| 1. |
- Helseth, Ragnhild, et al.
(författare)
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Gestational diabetes mellitus among Nordic Caucasian women: Prevalence and risk factors according to WHO and simplified IADPSG criteria
- 2014
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 74:7, s. 620-628
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Tidskriftsartikel (refereegranskat)abstract
- Background. Gestational diabetes mellitus (GDM) is associated with both maternal and offspring adverse effects. The World Health Organization (WHO) has recently adopted novel GDM criteria. The aim of this study was to evaluate the former WHO and a simplified version of the new International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria as to prevalence of and risk factors for GDM in a Nordic Caucasian population. Methods. A 75 g oral glucose tolerance test was performed in 687 women at 18-22 and 32-36 pregnancy weeks. GDM was defined according to the WHO criteria as fasting plasma glucose >= 7.0 mmol/L and/or 2-hour plasma glucose >= 7.8 mmol/L and by a simplified version of the IADPSG criteria as either fasting glucose >= 5.1 mmol/L and/or 2-h plasma glucose >= 8.5 mmol/L. One-hour glucose values were not available and were thus not included in the diagnosis of GDM by IADPSG. Prevalence of GDM during pregnancy and risk factors for GDM at 18-22 weeks were studied in retrospect according to each of the two criteria. Results. The total prevalence of GDM during pregnancy was 6.1% (42/687) for the WHO criteria and 7.4% (51/687) for the simplified IADPSG criteria. High maternal age and short stature were independently associated with WHO GDM. Maternal age, fasting insulin and no regular exercise at 18-22 pregnancy weeks associated with simplified IADPSG GDM. Conclusions. Simplified IADPSG criteria moderately increase GDM prevalence compared with the WHO criteria. Risk factors for GDM differ with the diagnostic criteria used.
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| 2. |
- Austdal, Marie, et al.
(författare)
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First Trimester Urine and Serum Metabolomics for Prediction of Preeclampsia and Gestational Hypertension: A Prospective Screening Study.
- 2015
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Ingår i: International Journal of Molecular Sciences. - : MDPI AG. - 1422-0067. ; 16:9, s. 21520-21538
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Tidskriftsartikel (refereegranskat)abstract
- Hypertensive disorders of pregnancy, including preeclampsia, are major contributors to maternal morbidity. The goal of this study was to evaluate the potential of metabolomics to predict preeclampsia and gestational hypertension from urine and serum samples in early pregnancy, and elucidate the metabolic changes related to the diseases. Metabolic profiles were obtained by nuclear magnetic resonance spectroscopy of serum and urine samples from 599 women at medium to high risk of preeclampsia (nulliparous or previous preeclampsia/gestational hypertension). Preeclampsia developed in 26 (4.3%) and gestational hypertension in 21 (3.5%) women. Multivariate analyses of the metabolic profiles were performed to establish prediction models for the hypertensive disorders individually and combined. Urinary metabolomic profiles predicted preeclampsia and gestational hypertension at 51.3% and 40% sensitivity, respectively, at 10% false positive rate, with hippurate as the most important metabolite for the prediction. Serum metabolomic profiles predicted preeclampsia and gestational hypertension at 15% and 33% sensitivity, respectively, with increased lipid levels and an atherogenic lipid profile as most important for the prediction. Combining maternal characteristics with the urinary hippurate/creatinine level improved the prediction rates of preeclampsia in a logistic regression model. The study indicates a potential future role of clinical importance for metabolomic analysis of urine in prediction of preeclampsia.
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| 3. |
- Bak, Geske S., et al.
(författare)
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Prospective population-based cohort study of maternal obesity as a source of error in gestational age estimation at 11–14 weeks
- 2016
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 95:11, s. 1281-1287
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: An impact of maternal obesity on ultrasound dating of pregnancy at 11–14 gestational weeks is possible and was investigated. Material and methods: A prospective cohort study based on the Danish national population during a 4-year period in which we entered all mothers with singleton pregnancies who had a known last menstrual period (LMP), a recorded booking of body mass index (BMI), and a late first trimester ultrasound dating scan using crown-rump-length measurement (gestational age 11+0–13+6 weeks). Almost all scans were performed transabdominally. Transvaginal ultrasound was only performed in the case of limited visibility by transabdominal scanning. Differences between LMP and ultrasound estimated date of delivery (EDD) were stratified by BMI classes. Odds ratios (ORs) were calculated and adjusted for maternal age, parity and smoking. Results: In total, 187 486 women were analyzed: 21.8% were overweight and 12.3% obese. Ultrasound EDD was ≥7 days later than by LMP in 5.8% of normal-weight women, 7.3% of obese women, and 10.0% of women with morbid obesity. Compared with normal BMI (18.5–24.9), the OR for postponing EDD increased with increasing BMI; BMI 25–29.9 [OR 0.97, 95% confidence interval (CI) 0.93–1.02], BMI 30–34.9 (OR 1.14, 95% CI 1.07–1.23), BMI 35–39.9 (OR 1.28, 95% CI 1.15–1.42), and BMI 40+ (OR 1.73, 95% CI 1.50–1.98). Lean pregnant women (BMI <18.5) also had a higher chance of having EDD postponed 7 days or more (OR 1.11, 95% CI 1.01–1.22). Conclusion: Rising maternal BMI appears to be associated with postponement of ultrasound EDD.
