ open, 4(2), E338.


Inadequate or excessive weight gain during pregnancy increases the risk of adverse outcomes for the woman and her baby. Gaining too little weight has been associated with higher risk of being small for gestational age and infant death. Whereas gaining too much weight increases the risk of pregnancy conditions such as gestational hypertension, cesarean delivery and retaining weight after delivery in women and her infant being large for gestational age and subsequent childhood obesity.

Our observations reinforce Health Canada’s recommendations that gestational weight gain be discussed with all pregnant patients, irrespective of pre pregnancy BMI category, and that messages may need to be tailored for those in different pre pregnancy BMI categories. Our observations also suggest that these conversations need to be held early in pregnancy, when it is more feasible to provide support that may mitigate the risk of excessive or inadequate weight gain. Consideration of the average weekly rate of weight gain may be particularly important for health care providers. The rate of gestational weight gain reflects the likely trajectory of total weight gain during the pregnancy and may provide a tool to identify and provide additional support for women at risk of not meeting weight gain guidelines.

Click here to view the full project summary poster.

6. Lebel, C., MacMaster F.P., Dewey, D. (2016). Brain metabolite levels and language abilities in preschool children. Brain and behavior, 6(10).

7. Lebel, C., Walton, M., Letourneau, N., Giesbrecht, G. F., Kaplan, B. J., & Dewey, D. (2016). Prepartum and postpartum maternal depressive symptoms are related to children’s brain structure in preschool. Biological psychiatry, 80(11), 859-868.

8. Leung, B., Giesbrecht, G.F., Letourneau, N., Field, D., Bell, R., Dewey, D. & the APrON Study Team. (2016). Perinatal nutrition in maternal mental health and child development: Birth of a pregnancy cohort. Early Human Development, 93, 1-7.

9. Manhas, K.P., Page, S., Dodd, S., Letourneau, N., Ambrose, A., Cui, X., Tough, S. (2016). Parental perspectives on consent for participation in large-scale, non-biological data repositories. Life Sciences, Society and Policy, 12(1): 1-13.

10. Rash, J.A., Thomas, J.C., Campbell, T.S., Letourneau, N., Granger, D.A., Giesbrecht, G.F. & the APrON Study Team. (2016). Developmental origins of infant stress reactivity profiles: A multi-systems approach. Developmental Psychobiology, 58(July), 578-599.

11. Rouleau, C. R., Tomfohr, L. M., Campbell, T. S., Letourneau, N., O’Beirne, M., *Giesbrecht, G.F. & the APrON Study Team. (2016). The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension. Biological Psychology, 117, 32-42.


1. Ejaredar, M., Nyanza, E.C., Ten Eycke, K., Dewey, D. (2015). Phthalate exposure and children’s neurodevelopment: A systematic review. Environ Res, 2015 June 19;142:51-60 doi: 10.1016/j.envres.2015.06.014. [Epub ahead of print] Review. PMID: 26101203.

2. Giesbrecht, G.F., Bryce, C., Letourneau, N., Granger, D. & the APrON Study Team. (2015). Latent trait cortisol (LTC) during pregnancy: Composition, continuity, change, and concomitants. Psychoneuroendocrinology, 62 (August), 149-158.

3. Giesbrecht, G.F., Campbell, T., & Letourneau, N. (2015). Sexually dimorphic adaptations in basal maternal stress physiology during pregnancy and implications for fetal development. Psychoneuroendocrinology, 56, 168-178.

4. Gómez, M. F., Filed, C. J., Olstad, D. L., Loehr, S., Ramage, S., McCargar, L. J, & APrON Study Team. (2015). Use of micronutrient supplements among pregnant women in Alberta: results from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort. Maternal & Child Nutrition, 11(4), 497-510.

5. Jia, X., Pakseresht, M., Watter, N., Wildgrube, J., Sontag, S., Andrews, M., Begum Subhan, F., McCargar, L.M., Field C. & the APrON Study Team. (2015). Women who take n-3 long-chain polyunsaturated fatty acid supplements during pregnancy and lactation meet the recommended intake. Applied Physiology, Nutrition, and Metabolism, 40(5), 474-481


An overwhelming number of pregnant and lactating women in Alberta are not meeting the recommended intake of specific omega-3 fatty acids vital to their babies’ development and to their own health, according to new AFNS research.

