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Rönnberg, A., Hanson, U., Östlund, I. & Nilsson, K. (2016). Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 95(9), 999-1007
Öppna denna publikation i ny flik eller fönster >>Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial
2016 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, nr 9, s. 999-1007Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate if an antenatal intervention, compared to standard care, could reduce postpartum weight retention (PPWR).

Material and methods: Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared to a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until one year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated.

Results: Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at one year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks (1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p=0.016). At one year postpartum, mean retention was still 0.7 kg lower in the intervention group (0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)), the difference was not statistically significant (p=0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI; 1.08-5.52, p=0.029).

Conclusions: A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at one year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2016
Nyckelord
Prenatal care, obesity, women´s health issues, pregnancy
Nationell ämneskategori
Reproduktionsmedicin och gynekologi Näringslära
Identifikatorer
urn:nbn:se:oru:diva-49940 (URN)10.1111/aogs.12910 (DOI)000386782100007 ()27100375 (PubMedID)2-s2.0-84982221108 (Scopus ID)
Anmärkning

Funding Agency:

Research Committee at Orebro County Council

Tillgänglig från: 2016-04-26 Skapad: 2016-04-26 Senast uppdaterad: 2018-07-10Bibliografiskt granskad
Rönnberg, A., Östlund, I., Fadl, H., Gottvall, T. & Nilsson, K. (2015). Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial. British Journal of Obstetrics and Gynecology, 122(4), 537-544
Öppna denna publikation i ny flik eller fönster >>Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial
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2015 (Engelska)Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, nr 4, s. 537-544Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To evaluate if a feasible, low-cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine (IOM) recommendations on gestational weight gain (GWG) compared with standard maternity care.

Design: A randomised controlled interventional design.

Setting: Antenatal clinics (n=14) in orebro county, Sweden, participated.

Population: Healthy women with a body mass index (BMI) 19kg/m(2), age 18years and adequate knowledge of Swedish language who signed in for maternity care at 16weeks of gestation.

Methods: Standard care was compared with a composite intervention consisting of education on recommended GWG according to IOM, application of personalised weight graph, formalised prescription of exercise and regular monitoring of GWG at every antenatal visit.

Outcome: The proportion of women gaining weight above IOM guidelines (1990) and mean GWG (kg) was compared between groups.

Results: In all, 445 women were randomised and 374 women remained for analysis after delivery. A majority of the women analysed were normal weight (72%). The intervention reduced the proportion of women who exceeded the IOM guidelines (41.1% versus 50.0%). The reduction was, however, not statistically significant (P=0.086). Mean GWG was significantly lower among women receiving the intervention, 14.2kg (SD 4.4) versus 15.3kg (SD 5.4) in the standard care group (P=0.029).

Conclusions: The low-cost intervention programme tested did significantly reduce the mean GWG but the proportion of women who exceeded the IOM recommendations for GWG was not significantly lower. ClinicalTrials.gov Id NCT00451425

Nyckelord
Gestational weight gain, maternal health, pregnancy, prevention of obesity
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:oru:diva-44110 (URN)10.1111/1471-0528.13131 (DOI)000350139300022 ()25367823 (PubMedID)2-s2.0-84923328050 (Scopus ID)
Anmärkning

Funding Agency:

Research Committee at Orebro County Council

Tillgänglig från: 2015-04-08 Skapad: 2015-04-08 Senast uppdaterad: 2018-06-27Bibliografiskt granskad
Allbrand, M., Björkqvist, M., Nilsson, K., Östlund, I. & Åman, J. (2015). Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women. Journal of Perinatal Medicine, 43(2), 159-164
Öppna denna publikation i ny flik eller fönster >>Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women
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2015 (Engelska)Ingår i: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, nr 2, s. 159-164Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To survey the placental gene expression of inflammatory markers and growth factors in non-smoking obese women with an uncomplicated pregnancy without associated morbidity and delivery at term compared with normal weight women.

Methods: Placental tissue samples from 32 obese women (body mass index, BMI >= 35.0 kg/m(2)) were compared with samples from 94 normal weight women (BMI 18.5-25.0 kg/m(2)) matched for age (+/- 1 year), gestational age (+/- 3 days), parity and mode of delivery. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to analyse toll receptor-2 and -4, interleukin-6 and -8, tumour necrosis factor-alpha, leptin, adiponectin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor.