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| 4. |
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| 5. |
- Belachew, Johanna, 1976-
(författare)
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Retained Placenta and Postpartum Haemorrhage
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to explore the possibility to diagnose retained placental tissue and other placental complications with 3D ultrasound and to investigate the impact of previous caesarean section on placentation in forthcoming pregnancies.3D ultrasound was used to measure the volumes of the uterine body and cavity in 50 women with uncomplicated deliveries throughout the postpartum period. These volumes were then used as reference, to diagnose retained placental tissue in 25 women with secondary postpartum haemorrhage. All but three of the 25 women had retained placental tissue confirmed at histopathology. The volume of the uterine cavity in women with retained placental tissue was larger than the reference in most cases, but even cavities with no retained placental tissue were enlarged (Studies I and II).Women with their first and second birth, recorded in the Swedish medical birth register, were studied in order to find an association between previous caesarean section and retained placenta. The risk of retained placenta with heavy bleeding (>1,000 mL) and normal bleeding (≤1,000 mL) was estimated for 19,459 women with first caesarean section delivery, using 239,150 women with first vaginal delivery as controls. There was an increased risk of retained placenta with heavy bleeding in women with previous caesarean section (adjusted OR 1.61; 95% CI 1.44-1.79). There was no increased risk of retained placenta with normal bleeding (Study III).Placental location, myometrial thickness and Vascularisation Index were recorded on 400 women previously delivered by caesarean section. The outcome was retained placenta and postpartum haemorrhage (≥1,000 mL). There was a trend towards increased risk of postpartum haemorrhage for women with anterior placentae. Women with placenta praevia had an increased risk of retained placenta and postpartum haemorrhage. Vascularisation Index and myometrial thickness did not associate (Study IV).In conclusion: 3D ultrasound can be used to measure the volume of the uterine body and cavity postpartum, but does not increase the diagnostic accuracy of retained placental tissue. Previous caesarean section increases the risk of retained placenta in subsequent pregnancy, and placenta praevia in women with previous caesarean section increases the risk for retained placenta and postpartum haemorrhage.
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| 6. |
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| 7. |
- Christiansen, S C, et al.
(författare)
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The effect of exercise and metformin treatment on circulating free DNA in pregnancy.
- 2014
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Ingår i: Placenta. - : Elsevier BV. - 1532-3102 .- 0143-4004. ; 35:12, s. 989-993
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Tidskriftsartikel (refereegranskat)abstract
- Some pregnancy complications are characterized by increased levels of cell-free fetal (cffDNA) and maternal DNA (cfmDNA), the latter may also be elevated during physical strain. This study aims at assessing the impact of exercise and metformin intervention in pregnancy, and to compare the levels of cell free DNA in pregnant women with or without PCOS diagnosis.
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| 8. |
- Eggebo, T. M., et al.
(författare)
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Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor
- 2015
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 46:5, s. 606-610
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To ascertain if fetal head position on transabdominal ultrasound is associated with delivery by Cesarean section in nulliparous women with a prolonged first stage of labor. Methods This was a prospective observational study performed at Stavanger University Hospital, Norway, and Addenbrooke's Hospital, Cambridge, UK, between January 2012 and April 2013. Nulliparous pregnant women with a singleton cephalic presentation at term and prolonged labor had fetal head position assessed by ultrasound. The main outcome was Cesarean section vs vaginal delivery, and secondary outcomes were association of fetal head position with operative vaginal delivery and duration of remaining time in labor. Results Fetal head position was assessed successfully by ultrasound examination in 142/150 (95%) women. In total, 19/50 (38%) women with a fetus in the occiput posterior (OP) position were delivered by Cesarean section compared with 16/92 (17%) women with a fetus in a non-OP position (P= 0.01). On multivariable logistic regression analysis, the OP position predicted delivery by Cesarean section with an odds ratio (OR) of 2.9 (95% CI, 1.3-6.7; P= 0.01) and induction of labor with an OR of 2.4 (95% CI, 1.0-5.6; P= 0.05). Fetal head position was not associated with operative vaginal delivery or with remaining time in labor. The agreement between a digital and an ultrasound assessment of OP position was poor (Cohen's kappa= 0.19; P= 0.18). Conclusion OP fetal head position assessed by transabdominal ultrasound was significantly associated with delivery by Cesarean section. Copyright (C) 2014 ISUOG. Published by John Wiley & Sons Ltd.
