| 11. |
- Fadl, Helena E., 1965-, et al.
(författare)
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Trends in diabetes in pregnancy in Sweden 1998-2012
- 2016
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Ingår i: BMJ Open Diabetes Research & Care. - : BMJ Publishing Group Ltd. - 2052-4897. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Diabetes in pregnancy has been shown to increase in parallel with the increasing prevalence of obesity. In this national population-based study, we analyzed the trends for gestational diabetes mellitus (GDM), type 1 diabetes in pregnancy, and type 2 diabetes in pregnancy in Sweden between 1998 and 2012.Research design and methods: A population-based cohort study using the Swedish national medical birth registry data. The time periods were categorized into 3-year intervals and adjusted for maternal body mass index (BMI), ethnicity, and age in a logistic regression.Results: Each type of diabetes increased over the studied 15-year period. Type 1 diabetes increased by 33.2% (22.2-45.3) and type 2 diabetes by 111% (62.2-174.4) in the adjusted model. Nordic women had the highest prevalence of type 1 diabetes (0.47%) compared with other ethnic groups. The increase in GDM and, to a lesser extent, type 2 diabetes was explained by country of birth, BMI, and maternal age. The prevalence of GDM in Nordic women (0.7-0.8%) did not increase significantly over the time period.Conclusions: All types of diabetes in pregnancy increased over the 15-year time period in Sweden. Maternal pre-pregnancy BMI remains the key factor explaining the increase in GDM/type 2 diabetes. How to turn around the growing prevalence of diabetes in pregnancy, with its short-term and long-term health effects on both mother and child, requires population-based interventions that reduce the likelihood of entering pregnancy with a raised BMI.
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| 12. |
- Harreiter, Jürgen, et al.
(författare)
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Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?
- 2020
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Ingår i: Current Diabetes Reports. - : Springer. - 1534-4827 .- 1539-0829. ; 20:11
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Forskningsöversikt (refereegranskat)abstract
- Purpose of review: This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes.Recent findings: In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher "within-gender" RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities.Summary: The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.
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| 13. |
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| 14. |
- Hildén, Karin, 1978-, et al.
(författare)
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Born over 4500 g : the trends in birth trauma and mode of delivery in women with GDM and type 1 diabetes in Sweden between 1998-2012
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: We have previously shown that during the years 1998-2012, the overall incidence of LGA and birthweight decreased in both women with and without GDM in Sweden, and unpublished preliminary results show that there is a converse trend among women with T1DM. The incidence of Erbs palsy also decreased in the GDM and background population, but remained unchanged for women with T1DM. Since macrosomia is one of the most prominent risk factors for Erb´s palsy and delivery complications, the aim of the study was to evaluate trends in incidence of Erb´s palsy and delivery mode in the macrosomic group defined as weight ≥4500g and we present here our preliminary results.Method: This is a cohort study in Sweden 1998-2012 , including singleton macrosomic (≥4500 g) births. Vaginal deliveries were selected for the analyses relating to Erb´s plasy. Poisson regression was used to evaluate trends per year in both the GDM, T1DM and the background population. Results were partly stratified on BMI, to be able to detect any group differences in trends. P-value of <0.05 was considered statistically significant.Results: In total there were 57 2015 macrosomic infants, of whom (n= 36 933, 64,6%) were delivered vaginally. Of these, only 2.1 % (n=798) were vaginally delivered by women with GDM, (1.4%) type 2 diabetes (0.1%) or T1DM (0.7%). The trend in Erb´s palsy decreased significantly in the background population at a rate of OR 0.954 (95% CI 0.936-0.973) per year. For women with GDM or T1DM there was no significant change in incidence of trends over these years for Erb´s palsy. As for Caesarean section (CS) there was a significant increase per year for GDM pregnancies (OR 1.028, 95% CI 1.007-1.049) and in the background population (1.018 95% CI 1.013-1.022). No change was seen for CS in pregnancies with T1DM.Conclusion: Even though the rates of LGA and birthweight have decreased in Sweden over this time period for women with GDM and the background population, we could not see a significant decrease in Erb´s palsy among women with vaginal births in either the GDM group or for women with T1DM in the macrosomic infants. However, a decrease was seen in the incidence of Erb´s palsy in the macrosomic babies in the background population. The rates of CS have significantly increased in the background population and for GDM pregnancies, but been stable for T1DM. We conclude that the disparity in risk of Erbs has grown over this time period. Further work is needed to ascertain whether this is due to the need for improved surveillance, a higher CS rate, and/or improved glycaemic management (or other factors).
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| 15. |
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| 16. |
- Hildén, K., et al.
