| 1. |
- Lilliecreutz, Caroline, et al.
(författare)
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Mental disorders and risk factors among pregnant women with depressive symptoms in Sweden : A case-control study
- 2021
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 100:6, s. 1068-1074
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Identification of pregnant women suffering from depression or other mental disorders is a challenge for antenatal caregivers. The purpose of this case-control study was to describe mental disorders and the risk factors for mental disorders in women with depressive symptoms assessed with the Edinburgh Postnatal Depression Scale during the first trimester and to compare them with pregnant women without depressive symptoms. Material and methods In total, 2271 women answered the Edinburgh Postnatal Depression Scale at the first antenatal visit with a midwife. An Edinburgh Postnatal Depression Scale score of 13 or higher was considered to be screen-positive and these women were further assessed. Screen-negative pregnant women, matched for age and parity, were chosen as controls. Results In total, 149 (6.6%) women were found to be screen-positive. The majority (126, 85%) had at least one mental disorder or risk factor for mental disorder, such as depression (36.0%), anxiety (14.8%), or severe fear of childbirth (20.8%). The screen-positive women were more often smokers (16.1% vs 1.3%), unemployed (19.9% vs 1.3%), or on sick leave (25.3% vs 14.1%) during pregnancy and more often used selective serotonin reuptake inhibitor during pregnancy (14.2% vs 2.7%) compared with the screen-negative women (P<.001). Among the screen-negative women (n = 150) only three (2%) presented with symptoms of depression during pregnancy. Conclusions The Edinburgh Postnatal Depression Scale seems to be a valuable screening tool to detect depressive symptoms as well as other mental disorders during early pregnancy.
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| 2. |
- Areskoug Josefsson, Kristina, 1973-, et al.
(författare)
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Using ICF and ICHI to promote sexual health
- 2021
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Ingår i: Cogent Medicine. - : Taylor & Francis. - 2331-205X. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Sexual health is an important but often neglected field in health and welfare practice. Using structured documentation in a systematic work process can promote sexual health care including rehabilitation. Objectives: To present an overview of the usefulness of International Classification of Functioning, Disability and Health (ICF) and International Classification of Health Interventions (ICHI) concerning sexual health in the care process, in the electronic health record (EHR) and for follow-up of results. Using experience from practice and research to identify relevant information in health care processes related to sexual health, which are coded by using ICF and ICHI. The ICF and ICHI can be useful tools to describe functioning, patient's goals, results, planned and performed interventions for investigation, treatment, prevention, and follow-up at individual level in care processes concerning sexual health with unified and unambiguous terms, concepts, and codes in the EHR. Using the ICF and ICHI can support improvement of individual sexual health care including rehabilitation, and also support follow-up and quality management at local to global level within the domain of sexual health.
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| 3. |
- Jää-Aro, Kai-Mikael, 1966-, et al.
(författare)
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Professional development for ICT-based teaching
- 2020
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Ingår i: Electronic Proceedings of the ESERA 2019 Conference. - Bologna : ALMA MATER STUDIORUM – University of Bologna. - 9788894587401 ; , s. 1722-1727
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Konferensbidrag (refereegranskat)abstract
- Using information and communications technologies (ICT) in the classroom requires new skills on the part of educators. We have elicited current best practices for professional development of educators from the participants in this workshop, what knowledge teachers need and how it is best imparted. We found that even given their different starting points, teachers in different regions are often feeling unsure about how to use ICT in a pedagogical context, and there is no clear consensus on how to best train teachers in this use, but that the digitalisation of schools will require a long-term commitment from school management and political leadership.
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| 4. |
- Lindblad, Maria, et al.
