| 1. |
- Berggren, Vanja, 1972-, et al.
(författare)
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Infibulated women have an increased risk of anal sphincter tears at delivery : a population-based Swedish register study of 250 000 births
- 2013
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 92:1, s. 101-108
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the risk for anal sphincter tears (AST) in infibulated women. Design. Population-based cohort study. Setting. Nationwide study in Sweden. Population. The study population included 250 491 primiparous women with a vaginal singleton birth at 37–41 completed gestational weeks during 1999–2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalian-group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan-group, n = 955, where the majority is infibulated, compared to other African countries, n = 1035, where few individuals are infibulated, but had otherwise similar anthropometric characteristics. These women were compared to 247 572 Swedish-born women. Methods. Register study with data from the National Medical Birth Registry. Main outcome measures. AST in non-instrumental and instrumental vaginal delivery. Results. Compared to Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95% CI 2.08–3.54), followed by women from Eritrea-Ethiophia-Sudan 1.80 (1.41–2.32) and other African countries 1.23 (0.89–1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. Conclusion. Delivering African women from countries where infibulation is common have an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.
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| 2. |
- Ahlberg, Mia, et al.
(författare)
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Birth by vacuum extraction delivery and school performance at 16 years of age
- 2013
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 210:4, s. 361.e1-361.e8
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of the present study was to investigate cognitive competence, as indicated by school performance, at 16 years of age, in children delivered by vacuum extraction.Study design This was a register study of a national cohort of 126,032 16 year olds born as singletons, with a vertex presentation, at a gestational age of 34 weeks or older, with Swedish-born parents, delivered between 1990 and 1993 without major congenital malformations. Linear regression was used to analyze mode of delivery in relation to mean scores from national tests in mathematics (40.2; scale, 10-75; SD, 14.9) and mean average grades (223.8; scale, 10-320; SD, 52.3), with adjustment for perinatal and sociodemographic confounders.ResultsChildren delivered by vacuum extraction (-0.51; 95% confidence interval [CI], -0.76 to 0.26) as well as by nonplanned cesarean section (-0.51; 95% CI, -0.82 to -0.20) had slightly lower mean mathematics test scores than children born vaginally without instruments, after adjustment for major confounders. Mean average grades in children delivered by vacuum extraction were -1.05 (95% CI, -1.87 to -0.23) and -1.20 (95% CI,-2.24 to -0.16) in children delivered by nonplanned cesarean section compared with children born vaginally.ConclusionChildren delivered by vacuum extraction had slightly lower grades at age 16 years compared with those born by noninstrumental vaginal delivery but very similar to those delivered by nonplanned cesarean. This suggests that vacuum extraction and nonplanned cesarean are equivalent alternatives for terminating deliveries with respect to cognitive outcomes.
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| 3. |
- Alken, Jenny, et al.
(författare)
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Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden
- 2019
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 2:3
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. OBJECTIVES To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. DESIGN, SETTING, AND PARTICIPANTS This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. EXPOSURES Extreme (serum bilirubin levels, 25.0-29.9mg/dL [425-509 mu mol/L]) and hazardous (serum bilirubin levels, >30.0mg/dL [>510 mu mol/L]) neonatal hyperbilirubinemia. MAIN OUTCOMES AND MEASURES The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomeswere health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. RESULTS Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). CONCLUSIONS AND RELEVANCE Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.
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| 4. |
- Bengtsson, Frida, et al.
(författare)
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Neonatal outcomes of elective labor induction in low-risk term pregnancies
- 2023
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- The rate of labor induction has increased in recent years. The results of previously conducted studies examining associations between elective induction of labor (IOL) and neonatal outcomes have been contradictory. The aim of this study was to examine the intrinsic neonatal risks following IOL. We conducted a population-based cohort study, including all women with recorded low-risk singleton pregnancies at a gestational age between 37+0 and 41+6 weeks in Sweden from 1999 to 2017. Data were collected from the Swedish Medical Birth register. Two study groups were compared-the elective induction group with the spontaneous labor onset group. The results showed that the rate of elective IOL increased from 7.2% in 1999 to 16.4% in 2017. Elective IOL was associated with a higher OR for chorioamnionitis, bacterial sepsis, intracranial hemorrhage, assisted ventilation, hyperbilirubinemia, APGAR<7 at 5 min, and neonatal seizures compared to deliveries with spontaneous labor onset. Regarding mortality outcomes, no significant differences were shown between the groups for either early term or full-term deliveries. We conclude that IOL is associated with neonatal complications, although causality could not be established in this observational study. It is important to be aware of the increased risk and perform IOL with caution.