In a study of 600 pregnant women in Edmonton and Calgary, only 27 per cent were meeting the International Society for the Study of Fatty Acids and Lipids’ recommended minimum of 200 mg per day of DHA (docosahexaenoic acid) during pregnancy. By three months postpartum, that had dropped to 25 per cent.

DHA is the major omega-3 fatty acid required during pregnancy for fetal and placental development, and is critical for infant brain development and other growth in every cell of the body. After a baby’s birth, DHA, along with two other fatty acids (known collectively as omega-3 LCPUFA) also helps babies’ health, particularly their neuro-cognitive development.

“DHA is also important to a mother’s health,” said Catherine Field, lead researcher on the study and a professor of nutrition in the Department of Agricultural, Food and Nutritional Science. “Low levels in the body have been associated with depression.”

The recommended intake of DHA during pregnancy could be met by consuming one to two portions per week of fish that are high in omega-3 fatty acids. Health Canada cites the best sources as salmon, tuna, herring and trout, and provides information on safe sources on its website.

Taking supplements also significantly improved the likelihood pregnant women would meet the recommended amounts, according to the study, which uses the large Alberta based maternal-infant birth cohort called Alberta Pregnancy Outcomes and Nutrition (APrON).

“Women who took a supplement containing DHA were 10.6 and 11.1 times more likely to meet the current EU consensus for pregnancy and postpartum respectively,” said the study. However, 44 per cent of women in the study who reported taking a supplement during pregnancy were no longer doing so at three months postpartum, which led researchers to suggest that nutritional counselling about the benefits of a supplement should extend beyond pregnancy.

6. Leung, B.M., Giesbrecht, G.F., Letourneau, N., Field, C.J., Bell, R.C., Dewey, D., & the APrON Study Team. (2015). Perinatal nutrition in maternal mental health and child development: Birth of a pregnancy cohort. Early Hum Dev. 2016 Feb;93:1-7. Epub 2015 Dec 17.

7. Leung, Y.P.Y., Kaplan, G.G., Coward, S., Tanyingoh, D., Kaplan, B.J., Johnston, D.W., Barkema, H.W., Ghosh, S., Panaccione, R., and Seow, C.H. on behalf of the Alberta IBD Consortium and the APrON Study Team. (2015). Intrapartum corticosteroid use significantly increases the risk of gestational diabetes in women with inflammatory bowel disease. Journal of Crohn’s and Colitis. [Epub ahead of print].

8. Manhas, K.P., Page, S., Dodd, S., Letourneau, N., Ambrose, A., Cui, X., & Tough S. (2015). Parent perspectives on privacy and governance for a pediatric repository of non-biological, research data. Journal of Empirical Research on Human Research Ethics, 10(1): 88-99.

9. Ramage, S., McCargar, L.J., Berglund, C. Harber, V., Bell, R.C. & the APrON Study Team. (2015). Assessment of pre-pregnancy dietary intake with a food frequency questionnaire in Alberta Women. Nutrients, 7(8), 6155-6166.

10. Rash, J., Campbell, T., Letourneau, N., Giesbrecht, G.F.* (2015). Maternal cortisol during pregnancy is related to infant cardiac vagal control. Psychoneuroendocrinology, 54( April), 78–89.

11. Tomfohr, L., Buliga, E., Campbell, T., Letourneau, N., Giesbrecht, G. (2015). Trajectories of sleep quality and associations with mood during the perinatal period. Sleep38(8), 1237-1245.

12. Velji Z, Manhas K P, Page S, et al. Using Cognitive Interviewing to Develop an Online Survey of Parent Perspectives on Data Sharing. (2015). Journal of Undergraduate Research in Alberta, 2015, 4(2).