(författare)
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Risk factors during pregnancy and delivery for the development of Perthes disease, a nationwide Swedish study of 2.1 million individuals
- 2020
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTo ascertain or disprove a correlation between suboptimal birth characteristics, breech position at delivery and development of Perthes’ disease.MethodsStudy material was collected from nationwide registers regarding diagnoses, birth statistics and delivery data. As study population were included children with a diagnosis code for Perthes’ disease who were alive and living in Sweden at age 13. Children with missing birth statistics were excluded. All children with no Perthes’ disease diagnosis were used as control group. Both single and multiple logistical regression analyses were used to calculate OR for the included characteristics.ResultsChildren in breech position had a higher risk for developing Perthes’ disease. Children with Perthes’ disease had also a higher probability of having been born pre-term, very pre-term or post-term. Lower than normal birth weight and a lower Apgar-score were also associated with Perthes’ disease.ConclusionsThere is a correlation between breech birth and development of Perthes’ disease. There is also correlation to suboptimal birth characteristics. Despite our findings this should not be used for screening of Perthes’ disease as the percentage of children who actually develop it is very low. Also, as of yet there is no possibility to diagnose Perthes’ disease before the presence of skeletal changes. Our findings could be important in finding the cause of Perthes’ disease and therefore developing better diagnostics, treatment and prevention.
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| 5. |
- Lindell, Nina, 1984-
(författare)
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Perinatal risk factors for type 1 diabetes in children and adolescents
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Type 1 diabetes (T1D) is an autoimmune disease characterized by progressive loss of the insulin producing pancreatic β-cells. The disease process starts years before the clinical diagnosis. The cause of T1D is unknown, but it is believed to be a combination of genetic and environmental factors. Around 50% of the genetic risk is attributed to the human leucocyte antigen (HLA) genes and the strongest associations are with the HLA-DR3-DQ2 and HLA-DR4-DQ8 haplotypes. The highest risk genotype is the heterozygote form of the two, the HLA-DQ2/8 genotype. It may be that certain environmental factors pose a risk to individuals with a particular genetic susceptibility but not to others. In the last few decades T1D incidence has risen very quickly and due to the rate of the increase, it is believed to depend on environmental factors rather than genetic. In parallel with this increase, the incidence of several environmental factors has also risen i.e., the incidence of cesarean section (CS), overweight/obesity in the general population and birthweight. These environmental factors have been implicated as risk factors for T1D, but studies have had conflicting results.Objective The overall aim of this thesis was to increase knowledge regarding factors during pregnancy and the perinatal period that could increase or decrease the risk of T1D among children and adolescents. The environmental risk factors studied were mode of childbirth (study I), maternal BMI and gestational weight gain (GWG) (study II) and the child’s size for gestational age and birthweight (study III). In the last study the environmental risk factors were compared between children with different genetic risks of T1D.Material and methods The studies included in this thesis are population-based register studies, three case-control studies and one cohort study, using prospectively collected material from the Swedish medical birth registry (MBR) and the Swedish pediatric diabetes quality registry (SWEDIABKIDS), as well as information from the Swedish national cohort study Better Diabetes Diagnosis (BDD). The study population consists of children and adolescents (0–18/19 years) diagnosed with T1D Jan 2000-Oct 2012 and registered in SWEDIABKIDS (n=9,376). All children with T1D were matched with four control children from the MBR with the same year and day of birth, same sex, and born in the same region of Sweden (n=37,504). In study I, the entire study population was used but in study III twins were excluded (n=552). In study II, children for whom data on their mother’s BMI in early pregnancy and GWG were available were included (3,231 children with T1D and 12,948 control children). In study IV, children with T1D who also participated in the BDD study were included (4,533 children).Results and conclusions Maternal overweight and obesity were associated with an increased risk of T1D in the offspring but were not more common among children with high or low genetic risk. Maternal BMI was also inversely associated with the age at onset of T1D in children with HLADQ8/ X and/or HLA-DQ2/X. Neither GWG nor mode of childbirth had any obvious impact on the risk of developing T1D. Being born large for gestational age or with a birthweight ≥4000 g (macrosomia) was associated with an increased risk of T1D and being born small for gestational age or with a low birthweight (<2500 g) was associated with a decreased risk of T1D, irrespective of maternal BMI and diabetes. Comparing children with T1D and different HLA genotypes revealed a slight difference in birthweight between the genotype groups. Children with HLA-DQ2/8 were more often born with macrosomia compared to children with HLA-DQ8/X. Children without either HLA-DQ2 or HLADQ8 (HLA-DQX/X) were more often born with a low birthweight compared to those with HLADQ2/ 8 and HLA-DQ8/X. Size for gestational age did not differ between the genotype groups, and the effect of size for gestational age and birthweight on age at onset of T1D was ambiguous.The effects of the environmental risk factors identified in this thesis are generally weak and no clear conclusion on whether they are causative can be drawn. Yet since overweight/obesity and a high birthweight are common in the population, even a small increase in risk can result in many cases of T1D. Overweight/obesity and a high birthweight are also associated with other adverse health outcomes and they are, at least partly, modifiable. This motivates additional research regarding their involvement in T1D etiology as well as preventive actions against overweight and obesity in the population.