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| 5. |
- Berg, Jenny, et al.
(författare)
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Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data
- 2023
-
Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 26:5, s. 639-648
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: There is a lack of consensus around the definition of delivery by cesarean section (CS) on maternal request, and clinical practice varies across and within countries. Previous economic evaluations have focused on specific populations and selected complications. Our aim was to evaluate the cost-effectiveness of CS on maternal request compared with planned vaginal birth in a Swedish context, based on a systematic review of benefits and drawbacks and national registry data on costs.Methods: We used the results from a systematic literature review of somatic risks for long-and short-term complications for mother and child, in which certainty was rated low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation. Swedish national registry data were used for healthcare costs of delivery and complications. Utilities for long-term complications were based on a focused literature review. We constructed a decision tree and conducted separate analyses for primi-and multiparous women. Costs and effects were discounted by 3% and the time horizon was varied between 1 and 20 years.Results: Planned vaginal birth leads to lower healthcare costs and somatic health gains compared with elective CS without medical indication over up to 20 years. Although there is uncertainty around, for example, quality-of-life effects, results remain stable across sensitivity analyses.Conclusions: CS on maternal request leads to increased hospitalization costs in a Swedish setting, taking into account short -and long-term consequences for both mother and child. Future research needs to study the psychological consequences related to different delivery methods, costs in outpatient care, and productivity losses.
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| 6. |
- Berggren, Vanja, et al.
(författare)
-
Infibulated women have an increased risk of anal sphincter tears at delivery : a population-based Swedish register study of 250 000 births
- 2013
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 92:1, s. 101-108
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the risk for anal sphincter tears (AST) in infibulated women. Design. Population-based cohort study. Setting. Nationwide study in Sweden. Population. The study population included 250 491 primiparous women with a vaginal singleton birth at 37–41 completed gestational weeks during 1999–2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalian-group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan-group, n = 955, where the majority is infibulated, compared to other African countries, n = 1035, where few individuals are infibulated, but had otherwise similar anthropometric characteristics. These women were compared to 247 572 Swedish-born women. Methods. Register study with data from the National Medical Birth Registry. Main outcome measures. AST in non-instrumental and instrumental vaginal delivery. Results. Compared to Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95% CI 2.08–3.54), followed by women from Eritrea-Ethiophia-Sudan 1.80 (1.41–2.32) and other African countries 1.23 (0.89–1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. Conclusion. Delivering African women from countries where infibulation is common have an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.
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| 7. |
- Bråbäck, Lennart, et al.
(författare)
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Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication : a national cohort study
- 2013
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Ingår i: Allergy, Asthma & Clinical Immunology. - : BioMed Central. - 1710-1484 .- 1710-1492. ; 9:1, s. 14-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mode of delivery may affect the risk of asthma but the findings have not been consistent and factors shared by siblings may confound the associations in previous studies. METHODS: The association between mode of delivery and dispensed inhaled corticosteroid (ICS) (a marker of asthma) was examined in a register based national cohort (n=199 837). A cohort analysis of all first born children aged 2-5 and 6-9 years was performed. An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors. RESULTS: Analyses of first-borns demonstrated that elective caesarean section was associated with an increased risk of dispensed ICS in both 2-5 (adjusted odds ratio (aOR)=1.19, 95% confidence interval (CI) 1.09-1.29) and 6-9 (aOR=1.21, 1.09-1.34) age groups. In the sibling-pair analysis, the increased risk associated with elective caesarean section was confirmed in 2-5 year olds (aOR=1.22, 1.05-1.43) but not in 6-9 year olds (aOR=1.06, 0.78-1.44). Emergency caesarean section and vacuum extraction had some association with dispensed ICS in the analyses of first-borns but these associations were not confirmed in the sibling-pair analyses. CONCLUSIONS: Confounding by familial factors affects the association between mode of delivery and dispensed ICS. Despite this confounding, there was some evidence that elective caesarean section contributed to a modestly increased risk of dispensed ICS but only up to five years of age.
