| 1. |
- Armuand, Gabriela, et al.
(författare)
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Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women : a survey study
- 2020
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Ingår i: Fertility research and practice. - : BioMed Central. - 2054-7099. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: The number of families conceived through sperm donation to single women is increasing. However, there is limited knowledge about health care professionals' attitudes towards solo-mothers by choice, and there is some indication that professionals' personal opinions influence their care of individuals who use alternate ways to build a family. The primary aim of the study was to investigate attitudes towards, and experiences of, families following sperm donation to single women among healthcare professionals working in primary child healthcare.Methods: Between April and November 2016 a total of 712 physicians, registered nurses and psychologists working within primary healthcare in Sweden were invited to participate in a cross-sectional online survey study. The study-specific questionnaire contained the following four domains: Attitudes towards legalization and financing, Attitudes towards the family and the child's health, Clinical experience and Knowledge about sperm donation to single women.Results: The majority of the participants were positive or neutral towards sperm donation being allowed to single women in Sweden. However, one third believed that children risk worse mental health and social stigma. Half of healthcare professionals had own clinical experience of caring for solo-mothers by choice and their children, and of these one third perceived that these families had more need of support than other parents. One out of four indicated that they did not have sufficient knowledge to be able to provide adequate care to these families.Conclusions: The present results indicate that while there was a relatively large support for sperm donation being allowed to single women in Sweden among health care professionals, many expressed concerns about the child's health, as well as low confidence in their knowledge about the specific needs in this patient group. There is a need for educational interventions targeted to healthcare professionals in primary child healthcare in order to provide adequate care to solo-mothers by choice and their children.
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| 2. |
- Eckerdal, Patricia, 1972-, et al.
(författare)
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Epidural analgesia during Childbirth and Postpartum depressive symptoms : A population-based longitudinal cohort study
- 2020
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Ingår i: Anesthesia and Analgesia. - 0003-2999 .- 1526-7598. ; 130:3, s. 615-624
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe pain has been linked to depression, which raises the question of whether epidural analgesia (EDA) during childbirth is associated with a reduced risk of postpartum depression (PPD). This association has been explored previously, but the studies were restricted by small sample sizes and the inability to control for relevant confounders. This study aimed to investigate the association between the administration of EDA and the development of PPD after adjusting for sociodemographic, psychosocial, and obstetric variables.METHODS: Data were retrieved from the Biology, Affect, Stress, Imaging and Cognition (BASIC) project (2009-2017), a population-based longitudinal cohort study of pregnant women conducted at Uppsala University Hospital, Sweden. The outcome was PPD at 6 weeks postpartum, defined as a score of >= 12 points on the Edinburgh Postnatal Depression Scale (EPDS). Information was collected through medical records and self-reported web-based questionnaires during pregnancy and 6 weeks after childbirth. Only primiparous women with spontaneous start of childbirth were included (n = 1503). The association between EDA and PPD was examined in multivariable logistic regression models, adjusting for sociodemographic, psychosocial, and obstetric variables. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of the 1503 women included in the analysis, 800 (53%) reported use of EDA during childbirth. PPD at 6 weeks postpartum was present in 193 (13%) women. EDA was not associated with higher odds of PPD at 6 weeks postpartum after adjusting for suspected confounders (age, fear of childbirth, antenatal depressive symptoms; adjusted OR [aOR] = 1.22; 95% CI, 0.87-1.72).CONCLUSIONS: EDA was not associated with the risk of PPD at 6 weeks postpartum after adjusting for sociodemographic, psychosocial, and obstetric variables. However, these findings do not preclude a potential association between PPD and childbirth pain or other aspects of EDA that were not assessed in this study.
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| 3. |
- Elenis, Evangelia, 1983-, et al.