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| 9. |
- Eggebo, T. M., et al.
(författare)
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Sonographic prediction of vaginal delivery in prolonged labor: a two-center study
- 2014
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 43:2, s. 195-201
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). Methods This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor. Results Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was <= 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was >40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was >= 110 degrees in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was <110 degrees in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD <= 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP >= 110 degrees (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor. Conclusion Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor. Copyright (C) 2013 ISUOG. Published by John Wiley & Sons Ltd.
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| 10. |
- Hambraeus, Mette, et al.
(författare)
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Sacrococcygeal teratoma: A population-based study of incidence and prenatal prognostic factors.
- 2015
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468.
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Tidskriftsartikel (refereegranskat)abstract
- Sacrococcygeal teratoma (SCT) is a rare congenital tumor associated with high rates of perinatal mortality and morbidity. This study evaluated the incidence, prenatal detection rate, and early predictors of a complicated outcome following diagnosis of SCT.
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| 11. |
- Hassan, Wassim A, et al.
(författare)
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Intrapartum assessment of caput succedaneum by transperineal ultrasound: a two-centre pilot study.
- 2015
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Ingår i: Australian and New Zealand Journal of Obstetrics and Gynaecology. - : Wiley. - 1479-828X .- 0004-8666. ; 55:4, s. 401-403
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Tidskriftsartikel (refereegranskat)abstract
- Digital assessments of caput succedaneum are subjective; however, caput succedaneum can also be expressed as ultrasound measured skin-skull distance (SSD). In this study, we aimed to compare the clinical and ultrasound assessment of caput succedaneum (caput) in nulliparous women in the first stage of labour. Furthermore, we aimed to investigate the repeatability of ultrasound measurements. We observed a significant but low correlation between clinical and ultrasound assessments (Kappa value 0.29; P < 0.01). Interobserver repeatability for SSD showed an intraclass correlation coefficient of 0.96 (95% CI, 0.93-0.98). The mean difference for the caput measurements was -0.4 mm (95% CI, -0.85 to 0.05), and limits of agreement were -3.44 to 2.64 mm. We conclude that ultrasound measured SSD is an objective expression of caput with significant correlation with clinical assessment.
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| 12. |
- Hellenes, Olav Morkved, et al.
(författare)
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Regular moderate exercise during pregnancy does not have an adverse effect on the neurodevelopment of the child
- 2015
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 104:3, s. 285-291
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Tidskriftsartikel (refereegranskat)abstract
- AimCurrent U.S. guidelines suggest that pregnant women should exercise regularly during pregnancy, and we examined the neurodevelopment of the children whose mothers had taken that advice. MethodsThis Norwegian study included 188 children whose mothers had followed a structured exercise protocol and 148 control children whose mothers had not. Their cognitive, language and motor skills were assessed at 18months of age by the Bayley Scales of Infant Development-III and daily life functioning with the Ages and Stages Questionnaire. ResultsNo significant differences were found between the two groups. Subgroup analyses revealed that the children whose mothers had exercised had a slightly lower motor composite score (mean: 97.6, 95% CI: 96.0-99.2) than the control group (mean: 100.0, 95% CI: 98.6-101.5) (p=0.03). Boys in the intervention group had lower fine motor scores (mean: 10.6, 95% CI: 10.3-11.0) than boys in the control group (mean: 11.5, 95% CI: 11.0-11.9) (p=0.01). ConclusionOur main finding was that regular moderate exercise during pregnancy does not adversely affect neurodevelopment in children. The lower motor scores in the subgroup analyses are probably clinically insignificant, but the lower fine motor scores for boys in the intervention group warrant further research.