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| 8. |
- Ekeus, Cecilia, et al.
(författare)
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Epidural analgesia during labor among immigrant women in Sweden
- 2010
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 89:2, s. 243-249
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 455,274 primiparous women, who gave birth to a singleton infant at 37-41 completed gestational weeks during 1992-2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses. Methods. Register study with perinatal data from the Medical Birth Register and socio-demographic variables from national income and population registers. Main outcome measure. Use of EDA during vaginal delivery. Results. Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23-1.57); Iran, OR 1.38 (1.26-1.53); Poland, OR 1.22 (1.08-1.37) and Finland, OR 1.10 (1.03-1.17) after adjustments for perinatal and socio-demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46-0.70); Iraq, OR 0.71 (0.64-0.78); Turkey, OR 0.77(0.69-0.86) and Yugoslavia, OR 0.85 (0.79-0.91). Having a native Swedish partner increased the use of EDA in immigrant women. Conclusion. EDA use during labor varies more by maternal country of origin than by socio-economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.
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| 9. |
- Ekéus, Cecilia, et al.
(författare)
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Short stature, smoking habits and birth outcome in international adoptees in Sweden.
- 2008
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. - 1600-0412 .- 0001-6349. ; 87:12, s. 1309-14
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Tidskriftsartikel (refereegranskat)abstract
- Short stature, smoking habits and birth outcome in international adoptees in Sweden.Ekéus C, Lindblad F, Hjern A.Department of Woman and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden. cecilia.ekeus@ki.seOBJECTIVE: To investigate short stature and smoking habits as risk factors for birth outcome in international adoptees in comparison with non-adopted mothers. DESIGN: Prospective cohort study. SETTING: Nationwide study in Sweden. POPULATION: Two study groups were identified from mothers who were born 1968-1979 and gave birth during 1982-2001-3,610 mother-child dyads with a mother adopted from a non-European country and 336,992 mother-child dyads with a mother born in Sweden. METHOD: Register study. OUTCOME MEASURES: Pre-eclampsia, instrumental delivery, preterm delivery, small for gestational age (SGA), Apgar score, cephalhematoma and perinatal mortality and birth weight. RESULTS: Short stature and smoking were more common in international adoptees compared with non-adopted, odds ratios (ORs) 29.07 (95% C.I.: 25.29-33.42) and 1.39 (1.27-1.52), respectively. International adoptees had a slightly increased risk for instrumental delivery (OR: 1.42; 1.32-1.54) and preterm delivery (<37 weeks) (OR: 1.39; 1.24-1.56) and there was a slightly increased risk for SGA (OR: 1.24; 1.01-1.52) in their offspring. However, when we adjusted for maternal height, preterm delivery was the only outcome that remained statistically significant. Adjustment for smoking habits had marginal effects on all outcomes. CONCLUSION: The short stature of international adoptees increased their risk for delivery and birth complications in a predictable manner, but otherwise outcomes were very similar to the general population. No special obstetric monitoring is indicated by adoption status in itself.
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| 10. |
- Ekéus, Cecilia, et al.
(författare)
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Stillbirth among foreign-born women in Sweden
- 2011
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 21:6, s. 788-792
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aims of this study were: (i) to investigate stillbirth risk in offspring to foreign-born women by region of birth; (ii) if disparities in risks can be explained by socio-economic factors, pregnancy complications or maternal morbidity; and (iii) if the risk varies by time since immigration. METHODS: This was a population-based register study with data from the Swedish Medical Birth Register and socio-economic variables from national income and population registers. We studied single births from 1992 to 2005, and included 219 832 births to foreign-born women and 1 094 146 births to Swedish-born women. Logistic regression analysis was used to calculate odds ratios (ORs), using 95% confidence intervals (CIs). RESULTS: In all, 4104 antepartal and 255 intrapartal stillbirths occurred. Compared with births to Swedish women, the OR of stillbirth was 2.27 (95% CI 1.84-2.80) for births to women from Africa and 1.41 (95% CI 1.22-1.64) for births to women from Middle East, after adjustment for confounding factors. The risk of stillbirth was higher in immigrants who had been in Sweden for a short time period (<5 years) compared with those who had been in Sweden for a longer period, OR 1.21 (95% CI 1.05-1.40). CONCLUSIONS: The risk of stillbirth in immigrant women varies by region of birth and time since immigration, being highest in women from Africa and the Middle East, and the recently settled. Further studies are needed to identify the mechanisms behind these patterns.
