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  • 1. Adolfsson, Annsofie
    Miscarriage: women’s experience and its cumulative incidence2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively.

    Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss.

    Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type.

    We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage.

    Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.

    List of papers
    1. Cumulative incidence of previous spontaneous abortion in Sweden in 1983-2003: a register study
    Open this publication in new window or tab >>Cumulative incidence of previous spontaneous abortion in Sweden in 1983-2003: a register study
    2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 6, p. 741-747Article in journal (Refereed) Published
    Abstract [en]

    AIM: The aim of this study is to find out how common miscarriages are among women who have delivered a child. METHODS: The numbers of deliveries and miscarriages were extracted from the Swedish Medical Birth Register between 1983 and 2003. Linear regression was performed in order to investigate whether the increasing mean age of mothers or differences in pregnancy identification methods could explain the increased frequency of miscarriage. RESULTS: The reported number of miscarriages increased each year during the 21-year period, with a marked increase between 1991 and 1993 and only a slight increase during the final 10 years. For primiparous women, the frequency of reported miscarriages per delivery increased from 8.6% in 1983 to 13.9% in 2003. The corresponding figures for 2-parous women showed an increase from 14.5% to 21.3% respectively. Women aged 30-34 years had an odds ratio of 1.43 (95% CI 1.40-1.45) to suffer spontaneous abortion compared to the age group 25-29 years. Linear regression showed that an increase in mean age at delivery could only partly explain the increase in the frequency of reported miscarriages. A possible explanation could be differences in methods of identifying early pregnancy. CONCLUSION: Of all women who deliver a child, nearly 20% have experienced previous miscarriage. The increased mean age of women could only explain a small portion of the seen increase in miscarriage. The marked increase from 1991 to 1993 is interesting. Possible reasons for the increase are discussed.

    Keywords
    Abortion, Spontaneous/*epidemiology
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-27333 (URN)10.1080/00016340600627022 (DOI)16752269 (PubMedID)
    Available from: 2013-02-05 Created: 2013-02-05 Last updated: 2017-12-06Bibliographically approved
    2. Guilt and emptiness: women's experiences of miscarriage
    Open this publication in new window or tab >>Guilt and emptiness: women's experiences of miscarriage
    2004 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 25, no 6, p. 543-560Article in journal (Refereed) Published
    Abstract [en]

    Women who lose an early pregnancy are shocked when they are first given the information that they have miscarried. Later they feel guilt and emptiness. Heideggerian interpretive phenomenology has been used with 13 women from southwest Sweden to uncover their lived experience of miscarriage. Women plan their future with a child during early pregnancy. When miscarriage occurs it is not a gore, an embryo, or a fetus they lose, it is their child. They feel that they are the cause of the miscarriage through something they have done, eaten, or thought. They feel abandonment and they grieve for their profound loss; they are actually in bereavement.

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-25616 (URN)10.1080/07399330490444821 (DOI)15354621 (PubMedID)
    Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2017-12-07Bibliographically approved
    3. Translation of the short version of the Perinatal Grief Scale into Swedish
    Open this publication in new window or tab >>Translation of the short version of the Perinatal Grief Scale into Swedish
    2006 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 3, p. 269-273Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: Women's emotions and grief after miscarriage are influenced not only by the context in which the miscarriage occurred but also by their past experience, the circumstances around the miscarriage and their future prospects. Their emotions therefore express a specific form of grief. Normally the time needed to work through the loss varies. A number of different scales, measuring women's emotions and grief after miscarriage have been published. One instrument that measures the specific grief, such as the grief after miscarriage is the Perinatal Grief Scale (PGS) that was designed to measure grief after perinatal loss and has good reliability and validity.

    AIMS: The purpose of this study was to translate the PGS into Swedish and to use the translation in a small pilot study.

    MATERIAL AND METHOD: The original short version of the PGS was first translated from English into Swedish and then back-translated into English, using different translators. During translation and back-translation, not only the linguistic and grammatical aspects were considered but also cultural differences. The Likert 5-point and a 10-point scale were tested in a pilot study where 12 volunteers anonymously answered the PGS twice. The intra-personal correlations were compared and analysed with weighted kappa-coefficient.

