| 1. |
- Josefsson, Ann, et al.
(författare)
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Continuation rates of oral hormonal contraceptives in a cohort of first-time users : a population-based registry study, Sweden 2005–2010
- 2013
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 3:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives.Design: A longitudinal national population-based registry study.Setting: The Swedish prescribed drug register.Participants: All women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226211).Main outcome measures: A tendency to switch the type of hormonal contraceptive within 6months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians' and midwives' prescription patterns concerning the women's continuation rates of oral hormonal contraceptive type.Results: In Sweden, there were 782375 women born between 1977 and 1994 at the time of the study. Of these, 226211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the women's continuation rates depending on the prescriber categories.Conclusions: Desogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.
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| 2. |
- Josefsson, Ann, et al.
(författare)
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Risk for congenital malformations in offspring of women who have undergone bariatric surgery. A national cohort
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 120:12, s. 1477-1482
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo study the risk for congenital anomalies in the first child of women after bariatric surgery compared with all other women giving birth to their first child and divided by maternal body mass index (BMI) groups.DesignProspective, population-based register study.SettingSweden.SampleAll firstborn children to women born 1973–83 were studied to determine if they had a congenital anomaly and a mother who had undergone bariatric surgery before pregnancy.MethodsA total of 270 805 firstborns; of which 341 had mothers who had had bariatric surgery before delivery. We retrieved information on the women's marital or cohabitation status, smoking, BMI, diabetes and hypertension during pregnancy.Main outcome measuresCongenital malformations.ResultsOf the firstborn children to mothers who had had bariatric surgery before pregnancy, 4.1% (95% confidence interval [95% CI] 2.2–6.0) were malformed compared with 3.4% (95% CI 3.3–3.5) of those whose mothers had not undergone bariatric surgery. The risk for congenital malformation in firstborn children increased with increasing maternal BMI. The adjusted odds ratio (OR) for congenital malformation among children whose mothers' BMI ranged between 25 and 29 kg/m2 was 1.09 (95% CI 1.03–1.15), whose mothers' BMI ranged between 30 and 34 kg/m2 was 1.14 (1.05–1.24) and whose mothers' BMI was ≥35 kg/m2 was 1.30 (95% CI 1.16–1.45) compared with those whose mothers had a normal BMI. Bariatric surgery before pregnancy did not have any effect on the odds ratio for having congenital malformation (OR = 1.09, 95% CI 0.63–1.91).ConclusionsPreconception bariatric surgery does not seem to affect the risk for congenital malformations but a high to very high BMI does appear to increase the risk.
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| 3. |
- Lindberg, Malou, et al.
(författare)
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Differences in prescription rates and odds ratios of antidepressant drugs in relation to individual hormonal contraceptives: A nationwide population-based study with age-specific analyses
- 2012
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Ingår i: European journal of contraception & reproductive health care. - : Informa Healthcare. - 1362-5187 .- 1473-0782. ; 17:2, s. 106-118
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To examine, among young women, the association of individual hormonal contraceptives, within two broad groupings, with antidepressant therapy. less thanbrgreater than less thanbrgreater thanMethods In a nationwide register-based study, we examined the prescription rates of antidepressant drugs in relation to individual combined hormonal and progestin-only contraceptives among Swedish women aged 16-31 years (N = 917,993). Drug data were obtained from the Swedish Prescribed Drug Register for the period 1 July 2005-30 June 2008. Data on the total population of women aged 16-31 in 2008 were obtained from the Total Population Register of Statistics Sweden. The proportion of women using both hormonal contraception and antidepressants, and odds ratios (ORs) for antidepressant use for hormonal contraceptive users versus non-users, were calculated, the latter by logistic regression, for each formulation. less thanbrgreater than less thanbrgreater thanResults The highest antidepressant OR in all age groups, particularly in the 16-19 years age group, related to medroxyprogesterone-only, followed by etonogestrel-only, levonorgestrel-only and ethinylestradiol/norelgestromin formulations. Oral contraceptives containing ethinylestradiol combined with lynestrenol or drospirenone had considerably higher ORs than other pills. ORs significantly lower than 1 were observed when ethinylestradiol was combined with norethisterone, levonorgestrel or desogestrel. less thanbrgreater than less thanbrgreater thanConclusion The association between use of hormonal contraceptives and antidepressant drugs varies considerably within both the combined hormonal contraceptive and the progestin-only groups.
