| 1. |
- Bacq, Yannick, et al.
(författare)
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Efficacy of Ursodeoxycholic Acid in Treating Intrahepatic Cholestasis of Pregnancy: A Meta-analysis.
- 2012
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Ingår i: Gastroenterology. - : Elsevier BV. - 1528-0012 .- 0016-5085. ; 143:6, s. 1492-1501
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: We performed a meta-analysis to evaluate the effects of ursodeoxycholic acid (UDCA) on pruritus, liver test results, and outcomes of babies born to women with intrahepatic cholestasis of pregnancy (ICP). METHODS: We performed a systematic review of 9 published, randomized controlled trials (3 double blinded) that compared the effects of UDCA to other drugs, placebo, or no specific treatment (controls) in patients with ICP. We analyzed data from 454 patients: 207 received only UDCA, 70 received only placebo, 42 received cholestyramine, 36 received dexamethasone for 1 week and then placebo for 2 weeks, 65 received S-adenosyl-methionine, and 34 received no specific treatment. To achieve consistency among end points, a standard questionnaire was sent to all corresponding authors. For each end point, we performed pooled analysis that compared the effects of UDCA with those of all controls and UDCA with those of placebos. RESULTS: In pooled analyses that compared UDCA with all controls, UDCA was associated with total resolution of pruritus (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.07-0.74; P < .01), reduced pruritis (OR, 0.27; 95% CI, 0.13-0.55; P < .0001), normalization of serum levels of alanine aminotransferase (ALT) (OR, 0.23; 95% CI, 0.10-0.50; P < .001), decreased serum level of ALT (OR, 0.24; 95% CI, 0.11-0.52; P < .0001), reduced serum levels of bile acids (OR, 0.37; 95% CI, 0.19-0.75; P < .001), fewer premature births (OR, 0.44; 95% CI, 0.24-0.79; P < .01), reduced fetal distress (OR, 0.46; 95% CI, 0.25-0.86; P < .01), less frequent respiratory distress syndrome (OR, 0.30; 95% CI, 0.12-0.74; P < .01), and fewer neonates in the intensive care unit (OR, 0.49; 95% CI, 0.25-0.98; P = .046). In pooled analyses that compared the effects of UDCA with placebo, UDCA reduced pruritus (OR, 0.21; 95% CI, 0.07-0.62; P < .01), normalized (OR, 0.18; 95% CI, 0.06-0.52; P < .001) or decreased serum levels of ALT (OR, 0.12; 95% CI, 0.05-0.31; P < .0001), and reduced serum levels of bile acids (OR, 0.30; 95% CI, 0.12-0.73; P < .01). CONCLUSIONS: Based on a meta-analysis, UDCA is effective in reducing pruritus and improving liver test results in patients with ICP; UDCA therapy might also benefit fetal outcomes.
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| 2. |
- Dencker, Anna, 1956, et al.
(författare)
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Adopting a healthy lifestyle when pregnant and obese – an interview study three years after childbirth.
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background Obesity during pregnancy is increasing and is related to life-threatening and ill-health conditions in both mother and child. Initiating and maintaining a healthy lifestyle when pregnant with body mass index (BMI)≥30 kg/m2 can improve health and decrease risks during pregnancy and of long-term illness for the mother and the child. To minimise gestational weight gain women with BMI≥30 kg/m2 in early pregnancy were invited to a lifestyle intervention including advice and support on diet and physical activity in Gothenburg, Sweden. The aim of this study was to explore the experiences of women with BMI≥30 kg/m2 regarding minimising their gestational weight gain, and to assess how health professionals’ care approaches are reflected in the women’s narratives. Methods Semi-structured interviews were conducted with 17 women who had participated in a lifestyle intervention for women with BMI≥30 kg/m2 during pregnancy 3 years earlier. The interviews were digitally recorded and transcribed in full. Thematic analysis was used. Results The meaning of changing lifestyle for minimising weight gain and of the professional’s care approaches is described in four themes: the child as the main motivation for making healthy changes; a need to be seen and supported on own terms to establish healthy routines; being able to manage healthy activities and own weight; and need for additional support to maintain a healthy lifestyle. Conclusions To support women with BMI≥30 kg/m2 to make healthy lifestyle changes and limit weight gain during pregnancy antenatal health care providers should 1) address women’s weight in a non-judgmental way using BMI, and provide accurate and appropriate information about the benefits of limited gestational weight gain; 2) support the woman on her own terms in a collaborative relationship with the midwife; 3) work in partnership to give the woman the tools to self-manage healthy activities and 4) give continued personal support and monitoring to maintain healthy eating and regular physical activity habits after childbirth involving also the partner and family.
