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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: 2019-11-15Bibliographically 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
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: 2019-06-14Bibliographically 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
Saeedi, M., Hanson, U., Simmons, D. & Fadl, H. (2018). Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study. BMC Pregnancy and Childbirth, 18(1), Article ID 225.
Open this publication in new window or tab >>Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study
2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 225Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Swedish National Board of Health and Welfare (SNBHW) recommended the new diagnostic criteria for GDM based upon Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study thresholds. Due to limited knowledge base, no recommendations were made on GDM screening. The aim of this study is to evaluate test characteristics of risk factors and fasting blood glucose as screening tests for diagnosing GDM using diagnostic thresholds based upon HAPO study 1.75/2.0 (model I/II respectively) odds ratio for adverse pregnancy outcomes.

METHODS: This cross-sectional, population-based study included all pregnant women who attended maternal health care in Örebro County, Sweden between the years 1994-96. A 75 g OGTT with capillary fasting and 2-h blood glucose was offered to all pregnant women at week 28-32. Risk factors and repeated random glucose samples were collected. Sensitivity, specificity and predictive values of blood glucose were calculated.

RESULTS: Prevalence of GDM was 11.7% with model I and 7.2% with the model II criteria. Risk factors showed 28%, (95% CI 24-32) and 31%, (95% CI 25-37) sensitivity for model I and II respectively. A fasting cut off ≥4.8 mmol/l occurred in 24% of women with 91%, (95% CI 88-94) sensitivity and 85%, (95% CI 83-86) specificity using model I while a fasting cut off ≥5.0 mmol/l occurred in 14% with 91%, (95% CI 87-94) sensitivity and 92%, (95% CI 91-93) specificity using model II.

CONCLUSION: Risk factor screening for GDM was found to be poorly predictive of GDM but fasting glucose of 4.8-5.0 mmol/l showed good test characteristics irrespective of diagnostic model and results in a low rate of OGTTs.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Gestational diabetes mellitus, Screening, Fasting plasma glucose, Risk factors, Sensitivity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-67317 (URN)10.1186/s12884-018-1875-1 (DOI)000435456900003 ()29898685 (PubMedID)2-s2.0-85048591554 (Scopus ID)
Note

Funding Agency:

Research committee of Örebro County 

Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2019-01-22Bibliographically approved
Skogsdal, Y. R., Karlsson, J. Å., Cao, Y., Fadl, H. & Tydén, T. A. (2018). Contraceptive use and reproductive intentions among women requesting contraceptive counseling. Acta Obstetricia et Gynecologica Scandinavica, 97(11), 1349-1357
Open this publication in new window or tab >>Contraceptive use and reproductive intentions among women requesting contraceptive counseling
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 11, p. 1349-1357Article in journal (Refereed) Published
Abstract [en]

Introduction: Limited attention has been paid to the use of contraception in relation to women's family planning intentions. The aim of this study was to investigate the use of contraception during the most recent intercourse as well as the reproductive intentions of Swedish-speaking women requesting contraceptive counseling.

Material and methods: Across-sectional baseline survey in a randomized controlled trial regarding reproductive life planning (before randomization). Women requesting contraceptive counseling answered questions about contraception and whether they wanted to have children/more children in the future.

Results: In total, 1946 women participated: 33.7% (n = 656) parous and 65.7% (n = 1279) nulliparous. The majority, 87.1% (n = 1682), had used contraception during their latest intercourse; 64.6% (n = 1239) used short-acting reversible contraception, 22.8% (n = 443) used long-acting reversible contraception (LARC), and 12.9% (n = 251) had not used any contraception. A combined oral contraceptive was more common among nulliparous and LARC among parous. Among all women, 64.8% (n = 1253) intended to have children/more children in the future, among parous women 35.7% (n = 220) and among nulliparous 80.0% (n = 1033). Among women who did not intend to have children/more children, 22.6% (n = 60) of parous and 10% (n = 8) of nulliparous had not used contraceptives during their most recent intercourse.

Conclusions: Women did not always use contraceptives that were suitable for their reproductive intentions. Questioning women who request contraceptive counseling about their pregnancy intention can give healthcare providers better opportunities for individualized counseling.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Contraception, counseling, long-acting reversible contraception, preconception care, reproductive health, unintended pregnancy, unplanned pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-69535 (URN)10.1111/aogs.13426 (DOI)000446155300010 ()30007091 (PubMedID)2-s2.0-85052671672 (Scopus ID)
Note

Funding Agencies:

ALF founding Region Örebro län  

Research Council of Örebro Region County  

Bayer AB 

Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-11-06Bibliographically approved
Valgeirsdottir, I.-R., Hanson, U., Simmons, D. & Fadl, H. (2018). Diet as treatment for GDM: enough for improving outcomes?. 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 >>Diet as treatment for GDM: enough for improving outcomes?
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction: We wanted to compare the excess risk of adverse maternal and neonatal outcomes for women with diet (d-GDM) and insulin treated gestational diabetes (GDM) (i-GDM) in Sweden.