Results: There was no significant difference in gene expression in placental tissue samples from obese and normal weight women.

Conclusion: We found no difference in the occurrence of inflammatory marker and growth factor mRNA levels in placental tissue samples from a large group of obese women without associated morbidity and with healthy infants compared to a closely matched control group of healthy normal weight women. Compared with the previous studies, this anomalous finding may be explained by the absence of associated morbidity in the obese women in our study.

Ort, förlag, år, upplaga, sidor
Walter de Gruyter, 2015
Nyckelord
Obesity, pregnancy
Nationell ämneskategori
Reproduktionsmedicin och gynekologi Pediatrik
Forskningsämne
Obstetrik och gynekologi; Pediatrik
Identifikatorer
urn:nbn:se:oru:diva-44240 (URN)10.1515/jpm-2013-0343 (DOI)000350338000005 ()25014513 (PubMedID)
Anmärkning

Funding Agency:

Foundation for Medical Research, Orebro University Hospital

Tillgänglig från: 2015-04-14 Skapad: 2015-04-14 Senast uppdaterad: 2018-06-29Bibliografiskt granskad
Fadl, H. E., Gärdefors, S., Hjertberg, R., Nord, E., Persson, B., Schwarcz, E., . . . Hanson, U. S. B. (2015). Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes. Acta Obstetricia et Gynecologica Scandinavica, 94(11), 1181-1187
Öppna denna publikation i ny flik eller fönster >>Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes
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2015 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 11, s. 1181-1187Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: A randomized multicenter study was conducted in the Stockholm-orebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia.

Material and methods: Pregnant women with hyperglycemia defined as fasting capillary plasma glucose <7.0 mmol/L and a two-hour plasma glucose value 10.0 and <12.2 mmol/L following a 75-g oral glucose tolerance test (OGTT) diagnosed before 34 weeks of gestation were randomized to treatment (n=33) or controls (n=36). Women assigned to the control group were blinded for the OGTT results and received routine care. The therapeutic goal was fasting plasma glucose 4-5 mmol/L, and <6.5 mmol/L after a meal. Primary outcomes were size at birth and number of large-for-gestational age (>90th percentile) neonates. Secondary outcomes were pregnancy complications, neonatal morbidity and glycemic control.

Results: The planned number of participating women was not reached. There was a significantly reduced rate of large-for-gestational age neonates, 21 vs. 47%, P<0.05. Group differences in pregnancy complications and neonatal morbidity were not detected because of limited statistical power. In total, 66.7% of the women in the intervention group received insulin. Of all measured plasma glucose values, 64.1% were in the target range, 7.2% in the hypoglycemic range and 28.7% above target values. There were no cases of severe hypoglycemia.

Conclusions: Aiming for normalized glycemia in a pregnancy complicated by severe hyperglycemia reduces fetal growth but is associated with an increased rate of mild hypoglycemia.

Ort, förlag, år, upplaga, sidor
Wiley-Blackwell, 2015
Nyckelord
Pregnancy, gestational diabetes mellitus, hyperglycemia, treatment, birthweight, compliance, large-for-gestational age
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:oru:diva-46438 (URN)10.1111/aogs.12717 (DOI)000362844400006 ()26222270 (PubMedID)2-s2.0-84943587292 (Scopus ID)
Forskningsfinansiär
Diabetesförbundet
Anmärkning

Funding Agencies:

Uppsala-Örebro Regional Research Council

Praktikertjänst AB, Stockholm, Sweden

Tillgänglig från: 2015-11-10 Skapad: 2015-11-10 Senast uppdaterad: 2018-04-16Bibliografiskt granskad
Austeng, D., Blennow, M., Ewald, U., Fellman, V., Fritz, T., Hellstrom-Westas, L., . . . Westgren, M. (2010). Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatrica, 99(7), 978-992
Öppna denna publikation i ny flik eller fönster >>Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)
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2010 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, nr 7, s. 978-992Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.

