| 1. |
- Zaigham, Mehreen, et al.
(författare)
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Intrauterine vertical SARS-CoV-2 infection : a case confirming transplacental transmission followed by divergence of the viral genome
- 2021
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 128:8, s. 1388-1394
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Tidskriftsartikel (refereegranskat)abstract
- A 27-year-old woman (gravida 2, para 1) was transported to the regional university hospital in gestational week (GW) 34 + 4 due to a three-day history of fever, abdominal pain and reduced foetal movements. She had developed a dry cough one day prior to the admission (Figure S1). The woman, was slightly overweight (BMI 27 kg/m2 ) but otherwise healthy. She had normal antenatal check-ups and an obstetric ultrasound at GW 32 + 2 showed a normal foetal weight deviation of +8%1 .
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| 2. |
- Hildén, Karin, 1978-, et al.
(författare)
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Previous pre-eclampsia, gestational diabetes mellitus and the risk of cardiovascular disease : A nested case-control study in Sweden
- 2023
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 130:10, s. 1209-1216
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivePre-eclampsia and gestational diabetes mellitus (GDM) are two common pregnancy complications that affect birth outcomes and are associated with a long-term risk of cardiovascular disease (CVD). The aims of this study were to investigate if the pre-eclampsia association with CVD is independent of GDM and modified by body mass index (BMI) or GDM.DesignCase–control study.SettingSweden.PopulationCases were women with a first CVD event between 1991 and 2008 and a previous pregnancy who were matched with controls without CVD (1:5) by year of birth, age and region of birth.MethodsConditional logistic regression was used to evaluate the associations of GDM, pre-eclampsia and maternal BMI with CVD adjusted for potential confounders and effect modifications with interaction tests.Main outcome measuresCVD.ResultsThere were 2639 cases and 13 310 controls with complete data. Pre-eclampsia and GDM were independent risk factors for CVD (adjusted odds ratio [aOR] 2.59, 95% CI 2.12–3.17 and aOR 1.47, 95% CI 1.04–2.09, respectively). After stratifying by maternal BMI, the adjusted association of pre-eclampsia with CVD did not differ notably between BMI groups: normal weight (aOR 2.65, 95% CI 1.90–3.69), overweight (aOR 2.67, 95% CI 1.52–4.68) and obesity (aOR 3.03, 95% CI 0.74–12.4). Similar findings were seen when stratifying on GDM/non-GDM.ConclusionsPre-eclampsia and GDM are independent risk factors for later CVD and having both during pregnancy is a major risk factor for later CVD. The association between pre-eclampsia and CVD is not modified by BMI. Effective CVD preventive programs for high-risk women are urgently needed in order to improve women's long-term health.
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| 3. |
- Koubaa, S., et al.
(författare)
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Retarded head growth and neurocognitive development in infants of mothers with a history of eating disorders: longitudinal cohort study
- 2013
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 120:11, s. 1413-1422
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo characterise early growth and neurocognitive development in children of mothers with a history of eating disorders (ED). PopulationChildren born to mothers with previous ED (n=47) (24 anorexia nervosa, 20 bulimia nervosa, 3 unspecified ED), and controls (n=65). MethodsMean values and standard deviation scores of weight and height from birth to 5years of age and head circumference up to 18months of age were compared between groups. Neurocognitive development was studied at the age of 5years by the validated parent questionnaire Five to Fifteen. ResultsWe previously reported that mothers with a history of ED conceived infants with lower birthweight and head circumference than controls. At 3months of age, body mass index (BMI) was no longer reduced but mean head circumferences of the children born to mothers with ED were smaller throughout the observation period. Similarly, the longitudinal results of the standard deviation scores of head circumference showed a significant overall group effect with lower levels in both subgroups of ED (anorexia nervosa and bulimia nervosa). The children of the ED mothers also had significantly higher Five to Fifteen scores than controls, reflecting difficulties in language skills. Head circumference at birth correlated with language skills in the children of mothers with ED. ConclusionChildren of mothers with previous ED demonstrated an early catch-up in BMI, but the average head circumference continued to be delayed until at least 18months of age. The reduced head growth was related to delayed neurocognitive development.
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| 4. |
- Vikström, Josefin, 1984-, et al.
