| 1. |
- Ahangari, Alebtekin, et al.
(författare)
-
Acute intermittent porphyria symptoms during the menstrual cycle
- 2015
-
Ingår i: Internal medicine journal (Print). - : Wiley. - 1444-0903 .- 1445-5994. ; 45:7, s. 725-731
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Acute intermittent porphyria (AIP), a life-threatening form of the disease, is accompanied by several pain, mental and physical symptoms.Aims: In this study, we evaluated the cyclicity of AIP and premenstrual syndrome (PMS) symptoms in 32 women with DNA-diagnosed AIP during their menstrual cycles, in northern Sweden.Methods: The cyclicity of AIP symptoms and differences in them between the follicularand luteal phases, and the cyclicity of each symptom in each individual woman indifferent phases of her menstrual cycle were analysed with a prospective daily ratingquestionnaire. PMS symptoms were also evaluated in the patients on a daily rating scale.Results: Of the 32 women, 30 showed significant cyclicity in at least one AIP or PMS symptom (P < 0.05–0.001). Back pain (10/32) was the most frequent AIP pain symptomand sweet craving (10/15) was the most frequent PMS symptom. Pelvic pain (F = 4.823,P = 0.036), irritability (F = 7.399, P = 0.011), cheerfulness (F = 5.563, P = 0.025), sexualdesire (F = 8.298, P = 0.007), friendliness (F = 6.157, P = 0.019), breast tenderness (F =21.888, P = 0.000) and abdominal swelling (F = 16.982, P = 0.000) showed significantcyclicity. Pelvic pain and abdominal swelling (rs= 0.337, P < 0.001) showed the strongest correlation. The age of women with latent AIP was strongly correlated with abdominal swelling during the luteal phase (rs= 0.493, P < 0.01).Conclusion: Our results suggest that the symptoms of AIP patients change during their menstrual cycles.
|
|
| 2. |
- Danielsson, C., et al.
(författare)
-
Management and outcomes of preterm premature rupture of the membranes
- 2018
-
Ingår i: CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY. - : I R O G CANADA, INC. - 0390-6663. ; 45:3, s. 419-424
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose of investigation: To compare the maternal and neonatal outcomes of preterm premature rupture of the membranes (PPROM) between two management strategies. Materials and Methods: This retrospective cohort study involved 153 pregnant women who presented with PPROM at a gestational age of 28+0 to 36+6 weeks to evaluate the effects of expectant management (EM; labor > 36 hours) and active management (AM; labor < 36 hours) on maternal and neonatal outcomes. The EM and AM groups were also compared independently of gestational age and after being divided into two subgroups: early PPROM (gestational age 28+0 to 33+6 weeks) and late PPROM (34+0 to 36+6 weeks). Results: There were no differences between the AM and EM groups in the rates of maternal infection or placental abruption, or in neonatal outcomes, including low Apgar scores, respiratory distress syndrome, or the need for continuous positive airway pressure (CPAP). In the early PPROM subgroup, arterial umbilical blood base excess levels were more negative in the AM group (p = 0.007). In the late PPROM subgroup, the change in systolic blood pressure between admission to the maternity care center and membrane rupture was greater in the AM group (p = 0.049). Conclusions: There were no clinically significant differences in the maternal and neonatal outcomes of PPROM between AM and EM.
|
|
| 3. |
- Hautala, Laura, et al.
(författare)
-
Performance of Variables in Screening for Gestational Diabetes
- 2019
-
Ingår i: European Endocrinology. - : Touch Medical Media. - 1758-3780. ; 15:2, s. 101-105
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. The strategies used to screen for GDM vary both internationally and nationally. Therefore, we investigated the performance of the capillary random plasma glucose (RPG) test, maternal body mass index (BMI) and maternal age in predicting GDM.Methods: In a retrospective cohort study, we included pregnant women without pre-existing diabetes or metabolic disease who gave birth in Västernorrland County, Sweden, in 2015–2016. Values for RPG in gestational weeks 23–28 were obtained from obstetric medical records for each pregnancy. The development of GDM was confirmed by evaluating data in the obstetric records. The ability of RPG, maternal BMI, and age to predict GDM was assessed with receiver-operating characteristic curves.Results: In total, 4,698 pregnancies were included in the final statistical analysis. RPG was fairly effective in screening (area under the curve [AUC] 0.73; 95% confidence interval [CI] 0.66–0.80), and BMI performed slightly better (AUC 0.75; 95% CI 0.68–0.82), whereas maternal age performed poorly (AUC 0.61; 95% CI 0.53–0.68). Combining RPG ≥7 and BMI ≥27.9 yielded the best overall sensitivity (75.4%), specificity (70.1%), and AUC (0.75; 95% CI 0.68–0.82).Conclusions: Our results show that the sensitivity of capillary RPG alone in predicting GDM is fair. The combination of RPG with maternal BMI or age showed greater sensitivity. However, none of the screening factors (RPG, BMI, and maternal age), alone or combined, showed sufficiently good performance in predicting GDM.
|
|
| 4. |
- Hedström, Helena, et al.