Nyckelord
Bronchopulmonary dysplasia, Intraventricular haemorrhage, Necrotizing enterocolitis, Patent ductus arteriosus, Retinopathy of prematurity
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicin
Identifikatorer
urn:nbn:se:oru:diva-28390 (URN)10.1111/j.1651-2227.2010.01846.x (DOI)000278294800008 ()
Tillgänglig från: 2013-03-26 Skapad: 2013-03-14 Senast uppdaterad: 2018-09-12Bibliografiskt granskad
Blennow, M., Ewald, U., Fritz, T., Holmgren, P. Å., Jeppsson, A., Lindberg, E., . . . Stromberg, B. (2009). One-year survival of extremely preterm infants after active perinatal care in sweden. Journal of the American Medical Association (JAMA), 301(21), 2225-2233
Öppna denna publikation i ny flik eller fönster >>One-year survival of extremely preterm infants after active perinatal care in sweden
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2009 (Engelska)Ingår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 301, nr 21, s. 2225-2233Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Context Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling. Objective To determine the 1-year survival in all infants born before 27 gestational weeks in Sweden during 2004-2007. Design, Setting, and Patients Population-based prospective observational study of extremely preterm infants (707 live-born and 304 stillbirths) born to 887 mothers in 904 deliveries (102 multiple births) in all obstetric and neonatal units in Sweden from April 1, 2004, to March 31, 2007. Main Outcome Measures Infant survival to 365 days and survival without major neonatal morbidity (intraventricular hemorrhage grade > 2, retinopathy of prematurity stage > 2, periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia). Associations between perinatal interventions and survival. Results The incidence of extreme prematurity was 3.3 per 1000 infants. Overall perinatal mortality was 45% (from 93% at 22 weeks to 24% at 26 weeks), with 30% stillbirths, including 6.5% intrapartum deaths. Of live-born infants, 91% were admitted to neonatal intensive care and 70% survived to 1 year of age (95% confidence interval [CI], 67%-73%). The Kaplan-Meier survival estimates for 22, 23, 24, 25, and 26 weeks were 9.8% (95% CI, 4%-23%), 53% ( 95% CI, 44%-63%), 67% (95% CI, 59%-75%), 82% (95% CI, 76%-87%), and 85% ( 95% CI, 81%-90%), respectively. Lower risk of infant death was associated with tocolytic treatment (adjusted for gestational age odds ratio [ OR], 0.43; 95% CI, 0.36-0.52), antenatal corticosteroids (OR, 0.44; 95% CI, 0.24-0.81), surfactant treatment within 2 hours after birth ( OR, 0.47; 95% CI, 0.32-0.71), and birth at a level III hospital (OR, 0.49; 95% CI, 0.32-0.75). Among 1-year survivors, 45% had no major neonatal morbidity. Conclusion During 2004 to 2007, 1-year survival of infants born alive at 22 to 26 weeks of gestation in Sweden was 70% and ranged from 9.8% at 22 weeks to 85% at 26 weeks. JAMA. 2009;301(21):2225-2233 www.jama.com

Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Medicin
Identifikatorer
urn:nbn:se:oru:diva-28114 (URN)000266554100020 ()
Tillgänglig från: 2013-08-08 Skapad: 2013-03-14 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
Jonsson, M., Nordén-Lindeberg, S., Östlund, I. & Hanson, U. (2008). Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor. Acta Obstetricia et Gynecologica Scandinavica, 87(7), 745-750
Öppna denna publikation i ny flik eller fönster >>Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor
2008 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, nr 7, s. 745-750Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective. Evaluate obstetric characteristics during the last two hours of labor in neonates born with acidemia. Design. Case-control study. Setting. Delivery units at two university hospitals in Sweden. Study population. Out of 28,486 deliveries during 1994-2004, 305 neonates had an umbilical artery pH value <7.05 at birth. Methods. Cases: neonates with an umbilical artery pH < 7.05. Controls were neonates with pH ≥ 7.05 and an Apgar score ≥7 at 5 minutes. Obstetric characteristics, cardiotocographic patterns and oxytocin treatment during the last two hours of labor were recorded. Results. In the univariate analysis, ≥6 contractions/10 minutes (odds ratio (OR) 4.94, 95% confidence interval (CI) 3.25-7.49), oxytocin use (OR 2.20, 95% CI 1.66-2.92), bearing down ≥45 minutes (OR 1.77, 95% CI 1.31-2.38) and occipito-posterior position (OR 2.18, 95% CI 1.19-3.98) were associated with acidemia at birth. In the multivariate analysis, only ≥6 contractions/10 minutes (OR 5.36, 95% CI 3.32-8.65) and oxytocin use (OR 1.89, 95% CI 1.21-2.97) were associated with acidemia at birth. Among cases with ≥6 contractions/10 minutes, 75% had been treated with oxytocin. Pathological cardiotocographic patterns occurred in 68.8% of cases and in 26.1% of controls (p<0.001). Conclusion. A hyperactive uterine contraction pattern and oxytocin use are the most important risk factors for acidemia at birth. The increased uterine activity was related to overstimulation in the majority of cases. The duration of bearing down is less important when uterine contraction frequency has been considered.