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| 6. |
- Lindell, Nina, 1984-, et al.
(författare)
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Size for gestational age affects the risk for type 1 diabetes in children and adolescents : a Swedish national case–control study
- 2021
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 64:5, s. 1113-1120
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Tidskriftsartikel (refereegranskat)abstract
- Aim/hypothesis: Environmental factors are believed to contribute to the risk of developing type 1 diabetes. The aim of this study was to investigate how size for gestational age affects the risk of developing childhood type 1 diabetes. Methods: Using the Swedish paediatric diabetes quality register and the Swedish medical birth register, children with type 1 diabetes diagnosed between 2000 and 2012 (n = 9376) were matched with four control children (n = 37,504). Small for gestational age (SGA) and large for gestational age (LGA) were defined according to Swedish national standards. Data were initially analysed using Pearson’s χ2 and thereafter by single and multiple logistic regression models. Results: An equal proportion of children were born appropriate for gestational age, but children with type 1 diabetes were more often born LGA and less often born SGA than control children (4.7% vs 3.5% and 2.0% vs 2.6%, respectively, p < 0.001). In the multiple logistic regression analysis, being born LGA increased (adjusted OR 1.16 [95% CI 1.02, 1.32]) and SGA decreased (adjusted OR 0.76 [95% CI 0.63, 0.92]) the risk for type 1 diabetes, regardless of maternal BMI and diabetes. Conclusions/interpretation: Size for gestational age of Swedish children affects the risk of type 1 diabetes, with increased risk if the child is born LGA and decreased risk if the child is born SGA. Being born LGA is an independent risk factor for type 1 diabetes irrespective of maternal BMI and diabetes. Thus, reducing the risk for a child being born LGA might to some extent reduce the risk for type 1 diabetes. Graphical abstract: [Figure not available: see fulltext.].
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| 7. |
- Marteinsdottir, Ina, et al.
(författare)
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Parity-related variation in cortisol concentrations in hair during pregnancy
- 2021
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 128:4, s. 637-644
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate hair cortisol concentrations (HCC) monthly in pregnant women and to explore the effect of parity. Design Prospective cohort study from gestational week (GW) 26, at childbirth and postpartum. Setting An antenatal care clinic in southeast Sweden. Sample 390 pregnant women. Methods Cortisol was measured using radioimmunoassay in methanol extracts of ground hair samples. Main outcome measures Hair cortisol concentrations. Results Both primi- and multiparae exhibited an increase in HCC throughout pregnancy. Primiparae had significantly higher HCC in the latter part of the last trimester compared with multiparae (1 month P = 0.003, 2 months P = 0.038). The use of psychotropic medication in the first trimester correlated to HCC postpartum (P < 0.001). HCC in GW 14-17 was associated with HCC in GW 18-21 (primiparae and multiparae, P < 0.001), GW 22-25 (primiparae P = 0.036, multiparae P = 0.033), and 2 months postpartum (primiparae P = 0.049). HCC in GW 18-21 was associated with GW 22-25 in both primiparae (P < 0.001) and multiparae (P < 0.001) as well as 2 months prior to childbirth among primiparae (<0.037). In general, all estimates of HCC in pregnancy and postpartum showed a significant association between HCC for a specific month and the HCC in the previous month (all P < 0.001), except for the association of HCC among primiparae in GW 22-25 and 3 months prior to childbirth. Conclusions Increased cortisol concentrations in hair were observed during pregnancy, which decreased 3 months prior to childbirth in multiparae. The results indicate a quicker suppression of the hypothalamic CRH (corticotropin-releasing hormone) production by placenta CRH in multiparous women.