(författare)
-
Women with polycystic ovary syndrome have elevated serum concentrations of and altered GABA A receptor sensitivity to allopregnanolone
- 2015
-
Ingår i: Clinical Endocrinology. - : John Wiley & Sons. - 0300-0664 .- 1365-2265. ; 83:5, s. 643-650
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveSeveral studies have reported that -aminobutyric acid (GABA) ergic circuits are involved in the pathophysiology of polycystic ovary syndrome (PCOS). The progesterone metabolite allopregnanolone is a potent GABA(A)-receptor-modulating steroid, and patients may have increased concentrations of allopregnanolone or altered GABA(A) receptor sensitivity. We investigated both of these possibilities in this study. PatientsWe enrolled 9 women with PCOS and 24 age-matched eumenorrhoeic controls, who were divided into two groups by body mass index (BMI) (16 normal weight and 8 overweight). MeasurementsWe investigated the effects of allopregnanolone injection on GABA(A) receptor sensitivity in both groups of women. All women received a single intravenous dose of allopregnanolone (0050mg/kg). GABA(A) receptor sensitivity was assessed with the saccadic eye velocity (SEV) over 30 degrees (SEV30 degrees), the SEV30 degrees/allopregnanolone concentration ([Allo]) ratio, and sedation, which were measured together with serum allopregnanolone at intervals for 180min after injection. The controls were tested in the follicular phase of the menstrual cycle. ResultsBaseline allopregnanolone concentrations were higher in the PCOS women than in the normal-weight (P=0034) and overweight controls (P=0004). The allopregnanolone concentrations after injection were higher in the PCOS women (P=0006) and overweight controls (P=0037) than in the normal-weight controls. All groups showed a decline in the SEV30 degrees/[Allo] ratio after injection. Allopregnanolone had a smaller effect on the SEV30 degrees/[Allo] ratio in the overweight women (PCOS, P=0032; controls, P=0007) than in the normal-weight controls. The sedation score after allopregnanolone injection was lower in the PCOS patients than in the controls, but was not different between the two control groups. ConclusionsPCOS women had elevated baseline allopregnanolone concentrations compared with follicular-phase controls. All overweight women (PCOS and controls) were less sensitive to allopregnanolone than normal-weight controls.
|
|
| 5. |
- Holmberg, Ellinor, et al.
(författare)
-
Allopregnanolone involvement in feeding regulation, overeating and obesity
- 2018
-
Ingår i: Frontiers in neuroendocrinology (Print). - : Academic Press. - 0091-3022 .- 1095-6808. ; 48, s. 70-77
-
Forskningsöversikt (refereegranskat)abstract
- Obesity is strongly associated with ill health, primarily caused by consumption of excessive calories, and promoted (inter alia) by gamma-amino-butyric-acid (GABA) stimulating food intake by activating GABA(A) receptors (primarily with alpha 3 and alpha 2 subunits) in the hypothalamic arcuate nucleus and paraventricular nucleus. Allopregnanolone is a potent positive GABAA receptor modulating steroid (GAMS). As reviewed here, elevated allopregnanolone levels are associated with increases in food intake, preferences for energy-rich food, and obesity in humans and other mammals. In women with polycystic ovarian disease, high serum allopregnanolone concentrations are linked to uncontrolled eating, and perturbed sensitivity to allopregnanolone. Increases in weight during pregnancy also correlate with increases in allopregnanolone levels. Moreover, Prader-Willis syndrome is associated with massive overeating, absence of a GABA(A) receptor (with compensatory > 12-, > 5- and > 1.5-fold increases in alpha 4, gamma 2, and alpha 1, alpha 3 subunits), and increases in the alpha 4, beta x, delta receptor subtype, which is highly sensitive to allopregnanolone. GABA and positive GABA-A receptor modulating steroids like allopregnanolone stimulates food intake and weight gain.
|
|
| 6. |
- Klevedal, Charlotta, et al.
