| 1. |
- Berg, Marie, 1955
(författare)
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Genuine Caring in Caring for the Genuine : Childbearing and high risk as experienced by women and midwives
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth.The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports.Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.
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| 2. |
- Kernell, Kristina
(författare)
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Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundAdvances in medical treatment during the last 50 years have resulted in more individuals with congenital heart disease (CHD) and Marfan syndrome reaching childbearing age. The substantial physiological changes during pregnancy result in a high-risk situation, and pregnancy is a major concern in women with these conditions.AimsTo describe the socio-demographic characteristics, birth characteristics and reproductive patterns of individuals with CHD and women with Marfan syndrome.To investigate obstetric and neonatal outcomes in the firstborn children of individuals with CHD and women with Marfan syndrome.To study long-term cardiovascular outcomes after childbirth in women with Marfan´syndrome.MethodsThe studies are population-based register studies. The study population in the first paper included all women born between 1973 and 1983 who were alive and resident in Sweden at the age of 13 (494 692 women, of whom 2 216 were women with CHD). In the second paper, the same definition of the study population was chosen, except that it involved all men born between 1973 and 1983 (522 216 men, of whom 2 689 men with CHD). The third and fourth papers involved a study population of all Swedish women born between 1973 and 1993 who were still living in Sweden at age 13. This population consisted of 1 017 538 women, 273 of whom had been diagnosed with Marfan syndrome.Results and conclusionsThe individuals studied were more often born preterm, and were small-for-gestational age babies. They were more likely to have been born by cesarean section. In women with CHD, these characteristics were repeated in their firstborn children. No increased risks were found in children of men with CHD or in children of women with Marfan syndrome. There was no increased risk of aortic dissection in women with Marfan syndrome during pregnancy compared to women with Marfan syndrome who did not give birth. Higher frequencies of cardiac arrhythmia and valvular heart disease were found after childbirth in women with Marfan syndrome. Pregnancy in women with CHD is a high-risk situation associated with increased risk of adverse neonatal outcomes for the expected child. Pregnancy in women without CHD, but where the father has CHD is not so associated with increased risk of adverse obstetric or neonatal outcomes. Pregnancy in women with Marfan syndrome is not associated with adverse outcomes for the expected child.
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| 3. |
- Vikström Eckevall, Josefin, 1984-
(författare)
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The influence of infertility and in vitro fertilization treatment on postpartum and long-term mental health in women
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: It is estimated that about 10-15% of couples suffer from infertility, i.e. the inability to achieve a clinical pregnancy after at least one year of regular, unprotected intercourse and that between 2-5% of births are a result of in vitro fertilization (IVF) treatment. Infertility and its treatment can have adverse effects on psychological well-being. While previous studies on postpartum depression (PPD) in IVF women suffer some methodological issues, there are no published studies on the risk of postpartum psychosis (PPP) after IVF pregnancies. Long-term, most women adjust well emotionally after IVF treatment but some, especially the childless, still suffer negative consequences. Meanwhile, few studies have extended beyond the first decade after treatment. Some studies have found that the childless elderly have social networks of less support potential but most show that psychological well-being is not affected by parental status. None of the studies have focused on the oldest old (≥85 years) and many have excluded those who live in institutional care, thus the frailest.Objective: The overall aim of this thesis was to study postpartum mental health in women who have undergone IVF treatment, using psychiatric diagnoses as outcomes, while controlling for major PPD and PPP risk factors as well as to determine the influences of childlessness, infertility and IVF treatment on long-term mental health in women. Materials and methods: Studies I-II are register-based, case control studies of 3532 (I) and 10,412 (II) primiparous women included in the Swedish IVF register. A control group of 8,553 (I) and 18,624 (II) primiparous women with spontaneous conceptions was selected from the Medical Birth Register. The main outcomes were PPD and PPP diagnoses the 1st year postpartum collected from the National Patient Register. Studies III-IV are cross-sectional. Study III included 470 women who had undergone IVF treatment 20-23 years previously. The Symptom Checklist-90 was used to investigate self-reported mental health. The results were compared with those from a population-based study and by parental status group. Study IV included 496 85-year olds. Psychological well-being, living situation, demographics and social network was investigated through a questionnaire and an interview.Results: Study I-II: There were no differences between the IVF and control group in the risk of receiving a PPD or PPP diagnosis. Having previously been diagnosed with any