Methods: A population based cohort study including all singleton pregnancies without pre-existing diabetes recorded in the Swedish Medical Birth Register between 1998 and 2012. Logistic regression analyses were used to adjust for confounders (BMI, age, smoking, country of birth and chronic hypertension). The adjusted odds ratio (aOR) with 95% confidence interval (CI) for maternal and neonatal outcomes are presented.

Results: A total of 1,441,338 singleton pregnancies were included: 14,242 women were diagnosed with GDM (1.0%), 8,851 (62.1%) d-GDM and 5,391 (37.9%) i-GDM . Mean BMI was significantly higher than background in both groups (27.8 ± 6.0 and 30.3 ± 6.5 kg/m2 in the d-GDM group and i-GDM group, respectively, vs 24.5 ± 4.4 kg/m2, both p < 0.001). The d-GDM group had significantly higher risk for preeclampsia [aOR 1.71 (95% CI 1.55-1.88)], cesarean section [aOR 1.18 (95% CI 1.11-1.25)], LGA infants [aOR 1.85 (95% CI 1.75-1.96)] and birth injury/trauma [aOR 1.88 (95% CI 1.37-2.58)] compared to the background population. The risk was even higher in the i-GDM group, preeclampsia [aOR 2.11 (95% CI 1.88-2.36)], cesarean section [aOR 1.84 (95% CI 1.73-1.96)], LGA infants [aOR 3.38 (95% CI 3.17-3.60)] and birth injury/trauma [aOR 2.26 (95% CI 1.61-3.20)].

Conclusions: Adverse outcomes in the d-GDM group were higher than the background population and higher still among those with i-GDM.

National Category
Endocrinology and Diabetes Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-69524 (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
Kuusela, P., Fadl, H., Wesström, J., Lindgren, P., Hagberg, H., Jacobsson, B., . . . Valentin, L. (2018). Intra- and Interrater reliability of Transvaginal Sonographic Measurements of Cervixal length. In: : . Paper presented at ESPBC 2018, European Spontaneous Preterm Birth Congress, Edinburgh, Scotland, May 16-18, 2018.
Open this publication in new window or tab >>Intra- and Interrater reliability of Transvaginal Sonographic Measurements of Cervixal length
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-69351 (URN)
Conference
ESPBC 2018, European Spontaneous Preterm Birth Congress, Edinburgh, Scotland, May 16-18, 2018
Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2018-10-08Bibliographically approved
Saeedi, M., Simmons, D., Magnuson, A., Montgomery, S. & Fadl, H. (2018). The CDC4G trial: Impact of Changing Diagnostic Criteria for Gestational diabetes in Sweden – a stepped wedge national cluster randomised controlled trial-study protocol. 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 >>The CDC4G trial: Impact of Changing Diagnostic Criteria for Gestational diabetes in Sweden – a stepped wedge national cluster randomised controlled trial-study protocol
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2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction: In 2013 WHO recommended new criteria for GDM, defined as ≥5.1, ≥10.0 and/or ≥8.5 mmol/l fasting, 1 hour and/or 2 hour cut offs, which the Swedish National Board of Health adopted. With the current variation in GDM screening/diagnostic practice across Sweden and the debate over the criteria, we have established a stepped wedge cluster randomised controlled trial (SW-CRCT) to move towards a unified approach to GDM management. The objectives for the Changing Diagnostic Criteria for Gestational diabetes in Sweden (CDC4G) trial include: (1) To compare the rates of adverse neonatal and maternal outcomes before and after the change in GDM diagnostic criteria (2) To compare the health costs before and after the change and assess the net cost/saving (3)To compare the adverse outcomes and health costs using the new WHO criteria (75% excess risk) and the criteria based upon the 100% excess risk of neonatal adverse outcomes; using the national pregnancy register where all data needed is registered from the medical journals. The aim of this study is to describe the development of the study and the associated key issues.

Methods: The CDC4G study is a national prospective, unblinded, SW-CRCT of the switch from pre-existing Swedish diagnostic criteria to the WHO 2013 criteria for GDM. Each participating centre constitutes one cluster, in which the patients undergo screening for GDM following their usual approach. The time of switch to the new criteria is randomized and subsequently rolled out until all clusters (centres) have received the intervention (introduction of the new GDM regimens) during 2018. All women treated in the participating clusters (including within primary care and hospitals) will be included in the study. Women with preexisting diabetes and overt diabetes are excluded. The key issues were identification of primary outcome, recruitment of sites and undertaking the power calculation.The study is approved by the Uppsala –Örebro regional ethics board, Dnr: 2016/487.

