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. Merrill, S.M., Letourneau, N., Giesbrecht, G.F., Edwards, K., MacIsaac, J.L., Martin, J.W., … & APrON Study Team (accepted). Sex-specific associations between prenatal exposure to di(2-ethylhexyl) phthalate, epigenetic age acceleration, and susceptibility to early childhood upper respiratory infections. Epigenomes.

2. Lee, J. B., Ross, K. M., Ntanda, H., Fiest, K. M., & Letourneau, N. (2023). Mothers’ and Children’s Mental Distress and Family Strain during the COVID-19 Pandemic: A Prospective Cohort Study. Children. 10(11), 1725. 

3. Dewey, D., Martin, J.W., MacDonald, A.M., Kinniburgh, D.W., Letourneau, N., Giesbrecht, G.F., … & APrON Study Team (2023). Sex-specific associations between maternal phthalate exposure and neurodevelopmental outcomes in children at 2 years of age in the APrON cohort.NeuroToxicology. Advance online publication. Available at

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. Ostertag, C., Reynolds, J.E., *Kar, P., Dewey, D., Gibbard, W.B., Tortorelli, C., Lebel, C. (accepted) Arcuate Fasciculus and pre-reading language development in children with prenatal alcohol exposure. Frontiers in Neuroscience.

11. Merrill SM, Gladish N, Fu MP, Moore SR, Konwar C, Giesbrecht GF, MacIssac JL, Kobor MS, Letourneau NL. Associations of peripheral blood DNA methylation and estimated monocyte proportion differences during infancy with toddler attachment style. Attach Hum Dev. 2023 Feb;25(1):132-161. doi: 10.1080/14616734.2021.1938872.


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


High sugar levels in pregnant women are associated with both short and long-term effects in their children. This particular study aimed to investigate if high maternal sugar levels in pregnancy (gestational diabetes mellitus) alter the cardiovascular system of their affected children. In the study, there were further classifications made for children born to mothers with high sugar levels, as thus: i) those managed with diet, and ii) those managed with insulin. It was found that children born to mothers with high sugar levels had higher pulse wave velocity (a measure of stiffness) in the aorta compared to children born to mothers with normal sugar levels. The insulin-controlled group had the stiffest aortas, followed by those controlled with diet. These findings show that maternal gestational diabetes mellitus could impact the blood vessel health of the affected children, which could cause problems later on in life.

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. doi: 10.3390/ijerph19084900

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. doi: 10.3389/fpsyg.2022.995426

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.

13. Manning KY, Reynolds JE, Long X, Liera A, Dewey D, Lebel C. Multimodal brain features at 3 years of age and their relationship with pre-reading measures 1 year later. Front. Hum. Neurosci. 2022 Aug. 22. 16:965602 doi:10.3389/fnhum.2022.965602.

14. Zheng J, Reynolds JE, Long M, Ostertag C, Pollock T, Hamilton M, Dunn JF,Liu J, Martin J, Grohs M, Landman B,  Huo Y, Dewey D, Kurrasch D, Lebel C. The effects of prenatal bisphenol A exposure on brain volume of children and young mice. Environ Res. 2022; 214 (3): 114040

15. Srivastava R, Dunbar M, Shevell M, Oskoui M, Basu A, Rivkin M, Shany E, deVries LS, Dewey D, Letourneau N, Hill MD, Kirton A. Development and validation of a prediction model for perinatal arterial ischemic stroke in term neonates. JAMA Network Open, 2022 Jun 1;5(6):e2219203. doi: 10.1001/jamanetworkopen.2022.19203.

16. Ostertag C, Reynolds JE, Dewey D, Landman B, Huo Y, Lebel C. Altered gray matter development in pre-reading children with a family history of reading disorder, Dev Sc. 2022  Mar, 25(2):e13160


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.

Click here to read the summary

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.


The COVID-19 pandemic has no doubt changed family life with growing evidence showing that parents and children have been more anxious, unhappy, and stressed during the pandemic. This paper describes a study protocol to examine the impacts of the COVID-19 pandemic on family life and coping including mental health and well-being. Participants in this study are mothers from the Alberta Pregnancy Outcomes and Nutrition (APrON) study and the All Our Families (AOF) study. Mothers are asked to report on themselves, their families and AOF or APrON child and were ultimately surveyed 3 times. The first survey was completed no later than July 31, 2020. The next survey was sent out 6 months after the first report. The final survey was sent out 12 months after the first report. Survey questions asked about risk factors for coping with COVID-19 stress such as parental duties, social life changes, COVID-19 infections, financial issues, as well as protective factors for coping such as public assistance, childcare, and supportive relationships. 1756 mothers completed the initial survey. This study will help pick out factors that may ease or worsen impacts on families and suggest needed coping resources.

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.

15. England-MasonG, LiuJ, MartinJW, GiesbrechtGF, LetourneauN, DeweyD & The APrON Study Team. Postnatal BPA is associated with increasing executive function difficulties in preschool children. Pediatric Res. 2021. 89, 686-693.

16. Adhikari K, Patten SB, Williamson T, Patel AB, Premji S, Tough S, Letourneau N, Giesbrecht G, Metcalfe A. Assessment of anxiety during pregnancy: are existing multiple anxiety scales suitable and comparable in measuring anxiety during pregnancy? J Psychosom Obstet Gynaecol. 2021 Jun;42(2):140-146.

17. Thomas-Argyriou JC, Letourneau N, Dewey D, Campbell TS, Giesbrecht GS, APrON Study Team. The role of HPA-axis function during pregnancy in the intergenerational transmission of maternal adverse childhood experiences to child behavior problems. Dev Psychopathol. 2021 Feb 33 (1); 284-300.


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.


