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Östlund, Ingrid
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Publications (10 of 17) Show all publications
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
Open this publication in new window or tab >>Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial
2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 9, p. 999-1007Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
Prenatal care, obesity, women´s health issues, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-49940 (URN)10.1111/aogs.12910 (DOI)000386782100007 ()27100375 (PubMedID)2-s2.0-84982221108 (Scopus ID)
Note

Funding Agency:

Research Committee at Orebro County Council

Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2018-07-10Bibliographically approved
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
Open this publication in new window or tab >>Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial
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2015 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, no 4, p. 537-544Article in journal (Refereed) 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

Keywords
Gestational weight gain, maternal health, pregnancy, prevention of obesity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-44110 (URN)10.1111/1471-0528.13131 (DOI)000350139300022 ()25367823 (PubMedID)2-s2.0-84923328050 (Scopus ID)
Note

Funding Agency:

Research Committee at Orebro County Council

Available from: 2015-04-08 Created: 2015-04-08 Last updated: 2018-06-27Bibliographically approved
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
Open this publication in new window or tab >>Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women
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2015 (English)In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, no 2, p. 159-164Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Walter de Gruyter, 2015
Keywords
Obesity, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine Pediatrics
Research subject
Obstetrics and Gynaecology; Pediatrics
Identifiers
urn:nbn:se:oru:diva-44240 (URN)10.1515/jpm-2013-0343 (DOI)000350338000005 ()25014513 (PubMedID)
Note

Funding Agency:

Foundation for Medical Research, Orebro University Hospital

Available from: 2015-04-14 Created: 2015-04-14 Last updated: 2018-06-29Bibliographically approved
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
Open this publication in new window or tab >>Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes
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2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, p. 1181-1187Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Pregnancy, gestational diabetes mellitus, hyperglycemia, treatment, birthweight, compliance, large-for-gestational age
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-46438 (URN)10.1111/aogs.12717 (DOI)000362844400006 ()26222270 (PubMedID)2-s2.0-84943587292 (Scopus ID)
Funder
Swedish Diabetes Association
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council

Praktikertjänst AB, Stockholm, Sweden

Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2018-04-16Bibliographically approved
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
Open this publication in new window or tab >>Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)
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2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 7, p. 978-992Article in journal (Refereed) 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.

Keywords
Bronchopulmonary dysplasia, Intraventricular haemorrhage, Necrotizing enterocolitis, Patent ductus arteriosus, Retinopathy of prematurity
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-28390 (URN)10.1111/j.1651-2227.2010.01846.x (DOI)000278294800008 ()
Available from: 2013-03-26 Created: 2013-03-14 Last updated: 2018-09-12Bibliographically approved
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
Open this publication in new window or tab >>One-year survival of extremely preterm infants after active perinatal care in sweden
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2009 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 301, no 21, p. 2225-2233Article in journal (Refereed) 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

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-28114 (URN)000266554100020 ()
Available from: 2013-08-08 Created: 2013-03-14 Last updated: 2017-12-06Bibliographically approved
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
Open this publication in new window or tab >>Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor
2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 745-750Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Informa Healthcare, 2008
Keywords
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
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-3403 (URN)10.1080/00016340802220352 (DOI)18607817 (PubMedID)
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14Bibliographically approved
Åman, J. & Östlund, I. (2008). Preventivmedelsrådgivning (2ed.). In: Sture Sjöblad (Ed.), Barn- och ungdomsdiabetes: (pp. 195-197). Lund: Studentlitteratur
Open this publication in new window or tab >>Preventivmedelsrådgivning
2008 (Swedish)In: Barn- och ungdomsdiabetes / [ed] Sture Sjöblad, Lund: Studentlitteratur , 2008, 2, p. 195-197Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur, 2008 Edition: 2
National Category
Obstetrics, Gynecology and Reproductive Medicine Medical and Health Sciences
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-4670 (URN)978-91-44-04929-8 (ISBN)
Available from: 2008-10-27 Created: 2008-10-27 Last updated: 2017-10-18Bibliographically approved
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
Open this publication in new window or tab >>Fasting capillary glucose as a screening test for gestational diabetes mellitus
2007 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, no 3, p. 373-373Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2007
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-57844 (URN)10.1111/j.1471-0528.2006.01243.x (DOI)000244226900020 ()2-s2.0-33846998936 (Scopus ID)
Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-10-18Bibliographically approved
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
Open this publication in new window or tab >>Fasting capillary glucose as a screening test for gestational diabetes mellitus - Author's reply
2007 (English)In: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 114, no 2, p. 238-239Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2007
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-57842 (URN)10.1111/j.1471-0528.2006.01192.x (DOI)000243402500025 ()2-s2.0-33846121026 (Scopus ID)
Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-10-18Bibliographically approved
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