(författare)
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Access to infertility evaluation and treatment in two public fertility clinics and the reasons for withholding it : A prospective survey cohort study of healthcare professionals
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Study the proportion of patients affected by involuntary childlessness who are denied fertility treatment and the reasons behind this in a publicly funded healthcare system. Design Survey study using prospectively collected information by healthcare professionals. Setting Two university-affiliated fertility clinics in Sweden. Participants Single women and couples in heterosexual and homosexual relationships seeking fertility evaluation and treatment between November 2017 and April 2018 (943 individual cases). Primary and secondary outcome measures Number and proportion of individuals who were either denied, delayed or granted fertility treatment directly. Furthermore, the reasons behind delaying or completely withholding treatment. Results The majority of those seeking evaluation were heterosexual couples (75%), while 14% were single women and 7.5% were same-sex couples. The great majority of those undergoing evaluation were granted treatment either directly (85%) or after in-depth evaluation (7.5%), while 7.5% were denied treatment. Among those who were denied treatment, there were a greater proportion of single women and couples seeking treatment with donated gametes. Among heterosexual couples, gamete origin was not associated with treatment refusal. Although age did not differ between those granted and denied treatment, a higher body mass index (in both recipient and partner, when applicable) was observed among those being refused treatment. Fertility specialists in Sweden focused their assessment on parental factors that may indirectly entail a risk of harm to the future child, such as medical and psychiatric conditions of the individuals involved, their financial constraints and other social reasons, substance abuse and female obesity. Conclusion Being single or receiving treatment with donated gametes can both be reasons for withholding fertility treatment. Although difficult to operationalise, parenting assessment in Sweden is employed interchangeably in treatments with donated gametes (legally mandated assessment) and even autologous gametes (non-legally mandated assessment) - making evident a need for clear official policy guidelines regulating these assessments and the provision of treatment.
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| 4. |
- Lampic, Claudia, 1964-, et al.
(författare)
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National survey of donor-conceived individuals who requested information about their sperm donor-experiences from 17 years of identity releases in Sweden
- 2022
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 37:3, s. 510-521
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION What characterizes the group of donor-conceived (DC) individuals who request information about their identity-release sperm donor in Sweden, and what are their experiences of disclosure, information receipt and donor contact? SUMMARY ANSWER Following three decades of identity-release donation in Sweden, few DC individuals have requested donor information with varying experiences of information receipt and donor contact. WHAT IS KNOWN ALREADY In 1985, Sweden was the first country worldwide to enact legislation that gave DC individuals the right to obtain identifying information about their donor. Since then, identity-release gamete donation has become available in many countries but there is limited knowledge about the individuals who request donor information. STUDY DESIGN, SIZE, DURATION A nation-wide cross-sectional survey study was performed at all seven University hospitals that provided donation treatment in Sweden during 1985-2002. During this period only donor insemination to heterosexual couples was permitted. Inclusion criteria were being 18 years of age or older, conceived with donor sperm and having requested information about the donor by December 2020. Recruitment was performed during 2016-2020. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 60 individuals had requested information about their donor. Of these, 53 were approached and 40 individuals, representing 34 families, accepted study participation (75% response rate). Participants completed a postal survey with the WHO-10 well-being index and study-specific questions about experiences of disclosure, motivations for requesting donor information, receipt of information, as well as intentions and experiences of donor contact. Independent t-test and chi-square tests were used to compare ratings of participants with early and late disclosure. MAIN RESULTS AND ROLE OF CHANCE Of similar to 900 DC individuals who had reached adult age, a total of 60 (approximate to 7%) had requested information about the donor. Most of the 40 study participants (78%) made their requests within 2 years after reaching 18 years of age, or following disclosure at later ages (up to 32 years). Several participants had adult DC siblings in the family who had not requested any donor information. All except five participants received identifying information about the donor from the clinic. However, some donors had died or lacked contact information. Among those participants who were able to contact their donor, 41% had done so at the time of the study, while a third of the participants were unsure about potential contact. Several had met the donor in person and a few were in regular contact. About half of the participants had been informed about their donor conception in adolescence or adulthood (age 12-32), and there were significant differences between participants based on age at disclosure. Compared to those with early disclosure, participants with late disclosure were significantly more likely to be dissatisfied with the timing of their disclosure (P = 0.021), to react with negative emotions (P < 0.001), and to subsequently contact the donor (P = 0.047). LIMITATIONS, REASONS FOR CAUTION The limited population available for inclusion resulted in a small sample size, despite a high response rate. In addition, men's lower participation rate must be taken into consideration when interpreting the results. WIDER IMPLICATIONS OF THE FINDINGS The small number of individuals requesting information about their identity-release sperm donor is surprising. While not all DC individuals appear to be interested in donor information, it is reasonable to assume that some are unaware of their donor conception and thus unable to make informed decisions regarding their genetic origins. During the coming years, young women and men in many countries will become eligible to access identifying information about their donor. In order to meet the needs of these individuals, and to support positive outcomes for all involved parties, it is essential that adequate protocols and resources are developed. STUDY FUNDING/COMPETING INTEREST Financial support from The Swedish Research Council. There are no conflicts of interest to declare.
