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- Claesson, Ing-Marie, 1953-, et al.
(författare)
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Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.
- 2010
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Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 10, s. 766-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although studies have shown an association between anxiety and depression and obesity, psychological health among obese women during and after pregnancy has not been carefully studied. The aim of this study was to investigate psychological well-being using symptoms of depression and/or anxiety among obese pregnant women attending a weight gain restriction program and to then compare this group with a control group receiving traditional antenatal care. METHODS: 151 obese pregnant women in an intervention group and 188 obese pregnant women in a control group answered the Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Group differences between the two groups were estimated by using the χ2 - test on categorical variables. The Student's t-test on continuous, normally distributed variables measuring changes in mean score on BAI and EPDS over time was used. To make a more comprehensive assessment of group differences, between as well as within the two groups, logistic regressions were performed with the BAI and EPDS as dependent variables, measured at gestational weeks 15 and 35 and 11 weeks postnatal. The grouping variable has been adjusted for socio-demographic variables and complications. RESULTS: The prevalence of symptoms of anxiety during pregnancy varied between 24% and 25% in the intervention group and 22% and 23% in the control group. The prevalence of symptoms of anxiety postnatally was 9% in the intervention group and 11% in the control group. Five percent of the women in the intervention group and 4% of the women in the control group showed symptoms of anxiety during the course of pregnancy and at the postpartum assessment. The prevalence of symptoms of depression during pregnancy varied between 19% and 22% in the intervention group but was constant at 18% in the control group. Postnatal prevalence was 11% in both groups. Six percent of the women in the intervention group and 4% in the control group showed symptoms of depression during the course of pregnancy and at the postpartum assessment. We found no differences between the two groups as concerns demographic characteristics, weight gain in kg, or the distribution of scores on anxiety and depressive symptoms nor did we find differences in the fluctuation of anxiety and depressive symptoms over time between the women in the intervention group and in the control group. CONCLUSION: Obese pregnant women attending an intervention program seem to have the same risk of experiencing anxiety and/or depressive symptoms as do obese pregnant and postnatal women in general.
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| 2. |
- Claesson, Ing-Marie, 1953-
(författare)
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Weight gain restriction for obese pregnant women : An Intervention study
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain.Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms.Material and methods: The intervention group consisted of 155 obese (BMI >30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program.Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained <7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain <7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain.Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain <7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.
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| 3. |
- Cocozza, Madeleine, et al.
(författare)
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Child Protection in a Family Service Organisation in Sweden- What is the outcome for maltreated children?
- 2010
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Ingår i: Children and youth services review. - : Elsevier BV. - 0190-7409 .- 1873-7765. ; 32:7, s. 922-928
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Tidskriftsartikel (refereegranskat)abstract
- This study was conducted to increase the knowledge of what characterises the child-protection process in family-service organisations. A total of 1570 (regarding 1051 children) reports made to Social Services in one municipality during 1 year were followed to a final decision. A five-year follow-up study was conducted. There were 651 (41%) of the reports that were not investigated, 84% of the reports filed were judged not to demonstrate child maltreatment. The most usual cluster consisted of children that had committed a crime/offence when they were between 13 and 18 years old (314/1051–30%). The social worker reported 38% of the reports that regarded sexual or physical abuse to the police. Comparing the filtering pattern with the results from a study conducted in England, the family-service organisation does not seem to lead to the provision of services for a greater percentage of children than does a distinctive child-protection system. In the five-year follow-up period there were 61% of the children that were or had been targeted for an intervention or an investigation. This study raises questions about child protection in Sweden and emphasises the need for the system to be studied further.
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| 4. |
- Gunnervik, Christina, et al.