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| 8. |
- Martinez, Cristina A., et al.
(författare)
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Epigenetic modifications appear in the human placenta following anxiety and depression during pregnancy
- 2023
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Ingår i: Placenta. - : Elsevier. - 0143-4004 .- 1532-3102. ; 140, s. 72-79
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The future health of the offspring can be influenced by longstanding maternal anxiety and depression disorders during pregnancy. The present study aimed to explore the effect of psychiatric disorders during pregnancy on placental epigenetics. Methods: We measured DNA methylation patterns in term-placentas of women either suffering longstanding anxiety and depression symptoms (Index group, with overt symptoms), or a healthy population (Control, none/ only mild symptoms). Whole genome DNA methylation profiling was performed using the TruSeq (R) Methyl Capture EPIC Library Prep Kit (Illumina, San Diego, CA, USA) for library preparation and NGS technology for genomic DNA sequencing.Results: The results of high-throughput DNA methylation analysis revealed that the Index group had differential DNA methylation at epigenome-wide significance (p < 0.05) in 226 genes in the placenta. Targeted enrichment analyses identified hypermethylation of genes associated with psychiatric disorders (BRINP1, PUM1), and ion homeostasis (COMMD1), among others. The ECM (extracellular matrix)-receptor interaction pathway was significantly dysregulated in the Index group compared to the Control. In addition, DNA methylation/mRNA integration analyses revealed that four genes with key roles in neurodevelopment and other important processes (EPB41L4B, BMPR2, KLHL18, and UBAP2) were dysregulated at both, DNA methylation and transcriptome levels in the Index group compared to Control.Discussion: The presented results increase our understanding of how maternal psychiatric disorders may affect the newborn through placental differential epigenome, suggesting DNA methylation status as a biomarker when aiming to design new preventive techniques and interventions.
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| 9. |
- Martinez, Cristina A., et al.
(författare)
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Expression of Stress-Mediating Genes is Increased in Term Placentas of Women with Chronic Self-Perceived Anxiety and Depression
- 2020
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Ingår i: Genes. - : MDPI. - 2073-4425. ; 11:8, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- Anxiety, chronical stress, and depression during pregnancy are considered to affect the offspring, presumably through placental dysregulation. We have studied the term placentae of pregnancies clinically monitored with the Beck's Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 classed patients into an Index group (>10,n= 23) and a Control group (<10,n= 23). Cortisol concentrations in hair (HCC) were periodically monitored throughout pregnancy and delivery. Expression differences of main glucocorticoid pathway genes, i.e., corticotropin-releasing hormone (CRH), 11 beta-hydroxysteroid dehydrogenase (HSD11B2), glucocorticoid receptor (NR3C1), as well as other key stress biomarkers (Arginine Vasopressin, AVP and O-GlcNAc transferase, OGT) were explored in medial placentae using real-time qPCR and Western blotting. Moreover, gene expression changes were considered for their association with HCC, offspring, gender, and birthweight. A significant dysregulation of gene expression for CRH, AVP, and HSD11B2 genes was seen in the Index group, compared to controls, while OGT and NR3C1 expression remained similar between groups. Placental gene expression of the stress-modulating enzyme 11 beta-hydroxysteroid dehydrogenase (HSD11B2) was related to both hair cortisol levels (Rho = 0.54;p< 0.01) and the sex of the newborn in pregnancies perceived as stressful (Index,p< 0.05). Gene expression of CRH correlated with both AVP (Rho = 0.79;p< 0.001) and HSD11B2 (Rho = 0.45;p< 0.03), and also between AVP with both HSD11B2 (Rho = 0.6;p< 0.005) and NR3C1 (Rho = 0.56;p< 0.03) in the Control group but not in the Index group; suggesting a possible loss of interaction in the mechanisms of action of these genes under stress circumstances during pregnancy.
