| 1. |
- Borneskog, Catrin, et al.
(författare)
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Symptoms of anxiety and depression in lesbian couples treated with donated sperm : a descriptive study
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 120:7, s. 839-846
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression.DesignDescriptive, a part of the prospective longitudinal ‘Swedish study on gamete donation’.SettingAll university clinics in Sweden performing gamete donation.PopulationA consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated.MethodsParticipants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2 months after treatment; and time point 3 (T3), 2–5 years after first treatment.Main outcome measuresAnxiety and depression (HADS), pregnancy outcome and future reproductive plans.ResultsThe vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P = 0.011) and T3 (10% versus 4%, P = 0.018), as well as symptoms of depression at T2 (4% versus 0%, P = 0.03) and T3 (3% versus 0%, P = 0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 2–5 years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building.ConclusionLesbian women in Sweden reported good psychological health before and after treatment with donated sperm.
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| 2. |
- 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
- 2023
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Ingår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY. - : John Wiley & Sons. - 1470-0328 .- 1471-0528.
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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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| 3. |
- Lundin, C., et al.
(författare)
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There is no association between combined oral hormonal contraceptives and depression : a Swedish register-based cohort study
- 2022
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 129:6, s. 917-925
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether users of hormonal contraceptives (HCs) are at increased risk of depression compared with non-users. Design: Register-based cohort study.Setting: Sweden.Sample: Women aged 15–25 years between 2010 and 2017 with no prior antidepressant treatment, psychiatric diagnose or contraindication for HCs (n = 739 585).Methods: Women with a prescription of HC were identified via the Swedish Prescribed Drug Register (SPDR). Relative risks (RRs) for first depression diagnosis in current HC-users compared with non-users were modelled by Poisson regression. Adjustments included age, medical indication for HC-use and parental history of mental disorders, among others.Main outcome measures: Depression, captured by a redeemed prescription of antidepressant treatment, or a first depression diagnosis in the SPDR and the National Patient Register.Results: Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression, relative risk (RR) 0.89 (95% CI 0.87–0.91) and 1.03 (95% CI 0.99–1.06) after adjustments, respectively. Age-stratified analyses demonstrated that COC use in adolescents conferred no increase in risk (RR 0.96, 95% CI 0.93–0.98), whereas use of progestogen-only pills (RR 1.13, 95% CI 1.07–1.19), contraceptive patch/vaginal ring (RR 1.43, 95% CI 1.30–1.58), implant (RR 1.38, 95% CI 1.30–1.45) or a levonorgestrel intrauterine device (RR 1.59, 95% CI 1.46–1.73) were associated with increased risks.Conclusions: This study did not find any association between use of COCs, which is the dominating HC in first time users, and depression. Non-oral products were associated with increased risks. Residual confounding must be addressed in the interpretation of the results. Tweetable abstract: There is no association between combined hormonal contraceptives and depression.
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| 4. |
- Molin, Johanna, et al.
(författare)
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Gestational weight gain, appetite regulating hormones, and metformin treatment in polycystic ovary syndrome : A longitudinal, placebo-controlled study
- 2022
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 129:7, s. 1112-1121
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore mechanisms that modulate gestational weight gain (GWG) in women with polycystic ovary syndrome (PCOS) and healthy controls.Design: Sub-sample of randomised controlled trials (PCOS) combined with a prospective cohort (controls).Setting: Eleven Norwegian, Swedish, and Icelandic hospitals.Population: Pregnant women with PCOS treated with metformin (PCOS-M, n = 36) or placebo (PCOS-P, n = 37), and healthy pregnant women (HC, n = 15).Methods: Serum levels of the appetite regulating hormones leptin, ghrelin, allopregnanolone, and soluble leptin receptor (sOB-R) were determined in the first and third trimesters.Main Outcome Measures: Excessive GWG (eGWG) relative to body mass index according to Institute of Medicine (IOM) guideline. Serum leptin/sOB-R ratio, or free-leptin-index (FLI), as biomarker of leptin sensitivity. Serum ghrelin and allopregnanolone levels.Results: The overall prevalence of eGWG was 44% (38/86). Women with eGWG had higher first and third trimester FLI (P < 0.001), and lower third trimester allopregnanolone levels (P = 0.003) versus women with non-eGWG. The prevalence of eGWG was lower in PCOS-M versus PCOS-P (28% versus 62%, odds ratio = 0.4, 95% CI 0.2–0.8, P = 0.005). FLI decreased during pregnancy in PCOS-M (P = 0.01), but remained unaltered in PCOS-P and HC. Ghrelin and allopregnanolone levels were comparable in PCOS-M, PCOS-P and HC throughout pregnancy.Conclusion: Excessive GWG is associated with enhanced leptin resistance, and attenuated physiological increase in serum allopregnanolone levels during pregnancy. Metformin reduces the risk for eGWG and improves leptin sensitivity in pregnant women with PCOS.
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| 5. |
- Sandström, Anton, et al.