psychiatric, an affective or personality disorder increased the risk of PPD while any previous psychiatric, psychotic, bipolar, depressive, anxiety or personality disorder diagnosis increased the risk of PPP. None of the women had committed suicide. Study III: The IVF women reported symptoms of higher intensity and were at increased risk of symptoms of depression, obsessive-compulsion and somatisation compared with the reference group. Childless women, compared with parents, reported a higher level of mental health problems as well as symptoms of depression and phobic anxiety. Study IV: No differences in psychological wellbeing, living situation or having friends close by were found across parental status groups. The childless 85-year olds were less likely to have relatives close by and to receive help.Discussion: This thesis indicates that the risk of receiving a PPD or PPP diagnosis from in- or outpatient psychiatric care or of committing suicide during the first year postpartum is not increased in women who have undergone IVF treatment. Any negative effects of infertility and its treatment might have been mitigated by the “healthy patient effect”; those who choose to enter treatment are generally psychologically robust. A history of mental illness is a major risk factor for PPD and PPP. The risk of some adverse symptoms of mental illness might be increased in women who have undergone IVF treatment twenty years previously, especially in those who have remained childless. The childless elderly appear to have social networks of less support potential but are not more likely to live in institutional care and do not experience more adverse effects on psychological well-being than the elderly who are parents.
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| 4. |
- Brundin, Peik M. A., 1975-
(författare)
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Sex differences in immune response and sex hormone receptor expression in healthy individuals and during viral infection
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is sex-bias in morbidity and mortality from infectious diseases. Infections kill more men than women and several studies have pointed out differences in the immune system as a reason. The sex hormones estrogen, progesterone and testosterone all shape the effect of the immune response on multiple levels. Women at fertile age have been suggested to have higher proinflammatory responses from inflammatory stimuli compared to men and post-menopausal women, which has been ascribed to their higher estrogen levels. This could possibly lead to a more active pathogen response but may also result in a detrimental immunopathology to infections or development of autoimmune reaction.The overall aim of this thesis is to study the contribution of sex hormones and sex hormone receptors (SHR) to sex differences in immune response. We focus on peripheral blood mononuclear cells (PBMCs) to study such relationships in healthy individuals, as well as in individuals with asymptomatic Torque Teno Virus infection, and individuals with acute Puumala virus infection.In Paper I, we investigated expression of SHR and immune response genes in PBMC from healthy premenopausal (pre-MP) women during the menstrual cycle. The expression levels were estimated using a qPCR Array (Taqman low-density array, TLDA). SHR expression did not change significantly during the menstrual cycle, but several key immune regulatory genes were significantly more expressed during the ovulatory and mid luteal phase. Further, we separated PBMC into cell subsets (CD4+ T-cells, CD8+ T-cells, CD56+ NK-cells, CD14+ monocytes and CD19+ B-cells) and analyzed the expression through qPCR of estrogen receptors (ERs), ERα, ERβ1 (wildtype) and the isoform ERβ2. For the first time and unexpectedly, we demonstrate that the isoform ERβ2 was more abundant than wildtype ERβ1. The data from this paper provides new knowledge on the contribution of the menstrual cycle on immune response.In Paper II, we explored the use of Torque Teno Virus as a secondary functional immune marker in men and women. Expression of viral TTV DNA in PBMCs was estimated using a qPCR kit from Argene (R-gene) and analyzed in relation to serum sex hormone levels. The results showed that 50% of the men, 25% the post-MP women, and 18% of the pre-MP women were TTV+. Interestingly, all pre-MP women that were TTV+ had hormonal aberrances and were either anovulatory and/or hypothyroid. TTV+ pre-MP women also had significantly lower progesterone levels than TTV- pre-MP women. This paper indicates that the prevalence of TTV in PBMC differs between men, pre-MP and post-MP women. Furthermore, hormonal aberrances (at least in pre-MP women) will lead to increased prevalence of TTV.In Paper III we investigated the expression of ERα, ERβ1 and ERβ2 in PBMC from patients with Nephropathia epidemica, the viral zoonotic disease caused by Puumala virus, a Hanta virus known to affect more men than women. Expression of ERs in PBMCs and clinical laboratory results during the acute and convalescent phases were analyzed using a principal component analysis (PCA). The results show differences in ER expression and support previous findings that men and women have a different clinical pictureIn conclusion, the results in this thesis reveal distinct patterns of immune response related to sex hormone levels, SHR expression and the phases of the menstrual cycle supporting that there a link between sex hormone levels and immune responses. Further, we show that the ER isoform ERβ2 is more abundant in PBMCs than what was previously described. The data in this thesis adds to the knowledge to the sex differences in immune response and exemplifies the importance of taking these differences into account in the clinic.