(författare)
-
Fetal-maternal outcomes and complications in pregnant women with polycystic ovary syndrome
- 2017
-
Ingår i: Minerva Ginecologica. - Turin : Edizioni Minerva Medica. - 0026-4784 .- 1827-1650. ; 69:2, s. 141-149
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Earlier studies have shown that polycystic ovary syndrome (PCOS) is associated with cardiovascular disease as well as pregnancy complications. We examined whether women with PCOS have an increased risk of complications in pregnancy compared with healthy women, and if there are any correlations between complications and clinical/demographic variables before and/or in early pregnancy.METHODS: This retrospective cohort study comprised 37 women with PCOS and 126 healthy women whose birth was recorded at Sundsvall County Hospital, Sweden, from 2009 to 2014. Medical records were searched to identify pregnancy complications, maternal outcomes, and neonatal outcomes.RESULTS: Compared with healthy women, the women with PCOS were more likely to have a history of miscarriage (42.9% vs. 19.8% P=0.005) and undergo caesarean section (41.2% vs. 21.4%, P=0.019). They were also at increased risk of developing a complication (odds ratio 2.38, 95% CI: 1.05-5.38) or having multiple concurrent complications (odds ratio 8.27, 95% CI: 1.45-47.3). The rates of premature birth, birth weight and Apgar score at 5 min were similar between the two groups. The preconception serum testosterone concentration was positively correlated with the complication rate and negatively correlated with gestational age.CONCLUSIONS: We found that women with PCOS are at greater risk of complications during pregnancy than healthy women, consistent with the results of earlier studies. High testosterone concentrations could be an aggravating factor in the risk of complications. Therefore, women with PCOS may require more careful monitoring during pregnancy than healthy women.
|
|
| 7. |
- Persson, Sofia, et al.
(författare)
-
Fecundity among women with polycystic ovary syndrome (PCOS)-a population-based study
- 2019
-
Ingår i: Human Reproduction. - : Oxford University Press. - 0268-1161 .- 1460-2350. ; 34:10, s. 2052-2060
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: Does the long-term fecundity of women with polycystic ovary syndrome (PCOS) differ from those without PCOS?SUMMARY ANSWER: Cumulative probability of childbirth is similar between women with and without PCOS.WHAT IS KNOWN ALREADY: PCOS is the main cause of anovulatory infertility in women after menarche. Previous studies indirectly suggest that fecundity in women with PCOS over the longer term may not be lower than in women without PCOS.STUDY DESIGN, SIZE, DURATION: This is a population-based study using four linked Swedish national registries. A total of 45 395 women with PCOS and 217 049 non-PCOS women were included. Follow-up began at the age of 18 years and continued for a maximum of 26 years, from 1989 to the end of 2015. Childbirth was the main outcome, as identified from the Medical Birth Register.PARTICIPANTS/MATERIALS, SETTING, METHODS: All women born between 1971 and 1997 who were identified with a PCOS diagnosis in the Swedish Patient Registry between 1 January 2001 and 31 December 2016 were included in the study population. Five controls per women with PCOS were randomly drawn from the Total Population Registry. The control women were born in the same year and living in the same municipality as the patient. The fecundity ratio (FR) was calculated by clustered Cox regression using a robust variance, adjusted for maternal birth period, country of birth and level of education.MAIN RESULTS AND THE ROLE OF CHANCE: The cumulative probability of childbirth was 80.2% (95% CI, 79.5–80.9%) in women with PCOS and 78.2% (95% CI, 77.9–78.5%) in those without PCOS. Adjusted FR was 0.81 (95% CI, 0.80–0.82) for first childbirth and 0.58 (95% CI, 0.57–0.60) for first childbirth following a spontaneous pregnancy. The FR for second childbirth was 0.79 (95% CI, 0.77–0.80). Women with PCOS had more than one child less frequently than the comparison group. Within the PCOS group, early age at diagnosis, later birth year, Nordic country of origin and low educational level positively influenced the FR.LIMITATIONS, REASONS FOR CAUTION: Results are not adjusted for BMI, and time from intention to conceive to first childbirth could not be captured. Data on pregnancies, miscarriages or abortions and fertility treatment are unknown for women who did not give birth during the study period. Women with PCOS who did not seek medical assistance might have been incorrectly classified as not having the disease. Such misclassification would lead to an underestimation of the true association between PCOS and outcomes.WIDER IMPLICATIONS OF THE FINDINGS: While cumulative probability of childbirth is similar between groups, women with PCOS need longer time to achieve their first childbirth. Women with PCOS have a lower FR and give birth to fewer children per woman than women without PCOS. Early diagnosis of and information about PCOS may improve affected women’s reproductive potential.STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Swedish Society of Medicine. Inger Sundström Poromaa has, over the past 3 years, received compensation as a consultant and lecturer for Bayer Schering Pharma, MSD, Gedeon Richter, Peptonics and Lundbeck A/S. The other authors declare no competing interests.
|
|
| 8. |
- Tawhid Söderholm, Nora, et al.