1. Bridgman, S.L., Azad, M.B., Field, C.J., Letourneau, N., Johnston, D.W., Kaplan, B.J., Kozyrskyj, A.L. (2014). Maternal perspectives on the use of probiotics in infants: a cross sectional survey. BMC Complementary and Alternative Medicine 14:366.


Probiotics are products that can modify the tiny organisms in our digestive system, and they may be beneficial for some people. Many scientists are studying probiotics, so we wondered how much our APrON mothers knew about probiotics and their uses for themselves and their babies. Dr. Anita Kozyrskyj and her team of scientists at the University of Alberta in Edmonton asked if they could study this question with APrON.

Findings: APrON mothers with a child aged two years or younger were invited to complete a 29 item questionnaire, and 413 mothers did so. The majority (99.3%) of them had heard of probiotics and were aware that they contained live bacteria (87.0%); 89.3% had used a product containing probiotics themselves but only 50.3% had given one to their infant. Most mothers said they believed that probiotics were beneficial (73.1%) and none thought they were harmful. Over a third of mothers did not feel informed enough to make a decision on whether probiotics were safe to use in infants (36.6%).

Comment: The study demonstrated that awareness and understanding of probiotics is high among mothers in Alberta. However, there is still uncertainty regarding the benefit and safety of probiotics in infants. Further studies that demonstrate beneficial effects and safety of probiotics in healthy infants should help to answer their questions.

2. Fayyaz, F., Wang, F., Jacobs, R.L., O’Connor, D.L., Bell, R.C., Field, C.J.; & the APrON Study Team. (2014). Folate, vitamin B12, and vitamin B6 status of a group of high socioeconomic status women in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort. Applied Physiology Nutrition and Metabolism, 39: 1402–1408


Folate requirements increase during pregnancy to support the development of the infant. Although better folate status has been seen in women of child bearing age and there has been a significant decline in Neural Tube Defects (NTD) in Canada after folic acid fortification of flour in Canada in 1998, some recent studies have suggested that women may not be consuming enough of two related B vitamins, vitamin B12 and vitamin B6. This study described the status of folate, vitamin B12 and vitamin B6 status in a cohort of pregnant women. Information on the supplement use and dietary intake was collected in each trimester from the first cohort (n=599) of the APrON (Alberta Pregnancy Outcomes and Nutrition) study. Red blood cell folate (RBCF) and plasma folate, holotranscobalamin and pyridoxal 5-phosphate were measured to assess status of these nutrients. Overt folate deficiency was rare (3%) but 24% of women in their first trimester had sub-optimal RBCF concentration (< 906 nmol.L-1) which places them at risk for a deficiency. The proportion of the cohort in this category declined substantially in second (9%) and third (7%) trimesters due to the use of supplements containing folic acid. RBCF in concentrations above the normal range (>1360 nmol.L-1) were observed in approximately half of the women during each pregnancy trimester. Vitamin B12 and B6 deficiencies were also rare (<1% of the cohort). Women consuming folic acid supplements above the upper level (>1000 ug/day) had significantly higher RBCF and plasma folate concentrations. The implications of this on health are not known and requires further study. In conclusion, the prevalence of vitamin B12 and B6 deficiency was very low. A quarter of the women had sub-optimal folate status in the first trimester of pregnancy and over half the women had folate status above the normal range, suggesting that supplementation practices for this micronutrient may not be optimal in this cohort of women considered to be healthy and a low risk for nutritional deficiencies.

3. Giesbrecht, G.F., & Dewey, D. (2014). The effects of ‘does not apply’ on measurement of temperament with the Infant Behavior Questionnaire-Revised: A cautionary tale for very young infants. Early Human Development, 90(10), 627-634.


When the investigators were planning the APrON study, our first priority was to conduct good science, which usually means asking lots of questions. But close behind the desire to do good science was a concern to limit the number of questions that we ask our participants. Almost all of the questionnaires we selected are ‘standardized’, which means that they must be administered ‘as is’ in order to provide accurate data. Because the things we are studying (diet, stress, child development) change over time, we ask many of the same questions in each questionnaire so we can track changes over time.