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| 5. |
- Gingnell, Malin, 1982-
(författare)
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Ovarian Steroid Hormones, Emotion Processing and Mood
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is known that some psychiatric disorders may deteriorate in relation to the menstrual cycle. However, in some conditions, such as premenstrual dysphoric disorder (PMDD), symptomatology is triggered mainly by the variations in ovarian steroid hormones. Although symptoms induced by fluctuations in ovarian steroids often are affective, little is known about how emotion processing in women is influenced by variations, or actual levels, of ovarian steroid hormones.The general aim of this thesis was to evaluate menstrual cycle effects on reactivity in emotion generating and controlling areas in the corticolimbic system to emotional stimulation and anticipation, in healthy controls and women with PMDD. A second aim was to evaluate corticolimbic reactivity during long-term administration of exogenous ovarian steroids.In study I, III and IV effects of the menstrual cycle on emotional reactivity in women with PMDD was studied. In study I, women with PMDD in displayed higher amygdala reactivity than healthy controls to emotional faces, not in the luteal phase as was hypothesised, but in the follicular phase. No difference between menstrual cycle phases was obtained in women with PMDD, while healthy controls had an increased reactivity in the luteal phase. The results of study I was further elaborated in study III, where women with PMDD were observed to have an increased anticipatory reactivity to negative emotional stimuli. However, no differences in amygdala reactivity to emotional stimuli were obtained across the menstrual cycle. Finally, in study IV the hypothesis that amygdala reactivity increase in the luteal phase in women with PMDD is linked to social stimuli rather than generally arousing stimuli was suggested, tested and supported.In study II, re-exposure to COC induced mood symptoms de novo in women with a previous history of COC-induced adverse mood. Women treated with COC reported increased levels of mood symptoms both as compared to before treatment, and as compared to the placebo group. There was a relatively strong correlation between depressive scores before and during treatment. The effects of repeated COC administration on subjective measures and brain function were however dissociated with increased aversive experiences accompanied by reduced reactivity in the insular cortex.