(författare)
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Attitudes towards mode of birth among Swedish midwives
- 2010
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Ingår i: MIDWIFERY. - : Elsevier BV. - 0266-6138. ; 26:1, s. 38-44
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Tidskriftsartikel (refereegranskat)abstract
- Objective: to investigate midwives attitudes and opinions on mode of birth. Design: exploratory descriptive study. Data were collected via study-specific questionnaires during 2006. Setting: southeastern Sweden. Participants: all midwives working in two counties. Findings: regardless of age, experience and working field, the midwives considered a reasonable caesarean rate to be around 11.5 per cent. None of the participants thought that the caesarean rate was too low. Midwives younger than 50 years tended to consider the current caesarean rate to be too high (p = 0.059). Midwives working on labour wards stated that they thought the current caesarean rate was too high compared with midwives working at antenatal care clinics (ACCs)(pandlt;0.001). Midwives working at ACCs agreed with the statements one should agree to a womans right to have an elective caesarean (pandlt;0.001) and elective caesarean is the best choice for a woman with fear of birth (p = 0.046) more often than midwives working on labour wards, regardless of age or working experience. Key conclusions and implications for practice: midwives working at ACCs are more willing to accept caesarean section at the womans request and for women with fear of birth. It is of importance that ACC caregivers and professionals on labour wards increase their collaboration and have continuous discussions with one another in an attempt to reach consensus about the appropriate caesarean rates on evidence-based grounds.
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| 5. |
- Josefsson, Ann, et al.
(författare)
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Complex Biphasic Changes of Neuropeptide Concentrations in the Rat Limbic System During Pregnancy and Parturition
- 2010
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Ingår i: The Open Neuroendocrinology Journal. - : Bentham Open. - 1876-5289. ; 3, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Sex hormones including estrogens affect brain areas involved in mood and cognition in addition to directly controlling reproduction and reproductive behavior. We studied the effect of pregnancy and puerperium on the concentrations of cholecystokinin (CCK), neuropeptide Y (NPY), substance P (SP) and galanin in tissue extracts from the rat striatum, frontal cortex and the hippocampal formation by means of radioimmunoassay. The most profound effects were found in the frontal cortex. Thus, cholecystokinin-like immunoreactivity (CCK-LI) was increased by 40 % during late pregnancy (p < 0.01) compared to estrous whereas SP-LI and galanin-LI decreased 25 % and 10 %, respectively. Postpartum, CCKLI decreased by 26% compared to pregnancy (p < 0.05) whereas SP-LI and galanin-LI were increased to a level above estrous (SP, P < 0.01; galanin, P < 0.05). No significant effect was observed in NPY-LI in this area. In the striatum during late pregnancy the concentrations of cholecystokinin-LI increased by 29 % (p < 0.05), NPY-LI by 22% (p < 0.05) whereas SP-LI slightly increased (not significant). Postpartum, cholecystokinin-LI decreased by 25 % (p < 0.01) compared to pregnancy and NPY by 16 % (p < 0.01). SP continued to increase postpartum by 33 % (p < 0.05) whereas no effect was observed on galanin-LI concentration. Surprisingly, we did not observe any changes in any peptide or groups measured in the hippocampal formation. The complex hormonal adjustments occurring during pregnancy and in the puerperium induce profound changes in the concentrations of several neuropeptides in regions of the rat brain involved in the control of mood and motor control.
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| 7. |
- Lilliecreutz, Caroline, et al.
(författare)
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An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women-a group intervention program
- 2010
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Ingår i: ARCHIVES OF WOMENS MENTAL HEALTH. - : Springer Science Business Media. - 1434-1816 .- 1435-1102. ; 13:3, s. 259-265
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Tidskriftsartikel (refereegranskat)abstract
- Around 7% of pregnant women suffer from blood- and injection phobia. The aim was to investigate if cognitive behavior group therapy (CBT) is effective in treating pregnant womens blood- and injection phobia. Thirty pregnant women with blood- and injection phobia according to DSM-IV took part in an open treatment intervention. A two-session cognitive behavior group therapy was conducted. As controls, 46 pregnant women with untreated blood- and injection phobia and 70 healthy pregnant women were used. Repeated measures ANOVA were performed. The scores for the CBT treatment group on the "Injection Phobia Scale-Anxiety" were reduced both after each treatment session and postpartum (p andlt; 0.001). Anxiety and depressive symptoms were also reduced (p andlt; 0.001). Cognitive-behavior group therapy for pregnant women with blood- and injection phobia is effective and stable up to at least 3 months postpartum. It seems also to reduce anxiety and depressive symptoms during pregnancy.