Temperament refers to the unique differences found in each person. These differences can affect our reactions to certain events. Within it, there are three broad aspects that define it even more. One aspect is called negative emotionality (NE), which describes the expression of emotions like fear or anger. Another aspect is referred to as regulatory capacity/orienting (RCO), which describes processes that could enhance or suppress how we react. The last aspect is positive affect/surgency (PAS), which can lead to positive experiences with our environment. This study seeks to find more knowledge about how these aspects develop during infancy. Findings show that each aspect has four to five distinct patterns of development for the first twelve months of an infant’s life. As well, these patterns were not linked with the sex of the infant. The study also shows that NE and RCO could predict behaviors in children. Results of this study could be very useful in future efforts to help children with behavioral problems.

3. McDonald S, Edwards S, Hetherington E, Racine N, Mueller M,McArthur BA, Madigan S, Dewey D,  Letourneau N., Tough S, Giesbrecht G. (2020). Experiences of Alberta families with young children during the COVID 19 pandemic: A descriptive study. Nursing, Nov 30.

4. 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.

Click here to read the summary

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


The brain grows and develops rapidly during childhood. To support this growth, blood and nutrients must be delivered and distributed throughout the brain. Adequate cerebral blood flow (CBF) is essential for proper brain function and development. Previous studies have shown CBF increases during infancy and decreases during adolescence, yet we did not know when the increases changed to decreases because no one had thoroughly studied CBF changes during early childhood. This study aimed to identify developmental changes of CBF and evaluate sex differences in young children 2-7 years. Arterial spin labeling, a magnetic resonance imaging (MRI) technique, was used to map age-related changes of CBF in a large longitudinal sample of 96 participants ages 2-7 years. Steady increases of CBF were found across early childhood in many different brain regions. Boys and girls showed similar age-related changes. Our results show that CBF continues to increase until at least 7 years. These changes happen alongside improvements in brain structure and function, suggesting that CBF provides ongoing support for growth, learning, and behaviour.

6. 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.

7. 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.


Phthalates are plastic chemicals that can affect the development of the nervous system during embryonic development and childhood. However, studies on the effects of prenatal exposure to phthalates on child behavior have reported mixed results. The objective of this study was to examine whether differences in study methodology, specifically different methods used to analyze phthalate levels and different measures of child behaviour problems, may be a contributor to the mixed results reported. To do this, this study used two commonly used methods of correcting for dilution and two gold standard parent-report measures of child behaviour. The results of this study confirmed that prenatal exposure to phthalates was linked to child behaviour problems, including hyperactivity, aggression, depression, and anxiety. However, the specific effects differed depending on the method of correcting for dilution that was used and the parent-rating scale of child behaviour that was looked at Future research is encouraged to consider the analytical approach used to correct for dilution and the specific child behaviour scale administered when interpreting results.

Abstract coming soon!

8. 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!

9. 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.

Corresponding author: Dr. Dewey

Behaviour and mental health problems are a leading cause of health loss among children in high income countries. Genetic factors, social determinants, and environmental factors affect the developing brain and contribute to these problems in children. Given the rapid changes in the brain, the fetal period is a critical window of susceptibility for environmental insults. Toxic environmental chemicals are receiving growing attention as their contribution is potentially preventable. One group of chemicals that are of particular concern are phthalates. Phthalates are used in plastics and solvents in a wide range of everyday products including personal care products, food packaging, and vinyl flooring. Previous studies have reported that exposure to phthalates during pregnancy is associated with behaviour problems in children. This study investigated if exposure to phthalates during the fetal period could alter the brain’s white matter in preschool children, and if these brain alterations were related to children’s behaviour. White matter contains the nerve fibres (axons) that allow different areas of the brain to talk to each other, and previous research suggests that brain alterations in white matter are related to children’s behaviour. A subset of 76 mother-child pairs from APrON residing in Calgary were included in this study. Phthalates were measured in urine samples that mothers provided in the second trimester of pregnancy. At 2 – 5 years of age, the children participated in an MRI scan at the Alberta Children’s Hospital. The mothers of the children completed the Child Behavior Checklist within 6 months of the MRI scan. The Child Behavior Checklist measured children’s internalizing (i.e., anxiety/depression, withdrawn, somatic problems, emotionally reactive) and externalizing (i.e., aggressive behaviours, attention problems) behaviour problems. We found that maternal exposure to phthalates during pregnancy was associated with children’s white matter structure, and that these brain differences may transmit the risk for behaviour problems. This was the first study in children to show that prenatal exposure to phthalates is associated with brain structure. It provides important new information on the potential effects of prenatal exposure to phthalates on children’s brains and behaviour, and preliminary evidence that supports the importance of public health interventions to limit phthalate exposure during pregnancy. Longitudinal studies that examine the relationships among prenatal and childhood exposure to phthalates and children’s behaviour are needed to determine the long-term implications for public health including the risk for mental health problems later in life.

Abstract coming soon!

10. 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.


Corresponding author: Dr. Giesbrecht

The impact of mothers’ adverse childhood experiences (ACEs) during childhood and adolescence upon the development of their children is an important research topic. These ACEs include neglect; physical, verbal, and/or sexual abuse; witnessing such abuse; parental divorce; and if a household member engaged in substance abuse, went to prison, or was mentally ill. Previous research has demonstrated that such traumatic experiences affect children’s behaviour. The goal of this study was to investigate the mechanism behind this association. A subset of 248 mother-child pairs from APrON participants residing in Calgary and Edmonton was analyzed for this study. Mothers completed a questionnaire which inquired about their ACEs from birth to 18 years of age. Mothers self-collected saliva samples on two consecutive days at 6 – 26 weeks in pregnancy (T1) and 27 – 37 weeks in pregnancy (T2) in order to measure cortisol, which the hypothalamic pituitary adrenal (HPA) axis (the body’s central stress response system) produces. Mothers were also asked about their children’s behaviour at 4 years of age. The results of this study showed that mothers’ ACEs are related to children’s behaviour, as influenced by their cortisol production during pregnancy. This is the first known study to demonstrate this relationship. Importantly, this study provides preliminary evidence towards the importance of preventing ACEs from occurring in the first place, promoting mental health interventions immediately after ACEs occur, and providing mental health interventions during pregnancy towards mothers who have been exposed to ACEs.