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| 4. |
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| 5. |
- Sarberg, Maria, et al.
(författare)
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Restless legs syndrome during and after pregnancy and its relation to snoring
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare / Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 91:7, s. 850-855
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms. Design. Prospective study. Setting. Antenatal care clinics in the catchment area of Linkoping university hospital, Sweden. Population. Five hundred consecutively recruited pregnant women. Methods. Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. Main outcome measures. Symptoms of RLS in relation to snoring in each trimester. Results. Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. Conclusions. Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.
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| 6. |
- Sarberg, Maria, et al.
(författare)
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Snoring during pregnancy and its relation to sleepiness and pregnancy outcome - a prospective study
- 2014
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 14:15
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Tidskriftsartikel (refereegranskat)abstract
- Background: The incidence of snoring and sleepiness is known to increase during pregnancy, and this might impact maternal health and obstetric outcome. However, the association between snoring and sleepiness during pregnancy is not fully understood. This study was aimed at investigating the development of snoring during pregnancy and prospectively assessing if there is an association between snoring and sleepiness or adverse pregnancy outcomes, such as preeclampsia, mode of delivery, and fetal complications. Methods: Consecutively recruited pregnant women (n = 500) received a questionnaire concerning snoring and sleep at the 1st and 3rd trimester of pregnancy. The women who had rated their frequency of snoring at both occasions (n = 340) were divided into subgroups according to the development of snoring they reported and included in the subsequent analyses. Additional medical data were collected from the medical records. Results: The frequency of snoring was 7.9% in the 1st trimester and increased to 21.2% in the 3rd trimester of pregnancy. The women who snored already in early pregnancy had significantly higher baseline BMI (p = 0.001) than the women who never snored, but snoring was not associated with the magnitude of weight gain during pregnancy. Snoring women were more likely to experience edema in late pregnancy than the non-snorers. Women who started to snore during pregnancy had higher Epworth Sleepiness Scores than the non snorers in both early and late pregnancy. No significant association between obstetric outcome and snoring was found. Conclusion: Snoring does increase during pregnancy, and this increase is associated with sleepiness, higher BMI at the start of pregnancy and higher prevalence of edema, but not with weight gain.
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| 7. |
- Wiréhn, Ann-Britt, et al.
(författare)
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Use of hormonal contraceptives in relation to antidepressant therapy: A nationwide population-based study
- 2010
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Ingår i: European journal of contraception & reproductive health care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 15:1, s. 41-47
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The relation between the use of different hormonal contraceptives and antidepressant therapy was investigated. METHODS: In a nationwide cross-sectional study among all women in Sweden aged 16-31, drug expenditure data on hormonal contraceptives and antidepressants were obtained from the Swedish Prescribed Drug Register. Odds ratios (ORs) for antidepressant use were calculated by logistic regression for progestin-only users versus non-users as well as for combined hormonal contraceptive (CHC) users versus non-users. RESULTS: In the study population (N = 917,993), 58.9% were hormonal contraceptive users, and 8.5% were antidepressant users. The age-pattern for antidepressant ORs differed between the two types of users of contraceptives; progestin-only users had significant ORs above 1 in all age groups whereas among CHC users the OR was above 1 solely in those aged 16-19. The largest difference between types of users was seen in the age group 16-19 in which women resorting to a progestin-only contraceptive had a 67% (95% confidence interval: 57- 78%) higher antidepressant use than women treated with a CHC. CONCLUSION: Progestin-only contraceptive users resorted to antidepressants more than users of CHCs. This phenomenon is particularly pronounced among teenagers. Therefore, special attention should be given to young women's mental history when prescribing hormonal contraceptives and vice versa: the contraceptive history should be taken into account when prescribing antidepressants.
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| 8. |
- Abu-Elyazeed, R R, et al.
