Shiyani Balakumar, an MPH Epidemiology practicum student from the Dalla Lana School of Public Health at the University of Toronto, joined the Edwin S.H. Leong Centre for Healthy Children in May 2025. In this feature, Shiyani reflects on her practicum experience at the Centre, sharing how she applied her epidemiology training through hands-on research with the Canadian Perinatal Opioid Project, contributing to all stages of the research process from literature reviews and analysis in SAS to manuscript development.
My time at the Centre has been a great learning experience. During my practicum, I had the chance to be involved in many parts of the research process, from reviewing literature and shaping a research question to building an analysis plan, running analyses in SAS, preparing a team presentation, and now working on a first-author manuscript. Even though four months felt short, it gave me the opportunity to apply what I learned in class to an actual project.
My project focused on opioid and benzodiazepine co-prescribing during pregnancy in Ontario, examining patterns and predictors of concurrent exposure. While the risks associated with opioid use are well established in the literature, I was surprised to learn how strongly concurrent use with benzodiazepines is discouraged due to their combined effects as central nervous system depressants. Despite known risks, including overdose outside of pregnancy and potential neonatal harms, there is limited research on how these medications are prescribed together during pregnancy, particularly in Canada. Through this work, I examined prescribing trends over time and used regression analyses to identify key maternal predictors. Overall, preconception opioid use, preconception benzodiazepine use, and opioid use disorder consistently stood out as strong predictors across prescription use categories.
What made this experience especially meaningful was the people. I had the privilege of learning from supportive mentors and working alongside thoughtful and passionate colleagues, especially my supervisors, Dr. Andi Camden, Senior Research Associate, and Dr. Astrid Guttmann, Chief Science Officer and Interim Chief Executive at ICES, and Co-Director of the Edwin S.H. Leong Centre for Healthy Children. The collaborative and welcoming environment made a lasting impression and introduced me to pharmacoepidemiology. I also had the opportunity to listen in on advocacy group discussions, which made me even more proud to contribute to CPOP and its efforts to improve maternal and child health outcomes.
As I wrap up my MPH and practicum, I will continue working on my manuscript while starting a new role in pharmacoepidemiology as an Epidemiology Intern at Alexion AstraZeneca Rare Disease. I’m excited to continue growing in this field and further develop my skills in using real-world data to study medication safety, patterns of use, and health outcomes. I’m very grateful for my time at the Centre and everything it has taught me as I take this next step.
