Dr. Kuruthukulangar S. Joseph

Perinatal Epidemiology
Associate Professor
Departments of Obstetrics & Gynecology and of Pediatrics
Faculty of Medicine, Dalhousie University

Current Research

My research has a broad focus within the perinatal domain. I am currently working on a project funded by the Canadian Institute of Health Research that is attempting to quantify the perinatal effects of delayed childbearing. Births to older women, particularly first births to older women, are increasingly common in industrialized countries. Our project is designed to yield information that is useful for mothers-to-be and for health care personnel involved in the care of older mothers.

Recently, I have been involved in studying the contribution of changes in maternal characteristics (such as maternal age and prepregnancy weight) and changes in obstetric practice to increases in cesarean delivery. Rates of cesarean delivery in Canada, the United States, and the United Kingdom have increased substantially in recent years despite various targets and guidelines designed to lower them. Our findings suggest that most of the recent increase in primary cesarean delivery rates is a consequence of changes in maternal characteristics (such as increases in older maternal age, prepregnancy weight, etc) and changes in obstetric practice due to maternal and fetal safety concerns.

I have also been attempting to explain why low birth weight infants have a lower death rate in the first month of life when their mothers are smokers rather than non-smokers. My colleagues and I have proposed a solution which explains these paradoxical findings and provides insights into several other issues of perinatal concern. Our findings, based on a reformulation of perinatal risk, suggest that infants of smokers in fact have higher mortality at all birth weights and all gestational ages.

Finally, I am working on a project re-examining current fetal growth standards, as these do not appear to be sufficiently empirical at the present time.

Inspirations

After graduating from medical school I worked in obstetrics and pediatrics for several years in rural South India. This background is sometimes helpful as it provides an understanding of the substantive issues in the perinatal area.

Potential impact of research

Much of the work I do has an indirect (occasionally direct) application within obstetrics and/or perinatology. The surveillance work I do in collaboration with Health Canada informs both clinical practice and public policy. I hope that my research related to intersecting mortality curves will eventually contribute to the further development of obstetric theory.

Scientific background

M.B.,B.S. (Bachelor of Medicine and Surgery, Christian Medical College, Vellore, India)
MD (Doctor of Medicine - Community Health Christian Medical College, Vellore, India)
PhD (Epidemiology and Biostatistics, McGill University, Montreal)

Awards and accomplishments (highlights)

The Clinical Scholar award from the Dalhousie University Faculty of Medicine
The Peter Lougheed/CIHR New Investigator award from the Peter Lougheed Medical Research Foundation and the Canadian Institutes of Health Research

Why Dalhousie?

I came to Dalhousie in 1999 at the invitation of Dr. Alexander Allen, Head of the Division of Neonatology, to join a newly created Perinatal Epidemiology Research Unit, a joint venture of the Department of Obstetrics & Gynecology and the Department of Pediatrics.

The unit members include Dr. Alec Allen (Director), Dr. Linda Dodds, Dr. Colleen O' Connell and myself. We have had a fair bit of success in securing research funding from the Canadian Institutes of Health Research for our work.

Being located at Dalhousie University also gives me ready access to the Nova Scotia Atlee Perinatal Database, which I use for a lot of my work. The database is a unique resource for perinatal surveillance and research.

This clinically focused, population-based information bank is maintained by the Reproductive Care Program of Nova Scotia. No other perinatal database contains as much detail or has been maintained for long as this one has.

Centres of related research

Several centres in Canada carry out research in the perinatal epidemiology. One of the most interesting and productive Canadian organizations involved in perinatal research (that I have the privilege of being involved with) is the Canadian Perinatal Surveillance System. This organization was put together by Health Canada and consists of a multidisciplinary group of experts who help carry out perinatal surveillance in Canada. Besides surveillance, this group has also been responsible for a lot of high quality research. A recent publication from this group on prenatal diagnosis and its impact on infant mortality rates in Canada was chosen by the Canadian Centre of Excellence for Early Childhood Development as one of the "Top Ten" research papers published in 2002 (see Liu et al JAMA 2002;287:1561-7).

Diversions

Gardening!

For further information, please contact Dr. Kuruthukulangar S. Joseph using the Email contact form