(författare)
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Safety and immunogenicity of a glycoprotein D genital herpes vaccine in healthy girls 10-17 years of age : results from a randomised, controlled, double-blind trial
- 2013
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Ingår i: Vaccine. - : Elsevier BV. - 0264-410X .- 1873-2518. ; 31:51, s. 6136-6143
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The investigational AS04-adjuvanted herpes simplex virus type 2 (HSV-2) glycoprotein D (gD2) subunit prophylactic vaccine ('HSV vaccine'; GlaxoSmithKline Vaccines) has been shown to be well tolerated in adults, but limited data exist for pre-teen and adolescent girls, a likely target population. The primary objective of this study was to compare the occurrence of serious adverse events (SAEs) over 12 months between HSV vaccine recipients and saline recipients (placebo control group) in pre-teen and adolescent girls. The immunogenicity of the HSV vaccine was also assessed.METHODS: Healthy girls aged 10-17 years, stratified by age (10-15 years; 16-17 years), were randomised 2:1:1 to receive the HSV vaccine, a hepatitis A vaccine (Havrix™; HAV control) or placebo (saline) according to a 0-, 1-, 6-month schedule. Participants and study personnel not involved in the preparation or administration of vaccines were blinded to treatment. Safety and immunogenicity analyses were performed overall and by age (10-15 years; 16-17 years) and HSV serostatus.RESULTS: No statistically significant difference in the percentage of subjects with SAEs was observed between the HSV and saline group, or between the HSV and pooled control (HAV and saline) groups. The HSV vaccine was well tolerated, although a higher incidence of solicited local symptoms was observed in the HSV group than in the control group. Neither age nor HSV serostatus at the time of study entry had an impact on the safety profile of this vaccine. The HSV vaccine was immunogenic regardless of pre-vaccination HSV serostatus. Higher anti-gD geometric mean concentrations were observed in HSV-1 seropositive participants than in HSV-1 seronegative participants.CONCLUSION: The HSV vaccine had an acceptable safety profile, and was well tolerated and immunogenic when administered to girls aged 10-17 years regardless of age or HSV pre-vaccination serostatus.
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| 9. |
- Ahldén, Ingegerd, et al.
(författare)
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Parents' Expectations About Participating in Antenatal Parenthood Education Classes
- 2012
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Ingår i: The Journal of Perinatal Education. - : Springer Publishing Company. - 1058-1243 .- 1548-8519. ; 21:1, s. 11-17
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Tidskriftsartikel (refereegranskat)abstract
- Our objective was to assess parents' expectations about participating in antenatal parenthood education classes and to determine whether their expectations might be related to gender, age, and educational level. Data from 1,117 women and 1,019 partners residing in three cities in Sweden were collected with a questionnaire in a cross-sectional study. Participants believed that antenatal education classes would help them to feel more secure as parents and to be better oriented toward childbirth. Men had more positive expectations about the childbirth than the women. The participants mostly wanted help in preparing for parenthood and in learning infant care skills, followed by help in preparing for childbirth. The participants' expectations were affected by gender, age, and educational level. The expectant parents appeared to want more focus on preparation for parenthood than on childbirth.
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| 10. |
- Areskoug Josefsson, Kristina, et al.
(författare)
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Evidence-based practice in a multiprofessional context
- 2012
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Ingår i: International Journal of Evidence-Based Healthcare. - : Ovid Technologies (Wolters Kluwer Health). - 1744-1595 .- 1744-1609. ; 10:2, s. 117-125
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Tidskriftsartikel (refereegranskat)abstract
- Background Healthcare today is a complex system with increasing needs of specific knowledge of evaluation of research and implementation into clinical practice. A critical issue is that we all apply evidence-based practice (EBP) with standardised methods and continuing and systematic improvements. EBP includes both scientific and critical assessed experience-based knowledge. For the individual, this means applying evidence-based knowledge to a specific situation, and for the organisation, it means catering for a systematic critical review and evaluation and compiling research into guidelines and programmes. In 2009, the County Council of Jönköping had approximately 335 000 inhabitants and the healthcare organisation had more than 10 000 employees. As the County Council actively promotes clinical improvement, it is interesting to explore how healthcare employees think about and act upon EBP. The aim of this survey was therefore to describe factors that facilitate or hinder the application of EBP in the clinical context.Method A quantitative study was performed with a questionnaire to healthcare staff employed in the County Council of Jönköping in 2009. The questionnaire consisted of questions concerning which factors are experienced to affect the development of evidence-based healthcare. There were 59 open and closed questions, divided into the following areas:• Sources of knowledge used in practice• Barriers to finding and evaluating research reports and guidelines• Barriers to changing practice on the basis of best evidence• Facilitating factors for changing practice on the basis of best evidence• Experience in finding, evaluating and using different sources of evidenceThe participants were selected using the county council's staff database and included medical, caring and rehabilitative staff within hospitals, primary care, dentistry and laboratory medicine. The inclusion criteria were permanent employment and clinical work. Invitations were sent to 5787 persons to participate in the study and 1445 persons answered the questionnaire.Results Knowledge used in daily clinical practice was mainly based on information about the patient, personal experience and local guidelines. Twenty per cent answered that they worked ‘in the way they always had’, and 11% responded that they used evidence from research as a basis for change. The participants experienced that EBP was not used enough in clinical healthcare and explained this with practical and structural barriers, which they thought should be better monitored by the organisation and directors.Conclusion Overall, the results indicate that the scientific evidence for healthcare is not used sufficiently as a base for decisions in daily practice as well as for changing practice. This is more prominent among assistant staff. As a consequence, this might affect the care of the patients in a negative way. Increased awareness of EBP and a stronger evidence-based approach are keys in the ongoing improvement work in the county. Local guidelines seem to be a way to implement knowledge. But, as the arena of activities is complex and the employees have diverse education levels, different strategies to facilitate and promote EBP are necessary.