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| 13. |
- Huber, Malin, 1979-
(författare)
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To tear and to heal : pelvic floor dysfunction and childbirth
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Up to 80% of women are affected by a perineal laceration after their first vaginal birth. An estimated 40–50% of lacerations involve the perineal muscles, and up to 7% are obstetric anal sphincter injuries (OASI). There is a lack of knowledge about the extent of short-term complications such as pelvic floor dysfunction (PFD) following spontaneous or iatrogenic pelvic floor trauma. Women’s experiences of daily life after childbirth complicated by OASI is poorly understood. Three-dimensional endoanal ultrasonography (3D-EAUS) is a welldocumented method for evaluating damage to the anal sphincter in other contexts. Adding ultrasonography to standard clinical examination has revealed injuries previously missed, and research evaluating diagnostic methods for the routine screening of OASI has been called for.Aim: This thesis aims to evaluate the diagnostics of OASI, determine if the degree of perineal injury or anal sphincter defects after childbirth are associated with pelvic dysfunction, and explore women’s experiences of OASI.Methods Studies I and IV were prospective cohort-studies to evaluate any association between perineal tear or sphincter defect to PFD. Study II was an interview study addressing women’s experiences of OASI by qualitative content analysis. Study III was a cross-sectional study designed to examine the utility of endoanal ultrasound to detect OASI. Participants were clinically examined after birth and 3D-EAUS was performed immediately after giving birth and 3 months postpartum. PFD was evaluated using a web-based questionnaire one year after delivery.Results: A total of 511 women completed the one-year questionnaire (Study I) and a purposive sample of 11 women were invited to take part in Study II. In Study III, 680 women underwent a clinical examination and 3D-EAUS recording immediately after birth. In Study IV, 239 women who attended all follow-ups were included. PFD was experienced by women with a perineal laceration of any grade, but also those with an intact perineum. Dyspareunia and urinary incontinence were the most common problems. Women with OASI had a higher risk for developing vi symptoms of prolapse, urinary urge incontinence, dyspareunia, and pain as well as experiencing a negative impact on their daily life. Elements that negatively influenced women’s experiences of OASI were pain and symptoms of PFD, normalisation of symptoms by healthcare providers, and unrealistic expectations about this period in life. 3D-EAUS immediately after delivery had poor sensitivity and specificity in detecting clinically diagnosed OASI. Postpartum anal sphincter defects were associated with genital pain and dyspareunia.Conclusions: OASI is an evident risk factor for pelvic floor dysfunction after childbirth, but symptoms of pelvic floor disorder were found to be common, even in women with mild to moderate perineal laceration. OASI has a negative impact on how a woman experiences relationships, social contact, and sexuality. Using 3D-EAUS in a maternity ward to diagnose OASI is demanding. Staff generally have little experience in 3D-EAUS. There are also difficulties in obtaining good image quality, due to local oedema, bleeding, positioning of the woman, and unintentional movements. These factors all complicate the interpretation of images.
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| 14. |
- Kahrs, Birgitte H., et al.
(författare)
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Fetal rotation during vacuum extractions for prolonged labor : a prospective cohort study
- 2018
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 97:8, s. 998-1005
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of the study was to investigate fetal head rotation during vacuum extraction. Material and methods: We conducted a prospective cohort study from November 2013 to July 2016 in seven European hospitals. Fetal head position was determined with transabdominal or transperineal ultrasound and categorized as occiput anterior (OA), occiput transverse (OT) or occiput posterior (OP) position. Main outcome was the proportion of fetuses rotating during vacuum extraction. Secondary outcomes were conversion of delivery method, duration of vacuum extraction, umbilical artery pH <7.10 and agreement between clinical and ultrasound assessments. Results: The study population comprised 165 women. During vacuum extraction 117/119 (98%) remained in OA and two fetuses rotated to OP position. Rotation from OT to OA position occurred in 14/19 (74%) and to OP position in 5/19 (26%). Rotation from OP to OA position occurred in 15/25 (60%), and 10/25 (40%) fetuses remained in OP position. Delivery information was missing in two cases. The conversion rate from vacuum extraction to cesarean section or forceps was 10% in the OA group vs. 23% in the non-OA group; p < 0.05. The estimated duration of vacuum extraction was significantly shorter in OA fetuses, 7 min vs. 10 min (log rank test p < 0.01). There was no significant difference in umbilical artery pH < 7.10 between OA and non-OA position. Cohens Kappa of agreement between clinical and ultrasound assessments was 0.42 (95% CI 0.26–0.57). Conclusion: Most fetuses in OP or OT positions rotated to OA position during vacuum extraction, but the proportion of failed vacuum extractions remained high.
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| 15. |
- Lindström, Linda, 1978-
(författare)
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Born Small for Gestational Age : Beyond Size at Birth
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children born small for gestational age (SGA) run increased risk of perinatal morbidity and mortality, but also of long-term health impairment. Risks on long term may vary depending on postnatal growth patterns. The overall aim of the thesis was to gain further knowledge about long-term consequences of being born SGA, as well as the impact of perinatal exposures on postnatal growth patterns. The thesis is based on four register-based cohort studies.In paper I, risk of chronic hypertension was assessed in 731,008 first-time mothers. Perinatal exposure to pre-eclampsia, being born SGA and preterm were all independently associated with increased risk of chronic hypertension. The risk was further enhanced after combined exposure. The strongest association was seen in combinations including pre-eclampsia.In paper II, risk of poor school performance at time of graduation from compulsory school was assessed in 1,088,980 children born SGA at term. Being born SGA was associated with increased risk of poor school performance, following a dose-response pattern with increased risk even for birthweight for gestational age (GA) –1.01 to –2 SD. Boys with short adult stature were associated with higher risk of poor school performance than those with non-short stature.In paper III, differences in postnatal growth patterns depending on SGA status and maternal smoking habits were assessed in 32,493 children. Children born SGA with smoking mothers had a more rapid catch-up growth than those with non-smoking mothers. Compared with children born appropriate for GA (AGA) with non-smoking mothers, only children born SGA with non-smoking mothers were associated with increased risk of short stature at 1.5 and 5 years.In paper IV, differences in postnatal growth patterns until age five years, depending on SGA status and GA at birth, were assessed in 41,669 children born between 32-40 gestational weeks. Being born SGA and moderate to late preterm was associated with shorter stature and lower BMI, compared with being born AGA at term. SGA status had greater impact on growth and body proportions than GA at birth.In conclusion, children born SGA are at higher risk of chronic hypertension and cognitive impairment than children born AGA. Postnatal growth patterns vary in children born SGA, depending on intrauterine exposure to smoking and GA at birth. This may modify risks of long-term health impairment.