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| 6. |
- Holmer, Hampus
(författare)
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Measuring global surgery, obstetrics and anaesthesia from health systems to patients
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundWorldwide, an estimated 5 billion people lack access to safe, affordable surgical care when needed. This leads to millions of avertable deaths and unnecessary morbidity each year. To change this situation, urgent action is needed at many levels, but indicators and data have been lacking to guide improvement.AimsThe aim of this thesis was to describe and evaluate measurement of surgical public health. Organised according to the Lancet Commission on Global Surgery indicator framework, the thesis specifically aimed to: I. quantify global access to emergency obstetric care; II. describe the global distribution of specialist surgeons, anaesthesiologists and obstetricians; III. measure the rate and mortality of Caesarean sections in Sierra Leone, the country with the world’s highest maternal mortality; IV. to propose a new study design for collecting data on surgical outcomes; V. calculate the cost-effectiveness of surgical care, as exemplified by Ponseti club foot repair, and; VI. critically review the global data collection efforts of the six Lancet global surgery indicators.MethodsTo address these aims, a range of methodologies were employed: I. Available reports of national and sub-national data on the met need for emergency obstetric care were collected, reviewed and analysed; II. National data on the number and distribution of the specialist surgical workforce were collected; III. The rate and outcomes of Caesarean sections in Sierra Leone were analysed based on data from facilities and from the national Maternal Death Surveillance and Response system; IV. A protocol for collecting data on perioperative mortality of emergency abdominal surgery was developed; V. Cost effectiveness analysis was carried out for club foot repair; VI. Data on the six indicators proposed by the Lancet Commission on Global Surgery in 2015 were collected, and indicators analysed and critically reviewed.ResultsThe global met need for emergency obstetric care was 45% [interquartile range 28–57%], and the met need was significantly correlated with the proportion of births attended by skilled birth attendants. There were an estimated two million specialist surgeons, obstetricians and anaesthesiologists, of which only 20% serve the poorest half of the world. In 2016, the Sierra Leonean Caesarean section rate was 2.9% of all deliveries, with a perioperative mortality rate of 1.5%. A multicentre, international, prospective cohort study protocol for the measurement of perioperative mortality of emergency abdominal surgery was published. Clubfoot repair by the Ponseti method was highly cost-effective at 22 USD per averted Disability Adjusted Life Year. The six indicators proposed by The Lancet Commission on Global Surgery have been implemented to varying degrees, with definitional challenges as well as lack of commitment and structures for data collection.SignificanceMeasuring global surgery, obstetrics and anaesthesia – from health systems to patients explores methods of measuring surgical care in the context of a growing recognition of the need to increase access to safe, affordable surgical care around the globe. This research has provided baseline data on several indicators, some of which have been adopted by the WHO and the World Bank. Furthermore, it has critically reviewed the six indicators proposed for global implementation, and made suggestions for further improvement. Good quality indicators are paramount for guiding further efforts in global surgery, obstetrics and anaesthesia, with potential impact for surgical patients, families and societies today and in the future.
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| 7. |
- Hayden, Jane M.
(författare)
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The effect of intra-abdominal local anaesthetics following major gynaecological surgery. Clinical and experimental studies
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Local anaesthetics (LA), in addition to inhibition of pain signalling, also have anti-inflammatory properties. In vitro studies have demonstrated anti-proliferative and cytotoxic effect of LAs on cancer cells when administered in therapeutic concentrations. Intraperitoneal administrated LA is shown to reduce pain, improve surgical recovery and to blunt the postsurgical inflammatory response. Retrospective studies have indicated beneficial oncological outcome of regional anaesthesia on cancer recurrence when used in cancer surgery. Abdominal hysterectomy causes moderate to severe pain, and assessing new tools for pain treatment is crucial. The postoperative period of extensive surgery for advanced ovarian cancer is associated with high morbidity. When the patients have recovered from cancer surgery, chemotherapy can be initiated. New therapeutic approaches to enhanced recovery with reduced postoperative pain and inflammation is of great interest. Methods and aim: The thesis aimed to evaluate the efficacy of intra-abdominal local anaesthetics on pain, inflammatory response, serum concentration of LA and patient recovery after gynaecological surgery (study I, II and III). The aim of study IV was to determine the effects of LA on ovarian cancer cells in vitro. The clinical studies were prospective, double blind, randomized and placebo-controlled. In study I, women scheduled for abdominal hysterectomy, were randomised