| 1. |
- Zaigham, Mehreen, et al.
(författare)
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Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome: case series with and without congenital transmission
- 2022
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Ingår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:8, s. 1361-1374
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Tidskriftsartikel (refereegranskat)abstract
- Objective To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and live-born infants presenting with fetal distress. Design Retrospective, observational. Setting Nationwide. Population Five stillborn and nine live-born infants from 13 pregnant women infected with SARS-CoV-2 seeking care at seven different maternity units in Sweden. Methods Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS-CoV-2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells. Main outcome measures Maternal and fetal clinical outcomes and placental pathology in stillborn and live-born infants. Results Reduced fetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of fetal distress among live-born infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the live-born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live-born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live-born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS-CoV-2 placental infection and congenital transmission. Conclusions SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration.
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| 2. |
- Johansson, Kari, et al.
(författare)
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Risk of pre-eclampsia after gastric bypass : a matched cohort study
- 2022
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Ingår i: British Journal of Obstetrics and Gynecology. - : Blackwell Publishing. - 1470-0328 .- 1471-0528. ; 129:3, s. 461-471
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether gastric bypass before pregnancy is associated with reduced risk of preeclampsia.DESIGN: Nationwide matched cohort study.SETTING: Swedish national health care.POPULATION: =2766:2766) on pre-surgery/early-pregnancy BMI, diabetes status (pre-surgery/pre-conception), maternal age, early-pregnancy smoking status, educational level, height, country of birth, delivery year and history of preeclampsia.MAIN OUTCOME MEASURES: Preeclampsia categorised into any, preterm onset (<37+0 weeks), and term onset (≥37+0 weeks).RESULTS: (39kg). Post-gastric bypass pregnancies had lower risk of preeclampsia compared to pre-surgery BMI-matched controls (1.7 vs. 9.7 per 100 pregnancies; hazard ratio [HR] 0.21, 95%CI 0.15-0.28) and early-pregnancy BMI-matched controls (1.9 vs. 5.0 per 100 pregnancies; HR 0.44, 95%CI 0.33-0.60). Although relative risks for preeclampsia for post-gastric bypass pregnancies vs. pre-surgery matched controls was similar, absolute risk differences were significantly greater for nulliparous (RD -13.6 per 100 pregnancies, 95%CI -16.1 to -11.2) vs. parous women (RD -4.4 per 100 pregnancies, 95%CI -5.7 to -3.1).CONCLUSION: We found that gastric bypass was associated with lower risk of preeclampsia, with the largest absolute risk reduction among nulliparous women.
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| 3. |
- Valgeirsdóttir, Heiddis, et al.
(författare)
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Polycystic ovary syndrome and risk of stillbirth : A nationwide register-based study
- 2021
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 128:13, s. 2073-2082
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate whether polycystic ovary syndrome (PCOS) is associated with increased risk of stillbirth and whether any such association is linked to PCOS with a severe hyperandrogenic profile.DesignNationwide register-based cohort study.SettingSweden.PopulationThe cohort consisted of women giving birth to singleton infants in 1997–2015. All women with a diagnosis of PCOS in the period 1997–2017 and a randomly selected reference group of women without PCOS diagnosis were included. PCOS with a severe hyperandrogenic profile was defined as a PCOS diagnosis with at least two dispensations of prescribed anti-androgens during 2005–2017.MethodsThe risk of stillbirth in women with PCOS was estimated through multiple logistic regression, using women without PCOS as a reference. Risks were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs), adjusted for maternal age, parity, body mass index, type-1 diabetes, educational level and country of birth.Main outcome measuresStillbirth, at ≥22 weeks of gestation in 2008–2015 and at ≥28 weeks of gestation in 1997–2007.ResultsCompared with women without PCOS (n = 241 750), women with PCOS (n = 41 851) had a 50% increased risk of stillbirth (aOR 1.50, 95% CI 1.28–1.77). The incidence of stillbirth in women with PCOS was particularly increased at term. Women with PCOS and a severe hyperandrogenic profile (n = 13 713) did not have a stronger association with stillbirth than women with PCOS who did not have such a profile.ConclusionsPCOS is associated with stillbirth and should be considered as a possible risk factor in antenatal care. Further research is warranted to investigate possible causal mechanisms.
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| 4. |
- Bolin, Marie, et al.