    FINDINGS: In all, five different versions were tested before the final Swedish version was established. The weighted kappa-coefficient for the volunteers was 0.58, which is regarded as representing good reproducibility.

    CONCLUSION: The PGS was translated successfully into Swedish and could be used in a Swedish population. As this work is rather time-consuming we therefore wish to publish the Swedish version so that it may be used by other researchers.

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-25613 (URN)10.1111/j.1471-6712.2006.00404.x (DOI)16922980 (PubMedID)
    Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2017-12-07Bibliographically approved
    4. Effect of a structured follow-up visit to a midwife on women with early miscarriage: a randomized study
    Open this publication in new window or tab >>Effect of a structured follow-up visit to a midwife on women with early miscarriage: a randomized study
    2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 3, p. 330-335Article in journal (Refereed) Published
    Abstract [en]

    Background: Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2).

    Methods: We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post.

    Results: There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit.

    Conclusions: A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

    Place, publisher, year, edition, pages
    Oslo, Norway: Taylor & Francis, 2006
    Keywords
    Early miscarriage, grief, midwife, support, treatment
    National Category
    Obstetrics, Gynecology and Reproductive Medicine Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-25614 (URN)000236110500012 ()16553182 (PubMedID)
    Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2017-12-07Bibliographically approved
    5. Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale
    Open this publication in new window or tab >>Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale
    2010 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 3, p. 201-209Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief.

    MATERIAL AND METHODS: Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks.

    RESULTS: Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage.

    CONCLUSION: Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-25610 (URN)10.3109/03009731003739851 (DOI)000281013000008 ()20636255 (PubMedID)
    Note

    Per-Göran Larsson is also affiliated toDepartment of Obstetrics and Gynecology, Skaraborgs sjukhus, Kärnsjukhuset Skövde, Skövde, SwedenandDivision of Women and Child Health, Department of Clinical and Experimental Medicine, Faculty of Health and Sciences, Linköping University, Linköping, Sweden

    Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2018-02-23Bibliographically approved
  • 2.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. The Centre for Women’s, Family and Child Health, Faculty of Health Sciences, Buskerud & Vestfold University, Kongsberg, Norway.
    Arbhede, Emelie
    Department Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden.
    Marklund, Elisabeth
    Women’s Clinic, Highland Distric County Hospital, Eksjö, Sweden.
    Larsson, Per-Göran
    Department of Obstetrics and Gynaecology, University of Linköping, Linköping, Sweden.
    Berg, Marie
    Institutes of Health and Care Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Miscarriage: Evidence Based Information for the Web and Its Development Procedure2015In: Advances in Sexual Medicine, ISSN 2164-5191, Vol. 5, no 4, p. 89-110Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this paper is to describe the process of developing web information on miscarriage based on scientific evidence, for women and couples in Sweden experiencing miscarriage. Method: A participatory design was used which included researchers, professional  xperts and users. A participatory design was used involving researchers, professional experts and users. The information was developed in six stages: 1) identifying the needs of information; 2) identifying and constructing the main areas of information and its paths; 3) identifying and inviting experts for revision; 4) developing the text; 5) reviewing the text; 6) design and structuring for adaption to website. Results: The text of information developed gradually based on the seven steps. The final text comprised three parts: 1) what is miscarriage; 2) experiences of miscarriage; 3) processing and lanning for new pregnancy. Conclusion: Using participatory design was time and resource consuming, however it was functional for producing appropriate information for the target group. The developed evidence based facts text is assumed to be a complement to the information that is provided by the health care system.

  • 3.
    Adolfsson, Annsofie
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Berterö, Carina
    Division of Nursing Science, Department of Medicine and Care, Faculty of Health Science, Linköping University, Linköping, Sweden.
    Larsson, Per-Göran
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Effect of a structured follow-up visit to a midwife on women with early miscarriage: a randomized study2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 3, p. 330-335Article in journal (Refereed)
    Abstract [en]

    Background: Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2).