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| 3. |
- Dencker, Anna, 1956, et al.
(författare)
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Support to adopt a healthy lifestyle for pregnant women with BMI > 30
- 2016
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Ingår i: The NJF Congress (Nordiskt Jordemorförbund), Gothenburg, 12-14 May 2016. - 9789163742699
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Konferensbidrag (refereegranskat)abstract
- Background A change towards healthy habits during pregnancy and in early motherhood, including weight control, increased physical activity and optimal diet habits will promote health for the woman with body mass index (BMI) ≥ 30 kg/m2, her fetus/ child, as well as for the whole family. To optimise a healthy lifestyle from early pregnancy in women with BMI ≥ 30 kg/m2 an intervention called Mighty Mums, including advice and support on diet and physical activity was carried out in the maternity health care in Gothenburg, Sweden. . Aim To explore women´s experiences 3 years after participating in a lifestyle intervention targeting pregnant women with BMI ≥ 30 kg/m2. Methods Qualitative interviews were performed with 17 mothers who had participated in a lifestyle intervention 3 years earlier. The interviews were semi-structured and thematic analysis was used. Results All interviews were transcribed verbatim and read in full in the first analysis step. Second, initial codes were identified in the data. All features with a meaning were coded and initial codes were condensed and formed four themes. Conclusions The expected child was the main motivation for the women to participate in the intervention. The women needed to be seen and get personal support from the antenatal health care midwife and receive help to be able to control the selection and implementation of healthy activities. Extra support during pregnancy helped temporarily but there was still a need of support to maintain a healthy lifestyle in the long run.
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| 4. |
- Elden, Helen, 1959, et al.
(författare)
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Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: A multicentre, single blind, randomised controlled trial
- 2013
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:7, s. 775-782
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Pelvic girdle pain (PGP) is a disabling condition affecting 30% of pregnant women. The aim of this study was to investigate the efficacy of craniosacral therapy as an adjunct to standard treatment compared to standard treatment alone for PGP during pregnancy. Design. Randomised, multicentre, single blind, controlled trial. Setting. University hospital, a private clinic and 26 maternity care centres in Gothenburg, Sweden. Population. 123 pregnant women with PGP. Methods. Participants were randomly assigned to standard treatment (control group, n=60) or standard treatment plus craniosacral therapy (intervention group, n=63). Main Outcome Measures. Primary outcome measures: Pain intensity (Visual Analogue Scale 0-100mm) and sick leave. Secondary outcomes: function (Oswestery Disability Index), health-related quality of life (Euro-Qol), unpleasantness of pain (VAS), and assessment of the severity of PGP by an independent examiner. Results. Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group. VAS median was 27 mm (95%CI 24.6-35.9) vs. 35 mm (95%CI 33.5-45.7)(p=0.017) and the function disability index was 40 (range 34-46) vs. 48 (range 40-56)(p=0.016). Conclusions. Lower morning pain intensity and lesser deteriorated function was seen after craniosacral therapy in conjunction with standard treatment compared to standard treatment alone, but no effects regarding evening pain and sick-leave. Treatment effects were small and clinically questionable and conclusions should be drawn carefully. Further studies are warranted before reccomending craniosacral therapy for pelvic girdle pain.