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| 5. |
- Lampic, Claudia, et al.
(författare)
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Understanding parents' intention to disclose the donor conception to their child by application of the theory of planned behaviour
- 2021
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Ingår i: Human Reproduction. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 36:2, s. 395-404
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: Does the theory of planned behaviour (TPB) contribute to understanding parents' intention to share information about genetic origin with their donor-conceived child?SUMMARY ANSWER: Parents' intention to start disclosure was associated with beliefs that disclosure would have desired consequences and a desire to act in accordance to societal norms.WHAT IS KNOWN ALREADY: Despite a growing consensus on donor-conceived offspring's right to information about their genetic origin, disclosure to the child remains a challenge for many parents, particularly heterosexual couples. TPB has successfully been applied to many health-related contexts and may contribute to increase understanding of parents' decision-making about disclosing the genetic origin to their children.STUDY DESIGN, SIZE, DURATION: A cross-sectional survey study of heterosexual couples with children aged 7-8 years following identity-release oocyte donation (OD, n = 83) or sperm donation (SD, n = 113).PARTICIPANTS/MATERIALS, SETTING, METHODS: The study is part of the prospective longitudinal Swedish Study on Gamete Donation. Couples accepted for oocyte or sperm donation treatment at seven fertility clinics were recruited in 2005-2008 and requested to complete four postal surveys in the following 10 years. The present study sample includes heterosexual couples with donor-conceived children aged 7-8 years. Data were collected with the study-specific TPB Disclosure Questionnaire and analysed with path analysis.MAIN RESULTS AND THE ROLE OF CHANCE: More than half of parents following OD or SD had already disclosed the donor conception to their child (OD 61%, SD 58%). Among parents who had not yet started the disclosure process, the belief that disclosure would have desired consequences (P < 0.05) and a desire to act in accordance to social norms favouring disclosure (P < 0.01) were positively associated with their intention to talk with their child about the donor conception during the upcoming year. In contrast, perceived confidence to talk with the child about his/her genetic origin was found to be negatively associated with the intention to start the disclosure process (P < 0.05). Type of treatment (OD/SD) and the existence or absence of a genetic link to the child were not directly associated with parents' disclosure intentions.LIMITATIONS, REASONS FOR CAUTION: The study was performed with heterosexual couples within the context of the Swedish legislation on identity-release donation, which limits the generalizability to other populations. Also, attrition may have introduced selection bias to the study findings. Future studies using the TPB Disclosure Questionnaire (TPB-DQ) with larger samples are needed to validate this measure.WIDER IMPLICATIONS OF THE FINDINGS: Application of the theory of planned behaviour highlighted the importance of attitudes and social norms for parents' intention to share information about the donor conception with their child. The present results add to the complexity of disclosure of donor conception, and may contribute to promote open communication and support family life following donor conception.STUDY FUNDING/COMPETING INTEREST(S): Financial support from the Swedish Research Council. There are no conflicts of interest to declare.TRIAL REGISTRATION NUMBER: N/A.
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| 6. |
- Lindell Pettersson, Malin, et al.