(författare)
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Effect of hysterectomy on pain in women with endometriosis : a population-based registry study
- 2020
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 127:13, s. 1628-1635
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess pain symptoms before and after hysterectomy in women with endometriosis.Design: A population-based registry study.Setting: Sweden.Population: Women aged 18-45 years who underwent hysterectomy for endometriosis between 2010 and 2015.Methods: Pain symptoms before hysterectomy and 12 months after surgery were collected from the Swedish National Quality Register for Gynaecological Surgery (GynOp). Pain symptoms were also assessed by follow-up surveys after a median follow-up period of 63 months.Main outcome measures: Pelvic or lower abdominal pain after hysterectomy.Results: The study included 137 women. The proportion of women experiencing pain of any severity decreased by 28% after hysterectomy (P < 0.001). The proportion of women with severe pain symptoms decreased by 76% after hysterectomy (P < 0.001). The majority of women (84%) were satisfied with the surgical result. Presence of severe pain symptoms after the hysterectomy was associated with less satisfaction (P < 0.001). Pain symptoms after surgery, patient satisfaction and the patient's perceived improvement were not significantly different between women whose ovarian tissue was preserved and women who underwent bilateral oophorectomy.Conclusions: We observed a significant, long-lasting reduction in pain symptoms after hysterectomy among women with endometriosis. Hysterectomy, with the possibility of ovarian preservation, may be a valuable option for women with endometriosis who suffer from severe pain symptoms.Tweetable abstract: Hysterectomy is a valuable option for women with endometriosis and severe pain symptoms.
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| 6. |
- Håkansson, S, et al.
(författare)
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Impact and risk factors for early-onset group B streptococcal morbidity : analysis of a national, population-based cohort in Sweden 1997-2001.
- 2006
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Ingår i: BJOG. - : Wiley. - 1470-0328 .- 1471-0528. ; 113:12, s. 1452-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study early-onset group B streptococcal (EOGBS) morbidity, mortality, and maternal risk factors. Design: Observational, population-based, retrospective. Data from national registers and medical records. SETTING: Sweden, 1997-2001. POPULATION: Cohort of 640 infants with a diagnosis of GBS infection out of 435 070 live births. METHOD: Infants with diagnoses GBS sepsis (P36.0) and/or pneumonia (P23.3) were analysed. In cases with P36.0, register data were validated against infant and maternal medical records. Odds ratios (OR) were estimated by multiple logistic regression. MAIN OUTCOME MEASURES: Incidence of EOGBS morbidity, mortality, frequency of maternal risk factors and administration of intrapartum antibiotics. RESULTS: There were 319 cases with EOGBS sepsis. Blood culture verified 174 cases. There were 145 with clinical sepsis and 180 with pneumonia only. The incidences were 0.40, 0.33, and 0.41 per 1000 live births, respectively. The mortality was 7.5, 0.7, and 2.2% in respective groups. The frequencies of established maternal risk factors were: membrane rupture > or =18 hours, 44%; prematurity, 26%; temperature during labour > or =38 degrees C, 22%. Novel maternal risk factors identified in verified cases were gestational age (GA) of 37 completed weeks (OR 3.5, 1.8-6.5) and gestational diabetes (OR 3.7, 1.8-8.5). When including clinical sepsis, also epidural anaesthesia, infant large for GA, postmaturity, and high maternal age were significant risk factors. CONCLUSION: The incidence of verified EOGBS disease was 0.4 per 1000 live births with a total burden of EOGBS morbidity approximately three times higher. GA of 37 completed weeks and gestational diabetes were identified as additional significant risk factors.
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| 7. |
- Faulks, Fiona, et al.
(författare)
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Perinatal outcomes of socially disadvantaged women in Australia : a population-based retrospective cohort study
- 2023
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 130:11, s. 1380-1393
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016.Design: Population-based, retrospective cohort study.Setting: Victoria, Australia.Population or Sample: A total of 1 188 872 singleton births were included.Methods: Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures.Main Outcome Measures: Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU).Results: Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section.Conclusions: Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
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| 8. |
- Gazeley, Ursula, et al.
(författare)
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Pregnancy-related mortality up to 1 year postpartum in sub-Saharan Africa : an analysis of verbal autopsy data from six countries
- 2024
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 131:2, s. 163-174
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum.Design: Open population cohort (Health and Demographic Surveillance Systems).Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa.Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019.Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases-Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43–365 days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019).Main outcome measures: Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs).Results: Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non-communicable diseases constituted a significantly larger proportion of late pregnancy-related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy-related mortality within and beyond 42 days postpartum did not change significantly between 2000–2009 and 2010–2019.Conclusions: Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non-communicable diseases to (late) pregnancy-related mortality highlights the need for better integration of non-obstetric care with ante-, intra- and postpartum care in high-burden settings.
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| 9. |
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| 10. |
- Hussein, Julia, et al.
(författare)
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Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes : findings from five South Asian countries
- 2010
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 117:3, s. 304-313
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The successful implementation of programmes to reduce maternal mortality is constrained by a 'know-do' gap: the disparity between what is known and the application of that knowledge in policy and practice. This study identified innovations, practices and ideas aimed to improve project and programme implementation. DESIGN: Cross-sectional. SETTING: Five South Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. SAMPLE: Sixteen projects and programmes, and 100 key informants. METHODS: In-depth review of documents, key informant interviews and focus-group discussions. MAIN OUTCOME MEASURES: Innovations and ideas to improve programme implementation, and their perceived effects. RESULTS: Delegation of duties to intermediate-level health workers, incentivisation of health workers, providing the means to overcome financial barriers for accessing care, quality improvements and knowledge transfer were examples of ideas put into practice to improve programme implementation. There was a perception that these improved service use and availability, but objective evidence was lacking. CONCLUSIONS: Some innovations, practices and ideas are supported by evidence of effect, and could be replicated, whereas others have not been formally evaluated. Testing of these innovations is required before more widespread adoption can be recommended, although experiences should be shared to narrow the 'know-do' gap, even though the evidence on beneficial effects remains unclear.
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