(författare)
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Gestational diabetes and adiposity are independent risk factors for perinatal outcomes : a population based cohort study in Sweden
- 2019
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Ingår i: Diabetic Medicine. - : Wiley-Blackwell Publishing Inc.. - 0742-3071 .- 1464-5491. ; 36:2, s. 151-157
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To evaluate the interaction effects of gestational diabetes (GDM) with obesity on perinatal outcomes.METHODS: A population-based cohort study in Sweden excluding women without pre-gestational diabetes with a singleton birth between 1998 and 2012. Logistic regression was performed to evaluate the potential independent associations of GDM and BMI with adverse perinatal outcomes as well as their interactions. Main outcome measures were malformations, stillbirths, perinatal mortality, low Apgar score, fetal distress, prematurity and Erb's palsy.RESULTS: ) had significantly increased risks of all outcomes including stillbirth 1.51 (1.40-1.62) to 2.85 (2.52-3.22) and perinatal mortality 1.49 (1.40-1.59) to 2.83 (2.54-3.15).CONCLUSIONS: There is no interaction effect between GDM and BMI for the studied outcomes. Higher BMI and GDM are major independent risk factors for most serious adverse perinatal outcomes. More effective pre-pregnancy and antenatal interventions are required to prevent serious adverse pregnancy outcomes among women with either GDM or high BMI.
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| 17. |
- Hildén, Karin, 1978-
(författare)
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Gestational diabetes, obesity and pregnancy outcomes in Sweden
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to evaluate maternal and fetal outcomes in relation to gestational diabetes mellitus (GDM) in both a shortand long term perspective.Study I was a population based cohort study including 1 249 908 pregnancies during the years 1998-2012. Maternal outcomes and fetal size were studied in relation to BMI and presence/absence of GDM. The conclusions were that maternal overweight and obesity are associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Study II was a population based cohort study using the same cohort as in study I. Fetal outcomes were studied in relation to GDM-status and BMI. Interaction between GDM and BMI for the outcomes was also analyzed. Conclusions were that excess maternal weight and GDM were, both major independent risk factors for adverse, perinatal outcomes, there were no intercation. In study III the same cohort was used to study time trends 1998-2012 in maternal and perinatal outcomes in women with GDM. Trends were also analyzed in women without GDM for comparison. This study showed that there have been improvements in fetal outcomes for women with GDM. But since the improvements were similar or less than the changes in the background population this was probably not due to better medical care for women with GDM alone. The conlusion is that there is still a lot to do to improve outcomes for women with GDM. Study IV was a case control study aiming to evaluate if there was an interaction between GDM and preeclampsia (PE) or if the conditions were independent risk factors for later cardio vascular disease (CVD). We also wanted to analyze how BMI influenced the association between PE and later CVD. We showed that GDM and PE are independently associated with elevated risk for CVD. The association of PE and CVD is not affected by BMI to a great extent as is the case in GDM and CVD.
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| 18. |
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| 19. |
- Hildén, Karin, 1978-, et al.
(författare)
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Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012 : a nationwide cohort study
- 2020
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Ingår i: Diabetic Medicine. - : Wiley-Blackwell Publishing Inc.. - 0742-3071 .- 1464-5491. ; 37:12, s. 2050-2057
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time.METHODS: Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score.RESULTS: The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an OR per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM.CONCLUSIONS: This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.
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| 20. |
- Joffrin, E., et al.
(författare)
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Overview of the JET preparation for deuterium-tritium operation with the ITER like-wall
- 2019
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Ingår i: Nuclear Fusion. - : IOP Publishing. - 1741-4326 .- 0029-5515. ; 59:11
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Forskningsöversikt (refereegranskat)abstract
- For the past several years, the JET scientific programme (Pamela et al 2007 Fusion Eng. Des. 82 590) has been engaged in a multi-campaign effort, including experiments in D, H and T, leading up to 2020 and the first experiments with 50%/50% D-T mixtures since 1997 and the first ever D-T plasmas with the ITER mix of plasma-facing component materials. For this purpose, a concerted physics and technology programme was launched with a view to prepare the D-T campaign (DTE2). This paper addresses the key elements developed by the JET programme directly contributing to the D-T preparation. This intense preparation includes the review of the physics basis for the D-T operational scenarios, including the fusion power predictions through first principle and integrated modelling, and the impact of isotopes in the operation and physics of D-T plasmas (thermal and particle transport, high confinement mode (H-mode) access, Be and W erosion, fuel recovery, etc). This effort also requires improving several aspects of plasma operation for DTE2, such as real time control schemes, heat load control, disruption avoidance and a mitigation system (including the installation of a new shattered pellet injector), novel ion cyclotron resonance heating schemes (such as the three-ions scheme), new diagnostics (neutron camera and spectrometer, active Alfven eigenmode antennas, neutral gauges, radiation hard imaging systems...) and the calibration of the JET neutron diagnostics at 14 MeV for accurate fusion power measurement. The active preparation of JET for the 2020 D-T campaign provides an incomparable source of information and a basis for the future D-T operation of ITER, and it is also foreseen that a large number of key physics issues will be addressed in support of burning plasmas.
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