| 1. |
- Steen, Emma, et al.
(författare)
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Preterm birth may be a larger risk factor for increased blood pressure thanintrauterine growth restriction
- 2015
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 104:11, s. 1098-1103
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Tidskriftsartikel (refereegranskat)abstract
- AimVery low birthweight (VLBW) and prematurity have been associated with an increased risk of high blood pressure (BP). We compared BP and salivary cortisol responses to a stressful situation between adolescents with a VLBW and controls. MethodsWe compared three groups aged 12-17years: 30 born VLBW but appropriate for gestational age (AGA) at a mean of 27weeks, 19 born VLBW but small for gestational age (SGA) at a mean of 31weeks and 43 term-born AGA controls. Three consecutive BP measurements were performed before a magnetic resonance imaging (MRI) examination. Salivary cortisol and perceived stress were assessed before and after the MRI. ResultsSystolic and diastolic BP decreased significantly for each repeated measurement in the VLBW-SGA group and controls, but remained unchanged in the VLBW-AGA group. The third systolic BP measurement was 9-12mmHg higher in the VLBW-AGA group than the other groups (p<0.05). There were no differences in salivary cortisol between the groups, before and after the MRI or between the sexes. ConclusionDynamic BP responses differed between adolescents born VLBW-AGA and the other groups, indicating that extremely preterm birth may be a larger risk factor for increased BP than intrauterine growth restriction.
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| 2. |
- Elsmén, Emma, et al.
(författare)
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Fetal gender and gestational-age-related incidence of pre-eclampsia.
- 2006
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 85:11, s. 1285-1291
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Tidskriftsartikel (refereegranskat)abstract
- Background. Male fetal gender is associated with an overall increased risk of pre-eclampsia. However, it was recently shown that the male: female birth ratio was decreased in pre-eclampsia associated with preterm delivery. The reason for this discrepancy is not known. Objective. To investigate whether the fetal and newborn gender is associated with the incidence of antenatal maternal pregnancy complications, and to investigate if gender-associated risk changes with gestational age at delivery. Methods. Population-based study including 1,158,276 infants born in Sweden 1990-2001. Five maternal diagnosis groups (pre-eclampsia, infection, preterm premature rupture of membranes, abruptio placentae, and polyhydramnios) were explored in relation to newborn infant gender and gestational age at delivery. Results. When all gestational ages were evaluated, male newborn gender was associated with increased odds ratios for all five diagnosis groups, and for preterm birth before 37 weeks gestation, M/F ratio 1.17. In very preterm births (gestational age below 32 weeks), male newborn gender was associated with a significantly lower risk for pre-eclampsia (OR 0.88, 95%CI 0.80-0.97), and a marginally lower risk for polyhydramnios (OR 0.74, 95%CI 0.54-1.01). Conclusion. The fetal gender seems to affect the occurrence of pre-eclampsia, and possibly also polyhydramnios. The finding could be due to an increased risk for spontaneous abortions in pregnancies with male fetuses, but could also be associated with the etiology of these conditions. Evaluation of antenatal pregnancy complications from a fetal/newborn gender perspective may contribute to new insights regarding their pathophysiological mechanisms.
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| 3. |
- Elsmén, Emma
(författare)
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Gender differences in perinatal morbidity and long term consequences of preterm birth
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Newborn male infants have higher morbidity and mortality than female infants. Male fetal gender is associated with an overall increased risk of preterm birth and complications related to pregnancy are overrepresented in women carrying male fetuses. Several studies have shown that being newborn and of male gender are independent risk factors for adverse outcome. Even though experimental data from newborn animals have shown that many gender differences can be explained by differences in hormonal function and stress responses, the specific mechanisms leading to the increased risks for newborn boys have not been clarified. However, several gender specific reactions and physiologic responses have been described in both the fetus and newborn infant, some of these differences persist during childhood; although later other gender specific differences become more important. The aim of this thesis was to further study gender differences in perinatal morbidity and long term consequences of preterm birth. It is important to identify early predicting factors that can help to screen which male preterm infants who face increased mortality and morbidity risks. In an attempt to find such early signs, gender related differences in clinical parameters during the first week of life were assessed in paper I. This paper concludes that there are gender related differences in ventilatory and circulatory support that may contribute to the worse long-term outcome in prematurely born male infants. Two epidemiological studies were carried out (papers III and V) using the Medical Birth Register (MBR) to further elucidate gender differences in morbidity, mortality and long term consequences of preterm birth. The aim of paper III was to investigate if the fetal and newborn gender is associated with the incidence of pregnancy complications and if the gender associated risk changes with gestational age at delivery. The fetal gender affected the occurrence of preeclampsia, woman carrying male infants were subjected to an overall a higher risk of developing preeclampsia. However, the male:female ratio was decreased in preeclampsia associated with preterm delivery. In paper V we investigated if gender mix in twin pairs was related to obstetric and neonatal morbidity and mortality. The results show that male twin gender was significantly associated with respiratory morbidity and increased risk of mortality. Paper II and V were carried out in order to understand if the gender related differences associated with preterm birth can be explained by differences in hormonal and stress responses. Paper II focused on response aspects immediately after birth, whereas paper V focused on long-term response aspects. In paper II we tested the hypothesis that umbilical cord interleukin-1 receptor antagonist (IL-1ra) correlates with infant gender and neonatal outcome in preterm infants. We concluded that umbilical cord IL-1ra was associated with neonatal morbidity, especially postnatal depression after delivery and development of BPD in very preterm female infants. Although there were no gender differences in levels of umbilical cord IL-1ra the concentration of IL-1ra had different implications for neonatal morbidity depending on infant´s gender. The aim of paper IV was to investigate if salivary cortisol and blood pressure responses differed in adolescents born prematurely compared to term born controls, and whether there were gender differences in these responses. Blood pressure was significantly higher and dynamic blood pressure responses differed in prematurely born AGA children as compared to both term controls and preterm SGA children, but there were no gender specific differences in these responses. In conclusion, this thesis contributes to increased understanding of gender-related differences associated with preterm birth. The work highlights gender related differences from both short-term and long-term perspectives. The results show that there are gender related differences with regards to pregnancy complications, the need for ventilatory and circulatory support as well as respiratory morbidity during the neonatal period. It was also confirmed that markers such as IL1-ra, cortisol and blood pressure correlate to neonatal morbidity and preterm birth; however no clear gender-related differences were seen in these responses. Further research on preterm birth with a gender perspective is warranted and will be beneficial for both boys and girls as an increased knowledge and understanding of general disease mechanisms will further improve and personalize the neonatal care
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| 4. |
- Elsmén, Emma, et al.