11. 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.

12. 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.


Corresponding author: Dr. Jarman

An important objective of the APrON study has been to investigate the diet quality of preschool children who reside in Calgary and Edmonton. APrON data for 1260 children was analyzed for this study. Mothers completed a questionnaire which inquired about children’s food and drink intakes at 3 years of age, in accordance with the four components of Canada’s Food Guide (vegetables & fruit, grain products, milk & alternatives, and meat & alternatives) and two components that represent less healthy intakes (candy/snacks and sugar-sweetened beverages), in order to provide information on diet quality. While most children met the recommendations for vegetables & fruit and meat & alternatives, fewer met the recommendations for milk & alternatives and grain products. The results of this study also recommended a reduction in children’s intake of candy/snacks and sugar-sweetened beverages. Overall, this study is valuable in highlighting the extent to which young children’s diets align with national nutrition guidelines among a representative sample of children in Alberta, and identifying areas for improvement.

13. 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.


We are trying to better understand stressors that may put pregnant women at greater risk of preterm birth (which is defined as delivery before 37 weeks). This research may offer insight into where extra supports may be needed to help expectant mothers carry their babies to term. Previous research has linked preterm birth to anxiety and depression in pregnancy. Our research looks at a cohort of pregnant women in the community to see whether women with either anxiety, depression, or with symptoms of both, had a higher likelihood of preterm birth. We also looked at how these mental health symptoms interact with the socio-economic status of the neighbourhoods where study participants live.

We found that women who suffer from anxiety and depression combined during pregnancy may be at greater risk for preterm birth, and that women with these symptoms may be at even greater risk if they live in lower-income communities. We found that anxiety and depression increased the probability of an early delivery by 1% for women in the highest-income communities, but there was a 16% increase for pregnant women with anxiety and depression living in the lowest-income communities.

Our findings suggest that communities are important to pregnant women’s health. We hope these findings will help to develop strategies that focus on early identification of anxiety and depression in pregnant patients living in lower-income communities, and supports to help them manage their symptoms and maintain better mental health during pregnancy.

14. 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.


Improving the assessment and management of anxiety symptoms during pregnancy is an important public health policy objective, with the objective of improving women’s mental health and birth outcomes. Self-reported anxiety scales are often used to screen for anxiety symptoms during pregnancy. Determining the suitability of specific anxiety scales and how they compare to each other is important, in order to guage which anxiety scales best reflect anxiety during pregnancy. Accordingly, this study administered anxiety screening scales to mothers who participated in the Alberta Pregnancy Outcomes and Nutrition (APrON) study at 27 – 42 weeks gestation and the All Our Families (AOF) study at 34 – 36 weeks gestation. The construct validity (i.e., the degree to which a test assesses what it claims to be assessing) and the convergent validity (i.e., the degree to which two measures that should be related are indeed related to each other) of these anxiety screening scales were examined. The results of this study indicated that some anxiety scales demonstrated better utility than others in assessing anxiety among pregnant women. In addition, the anxiety scales which were examined do not measure anxiety as a single dimension and are incomparable with each other. Overall, these findings could explain variations in the prevalence of anxiety during pregnancy and its impact on pregnancy outcomes and child development within the literature. Further research into the usefulesness of existing pregnancy-specific anxiety scales and the development of anxiety scales that are attentive to general and pregnancy-specific anxiety symptoms is thereby warranted.

Abstract coming soon!

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

16. 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 Psychopathology30, 921-939.

17. 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.

18. 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.

19. 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.

20. 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.

Click here to read the summary

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!


Many women experience prenatal anxiety (PA) during pregnancy, which is a sensation of stress and unease that often causes symptoms like rapid heart rate, sweat, tremors, short breath, etc. Sometimes, anxiety never fully disappears after the baby is born. Prenatal anxiety can disrupt the relationship between a parent and their child, which can lead to the children’s anxiety, depression, hyperactivity and aggression. Boys are more likely to be aggressive and hyperactive, while girls are mor likely to be anxious and depressed. However, not many studies have explored how the relationship, specifically the security of attachment between a parent and child, is associated with prenatal anxiety, as well as child behavioral problems. This research focused on two main goals: 1) Examining how the mother’s PA impacts children’s behavioural problems; and 2) Finding out if mother-child attachment quality and the child’s gender, influenced the relationship between PA and the child’s behavioral problems. Findings showed that PA predicted increased behavioural problems in children. It also found that when children were securely attached to their mother, the impact of PA on children’s behaviour diminished. The sex of the children did not affect the association between PA and children’s behaviour. Understanding the factors that contribute to PA can guide supports for pregnant women to prevent children’s behavioural problems. This study also emphasizes the risks of PA, and highlights the importance of developing a secure parent-child attachment, in order to protect the social, emotional and behavioral health of children, especially when mothers are affected by PA.

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.


Bisphenol A (BPA) is a chemical that is commonly used in the production of plastics, such as food packaging and children’s toys. Studies have reported that early exposure to BPA in children is associated with negative health outcomes including anxiety and depression as well as attention problems. However, the effects of BPA on the physical structure of the brain have not been studied. The goal of this APrON study is to investigate the relationship between BPA exposure during pregnancy and early childhood, and children’s brain and behaviour. It is particularly important to understand the health implications of BPA exposure given that children are exposed to this chemical on a daily basis during all stages of development. In this APrON study, parents will complete urine sampling during their second trimester of pregnancy. Once children are between 2-5 years old they will also complete urine sampling as well as non-invasive brain imaging (MRI); a caregiver report of child behaviour, known as the Child Behaviour Checklist (CBCL), will also be completed at the time of child urine sampling.

