| 1. |
- Finnbogadottir, Hafrún, et al.
(författare)
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Risk for partners' depression and anxiety during pregnancy and up to one year postpartum : A longitudinal cohort study
- 2022
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Ingår i: European Journal of Midwifery. - : European Publishing. - 2585-2906. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION Families may benefit from increased focus on partner emotional well-being during pregnancy and the perinatal period. Our aim was to explore the risk for depression and anxiety during pregnancy and one year postpartum in relation to partners' self-reported health, sense of coherence, social support, and lifestyle factors. METHODS This is a longitudinal cohort study using three questionnaires that were answered twice during pregnancy and at one year postpartum. Participants (n=532) were recruited between April 2012 and September 2013, and follow-up was between April 2012 and March 2015, in Sweden.RESULTS In late pregnancy, 8.9% of the prospective partners were at high risk for depression and 8.3% one year postpartum. An increased risk for depression was found amongst those reporting 'fair or very poor' sexual satisfaction and those reporting 'fair or very poor' health during pregnancy and postpartum. High anxiety was reported by 10.8% during late pregnancy and 12.4% one year postpartum. Partners who were unemployed, had financial difficulties, and who scored low on a Sense of Coherence scale, showed significantly higher anxiety in late pregnancy and postpartum. Social support has a significant and positive impact concerning signs of depression and anxiety, both during pregnancy and postpartum. CONCLUSIONS More than 10% of partners in this study showed depressive symptoms and anxiety, indicating a problem in need of attention by stakeholders. Strengthening social support is of greatest importance. It is time for the introduction of family-focused care aimed at prevention of depression and anxiety, and maintenance of family well- being.
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| 2. |
- Skagerström (Malmsten), Janna, et al.
(författare)
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Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden
- 2013
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 13:780
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach.MethodsThe study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support.ResultsQuestionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives.ConclusionsThe prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.
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| 3. |
- Wendt, Eva, et al.
(författare)
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Trust and confirmation in a gynecologic examination situation : A critical incident technique analysis
- 2004
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - Copenhagen : Blackwell. - 0001-6349 .- 1600-0412. ; 83, s. 1208-15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gynecologic examination is a common measure in reproductive health care. Many women experience the examination as a more or less negative event, with shortcomings in the examiner's behavior. The aim of the study was to describe, in terms of critical incidences, women's experiences concerning the personnel's behavior in the situation of gynecologic examination. Methods. The informants were strategically chosen and consisted of 30 Swedish women between the ages of 18-82 years old. The data collection method was qualitative research interviews analyzed by critical incident technique. Results. The result consisted of 30 subcategories, five categories, and two main areas - trust and confirmation. The personnel enabled trust when they promoted participation, created confidence, and were supportive. The opposite behavior contributed to the lack of trust. Confirmation described behavior that confirmed, respectively, did not confirm the women. This was shown through the presence or lack of respect and engagement. Conclusion. The personnel's positive behavior enabled trust and confirmed the women as individuals, while negative behavior was decisive in an unfavorable way. A complexity of patterns of knowing in nursing was identified. Participation through information that contributed to trust was important and amounted to one fourth of the incidents in the material. Respect and engagement, which confirmed the women, facilitated a positive caring relationship. The examination situation can be improved through reflection of the personnel's own behavior and further research about women's own experiences.
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| 4. |
- Stogianni, Anna, et al.
(författare)
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Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden
- 2019
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDiabetes during pregnancy is an increasingly common metabolic disorder, associated with significantly increased risks for both mother and child. Aim of this study was to compare maternal and perinatal outcomes in women with pregestational (PDM) type 1 (T1DM), type 2 diabetes (T2DM), gestational diabetes mellitus (GDM) and compare these to pregnancies not complicated with diabetes. This study also evaluated a specifically organized care-model mostly involving specialist diabetes nurses.MethodsRetrospective population-based records review 2009-2012. Rates of maternal (preeclampsia, pre-term delivery, cesarean section (CS)) and fetal outcomes (large for gestational age (LGA), macrosomia, congenital malformations/intrauterine death) were assessed and potential predisposing or contributing factors as maternal age, ethnicity, obesity, weight gain, parity, HbA1c levels, insulin types and doses.ResultsAmong 280 pregnancies 48 were PDM, 97 GDM and 135 without diabetes. Within the group with diabetes, early-pregnancy BMI was higher (p=0.0001), pregnancy weight gain lower (11.16.7kg vs 13.1 +/- 7.1kg, p=0.005), more delivered preterm (p=0.0001), by CS (p=0.05), and had more LGA neonates (p=0.06) than the group without diabetes. Among pregnancies with diabetes, GDM mothers gained less weight (9.9kg vs 13.5kg) (p=0.006), and rates of CS (p=0.03), preterm deliveries (p=0.001) and LGA (p=0.0001) were not increased compared to PDM; More T1DM infants were LGA, 60% vs. 27% in T2DM. In pregnancies with diabetes obesity, excessive weight gain and multiparity were associated with increased risk of LGA neonates, and mother's type of diabetes and gestational week were associated with higher rates of CS.Conclusion p id=Par4 Weight gain during pregnancy was lower in pregnancies with diabetes and prevalence of LGA, CS and preterm deliveries in GDM was not elevated, also for T2DM, except increased prevalence of LGA in T1DM that warrants increased clinical attention, indicating that this model of antenatal diabetes care may have contributed to improved maternal and fetal outcomes.
