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- Viirman, Frida
(författare)
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Mother, how are you? : Studies on self-rated health and childbirth experience
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pregnancy and childbirth are characterised by emotional and physical changes, which can affect the mother’s mental health postpartum, as well as the infant. One step towards alleviating adverse consequences is to measure health status and childbirth experience. The aim of this thesis was to investigate women’s subjective health prior to pregnancy in relation to infant birth outcomes and childbirth experience, and to explore childbirth experience and its measurement from different perspectives.The thesis consists of four papers, of which the first two were based on data from the Swedish Pregnancy Register 2013-2018. In Paper I, self-rated health (SRH) prior to pregnancy was explored in relation to adverse birth outcomes, while Paper II investigated risk factors for negative childbirth experience. In Paper III, 112 written descriptions of negative childbirth experience were qualitatively explored in relation to events during labour and birth. In Paper IV, a single-item question about overall childbirth experience was compared to the validated four-dimensional Childbirth Experience Questionnaire 2, completed by 2,953 women.Overall, the prevalence of poor SRH prior to pregnancy was 9.9%. Among primiparas, 8.5% reported poor SRH, and 8.4% negative childbirth experience. Poor SRH was independently associated with small for gestational age, preterm birth, and negative childbirth experience. It was also associated with stillbirth, but not after adjustment for other risk factors. The main contributing factors to negative childbirth experience were related to labour and birth, with operative birth modes being the most prominent. Poor SRH was the only pre-gestational factor independently associated with negative childbirth experience. Only small differences between type of negative childbirth experience, in terms of qualitative sub-themes, were found between birth modes and complications during labour. Fear-based emotions was the most common sub-theme. The single-item measurement of overall childbirth experience mainly captured experiences of perceived safety, to a lesser extent own capacity and participation, but not experiences related to professional support.In conclusion, findings show the potential of using SRH assessments clinically to identify women in need of more extensive attention during pregnancy and childbirth. This thesis provides further proof of negative childbirth experience being multidimensional and subjective, and dominated by fear. When using single-item ratings of childbirth experience clinically, one must be aware that experiences of support are not well represented.
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| 2. |
- Kupka, Ellen, et al.
(författare)
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Low-dose aspirin use in pregnancy and the risk of preterm birth: a Swedish register-based cohort study.
- 2023
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Ingår i: American journal of obstetrics and gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 228:3
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Tidskriftsartikel (refereegranskat)abstract
- Preterm birth is the leading cause of neonatal mortality and morbidity. Women who have had a previous preterm birth are at increased risk for preterm birth in their subsequent pregnancies. Low-dose aspirin use reduces the risk for preterm birth among women at risk of developing preeclampsia, however, it is unclear whether low-dose aspirin may reduce the risk of recurrent preterm birth.This study aimed to investigate the association between low-dose aspirin use and preterm birth among women with a previous preterm birth.We conducted a Swedish register-based cohort study and included women who had a first and second pregnancy between 2006 and 2019, with the first pregnancy ending in preterm birth (medically indicated or with spontaneous onset <37 weeks of gestation). The association between low-dose aspirin use and preterm birth in the second pregnancy was estimated via logistic regression via standardization and expressed as marginal relative risks with the 95% confidence interval.Among the study cohort (N=22,127), 3057 women (14%) were prescribed low-dose aspirin during their second pregnancy and 3703 women (17%) gave birth prematurely. Low-dose aspirin use was associated with a reduced risk for preterm birth, (marginal relative risk, 0.87; 95% confidence interval, 0.77-0.99). There were no statistically significant associations between low-dose aspirin use and an altered risk for moderate preterm birth, defined as birth between 32 and 36 weeks' gestation (marginal relative risk, 0.90; 95% confidence interval, 0.78-1.03), or very preterm birth, defined as birth <32 weeks' gestation (marginal relative risk, 0.75; 95% confidence interval, 0.54-1.04). Regarding the onset of preterm birth, low-dose aspirin use was associated with a reduced risk for spontaneous preterm birth (marginal relative risk, 0.70; 95% confidence interval, 0.57-0.86) but no reduction in the risk for medically indicated preterm birth (marginal relative risk, 1.09; 95% confidence interval, 0.91-1.30) was observed.Among women with a previous preterm birth, low-dose aspirin use was associated with a reduced risk for preterm birth. When investigating preterm birth by onset in the second pregnancy, low-dose aspirin use was associated with a reduced risk for spontaneous preterm birth. Our results suggest that low-dose aspirin may be an effective prophylaxis for recurrent preterm birth.
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| 3. |
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| 4. |
- Sturm, Amanda, et al.
(författare)
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Lungemboli under graviditet – en jämförelse av rutiner i två regioner : Kan val av röntgenmetod förklara den stora skillnaden i incidens mellan Region Dalarna och Region Värmland?