This study highlights the potential effects of chemical exposure on children’s brain and behaviour; it encourages future studies to build upon this research to provide further information on the impact that these chemicals have on child development. Finally, this project can help educate parents on how to create a safe and healthy environment for their children to thrive and grow.

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.


Citation: Letourneau, N. L., de Koning, A. J., Sekhon, B., Ntanda, H. N., Kobor, M., Deane, A. J., … & APrON Study Team. (2019). Parenting Interacts With Plasticity Genes in Predicting Behavioral Outcomes in Preschoolers. Canadian Journal of Nursing Research, 0844562119863612. doi:

Summary: This paper provides a deep understanding of genetics and how nature and nurture work together to influence human development. Specifically, the paper explores the interaction between parent-child interaction quality and children’s genotype in predicting children’s behavioural problems. Existing research supports the notion that interactions between early exposures to stress in parenting and child genotype predicts children’s behavioral problems. Certain genotypes hint at greater differential susceptibility or plasticity to environmental stressors. Therefore, this paper uncovers the interaction between maternal–child relationship qualities (specifically, sensitivity, controlling, and unresponsiveness) and genotype in 6-month- old infants, in predicting behavioral problems when children are 24 months of age. Problems under study include internalizing (e.g. anxiety and depression) and externalizing (e.g. hyperactivity, inattention, aggression) behaviors. The authors tested the assumption that individual genotype “allelic variants” would interact with parent–child relationship quality in a differentially susceptible manner to predict behavioral outcomes. Findings show children’s genotype interacts with parenting qualities of controlling and responsiveness in parent-child interactions in predicting internalizing and externalizing behavioral problems in children. For externalizing behaviors such as aggression and inattention, children who possessed the CNR1-A plasticity allele and experienced higher caregiver controlling behavior displayed significantly more externalizing behavior, while other children who possessed the CNRI-A plasticity allele and experienced lower caregiver controlling behavior displayed significantly fewer externalizing behaviors, in a differentially susceptible manner. To summarize, parents who are emotionally engaged and supportive of their children during infancy and early life may prevent behavioral problems in their children.

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. Paniukov D, Lebel RM, Giesbrecht G, Lebel C. (2019) Cerebral blood flow increases across early childhood.

Click here to read the summary

10. 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.


Thyroid hormones are essential for proper growth and brain development of unborn children during pregnancy. During the early stages of pregnancy, the mother provides all needed thyroid hormones until the fetus develops the capability to produce hormones independently. Perfluoroalkyl acids (PFAAs) are a class of chemicals used in everyday products such as non-stick cookware, microwave popcorn bags and food take-out containers. PFAAs are often referred to as “forever chemicals” due to their resistance to breaking down in the environment. Their constant presence means we are continually exposed to these chemicals which leads to their accumulation in our blood. Studies have shown that exposure to PFAAs disrupts thyroid hormones, which are vital to normal growth and brain development of the fetus, especially during early pregnancy. This APrON study investigated the impact of exposure to PFAAs on thyroid hormone levels among Canadian mothers throughout pregnancy. Our findings were in agreement with previous studies that found specific PFAAs to influence a mothers thyroid hormones during pregnancy. However, unlike past studies that only took one sample from each mother to represent the entire pregnancy, our work considered these effects at each trimester of by taking samples throughout. By observing each trimester we identified that mothers were most vulnerable to PFAA exposure during the early stages pregnancy. This was a concerning finding given that during the first trimester the fetus is entirely reliant on the mothers thyroid hormone supply. We also found that external stressors, such as the presence of mercury in the blood, may modify or exacerbate effects from PFAAs. Our findings will help influence government regulation of chemical manufacturers to ensure the safest exposure levels of PFAAs for all Canadians. The APrON group may use these findings to educate vulnerable mothers and families about the importance of thyroid hormones for normal brain development and to provide guidance to mothers with pre-existing thyroid conditions on avoiding excessive exposure to PFAAs and other interacting chemicals that may be pose a danger during pregnancy.

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

Click here to read the summary

12. 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!

13. 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.


The goal of this study is to learn if partner social support during pregnancy relates to the inflammatory markers in 3 month old infants. Partner support was measured through surveys that were given to the mothers during pregnancy and 3 months after birth. To measure the amount of these markers in infants, blood was drawn when they were 3 months old. Partners giving ambivalent support to the mother results in a greater amount of the markers in infants. This type of support is defined as help that causes distress for the mother. It should be noted that helpful support was not related to the markers. On the other hand, support that resulted in distress caused a higher rate of a certain marker. This shows that helpful support have a lesser affect on health and well being than vexing support.

14. 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!

15. 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!

16. 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.

17. Letourneau, N., Leung, B., Ntanda, H., Dewey, D., Deane, A.J., & Giesbrecht, G.F. (2019). Maternal and paternal perinatal depressive symptoms associate with 2-and 3-year-old children’s behaviour: findings from the APrON longitudinal study. BMC Pediatrics19, 1-13.


It is common for new parents to experience pregnancy or post-birth related depressive symptoms. Many studies report that children who grow up watching their parents suffer with depressive symptoms are more likely to struggle with various behavioral, emotional, social and physical problems. Children can develop behavioral issues ranging from anxiety, depression, or be prone to aggressive and hyperactive behaviours.

The APrON study examined how parents’ depressive symptoms may negatively impact their children’s behavior. Children who develop behavioral problems may struggle with the following issues: 1) inability to deal with stress; 2) struggle to interact with people; 3) more likely to develop future mental health problems. Furthermore, the total cost to treat childhood mental disorders is estimated to be around $51 billion per year in Canada.

