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Thornton, J., Fadl, H., Walker, K. F. & Torgerson, D. (2020). Avoiding biased exclusions in cluster trials. Acta Obstetricia et Gynecologica Scandinavica, 99(2), 145-146
Open this publication in new window or tab >>Avoiding biased exclusions in cluster trials
2020 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 99, no 2, p. 145-146Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2020
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-79599 (URN)10.1111/aogs.13776 (DOI)000508080900001 ()31953858 (PubMedID)2-s2.0-85078006132 (Scopus ID)
Available from: 2020-01-31 Created: 2020-01-31 Last updated: 2020-01-31Bibliographically approved
Kristensen, K., Wangel, A.-M., Katsarou, A., Shaat, N., Simmons, D., Fadl, H. & Berntorp, K. (2020). Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference. Journal of Diabetes Research, 2020, Article ID 7937403.
Open this publication in new window or tab >>Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference
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2020 (English)In: Journal of Diabetes Research, ISSN 2314-6745, E-ISSN 2314-6753, Vol. 2020, article id 7937403Article in journal (Refereed) Published
Abstract [en]

Background: In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference.

Methods: A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy.

Results: Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (-1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL.

Conclusions: A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2020
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-81222 (URN)10.1155/2020/7937403 (DOI)000522892500001 ()32280717 (PubMedID)2-s2.0-85082967727 (Scopus ID)
Note

Funding Agencies:

Research Funds of Skåne University Hospital  

Skåne County Council Research and Development Foundation

Available from: 2020-04-20 Created: 2020-04-20 Last updated: 2020-04-20Bibliographically approved
Kuusela, P., Wennerholm, U.-B., Fadl, H., Wesström, J., Lindgren, P., Hagberg, H., . . . Valentin, L. (2020). Second trimester cervical length measurements with transvaginal ultrasound: a prospective observational agreement and reliability study. Acta Obstetricia et Gynecologica Scandinavica
Open this publication in new window or tab >>Second trimester cervical length measurements with transvaginal ultrasound: a prospective observational agreement and reliability study
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2020 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412Article in journal (Refereed) Epub ahead of print
Abstract [en]

INTRODUCTION: Universal screening for preterm delivery by adding transvaginal ultrasound measurement of cervical length to routine second trimester ultrasound has been proposed. The aim is to estimate inter- and intra-observer agreement and reliability of second trimester transvaginal ultrasound measurements of cervical length performed by specially trained midwife sonographers.

MATERIAL AND METHODS: This is a prospective reliability and agreement study performed in seven Swedish ultrasound centers. In total, 18 midwife sonographers specially trained to perform ultrasound measurements of cervical length and 286 women in the second trimester were included. In each center two midwife sonographers measured cervical length a few minutes apart in the same woman, the number of women examined per examiner pair varying between 24 and 30 (LIVE study). Sixteen midwife sonographers measured cervical length twice ≥2 months apart on 93 video-clips (CLIPS study). The main outcome measures were mean difference, limits of agreement, intra-class correlation coefficient, intra-individual standard deviation, repeatability, Cohen´s kappa, and Fleiss kappa.

RESULTS: The limits of agreement and intra-class correlation coefficient of the best examiner pair in the LIVE study were -4.06 to 4.72 mm and 0.91, those of the poorest were -11.11 to 11.39 mm and 0.31. In the CLIPS study, median (range) intra-individual standard deviation was 2.14 mm (1.40 to 3.46), repeatability 5.93 mm (3.88 to 9.58), intra-class correlation coefficient 0.84 (0.66 to 0.94). Median (range) inter-observer agreement for cervical length ≤25 mm in the CLIPS study was 94.6% (84.9% to 98.9%) and Cohen´s kappa 0.56 (0.12 to 0.92), median (range) intra-observer agreement was 95.2% (87.1% to 98.9%) and Cohen´s kappa 0.68 (0.27 to 0.93).

CONCLUSIONS: Agreement and reliability of cervical length measurements differed substantially between examiner pairs and examiners. If cervical length measurements are used to guide management there is potential for both over- and under-treatment. Uniform training and rigorous supervision and quality control are advised.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
Reproducibility of results, cervical length, cervical length measurement, data accuracy, inter-observer variation, intra-observer variation, preterm delivery, quality control, second trimester of pregnancy, transvaginal ultrasound
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-81840 (URN)10.1111/aogs.13895 (DOI)32392356 (PubMedID)
Available from: 2020-05-14 Created: 2020-05-14 Last updated: 2020-05-14Bibliographically approved
Hildén, K., Magnuson, A., Hanson, U., Simmons, D. & Fadl, H. (2020). Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study. Diabetic Medicine
Open this publication in new window or tab >>Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort study
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2020 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time.