(författare)
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Hyperemesis gravidarum and risks of placental dysfunction disorders : a population-based cohort study
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 120:5, s. 541-547
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study whether pregnancies complicated by hyperemesis gravidarum in the first (<12weeks) or second (1221weeks) trimester are associated with placental dysfunction disorders. Design Population-based cohort study. Setting Sweden. Population All pregnancies in the Swedish Medical Birth Register estimated to have started on 1 January 1997 or later and ended in a single birth on 31 December 2009 or earlier (n=1156050). Methods Odds ratios with 95% confidence intervals were estimated for placental dysfunction disorders in women with an inpatient diagnosis of hyperemesis gravidarum, using women without inpatient diagnosis of hyperemesis gravidarum as reference. Risks were adjusted for maternal age, parity, body mass index, height, smoking, cohabitation with the infant's father, infant's sex, mother's country of birth, education, presence of hyperthyreosis, pregestational diabetes mellitus, chronic hypertension and year of infant birth. Main outcome measures Placental dysfunction disorders, i.e. pre-eclampsia, placental abruption, stillbirth and small for gestational age (SGA). Results Women with hyperemesis gravidarum in the first trimester had only a slightly increased risk of pre-eclampsia. Women with hyperemesis gravidarum with first admission in the second trimester had a more than doubled risk of preterm (<37weeks) pre-eclampsia, a threefold increased risk of placental abruption and a 39% increased risk of an SGA birth (adjusted odds ratios [95% confidence intervals] were: 2.09 [1.383.16], 3.07 [1.885.00] and 1.39 [1.061.83], respectively). Conclusions There is an association between hyperemesis gravidarum and placental dysfunction disorders, which is especially strong for women with hyperemesis gravidarum in the second trimester.
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| 5. |
- Sorbye, L. M., et al.
(författare)
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Interpregnancy weight change and recurrence of gestational diabetes mellitus : a population-based cohort study
- 2020
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Ingår i: British Journal of Obstetrics and Gynecology. - : WILEY. - 1470-0328 .- 1471-0528. ; 127:13, s. 1608-1616
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Tidskriftsartikel (refereegranskat)abstract
- Objective To estimate recurrence risk of gestational diabetes mellitus (GDM) by interpregnancy weight change. Design Population-based cohort study. Setting and population Data from the Swedish (1992-2010) and the Norwegian (2006-2014) Medical Birth Registries on 2763 women with GDM in first pregnancy, registered with their first two singleton births and available information on height and weight. Methods Interpregnancy weight change (BMI in second pregnancy minus BMI in first pregnancy) was categorised in six groups by BMI units. Relative risks (RRs) of GDM recurrence were obtained by general linear models for the binary family and adjusted for confounders. Analyses were stratified by BMI in first pregnancy (<25 and >= 25 kg/m(2)). Main outcome measure GDM in second pregnancy. Results Among overweight/obese women (BMI >= 25), recurrence risk of GDM decreased in women who reduced their BMI by 1-2 units (relative risk [RR] 0.80, 95% CI 0.65-0.99) and >2 units (RR 0.72, 95% CI 0.59-0.89) and increased if BMI increased by >= 4 units (RR 1.26, 95% CI 1.05-1.51) compared wth women with stable BMI (-1 to 1 units). In normal weight women (BMI <25), risk of GDM recurrence increased if BMI increased by 2-4 units (RR 1.32, 95% CI 1.08-1.60) and >= 4 units (RR 1.61, 95% CI 1.28-2.02) compared with women with stable BMI. Conclusion Interpregnancy weight loss reduced risk of GDM recurrence in overweight/obese women. Weight gain between pregnancies increased recurrence risk for GDM in both normal and overweight/obese women. Our findings highlight the importance of weight management in the interconception window in women with a history of GDM.
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| 6. |
- Stephansson, O., et al.