Four patterns of depressive symptoms among parents were analyzed during the perinatal period (first or second trimester of pregnancy and 3 months postpartum): 1) mother depressed; 2) father depressed; 3) both mother and father depressed; 4) neither mother nor father depressed. Significant associations between probable depression in both mothers and fathers and internalizing behavioural problems among children (i.e., being emotionally reactive and withdrawn) were demonstrated at 24 and 36 months of age. Significant associations were also found between probable depression in mothers and externalizing behavioural problems (i.e., aggressive behaviour, attention problems) among children.

Ultimately, the APrON study emphasized how parents play a crucial role in shaping their child’s mentality. This study can encourage new parents to nurture and pay attention to their child in order to satisfy their needs for a deep parent-to-child relationship.

18. Hay, R.E., Reynolds, J.E., Grohs, M., Paniukov, D., Giesbrecht, G.F., Letourneau, N., … & Lebel, C. (2019). Examining the relationship between prenatal depression, amygdala-prefrontal structural connectivity and behaviour in preschool children. bioRxiv, 692335.

19. Ejaredar M. Neuropsychological Outcomes of Prenatal Exposure to Phenols and Phthalates in Young Children [PhD thesis], University of Calgary, 2019.  Available from:


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.


The diet of a woman often changes with pregnancy. A good diet will improve the growth of the fetus. This means eating enough vitamins, minerals, and calories. Health Canada has suggested what foods women need to eat to help them meet demands when pregnant. This study asked women why they changed their diets while pregnant. It also wanted to see which changes these women made that helped them eat more healthy foods. It was found that women usually made around 6 changes to their diets. Women usually increased the amount of vegetables, fruits, grains, and milk/alternatives they ate. Women usually decreased the amount of meaty foods they ate. About 25 % of the women increased the amount of sweet foods and beverages they had. Women pregnant for the first time changed their diet more than those who had been pregnant before. The main reasons women eliminated foods were for the baby’s health, nausea, concern, and aversions. The main reasons women increased or added foods were due to cravings, health, enjoyment, to decrease illness, and nutrition. This showed that women were choosing to not eat foods that could be bad for the baby’s growth. It also shows that some nutrients were not taken enough with the diets chosen. Doctors need to tell families and pregnant women about the importance of having diets with lots of nutrients to help the baby’s growth.

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.


The objectives of this study were to:

  1. Derive pre-pregnancy dietary patterns for women enrolled in a prospective cohort study (Alberta Pregnancy Outcomes and Nutrition; APrON) in the province of Alberta, Canada.
  2. Describe associations between dietary patterns and socio-demographic characteristics.
  3. Describe associations between dietary patterns and pregnancy complications. 

Upon enrolment into APrON (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed “in the 12 months prior to pregnancy”. Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis.

This study adds to the growing evidence that preconception diet and lifestyle is crucial for the optimal health of the mother, and possibly her offspring, and needs to be the focus for future health interventions. Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension.

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.


Researchers require informed consent from participants before a study can begin; participants must be told what they will be doing throughout the study, and how the information collected during their participation will be used. Studies like the APrON study often follow participants for years and yield a large amount of data that is useful after the original study is completed. In this study, researchers asked parents of participants of previous longitudinal studies if and how they would like their consent to be obtained to include their child’s unidentifiable, non-biological results in future research projects. The study results show most participants supported an all-in-one consent process. Parents preferred to give consent one time, during the original consent process they would confirm whether their child’s dataset is to be used for possible future studies. Furthermore, parents agree that when the child participant is approximately 12 years old, parents should inform their child that their data is included in a database and may be used again for a different research question. Parents also stated their child should be at least 18 years old before allowing them to decide whether their data would be used in future research.

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.


Magnetic resonance imaging (MRI) is a powerful tool for studying the brain, and for diagnosing disease. However, it requires individuals to stay still for a period of time, something that can be difficult for young children. Sometimes, research centres or hospitals will train children ahead of time on a mock MRI scanner to help improve the likelihood of success.

In this study, we compared scan success (whether a child provided images) and quality (how good the images were) in children aged 2-5 years, based on whether they had mock MRI training prior to scanning. We also examined whether age, sex, and cognitive and behavioural scores predicted success or scan quality. We found no differences in scan success between participants who received mock MRI training and those who didn’t, but some MRI images of participants who underwent training were better in quality. Children with successful scans had better language and cognitive scores than the unsuccessful group. Age, sex, and behavioural scores were not associated with scan success.

Our study suggests that cognitive scores predict MRI success for young children, and that mock MRI training may improve scan quality. More research is needed to determine the extent to which mock scanner training helps, and which children would benefit the most from it.

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.

Summary coming soon!

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.


Infants who do not have enough vitamin D (VIT D) are at risk of poor bone health. Breast milk can be a crucial source of VIT D for infants who are fully or partly breastfed. VIT D content in a mother’s breast milk also depends on the VIT D in her diet. Many mothers and infants around the world do not have enough VIT D in their body, despite reporting intakes that do meet current recommendations. There have been studies on VIT D supplements for either the mother or the infant, but not for both. This study aimed to find out if both the mother and her infant need a VIT D supplement during breastfeeding. This study surveyed a group of mothers in Alberta on their diets, and then measured the VIT D levels in their infants through blood samples. The study found that 90% of the mothers reported providing daily VIT D supplements to their infants, still 25% of the infants did not have enough VIT D in their bodies. The study concluded both the infant and their breastfeeding mothers need a VIT D supplement to ensure adequate vit D for infants.

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.