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| 11. |
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| 12. |
- Ekéus, Cecilia
(författare)
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Teenage parenthood : paternal characteristics and child health outcomes
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis had two general aims. The first was to describe and compare the social-economic and reproductive characteristics and involvement in pregnancy and childbirth of fathers of children born to teenage mothers in Stockholm (Papers I and II). The second aim was to study the risk of long-term morbidity in children born to teenage mothers, measured as injuries in pre-school children (Paper III) and psychiatric morbidity in adolescence and young adulthood (Paper IV). Methods: Papers I and II are descriptive comparative studies, based on the same study population and on the same instrument. Data were collected with questionnaires in 132 fathers of children born to teenage mothers and 132 fathers of children born to primiparas aged 25-29 years. All fathers were present on postnatal wards in Stockholm between May 1997 and April 1998. Papers III and IV are national cohort studies based on Swedish national registers. The study population in Paper III comprised all 800.190 children born in Sweden during 1987-93 who were followed prospectively in registers from birth to their seventh birthday regarding hospital admissions for unintentional and violent injuries. The study population in Paper IV included the 292.129 children born to primiparas in 1973-79. This group was followed prospectively during 1987-2002 regarding hospital admissions for substance abuse, suicide attempts, suicide deaths and schizophrenia. Results: Papers I and II. A significantly larger proportion of fathers of children born to teenage mothers (Group A) compared to fathers in the control group (B), had a compromised social situation, including unstable family backgrounds, low educational attainment, illicit drug use and involvement in criminal activities. In addition, the Group A fathers more often had their sexual debut before 15 years of age and participated less in the family classes. Papers III and IV. After adjustments for social background factors, the pre-school children of teenage mothers had a 40 % increased risk for unintentional injury and a doubled risk for violent injuries compared to the children of older mothers. Also in a long-term perspective, the children of teenage mothers had an increased risk of substance abuse, suicide attempts and suicide deaths. In. contrast, the children of the oldest parents had the highest risk for schizophrenia. Conclusions: Many fathers of children born to teenage mothers showed problem behaviours, which may negatively influence their ability to engage in successful parenting. Owing to the findings of use of illicit drugs and violent crimes among the fathers and the increased risk of injuries in early childhood among the children of teenage mothers, we suggest that midwives should consider asking the teenage women about inflicted violence in early pregnancy. Moreover, midwives should consider developing separate family classes for young parents and also encouraging the expectant fathers to participate. This recommendation is also related to the finding of the increased risk of injury and psychiatric morbidity in the children of teenage mothers, which indicates that young parents might need intense information and education concerning child development and parenting in general. Owing to the findings of an increased risk for injury in the pre-school children of teenage mothers, we suggest that young parents should be given priority in injury prevention programmes.
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| 13. |
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| 14. |
- Ekeus, Cecilia, et al.
(författare)
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Vacuum assisted birth and risk for cerebral complications in term newborn infants : a population-based cohort study
- 2014
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 14, s. 36-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have focused on cerebral complications among newborn infants delivered by vacuum extraction (VE). The aim of this study was to determine the risk for intracranial haemorrhage and/or cerebral dysfunction in newborn infants delivered by VE and to compare this risk with that after cesarean section in labour (CS) and spontaneous vaginal delivery, respectively. Methods: Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010 including all singleton newborn infants delivered at term after onset of labour by VE (n = 87,150), CS (75,216) or spontaneous vaginal delivery (n = 851,347), we compared the odds for neonatal intracranial haemorrhage, traumatic or non-traumatic, convulsions or encephalopathy. Logistic regressions were used to calculate adjusted (for major risk factors and indication) odds ratios (AOR), using spontaneous vaginal delivery as reference group. Results: The rates of traumatic and non-traumatic intracranial hemorrhages were 0.8/10,000 and 3.8/1,000. VE deliveries provided 58% and 31.5% of the traumatic and non-traumatic cases, giving a ten-fold risk [AOR 10.05 (4.67-21.65)] and double risk [AOR 2.23 (1.57-3.16)], respectively. High birth weight and short mother were associated with the highest risks. Infants delivered by CS had no increased risk for intracranial hemorrhages. The risks for convulsions or encephalopathy were similar among infants delivered by VE and CS, exceeding the OR after non-assisted spontaneous vaginal delivery by two-to-three times. Conclusion: Vacuum assisted delivery is associated with increased risk for neonatal intracranial hemorrhages. Although causality could not be established in this observational study, it is important to be aware of the increased risk of intracranial hemorrhages in VE deliveries, particularly in short women and large infants. The results warrant further studies in decision making and conduct of assisted vaginal delivery.