(författare)
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Mothers who have given birth at an advanced age - health status before and after childbirth
- 2020
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Ingår i: Scientific Reports. - : NATURE PUBLISHING GROUP. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Women postpone childbirth to an age when morbidity is higher and fertility has decreased and yet the knowledge of mothers morbidity related to age remains scarce. Swedish national register data from the Medical Birth Register and National Patient Register was used to investigate the incidence of diseases listed in the International Classification of Diseases, version 10 (ICD-10) in women who gave birth 2007-8. The index group consisted of women 40 years of age or older (n=8 203) were compared to a control group of women, younger than 40 years (n=15 569) at childbirth. The period studied was five years before childbirth to five years after. The main outcome measures were incidence of disease diagnosed in specialized hospital care. Demographical data and use of assisted reproduction (ART) were adjusted for. The results showed that older women were more likely to be single; less frequently used tobacco; were educated on a higher level; had a higher BMI and more often had used ART to become pregnant. The older women showed a higher morbidity rate. In the diagnostic groups: Neoplasms, Blood and immune system, Eye and adnexa, Ear and mastoid, Circulatory, Digestive, Skin and subcutaneous tissue, Musculoskeletal and connective tissue, and Genitourinary. The results add to the body of knowledge of a number of specific risks faced by older mothers and may be used to identify preventive actions concerning fertility and morbidity both before and after childbirth.
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| 7. |
- Lindell Pettersson, Malin, 1979-
(författare)
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Women giving birth at an advanced age and their children : obstetric and neonatal outcomes, health and social support
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postponement of parenthood is an increasing trend in Western societies today. Delaying motherhood to a later time in life increases the use of assisted reproduction technology (ART), and the risk for adverse obstetric and neonatal outcomes. Along with postponement of motherhood, the number of women requesting treatment to become solo mothers has increased. The aim of the present thesis was to evaluate the obstetric outcomes and morbidity among mothers and their children, and the association of these outcomes with advanced maternal age, single status and the use of ART.Data from the Medical Birth Register (MBR) pertaining to pregnancy, childbirth and neonatal outcomes were retrieved. In total, 37,558 mothers aged ≥ 40 years formed the index group, which was divided into two subgroups, mothers 40-44 years of age and mothers aged ≥ 45, and compared to a control group of 71,472 mothers age ≤ 39 years (Study I). To investigate the mothers’ morbidity up to five years prior to, and up to five years after childbirth (study II), and their children’s morbidity up to five years of age (study III), data from the MBR and the National Patient Register (NPR) on Swedish women giving birth during 2007-2008 and their children were retrieved. The index group comprised 8203 mothers ≥ 40 years, and the control group comprised 15,569 mothers ≤ 39 years and their children. Diagnosis and number of inpatient and outpatient visits in hospital specialized care units were studied as well as mode of conception i.e., using ART or spontaneously conceived. Civil status, defined as single or cohabiting/married, was also investigated. In study IV, 207 single women accepted for treatment with donor sperm were compared with 256 cohabiting women treated with IVF with their own gametes. The women’s sociodemographic data, their descriptions of their social networks, as well as self-assessment of their social support were investigated through a questionnaire.The results showed an increased risk for an adverse pregnancy outcome in older mothers and the children were more often born preterm, with low birthweight or were small-for-gestational age. In addition, the older mothers had more often used ART, and were more likely to be single, to use less tobacco and to have a higher BMI compared to younger women. Also, the results indicated an increased risk for morbidity among older women, both before and after pregnancy, compared to the younger women. Women of both age groups who had used ART to conceive also had higher morbidity than women who conceived spontaneously. Among mothers and children, morbidity was significantly higher in both mother and child when the mother was single at the time of pregnancy. Children born to older mothers were more often diagnosed with conditions diagnosed in the perinatal period and with congenital malformations, deformations and chromosomal abnormalities compared with children born to younger mothers.Solo women who were to be treated with sperm donation were older compared to cohabiting women. Solo women more often had a higher level of education and full-time employment, and were in a profession with a higher salary compared with cohabiting women. Solo women expected to receive much help, primarily from a parent but also from friends.The significantly increased risk for adverse outcomes in pregnancy and childbirth associated with advanced maternal age and the diagnoses their children were more likely to receive during the first five years of life is perhaps small but will have an impact on the individual. Single parenthood is historically associated with social and economic disadvantages. The results are in part promising concerning the sociodemographic characteristics of solo-mothers-to-be and their high levels of perceived social support. However, the potential risk for long-term morbidity in children born to advanced aged mothers, in combination with maternal single civil status and use of ART, is important to follow closely to provide proper and adequate support and health care to these mothers and their children.