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| 16. |
- Myklestad, Kirsti, et al.
(författare)
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Do parental heights influence pregnancy length?: a population-based prospective study, HUNT 2
- 2013
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The objective of this study was to examine the association of maternal and paternal height with pregnancy length, and with the risk of pre- and post-term birth. In addition we aimed to study whether cardiovascular risk factors could explain possible associations. Methods: Parents who participated in the Nord-Trondelag Health Study (HUNT 2; 1995-1997) were linked to offspring data from the Medical Birth Registry of Norway (1997-2005). The main analyses included 3497 women who had delivered 5010 children, and 2005 men who had fathered 2798 pregnancies. All births took place after parental participation in HUNT 2. Linear regression was used to estimate crude and adjusted differences in pregnancy length according to parental heights. Logistic regression was used to estimate crude and adjusted associations of parental heights with the risk of pre-and post-term births. Results: We found a gradual increase in pregnancy length by increasing maternal height, and the association was essentially unchanged after adjustment for maternal cardiovascular risk factors, parental age, offspring sex, parity, and socioeconomic measures. When estimated date of delivery was based on ultrasound, the difference between mothers in the lower height quintile (<163 cm cm) and mothers in the upper height quintile (>= 173 cm) was 4.3 days, and when estimated date of delivery was based on last menstrual period (LMP), the difference was 2.8 days. Shorter women (< 163 cm) had lower risk of post-term births, and when estimated date of delivery was based on ultrasound they also had higher risk of pre-term births. Paternal height was not associated with pregnancy length, or with the risks of pre-and post-term births. Conclusions: Women with shorter stature had shorter pregnancy length and lower risk of post-term births than taller women, and when EDD was based on ultrasound, they also had higher risk of preterm births. The effect of maternal height was generally stronger when pregnancy length was based on second trimester ultrasound compared to last menstrual period. The association of maternal height with pregnancy length could not be explained by cardiovascular risk factors. Paternal height was neither associated with pregnancy length nor with the risk of pre-and post-term birth.
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| 17. |
- Rogozińska, Ewelina, et al.
(författare)
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Effects of antenatal diet and physical activity on maternal and fetal outcomes : Individual patient data meta-analysis and health economic evaluation
- 2017
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Ingår i: Health Technology Assessment. - : National Institute for Health Research. - 1366-5278 .- 2046-4924. ; 21:41
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Tidskriftsartikel (refereegranskat)abstract
- Background: Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes. Objectives: To assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions. Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search). Review methods: Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions. Results: Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI-0.92 to-0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate-0.10 kg, 95% CI-0.14 to-0.06 kg) and multiparity (summary estimate-0.73 kg, 95% CI-1.24 to-0.23 kg). Limitations: The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies. Conclusion: Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes. Future work: The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation. Study registration: This study is registered as PROSPERO CRD42013003804.
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| 18. |
- Ruifrok, Anneloes E, et al.
(författare)
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Study protocol : Differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes: Individual patient data (IPD) meta-analysis and health economic evaluation
- 2014
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Ingår i: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPregnant women who gain excess weight are at risk of complications during pregnancy and in the long term. Interventions based on diet and physical activity minimise gestational weight gain with varied effect on clinical outcomes. The effect of interventions on varied groups of women based on body mass index, age, ethnicity, socioeconomic status, parity, and underlying medical conditions is not clear. Our individual patient data (IPD) meta-analysis of randomised trials will assess the differential effect of diet- and physical activity-based interventions on maternal weight gain and pregnancy outcomes in clinically relevant subgroups of women.Methods/designRandomised trials on diet and physical activity in pregnancy will be identified by searching the following databases: MEDLINE, EMBASE, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database. Primary researchers of the identified trials are invited to join the International Weight Management in Pregnancy Collaborative Network and share their individual patient data. We will reanalyse each study separately and confirm the findings with the original authors. Then, for each intervention type and outcome, we will perform as appropriate either a one-step or a two-step IPD meta-analysis to obtain summary estimates of effects and 95% confidence intervals, for all women combined and for each subgroup of interest. The primary outcomes are gestational weight gain and composite adverse maternal and fetal outcomes. The difference in effects between subgroups will be estimated and between-study heterogeneity suitably quantified and explored. The potential for publication bias and availability bias in the IPD obtained will be investigated. We will conduct a model-based economic evaluation to assess the cost effectiveness of the interventions to manage weight gain in pregnancy and undertake a value of information analysis to inform future research.