Early on we noticed that one of our infant behaviour questionnaires had some items that didn’t seem to be relevant to very young infants. We wanted to eliminate those items to reduce the number of questions that we asked, but because the questionnaire is standardized, we couldn’t just pick and choose which items to delete. What we decided to do instead was to pay attention to the ways that parents answered this questionnaire when their infants were 3 months old and to see how those answers changed when they answered the same items at 6 months.

What we found was that parents answered ‘does not apply’ to about 22% of the items on the infant behaviour questionnaire when their infants were 3-months-old. In other words, parents were telling us that about a quarter of the items probably shouldn’t be asked about 3-month-old infants. By the time the infants reached 6 months of age, this number dropped to about 7%. We also learned something about what makes some questions difficult for parents to answer. We noticed, for example, that many of the items that parents told us didn’t apply to 3-month-old infants seemed to all be related to things like the infant’s ability to notice things in the environment.

These findings give us the information we need to select the items that can be eliminated in future studies with very young infants. We are very grateful to APrON participants who provided the information we need to help streamline this questionnaire in future studies. The results of this study, authored by APrON investigator Dr. Gerry Giesbrecht, were recently published in Early Human Development.

4. Kaplan, B.J., Geisbrecht, G.F., Leung, B.M.Y, Field, C.J., Dewey, D., Bell, R.C., Manca, D.P., O’Beirne, M., Johnston, D.W., Pop, V.J., Singhal, N., Gagnon, L., Bernier, F.P., Eliasziw, M., McCargar, L.J., Kooistra, L., Farmer, A., Cantell, M., Goonewardene, L., Casey, L.M., Letourneau, N., Martin, J.W. (2014). The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: Rationale and Methods. Maternal and Child Nutrition, 2014;10(1):44-60.


The purpose of this article was to describe the reasons for establishing the APrON cohort and the methods that we used. The rationale is based on lots of previous scientific studies on three topics: that nutrition affects mood, that some nutrients might affect the events that happen around birth, and that prenatal nutrition might also have a significant influence on how a baby’s brain develops. Because of those earlier studies, we decided to build the APrON cohort but to do a much better job of evaluating prenatal nutrition than had been done in the past. For instance, most studies asked women about what they ate on only one occasion during pregnancy. We decided to ask women every trimester and once postpartum, and also to ask them for blood samples so that we could evaluate various nutrient levels. To cover the three areas mentioned (maternal mood, birth outcomes, and infant brain development), we had to select measures that other scientists would accept. In summary, this paper reviews the literature on those three areas of maternal mood, birth outcomes and infant neurodevelopment, and presents the measures and other details of methodology.

5. Lewis, E.D., Subhan, F.B., Bell, R.C., McCargar, L.J., Curtis, J.M., Jacobs, R.L., Field, C.J. and the APrON team. (2014). Estimation of choline intake from 24 h dietary intake recalls and contribution of egg and milk consumption to intake among pregnant and lactating women in Alberta. British Journal of Nutrition, 112, 112–121.

Summary coming soon!


1. Giesbrecht, G., Campbell, T., Letourneau, N., Kaplan, B., & the APrON Study Team (2013). Advancing gestation does not attenuate biobehavioural coherence between psychological distress and cortisol. Biological Psychology 93: 45– 51.


Many people believe that a pregnant woman’s body becomes less responsive to stress as her pregnancy progresses. This reduction of her biological response to stress is thought to protect mother and fetus from exposure to too much cortisol. There is little scientific evidence, however, to support this idea. The aim of this study was to determine whether stress has different effects on a pregnant woman’s stress response at different points in pregnancy. We examined the everyday experiences of 82 women by assessing their stress and cortisol 5 times daily for 2 days in each trimester of pregnancy and found that the association between stress and cortisol was not, in fact, weakened across the course of pregnancy. The findings do not support the claim that mother and fetus are protected from the effects of stress at the end of pregnancy. This research provides important new evidence suggesting that stressful experiences during any period of pregnancy have the potential to affect fetal development. As our sample consisted mainly of women without complicated pregnancies and who reported on the ‘everyday’ stressors of life, our findings may not apply to all pregnant women. Taken together with evidence from other studies, however, this research demonstrates the need to make assessment and treatment of stress as a healthcare priority for pregnant women.