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| 5. |
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| 6. |
- Glantz, Anna, 1959
(författare)
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Intrahepatic cholestasis of pregnancy
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Intrahepatic cholestasis of pregnancy (ICP) is a condition that has been reported to be associated with an increased fetal risk. A prospective study of ICP was conducted in the Västra Götaland region of Sweden between February 1, 1999 and January 31, 2002.Objectives were to study:I) The incidence of pruritus in pregnancy and ICP (defined as serum bile acid levels >10 μmol/L), the complications associated with ICP and whether complication rates correlate with serum bile acid levels, in an observational study with 690 subjects.II) Whether fetal complication rates, laboratory parameters of cholestasis and pruritus could be reduced by treatment with ursodeoxycholic acid (UDCA) or dexamethasone in a randomised, placebo-controlled intervention trial with 130 participants.III) If common haplotypes of the ABCB4-gene and the ABCB11-gene were associated with severe ICP. Fifty-two women with bile acid levels ≥40 μmol/L were included and compared to fifty-two healthy controls.IV) If serum bile acid composition is dominated by cholic acid, if sulphated progesterone metabolites are found in urine and if serum bile acid composition and the relative amounts of sulphated progesterone metabolites would change during treatment with UDCA, dexamethasone or placebo in women with ICP. This study had 39 participants, who were also included in the intervention trial.Results: Of 45,485 pregnancies leading to delivery in the region during the study period, 2,1% were complicated by pruritus of pregnancy and ICP was diagnosed in 1,5%. Of all women with ICP, 81% had the mild form with bile acid levels <40 μmol/L: no increase in fetal risk was found in these cases. Severe ICP (≥40 μmol/L) was diagnosed in 19%; fetal risk (spontaneous preterm delivery, asphyxial events and meconium-staining of amniotic fluid, placenta and membranes) was increased in these pregnancies. No reduction in fetal complications were found in the intervention study. Intention-to-treat-analysis showed reduction of alanine transferase (ALT) and bilirubin levels in the UDCA group. Sub-analysis of women with severe ICP showed reduction of serum bile acids in the UDCA and dexamethasone groups (greater reduction in the UDCA group) but reduction of pruritus was only associated with UDCA treatment. The genetic study showed that common haplotypes of the ABCB4-gene, but not of the ABCB11-gene, are associated with severe ICP. The metabolic study demonstrated ICP is characterised by a dominance (>50%) of cholic acid in the bile acid pool and that sulphated progesterone metabolites are found in ICP patients´ urine. Treatment with UDCA, but not dexamethasone, reduced relative amounts of sulphated progesterone metabolites in urine.Conclusions: ICP occured in 1.5% of the pregnancies. Increased fetal risk was only associated with the severe form (serum bile acids ≥40 μmol/L), found in 19% of the cases. Treatment with UDCA reduced ALT and bilirubin levels regardless of the severity of ICP. In women with severe ICP, UDCA treatment alleviated pruritus and was more effective than dexamethasone in reducing serum bile acid levels. Common haplotypes of the ABCB4-gene were found to be associated with severe ICP. Women with ICP have increased relative amounts of cholic acid in serum and sulphated progesterone metabolite levels in urine, the latter of which was reduced by UDCA.
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| 7. |
- Glantz, Anna, 1959, et al.
(författare)
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Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid
- 2005
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Ingår i: Hepatology. ; 42:6, s. 1399-405
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Tidskriftsartikel (refereegranskat)abstract
- Intrahepatic cholestasis of pregnancy (ICP) is characterized by troublesome maternal pruritus, elevated serum bile acids (> or =10 micromol/L) and increased fetal risk. Recently we determined a cutoff level of serum bile acids, > or =40 micromol/L, to be associated with impaired fetal outcome. We have now studied the effects of ursodeoxycholic acid (UDCA) and dexamethasone on pruritus, biochemical markers of cholestasis, and fetal complication rates in a double-blind, placebo-controlled trial. For this purpose, 130 women with ICP were randomly allocated to UDCA (1 g/day for three weeks), or dexamethasone (12 mg/day for 1 week and placebo during weeks 2 and 3), or placebo for 3 weeks. Pruritus and biochemical markers of cholestasis were analyzed at inclusion and after 3 weeks of treatment. Fetal complications (spontaneous preterm delivery; asphyxial events; and meconium staining of amniotic fluid, placenta, and membranes) were registered at delivery. An intention-to-treat analysis showed significant reduction of alanine aminotransferase (ALT) (P = .01) and bilirubin (P = .002) in the UDCA group only. In a subgroup analysis of ICP women with serum bile acids > or =40 micromol/L at inclusion (n = 34), UDCA had significant effects on pruritus (-75%), bile acids (-79%), ALT (-80%), and bilirubin (-50%) as well, but not on fetal complication rates. Dexamethasone yielded no alleviation of pruritus or reduction of ALT and was less effective than UDCA at reducing bile acids and bilirubin. In conclusion, 3 weeks of UDCA treatment improved some biochemical markers of ICP irrespective of disease severity, whereas significant relief from pruritus and marked reduction of serum bile acids were only found in patients with severe ICP.
