First Exposure members conduct research and collaborate with other experts in the field. 80-90% of people use at least one medication during pregnancy. Unfortunately, most medications are not tested for safety in pregnancy in humans before they are released for use. Follow-up and research are essential to guide safe practice and detect potential safety concerns.
On this page you will find the research projects that we are conducting, a list of studies that are open for patient participation that are being conducted by other independent research groups, and selected publications by our team and Subject Matter Experts.
Prescriptions commonly filled during pregnancy and postpartum by people covered by the Ontario Drug Benefits (ODB) Plan
Principal Investigator: Dr. Jonathan Zipursky
Affiliations: University of Toronto, Sunnybrook Health Sciences Centre and Institute for Clinical Evaluative Sciences (ICES)
The study is determining the frequencies of prescription drug fills through ODB in pregnant people in Ontario from 2003 to 2023. We are examining prescription fills in the one year after delivery to capture drugs prescribed during lactation. The data will help inform an evidence-based approach to our drug review process and future knowledge translation activities through the First Exposure organization.
HIROC Foundation Safety Grant
Principal Investigator: Dr. Jennifer Blake
Co-Investigators: Anna Pupco, Pina Bozzo
First Exposure in partnership with The Institute for Safe Medication Practices Canada (ISMP Canada) to create a resource(s) for patients and health care providers on known and potential teratogenic medications which should be avoided during pregnancy or for which additional consultation and monitoring is advised.
The studies listed below are conducted by independent research groups currently seeking participants and is for informational purposes only. All study information is provided by the respective research groups. Participation is entirely voluntary and at your own discretion. This list does not imply any recommendation or endorsement of these studies by First Exposure or by the University of Toronto.
MotherToBaby Pregnancy Studies:
These studies aim to determine if medications/vaccines may have any effects on a pregnancy or a developing baby. They follow individuals who are being treated with the medication (as part of their already existing treatment) that is being studied, individuals with certain medical conditions and individuals without those conditions who are not taking those medications. The pregnant individuals in these studies are not asked to take any medications, beyond their regular treatment, or change their current treatments. The study follows their pregnancy until they deliver their baby, and their babies for a period of time after birth. Visit their website to see their ongoing studies MotherToBaby Studies.
Targeting Maternal Gut Microbiome to Improve Mental Health Outcomes:
Principal Investigators: Dr. Neda Ebrahimi, Dr. Sophie Grigoriadis
Institutions: Canadian College of Naturopathic Medicine and Sunnybrook Health Sciences Centre
The study will examine a combination of non-pharmacological interventions (e.g. probiotics, diet, fish oils) in currently stable pregnant women with a history of anxiety and/or depression. To learn more visit Targeting Maternal Gut Microbiome to Improve Mental Health Outcomes
Postill G, Hussain-Shamsy N, Dephoure S, Wong A, Shore EM, Cooper J, Pak N, Fahim C, Kasperavicius D, Bogler T. Evaluation of a Canadian social media platform for communicating perinatal health information during a pandemic. PLOS Digit Health. 2025;4(4):e0000802. [PMID: 40193332]. [PMC11975109].
Zipursky JS, Bogler T, Maxwell C. Glucagon-like peptide-1 receptor agonists during pregnancy and lactation. Canadian Medical Association Journal. 2024;196(43):E1413. [PMID: 39681363].
McClymont E, Atkinson A, Albert A, Av-Gay G, Andrade J, Barrett J, Bogler T, et al. Reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy in Canada: A national prospective cohort study. Vaccine. 2023;41(48):7183-91. [PMID: 37865598].
Cusimano MC, Liu J, Azizi P, Zipursky J, Sajewycz K, Sussman J, et al. Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy: A Systematic Review and Meta-analysis. Ann Surg. 2023;278(1):e147-e57. [PMID: 34966066].
Zipursky JS, Gomes T, Everett K, Calzavara A, Paterson JM, Austin PC, et al. Maternal opioid treatment after delivery and risk of adverse infant outcomes: population based cohort study. Bmj. 2023;380:e074005. [PMID: 36921977].
Zipursky J, Juurlink DN. Opioid use in pregnancy: An emerging health crisis. Obstet. 2021;14(4):211-9. [PMID: 34880933].
D’Souza R, Ashraf R, Rowe H, Zipursky J, Clarfield L, Maxwell C, et. al. Pregnancy and COVID-19: pharmacologic considerations. Ultrasound Obstet Gynecol. 2021;57(2):195-203. [PMID: 32959455]. [PMCID: PMC7537532].
Maxwell C, Alavifard S, Warner E, Barrera M, Brezden-Masley C, Colapinto N, Kassirian S, Madarnas Y, Srikala S, Tozer R, Yu J, Nulman I. Neurocognitive outcomes following fetal exposure to chemotherapy for gestational breast cancer: A Canadian multi-center cohort study. Breast. 2021;58:34-41. [PMID:33901920]. [PMC8099599].
Gubatan J, Nielsen OH, Levitte S, Juhl CB, Maxwell C, Streett SE, Habtezion A. Biologics During Pregnancy in Women With Inflammatory Bowel Disease and Risk of Infantile Infections: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2021;116(2):243-253. [PMID: 33110017].
Nielsen OH, Gubatan JM, Juhl CB, Streett SE, Maxwell C. Biologics for Inflammatory Bowel Disease and Their Safety in Pregnancy: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2020:S1542-3565(20)31281-7. [PMID:32931960].
Pfaller B, Pupco A, Leibson T, Aletaha D, Ito S. A critical review of the reproductive safety of Leflunomide. Clin Rheumatol. 2020;39(2):607-612. [PMID: 31758422].
Maxwell CV, Al-Sehli H, Parrish J, D’Souza R. Breast Cancer in Pregnancy: A Retrospective Cohort Study. Gynecol Obstet Invest. 2019;84(1):79-85. [PMID: 30219806].
Wanigaratne S, Shakya Y, Gagnon AJ, Cole DC, Rashid M, Blake J, et al. Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study. BMJ Open. 2018;8(4):e018979. [PMID: 29643152]. [PMC5898303].
Diav-Citrin O, Shechtman S, Arnon J, Wajnberg R, Borisch C, Beck E, Richardson JL, Bozzo P, Nulman I, Ornoy A. Methylphenidate in Pregnancy: A Multicenter, Prospective, Comparative, Observational Study. J Clin Psychiatry. 2016;77(9):1176-1181. [PMID: 27232650].
Di Renzo GC, Conry JA, Blake J, DeFrancesco MS, DeNicola N, et al. International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals. Int J Gynaecol Obstet. 2015;131(3):219-25. Epub 2015 Oct 1. [PMID: 26433469]. [PMC6663094].