to local infiltration analgesia (Group LIA) or placebo (group C). Rescue analgesic consumption and opioid related side effects were analysed. In study II and III, women undergoing cytoreductive surgery for advanced ovarian cancer were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Control) peroperatively. Inflammatory markers in serum, LA concentrations (study II), and objective measures of patient comfort, postoperative complications, pain, home readiness and time to initiation of chemotherapy (study III) were analysed. In study IV proliferation and migration in two ovarian cancer cell lines, exposed to LA in concentrations corresponding to doses used in study II and III, were analysed. Analysis of cancer stem cells (CSC) phenotypes were performed. Results: The median supplemental requirements of morphine during 0–24 hours after abdominal hysterectomy was significantly lower in group LIA compared to group C (18 mg vs. 27 mg, p = 0.028) and the median time to first analgesic injection was significantly longer in group LIA (40 min vs. 20 min, p = 0.005) (Study I). Perioperative intraperitoneal LA resulted in significantly decreased serum cortisol levels. Serum concentrations of ropivacaine were well below toxic concentrations (study II). Time to initiation of chemotherapy was significantly shorter in group IPLA (Median 21, IQR 19-29 vs. 29 days, IQR 21-40, p = 0.021). No differences in standardised recovery endpoints were found between the groups (Study III) . The laboratory study showed a significantly reduced cell number and an inhibited cell migration. Cell size were significantly increased and CSC phenotype analysis showed a reduction in all cells by up to 50% (Study IV). Discussion: Local infiltration analgesia results in a significantly lower rescue morphine consumption following abdominal hysterectomy. Intraperitoneal local anestetics can be administered in ovarian cancer cytoreductive surgery safely, without achieving toxic doses. Although IPLA do not provide further anti-inflammatory effects, the stress response is briefly blunted and there might be positive effects such as earlier start of chemotherapy. LA reduce the ability of cancer cells to metastasise. Intra-abdominal LA offers a potential to have beneficial effects on pain, recovery and circulating tumour cells after gynaecological surgery.
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| 8. |
- Leonhardt, Henrik, 1963
(författare)
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Polycystic ovary syndrome - morphologic and dynamic evaluation by magnetic resonance imaging
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting up to 15% of women of reproductive age. The syndrome is characterized by oligo-anovulation, hyperandrogenism and polycystic ovaries. What constitutes the best definition of PCOS is still a matter of debate. Women with PCOS have a higher risk of developing abdominal obesity, insulin resistance with progression to type 2 diabetes, hypertension, and endometrial hyperplasia/cancer. The etiology of PCOS remains incompletely understood, but insulin resistance may be central in the pathogenesis. The main aims of this thesis were to: 1) characterize the distribution of abdominal adipose tissue in PCOS, 2) assess whether women with PCOS have altered uterine morphology or peristalsis, 3) compare transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) for estimation of ovarian volume and antral follicle count (AFC), and assess reproducibility and interobserver agreement of MRI measurements, and 4) investigate how well ovarian morphology and perfusion discriminate women with PCOS from controls and to elucidate associations between ovarian morphology and serum anti-Müllerian hormone (AMH), a potential surrogate for AFC. Sixty women with PCOS and 31 age- and BMI-matched controls were recruited by advertising in the local community. There were no differences in abdominal volumes of total, subcutaneous and visceral adipose tissue, as determined by MRI, between the groups. The endometrium was thinner in PCOS with oligo-amenorrhea compared to controls. Based on cine MRI, uterine peristalsis was less commonly observed in women with PCOS than in controls. 2D MRI revealed more antral follicles, especially of small size, than 3D TVUS. Ovarian volume estimation by 3D MRI provided volumes closer to 2D TVUS values than did 2D MRI. AFC, ovarian volume, ovarian stroma volume, ovarian total cross-sectional area, AMH, and free testosterone differ in women with PCOS compared with controls. AFC and free testosterone are the best variables to distinguish women with PCOS from controls. AMH was not independently associated with PCOS. In conclusion, women with PCOS display hyperandrogenemia, insulin resistance and adipose tissue abnormalities, although their abdominal adipose tissue distributions were indistinguishable from age/BMI-matched controls. A thinner rather than thicker endometrium was found in women with PCOS and oligo-amenorrhea as compared to controls, contrary to the general belief. Uterine peristalsis was less commonly observed in women with PCOS, but whether disturbed peristalsis contributes to infertility in PCOS remains to be investigated. Our findings suggest, when either oligo-anovulation or clinical signs of hyperandrogenism is absent, that AFC or free testosterone rather than AMH should be added in the estimation if a woman has PCOS or not. MRI had a high ability to distinguish and count small antral follicles, with an adequate intra- and interobserver reliability. MRI is a method well suited for scientific studies on this heterogeneous syndrome.