(författare)
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Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period
- 2016
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 123:4, s. 608-616
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo study the association between duration of second stage of labour and risks of maternal complications (infection, urinary retention, haematoma or ruptured sutures) in the early postpartum period. DesignPopulation-based cohort study. Setting and sampleWe included 72593 mothers with singleton vaginal deliveries at 37weeks of gestation in cephalic presentation, using the obstetric database from the Stockholm-Gotland region in Sweden, 2008-12. MethodsLogistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated and adjustments were made for maternal age, body mass index, height, smoking, cohabitation, gestational age, labour induction, epidural analgesia and oxytocin augmentation. ResultsRates of any complication varied by parity from 7.3% in parous women with previous caesarean section, 4.8% in primiparas and 1.7% in parous women with no previous caesarean section. Compared with a second stage <1hour, the adjusted ORs for any complication (95% CI) in primiparas were for 1 to <2hours 1.28 (1.11-1.47); 2 to <3hours 1.54 (1.32-1.79), 3 to <4hours 1.63 (1.38-1.93) and 4hours 2.08 (1.74-2.49). The corresponding adjusted ORs for parous women without previous caesarean were 2.27 (1.78-2.90), 2.97 (2.09-4.22), 3.65 (2.25-5.94) and 3.16 (1.44-6.94), respectively. The adjusted ORs for women with previous caesarean were for 1 to <2hours 1.62 (1.13-2.32); 2 to <3hours 1.56 (1.00-2.43), 3 to <4hours 2.42 (1.52-3.87), and 4hours 2.31 (1.25-4.24). ConclusionsRisks of maternal complications in the postpartum period increase with duration of second stage of labour also after accounting for maternal, pregnancy and delivery characteristics. Special attention has to be given to parous women with previous caesarean deliveries.
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| 7. |
- Axfors, Cathrine, et al.
(författare)
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Pre-pregnancy participation and performance in world's largest cross-country ski race as a proxy for physical exercise and fitness, and perinatal outcomes : Prospective registry-based cohort study
- 2023
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 130:8, s. 891-901
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Investigate associations between pre-pregnancy participation and performance in a demanding cross-country ski race (proxy for exercise volume and fitness) and perinatal outcomes. Pre-registered protocol: osf.io/aywg2.Design: Prospective cohort study.Setting: Based on entire overlap between the Vasaloppet registry and the population-based Swedish Pregnancy Register.Sample: All female Vasaloppet participants 1991-2017 with subsequent singleton delivery (skiers), and age- and county-matched non-skiers.Methods: We calculated odds ratios (ORs) for non-skiers versus skiers (model 1) and, among skiers, by performance (model 2), in Bayesian logistic regressions adjusted for socio-demographics, lifestyle factors, and comorbidities. We repeated calculations adjusting for early pregnancy body mass index (potential mediator) and explored robustness (selection/exposure settings; multiple comparisons correction).Main outcome measures: Twenty-nine important perinatal outcomes, predefined based on existing expert consensus.Results: Non-skiers (n = 194 384) versus skiers (n = 15 377) (and slower versus faster performance, not shown) consistently had higher odds of gestational diabetes mellitus (GDM) (OR 1.70, 95% highest density interval: 1.40-2.09), excessive gestational weight gain (GWG) (1.28, 1.22-1.38), psychiatric morbidity (1.60, 1.49-1.72), any caesarean section (CS) (1.34, 1.28-1.40), elective CS (1.39, 1.29-1.49), and large-for-gestational-age babies (> 90th percentile, 1.11, 1.04-1.18); lower odds of inadequate GWG (0.83, 0.79-0.88); and no associations with fetal/neonatal complications (e.g. preterm birth [1.09, 0.98-1.20], small for gestational age [SGA] [1.23, 1.05-1.45]). Adjustment for body mass index attenuated associations with excessive (1.20, 1.14-1.30) and inadequate GWG (0.87, 0.83-0.92) and large for gestational age (1.07, 1.00-1.13).Conclusion: Non-skiers compared with skiers, and slower versus faster performance, consistently displayed higher odds of GDM, excessive GWG, psychiatric morbidity, CS and large-for-gestational-age babies; and lower odds of inadequate GWG, after adjustment for socio-demographic and lifestyle factors and comorbidities. There were no associations with fetal/neonatal complications.
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| 8. |
- Baba, S, et al.