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| 15. |
- Elvander, Charlotte, et al.
(författare)
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The influence of fetal head circumference on labor outcome : a population-based register study
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:4, s. 470-475
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Methods. Register study with data from the Swedish Medical Birth Register. Main outcome measures. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. Results. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (3941 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.331.67], signs of fetal distress (OR 1.73, 95% CI 1.492.03) and maternal distress (OR 2.40, 95% CI 1.962.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.103.88) and 1.22 (95% CI 1.041.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 3741 cm. Conclusions. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.
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| 16. |
- Goldberg, Alexandra, et al.
(författare)
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Swedish guidelines for type 1 diabetes and pregnancy outcomes : A nationwide descriptive study of consensus and adherence
- 2021
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 15:6, s. 1040-1051
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Type 1 diabetes (DM1) during pregnancy and labor is associated with an increased risk of maternal and fetal complications. Evidence-based care is therefore provided in accordance with guidelines. In this study, we aimed to compare all the Swedish guidelines for DM1 during pregnancy and labor in terms of the variables emphasized in the national guidelines from the US and from England and Wales. The second aim was to measure adherence to local guidelines at the four hospitals in Stockholm that cared for pregnant women with DM1 during 2016 and to describe the pregnancy and labor outcomes. Methods: All the Swedish guidelines for DM1 during pregnancy and labor were reviewed on 31 variables. The medical records of 114 women were reviewed according to whether >= 70% of 22 variables in the guidelines were followed. Results: No consensus was found in the Swedish guidelines for any of the 31 variables. Some guidelines were contradictory. The pregnancy guidelines were followed in 17.5% of the medical records, 18.4% followed the labor guidelines, and 5.3% followed both guidelines. The onset of labor, mode of delivery and HbA1c in the third trimester varied significantly, depending on the adherence to guidelines. Conclusions: The Swedish guidelines for DM1 during pregnancy and labor lack both consensus and adherence. A national guideline on DM1 during pregnancy and childbirth with high adherence could improve care for pregnant Swedish women with DM1 and their fetuses.
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| 17. |
- Hjern, Anders, et al.
(författare)
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Educational achievement and vocational career in twins - a Swedish national cohort study
- 2012
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 101:6, s. 591-596
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate how being born and raised as a twin is associated with IQ, educational achievement and vocational career. Methods: Register study in a national birth cohort, complemented with a siblings study. The study population included 13 368 individuals born and raised as twins and 837 752 singletons, including 3019 siblings of twins, in the Swedish birth cohorts of 19731981. Our outcome measures were mean grade points on a five point scale from ninth grade of primary school at 1516 years, IQ tests on a nine grade point scale from male conscripts at 1819 years, highest completed education, disability benefits, work income and employment at 2735 years of age. Results: Twins had slightly better mean grade point averages in ninth grade; +0.08 (95% CI 0.040.11) and more often had completed a university education in young adulthood; OR 1.16 (1.021.21) compared with singleton siblings, despite male twins having a slightly lower IQ at military conscription compared with male singletons. Employment rates, mean income and disability benefits were similar in twins and singletons. Conclusions: Twins have slightly better educational careers and similar vocational careers compared with those born as singletons.
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| 18. |
- Isman, Elisabeth, et al.