(författare)
-
Impact of Epidural Analgesia in Labour onNeonatal and Maternal Outcomes
- 2018
-
Ingår i: Open Journal of Obstetrics and Gynecology. - : Scientific Research Publishing. - 2160-8792 .- 2160-8806. ; 8, s. 767-779
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. Methods: A retrospective cohort study of nulliparous parturients who gave birth in Vasternorrland County, Sweden, over a 2-year period between 2015 and 2016. Neonatal outcomes (Apgar score at 5 min and umbilical cord arterial blood gases), maternal outcomes (perineal injury, total bleeding volume and maternal satisfaction with birth) and labour parameters (mode of delivery and the durations of labour and postpartum hospital stay) were evaluated. Results: The study cohort consisted of 1449 women with singleton pregnancies. Patients were divided into two groups according to whether during labour they were administered epidural analgesia using bupivacaine and sufentanil (EDA group, n = 615) or not (non-EDA group, n = 834). The rate of assisted vaginal delivery was significantly higher in the EDA group than in the non-EDA group (15.6% and 11.3%, respectively, p < 0.05), whereas the rates of caesarean section were similar. The duration of the active phase of labour was significantly longer in the EDA group than in the non-EDA group (489 ± 217 min versus 371 ± 210 min, respectively, p < 0.001). The Apgar score at 5 min and umbilical cord blood pH were lower and the base deficit greater in the EDA group (p < 0.001, p < 0.001 and p < 0.01, respectively). Bleeding volume was similar between the groups after adjusting for gestational age. Women in the EDA group were more satisfied with their labour experience, as measured by the visual analogue scale (p < 0.05). Conclusion: The results of this study suggest that EDA affects delivery and neonatal-maternal outcomes negatively, but increases the mother’s satisfaction with labour.
|
|
| 9. |
- Turkmen, Sahruh, et al.
(författare)
-
Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome
- 2015
-
Ingår i: Gynecological Endocrinology. - : Informa Healthcare. - 0951-3590 .- 1473-0766. ; 31:4, s. 301-305
-
Tidskriftsartikel (refereegranskat)abstract
- Polycystic ovary syndrome (PCOS) is associated with abnormal eating habits. We examined whether surgical treatment affected allopregnanolone levels and eating behaviour in nine women with PCOS who qualified for Rou-en-Y gastric bypass surgery. Blood samples were obtained to measure sex-hormone-binding globulin, total testosterone, progesterone, and allopregnanolone, and eating behaviour was evaluated using the Three-Factor Eating Questionnaire before surgery and at 6 and 12 months after surgery. Body mass index and total testosterone levels decreased, and progesterone and sex-hormone-binding globulin levels increased after bariatric surgery compared with pre-surgical values. In patients with anovulatory menstrual cycles, both the serum allopregnanolone level and the allopregnanolone/progesterone ratio were unchanged after surgery. The patients had high uncontrolled and emotional eating scores, and low cognitive restraint scores before surgery, and these scores had improved significantly at 6 and 12 months after surgery. The presurgical allopregnanolone levels were significantly correlated with uncontrolled eating. In conclusion, these results suggest that allopregnanolone appear to be part of the mechanism underlying the abnormal eating behaviour of obese PCOS patients by causing the loss of control over food intake. Roux-en-Y gastric bypass surgery can improve eating behaviour and clinical symptoms, and may facilitate weight loss in obese women with PCOS.
|
|
| 10. |
- Turkmen, Sahruh, et al.
(författare)
-
Foetal Macrosomia and Foetal-Maternal Outcomes at Birth
- 2018
-
Ingår i: Journal of Pregnancy. - : Hindawi Publishing Corporation. - 2090-2727 .- 2090-2735.
-
Tidskriftsartikel (refereegranskat)abstract
- To investigate how macrosomia affects foetal-maternal birth outcomes, we conducted a retrospective cohort study of singleton pregnant women who gave birth at gestational age >= 37+0 weeks. The patients were divided into three groups according to birth weight: "macrosomia" group, >= 4500 g, n=285; "upper-normal" group, 3500-4499 g, n=593; and "normal" group, 2500-3499 g, n=495. Foetal-maternal and delivery outcomes were compared among the three groups after adjustment for confounders. Caesarean section was more frequent in the macrosomia group than in upper-normal and normal groups. The duration of labour (p < 0.05) and postpartum care at the hospital (p < 0.001) were the highest in the macrosomia group. Increased birth weight was associated with higher risks of shoulder dystocia (p < 0.001), increased bleeding volume (p < 0.001), and perineal tear (p < 0.05). The Apgar score at 5 minutes (p < 0.05), arterial cord pH (p < 0.001), and partial pressure of O2 (p < 0.05) were lower, while the arterial cord partial pressure of CO2 was higher (p < 0.001), in the macrosomia group. Macrosomia has potentially serious impacts for neonate and mother as a result of a complicated and occasionally traumatic delivery.
|
|