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| 8. |
- Massae, Agnes Fredrick, et al.
(författare)
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Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics.Methods: We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation.Results: The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69).Conclusions: FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.
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| 9. |
- Massae, Agnes Fredrick
(författare)
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Women’s fear of childbirth and depressive symptoms before and after birth : Studies on the magnitude, challenges, and coping strategies in Pwani region, Tanzania
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Most women experience fear of childbirth (FoB) and depressive symptoms (DS), which have been associated with adverse obstetric outcomes. Such adverse effects are rarely screened in clinical practice, and knowledge of magnitude, associated factors, challenges, and coping strategies is lacking in Tanzania. This thesis aimed to assess the magnitude, challenges, and coping strategies regarding women's fear of childbirth and depressive symptoms before and after childbirth.A mixed-method study was carried out in the Pwani region, Tanzania. A longitudinal study was performed to establish psychometric properties of W-DEQ-A and W-DEQ-B (Paper I), prevalence and predictors of FoB and DS during pregnancy (Paper II), and patterns and predictors of FoB and DS from pregnancy and postpartum (Paper III). Six hundred ninety-four pregnant women were recruited, and 625 completed the study. Individual interviews with women (n = 13) and traditional birth attendants (n = 3) and focus group discussions with women (n = 5), men (n = 2), and nurse-midwives (n = 4) were conducted to explore barriers, support, and coping strategies for overcoming FoB (Paper IV). Factor analysis for W-DEQ revealed seven factors with 29 items with acceptable indices. Both versions of W-DEQ had good internal consistency.The prevalence rates of FoB decreased from 16.2% during pregnancy to 13.9% after childbirth, while DS reduced significantly from 18.2% to 8.5% (p < 0.001). Some women had persistent FoB (6.4%) or DS (4.3%). Pregnant women above 30 years old, with informal education, and/or nulliparous were more likely to have FoB and DS. Giving birth by cesarean section and spending more than 12 hours at a health facility from admission to birth were associated with postnatal FoB. Furthermore, giving birth to an ill or dead baby was a predictor for postpartum DS. In coping with FoB, three themes were identified: (i) perceived barriers to overcoming FoB, (ii) individual strength, family, community, and friendly healthcare facilities as proposed sources of support, (iii) turning to a higher power, socializing, and preparation as strategies to cope with FoB.The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable for measuring FoB with a multifactorial structure, incorporating seven factors with 29 items. FoB and DS coexist and get reduced with time. Recognizing predictors of both conditions, barriers to overcoming FoB, support, and coping strategies will help in the early identification of women at risk and in planning for timely interventions. Standardized tools and routine screening for FoB and DS during the perinatal period are recommended.
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| 10. |
- Massae, Agnes, et al.
(författare)
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Fear of childbirth : validation of the Kiswahili version of Wijma delivery expectancy/experience questionnaire versions A and B in Tanzania
- 2022
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Nature. - 1471-2393 .- 1471-2393. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations.Methods: A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions' items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach's alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, convergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively.Results: Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipation; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach's alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discriminant validity. The other six factors showed some problems with convergent validity. The final model from the confirmatory factor analysis yielded 29 items with good psychometric properties (chi(2)/df = 2.26, p = < .001, RMSEA = .045, CFI = .90 and TLI = .81).Conclusions: The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsistent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages.
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