- 2023
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- Pulmonary embolism during pregnancy is a potentially life-threatening condition and the second leading cause of maternal mortality in Sweden. Diagnosis during pregnancy is challenging, and radiologic diagnostic modality is important. The incidence of pulmonary embolism among pregnant women in the Swedish region of Dalarna was 47.8/100 000 women aged 15-49 years in 2016, compared with 5.4/100 000 women in the region of Värmland, which is a region comparable in size and population. This study aimed to investigate differences in clinical practice and choice of imaging modality among pregnant women with suspected pulmonary embolism in the two regions during 2013-2017. There was no difference in background maternal characteristics, but the primary modality of diagnostic imaging was lung scintigraphy in Dalarna (79 percent), whereas computed tomography pulmonary angiography was performed in 75 percent of the cases in Värmland (P < 0.01). There were more women with a confirmed diagnosis of pulmonary embolism after diagnostic imaging in Dalarna (25 percent, n = 65) compared to Värmland (5 percent, n = 8) (P < 0,.01). Pulmonary embolism was diagnosed in more than one quarter of women investigated with scintigraphy, compared to 6 percent when computed tomography was performed.
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| 5. |
- Törn, Anna E., et al.
(författare)
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Outcomes in children after mild neonatal hypoxic ischaemic encephalopathy : A population‐based cohort study
- 2023
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate whether mild neonatal hypoxic ischaemic encephalopathy (HIE) in term born infants is associated with cerebral palsy, epilepsy, mental retardation and death up to 6 years of age.DesignPopulation-based cohort study.SettingSweden, 2009–2015.PopulationLive term born infants without congenital malformations or chromosomal abnormalities (n = 505 075).MethodsBirth and health data were retrieved from Swedish national health and quality registers. Mild HIE was identified by diagnosis in either the Swedish Medical Birth Register or the Swedish Neonatal Quality Register. Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).Main outcome measuresA composite of the outcomes cerebral palsy, epilepsy, mental retardation and death up to 6 years of age.ResultsMedian follow-up time was 3.3 years after birth. Of 414 infants diagnosed with mild HIE, 17 were classified according to the composite outcome and incidence rates were 12.6 and 2.9 per 1000 child-years in infants with and without HIE respectively. Infants with mild HIE was four times as likely to be diagnosed with the composite outcome (HR 4.42, 95% CI 2.75–7.12) compared with infants without HIE. When analysed separately, associations were found with cerebral palsy (HR 21.50, 95% CI 9.59–48.19) and death (HR 19.10, 95% CI 7.90–46.21). HRs remained essentially unchanged after adjustment for covariates.ConclusionsMild neonatal HIE was associated with neurological morbidity and mortality in childhood. Challenges include identifying infants who may develop morbidity and how to prevent adverse outcomes.
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| 6. |
- Viirman, Frida, et al.
(författare)
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Negative childbirth experience in relation to mode of birth and events during labour: a mixed method study
- 2023
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier. - 0301-2115 .- 1872-7654. ; 282, s. 146-154
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore descriptions of negative childbirth experience in relation to mode of birth and events during labour.Design: A descriptive study using a convergent mixed methods design. Written responses to open-ended online questions regarding negative childbirth experience were explored using qualitative content analysis. Generated sub-themes were quantified, and stratified on mode of birth and events during labour.Participants and setting: 112 women with low ratings of overall childbirth experience, participating in a randomised controlled trial evaluating internet-based cognitive behavioural therapy in Sweden. Qualitative data were collected before randomisation, three months postpartum.Results: Four sub-themes emerged from the qualitative analysis: Experiencing fear-based emotions, Experiencing physical distress, Being affected by caregivers’ and partner’s behaviour and Being affected by bad facilities and poor organisation. Only small differences were found when stratifying sub-themes on mode of birth and events during labour. Regardless of mode of birth and events during labour, the childbirth experience was dominated by fear-based emotions.Key conclusions and implications for practice: Mixed-methods analyses demonstrate the challenges in understanding negative childbirth experience in relation to mode of birth and specific events during labour, with results clearly showing the multifaceted nature of this concept. The central role of fear in relation to negative childbirth experience should be considered when designing support during and after labour, to prevent adverse effects of the childbirth experience.
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| 7. |
- Viirman, Frida, et al.
(författare)
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Overall childbirth experience : what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central (BMC). - 1471-2393 .- 1471-2393. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: In clinical settings and research studies, childbirth experience is often measured by the use of a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure.Methods: Ratings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach’s alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1–4), mixed (NRS ratings 5–6) or positive (NRS ratings 7–10). A multiple linear regression analysis, presented as beta coefficients (B) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience.Results: The prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach’s alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety (B = 1.60, CI 1.48–1.73), followed by own capacity (B = 0.65, CI 0.53–0.77) and participation (B = 0.43, CI 0.29–0.56).Conclusions: In conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation, but appears not to reflect professional support. CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.
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