    Methods: We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post.

    Results: There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit.

    Conclusions: A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

  • 4.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berterö, Carina
    Hälsohögskolan i Jönköping, Sweden.
    Larsson, Per-Göran
    Skaraborgssjukhus Skövde, Sweden.
    Effekten av strukturerat återbesök till barnmorska för kvinnor med tidiga missfall: en randomiserad studie2004In: , 2004Conference paper (Refereed)
  • 5.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berterö, Carina
    Hälsohögskolan i Jönköping, Jönköping, Sweden.
    Larsson, Per-Göran
    Skaraborgs sjukhus, Skövde, Sweden.
    The effect of structured second visit to midwifes in women with early miscarriage: a randomized study2004Conference paper (Refereed)
  • 6.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berterö, Carina
    Hälsohögskolan i Jönköping, Sweden.
    Larsson, Per-Göran
    Skaraborgs sjukhus Skövde, Sweden.
    The effect of structured second visit to midwifes in women with early miscarriage: a randomized study2005Conference paper (Refereed)
  • 7.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hogström, Lars
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Johansson, Marianne
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Livskvalitet bland par i Sverige efter adoption, efter IVF och efter spontan befruktning och förlossning2011In: Svenska barnmorskeförbundet 300 år. Stockholm Abstrakt bok, 2011Conference paper (Refereed)
  • 8.
    Adolfsson, Annsofie
    et al.
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Larsson, Per-Göran
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale2010In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 3, p. 201-209Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief.

    MATERIAL AND METHODS: Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks.

    RESULTS: Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage.

    CONCLUSION: Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.

  • 9.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Larsson, Per-Göran
    Skaraborgs sjukhus, Skövde, Sweden.
    Kvinnors sorg efter missfall kan minska med ändrade vårdrutiner2006Conference paper (Refereed)
  • 10.
    Adolfsson, Annsofie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Larsson, Per-Göran
    Skaraborgssjukhus Skövde, Sweden.
    Berterö, Carina
    Hälsohögskolan i Jönköping, Sweden.
    Missfall: kvinnans upplevelser2004In: , 2004Conference paper (Refereed)
  • 11.
    Adolfsson, Annsofie
    et al.
    Department of Obstetrics and Gynecology, Central Hospital Skövde, Skövde, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Tullander-Tjörnstrand, Karin
    Department of Obstetrics and Gynecology, Central Hospital Skövde, Skövde, Sweden.
    Larsson, Per-Göran
    Department of Obstetrics and Gynecology, Central Hospital Skövde, Skövde, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Decreased need for emergency services after changing management for suspected miscarriage2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 921-923Article in journal (Refereed)
    Abstract [en]

    We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.

  • 12.
    Alder, Susanna
    et al.
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Megyessi, David
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Sundström, Karin
    Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.
    Östensson, Ellinor
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Mints, Miriam
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Belkić, Karen
    Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; School of Community and Global Health, Claremont Graduate University, California, USA; Keck School of Medicine, University of Southern California, USA.
    Arbyn, Marc
    Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium.
    Andersson, Sonia
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
    Incomplete Excision of Cervical Intraepithelial Neoplasia as a Predictor of the Risk of Recurrent Disease -: a 16 Year Follow-Up Study2019In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Women treated for high-grade cervical intraepithelial neoplasia (CIN, grade 2 or 3) are at elevated risk of developing cervical cancer. Suggested factors identifying women at highest risk for recurrence post-therapeutically include incomplete lesion excision, lesion location, size and severity, older age, treatment modality and presence of high-risk human papilloma virus (hrHPV) after treatment. This question has been intensively investigated over decades, but there is still substantial debate as to which of these factors or combination of factors most accurately predict treatment failure.