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| 5. |
- Martinez, Cristina A., et al.
(författare)
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Expression of Stress-Mediating Genes is Increased in Term Placentas of Women with Chronic Self-Perceived Anxiety and Depression
- 2020
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Ingår i: Genes. - : MDPI. - 2073-4425. ; 11:8, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- Anxiety, chronical stress, and depression during pregnancy are considered to affect the offspring, presumably through placental dysregulation. We have studied the term placentae of pregnancies clinically monitored with the Beck's Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 classed patients into an Index group (>10,n= 23) and a Control group (<10,n= 23). Cortisol concentrations in hair (HCC) were periodically monitored throughout pregnancy and delivery. Expression differences of main glucocorticoid pathway genes, i.e., corticotropin-releasing hormone (CRH), 11 beta-hydroxysteroid dehydrogenase (HSD11B2), glucocorticoid receptor (NR3C1), as well as other key stress biomarkers (Arginine Vasopressin, AVP and O-GlcNAc transferase, OGT) were explored in medial placentae using real-time qPCR and Western blotting. Moreover, gene expression changes were considered for their association with HCC, offspring, gender, and birthweight. A significant dysregulation of gene expression for CRH, AVP, and HSD11B2 genes was seen in the Index group, compared to controls, while OGT and NR3C1 expression remained similar between groups. Placental gene expression of the stress-modulating enzyme 11 beta-hydroxysteroid dehydrogenase (HSD11B2) was related to both hair cortisol levels (Rho = 0.54;p< 0.01) and the sex of the newborn in pregnancies perceived as stressful (Index,p< 0.05). Gene expression of CRH correlated with both AVP (Rho = 0.79;p< 0.001) and HSD11B2 (Rho = 0.45;p< 0.03), and also between AVP with both HSD11B2 (Rho = 0.6;p< 0.005) and NR3C1 (Rho = 0.56;p< 0.03) in the Control group but not in the Index group; suggesting a possible loss of interaction in the mechanisms of action of these genes under stress circumstances during pregnancy.
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| 6. |
- Stening, Kent, 1968-, et al.
(författare)
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Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: a double-blind, randomized placebo-controlled trial
- 2011
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Ingår i: Rheumatology. - London : Oxford univesity press. - 1462-0324 .- 1462-0332. ; 50:3, s. 544-551
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. FM is a condition that preferentially affects women. Sex hormones, and in particular oestrogens, have been shown to affect pain processing and pain sensitivity, and oestrogen deficit has been considered a potentially promoting factor for FM. However, the effects of oestrogen treatment in patients suffering from FM have not been studied. Here, we examined the effect of transdermal oestrogen substitution treatment on experimental as well as self-estimated pain in women suffering from FM.Methods. Twenty-nine post-menopausal women were randomized to either 8 weeks of treatment with transdermal 17β-oestradiol (50 µg/day) or placebo according to a double-blind protocol. A self-estimation of pain, a set of quantitative sensory tests measuring thresholds to temperature, thermal pain, cold pain and pressure pain, and a cold pressor test were performed on three occasions: before treatment, after 8 weeks of treatment and 20 weeks after cessation of treatment.Results. Hormonal replacement treatment significantly increased serum oestradiol levels as expected (P < 0.01). However, no differences in self-estimated pain were seen between treatment and placebo groups, nor were there any differences between the two groups regarding the results of the quantitative sensory tests or the cold pressor test at any of the examined time points.Conclusion. Eight weeks of transdermal oestradiol treatment does not influence perceived pain, pain thresholds or pain tolerance as compared with placebo treatment in post-menopausal women suffering from FM.
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| 7. |
- Forsell, Erik, et al.