METHODS: Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score.

RESULTS: The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an OR per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM.

CONCLUSIONS: This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2020
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-79938 (URN)10.1111/dme.14266 (DOI)32027045 (PubMedID)
Available from: 2020-02-19 Created: 2020-02-19 Last updated: 2020-02-19Bibliographically approved
Skogsdal, Y. R., Fadl, H., Cao, Y., Karlsson, J. & Tydén, T. (2019). An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial. Upsala Journal of Medical Sciences, 124(3), 203-212
Open this publication in new window or tab >>An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial
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2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 3, p. 203-212Article in journal (Refereed) Published
Abstract [en]

Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC.

Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health.

Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling.

Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Contraceptive counseling, fertility, lifestyle factors, preconception care, preconception health, pregnancy, reproductive life plan
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-76430 (URN)10.1080/03009734.2019.1653407 (DOI)000485618600001 ()31495254 (PubMedID)
Note

Funding Agencies:

Research, Development and Education (ALF) from Uppsala County Council  AS 2014-0831

Region Örebro County  OLL-640211 OLL-734371

Bayer AB 

Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2020-01-16Bibliographically approved
Fadl, H., Saeedi, M., Montgomery, S., Magnuson, A., Schwarcz, E., Berntorp, K., . . . Simmons, D. (2019). Changing diagnostic criteria for gestational diabetes in Sweden: a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol. BMC Pregnancy and Childbirth, 19(1), Article ID 398.
Open this publication in new window or tab >>Changing diagnostic criteria for gestational diabetes in Sweden: a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 398Article in journal (Refereed) Published
Abstract [en]

Background: The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden () is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches.

Methods: This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January-December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included.

Discussion: The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Gestational diabetes mellitus, Pregnancy outcomes, Diagnostic criteria, WHO 2013 criteria, Stepped wedge cluster randomised controlled trial, LGA, Health economics, Obesity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-77999 (URN)10.1186/s12884-019-2547-5 (DOI)000494447700004 ()31675922 (PubMedID)2-s2.0-85074418210 (Scopus ID)
Funder
Swedish Research Council, 2018-00470
Note

Funding Agencies:

Fru Mary von Sydows, född Wijk, donation fond  1017 4917 2618

Nyckelfonden Region Örebro County  OLL-597601

Region Örebro County Research committee  OLL-693551 OLL-786911

Regional Research committee Uppsala-Örebro  RFR-749241

Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-11-22Bibliographically approved
Hildén, K., Hanson, U., Persson, M., Magnuson, A., Simmons, D. & Fadl, H. (2019). Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden. Diabetic Medicine, 36(2), 151-157
Open this publication in new window or tab >>Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden
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2019 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 36, no 2, p. 151-157Article in journal (Refereed) Published
Abstract [en]

AIMS: To evaluate the interaction effects of gestational diabetes (GDM) with obesity on perinatal outcomes.

METHODS: A population-based cohort study in Sweden excluding women without pre-gestational diabetes with a singleton birth between 1998 and 2012. Logistic regression was performed to evaluate the potential independent associations of GDM and BMI with adverse perinatal outcomes as well as their interactions. Main outcome measures were malformations, stillbirths, perinatal mortality, low Apgar score, fetal distress, prematurity and Erb's palsy.

RESULTS: ) had significantly increased risks of all outcomes including stillbirth 1.51 (1.40-1.62) to 2.85 (2.52-3.22) and perinatal mortality 1.49 (1.40-1.59) to 2.83 (2.54-3.15).

CONCLUSIONS: There is no interaction effect between GDM and BMI for the studied outcomes. Higher BMI and GDM are major independent risk factors for most serious adverse perinatal outcomes. More effective pre-pregnancy and antenatal interventions are required to prevent serious adverse pregnancy outcomes among women with either GDM or high BMI.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-72039 (URN)10.1111/dme.13843 (DOI)000457530200003 ()30698864 (PubMedID)2-s2.0-85060805274 (Scopus ID)
Note

Funding Agency:

Örebro County Council 

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-19Bibliographically approved
Wennerholm, U.-B., Saltvedt, S., Wessberg, A., Alkmark, M., Bergh, C., Wendel, S. B., . . . Hagberg, H. (2019). Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial. BMJ. British Medical Journal, 367, Article ID l6131.
Open this publication in new window or tab >>Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial
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2019 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 367, article id l6131Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks.

DESIGN: Multicentre, open label, randomised controlled superiority trial.

SETTING: 14 hospitals in Sweden, 2016-18.

PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group.

INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks.

MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat.

RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups.

CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-78055 (URN)10.1136/bmj.l6131 (DOI)000498841000001 ()31748223 (PubMedID)2-s2.0-85075603743 (Scopus ID)
Note

Funding Agencies:

Swedish government  

ALF-agreement  ALFGBG-440301 ALFGBG-718721 ALFGBG-70940 ALFGBG-426401

Health Technology Centre at Sahlgrenska University Hospital  

Foundation of the Health and Medical care committee of the Region of Västra Götaland, Sweden  VGFOUREG387351 VGFOUREG640891 VGFOUREG854081

Hjalmar Svensson Foundation  

Foundation Mary von Sydow  

Born Wijk donation fund  

Uppsala-Örebro regional research council  RFR-556711 RFR-736891

Region Örebro County research committee  OLL-715501

ALF-agreement in Stockholm  ALF-561222 ALF-562222 ALF-563222

Centre for Clinical Research Dalarna-Uppsala University, Sweden  CKFUU-417011

Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2019-12-10Bibliographically approved
Hildén, K., Hanson, U., Persson, M., Magnuson, A., Simmons, D. & Fadl, H. (2018). Are gestational diabetes and adiposity independent risk factors for perinatal outcomes?: A population based cohort study in Sweden. Diabetic Medicine
Open this publication in new window or tab >>Are gestational diabetes and adiposity independent risk factors for perinatal outcomes?: A population based cohort study in Sweden
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2018 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Article in journal (Refereed) Accepted
Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell Publishing Inc., 2018
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-69788 (URN)
Available from: 2018-10-24 Created: 2018-10-24 Last updated: 2020-02-14Bibliographically approved
Hildén, K., Arntyr-Hellgren, P., Magnuson, A., Hanson, U., Simmons, D. & Fadl, H. (2018). Born over 4500 g: the trends in birth trauma and mode of delivery in women with GDM and type 1 diabetes in Sweden between 1998-2012. In: : . Paper presented at Diabetes Pregnancy Study Group (DPSG) Meeting 2018, Rome, Italy, September 27-30, 2018.
Open this publication in new window or tab >>Born over 4500 g: the trends in birth trauma and mode of delivery in women with GDM and type 1 diabetes in Sweden between 1998-2012
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: We have previously shown that during the years 1998-2012, the overall incidence of LGA and birthweight decreased in both women with and without GDM in Sweden, and unpublished preliminary results show that there is a converse trend among women with T1DM. The incidence of Erbs palsy also decreased in the GDM and background population, but remained unchanged for women with T1DM. Since macrosomia is one of the most prominent risk factors for Erb´s palsy and delivery complications, the aim of the study was to evaluate trends in incidence of Erb´s palsy and delivery mode in the macrosomic group defined as weight ≥4500g and we present here our preliminary results.

Method: This is a cohort study in Sweden 1998-2012 , including singleton macrosomic (≥4500 g) births. Vaginal deliveries were selected for the analyses relating to Erb´s plasy. Poisson regression was used to evaluate trends per year in both the GDM, T1DM and the background population. Results were partly stratified on BMI, to be able to detect any group differences in trends. P-value of <0.05 was considered statistically significant.

Results: In total there were 57 2015 macrosomic infants, of whom (n= 36 933, 64,6%) were delivered vaginally. Of these, only 2.1 % (n=798) were vaginally delivered by women with GDM, (1.4%) type 2 diabetes (0.1%) or T1DM (0.7%). The trend in Erb´s palsy decreased significantly in the background population at a rate of OR 0.954 (95% CI 0.936-0.973) per year. For women with GDM or T1DM there was no significant change in incidence of trends over these years for Erb´s palsy. As for Caesarean section (CS) there was a significant increase per year for GDM pregnancies (OR 1.028, 95% CI 1.007-1.049) and in the background population (1.018 95% CI 1.013-1.022). No change was seen for CS in pregnancies with T1DM.

Conclusion: Even though the rates of LGA and birthweight have decreased in Sweden over this time period for women with GDM and the background population, we could not see a significant decrease in Erb´s palsy among women with vaginal births in either the GDM group or for women with T1DM in the macrosomic infants. However, a decrease was seen in the incidence of Erb´s palsy in the macrosomic babies in the background population. The rates of CS have significantly increased in the background population and for GDM pregnancies, but been stable for T1DM. We conclude that the disparity in risk of Erbs has grown over this time period. Further work is needed to ascertain whether this is due to the need for improved surveillance, a higher CS rate, and/or improved glycaemic management (or other factors).

National Category
Endocrinology and Diabetes Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-69522 (URN)
Conference
Diabetes Pregnancy Study Group (DPSG) Meeting 2018, Rome, Italy, September 27-30, 2018
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2018-10-15Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2691-7525

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