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| 8. |
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| 9. |
- Haby, K., et al.
(författare)
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Mighty Mums - An antenatal health care intervention can reduce gestational weight gain in women with obesity
- 2015
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 31:7, s. 685-692
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Tidskriftsartikel (refereegranskat)abstract
- Background: overweight and obesity are growing public health problems and around 13% of women assigned to antenatal health care (ARC) in Sweden have obesity (Body Mass Index, BMI >= 30). The risk of complications during pregnancy and childbirth increase with increasing BMI. Excessive gestational weight gain (GWG) among obese women further increases the risks of adverse pregnancy outcomes. In this pilot-study from ARC in Gothenburg, a co-ordinated project with standardised care, given by midwives and supported by dietitian and aiming at reducing weight gain in obese pregnant women, is evaluated. Objective: to evaluate the effects of a behavioural intervention programme for women with BMI 30, with emphasis on nutrition and physical activity, with regards to GWG and effect on weight at the post partum check-up. Methods: in the pilot study, the intervention group consisted of the first 50 enrolled obese pregnant women in a large life style project within the AHC in Gothenburg. The control group consisted of 50 obese pregnant women in the same city. The intervention included 60 minutes extra time with the midwife and also offered food discussion group, walking poles and pedometers. The intervention group was prescribed physical activity and could choose from food advice with different content. If needed, the woman was offered referral to the dietitian for a personal meeting. A network was formed with the surrounding community. Outcome measures were GWG, weight change at the postnatal check-up compared with when signing in to antenatal health care, and change in BMI during the same period. Findings: women in the intervention group had a significantly lower GWG (8.6 +/- 49 kg versus 12.5 +/- 5.1 kg; p=0.001) and a significantly lower weight at the postnatal check up versus the first contact with ARC (-0.2 +/- 5.7 kg versus +2.0 +/- 4.5 kg; p=0.032), as well as a decrease in BMI (-0.04 +/- 2.1 versus +0.77 +/- 2.0; p=0.037). More women in the intervention than in the control group managed GWG < 7 kg [18 (36%) versus 8(16%), p=0.039]. Conclusion: obese pregnant women adhering to a standardised life style project in primary care using restricted resources can limit their weight gain during pregnancy, and show less weight retention after pregnancy compared to controls. (C) 2015 Elsevier Ltd. All rights reserved.
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| 10. |
- Petrov Fieril, Karolina, et al.
(författare)
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Experiences of a lifestyle intervention in obese pregnant women – A qualitative study
- 2017
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 44, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Objective to describe obese women's experiences of participating in a lifestyle intervention and its experienced impact on health and lifestyle. Design qualitative method with a phenomenological lifeworld approach. The interviews were analyzed in accordance with the phenomenological method. Participants and setting 11 women who had participated in a lifestyle intervention project, targeting pregnant women with BMI ≥30 in southwestern Sweden, were interviewed a few weeks before delivery. Findings the essence of these women's experiences was expressed as: implementing new habits required support, from midwives, partners, relatives, friends, or obese pregnant women in the same situation, or by participating in the intervention itself. The support had to be non-judgmental and with a balanced outlook on weight. Participation had taught them about weight gain control. The women were motivated to try to control their gestational weight gain, although not all of them were initially convinced that this would be possible. The essential structure of participation can be described with the following constituents: ‘‘pregnancy encourages change’’, ‘‘to be supported by non-judgmental people’’, ‘‘from bad habits to conscious choices’’ and; ‘‘barriers to change’’. Key conclusions in order to implement new habits, participants expressed a need for support, given with a non-judgmental attitude and a balanced outlook on weight. The women experienced that the lifestyle changes could be less burdensome than previously imagined, and that slight changes could yield unexpectedly successful results. In order to maintain a lifestyle change, obese women must perceive some kind of results, i.e. increased quality of life or weight gain control. Implications for practice non-judgmental support from midwives is crucial. Affinity with other pregnant obese women in an exercise group or dietary group setting is supportive. © 2016 Elsevier Ltd
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