(författare)
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Internet delivered cognitive behavior therapy for antenatal depression : A randomised controlled trial
- 2017
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Ingår i: Journal of Affective Disorders. - Amsterdam, Netherlands : Elsevier. - 0165-0327 .- 1573-2517. ; 221, s. 56-64
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Tidskriftsartikel (refereegranskat)abstract
- Major depression occurs in 5-10% of pregnancies and is associated with many negative effects for mother and child, yet treatment options are scarce. To our knowledge, this is the first published randomised controlled trial on Internet delivered Cognitive Behavior Therapy (ICBT) for this group.Objective: To test the efficacy of a pregnancy adapted version of an existing 10-week ICBT-program for depression as well as assessing acceptability and adherence.Design: Randomised controlled trial.Setting: Online and telephone.Population or sample: Self-referred pregnant women (gestational week 10-28 at intake) currently suffering from major depressive disorder.Methods: 42 pregnant women (gestational week 12-28) with major depression were randomised to either treatment as usual (TAU) provided at their antenatal clinic or to ICBT as an add-on to usual care.Main outcome measures: The primary outcome was depressive symptoms measured with the Montgomery-Asberg depression rating scale-self report (MADRS-S). The Edinburgh Postnatal Depression Scale and measures of anxiety and sleep were used. Credibility, satisfaction, adherence and utilization were also assessed.Results: The ICBT group had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g = 1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) (RR = 0.36; p = 0.004). Measures of treatment credibility, satisfaction, utilization, and adherence were comparable to implemented ICBT for depression.Limitations: Small sample size and no long-term evaluation.Conclusion: Pregnancy adapted ICBT for antenatal depression is feasible, acceptable and efficacious. These results need to be replicated in larger trials to validate these promising findings.
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| 8. |
- Palmér, Lina, 1979-, et al.
(författare)
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Severe breastfeeding difficulties : Existential lostness as a mother - Women’s lived experiences of initiating breastfeeding under severe difficulties
- 2012
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeksafter birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothersto realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeedingdifficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiatingbreastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparousand one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon isdescribed as ‘‘Existential lostness as a mother forcing oneself into a constant fight’’. This pattern is further explicated through itsconstituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself,and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel aloneand exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance theforming of a caring relationship through sharing rather than exposing.
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| 9. |
- Finnbogadottir, Hafrún, et al.
(författare)
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Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden
- 2012
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 28:2, s. 181-189
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Tidskriftsartikel (refereegranskat)abstract
- Objectiveto explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden.Designan inductive qualitative design, using focus groups interviews.Settingmidwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals.Findingsfive categories emerged: ‘Knowledge about ‘the different faces’ of violence’, perpetrator and survivor behaviour, and violence-related consequences. ‘Identified and visible vulnerable groups’, ‘at risk’ groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. ‘Barriers towards asking the right questions’, the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. ‘Handling the delicate situation’, e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. ‘The crucial role of the midwife’, insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category ‘Failing both mother and the unborn baby’ which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman.Key conclusions and implication for practiceavoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden.
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| 10. |
- Finnbogadottir, Hafrún, et al.
(författare)
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Midwives experience of meeting pregnant women who are exposed to Intimate Partner Violence at in hospital prenatal ward : A qualitative study
- 2020
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Ingår i: European Journal of Midwifery. - : European Publishing. - 2585-2906. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION Worldwide every third women is exposed to physical and/or sexualviolence and pregnancy is no safe period for the women. The aim was to elucidatemidwives experience of violence-exposed pregnant women who had been referred to aprenatal ward and were hospitalized.METHODS An inductive qualitative method was used with four focus-group interviewsperformed with sixteen midwives working at in-hospital prenatal ward. The data wereanalyzed with content analysis.RESULTS Three categories emerged. ‘Professional area of responsibility’, the midwivesworking at in-hospital prenatal ward considered it was the responsibility of the midwivesworking at antenatal care to ask routinely in order to detect violence-exposed women.Signs of help-seeking were based on the pregnant woman’s behavior. Suspicion ofintimate-partner violence was based on gut feeling. ‘Conditions for support’, the midwivesstrived to support pregnant women who were already identified as violence-exposed orif they had a suspicion that the pregnant woman was in a relationship where intimatepartnerviolence occurred. ‘Barriers for giving support’, both the work-place layout androutines constituted a barrier. The midwives own emotional state could affect her handlingof the situation.CONCLUSIONS The midwives working in-hospital considered it the responsibility of themidwives at antenatal healthcare to identify these women. The midwives had limitedexperience in dealing with violence-exposed pregnant women but recognized a number ofsigns and symptoms that could cause suspicion. They felt uncomfortable in the situationand expressed a need for both education and an action plan.
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