Previous research has shown that non-pregnant women with inflammatory bowel disease (IBD) were more prone to vitamin D insufficiency than the general population. Furthermore, vitamin D has shown to be associated with pregnancy-related health issues. With the objective of improving the care of pregnant women with IBD, the authors of this research study compared the vitamin D status of pregnant women with and without IBD. Women who were in their second or third trimesters were included in this cross-sectional study (n = 574). Women without IBD were identified from a subset of maternal APrON participants residing in Calgary (2009 – 2010) and women with IBD were identified from the research registry of the IBD Pregnancy Clinic at the University of Calgary (2012 – 2016). Clinical characteristics, presence of vitamin D supplementation, and risk factors for vitamin D insufficiency were obtained from chart reviews and self-reported questionnaires. Pregnant women with IBD were three times the risk of being vitamin D insufficient than pregnant women without IBD, even after taking women’s ethnicity and season of the year into account. While Health Canada recommends a minimum of 400 international units (IU)/day vitamin D supplementation, women with IBD are considered at increased risk of insufficiency and are recommended to take 2000 IU/day. The majority of pregnant women with IBD did not take 2000 IU/day and of those who did, 23% with Crohn’s disease and 45% with ulcerative colitis remained vitamin D insufficient. Overall, this study implies that the existing routine recommended daily vitamin D supplementation for pregnant women may be insufficient for women with IBD. This study led to the development of an algorithm utilizing higher doses of vitamin D supplementation in pregnant women with IBD.

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.


Vitamin D is important for the health of pregnant mothers and their children. Vitamin D levels in newborns largely depend on the mother’s vitamin D levels. Our study examined vitamin D levels in mother-child pairs. We also examined how individual characteristics affected vitamin D levels. These characteristics included skin color or geographic location. 2191 women participated in the study. 92 of these participants provided blood samples. These samples were taken from the umbilical cord to measure the child’s vitamin D levels. Samples were taken at the time of delivery and were compared with the mother’s vitamin D levels. Vitamin D measurements were categorized into three groups: deficient, insufficient, and sufficient. Participants with darker skin were more likely to have insufficient or deficient levels of vitamin D. The same was true for participants living further north. Mother’s with higher levels of vitamin D also gave birth to children with higher levels. However, 80% of children and 38 % of mothers had insufficient levels of vitamin D. Women who took higher doses of vitamin D were more likely to have sufficient levels. Their children were also more likely to have sufficient levels. The currently recommended intake of vitamin D may not be enough to reach sufficient levels in the blood. These recommendations may need to be updated in the future.

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.


The quality of mother-child relationships can greatly affect childhood development. Many studies have shown a link between mother-child relationships and asthma in children. Yet, the links between these relationships and other diseases are not well known. A skin disease known as atopic dermatitis is common in children who develop asthma later in life.

The goal of this study was to examine the link between atopic dermatitis and mother-child relationships. We focused on assessing the mother’s sensitivity, responsiveness, and controlling behavior. A healthy relationship consists of high sensitivity, high responsiveness, and non-controlling behavior. We examined the link between stress and depression in mothers and AD in children. We also considered the effect of social support on the prevalence of atopic dermatitis. 242 mother-child pairs participated in the study.

The participants were recruited from various clinics and media advertisements. Mother-child relationships were observed for 5 minutes when mothers and children were playing with safe and age appropriate toys. These observations were made when children were 6 months of age. Data was also collected using questionnaires and atopic dermatitis assessed at 18 months of age.

Mothers who were more sensitive were less likely to be controlling and unresponsive. Mothers over the age of 30 were likely to display higher sensitivity. The same was true for mothers who experienced depression after pregnancy. Children were much less likely to develop atopic dermatitis when mothers were more sensitive. This was also true for mothers who were non-controlling and responsive. Yet, child atopic dermatitis was more likely when mothers also had asthma. The same was true for mothers who experienced high stress before and after pregnancy. Lastly, child atopic dermatitis was less likely when mothers received social support after pregnancy.

Programs should be implemented to improve mother-child relationships, reduce stress, and provide support for new mothers. Future studies should look to develop these programs.

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.


Emotional regulation abilities develop in early childhood. These abilities are important for promoting emotional well-being later in life. We know that these developments are influenced before, during and after pregnancy. For example, stress, depression, and anxiety in mothers can harm their child’s development. The mother’s sensitivity towards the child is also known to play a role in these developments. We studied the relationship between these factors and emotional regulation in children. 254 mother-child pairs participated in the study. The pairs were recruited from various clinics. Data was collected at four different times. These included: early pregnancy, late pregnancy, 3 months and 6 months after pregnancy. Stress, anxiety, and depression were reported using questionnaires. Saliva samples from mothers were used to measure levels of stress hormones. The tendency to react to situations in a certain way is known as temperament. The child’s temperament was recorded using reports from the mother. Mothers were observed teaching the child a new task. This was done to test the mother’s level of sensitivity. The children were given a set of tasks to complete. We observed the children’s response to stressful tasks. This was done to assess the children’s emotional regulation abilities. Attentional strategies (like shifting attention away from a stressful event) reduced negative temperaments. This was also true for self-soothing behaviors (like a child sucking on their thumb). Negative temperaments were also reduced when mothers were more sensitive towards their children. Negative temperaments increased because of anxiety during pregnancy. They were also increased because of avoidance strategies (like escaping from a stressful situation). Our findings support the idea that emotional regulation abilities depend on many factors. Programs to reduce anxiety, stress, and depression would help to improve these developments.

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.


Vitamin D is important for the overall health of humans. A lack of vitamin D in pregnant women can cause difficulties during pregnancy. The total amount of vitamin D, or the vitamin D status, is made up of different forms. Each type of form shows some of the positive impacts that vitamin D has on the body. Some forms are more active than others. When looking at the vitamin D status, we need to count the one who have more active role in the body. This study wanted to look at the amount of each form of vitamin D found in pregnant women. One vitamin D form, called 3-epi-25(OH)D3, was found to be needed in higher amounts for it to work well. It was also seen that 5 % of pregnant women and 7 % of newborns were wrongly told they had enough vitamin D because of this form. The amount of 3-epi-25(OH)D3 increased with the amount of vitamin D supplements taken. Doctors should help pregnant women pick out the right amount and type of vitamin D supplement. Also, it is important that the vitamin D status of pregnant women is measured in the right way to make sure they have sufficient amounts of it.