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| 11. |
- Arp, Hans Peter H., et al.
(författare)
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Native Oxy-PAHs, N-PACs, and PAHs in historically contaminated soils from Sweden, Belgium, and France : their soil-porewater partitioning behavior, bioaccumulation in Enchytraeus crypticus, and bioavailability
- 2014
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Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 48:19, s. 11187-11195
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Tidskriftsartikel (refereegranskat)abstract
- Soil quality standards are based on partitioning and toxicity data for laboratory-spiked reference soils, instead of real world, historically contaminated soils, which would be more representative. Here 21 diverse historically contaminated soils from Sweden, Belgium, and France were obtained, and the soil-porewater partitioning along with the bioaccumulation in exposed worms (Enchytraeus crypticus) of native polycyclic aromatic compounds (PACs) were quantified. The native PACs investigated were polycyclic aromatic hydrocarbons (PAHs) and, for the first time to be included in such a study, oxygenated-PAHs (oxy-PAHs) and nitrogen containing heterocyclic PACs (N-PACs). The passive sampler polyoxymethylene (POM) was used to measure the equilibrium freely dissolved porewater concentration, C-pw, of all PACs. The obtained organic carbon normalized partitioning coefficients, K-TOC, show that sorption of these native PACs is much stronger than observed in laboratory-spiked soils (typically by factors 10 to 100), which has been reported previously for PAHs but here for the first time for oxy-PAHs and N-PACs. A recently developed K-TOC model for historically contaminated sediments predicted the 597 unique, native K-TOC values in this study within a factor 30 for 100% of the data and a factor 3 for 58% of the data, without calibration. This model assumes that TOC in pyrogenic-impacted areas sorbs similarly to coal tar, rather than octanol as typically assumed. Black carbon (BC) inclusive partitioning models exhibited substantially poorer performance. Regarding bioaccumulation, C-pw combined with liposome-water partition coefficients corresponded better with measured worm lipid concentrations, C-lipid (within a factor 10 for 85% of all PACs and soils), than C-pw combined with octanol-water partition coefficients (within a factor 10 for 76% of all PACs and soils). E. crypticus mortality and reproducibility were also quantified. No enhanced mortality was observed in the 21 historically contaminated soils despite expectations from PAH spiked reference soils. Worm reproducibility weakly correlated to C-lipid of PACs, though the contributing influence of metal concentrations and soil texture could not be taken into account. The good agreement of POM-derived C-pw with independent soil and lipid partitioning models further supports that soil risk assessments would improve by accounting for bioavailability. Strategies for including bioavailability in soil risk assessment are presented.
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| 12. |
- Bladh, Marie, et al.
