• Joseph, K.S.


    Investigator, BC Children's Hospital
    Professor, UBC Department of Obstetrics & Gynecology and the School of Population and Public Health

    Degrees / Designations
    MD, PhD
    Primary Area of Research
    Healthy Starts
    Secondary Area(s) of Research
    604-875-2000 ext. 4811
    Lab Phone
    Mailing Address

    Department of Obstetrics & Gynaecology
    BC Women's Hospital & Health Centre
    Room C403 
    4500 Oak Street
    Vancouver, BC V6H 3N1

    Affiliate Websites
    Research Areas
    • Perinatal epidemiology
    • Pregnancy complications
    • Preterm birth
    • Growth restriction
    • Fetal and infant mortality
    • Serious morbidity
    Current Projects

    Natural history of pregnancy
    Despite substantial advances in obstetrics in recent decades, obstetric theory has yet to satisfactorily resolve various conundrums that plague the perinatal domain.

    Whereas the frequency of perinatal outcomes declines exponentially with increasing gestational duration, gestational age distributions in industrialized countries have ‘shifted to the left’ as a consequence of medically indicated early delivery. This is evident from recent increases in preterm birth and declines in post-term birth.

    Various other problems also plague the perinatal literature including issues related to the patterns of fetal growth restriction and the paradox of intersecting perinatal mortality curves. Fetal growth related issues are a confusing topic and this is highlighted by the disconnection between stable rates of growth restriction across gestation and the exponential decline in perinatal mortality with increasing gestational age.

    The paradox of intersecting perinatal mortality curves is another highly intriguing phenomenon, first described over 4 decades ago, which shows that perinatal death rates are lower among low birth weight fetuses/infants of smokers compared with those of non-smokers. The reverse is true at higher birth weight and the phenomenon is also seen in contrasts between singletons and twins, across parity, infant gender, country and other determinants of birth weight.

    The recent extension of the fetuses-at-risk approach to embrace all pregnancy related phenomena including birth, growth restriction and perinatal mortality/morbidity provides an explanation that resolves these various paradoxes. However, the theory remains controversial. Further work on the natural history of pregnancy and on descriptive versus causal epidemiologic models is necessary to develop a fully coherent framework that describes the natural history of pregnancy and which includes an epidemiologic justification for medically indicated early delivery.

    My colleagues and I propose to work on these issues using data from large perinatal databases including the British Columbia Perinatal Database Registry and the United States NCHS perinatal mortality datafiles. 

    Socioeconomic status and perinatal health
    Although the Canadian health care system is designed to provide accessible and universal obstetric, neonatal and pediatric care for its citizens, it is necessary to examine if all socioeconomic groups experience healthy maternal, fetal and infant outcomes. Such studies are important for identifying potential deficiencies within the health care system and for targeting vulnerable subpopulations with appropriate public health programs.

    The increasing ability to link perinatal health databases with others that contain socioeconomic information (through a highly secure and confidential process) allows such public health objectives to be met. This research will also attempt to isolate the component of perinatal health that is a consequence of the social determinants and is distinct from health care interventions.

    My colleagues and I are in the process of carrying out studies (using CIHR funding) that examine rates of labour induction, cesarean delivery, pregnancy complications, perinatal mortality, serious neonatal morbidity and infant death by family income and other indices of socioeconomic status.

    Selected Publications

    Liu S, Metcalfe A, Leon JA, Sauve R, Kramer MS, Joseph KS, Canadian Perinatal Surveillance System (Public Health Agency of Canada). "Evaluation of the INTERGROWTH-21st project newborn standard for use in Canada." PLoS One. 2017 Mar 21. PMID: 28257473

    Joseph KS. Exegesis of effect modification: biologic or spurious. Paediatr Perinat Epidemiol (in press).

    Joseph KS, Fahey TJ, Platt RW, Liston RM, Lee SK, Sauve R, Liu 5, Allen AC, Kramer MS. An alternate approach to the creation of fetal growth standards: Do singletons and twins need separate standards? Am J Epidemiol 2009;169:616-24.

    George K, Prasad J, Singh D, Minz 5, Albert DS, Muliyil J, Joseph KS, Jayaraman J, Kramer MS. Perinatal outcomes in a South Asian setting with high rates of low birth weight. BMC Pregnancy and Childbirth 2009; 9:5.

    Joseph KS. An overview of perinatal health in Canada. Canadian Perinatal Health Report, 2008 Edition. McCourt C, Young D, Lindsay J, Joseph KS, Pelletier L, Rancourt N, Sauve R, Dzakpasu S (Eds). Public Health Agency of Canada. Ottawa: Minister of Public Works and Government Services Canada, 2008.

    Joseph KS. Theory of obstetrics: An epidemiologic framework for justifying medically indicated early delivery. BMC Pregnancy Childbirth 2007;7:4.

    Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Investigation of an increase in postpartum haemorrhage in Canada. BJOG 2007; 114:751 -9.

    Kramer MS, Rouleau J, Baskett TF, Joseph KS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet 2006;368:1444-8.

    Platt RW, Joseph KS, Ananth CV, Grondines J, Abrahamowicz M, Kramer MS. A Proportional Hazards Model with Time-dependent Covariates and Time-varying Effects for Analysis of Fetal and Infant Death. Am J Epidemiol 2004;160:199-206.

    Joseph KS. Incidence-based measures of birth, growth restriction and death can free perinatal epidemiology from erroneous concepts of risk. J Clin Epidemiol 2004;57:889-97.

    Joseph KS, Young DC, Dodds L, O’Connell CM, Allen VM, Chandra 5, Allen AC. Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstet Gynecol 2003;102:791 -800.

    Joseph KS. Early and Later Gestation Outcomes: Competing Risks Across the Pregnancy Continuum. Paediatr Perinat Epidemiol. 2017 Jan PMID:28029699

    Joseph KS, Lisonkova S, Muraca GM, Razaz N, Sabr Y, Mehrabadi A, Schisterman EF. Factors Underlying the Temporal Increase in Maternal Mortality in the United States. Obstet Gynecol. 2017 Jan PMID: 27926651 

    Lisonkova S, Mehrabadi A, Allen VM, Bujold E, Crane JM, Gaudet L, Gratton RJ7, Ladhani NN, Olatunbosun OA, Joseph KS. Atonic Postpartum Hemorrhage: Blood Loss, Risk Factors, and Third Stage Management. J Obstet Bynaecol Can. 2016 Dec PMID: 27986181 

    Robertson JE, Lisonkova S, Lee T, De Silva DA, von Dadelszen P, Synnes AR, Joseph KS, Liston RM, Magee LA. Fetal, Infant and Maternal Outcomes among Women with Prolapsed Membranes Admitted before 29 Weeks GestationPloS One.2016 Dec 21;11(12):e0168285.

    Honours & Awards

    Greg Alexander Award for Advancing Public Health Knowledge through Epidemiology and Applied Research, Coalition for Excellence in Maternal and Child Health Epidemiology - September 2014

    2014 Society for Pediatric and Perinatal Epidemiologic Research (SPER) Mentoring award

    CIHR Applied Chairs in Reproductive, Child & Youth Health Services & Policy Research – Project: "Health services research for optimizing maternal, fetal and infant health" (2012-2017)

    Geoffrey C. Robinson Award of the Canadian Pediatric Society for contributions to child and youth health through research in population health, 2005

    The Peter Lougheed/CIHR New Investigator award of the Canadian Institutes of Health Research, 2002

    Research Group Members
    • Dr. Sarka Lisonkova (Post-doctoral fellow) 
    • Dr. Jennifer Hutcheon (Post-doctoral fellow)