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].


Corresponding author: Dr. Ejaredar

This article reviews 11 other articles to show how BPA exposure affects the behaviour of children. This review article has three goals. First, Ejaredar et al wishes to determine the effects of differing BPA exposure on behaviour. The second goal is to see the adverse behaviour of children who are exposed to BPA before birth versus as a child. The last goal is to see if behaviour differs between boys and girls. The behaviours that this article refers to include some of the following: increased depression, aggression and ADHD. It is found that adverse behaviours are linked to greater exposure to BPA. Moreover, higher rates of adverse behaviours were linked to children who were exposed to BPA before birth as well as childhood. This review was unable to achieve the second goal as it is shown that both prenatal and childhood exposure to BPA are linked to adverse behaviours. Therefore, the authors of this review believe that more research needs to be done to reach a clear final answer for this goal. Finally, this review has in part achieved the third goal. BPA exposure results in both girls and boys having adverse behaviours.

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 a higher risk of being small for gestational age and infant death. Gaining too much weight increases the risk of maternal pregnancy medical conditions and childhood obesity.

Our observations reinforce Health Canada’s recommendations that gestational weight gain be discussed with all pregnant patients, regardless of pre-pregnancy body mass index (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 reduce 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).

Click here to read the summary

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.

Click here to read the summary

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.


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

Summary: The ‘Alberta Pregnancy Outcomes and Nutrition (APrON)’ study created a longitudinal pregnancy cohort to investigate the relationship between the maternal environment (e.g. nutritional status), maternal mental health status, birth outcomes, and child development. Depression during pregnancy called perinatal depression has been well studied in women, and can occur at any time in pregnancy, as well as after birth, lasting from several weeks to a year after delivery. Perinatal depression in fathers has been less studied but is a growing concern. Additionally, depression in either or both parents is considered to increase the risk of developmental problems in their children. Pregnant women 16 years or older were invited take part in the study, data were collected during pregnancy and at 3, 6, 12, 24, and 36 months after the birth of their infant. Data from mothers included information about their diet, mental and physical health, health history, and lifestyle. Additionally, women provided blood, urine, and breast milk samples . Fathers provided information about their mental and physical health status, health history, lifestyle, and saliva samples. For infants, saliva and blood were collected along with information on health, development and feeding behavior. At the end of recruitment, the APrON cohort included 2140 women, 2172 infants, and 1417 biological fathers. Stated simply, the study was initiated to better understand how perinatal environment impacts maternal mental health and child development. Indeed, mental disorders are one of the leading causes to the global burden of disease. Results from studies on the APrON cohort may have important implications for health policy and clinical practice. This study is unique with respect to the comprehensive collection of nutrition and mental health data of the family unit.

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.


Recent evidence has shown that early exposure to phthalates (a group of chemicals found in personal care products, plastics and lotions) can impact how children think and behave. To explore this idea further, we investigated the existing research on the relationship between the levels of these chemicals found in the body (which is most reliably measured through urine samples) and the resulting cognitive and behavioral outcomes in children. We narrowed our study to focus on phthalates levels found in children ages 0-12 to evaluate their intelligence and memory while observing some behaviors such as anxiety, depression, and aggression. This was accomplished by reviewing past research results and methods from numerous studies and then deciding which investigations best reflected our goals. Through our research, we found that increased phthalates levels in the body negatively affected cognitive and behavior development in children. Higher levels of phthalates resulted in lower IQ scores, more problems with attention, hyperactivity, and poorer social skills in these children. These findings show us the importance of reducing phthalates exposure in children and adults alike. Educating pregnant women about sources of phthalates and why it is important to limit exposure could help to reduce potential harmful effects on their child’s development.

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.


This study set out to determine if pregnant mothers produce different amounts of ‘stress hormones’ if they are pregnant with a female versus a male fetus. This issue is important because higher amounts of stress hormones can reduce fetal growth. But there may be sex differences in the ways stress hormones affect fetal growth because males and females have different growth strategies. Male fetuses tend to use the nutrients and resources they receive from their mother to maximize their growth. In contrast, female fetuses tend to save some resources in case they face difficult conditions in the womb. To measure stress hormones in mothers during pregnancy, we collected saliva samples four times a day over two days in both early and late pregnancy. This study found that mothers pregnant with a female produced more stress hormones compared to those pregnant with a male fetus. Furthermore, the increased levels of these substances in the mother was associated with lower birth weight of the infants. From this, we concluded that fetal sex influences the function of maternal stress systems during pregnancy, and this influence tends to match sex differences in fetal growth strategy.

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].