(författare)
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Hospitalization in Adolescence and Young Adulthood Among Twins and Singletons : A Swedish Cohort Study of Subjects Born Between 1973 and 1983
- 2013
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Ingår i: Twin Research and Human Genetics. - : Cambridge University Press (CUP). - 1832-4274 .- 1839-2628. ; 16:3, s. 707-715
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Tidskriftsartikel (refereegranskat)abstract
- Children born with non-optimal birth characteristics — that is, are small for gestational age and/or preterm — have an increased risk for several long-term effects such as neurological sequelae and chronic disease. The purpose of this study was to examine whether twins exhibited a different outcome, compared with singletons, in terms of hospitalization during adolescence and early adulthood, and to what extent differences remain when considering the divergence in birth characteristics between singletons and twins. Persons born between 1973 and 1983 in Sweden and surviving until age 13 were included and followed until the end of 2006. Data on birth characteristics, parental socio-demographic factors, and hospitalizations were collected from national registers. Adjusting for parental socio-demographic factors, twins had a higher risk of being hospitalized than singletons (odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10–1.25) and more often due to ‘Congenital anomalies’ (OR = 1.18, 95% CI = 1.06–1.28), ‘Infections’ (OR = 1.14; 95% CI = 1.08–1.20), ‘External causes of illness’ (OR = 1.10, 95% CI = 1.06–1.15), and ‘Diseases of the nervous system’ (OR = 1.18, 95% CI = 1.10–1.26). Stratifying for birth characteristics, this difference diminishes, and for some diagnoses non-optimal twins seem to do slightly better than non-optimal singletons. Thus, twins with non-optimal birth characteristics had a lower risk of hospitalization than non-optimal singletons on, for example, ‘Congenital anomalies’ and ‘Diseases of the nervous system’ (OR = 0.86, 95% CI = 0.77–0.96; OR = 0.88, 95% CI = 0.81–0.97, respectively) and Total (any) hospitalization (OR = 0.87, 95% CI = 0.83–0.92). Among those with optimal birth characteristics, twins had an increased hospitalization due to ‘External causes of illness’ (OR = 1.07, 95% CI = 1.02–1.13) compared with optimal singletons. Twins have higher hospitalization rates than singletons. In stratifying for birth characteristics, this difference diminishes, and for some diagnoses, non-optimal twins seem to do less poorly than non-optimal singletons.
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| 13. |
- Bladh, Marie, et al.
(författare)
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Reproductive patterns among twins : a Swedish register study of men and women born 1973-1983
- 2013
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDuring the last decades there has been a steady increase of twin births. A combination of improved medical treatment of preterm and small-for-gestational age children has contributed to a higher number of surviving twins. Prematurity is known to affect reproduction in a negative way. Few studies have focused on the potential effect twinning may have on future reproduction. Thus, the aim of this study was to investigate the effect of being born a twin compared to being born a singleton have on future reproduction.MethodsIn a national population-based register study, all individuals born between 1973–1983 who were alive and living in Sweden at 13 years of age (n = 1 016 908) constituted the sample. Data on each study subject’s own birth as well as the birth of their first offspring, and parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios and corresponding 95% CI was calculated using Cox proportional hazards model.ResultsTwins, both men and women, had a reduced likelihood of reproducing compared to singletons (women: HR = 0.89, 95% CI = 0.86-0.93; men: HR = 0.92, 95% CI = 0.87-0.97). This difference in birth rates can only partly be explained by diverging birth characteristics. Amongst men and women born very preterm, twins had an increased likelihood of reproducing compared to singletons (women: HR = 1.25, 95% CI = 1.02-1.62; men: HR = 1.34, 95% CI = 1.01-1.78).ConclusionsTwins have lower reproduction rates compared to singletons, which only to a certain degree can be explained by diverging birth characteristics.
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| 14. |
- Brynhildsen, Jan, et al.
(författare)
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Leptin and adiponectin in cord blood from children of normal weight, overweight and obese mothers
- 2013
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 102:6, s. 620-624
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Tidskriftsartikel (refereegranskat)abstract
- Aim To study cord blood concentrations of adiponectin and leptin in children born by normal weight, overweight and obese mothers and to study these parameters in relation to a weight gain intervention programme for obese mothers. Methods Ten millilitre cord blood was collected and analysed for leptin and adiponectin concentrations in children with gestational age andgt;37weeks born by 60 normal weight, 45 overweight and 145 obese mothers. 82 obese mothers took part in a weight gain intervention programme. Results Concentrations of leptin and adiponectin were higher in cord blood from children of overweight and obese mothers compared with children of normal weight mothers (leptin: Md 13.2, 30, 3 and 90.2ng/mL respectively, pandlt;0.001; adiponectin 35.9, 205.4, 213.8ng/L pandlt;0.001). No differences were found between overweight and obese mothers. The weight gain intervention programme for obese pregnant women had significant effects on the weight gain during pregnancy but had no effects on cord blood serum concentrations of leptin and adiponectin. Conclusion Cord blood leptin and adiponectin concentrations were higher in children born by overweight or obese women compared with children of normal weight mothers. A weight gain intervention programme for obese pregnant women did not affect these results. Intrauterine exposition to high concentrations of leptin and adiponectin may play a role in weight development later in life.