2. Giesbrecht, G.F., Granger, D., Campbell, T., Kaplan, B.J. & the APrON Study Team (2013). Salivary alpha-amylase during pregnancy: Diurnal course and associations with obstetric history, maternal characteristics and mood. Developmental Psychobiology. 55, 156-167


Salivary alpha-amylase (sAA) is an enzyme that is produced in saliva to help break down starch. Recent research has shown that levels of sAA are sensitive not only to stress but also to positive mood. This has led researchers to believe that sAA may be a useful measure of psychological arousal (how strongly you feel emotion). Very little is known about sAA during pregnancy, and especially whether it is a valid measure of psychological arousal during pregnancy. The aims of this study were to determine:

  1. the daily pattern of sAA during pregnancy,
  2. and
  3. whether positive or negative mood is associated with daily changes in sAA.

We examined the everyday experiences of 83 women by assessing their positive and negative mood and collecting sAA samples 5 times daily for 3 days in pregnancy. We found that:

  1. there was a strong daily pattern in pregnant women that is similar to the pattern in non-pregnant adults. This pattern did not change over the course of pregnancy; and
  2. both positive and negative mood were related to increases in sAA suggesting that sAA is a valid measure of psychological arousal during pregnancy.

These findings are important because they validate the use of a new tool that can be used to study the effects of psychological distress in pregnant women.

3. Giesbrecht, G.G., Poole, J., Letourneau, N., Campbell, T., Kaplan, B.J., & the APrON Study Team (2013). The buffering effect of social support on hypothalamic-pituitary-adrenal axis function during pregnancy. Psychosomatic Medicine. 2013 Nov-Dec;75(9):856-62.


Many studies have found that women who have highly supportive partners during pregnancy give birth to healthier babies than women whose partners are less supportive. For instance, social support has been associated with larger birth weight infants, fewer labor complications, and longer pregnancies. Almost nothing is known, however, about how social support changes what is happening within a mother’s body to encourage or discourage the healthy development of her baby. During pregnancy, too much cortisol, often called the ‘stress hormone’ because it increases when people are stressed, can be harmful to a baby’s development. We wondered whether levels of cortisol were different in women with lots of social support compared to women with less social support. To answer this question, we examined the everyday experiences of 82 women by assessing their negative mood and collecting cortisol samples 5 times daily for 2 days in each trimester of pregnancy. We also had them fill out a social support questionnaire during each trimester to assess their experiences of social support. We found that pregnant women who received low levels of social support release more cortisol after an episode of negative mood as compared to women who received more social support. In other words, women with highly supportive partners produced less cortisol when they were stressed compared to women with less supportive partners. This is an important finding because it suggests that social support may protect developing babies from the harmful effects of increases in cortisol that are related to negative mood.

4. Kaplan, B.J., Leung, B.M., Giesbrecht, G.F., Field, C.J., Bernier, F.P., Tough, S., Cui, X., Dewey, D., & the APrON Study Team. (2013). Increasing the quality of life from womb to grave: The importance of pregnancy and birth cohorts. Applied Physiology Nutrition and Metabolism, 38(1):85-89.


This article presents the major point in its subtitle: we wanted to write about how important it is to establish pregnancy and birth cohorts, and to track development of the babies over many years. This approach is very difficult to do for many reasons, one of which is that it can be very challenging to obtain funds for more than 3 years at a time. In this essay, we especially talked about how the new field of epigenetics requires long-term tracking of participants. Epigenetics refers to the fact that our genes are acquired at conception, but the way in which they function (how they are ‘expressed’) is influenced by environmental factors such as nutrition, stress, and exposure to toxins. So to understand epigenetic influences on development, we need to support longitudinal cohort research such as APrON.

5. Leung, B.M.Y., Kaplan, B.J., Field, C.J., Tough, S., Eliasziw, M., Gomez, M.F., McCargar, L.J., Gagnon, L., & the APrON Study Team. (2013). Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort. BMC Pregnancy and Childbirth, 13:2.