(författare)
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Perceptions and experiences of female genital mutilation after immigration to Sweden: An explorative study
- 2013
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Ingår i: Sexual & Reproductive Healthcare. - : Elsevier BV. - 1877-5764 .- 1877-5756. ; 4:3, s. 93-98
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study is to explore how women from part of the world where female genital mutilation (FGM) is normative perceive and experience FGM after immigrating to Sweden. Method: Interviews were conducted with eight women from Djibouti, Eritrea, Ethiopia and Somalia. The data were analyzed using qualitative content analysis. Results: The women's feelings were ambivalent: though they opposed FGM, on the one hand, because of its negative effects on health, they acknowledged the practice's positive cultural aspects on the other hand. The themes that emerged from the interviews are the role of FGM in ensuring virginity and protecting a family's honor, its role in avoiding shame and enhancing purity, social pressure experienced after immigration, an understanding of FGM as a symbol of the country of origin, and support for changing the tradition. Conclusion: These findings indicate that women originating from communities where FGM is normative live in a context in which the practice is viewed as an important aspect of life even after immigration. More research concerning this complex and deeply rooted cultural issue is recommended. (C) 2013 Elsevier B.V. All rights reserved.
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| 19. |
- Johansson, Margareta, et al.
(författare)
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Freebirth, the only option for women who do not fit into common practice : A Swedish national interview study.
- 2023
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 37
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore women's experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife.METHODS: Online semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis.RESULTS: The five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated.CONCLUSIONS: The women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.
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| 20. |
- Khalili, Molly, 1996-, et al.
(författare)
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Pregnancy, delivery, and neonatal outcomes among women with spinal cord injury in Sweden 1997-2015 : A population-based cohort study
- 2022
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 101:11, s. 1282-1290
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of this study was to describe the rate of pregnancy in spinal cord injured women in Sweden as well as pregnancy, delivery, and neonatal outcomes.MATERIAL AND METHODS: This study was based on data from the Swedish Medical Birth Register and the National Patient Register. The study population included women with spinal cord injury who gave birth in Sweden during the period 1997 to 2015. The general population was used as reference and included all non-spinal cord injured patients who gave birth during the same period of time.RESULTS: In the spinal cord injury group, 109 births were identified. Eighty-nine (82%) of them were among paraplegic women and 20 (18%) were among tetraplegic women. Women with spinal cord injury in our study population had urinary tract infections during pregnancy in five cases (5%) and anemia during pregnancy in nine cases (8%), compared with 0.2% and 4%, respectively, in the general population. Compared with the general population more deliveries were induced in the study population, 18 (17%) in the spinal cord injury group and 12% in the general population. Vaginal delivery was achieved in 52 (48%) of the births with 42 of them (39%) being non-instrumental and 10 (9%) being instrumental vaginal deliveries. Elective cesarean section rate was 34% (n = 37). Sixteen infants (15%) were born preterm (gestational week <37). We found an overall low rate of pregnancy and delivery complications.CONCLUSIONS: Our results show predominantly favorable outcomes of pregnancy and delivery in women with spinal cord injury as well as their infants. These results are in concordance with previous research.
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| 21. |
- Liu, Can, et al.
(författare)
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Paternal violent criminality and preterm birth : a Swedish national cohort study
- 2020
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fathers may affect expectant mothers’ daily living situations, which in turn might influence pregnancy outcomes. We investigated the association between paternal violent criminality and risk of preterm birth (≤36 weeks). Methods: We conducted a register-based study with all live singleton births in the Swedish Medical Birth Register from 1992 to 2012, linked with records of paternal violent crime convictions from the National Crime Register from 1973 to 2012. Results: Paternal violent criminality was associated with increased risk of preterm birth and lower gestational age. The association was especially pronounced among infants of reoffenders: men convicted of three or more violent crimes (adjusted odds ratio [aOR] 1.23 [95% CI 1.17, 1.29]). Maternal half sibling-comparisons, an analytic approach controlling for maternal factors stable across pregnancies, also suggested increased risk of preterm birth and lower gestational age when exposed to a violently reoffending father compared to a father without violent criminal convictions (aOR 1.30 [0.99, 1.72], adjusted mean difference − 1.07 [− 1.78, − 0.36]). Conclusions: Persistent paternal violent criminality was associated with increased risk of preterm birth, even after controlling for maternal characteristics that did not change between pregnancies.
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| 22. |
- Lowe, Adrian J, et al.