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| 19. |
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| 20. |
- Sande, Ragnar, et al.
(författare)
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Safety Aspects of Perinatal Ultrasound
- 2021
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Ingår i: Ultraschall in der Medizin. - : Georg Thieme Verlag KG. - 0172-4614. ; 42:6, s. 580-598
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Tidskriftsartikel (refereegranskat)abstract
- Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.
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| 21. |
- Skrastad, Ragnhild B., et al.
(författare)
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A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population
- 2014
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 93:12, s. 1238-1247
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy. DesignProspective screening study. SettingNational Center for Fetal Medicine, Trondheim, Norway. Population579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. MethodsWomen were examined between 11(+0) and 13(+6)weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves. Main outcome measuresPrediction of preeclampsia, severe preeclampsia and gestational hypertension. ResultsThe best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate. ConclusionsMaternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.
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| 22. |
- Skrastad, R. B., et al.
(författare)
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Risk assessment for preeclampsia in nulliparous women at 11-13weeks gestational age: prospective evaluation of two algorithms
- 2015
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 122:13, s. 1781-1788
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate two algorithms for prediction of preeclampsia in a population of nulliparous women in Norway. DesignProspective screening study. SettingNational Centre for Fetal Medicine in Trondheim, Norway. PopulationFive hundred and forty-one nulliparous women. MethodsThe women were examined between 11(+0) and 13(+6)weeks with interviews for maternal characteristics and measurements of mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein A and placental growth factor. The First Trimester Screening Program version 2.8 by The Fetal Medicine Foundation (FMF) was compared with the Preeclampsia Predictor TM version 1 revision 2 by Perkin Elmer (PREDICTOR). Main outcome measuresPrediction of preeclampsia requiring delivery before 37weeks, before 42weeks and late preeclampsia (delivery after 34weeks). ResultsThe performance of the two algorithms was similar, but quite poor, for prediction of preeclampsia requiring delivery before 42weeks with an area under the curve of 0.77 (0.67-0.87) and sensitivity 40% (95% CI 19.1-63.9) at a fixed 10% false positive rate for FMF and 0.74 (0.63-0.84) and sensitivity 30% (95% CI 11.9-54.3) at a fixed 10% false positive rate for PREDICTOR. The FMF algorithm for preeclampsia requiring delivery <37weeks had an area under the curve of 0.94 (0.86-1.0) and sensitivity of 80% (95% CI 28.4-99.5) at a 10% fixed false positive rate. ConclusionsFetal Medicine Foundation and PREDICTOR algorithms had similar and only modest performance in predicting preeclampsia. The results indicate that the FMF algorithm is suitable for prediction of preterm preeclampsia.
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| 23. |
- Stafne, S, et al.
(författare)
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Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial.
- 2012
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 119:10, s. 1270-1280
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Tidskriftsartikel (refereegranskat)abstract
- Please cite this paper as: Stafne S, Salvesen K, Romundstad P, Torjusen I, Mørkved S. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03426.x. Objective To assess whether pregnant women following a general exercise course, including pelvic floor muscle training (PFMT), were less likely to report urinary and anal incontinence in late pregnancy than a group of women receiving standard care. Design A two-armed, two-centred randomised controlled trial. Setting Trondheim University Hospital (St. Olavs Hospital) and Stavanger University Hospital, in Norway. Population A total of 855 women were included in this trial. Methods The intervention was a 12-week exercise programme, including PFMT, conducted between 20 and 36 weeks of gestation. One weekly group session was led by physiotherapists, and home exercises were encouraged at least twice a week. Controls received regular antenatal care. Main outcome measures Self-reported urinary and anal incontinence after the intervention period (at 32-36 weeks of gestation). Results Fewer women in the intervention group reported any weekly urinary incontinence (11 versus 19%, P = 0.004). Fewer women in the intervention group reported faecal incontinence (3 versus 5%), but this difference was not statistically significant (P = 0.18). Conclusions The present trial indicates that pregnant women should exercise, and in particular do PFMT, to prevent and treat urinary incontinence in late pregnancy. Thorough instruction is important, and specific pelvic floor muscle exercises should be included in exercise classes for pregnant women. The preventive effect of PFMT on anal incontinence should be explored in future trials.
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| 24. |
- Stafne, Signe N., et al.