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| 9. |
- Sjöberg, Inga, 1946-
(författare)
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The vagina : morphological, functional and ecological aspects
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The vagina is one organ of the body which has not been studied exhaustively. Moreover, most of the studies found in the contemporary literature have been performed on women affected by a variety of genital diseases.In the present study the vaginal epithelium was examined with a histological method, morphometry, whereby cyclical changes related to hormonal variation during the menstrual cycle were demonstrated. Determination of the quantity of estrogen receptors in the vaginal epithelium on two occasions during the menstrual cycle revealed a significantly greater number in the follicular than in the luteal phase. The results of these studies indicate the presence of a menstrual variation in the vaginal epithelium comparable to that in the endometrium.Phenoxymethylpenicillin (pcV) was used as a marker substance to study the dynamics of the transport mechanisms into the vagina. PcV was found to accumulate in the vaginal fluid and high concentrations persisted for a long period of time. In hysterectomized women, the appearance of pcV in the vaginal fluid followed the same pattern. Consequently, the substance is transported through the vaginal wall and need not enter with the secretions from the internal genitalia. The greatest concentration of pcV was in the distal portion of the vagina, possibly due to the specific internal circulation of fluid within the vagina.Bacterial vaginosis as an example of an ‘ecological disease’ has been studied with regard to the formation of endotoxin, a constituent of the cell wall of Gram- negative bacteria. Large amounts of endotoxin were found and the clinical implication of this finding has been pointed out.Furthermore, the influence of pcV on the vaginal microbial flora of healthy women has been investigated. A change from a situation with predominance of lactobacilli to the appearance of Gram-negative rods was observed. In one of the women the lactobacilli disappeared completely and were replaced by E. coliand high levels of endotoxin in the vaginal fluid were found. This study demonstrates the complexity of the ecological balance of the vaginal microbial flora and illustrates the difficulty of defining a ‘normal’ vaginal condition. Is there any unquestionable state of ‘normality’ even in a healthy woman free from symptoms of genital disease?
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| 10. |
- Axelsson, Jonatan
(författare)
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Reproductive function in young Swedish men - Time trend, prenatal and adult exposure to smoking and phthalates
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A decrease in male reproductive function, including sperm counts, during the second half of the 20th century, has been postulated. During this period, testicular cancer has increased several-fold. Environmental and lifestyle-related factors have been proposed as explanations for a possible negative trend in male reproductive function. One important lifestyle factor is smoking. However, smoking during pregnancy appears to play a greater role for a man's reproductive function than smoking by the man himself. As regards environmental chemicals, one type of compound to which humans are exposed is phthalates. These are often used as plasticizers in different consumer products. Several phthalates have been reported as decreasing male reproductive function in laboratory animals, especially when given during the foetal period. Between 2008 and 2010, 314 men from the general Swedish population were recruited. Their semen quality was compared with a group of men recruited in a similar manner between 2000 and 2001. The participants also delivered serum and urinary samples and answered questionnaires concerning maternal and paternal smoking during pregnancy. Data on maternal smoking was additionally assessed through the Swedish Medical Birth Register. Through a Swedish screening program for rubella, maternal serum samples were retrieved from the men's prenatal period. We analysed metabolites of phthalates as exposure markers both in the maternal sera and in urine and serum of the men. Associations between parental smoking during pregnancy as well as phthalate metabolite levels, and parameters of male reproductive function were studied. In summary, we found no change in semen quality between 2000-2001 and 2008-2010. However, both maternal and paternal smoking during pregnancy were associated with reduced sperm counts in men whose other parent did not smoke. In addition, prenatal exposure to diethylhexyl phthalate (DEHP) and diisononyl phthalate (DiNP) appeared to be associated with decreased semen volume, and exposure to DiNP as well with smaller testicular size. Finally, adult exposure to DEHP and dibutyl phthalate (DBP) were associated with decreased progressive sperm motility, and DEHP exposure was also linked to a higher proportion of immature sperm. Thus, although no change in semen quality appeared to have occurred in Swedish men during the last decade, parental smoking and prenatal and adult exposure to certain phthalates may play a role in the male reproductive function.
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