Result: Identification of outcomes: As many women with GDM are not identified in the pre-switch period, measures that could be influenced by knowing the diagnosis (eg screening for neonatal hypoglycaemia) were excluded. The measure also needed to be frequent enough to have a large enough absolute reduction to be detected in the total obstetric population. As LGA is common (10% total population, 20% in GDM), it was decided that LGA should be primary outcome. Secondary maternal and neonate outcomes and health economic outcomes will also be evaluated. Recruitment of sites: Regions/clinics adopted the same protocols and hence were taken as ‘clusters’. There are 21 regions in Sweden and 38 clinics with annual births ranging between 540 and 10 200 births. Stockholm regions overlap so were taken as one cluster (5 clinics) . Overall 11/21 regions with 67000 births per annum agreed to participate. Annual births in Sweden is 95-100 000/year. Power calculation: With 11 clinics (clusters) participating and an intra cluster correlation of 0.0026 a minimum sample size of 47916 pregnant women (23958 before change and 23958 after change of the new GDM criteria) have 90% statistical power to detect a risk reduction of LGA by 1.5% on a population level (from 10% to 8.5%). The power calculation incorporates consideration of the varying sizes in cluster.

Discussion: Establishing a national randomised controlled trial to evaluate the impact of the WHO 2013 criteria raised several challenges, which have now been addressed. The trial has commenced and final results of the study will be analyzed and disseminated in 2019 (www.cdc4g.com).

Trial registration CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017).

National Category
Endocrinology and Diabetes Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-69523 (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: 2019-01-22Bibliographically approved
Arntyr Hellgren, P., Simmons, D., Hanson, U., Magnuson, A. & Fadl, H. (2017). Birth trauma in babies born to women with and without type 1 diabetes in Sweden 1998-2012: relationship with maternal and baby weight. In: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book. Paper presented at 49th Annual Meeting of the Diabetic Pregnancy Study Group (EASD), Nyborg, Denmark, September 7-10, 2017 (pp. 66-67).
Open this publication in new window or tab >>Birth trauma in babies born to women with and without type 1 diabetes in Sweden 1998-2012: relationship with maternal and baby weight
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2017 (English)In: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book, 2017, p. 66-67Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

We compared birth trauma rates in pregnancies among women with and without type 1 diabetes (DM1) and tested the relationship with maternal body mass index (BMI) and large for gestational age (LGA) as a risk factor. This is a population-based cohort study 1998-2012 using the Swedish Medical Birth Registry (MBR) which includes 99% of Swedish pregnancies. All pregnancies up until gestational week 41 were included. We excluded mothers with other types of diabetes, duplex pregnancies and all pregnancies ending with a caesarean section (51.1% and 16.5% in women with and without DM1 respectively). The incidence of birth trauma was adjusted for BMI, maternal age, parity, Nordic or non-Nordic origin, smoking, chronic hypertensive disease, LGA and the baby ́s sex using logistic regression. This left 2,758 and 783,412 births with complete data among DM1 and control mothers respectively. The mean BMI, maternal age and gestational age at birth in full weeks was 25.6 (SD 4.5), 30.0 (SD 5.1) and 37.9 (SD 1.9) respectively among women with DM1 and 24.2 (SD 4.3), 29.7 (SD 5.1) and 38.9 (SD 1.5) respectively among controls. Preliminary results show that birth trauma rates did not vary significantly with increasing BMI compared with the reference BMI (18.50-24.9 kg/m2) among women with DM1 (odds ratios (OR) with increasing BMI (<18.49, 25.0-29.9, 30.0-34.9, >35.0 kg/m2) were 1.9 (95%CI 0.2-15.7), 1.0 (95%CI 0.7-1.5), 0.5 (95%CI 0.2-1.0), 1.1 (95%CI 0.5-2.4) respectively). Conversely, among controls, the OR for birth trauma increasedwith increasing BMI: 0.7 (95%CI 0.6-0.9), 1.4 (95%CI 1.3-1.5), 1.8 (95%CI 1.6-2.0), and 2.2 (95%CI 1.9-2.4) respectively. However, birth trauma was 3.9 (95%CI 2.7-5.7) and 7.0 (95%CI 6.5-7.5) fold more common after adjustment with LGA among women with andwithout DM1 respectively. We conclude that birth trauma rates are associated with LGA with comparatively greater impact among women without, than with, DM1. LGA is clearly an important outcome in its own right and a predictor of birth trauma. We hypothesise that the reduced risk of birth trauma from LGA among women with DM1 is due to increased monitoring with multiple ultrasounds to determine the fetal growth rate, along with earlier planned delivery (including earlier induction with vaginal delivery ata lower birthweight or caesarean section). While more research is needed to find better ways to reduce LGA in DM1, many of the obese control women would have undiagnosed/untreated GDM due to the Swedish criteria at the time (2 hours >=9.0mmol/l). Besidestreating lower levels of hyperglycaemia during pregnancy, the frequency of growth monitoring in obese mothers to reduce their babies’ risk of birth trauma due to LGA, needs to be evaluated. Life course cost effectiveness analyses would be useful.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-63379 (URN)
Conference
49th Annual Meeting of the Diabetic Pregnancy Study Group (EASD), Nyborg, Denmark, September 7-10, 2017
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2018-08-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2691-7525

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