(författare)
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Risk of postnatal depression or suicide after in vitro fertilisation treatment : a nationwide case–control study
- 2017
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Ingår i: British Journal of Obstetrics and Gynecology. - Chichester : Wiley-Blackwell Publishing Inc.. - 1470-0328 .- 1471-0528. ; 124:3, s. 435-442
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo examine whether women who undergo in vitro fertilisation (IVF) treatment are at greater risk of postnatal suicide or postnatal depression (PND) requiring psychiatric care, compared with women who conceive spontaneously.DesignCase–control study using data from national registers.SettingSweden during the period 2003–2009.Population Cases were 3532 primiparous women who had given birth following IVF treatment. An aged-matched control group of 8553 mothers was randomly selected from the medical birth register.MethodsLogistic regression analyses were performed with PND as the outcome, and with known risk factors of PND as well as IVF/spontaneous birth as covariates.Main outcome measuresPostnatal depression (PND), defined as diagnoses F32–F39 of the tenth edition of the International Classification of Diseases (ICD–10), within 12 months of childbirth.ResultsInitial analyses showed that PND was more common in the control group than in the IVF group (0.8 versus 0.4%; P = 0.04); however, these differences disappeared when confounding factors were controlled for. A history of any psychiatric illness (P = 0.000; odds ratio, OR = 25.5; 95% confidence interval, 95% CI = 11.7–55.5), any previous affective disorder (P = 0.000; OR = 26.0; 95% CI = 10.5–64.0), or specifically a personality disorder (P = 0.028; OR = 3.8; 95% CI = 1.2–12.7) increased the risk of PND. No woman in either group committed suicide during the first year after childbirth.ConclusionsWhereas mothers who receive IVF treatment are not at increased risk of PND, the risk is increased among mothers with a history of mental illness. Tweetable abstract A Swedish study on 3532 women showed that IVF treatment does not increase the risk of postnatal depression.
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| 5. |
- Waagaard, Lovisa, et al.
(författare)
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Body mass index and weight gain in pregnancy and cardiovascular health in middle age: A cohort study
- 2024
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Ingår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 131:8, s. 1136-1145
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine associations between body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with cardiovascular health in middle age using the 'Life's Essential 8' (LE8) concept of the American Heart Association (AHA).Design: Population-based cohort study.Setting: Swedish CardioPulmonary bioImage Study (SCAPIS).Population: A total of 8871 women from SCAPIS were included.Methods: Information on cardiovascular health in middle age was collected from SCAPIS and linked to pregnancy weight data obtained from the Swedish Medical Birth Register, with an average follow-up time of 24.5 years. An LE8 score between 0 and 100 was determined, where a score under 60 points was defined as poor cardiovascular health. Binary logistic regression and restricted cubic splines were used.Main outcome measures: Cardiovascular health according to LE8 in middle age.Results: The odds of having poor cardiovascular health in middle age were significantly higher in women who had overweight (adjusted odds ratio, aOR 3.30, 95% CI 2.82-3.88) or obesity (aOR 7.63, 95% CI 5.86-9.94), compared with women classified as being of normal weight in pregnancy. Higher odds were also found for excessive GWG (aOR 1.31, 95% CI 1.09-1.57), compared with women who gained weight within the recommendations. Conclusions: A high BMI in early pregnancy and excessive GWG were associated with greater odds of poor cardiovascular health in middle age. Although further studies are needed, our results highlight pregnancy as an important period to support long-term cardiovascular health.
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| 6. |
- Alkmark, Mårten, 1973, et al.
(författare)
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Induction of labour at 41weeks of gestation versus expectant management and induction of labour at 42weeks of gestation: a cost-effectiveness analysis
- 2022
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:13, s. 2157-2165
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the cost-effectiveness of induction of labour (IOL) at 41weeks of gestation compared with expectant management until 42weeks of gestation. Design: A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial. Setting: Fourteen Swedish hospitals during 2016–2018. Population: Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41weeks of gestation to IOL or to expectant management and induction at 42weeks of gestation. Methods: Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping. Main outcome measures: The cost per gained life year and per gained QALY. Results: The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was €4108 in the IOL group (n=1373) and €4037 in the expectant management group (n=1373), with a mean difference of €71 (95%CI −€232 to €379). The ICER for IOL compared with expectant management was €545 per life year gained and €623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes. Conclusions: Induction of labour at 41weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42weeks of gestation using standard threshold values for acceptable cost per life year/QALY. Tweetable abstract: Induction of labour at 41weeks of gestation is cost-effective compared with expectant management until 42weeks of gestation.