Ort, förlag, år, upplaga, sidor
Informa Healthcare, 2008
Nyckelord
Acidosis/*etiology, Adult, Cardiotocography, Case-Control Studies, Female, Humans, Hydrogen-Ion Concentration, Labor Stage; Second, Multivariate Analysis, Oxytocics/administration & dosage/*adverse effects, Oxytocin/administration & dosage/*adverse effects, Pregnancy, Risk Factors, Umbilical Arteries/chemistry, Umbilical Cord, Uterine Contraction
Nationell ämneskategori
Medicin och hälsovetenskap Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:oru:diva-3403 (URN)10.1080/00016340802220352 (DOI)18607817 (PubMedID)
Tillgänglig från: 2008-12-04 Skapad: 2008-12-04 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
Åman, J. & Östlund, I. (2008). Preventivmedelsrådgivning (2ed.). In: Sture Sjöblad (Ed.), Barn- och ungdomsdiabetes: (pp. 195-197). Lund: Studentlitteratur
Öppna denna publikation i ny flik eller fönster >>Preventivmedelsrådgivning
2008 (Svenska)Ingår i: Barn- och ungdomsdiabetes / [ed] Sture Sjöblad, Lund: Studentlitteratur , 2008, 2, s. 195-197Kapitel i bok, del av antologi (Övrigt vetenskapligt)
Ort, förlag, år, upplaga, sidor
Lund: Studentlitteratur, 2008 Upplaga: 2
Nationell ämneskategori
Reproduktionsmedicin och gynekologi Medicin och hälsovetenskap
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:oru:diva-4670 (URN)978-91-44-04929-8 (ISBN)
Tillgänglig från: 2008-10-27 Skapad: 2008-10-27 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
Fadl, H., Östlund, I., Nilsson, K. & Hanson, U. (2007). Fasting capillary glucose as a screening test for gestational diabetes mellitus. British Journal of Obstetrics and Gynecology, 114(3), 373-373
Öppna denna publikation i ny flik eller fönster >>Fasting capillary glucose as a screening test for gestational diabetes mellitus
2007 (Engelska)Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, nr 3, s. 373-373Artikel i tidskrift (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
Oxford: Blackwell Publishing, 2007
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:oru:diva-57844 (URN)10.1111/j.1471-0528.2006.01243.x (DOI)000244226900020 ()2-s2.0-33846998936 (Scopus ID)
Tillgänglig från: 2017-05-29 Skapad: 2017-05-29 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
Fadl, H., Östlund, I., Nilsson, K. & Hanson, U. (2007). Fasting capillary glucose as a screening test for gestational diabetes mellitus - Author's reply. BJOG: an International Journal of Obstetrics and Gynaecology, 114(2), 238-239
Öppna denna publikation i ny flik eller fönster >>Fasting capillary glucose as a screening test for gestational diabetes mellitus - Author's reply
2007 (Engelska)Ingår i: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 114, nr 2, s. 238-239Artikel i tidskrift (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
Oxford: Blackwell Publishing, 2007
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:oru:diva-57842 (URN)10.1111/j.1471-0528.2006.01192.x (DOI)000243402500025 ()2-s2.0-33846121026 (Scopus ID)
Tillgänglig från: 2017-05-29 Skapad: 2017-05-29 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
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