(författare)
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Impact of Maternal Obesity on Inhaled Corticosteroid Use in Childhood : A Registry Based Analysis of First Born Children and a Sibling Pair Analysis
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIt has been proposed that maternal obesity during pregnancy may increase the risk that the child develops allergic disease and asthma, although the mechanisms underpinning this relationship are currently unclear. We sought to assess if this association may be due to confounding by genetic or environmental risk factors that are common to maternal obesity and childhood asthma, using a sibling pair analysis.MethodsThe study population comprised a Swedish national cohort of term children born between 1992 and 2008 to native Swedish parents. Maternal body mass index (BMI) was measured at 8-10 weeks gestation. Unconditional logistic regression models were used to determine if maternal obesity was associated with increased risk of inhaled corticosteroid (ICS) in 431,718 first-born children, while adjusting for potential confounders. An age-matched discordant sib-pair analysis was performed, taking into account shared genetic and environmental risk factors.ResultsMaternal over-weight and obesity were associated with increased risk that the child would require ICS (for BMI >= 35 kg/m(2), aOR = 1.30, 95% CI = 1.10-1.52 compared with normal weight mothers) in children aged 6-12 years. Similar effects were seen in younger children, but in children aged 13-16 years, maternal obesity (BMI >= 30) was related to increased risk of ICS use in girls (aOR = 1.28, 95% CI = 1.07-1.53) but not boys (OR = 1.05, 95% CI = 0.87-1.26). The sib-pair analysis, which included 2,034 sib-pairs older than six years who were discordant for both ICS use and maternal BMI category, failed to find any evidence that increasing maternal weight was related to increased risk of ICS use.ConclusionMaternal obesity is associated with increased risk of childhood ICS use up to approximately 12 years of age, but only in girls after this age. These effects could not be confirmed in a sib pair analysis, suggesting either limited statistical power, or the effects of maternal BMI may be due to shared genetic or environmental risk factors.
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| 23. |
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| 24. |
- Lowe, Adrian, et al.
(författare)
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The association between maternal obesity and childhood asthma - an analysis based on swedish sib-pairs
- 2011
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Ingår i: Internal Medicine Journal - Special Issue. - Carlton, Vic. : Blackwell Science. ; , s. 11-11
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Konferensbidrag (refereegranskat)abstract
- Background: The prevalence of both asthma and obesity have increased inwesternised countries over recent decades. It has been proposed that maternalobesity during pregnancy may induce a pro-infl ammatory intrauterineenvironment, which may increase the child’s risk of asthma and allergicdisease. Sib-pair analysis is a powerful technique for assessing the possibilitythat an exposure is causal for an outcome.Methods: The study population comprised all children born between 1998and 2005 in Stockholm (n = 99,830 born to 43,103 separate mothers)registered on the Swedish Medical Birth Registry. Maternal BMI was typicallymeasured typically at 8–10 weeks post conception. Use of asthma medications(either inhaled corticosteroids or montelukast) was recorded inthe Swedish Prescription Registry between July 2005 and February 2011. Conditional logistic regression models were used to assess the effect ofchanging maternal BMI on asthma medication use within sibling pairsmatched for age. Adjustment was made for maternal smoking during pregnancy,pregnancy complications, the child’s gender and other potentialconfounders.Results: There were 4,311 children with siblings with discordant asthmamedication use between 5 and 9 years of age. There was a trend for childrenborn to obese mothers (30–34.9 kg/m2) to have an elevated risk (aOR = 1.53,95% CI = 0.88–2.65) of asthma medication use when compared to theirmatched sibs. Children born to very obese mothers (BMI > 35 kg/m2) hada much greater risk of asthma than their siblings (aOR = 4.45, 95%CI = 1.79–11.05).Conclusion: Maternal early pregnancy obesity is associated with increasedrisk of asthma in the child. These associations are unlikely to be due to sharedgenetic or other familial risk factors for obesity and asthma, as the reportedassociations are based on a sib-pair analysis. Maternal obesity, or changes inlifestyle factors that lead to it, appear to cause an increase risk of childhoodasthma.
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| 25. |
- Ulfsdottir, Hanna, et al.