The goals of this study were to assess:

  1. is prenatal micronutrient supplementation associated with reducing the risk of postpartum depressive symptoms?
  2. what other factors may protect against or worsen the risk for symptoms of postpartum depression?

We analysed the data from the first 600 women in the APrON study. Of the 465 women who filled out the questionnaire on mood, 416 (88%) had scores indicating no depressive symptoms while 59 (12%) had scores that indicated “at least probable minor depression”.

The results revealed women with postnatal depressive symptoms were more likely to have not been born in Canada, greater number of chronic conditions, greater number of stressful life events during this pregnancy, and lower prenatal and postnatal support. As well, women with high prenatal depression scores were three to four times more likely to have postpartum depressive symptoms, while prenatal supplemental selenium decrease the risk by 25% (per 10 µg) and postnatal social support by almost 15% (statistically significant).

6. Leung, B.M.Y., McDonald, S.W., Kaplan, B.J., Giesbrecht, G.F., Tough, S.C. (2013). Comparison of sample characteristics in two pregnancy cohorts: Community-based versus population-based recruitment methods. BMC Medical Research Methodology. 2013, 13:149.


One of the biggest challenges for population health studies is this one: how do we attract people to participate in the study, and do our recruitment methods influence those who volunteer for studies like ours? Recently, we had the opportunity to compare APrON’s recruitment methods to the methods used by another Calgary-based pregnancy cohort: the All Our Babies (AOB) study. The paper we published with AOB scientists compared sample characteristics of these two unrelated pregnancy cohort studies taking place in the same city, in the same time period, but which employed different recruitment strategies. We also compared both the APrON and AOB participants to provincial and national statistics derived from the Maternity Experiences Survey (MES). The recruitment methods in which the two Calgary cohorts differed:

  • The APrON study used only community-based recruitment (e.g., posters, pamphlets, interviews with community media and face-to-face recruitment in maternity clinics). This means that APrON relied on publicity, word-of-mouth, and interviews in maternity clinics.
  • AOB used some of those methods, but they also were able to do population-based recruitment, in which Calgary Laboratory Services identified pregnant women undergoing routine laboratory testing and asked their permission to let AOB contact them. This means that AOB could reach women who might be less likely to respond to ads and posters.

As to sample characteristics, we found that the two cohorts:

  • differed in education, income, ethnicity, and foreign-born status
  • but they were similar for maternal age, body mass index, and marital status
  • That is, AOB was able to reach more of the pregnant women who were less educated, lower income, and were new immigrants — women who were less likely to respond to posters and pamphlets.

When we compared APrON and AOB women to the Maternity Experiences Survey (MES), we again found some differences:

  • The MES used a method called ‘stratified sampling’ in which they defined potential participants by province or territory, and also by the mother’s age, and they continued sampling until each level was represented in their sample based on census data.
  • Neither APrON nor AOB had the resources to do that type of stratified sampling.
  • When compared to the MES, the APrON and AOB cohorts were underrepresented in the lowest age, education, and income groups.

These findings suggest that attracting and retaining young, low resource women into urban studies about pregnancy may require alternate and innovative approaches.

7. Jessri, M., Farmer, A. P., Maximova, K., Willows, N. D., Bell, R. C., & APrON Study Team. (2013). Predictors of exclusive breastfeeding: observations from the Alberta pregnancy outcomes and nutrition (APrON) study. BMC Pediatrics 2013, 13:77.


Despite growing evidence that feeding babies only breast milk for their first 6 months is best, it is common practice in Canada for parents to introduce solid foods to their infants at an earlier age. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding at 3 and 6 months. There were 402 mothers who provided complete details at 3 months postpartum, 300 of whom stayed on to provide information at 6 months postpartum.

Even though most women (98.6%) breastfed at some point, at 3 months 54% were exclusively breastfeeding, and at 6 months only 15% did so. Mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree. First mothers were less likely to breastfeed exclusively for 6 months compared to mothers with previous children. Mothers who had a more positive attitude toward breastfeeding (determined earlier from scores on the Iowa Infant Feeding Attitude Scale) were 4 to 5 times more likely to breastfeed exclusively for 3 months. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, first time mothers may help health practitioners focus their support and education for this group.