(författare)
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Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:5, s. 552-559
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study lumbopelvic pain in women randomized to a regular exercise program during pregnancy in comparison to women receiving standard antenatal care. Design. A two-armed, two-center, randomized controlled trial. Setting. St Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital. Population. A total of 855 pregnant women were randomized to intervention or control groups. Methods. The intervention was a 12 week exercise program, including aerobic and strengthening exercises, conducted between 20 and 36 weeks of pregnancy. One weekly group session was led by physiotherapists, and home exercises were encouraged twice a week. The control group received standard antenatal care. Main outcome measures. Self-reports of lumbopelvic pain and sick leave due to lumbopelvic pain. The data were analysed according to the intention-to-treat principle. Results. There were no significant differences between groups of women reporting lumbopelvic pain at 36 weeks (74 vs. 75%, p=0.76). The proportion of women on sick leave due to lumbopelvic pain was lower in the intervention group (22% vs 31%, p=0.01). Conclusions. Exercise during pregnancy does not influence the prevalence of lumbopelvic pain, but women offered a regular exercise course seem to handle the disorder better.
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| 25. |
- Stoknes, Magne, et al.
(författare)
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Cerebral Palsy and Neonatal Death in Term Singletons Born Small for Gestational Age
- 2012
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 1098-4275 .- 0031-4005. ; 130:6, s. 1629-1635
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: To investigate the probable timing of events leading to cerebral palsy (CP) in singletons born small for gestational age (SGA) at term, taking neonatal death into consideration. METHODS: In this registry-based cohort study, data on 400 488 singletons born during 1996-2003 were abstracted from the Medical Birth and the CP registries of Norway. Among 36 604 SGA children (birth weight <10th percentile), 104 died in the neonatal period and 69 developed CP. Apgar scores at 5 minutes, risk factors, MRI findings, and CP subtypes were used to assess the timing of events leading to CP or neonatal death. RESULTS: Intrapartum origin of CP was considered in 5 SGA children (7%; 95% confidence interval: 3-16) in comparison with 31 of 263 (12%; 95% confidence interval: 8-16) non-SGA children (P = .28). The proportions of children who died in the neonatal period after a probable intrapartum event did not differ between the groups when children with congenital malformations were excluded. Probable antenatal events leading to CP and neonatal death were more common among SGA than non-SGA children (P < .001). CONCLUSIONS: In similar to 90% of children born SGA the event leading to CP is of probable antenatal origin. The low proportion of SGA children with CP after a probable intrapartum event was not outweighed by a higher neonatal mortality rate when congenital malformations were excluded. The higher risk of CP among SGA than among non-SGA children is probably due to a higher prevalence of antenatal risk factors. Pediatrics 2012;130:e1629-e1635
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| 26. |
- Torkildsen, E. A., et al.
(författare)
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Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor
- 2012
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 39:3, s. 310-315
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study intraobserver repeatability and intermethod agreement between two- (2D) and three-dimensional (3D) transperineal ultrasound methods in assessing fetal head descent during the first stage of labor. Methods Fetal head descent was measured with transperineal ultrasound as the fetal head-perineum distance and the angle of progression in 106 primiparous women with prolonged first stage of labor. A single obstetrician performed all the scans, and another obstetrician analyzed the acquired 2D images and 3D volumes, blinded to clinical assessments and labor outcome. Intraobserver repeatability and intermethod agreement between 2D and 3D methods were analyzed. Results The repeatability coefficient was +/- 4.1 mm in 2D acquisitions and +/- 1.7 mm in 3D acquisitions of fetal head-perineum distance. The intraclass correlation coefficients ( ICC) were 0.94 for 2D and 0.99 for 3D measurements. The angle of progression repeatability coefficients were +/- 6.7. using 2D and +/- 5.7. using 3D ultrasound and ICCs were 0.91 and 0.94, respectively. The intermethod ICC for fetal head-perineum distance in 2D vs 3D acquisitions was 0.95 and for angle of progression it was 0.93; the intermethod 95% limits of agreement were -5.8 mm to + 7.2 mm and -8.9. to + 13.7., respectively. Cohen's kappa for 2D vs 3D acquisitions was 0.85 using 40 mm as a cut-off level for fetal head-perineum distance and 0.79 using 110. as cut-off level for angle of progression. Conclusions For one ultrasound operator the intraobserver repeatability and agreement between 2D and 3D ultrasound methods in prolonged first stage of labor were good. Given that 2D methods are simpler to learn and can be analyzed quickly online, 2D equipment might therefore be preferred in the labor room. Copyright (C) 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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| 27. |
- Torkildsen, Erik A, et al.
(författare)
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Predictive value of ultrasound assessed fetal head position in primiparous women with prolonged first stage of labor.