Citation: Leung, Y. P., Kaplan, G. G., Coward, S., Tanyingoh, D., Kaplan, B. J., Johnston, D. W., … & Seow, C. H. (2015). Intrapartum corticosteroid use significantly increases the risk of gestational diabetes in women with inflammatory bowel disease. Journal of Crohn’s and Colitis, 9(3), 223-230. doi:

Summary: Women with inflammatory bowel disease are at higher risk of adverse pregnancy outcomes. The inflammatory bowel diseases are chronic inflammatory diseases of the gastro-intestinal tract that often require medical therapy in the form of chronic immune suppression and/or surgical intervention. Consequently, pregnant women with inflammatory bowel disease face far greater challenges as compared to the average healthy pregnant woman. This paper compared the pregnancy outcomes in women with and without inflammatory bowel disease. The authors identified that women with inflammatory bowel disease were at higher risk of developing gestational diabetes, preterm birth, and cesarean section compared to the healthy age-matched population (6.9 versus 1.8%, 12.9 versus 0.3%; 43.1 versus 21.0% respectively). Women with IBD exposed to corticosteroids (e.g. prednisone) were more than 4 times more likely to develop diabetes during pregnancy than women without IBD (OR 4.5, p=0.03). The finding of a higher risk of gestational diabetes is a new finding not previously reported in the inflammatory bowel disease literature. It is recommended that women with inflammatory bowel disease who wish to conceive should be assessed for modifiable risk factors for diabetes during pregnancy, to achieve disease control with medications other than corticosteroids, and be followed closely for the development of gestational diabetes during pregnancy. This supports our present practice that women with inflammatory bowel disease should be closely monitored during their pregnancy in a center where gastroenterologists and obstetricians are familiar with managing their complex health issues.

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.


Citation: Manhas, K. P., Page, S., Dodd, S. X., Letourneau, N., Ambrose, A., Cui, X., & Tough, S. C. (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. doi:

Summary: Research data repositories are data storage centers where research data can be submitted, stored, and accessed later for purposes beyond the original intent of data collection and utilization. Research data may include both non-biological and biological data. There is an increasing interest worldwide that funders and custodians of public research encourage the sharing of research data to maximize the utility of data. Accordingly, research ethics standards recognize the need to seek informed consent when research with human subjects is to be undertaken. However, when considering issues of data use and re-use, issues of confidentiality privacy and data security become important. Children, particularly those in the younger age groups, do not have the capacity to consent, and therefore their consent is sought from their parents or legal guardians. Little information is available relating to non-biological research data repositories, nor considerations regarding pediatric data storage and re-use. It is important to gather information on these parent perspectives as they relate to participant understanding of the purpose, risks, and benefits of research repositories. Therefore, this paper describes parent perspectives on children, non-biological research data repositories by using qualitative research methods. The results from the study suggest that parent research participants strongly supported the sharing of their own, and their child’s, non-biological research data. The parents opinionated that altruism (recognition of the potential for knowledge accumulation and a hope to support the greater good) has limits. Participants also expressed ongoing privacy concerns. Some participants need the assurance of compatible values between themselves and researchers or research questions. Some parents differed in opinion on how to minimize bias in the RDR governance processes. To ensure fair, efficient access processes, parents advocated for tactics that reduced bias potentials. Overall, the establishment of research data repositories is important and maximizes participants’, researchers’, and funders’ investments. Participants as data donors have concerns relating to privacy, relationships, and governance that need to be taken into consideration in research data repositories development.

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, vitamin B12, and vitamin B6 are essential for a healthy pregnancy. Yet, recent studies found a deficiency of vitamin B12 and B6 in pregnant women with high folate levels. These deficiencies may negatively affect fetal health. The goal of our study was to examine how folate levels affect vitamin B12 and B6. We also examined the relationship between folate levels and folate supplementation. 599 pregnant women participated in the study. They were assessed once during each trimester (every 3 months) of their pregnancy. Medical history was gathered during the first visit. Information about folate intake and supplementation was assessed using questionnaires. Blood samples were taken at each visit to measure levels of folate, vitamin B12 and B6. 36% of participants reported taking a folate supplement in the year before pregnancy. However, folate deficiency was only noted in 3% of participants. In the first trimester, 24% of women had folate levels which were lower than recommended. This number fell to 9% and 7% in the following trimesters. About half of the women had higher than normal folate levels in each trimester. The upper limit for folate supplementation is defined as 1000 micrograms per day. Folate levels were much higher in women who took more than, compared to less than this limit. We also found that less than 1% of the participants were deficient in vitamin B12 and B6. Overall, we found no evidence of folate causing vitamin B12 and B6 deficiencies. Participants were generally healthy with a low risk for nutritional deficiencies. Because of this, supplementation with folic acid above what is recommended by Health Canada during pregnancy may not be appropriate. Further studies are needed to explore the risks of high and low folate levels in pregnancy.

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.


Giesbrecht and Dewey’s (2014) study explored the effects of “does not apply” responses on the Infant Behaviour Questionnaire (IBQ). The IBQ was made to study differences in infant behaviour that can be watched and described by parents. In this study, parents completed a short version of the IBQ (91 questions) when their children were at 3 and 6 months of age.

They found that there were more “does not apply” responses with 3-month olds (22%) compared to 6-month olds (7%). This hints that parents found there were questions that did not apply and were not fitting to ask very young infants. These questions were usually related to the baby’s ability to be aware of things around them. “Does not apply” responses cannot be completely avoided, but researchers should be careful when explaining results received from infants at 3 months of age.

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.


Researchers have previously questioned whether an inadequate diet contributes to the development of depression in pregnant and postpartum women. There is a known relationship between food and mood in the general population. Leung and Kaplan (2009) found credible links between inadequate diet and mood for folate, vitamin B12, calcium, iron, selenium, zinc and polyunsaturated fats. However, most of these studies have excluded pregnant and postpartum women. The studies indicated both a correlation (depressed patients suffer from poor nutrition) and a causation (improved mood following supplementation). Pregnant and postpartum women are particularly vulnerable to nutrient inadequacies because of increased demands by fetal and infant growth and the mom’s productive needs. These demands change throughout pregnancy and postpartum, and if the mother is unable to provide the energy and nutrients needed through her diet, both herself and her child risk long-lasting effects. The review reported inadequate consumption of folate, B vitamins, iron, calcium and polyunsaturated fats in pregnant women. Kaplan & Leung (2009) believe that nutrient intake is associated with the risk of depression during and after pregnancy. Further research is warranted to improve nutrition intake and mental health in pregnant and postpartum women.

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