8. Manca, D.P., O’Beirne, M., Lightbody, T., Johnston, D.W., Dymianiw, D-L., Nastalska, K., Anis, L., Loehr, S., Gilbert, A., Kaplan, B.J., & the APrON Study Team (2013). The most effective strategy for recruiting a pregnancy cohort: A tale of two cities. BMC Pregnancy and Childbirth, 13:75.


APrON evaluated all the various methods of recruitment that were followed from 2009-2012, in two very similar cities (Calgary and Edmonton). The recruitment methods we used included having research assistants in the waiting rooms of physician offices, distributing posters and pamphlets, and media coverage. What we found was that the most effective way to find potential participants for APrON was through face-to-face contact in clinics that see a large volume of women in early pregnancy. More women were recruited from Calgary, most likely because Calgary has more of the clinics that see a large volume of women in early pregnancy, whereas prenatal visits in Edmonton are distributed over many more sites.


1. Begum, F., Colman, I., McCargar, L., & Bell, R. (2012). Gestational weight gain and early postpartum weight retention in a prospective cohort of Albertan women. Journal of Obstetrics and Gynaecology Canada.J Obstet Gynaecol Can, 34(7):637-47.


Weight gain during pregnancy is a widely-used indicator of women and baby’s health during pregnancy. Health Canada updated the recommendations for healthy weight gain in pregnancy in 2010; women who enter pregnancy with a lower BMI (body mass index) are recommended to gain more weight, while those starting with a higher BMI are recommended to gain less weight. Gaining less weight than recommended can add risk for pre-term birth, while gaining more than recommended increases a woman’s risk of having complications such as an emergency c-section, having a large baby (macrosomia), hypertension in pregnancy and extra weight retention after delivery. This paper described how many APrON women adhered to Canadian guidelines for weight gain during pregnancy and also described their weight retention at about 3 months after delivery.

Here’s what we found: Most women gained more weight than is recommended. Those who started out with a higher BMI were more likely to gain more than recommended, in part because the recommendations are to gain less than those starting at a lower BMI. Women who gained more than recommended were also more likely to remain retain more weight after delivery (i.e. they lost less weight after the baby was born). Finding out that a large number of APrON women gain more than Health Canada recommends is very important because it tell us that most women (and their family members and care providers) may benefit from information and programs that support them in gaining within the healthy weight gain recommendations.

2. Giesbrecht, G.F, Campbell, T., Letourneau, N., Kooistra, L., Kaplan, B.J., & the APrON Study Team. (2012). Psychological distress and salivary cortisol covary within persons during pregnancy. Psychoneuroendocrinology, 37(2):270-279.


Stress during pregnancy is a risk factor for poor fetal outcomes, such as preterm birth. The way that maternal stress affects fetal development, however, is unclear. The goal of this study was to examine the role of maternal cortisol- known as the “stress hormone”- as a biological link between maternal stress during pregnancy and fetal development. Cortisol is an indicator of the human stress response, and high levels of cortisol during pregnancy are thought to be harmful to fetal development. We examined the everyday experiences of 83 women by assessing their stress and cortisol 5 times daily for 3 days in pregnancy and found that, on occasions when stress was greater, cortisol levels were also higher within the same individual.

To our knowledge, this is the first study to demonstrate this important link during pregnancy. These findings show that stress and cortisol are linked during pregnancy and they provide evidence suggesting that one of the ways stress during pregnancy affects fetal development is through increases in cortisol. More work needs to be done to determine what kinds of stress and what periods of pregnancy have the worst outcomes.

3. Giesbrecht, G., Letournaeau, N., Campbell, T., Kaplan, B .J. & the APrON Study Team. (2012). Affective experience in ecologically relevant contexts is dynamic, and not progressively attenuated. Archives of Women’s Mental Health. 15(6):481-485.