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| 15. |
- Claesson, Ing-Marie, et al.
(författare)
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Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme
- 2014
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 30:1, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- Objectivethe objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme. We also wanted to explore whether physical activity influences weight change or health status during pregnancy.Designa prospective intervention study.Settingantenatal care clinic.Participantsa total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group.Measurementsthe women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory, the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum. Physical activity was measured in metabolic equivalents.Findingsthe physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning, bodily pain, social functioning, role limitations due to emotional problems and general mental health as compared with the physically inactive women. There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications.Key conclusionsphysical activity among obese pregnant women provides better psychological well-being and improved quality of life, but does not prevent weight change.Implications for practicestaff at Antenatal Care Clinics that face obese pregnant women, should encourage and emphasise the benefits of being physically active throughout pregnancy.
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| 16. |
- 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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| 17. |
- Claesson, Ing-Marie, 1953-, et al.
(författare)
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Weight after childbirth : A 2-year follow-up of obese women in a weight-gain restriction program
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:1, s. 103-110
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth. Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum. Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018). Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.
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| 18. |
- 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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| 19. |
- Claesson, Ing-Marie, et al.
(författare)
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Weight six years after childbirth : a follow-up of obese women in a weight-gain restriction programmme
- 2014
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 30:5, s. 506-511
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme.DESIGN: follow-up of a prospective intervention study.SETTINGS: antenatal care clinics.PARTICIPANTS: a total of 129 women (88.4%) from the original intervention group and 166 women (88.8%) from the original control group.MEASUREMENTS: the women answered a study specific questionnaire, covering socio-demographic data and health- and weight status.FINDINGS: after adjusting for socio-demographic factors, the mean weight was lower (4.1kg) among the women in the intervention group, compared to the controls (p=0.028). Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2kg), e.g. weighed less than the women in the control group (-1.9kg) (p=0.046). Mean weight change expressed in 5kg classes also showed a significant difference between the two groups (p=0.030).KEY CONCLUSIONS: the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention.IMPLICATION FOR PRACTISE: a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short- and long term medical health benefits for the mother as well as the child.
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| 20. |
- DeKeyser, Nicholas, et al.
(författare)
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Premature birth and low birthweight are associated with a lower rate of reproduction in adulthood: a Swedish population-based registry study
- 2012
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Ingår i: Human Reproduction. - : Oxford University Press (OUP): Policy B1. - 0268-1161 .- 1460-2350. ; 27:4, s. 1170-1178
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate if individuals born with sub-optimal birth characteristics have reduced probability of reproducing in adulthood. less thanbrgreater than less thanbrgreater thanUsing population-based registries, the authors included 522 216 males and 494 692 females born between 1973 and 1983 and examined their reproductive status as of 2006. Outcome measure was the hazard ratio (HR) of reproducing. Adjustments were made for socio-economic factors. less thanbrgreater than less thanbrgreater thanMales and females born very premature displayed a reduced probability of reproducing [HR 0.78, 95 confidence interval (CI): 0.700.86 for males; HR 0.81, CI: 0.750.88 for females]. Likewise for very low birthweight (HR 0.83, CI: 0.710.95 for males; HR 0.80, 95 CI: 0.720.89 for females). Individuals born large for gestational age (LGA) displayed no significant changes. Males born small for gestational age (SGA) had a 9 lower reproductive rate (CI: 0.890.94) and that reduction increased as the individuals aged. Women born SGA tended to start reproducing at an earlier age. less thanbrgreater than less thanbrgreater thanThe results suggest that being born with low birthweight, premature or SGA (for males) is associated with a reduced probability of reproducing as an adult. LGA shows no statistically significant relationship with future reproduction.
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| 21. |
- DeKeyser, Nicholas, et al.
(författare)
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Total cost comparison of standard antenatal care with a weight gain restriction programme for obese pregnant women
- 2011
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Ingår i: Public Health. - : Elsevier Science B.V., Amsterdam. - 0033-3506 .- 1476-5616. ; 125:5, s. 311-317
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. Study design: A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. Methods: In total, 155 women in an intervention group attempted to restrict their gestational weight gain to less than7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros ((sic)). Results: Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was (sic)1283 more per woman/ infant in the intervention group compared with the control group (P = 0.025). The degree of obesity at programme entry had no bearing on the outcome. Conclusions: The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to less than7 kg, but had a higher total cost compared with standard antenatal care.