(författare)
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Impact of sex on perinatal mortality and morbidity in twins
- 2014
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Ingår i: Journal of Perinatal Medicine. - : Walter de Gruyter GmbH. - 0300-5577 .- 1619-3997. ; 42:2, s. 225-231
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Twin studies offer opportunities to investigate mechanisms underlying sex-associated differences in perinatal outcomes. The objective of the study was to investigate sex-related differences in perinatal complications. Study design: A cohort of 16,045 twin pregnancies 32,090 twins - was explored for obstetric complications, perinatal and infant mortality, and neonatal morbidities. Results: Twin pregnancies with a female fetus had an increased risk for preeclampsia, but otherwise there were no pregnancy complications associated with fetal sex. After birth, female-female twins had lower early neonatal and infant mortality, and lower risk for respiratory morbidities than male-male twins at all gestational ages. In unlike-sexed twin pairs, very preterm males had higher respiratory morbidity than females and, females were at higher risk for being growth restricted. Conclusion: Male-male twins have higher respiratory morbidity and neonatal mortality than female-female twins. In unliked-sexed twin pairs, the males seem to be protected by having a female co-twin.
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| 5. |
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| 6. |
- Elsmén, Emma, et al.
(författare)
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Sex and gender differences in newborn infants: why are boys at increased risk?
- 2004
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Ingår i: Journal of Men's Health & Gender. - : Mary Ann Liebert Inc. - 1571-8913. ; 1:4, s. 303-311
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Tidskriftsartikel (refereegranskat)abstract
- Newborn boys have higher morbidity and mortality than girls. Several studies have shown that male newborn sex is an independent risk factor for adverse outcome. The specific mechanisms leading to the increased risks for newborn boys are not known. However, several sex-specific reactions and physiologic responses have been described in both the fetus and newborn infants. Some of these differences persist during childhood; although later other sex and gender-specific differences become more important. Recently, the research aiming at explaining the vulnerability in male infants has been intensified. Experimental data from newborn animals have shown that many sex differences can be explained by differences in hormonal function and stress responses. However, if these findings apply to humans as well is not yet known. The aim of this paper is to review literature on very early sex-specific differences and shed some light on the increased risks for male fetuses and newborn boys.
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| 7. |
- Elsmén, Emma, et al.
(författare)
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Umbilical Cord Levels of Interleukin-1 Receptor Antagonist and Neonatal Outcome.
- 2006
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Ingår i: Biology of the Neonate. - : S. Karger AG. - 1421-9727. ; 89:4, s. 220-226
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies indicate that there may be infant gender differences in cytokine expression associated with differences in neonatal morbidity. Objective: We tested the hypothesis that umbilical cord interleukin-1 receptor antagonist (IL-1ra) correlates with infant gender and neonatal outcome in preterm infants. Study Design: IL-1ra was measured in cord blood taken from 58 preterm infants (33 males, 25 females) with gestational age less than 32 weeks. Receiver operating characteristics (ROC) curve were used for identifying IL-1ra values with high sensitivity and specificity for neonatal morbidity and adverse outcome, i.e., death or survival with severe intraventricular hemorrhage or periventricular leukomalacia. Results: In the female infants, but not the male infants, cord IL-1ra values correlated with postnatal depression, expressed as Apgar scores at 1 min (correlation coefficient, r(s); p value: -0.542; 0.005), 5 min (-0.571; 0.018), and 10 min (-0.442; 0.035); and postnatal age at intubation (-0.799; 0.001). The ROC area under the curve (AUC) was 0.735 for adverse outcome (p = 0.013), and 0.683 for bronchopulmonary dysplasia (p = 0.021) when all infants were included. However, there was a significant gender difference in the ROC curve for adverse outcome (p = 0.026), with AUC 0.640 (p = 0.240) in males and AUC 0.929 (p = 0.008) in females. Above a chosen cutoff at 13,500 ng/I for IL-1ra cord the sensitivity and specificity for predicting adverse outcome was 100 and 81%, respectively in females versus 50 and 84% in males. Conclusion: Increased levels of cord IL-1ra levels are associated with neonatal morbidity and adverse outcome in preterm infants. Comparable levels of IL-1ra have different predictive value depending on infant gender. Copyright (c) 2006 S. Karger AG, Basel.
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