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| 10. |
- Martinez, Cristina A., et al.
(författare)
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Prenatal stress, anxiety and depression alter transcripts, proteins and pathways associated with immune responses at the maternal-fetal interface
- 2022
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Ingår i: Biology of Reproduction. - : Oxford University Press. - 0006-3363 .- 1529-7268. ; 106:3, s. 449-462
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Tidskriftsartikel (refereegranskat)abstract
- During pregnancy, the immune system is modified to allow developmental tolerance of the semi-allogeneic fetus and placenta to term. Pregnant women suffering from stress, anxiety, and depression show dysfunctions of their immune system that may be responsible for fetal and/or newborn disorders, provided that placental gene regulation is compromised. The present study explored the effects of maternal chronic self-perceived stress, anxiety, and depression during pregnancy on the expression of immune-related genes and pathways in term placenta. Pregnancies were clinically monitored with the Beck Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 divided patients into two groups: Index group (>10, n = 11) and a Control group (<10, n = 11), whose placentae were sampled at delivery. The placental samples were subjected to RNA-Sequencing, demonstrating that stress, anxiety, and depression during pregnancy induced a major downregulation of placental transcripts related to immune processes such as T-cell regulation, interleukin and cytokine signaling, or innate immune responses. Expression differences of main immune-related genes, such as CD46, CD15, CD8 alpha & beta ILR7 alpha, and CCR4 among others, were found in the Index group (P < 0.05). Moreover, the key immune-like pathway involved in humoral and cellular immunity named "Primary immunodeficiency" was significantly downregulated in the Index group compared with Controls. Our results show that mechanisms ruling immune system functions are compromised at the maternal-fetal interface following self-perceived depressive symptoms and anxiety during pregnancy. These findings may help unveil mechanisms ruling the impact of maternal psychiatric symptoms and lead to new prevention/intervention strategies in complicated pregnancies. Summary Sentence Mechanisms ruling immune system functions are compromised at the maternal-fetal interface following self-perceived depressive symptoms and anxiety during pregnancy.
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| 11. |
- Skogsdal, Yvonne, 1964-
(författare)
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Preconception health in Sweden : The impact of lifestyle factors and the role of midwife's counselling
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Preconception health is an important topic since women and men have a possibility to change lifestyle habits preceding pregnancies, to increase the chances of a healthy pregnancy and child. The aim of this thesis was to increase knowledge about fertility and awareness of preconception health. Studies I and II were based on a randomised controlled trial among women who visited midwives for contraceptives counselling. Questionnaires were used before and after an intervention with the Reproductive Life plan (RLP), which is a discussion tool for preconception health. Study I showed that women do not always use a contraceptive that is suitable for their reproductive intentions and Study II indicated that women´s knowledge about fertility and awareness of preconception health increased with RLP-counselling (RLPC). Study II also showed that women appreciated the RLPC by the midwives.In studies III and IV, data from the Swedish Pregnancy Register were used. The main findings in Study III were that smoking, and use of snuff, in early pregnancy and risk consuming of alcohol the year preceding pregnancy were associated with spontaneous abortion (SA). Study IV showed that heavy alcohol consumption the year preceding pregnancy was associated with lower Apgar-score and might have been associated with lower birth weight. The studies contribute important new knowledge about lifestyle factors preceding pregnancy. It is important to highlight this new knowledge together with other factors about preconception health to midwives and other healthcare providers. Preconception counselling is also needed to increase women´s (and men´s) knowledge. There is still a lack of knowledge in the field, but it is a golden opportunity for midwives to start talking about reproductive health during contraception counselling.
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| 12. |
- Stålberg, Valerie, et al.
(författare)
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Study protocol for a modified antenatal care program for pregnant women with a low risk for adverse outcomes - a stepped wedge cluster non-inferiority randomized trial
- 2022
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Ingår i: BMC Pregnancy and Childbirth. - London, United Kingdom : BioMed Central. - 1471-2393 .- 1471-2393. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is crucial to provide care based on individual needs. Swedish health care is obliged to give care on equal conditions for the entire population. The person with the greatest need should be given the most care, and the health care system should strive to be cost-efficient. Medical and technical advances have been significant during the last decades and the recent Covid-19 pandemic has caused a shift in health care, from in-person visits to virtual visits. The majority of pregnant women with a low risk assessment have an uncomplicated antenatal course without adverse events. These women probably receive excessive and unnecessary antenatal care. This study will investigate if an antenatal care program for healthy pregnant women with a low risk for adverse outcomes could be safely monitored with fewer in-person visits to a midwife, and with some of them replaced by virtual visits.Methods: This is a non-inferiority trial where a stepped wedge cluster randomized controlled design will be used. Data collection includes register data and questionnaires that concern antenatal, obstetric and neonatal outcomes, patient- and caregiver-reported experiences, healthcare-economy, and implementation aspects. The modified antenatal care (MAC) study is performed in parts of the southeast of Sweden, which has approximately 8200 childbirths annually. At the start of the study, all antenatal care centers included in the study will use the same standard antenatal care (SAC) program. In the MAC program the in-person visits to a midwife will be reduced to four instead of eight, with two additional virtual meetings compared with the SAC program.Discussion: This presented study protocol is informed by research knowledge. The protocol is expected to provide a good structure for future studies on changed antenatal care programs that introduce virtual visits for healthy pregnant women with a low risk for adverse outcomes, without risking quality, safety, and increased costs.
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| 13. |
- Stålberg, Valerie, et al.
(författare)
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The risk of postpartum hemorrhage when lowering the oxytocin dose in planned cesarean section, a pilot study
- 2021
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Ingår i: Sexual & Reproductive HealthCare. - : ELSEVIER IRELAND LTD. - 1877-5756 .- 1877-5764. ; 29
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Oxytocin is the drug of choice in preventing postpartum hemorrhage (PPH). The aim was to compare the peroperative- and total blood loss within two hours and PPH after planned cesarean section (CS) when receiving 2.5 IU vs 5.0 IU of oxytocin in different risk groups for PPH. Study design: A pilot study including 927 women undergoing planned CS where women receiving 2.5 IU of oxytocin were compared to women receiving 5.0 IU of oxytocin. Main outcome measures: Data comparing peroperative blood loss, total blood loss within two hours and PPH were analyzed. Results: The women receiving 2.5 IU of oxytocin had a slightly higher peroperative blood loss, compared to the 5.0 IU group (476 ml vs 426 ml, p = 0.029). The total blood loss two hours after surgery showed no significant difference between the groups (626 ml vs 595 ml, p = 0.230). In the 2.5 IU group 13% had a blood loss > 1000 ml vs 10% in the 5 IU group (aOR 1.64, 95% CI = 1.05-2.56). When the women considered to be at high risk for postpartum hemorrhage were excluded, we found no difference in the likelihood for postpartum hemorrhage between the groups (aOR 1.13, 95% CI = 0.64-1.99). Conclusions: Women undergoing planned CS and receiving 2.5 IU of oxytocin had a slightly higher risk for postpartum hemorrhage in this study. However, a lower dose of 2.5 IU of oxytocin seems to be a safe option in planned CS for women without known risk factors for postpartum hemorrhage, but further research is needed to confirm these findings.