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| 8. |
- Lilliecreutz, Caroline
(författare)
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Blood-and Injection Phobia in Pregnancy : Epidemiological, Biological and Treatment aspects
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Blood- and injection phobia is an anxiety disorder with a prevalence of approximately 3-5% in the general population. The etiology is often a combination of genetic factors and a conditioning experience. The symptoms of blood- and injection phobia are dizziness, confusion, nausea, epigastria discomfort, anxiety and sometimes panic attacks when receiving injections, seeing blood or having a blood sample taken. Unique for this specific phobia is the high probability of fainting when the phobic situation is encountered if there is no possibility to escape or to avoid the stimuli.During pregnancy and labor, women with blood- and injection phobia are exposed to most of their fears and they therefore find themselves in anxiety-ridden situations. Stress and anxiety during pregnancy is known to be risk factors for adverse obstetric and neonatal outcomes. Studies have shown an altered hypothalamic-adrenal-pituitary axis in women with stress or/and anxiety during pregnancy and increased cortisol concentrations can imply negative consequences for the unborn child. Cognitive behavioral therapy (CBT) is known to be effective in treating specific phobias such as blood- and injection phobia.Aim: The prevalence, obstetric and neonatal consequences, impact on the hypothalamic adrenal-pituitary axis and treatment aspects of blood- and injection phobia in a pregnant population have not been investigated before. The aims of this thesis were to study each of these phenomena.Material and methods: During 2005 a total of 1606 pregnant women were approached at their first visit in an antenatal care clinic in the southeast region in Sweden. They were asked to complete the “Injection Phobia Scale-Anxiety” questionnaire. All women who scored ≥ 20 on the “Injection Phobia Scale-Anxiety” questionnaire (N=347), were interviewed and either diagnosed for blood- and injection phobia or dismissed. In total, 110 women were diagnosed as having blood- and injection phobia. Among the women who scored <20 on the “Injection Phobia Scale-Anxiety” questionnaire, 220 women were randomly stratified for age and parity as a control group. The women in the study population answered questionnaires in gestational week 25, 36 and postpartum concerning symptoms of blood- and injection phobia, depression and anxiety. Samples of cortisol in the saliva were collected in the morning and evening in gestational week 25 and 36 in both groups of pregnant women. The medical records from the antenatal care visits, the delivery and postpartum check-up was used to collect data of importance. A treatment study was conducted using a two session cognitive behavioral therapy in a group of pregnant woman with blood- and injection phobia.Results: The prevalence of blood- and injection phobia is 7 % in a pregnant population. Pregnant women with blood- and injection phobia stated more often a fear of childbirth (p<0.001) and were more frequently delivered by elective cesarean section (p=0.032). The incidence of having a baby diagnosed with a complication (p=0.001) was also higher among these women. The women with blood- and injection phobia had increased cortisol concentrations in the saliva compared to the healthy controls (p=0.014). A two-session CBT in group for pregnant women with blood- and injection phobia reduced phobic (p<0.001) anxiety (p<0.001) and depressive (p<0.001) symptoms during pregnancy.Conclusions: Blood- and injection phobia during pregnancy is rather common. Pregnant women with blood- and injection phobia are more likely to be delivered by elective cesarean section and having a baby born with a complication compared to women not suffering from this specific phobia. Untreated blood- and injection phobia during pregnancy increases salivary cortisol concentrations indicating an altered hypothalamic-adrenal-pituitary axis during these weeks of pregnancy. To enhance psychological well being in pregnant women with blood- and injection phobia a two-session program providing CBT for groups of pregnant women is valuable and produces stable results for at least 3 months after delivery.
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| 9. |
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| 10. |
- Sydsjö, Gunilla, et al.
(författare)
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Trends in caesarean section and instrumental deliveries in relation to Body Mass Index : a clinical survey during 1978 - 2001
- 2010
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Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755 .- 1742-4755. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS) and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women.Method: The design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001.Results: No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI >= 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (chi(2) test for trend; p < 0.001 for both CS and instrumental deliveries). The mean birth weight in relation to BMI and year of study among women delivered by means of CS decreased, a trend that was most evident between 1997 and 2001 (F-test; p = 0.005, p = 0.004, and p = 0.003 for BMI < 20, 20-24.9, and >= 25, respectively).Conclusion: Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications.
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