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| 7. |
- Stephansson, O., et al.
(författare)
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SARS-CoV-2 and pregnancy outcomes under universal and non-universal testing in Sweden: register-based nationwide cohort study
- 2022
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:2, s. 282-290
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes considering testing policy and test-positivity-to-delivery interval. Design Nationwide cohort study. Setting Sweden. Population From the Pregnancy-Register we identified 88 593 singleton births, 11 March 2020-31 January 2021, linked to data on SARS-CoV-2-positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing-policy and test-positivity-to-delivery interval. Main outcome measures Five-minute Apgar score, neonatal care admission, stillbirth and preterm birth. Results During pregnancy, SARS-CoV-2 test-positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non-universal testing. There were generally lower risks associated with SARS-CoV-2 under universal than non-universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62-3.11) in women testing positive <= 10 days before delivery under universal testing. There was no significant association with 5-minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24-1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10-5.20). Compared with term births (2.1%), test-positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60-4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62-2.02). Conclusions Testing policy and timing of test-positivity impact associations between SARS-CoV-2-positivity and pregnancy outcomes. Under non-universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. Tweetable abstract Testing policy and time from SARS-CoV-2 infection to delivery influence the association with pregnancy outcomes.
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| 8. |
- Nieminen, Katri, et al.
(författare)
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Nulliparous pregnant womens narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study
- 2015
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley: 12 months. - 1470-0328 .- 1471-0528. ; 122:9, s. 1259-1265
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe the expectations concerning imminent childbirth before and after 8weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth. DesignQualitative study of nulliparous pregnant womens narratives before and after CBT. SettingThe first ICBT programme for treating severe fear of childbirth. SampleFifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme. MethodsSemi-structured open-ended questions over the internet before and after 8weeks of ICBT. The data were analysed using thematic analysis. Main outcome measuresThe participants narratives pertaining to five different situations during labour and delivery before and after ICBT. ResultsAfter therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth. ConclusionsFollowing the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.
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| 9. |
- Hildingsson, Ingegerd, et al.
(författare)
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Few women wish to be delivered by caesarean section
- 2002
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 109:6, s. 618-623
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish. DESIGN: National survey. SETTING: Swedish antenatal clinics. POPULATION: 3,283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999-2000). METHODS: A questionnaire was mailed shortly after the first antenatal visit. MAIN OUTCOME MEASURES: Women's preferences for mode of delivery. RESULTS: 3,061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience. CONCLUSIONS: Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.
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| 10. |
- Wide-Swensson, Dag, et al.
(författare)
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Effects of isradipine, a new calcium antagonist, on maternal cardiovascular system and uterine activity in labour
- 1990
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Ingår i: British Journal of Obstetrics and Gynaecology. - : Wiley. - 1365-215X .- 1470-0328 .- 1471-0528. ; 97:10, s. 945-949
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Tidskriftsartikel (refereegranskat)abstract
- The effects of isradipine (a new calcium antagonist of the dihydropyridine type) on maternal blood pressure and heart rate, fetal heart rate, and uterine activity in labour were measured. Uterine activity was recorded by an intrauterine microtip transducer catheter connected to a fetal monitor. Isradipine was given as a slow injection in doses of 0.5 mg (10 women), 1 mg (11 women), and 1.5 mg (6 women). A reduction of systolic (6-16%) and diastolic (19-22%) blood pressure was seen, and concomitantly there was an increase in maternal (29-34%) and fetal (3-10%) heart rates. Reduction in uterine activity was not dose-related (maximum reduction 17%). Side effects (headache, palpitations) were minor and well tolerated. One women in the high-dose group had a shortlasting episode of hypotension. The results suggest that isradipine given as a bolus dose decreases blood pressure in pregnant women with little effects on uterine activity and fetal heart rate.
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