(författare)
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Changes in snuff and smoking habits in Swedish pregnant women and risk for small for gestational age births
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 120:4, s. 456-462
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To examine associations between antenatal exposure to Swedish oral moist snuff (which includes essentially only nicotine) and to smoking and risks of small-for-gestational-age (SGA) births and to compare risks among women who stopped or continued using snuff or smoking during pregnancy.DESIGN:Population-based cohort study.SETTING: Sweden.POPULATION:All live singleton births in Sweden 1999-2010.METHODS:Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis.MAIN OUTCOME MEASURES:SGA birth, also stratified into preterm (≤36 weeks of gestation) and term (≥37 weeks of gestation) SGA births.RESULTS: Compared with non-tobacco users in early pregnancy, snuff users and above all smokers in early pregnancy had increased risks of SGA births: adjusted ORs (95% CI) were 1.26 (1.09-1.46) and 2.55 (2.43-2.67), respectively). Snuff use had, if anything, a stronger association with preterm SGA than term SGA, whereas the opposite was true for smoking. Compared with non-tobacco users, women who stopped using snuff before their first visit to antenatal care had no increased risks of preterm or term SGA, and women who stopped using snuff later during pregnancy had no increased risk of term SGA. Smoking cessation early in pregnancy was associated with a larger reduction in risk than smoking cessation later in pregnancy.CONCLUSIONS:As both smoking and snuff use influence risk of SGA, both nicotine but above all tobacco combustion products are involved in the mechanisms by which maternal smoking increases the risk of SGA.
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| 9. |
- Belachew, Johanna, 1976-, et al.
(författare)
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Risk of retained placenta in women previously delivered by caesarean section : a population-based cohort study.
- 2014
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 121:2, s. 224-229
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate whether women with a caesarean section at their first delivery have an increased risk of retained placenta at their second delivery.DESIGN: Population-based cohort study.SETTING: Sweden.POPULATION: All women with their first and second singleton deliveries in Sweden during the years 1994-2006 (n = 258 608). Women with caesarean section or placental abruption in their second pregnancy were not included in the study population.METHODS: The risk of retained placenta at second delivery was estimated for women with a first delivery by caesarean section (n = 19 458), using women with a first vaginal delivery as reference (n = 239 150). Risks were calculated as odds ratios by unconditional logistic regression analysis with 95% confidence intervals (95%) after adjustments for maternal, delivery, and infant characteristics.MAIN OUTCOME MEASURES: Retained placenta with normal (≤1000 ml) and heavy (>1000 ml) bleeding.RESULTS: The overall rate of retained placenta was 2.07%. In women with a previous caesarean section and in women with previous vaginal delivery, the corresponding rates were 3.44% and 1.96%, respectively. Compared with women with a previous vaginal delivery, women with a previous caesarean section had an increased risk of retained placenta (adjusted OR 1.45; 95% CI 1.32-1.59), and the association was more pronounced for retained placenta with heavy bleeding (adjusted OR 1.61; 95% CI 1.44-1.79).CONCLUSIONS: Our report shows an increased risk for retained placenta in women previously delivered by caesarean section, a finding that should be considered in discussions of mode of delivery.
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| 10. |
- Dahlin, S., et al.
(författare)
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Maternal tobacco use and extremely premature birth - a population-based cohort study
- 2016
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 123:12, s. 1938-1946
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study the associations of maternal tobacco use (smoking or use of snuff) and risk of extremely preterm birth, and if tobacco cessation before antenatal booking influences this risk. To study the association between tobacco use and spontaneous or medically indicated onset of delivery. Design Population-based cohort study. Setting Sweden. Population All live singleton births, registered in the Swedish Medical Birth Register, 1999-2012. Methods Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis. Main outcome measures Extremely preterm birth (<28 weeks of gestation), very preterm birth (28-31 weeks), moderately preterm birth (32-36 weeks). Results Maternal snuff use (OR 1.58; 95% CI: 1.14-2.21) and smoking (OR 1.61; 95% CI: 1.39-1.87 and OR 1.91; 95% CI: 1.53-2.39 for moderate and heavy smoking, respectively) were associated with an increased risk of extremely preterm birth. When cessation of tobacco use was obtained there was no increased risk of preterm birth. Snuff use was associated with a twofold risk increase of medically indicated extremely preterm birth, whereas smoking was associated with increased risks of both medically indicated and spontaneous extremely preterm birth. Conclusions Snuff use and smoking in pregnancy were associated with increased risks of extremely preterm birth. Women who stopped using tobacco before the antenatal booking had no increased risk. These findings indicate that nicotine, the common substance in cigarettes and snuff, is involved in the mechanisms behind preterm birth. The use of nicotine should be minimized in pregnancy.
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