    OBJECTIVES: In this study, we examine the long-term risk of residual/recurrent CIN2+ among women previously treated for CIN2 or 3 and how this varies according to margin status (considering also location), as well as comorbidity (conditions assumed to interact with hrHPV acquisition and/or CIN progression), post-treatment presence of hrHPV and other factors.

    STUDY DESIGN: This prospective study included 991 women with histopathologically-confirmed CIN2/3 who underwent conization in 2000-2007. Information on the primary histopathologic finding, treatment modality, comorbidity, age and hrHPV status during follow-up and residual/recurrent CIN2+ was obtained from the Swedish National Cervical Screening Registry and medical records. Cumulative incidence of residual/recurrent CIN2+ was plotted on Kaplan-Meier curves, with determinants assessed by Cox regression.

    RESULTS: During a median of 10 years and maximum of 16 years follow-up, 111 patients were diagnosed with residual/recurrent CIN2+. Women with positive/uncertain margins had a higher risk of residual/recurrent CIN2+ than women with negative margins, adjusting for potential confounders (hazard ratio (HR)=2.67; 95% confidence interval (CI): 1.81-3.93). The risk of residual/recurrent CIN2+ varied by anatomical localization of the margins (endocervical: HR=2.72; 95%CI: 1.67-4.41) and both endo- and ectocervical (HR=4.98; 95%CI: 2.85-8.71). The risk did not increase significantly when only ectocervical margins were positive/uncertain. The presence of comorbidity (autoimmune disease, human immunodeficiency viral infection, hepatitis B and/or C, malignancy, diabetes, genetic disorder and/or organ transplant) was also a significant independent predictor of residual/recurrent CIN2+. In women with positive hrHPV findings during follow-up, the HR of positive/uncertain margins for recurrent/residual CIN2+ increased significantly compared to women with hrHPV positive findings but negative margins.

    CONCLUSIONS: Patients with incompletely excised CIN2/3 are at increased risk of residual/recurrent CIN2+. Margin status combined with hrHPV results and consideration of comorbidity may increase the accuracy for predicting treatment failure.

  • 13.
    Allbrand, Marianne
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstet & Gynaecol, Örebro Univ Hosp, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Örebro University Hospital. Örebro University. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Placental gene expression of inflammatory markers and growth factors: a case control study of obese and normal weight women2015In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, no 2, p. 159-164Article in journal (Refereed)
    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.

  • 14.
    Allbrand, Marianne
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Åman, Jan
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Placental ghrelin and leptin expression and cord blood ghrelin, adiponectin, leptin, and C-peptide levels in severe maternal obesity2017In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 31, no 21, p. 2839-2846Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to investigate placental ghrelin and leptin expression as well as cord blood ghrelin and adiponectin levels in maternal obesity and associations between placental ghrelin expression, cord blood ghrelin levels and maternal and infant variables.

    MATERIALS AND METHODS: Placental ghrelin and leptin expression were analyzed by RT-PCR in 32 severely obese and 32 matched normal-weight women. Cord blood ghrelin, adiponectin, leptin, and C-peptide concentrations were analyzed by ELISA.

    RESULTS: Neither ghrelin nor leptin expression and neither cord blood ghrelin nor adiponectin levels differed between the groups. Placental ghrelin expression was associated with BMI at delivery in the obese women (r = 0.424, p = .016) and in the infants born to normal-weight women with their weight z-scores at six (r = -0.642, p = .010), nine (r = -0.441, p = .015), and 12 months of age (r = -0.402, p = .028).

    CONCLUSIONS: Placental ghrelin and leptin expression as well as cord blood ghrelin and adiponectin levels do not seem to be altered in severe maternal obesity. Placenta-derived ghrelin may influence the infants' postnatal weight gain, but possibly only when the mother has normal weight.

  • 15.
    Allbrand, Marianne
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Åman, Jan
    Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences. Department of Pediatrics, School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Expression of genes involved in inflammation and growth: does sampling site in human full-term placenta matter?2019In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 47, no 5, p. 539-546Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the placental gene expression of substances in the inflammatory cascade and growth factors at nine different well-defined sampling sites in full-term placentas from 12 normal weight healthy non-smoking women with an uncomplicated singleton pregnancy.