It has long been thought that toward the end of pregnancy, women find stressful experiences less stressful than they normally would. It is assumed that this decrease in maternal perception of stress protects the fetus from the potentially harmful effects of maternal distress on development. To examine this assumption, we used an electronic diary to record 85 women’s experiences of positive and negative emotion in everyday life, five times each day over 2 days within each trimester of pregnancy. The women also completed a questionnaire assessing depression in each trimester. We found that the second trimester appears to offer more protective advantage than the third trimester, because this is when positive emotion is at its highest and negative emotion is at its lowest. However, women who rate higher on the depression questionnaire do not seem to get the positive mood ‘boost’ in the second trimester that other women do.

These results suggest that, for non-depressed women, the second trimester of pregnancy may provide a stronger protective advantage than previous research suggests. Furthermore, this research highlights the importance of assessing mood repeatedly during pregnancy and the need for pregnant women to be aware of stressors in their lives and work to lessen stress throughout their whole pregnancy.


1. Kaplan, BJ., Giesbrecht, G.F., Shannon, S., & McLeod, K. (2011). Evaluating treatments in health care: The instability of a one-legged stool. (2011). BMC Medical Research Methodology, 11:65.

2. Leung, B.M., Kaplan, B.J., Dewey, D., Field, C.J., Farmer, A., O’Beirne, M., & Johnston, D.W. (2011). Integrating KT within a research study: The APrON Experience. Interdisciplinary Teams – Making Research Make a Difference, KT Casebook, Alberta Innovates – Health Solutions, Vol 2, pp 5-12.


Knowledge translation (KT) is about the exchange of information between those who conduct the research and those who identify the issues for research and the end users of the knowledge generated from the research. This article presented the KT issues identified within the APrON project, and the KT strategies used to inform and engage target audience on the work of APrON. APrON’s KT strategies addressed a number of the barriers to KT. The main barrier identified was how to stimulate interest and engage individuals and organizations in the project. It was recognized early in the study that no single activity or event would capture mass interest or buy-in to our KT activity. Thus, by using multiple KT tools, we have enabled APrON’s messages to reach as wide an audience as possible.

Abstract coming soon!

3. Leung, B.M., Wiens, K.P., Kaplan, B.J. (2011). Does prenatal micronutrient supplementation improve children’s mental development? A systematic review. BMC Pregnancy and Childbirth, Feb 3, 2011; 11:12.


There are lots of studies worldwide that are asking: can we improve brain development and mental function in children by enhancing maternal nutrition during pregnancy? In 2010 we decided to do a formal review of all the studies on this topic to see if there is an answer to this important question. A “systematic review” uses methods that exclude studies that were not very, very rigorous. So when we did electronic searches of the published literature from 1983 – 2010, we found >1300 articles on the topic but only 18 that met our pre-defined criteria. We found it was very difficult to make sense of those 18 studies: there were so many different nutrients studied, and so many different outcomes measured that it was hard to find a consensus. All that we could say at the end was this:

There is some evidence to support two types of prenatal supplements having some benefit for children (omega 3s, and multi-nutrients), but very little evidence for individual nutrients There should be more studies of prenatal supplements, looking at children’s mental outcome (studies such as APrON!)


1. Leung, B.M.Y., Kaplan, B.J. Perinatal depression: prevalence, risks, and the nutrition link-a review of the literature. Journal of the American Dietetic Association. 2009;109:1566-75.


This article was a review of the world scientific literature that has evaluated the association between perinatal depression and nutrition. What we found was:

  • in the population in general (not just pregnant women), many studies have shown that deficiencies of nutrients such as folate, vitamin B12, calcium, iron, selenium, zinc, and omega 3s are associated with mood problems
  • in pregnant women specifically, many studies have found low omega 3 fatty acid levels are associated with symptoms of depression

since so many pregnant women don’t consume enough of nutrients like omega 3s, B vitamins, iron, and calcium, and since pregnancy itself can deplete a woman’s nutrient reserves, we need to ensure that pregnant women are counseled about eating well and taking prenatal vitamin formulas. These are issues that are very relevant to APrON, and we plan to analyze some of the same nutrients in relationship to symptoms of depression.

If you would like a copy of the journal articles above, please contact us: