| 1. |
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| 2. |
- Finnström, Orvar, et al.
(författare)
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Maternal and child outcome after in-vitro fertilization-a review of 25 years population based data from Sweden.
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:5, s. 494-500
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To summarize data on deliveries after IVF performed in Sweden up to 2006. Design. Cohort study of women and children, conceived after IVF with comparisons of deliveries after IVF before and after April 1, 2001. Setting. Study based on Swedish health registers. Population. Births registered in the Swedish Medical Birth Register with information on IVF from all IVF clinics in Sweden. Methods. Results from the second study period are summarized and outcomes between the two periods are compared. Long term follow-up is based on data from both periods. Main outcome measures. Maternal and perinatal outcomes, long term sequels. Results. Some maternal pregnancy complications decreased in rate, notably preeclampsia and PROM. The rate of multiple births and preterm births decreased dramatically with a better neonatal outcome, including neonatal mortality. No difference in outcome existed between IVF and ICSI or between the use of fresh and cryopreserved embryos, but children born after blastocyst transfer had a slightly higher risk for preterm birth and congenital malformations than children born after cleavage stage transfer. An increased risk for cerebral palsy, possibly for attention deficit and hyperactivity disorder, for impaired visual acuity, and for childhood cancer was noted but these outcomes were rare also after IVF. An increased risk for asthma was demonstrated. No effect on maternal cancer risk was seen. Conclusions. A marked decrease in multiple births was the main reason for better pregnancy and neonatal outcome and may also have a beneficial effect on long-term results, notably cerebral palsy.
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| 3. |
- Hagman, Anna, et al.
(författare)
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Obstetric and neonatal outcome after oocyte donation in 106 women with Turner syndrome: a Nordic cohort study.
- 2013
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 28:6, s. 1598-609
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Tidskriftsartikel (refereegranskat)abstract
- What are the obstetric and neonatal outcomes of deliveries after oocyte donation (OD) in women with Turner syndrome (TS)? SUMMARY ANSWER: Pregnancies among women with TS carry a substantial risk, particularly for hypertensive disorders. Potentially life-threatening complications occurred in 3.3% of pregnancies. The neonatal outcomes were generally reassuring, with similar rates of preterm birth and low birthweight (LBW) as after conventional IVF and better than previously reported in deliveries after OD in women with TS. WHAT IS KNOWN ALREADY: OD pregnancies in women with TS are known to be high-risk pregnancies. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study included 106 women with TS who delivered after OD (n = 122 deliveries, n = 131 newborns) in three Nordic countries (Finland, Denmark, Sweden) between 1992 and 2011. PARTICIPANTS, SETTING AND METHODS: Women with TS who delivered after OD in three Nordic countries were identified (n = 110). Four women declined to participate or were lost to follow-up, thus 106 women were included in the study. The medical data from fertility clinics, antenatal clinics and the hospitals where the women had been treated and/or delivered were scrutinized. MAIN RESULTS AND THE ROLE OF CHANCE: In this cohort, the karyotype was 45,X in 44% of the women with TS. Ten women (9.4%) had a known cardiac defect before pregnancy. Single embryo transfer was performed in 70.3% of the cases and the multiple birth rate was 7.4%. In total, 35.0% of the pregnancies were associated with a hypertensive disorder including pre-eclampsia in 20.5%. Potentially life-threatening complications occurred in four pregnancies (3.3%), including one woman with aortic dissection, one with mild regurgitation of the tricuspid and mitral valve, one with a mechanical heart valve who developed HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and one who underwent a post-partum hysterectomy due to severe haemorrhaging. Neonatal outcomes were reassuring, with a preterm birth rate of 8.0% and LBW rate of 8.8% in singletons. Major birth defects were found in 3.8% of the children. The perinatal mortality was 2.3% (3/131), including a set of extremely preterm twins. LIMITATIONS, REASONS FOR CAUTION: Although this study was performed over a period of almost 20 years in three different countries, with a low drop-out rate and little missing data, much larger series are needed to assess rare events. This study also lacks an appropriate control group. WIDER IMPLICATIONS OF THE FINDINGS: This study suggests that cardiovascular evaluation before and during pregnancy may contribute to favourable obstetric outcomes in many cases. Maternal outcomes were in agreement with the literature while neonatal outcomes were generally better than previously reported. The outcomes were consistent across the three countries, supporting generalizability to similar populations. STUDY FUNDING/COMPETING INTEREST(S): No conflict of interest was reported. The study was supported by grants from the Gothenburg Medical Society, the Medical Care Executive Board of the Region Västra Götaland, grants from the ALF agreement at the Sahlgrenska University Hospital, the Hjalmar Svensson foundation, NFOG Nordic Fund, the Finnish Society of Paediatric and Adolescent Gynecology and Liv och hälsa Foundation in Finland. The Nordic Expert group's research work was unconditionally supported by MSD Finland, Norway and Denmark.
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| 4. |
- Henningsen, Anna-Karina A, et al.
(författare)
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Infant and maternal health monitoring using a combined Nordic database on ART and safety.
- 2011
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:7, s. 683-691
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate infant and maternal health after assisted reproductive technology (ART), using data on over 90 000 ART children and their mothers in Denmark, Finland, Norway and Sweden. Data have been combined and will be compared with a control group of spontaneously conceived children and their mothers. The overall aim of this project is to evaluate the safety of ART. The size of the cohort should enable estimation of the prevalence of rare conditions such as birth defects, cancers, neurological impairments and imprinting diseases in the ART population compared to control children. Outcome data on the mothers of ART children can be used to study risks during pregnancy and obstetric complications after ART. Methods. A personal identification number given to all Nordic residents allows cross-linkage of the national health registers and enables long-term follow-up of ART children. The medical birth registers in the Nordic countries make it possible to cross-link data from mother and child. When a child is identified as conceived by ART, we can obtain a list of all International Classification of Diseases (ICD) codes ever registered on that specific child. Conclusion. Combining the Nordic ART and health registers is a complicated but feasible task. The main strengths of this ongoing study are the size of the cohort of ART children and their mothers and the possibility to follow the children through the health registers. The limitations are related to the national differences in reporting and recording of data together with the heterogeneity of data.
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| 5. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilization in Sweden : Maternal characteristics
- 2005
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 84:12, s. 1185-1191
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Tidskriftsartikel (refereegranskat)abstract
- Background. Deliveries among women who had an in vitro fertilization (IVF) are characterized by increased risks for both the mother and the infant/child. Part of these effects may be due to maternal characteristics. Methods. Using reports from all clinics performing IVF in Sweden, 12 186 women who gave birth after such procedures were identified (13 261 deliveries, 16 280 infants born). Various social and medical characteristics of the women were studied and compared with all women giving birth. Information was retrieved by interviews in early pregnancy or by linkage with various registers. Results. Women who had IVF were older than other women who gave birth and were older after standard IVF than after intracytoplasmatic sperm injection (ICSI). They were more often of first parity and smoked less than other delivered women. There were more women with high body mass index: they worked outside home less often and were more often of Swedish nationality. Women who had standard IVF had more previous miscarriages than expected, but this was not true for women who had ICSI. Their pattern of drug usage differed from that of other women who had given birth. Conclusions. Women who underwent IVF and gave birth showed marked deviations from other women who gave birth. Some of these characteristics may help to explain the increased risks associated with these procedures. Women who had ICSI were less deviating than women who had standard IVF. © Acta Obstet Gynecol Scand 2005.
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| 6. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilization (IVF) in Sweden : Risk for congenital malformations after different IVF methods
- 2005
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Ingår i: Birth defects research. Clinical and molecular teratology. - : Wiley. - 1542-0752 .- 1542-0760. ; 73:3, s. 162-169
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The possible excess of congenital malformations in infants born after in vitro fertilization (IVF) has been much discussed in the literature, with controversial conclusions. This population based study is aimed at analyzing the presence of congenital malformations in a large group of infants born after IVF and to compare malformation risk both with that of all infants born and according to IVF method used. METHODS: Infants born after IVF during the period 1982-2001 were ascertained from all IVF clinics in Sweden. The presence of congenital malformations was identified from three national health registers: the Swedish Medical Birth Register, the Swedish Registry of Congenital Malformations, and the Swedish Hospital Discharge Register. The IVF children were compared with all children born in Sweden during the same period and recorded in the Swedish Medical Birth Register. RESULTS: Among 16,280 IVF children (30% conceived after intracytoplasmatic sperm injection [ICSI]) a 42% excess of any congenital malformation was found, explainable by parental characteristics and in some cases by the high rate of multiple births. Among these children, 8% had a congenital malformation, and 15% had a relatively severe condition. For neural tube defects, choanal atresia, and alimentary tract atresia, an additional risk increase was seen. There was no difference in malformation rate according to IVF method except for an excess of hypospadias after ICSI. CONCLUSIONS: An increased risk for congenital malformations occurs after IVF, similar for the different IVF techniques used, and mainly a consequence of parental characteristics. A few specific conditions show an extra increase in risk. © 2005 Wiley-Liss, Inc.
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| 7. |
- Källén, Bengt, et al.
(författare)
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Is there an increased risk for drug treated attention deficit/hyperactivity disorder in children born after in vitro fertilization?
- 2011
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Ingår i: EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY. - : Elsevier Science B.V., Amsterdam. - 1090-3798. ; 15:3, s. 247-253
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is mounting evidence that children born after in vitro fertilization (IVF) run an increased risk of neurological complications and notably cerebral palsy. Whether developmental disturbances occur more often than expected is debated. Aim: To investigate the risk for ADHD in children conceived after IVF. Methods: Children conceived after IVF and born between 1982 and 2005 were identified from all IVF clinics in Sweden. Children who developed attention deficit/hyperactivity disorder (ADHD) were identified with the use of a register over all prescribed drugs in Sweden, using prescriptions for methylphenidate or atomixetine as indicators of ADHD. Maternal and neonatal characteristics were obtained by linkage with the Medical Birth Register and relevant confounders were adjusted for using Mantel-Haenszel procedures. We studied 28158 children born after IVF and compared them with 2417886 children in the population. Results: After adjustment for year of birth, maternal age, parity, smoking, BMI, and maternal education and after exclusion of women who did not cohabit, a weak but statistically significant association was found with an odds ratio = 1.18, 95% confidence interval 1.03-1.36. The effect was stronger in girls (OR = 1.40) than boys (OR = 1.11) but this difference could be random. After adjustment for length of involuntary childlessness, the OR decreased slightly and lost statistical significance. Conclusions: The study suggests a weak association between IVF and drug treated ADHD.
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| 8. |
- Lindström, Meta, 1941-
(författare)
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Gynekologer och barnmorskor inom svensk abortvård : åsikter, erfarenheter och upplevelser
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To investigate gynecologists’ and midwives’ views and experiences regarding work in abortion care in Sweden. Methods: Questionnaire to gynecologists (n=269) and midwives (n=258 comprising 48 questions, response 85%. The quantitative studies (articles I-III) were supplemented by a qualitative study (article IV), consisting of focus-group interviews with gynecologists and midwives/nurses. Results: From the questionnaire studies it was apparent that all the gynecologists had worked in abortion care, whilst not all midwives had done so. The male gynecologists were older than both their female colleagues and the midwives; they had most years of experience but were now working least with abortion patients. Both groups considered it absolutely right, that Sweden have legal abortion and that the law was being followed. Most thought that women should be allowed to have an abortion even after they had felt fetal movements. The midwives were generally somewhat more restrictive than the gynecologists. Half of all thought that the work with abortion patients brought something positive with it. Those having worked longest and most extensively, especially during the previous year were most liberal. Both groups felt that there was a difference between working with surgical and late abortions compared with medical abortions. One in four had had misgivings when involved in surgical and medical abortions, and one in two with abortions after the 18th week. All were positive about the transition to medical abortions, and roughly two thirds of the midwives thought that the primary care sector should be able to take care of these, whereas less than half of the gynecologists thought this. The majority considered it important to receive further and continuing professional development and ongoing guidance. From the focus-group interviews it was clear that the experiences of the gynecologists were largely connected with the technical development of abortion methods and those of the midwives/nurses with improved pain relief. The work was sometimes described in paradoxical terms and was occasionally experienced as frustrating, especially in connection with repeat abortions. Neither of the two groups, however, had had any doubts about participating in abortion. The gynecologists described how women now expected to get an abortion, whereas previously they had asked for one. The midwife/nurse group maintained that the meetings with the women had become considerably more frequent. The interaction between the two professional groups was marked by great trust in each other’s professional competence. Conclusions: Gynecologists and midwives working in abortion care support Swedish abortion legislation and have no doubts about participating in abortions, despite the fact that they have frequently experienced complex and difficult work situations. The character of the work is experienced as contradictory and frustrating, but also as challenging and rewarding. The awareness that the two professional groups have of the importance of continuing professional development and ongoing guidance should be acted on. Furthermore, their collective views and experiences should be made use of, so that abortion care can be developed, not only in order to promote women’s health, but also to improve the work environment for the abortion staff.
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| 9. |
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| 10. |
- Nygren, Karl-Gösta, et al.
(författare)
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The Nordic Fertility Society
- 2005
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Ingår i: Acta Obstet Gynecol Scand. ; 84:5
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Tidskriftsartikel (refereegranskat)
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