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- Akselsson, Anna, et al.
(författare)
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Prolonged pregnancy and stillbirth among women with overweight or obesity : A population-based study in Sweden including 64,632 women
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The proportion of overweight or obese pregnant women is increasing in many countries and babies born to a mother who is overweight or obese are at higher risk for complications. Our primary objective was to describe sociodemographic and obstetric factors across Body Mass Index (BMI) classifications, with secondary objective to investigate stillbirth and other pregnancy outcomes in relation to BMI classifications and gestational week.METHODS: This population-based cohort study with data partly based on a cluster-randomized controlled trial includes 64,632 women with singleton pregnancy, giving birth from 28 weeks' gestation. The time period was January 2016 to 30 June 2018 (2.5 years). Women were divided into five groups according to BMI: below 18.5 underweight, 18.5-24.9 normal weight, 25.0-29.9 overweight, 30.0-34.9 obesity, 35.0 and above, severe obesity.RESULTS: Data was obtained for 61,800 women. Women who were overweight/obese/severely obese had lower educational levels, were to a lesser extent employed, were more often multiparas, tobacco users and had maternal diseases to a higher extent than women with normal weight. From 40 weeks' gestation, overweight women had a double risk of stillbirth compared to women of normal weight (RR 2.06, CI 1.01-4.21); the risk increased to almost four times higher for obese women (RR 3.97, CI 1.6-9.7). Women who were obese or severely obese had a higher risk of almost all pregnancy outcomes, compared to women of normal weight, such as Apgar score < 7 at 5 min (RR1.54, CI 1.24-1.90), stillbirth (RR 2.16, CI 1.31-3.55), transfer to neonatal care (RR 1.38, CI 1.26-1.50), and instrumental delivery (RR 1.26, CI 1.21-1.31).CONCLUSIONS: Women who were obese or severely obese had a higher risk of almost all adverse pregnancy outcomes and from gestational week 40, the risk of stillbirth was doubled. The findings indicate a need for national guidelines and individualized care to prevent and reduce negative pregnancy outcomes in overweight/obese women. Preventive methods including preconception care and public health policies are needed to reduce the number of women being overweight/obese when entering pregnancy.
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- de Brun, Maryam, 1991-, et al.
(författare)
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Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden : A stepped wedge cluster randomised trial
- 2024
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 21:7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes.METHODS AND FINDINGS: A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations.CONCLUSIONS: In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term.TRIAL REGISTRATION: The trial is registered with ISRCTN (41918550).
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- Storck Lindholm, Elisabeth
(författare)
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Clinical and epidemiological aspects of obesity during pregnancy and the puerperium
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To study different aspects of obesity during pregnancy, birth and the puerperium. Paper I is an intervention study of obese pregnant women. Paper II compares fatty acid (FA) patterns in breast milk and neonates ́ plasma phospholipids in normal-weight mothers and an intervention group of obese mothers. Paper III reports the risk of obstetric anal sphincter lacerations in relation to maternal obesity among primiparas. Paper IV compares health care consumption and sick-listing among obese and normal-weight pregnant women. Methods: Paper I is a pilot clinical study of women with BMI ≥ 30, included during a first-trimester prenatal visit. Twenty-five pregnant women were included in the intervention program, comprising visits to midwife, obstetrician and dietician, as well as weekly water gymnastics. Paper II is a randomized observational study of 41 obese and 41 normal-weight pregnant women. Twenty-nine obese women participating in a weight reduction program were included for comparison. FA were analyzed with capillary gas chromatography of lipids in breast milk collected at three and 10 days and one and two months postnatally, as well as in infants’ plasma sampled three days after birth. Paper III is a nationwide register-based study including 210,678 primiparas who gave vaginal birth to a singleton, identified from the Swedish Medical Birth Register between January 1, 2003 and December 31, 2008. Body Mass Index (BMI) was categorized into four classes, according to World Health Organization (WHO) guidelines. Paper IV is a nationwide register-based study of 108,103 pregnant women, identified from the Swedish Medical Birth Register, the Maternal Health Care Register and the Swedish National Inpatient Register between January 1, 2003 and December 31, 2008. The women were categorized into four BMI classes, according to WHO guidelines. Results: Paper I. Fourteen (56 %) of the women had a gestational weight gain of ≤ 6 kg (study goal). There were no cases of gestational diabetes. Three (12 %) women had mild hypertension. Three women (12 %) were delivered by emergency cesarean section. All babies were healthy and had normal birth weights. Paper II. The concentrations of omega-3 FA were lower and the omega-6 / omega-3 ratio was higher in neonates and in consecutive samples of breast milk from obese mothers, compared to normal-weight mothers. FA patterns were more similar to those in normal-weight mothers when obese mothers participated in an intervention program with dietary advice and physical activity. Paper III. In multivariate analyses, increasing BMI showed a nearly dose-response-type protective effect against grade III-IV sphincter lacerations. Paper IV. Obese women made more visits to midwives, doctors and the specialized antenatal care unit. They also complained of fear of childbirth more often. They had longer in-hospital stays and were sick-listed more often during pregnancy. Conclusions: Obese pregnant women use more healthcare recourses during pregnancy. During delivery the risk for anal sphincter lacerations decreases with higher BMI. There might be an effect at eating and exercise habits with intervention and the results suggest the importance of health promoting guidance of obese pregnant women also influencing the early fatty acids pattern of their infants.
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