(författare)
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Long-term neurological morbidity among children delivered by vacuum extraction : a national cohort study
- 2023
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 102:7, s. 843-853
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Tidskriftsartikel (refereegranskat)abstract
- Introduction This is the first nationwide cohort study of vacuum extraction (VE) and long-term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long-term morbidity. The aim of this study was to investigate the risk of neonatal mortality, cerebral palsy (CP), and epilepsy among children delivered by VE in a long-term perspective.Material and methods The study population included 1 509 589 term singleton children planned for vaginal birth in Sweden (January 1, 1999 to December 31, 2017). We investigated the risk of neonatal death (ND), CP, and epilepsy among children delivered by VE (successful or failed) and compared their risks with those born by spontaneous vaginal birth and emergency cesarean section (ECS). We used logistic regression to study the adjusted associations with each outcome. The follow-up time was from birth until December 31, 2019.Results The percentage and total number of children with the outcomes were ND (0.04%, n = 616), CP (0.12%, n = 1822), and epilepsy (0.74%, n = 11 190). Compared with children delivered by ECS, those born by VE had no increased risk of ND, but there was an increased risk for those born after failed VE (adj OR 2.23 [1.33-3.72]). The risk of CP was similar among children born by VE and those born spontaneously vaginally. Further, the risk of CP was similar among children born after failed VE compared with ECS. The risk of epilepsy was not increased among children born by VE (successful/failed), compared with those who had spontaneous vaginal birth or ECS.Conclusions The outcomes ND, CP, and epilepsy are rare. In this nationwide cohort study, children born after successful VE had no increased risk of ND, CP or epilepsy compared with those delivered by ECS, but there was an increased risk of ND among those born by failed VE. Concerning the studied outcomes, VE appears to be a safe obstetric intervention; however, it requires a thorough risk assessment and awareness of when to convert to ECS.
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| 26. |
- Ulfsdottir, Hanna, et al.
(författare)
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Long-Term Neurological Morbidity Among Children Delivered by Vacuum Extraction-A National Cohort Study
- 2024
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Ingår i: Obstetrical and Gynecological Survey. - : Ovid Technologies (Wolters Kluwer Health). - 0029-7828 .- 1533-9866. ; 79:1, s. 13-15
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- (Abstracted from Acta Obstet Gynecol Scand 2023;102:843-853) Many factors during pregnancy and childbirth influence long term neurological outcomes, but some controllable factors have not been studied extensively; one of these factors is vacuum extraction (VE) as a method of assisted childbirth. This study was designed as the first nationwide cohort study examining VE and its impact on long-term neurological morbidity, and its aim was to assess the risks of neonatal mortality, cerebral palsy (CP), and epilepsy in children delivered by VE.
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| 27. |
- Ulfsdottir, Hanna, et al.
(författare)
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The association between pre‐eclampsia and neonatal complications in relation to gestational age
- 2023
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227.
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Tidskriftsartikel (refereegranskat)abstract
- Aim: There has been limited research about the associations between pre-eclampsiaand neonatal complications in relation to gestational age. This register-basedstudyaimed to address that gap in our knowledge.Methods: We used Swedish Medical Birth Register to carry out a population-basedstudy on primiparas with singleton pregnancies from 1999 to 2017. Descriptivestatistics and logistic regressions were used to study the associations betweenpre-eclampsiaand neonatal complications in different gestational ages. The data ispresented as adjusted odds ratios (aORs) with 95% CI.Results: The study comprised 805 591 primiparas: 2.9% had mild to moderate pre-eclampsiaand 1.4% had severe pre-eclampsia.Neonates born to women with pre-eclampsiahad increased risks of several complications compared to those born tomothers without pre-eclampsia.After adjustment for confounding variables, therisk of being small for gestational age (aOR 5.3, CI: 5.1–5.5) and needing resuscitation(aOR 2.6, CI: 2.4–2.7) were increased. The risk of a low Apgar score and convulsions/hypoxic ischemic encephalopathy was increased at 32–41 weeks of gestation.Moreover, the overall risk of sepsis (aOR 1.9. CI: 1.8–2.1) and perinatal death (aOR 1.2,CI: 1.1–1.5) was also increased.Conclusion: Compared with infants of mothers without pre-eclampsia,those exposedto pre-eclampsiahad higher risks of all the studied neonatal complications.
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