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:11, s. 1300-1305
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine how well ultrasound assessed occipitoposterior (OP) position or high sagittal (HS) position in primiparous women with a prolonged first stage of labor predicts a vaginal delivery and the duration of labor. Design: Prospective observational study. Setting. Stavanger University Hospital, a secondary referral center in Norway. Population. 105 primiparous women with prolonged first stage of labor. Methods. Ultrasound assessment of fetal head position. Main outcome measures. Vaginal delivery vs. cesarean section and duration of labor. Results: Twenty-five fetuses (24%) were delivered with cesarean section (CS), 45 (43%) had operative vaginal delivery and 35 (33%) delivered spontaneously. Eleven (27%) of 41 fetuses in OP position at the time of inclusion were born in OP position. Ten (24%) of the 41 fetuses in OP position at inclusion were delivered with CS compared to 15/64 (23%) fetuses in other positions (p = 0.91). Twenty-eight fetuses were in sagittal position and 12 in HS position, assessed with ultrasound at the time of diagnosed prolonged labor. Seven (58%) of 12 in HS position delivered vaginally and five (42%) had a CS (p = 0.89). Time from inclusion to labor was not significant longer neither for fetuses in OP compared to non-OP positions nor for fetuses in HS compared to non-HS positions. Conclusions: Most fetuses in OP or HS positions in the first stage of labor will rotate spontaneously and have a high probability of being delivered vaginally.
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| 28. |
- Wallenius, Marianne, et al.
(författare)
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No Excess Risks in Offspring With Paternal Preconception Exposure to Disease-Modifying Antirheumatic Drugs
- 2015
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Ingår i: Arthritis & Rheumatology. - : Wiley. - 2326-5191. ; 67:1, s. 296-301
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To examine pregnancy outcomes in the partners of male patients with inflammatory joint disease who were or were not exposed to disease-modifying antirheumatic drugs (DMARDs) before conception compared with the outcomes in reference subjects from the general population. Methods. Linkage of data from a longitudinal observational study of patients with inflammatory joint disease (the Norwegian Disease-Modifying Antirheumatic Drug [NOR-DMARD] registry study) and the Medical Birth Registry of Norway (MBRN) enabled a comparison of pregnancy outcomes in the partners of men with inflammatory joint disease. Outcomes of pregnancies in which the father was exposed to DMARDs within 12 weeks of conception and those in which the father was never exposed to DMARDs were analyzed separately and compared with the outcomes in reference subjects. Potential associations between DMARD exposure and adverse pregnancy outcomes were assessed by logistic regression analysis. Results. A total of 1,796 men with inflammatory joint disease were associated with 2,777 births in the MBRN. In 110 of these births, the father had been exposed to DMARDs within 12 weeks before conception, and in 230 births the father had never been exposed to DMARDs before conception. The DMARDs (monotherapy or combination treatment) to which the fathers were exposed most frequently within 12 weeks of conception were methotrexate (n = 49), sulfasalazine (n = 17), and tumor necrosis factor inhibitors (n = 57). Neither adverse pregnancy outcomes nor occurrence of congenital malformations differed between patients and reference subjects in either group. Conclusion. Preconception paternal exposure to DMARDs was not associated with an increase in adverse pregnancy outcomes. Importantly, no increased risk of congenital malformations was observed.
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| 29. |
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| 30. |
- Wallenius, Marianne, et al.
(författare)
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Systemic Lupus Erythematosus and Outcomes in First and Subsequent Births Based on Data From a National Birth Registry
- 2014
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 66:11, s. 1718-1724
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To examine the associations between systemic lupus erythematosus (SLE) and outcomes in first and subsequent births. Methods. Data from the Medical Birth Registry of Norway during the period December 1, 1998 to December 31, 2009 were used to assess maternal and perinatal outcomes in women diagnosed with SLE compared with the general population. Outcomes of first and subsequent births were analyzed separately. Associations between SLE and pregnancy outcomes were assessed in logistic regression analyses and are shown as adjusted odds ratios (aORs) after adjustment for maternal age, gestational age, smoking habits, and previous cesarean section (CS), when relevant. Results. We analyzed 95 first and 145 subsequent births in patients and compared them with references. The risk of CS was two-fold higher in SLE patients in first and subsequent births. More newborns of patients had a birth weight <2,500 gm (aOR 5.00 [95 % confidence interval (95% CI) 3.02, 8.27] in first births and aOR 4.33 [95% CI 2.64, 7.10] in subsequent births). Additionally, preterm birth was more frequent among SLE patients (aOR 4.04 [95% CI 2.45, 6.56] in first births and aOR 3.13 [95% CI 1.97, 4.98] in subsequent births). Congenital malformations were more prevalent among children of patients than references (aOR 2.71 [95% CI 1.25, 5.86] in first births and aOR 3.13 [95% CI 1.69, 5.79] in subsequent births). Perinatal death was more frequent in first births among patients (aOR 7.34 [95% CI 2.69, 20.03]), but no difference was observed in subsequent births. Conclusion. Pregnancy complications were more frequent in SLE patients than references, and the greatest differences between groups were observed in first births.
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