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| 22. |
- 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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| 23. |
- Hildebrand, Eric, et al.
(författare)
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Maternal obesity and risk of Down syndrome in the offspring
- 2014
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Ingår i: Prenatal Diagnosis. - : John Wiley & Sons. - 0197-3851 .- 1097-0223. ; 34:4, s. 310-315
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this article is to determine if maternal obesity is associated with an increased risk of Down syndrome in the offspring and whether the risk estimates for trisomy 21 based on combined screening is affected by maternal body mass index (BMI).METHODS: Study group I consisted of a nationwide cohort of 168 604 women giving birth; outcome was infants born with Down syndrome. Adjustment was made for maternal age. Study group II consisted of 10 224 women undergoing 1st trimester combined screening. Outcome was risk assessment for Down syndrome. All women were divided into six BMI groups, and outcomes were evaluated over the BMI strata with BMI 18.5 to 24.9 as reference and correcting for maternal age.RESULTS: Obese women had an increased risk for giving birth to an infant with Down syndrome compared with normal-weight women, BMI 30 to 34.9 odds ratio (OR) 1.31 [95% confidence interval (CI) 1.10-1.55], BMI 35 to 39.9 OR 1.12 (95% CI 0.82-1.53), BMI ≥ 40 OR 1.56 (95% CI 1.00-2.43). The observed and the expected numbers of women with a risk of Down syndrome >1/300 based on 1st trimester combined screen and maternal age were similar in each BMI group.CONCLUSION: Maternal obesity seems to increase the risk for Down syndrome births. The risk estimate for Down syndrome with 1st trimester combined screening is unaffected by BMI. © 2013 John Wiley & Sons, Ltd.
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| 24. |
- Josefsson, Ann, et al.
(författare)
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A Comparison Between Swedish Midwives and Obstetricians and Gynecologists Opinions on Cesarean Section
- 2011
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Ingår i: MATERNAL AND CHILD HEALTH JOURNAL. - : Springer Science Business Media. - 1092-7875 .- 1573-6628. ; 15:5, s. 555-560
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Tidskriftsartikel (refereegranskat)abstract
- To compare Swedish obstetricians/gynecologists and midwives attitudes and opinions on different aspects of cesarean section (CS). In total 330 midwives from the south east of Sweden and 1280 Swedish obstetricians/gynecologists were asked to answer a study-specific questionnaire anonymously about their opinions on different issues concerning CS. The majority of obstetricians/gynecologists and midwives had more than 10 years of experience in their professions (75.2% vs. 73.6%). The midwives thought that a reasonable CS rate would be 11.5% whereas the corresponding figures for the obstetricians/gynecologists was 13.8% (P andlt; 0.001). There are differences in opinions and attitudes concerning both CS rates and other aspects in connection with CS. There are evident differences in attitudes towards CS and mode of delivery between midwives and obstetricians/gynecologists. These need to be explored and discussed in relation to state-of-the-art knowledge and should become a part of the curriculum for both groups of professionals both in training as well as on a regular clinical basis.
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| 25. |
- Josefsson, Ann, et al.
(författare)
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Bariatric surgery in a national cohort of women: sociodemographics and obstetric outcomes
- 2011
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier. - 0002-9378 .- 1097-6868. ; 205:3, s. 25-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In a large, prospective Swedish national cohort, we investigated individual birth characteristics for women who had undergone bariatric surgery and their obstetric outcome and made comparisons with all other women during the same period. less thanbrgreater than less thanbrgreater thanSTUDY DESIGN: The cohort consisted of 494,692 women born 19731983 of which 681 women who had undergone bariatric surgery constituted the index group. less thanbrgreater than less thanbrgreater thanRESULTS: The index women more often have parents with lower sociodemographic status and are more often born large for gestational age. The women surgically treated before their first child had a shorter gestational length, their children had lower birthweight, and were more often born small for gestational age compared with the children born to the reference mothers. Women whose child was born before their bariatric surgery more often had a cesarean section, and their children were more often large for gestational age. less thanbrgreater than less thanbrgreater thanCONCLUSION: Preconception bariatric surgery in obese women may be associated with improved obstetric outcomes.
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