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| 14. |
- Wolgast, Emelie, 1982-
(författare)
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Drug use during pregnancy with focus on antidepressants
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: More than half of pregnant women use at least one prescribed medication during pregnancy, and almost all pregnant women use some kind of over-the-counter medication. Depression is one of the most common diseases in the world today, also during the peripartum period. The prevalence of pregnant women using antidepressant medication is increasing. General knowledge about the use of medication during pregnancy needs to improve. The overall aim of the studies on which this thesis is based is therefore to examine different aspects of medication use during pregnancy, with a focus on antidepressants.Material and methods: Study I was a questionnaire study where 850 pregnant women were asked about their perceptions on medication use during pregnancy. In Study II, plasma samples from 200 women were obtained at gestational weeks 10-12 and 25, and screened for drugs. The results of the analysis were compared with medication use noted in antenatal medical care records. Study III was a national register‐based cohort study including 262,329 pregnant women, and their first child born in 2012-2015. Maternal obstetric and neonatal outcomes were studied in three groups: women diagnosed with depression and who had redeemed an antidepressant before becoming pregnant and women who were diagnosed with depression and who had redeemed an antidepressant both before and during pregnancy, were compared with each other and with women who had neither been diagnosed with depression nor been prescribed antidepressants. Study IV was a pharmacokinetic study that included 81 pregnant women with ongoing antidepressant medical treatment. Antidepressant drug and metabolite concentrations were measured throughout pregnancy. Participants were genotyped for enzymes involved in antidepressant drug metabolism, i.e. CYP2D6 and CYP2C19. Results and conclusions: The majority of pregnant women in our study considered the use of medication during pregnancy as either “probably harmful” or “harmful”, and this perception was associated with non-use of medication. The women had high confidence in health care professionals when seeking advice about medication.There was a good coherence between reported drug intake in antenatal care records and presence of the drug in the pregnant women’s blood. For drugs prescribed for continuous use the coherence was 100%; thus, the reported use of medication in antenatal records is reliable. Women with major depressive disorder and antidepressant medication prior to becoming pregnant were at increased risk for adverse obstetric and neonatal outcomes compared with women without major depressive disorder. Continuation of antidepressant medication during pregnancy somewhat increased the risk of adverse obstetric and neonatal outcomes. The dose-adjusted concentrations of sertraline and citalopram and their metabolites, did not change significantly throughout pregnancy. Observed concentrations of escitalopram, mirtazapine and venlafaxine did not appear to change.
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| 15. |
- Wolgast, Emelie, et al.
(författare)
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The impact of major depressive disorder and antidepressant medication before and during pregnancy on obstetric and neonatal outcomes : A nationwide population-based study
- 2021
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier. - 0301-2115 .- 1872-7654. ; 257, s. 42-50
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the impact of major depressive disorder (MDD) and antidepressant medication before and during pregnancy on obstetric and neonatal outcomes. Study design: A national register-based cohort study of pregnant women born in Sweden, and their first child born in 2012-2015 (n = 262 329). Women diagnosed with MDD and who had redeemed an antidepressant one year before becoming pregnant ("before pregnancy") and women who were diagnosed with MDD and who had redeemed an antidepressant both before and during pregnancy ("before and during pregnancy") were compared with each other and with women who had neither been diagnosed with MDD nor been prescribed antidepressants (population controls). Results: In comparison to population controls, the "before pregnancy" and the "before and during pregnancy" groups had increased likelihoods of operative childbirth (aOR = 1.19, 95 % CI 1.12-1.27, aOR = 1.38, 95 % CI 1.28-1.48 respectively), and with an increased likelihood for the child being admitted to a neonatal intensive care unit (NICU) (aOR = 1.51, 95 % CI 1.17-1.95, aOR = 1.55, 95 % CI 1.14-2.11). Children born to mothers in the "before and during pregnancy" group had an increased likelihood of preterm birth (aOR = 1.72, 95 % CI 1.52-1.95,), while children to mothers in the "before pregnancy" group had an increased likelihood of low birthweight (aOR = 1.15, 95 % CI 1.00-1.33) compared to population controls. Women in the "before and during pregnancy" group had an increased likelihood for hyperemesis during pregnancy (aOR =1.93, 95 % CI = 1.60-2.32), having an operative childbirth (aOR =1.17, 95 % CI = 1.06-1.29) or a preterm birth (aOR = 1.53, 95 % CI = 1.28-1.81) compared to the "before pregnancy" group. Conclusions: Women with MDD and antidepressant medication prior to becoming pregnant are at increased risk for adverse obstetric and neonatal outcomes compared to women without an MDD. Continuation of antidepressant medication during pregnancy somewhat increased the risk for adverse obstetric and neonatal outcomes. (C) 2020 Published by Elsevier B.V.
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