    Methods: All placentas (six girls and six boys) were delivered vaginally. Quantitative real-time polymerase chain reaction was used to analyze toll receptor-2 and -4, interleukin-6 and -8, tumor necrosis factor-α, leptin, ghrelin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor (IR).

    Results: The leptin gene and the IR gene showed higher expression in lateral regions near the chorionic plate compared to central regions near the basal plate (P = 0.028 and P = 0.041, respectively).

    Conclusion: Our results suggest that the sampling site may influence the gene expression for leptin and IR in placental tissue obtained from full-term normal pregnancies. We speculate that this may be due to differences in placental structure and perfusion and may be important when future studies are designed.

  • 16.
    Andersen, Randi Dovland
    et al.
    Telemarkshospitalet, Skien, Norway; Karolinska Institutet, Stockholm, Sweden.
    Axelin, Anna
    University of Turku, Turku, Finland.
    Kristjánsdóttir, Guðrún
    University of Iceland, Reykjavik, Iceland.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    PEARL—Pain in Early Life: A New Network for Research and Education2017In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 31, no 2, p. 91-95Article in journal (Refereed)
  • 17.
    Andersson, Ida-Maria
    et al.
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Nilsson, Sandra
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Adolfsson, Annsofie
    School of Life Sciences, University of Skövde, Skövde, Sweden; Department of Obstetrics and Gynecology, Skaraborg Hospital, Skövde, Sweden.
    How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again: a qualitative interview study2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 262-270Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again.

    Method: Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach.

    Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal.

    Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.

  • 18.
    Arntyr Hellgren, P.
    et al.
    Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Simmons, D.
    School of Medicine, Western Sydney University, Campbelltown NSW, Australia.
    Hanson, U.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Magnuson, A.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Birth trauma in babies born to women with and without type 1 diabetes in Sweden 1998-2012: relationship with maternal and baby weight2017In: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book, 2017, p. 66-67Conference paper (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.

  • 19.
    Ban, L.
    et al.
    Division of Epidemiology and Public Health, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
    West, J.
    Division of Epidemiology and Public Health, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
    Sultan, A. Abdul
    Division of Epidemiology and Public Health, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
    Dhalwani, N. N.
    Division of Epidemiology and Public Health, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
    Ludvigsson, Jonas F.
    Örebro University Hospital.
    Tata, L. J.
    Division of Epidemiology and Public Health, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
    Limited risks of major congenital anomalies in children of mothers with coeliac disease: a population-based cohort study2015In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, no 13, p. 1833-1841Article in journal (Refereed)
    Abstract [en]

    Objective: To examine major congenital anomaly (CA) risks in children of mothers with coeliac disease (CD) compared with mothers without CD.

    Design: Population-based cohort study.

    Setting: Linked maternal-child medical records from a large primary care database from the UK.

    Population: A total of 562332 live singletons of mothers with and without CD in 1990-2013.

    Methods: We calculated the absolute major CA risks in children whose mothers had CD, and whether this was diagnosed or undiagnosed before childbirth. Logistic regression with a generalised estimating equation was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) for CAs associated with CD.

    Main outcome measures: Fourteen system-specific major CA groups classified according to the European Surveillance of Congenital Anomalies and neural tube defects (NTDs).

    Results: Major CA risk in 1880 children of mothers with CD was 293 per 10000 liveborn singletons, similar to the risk in those without CD (282; aOR 0.98, 95% CI 0.74-1.30). The risk was slightly higher in 971 children, whose mothers were undiagnosed (350; aOR 1.14, 95% CI 0.79-1.64), than in 909 children whose mothers were diagnosed (231; aOR 0.80, 95% CI 0.52-1.24). There was a three-fold increase in nervous system anomalies in the children of mothers with undiagnosed CD (aOR 2.98, 95%CI 1.06-8.33, based on five exposed cases and one had an NTD), and these women were all diagnosed with CD at least 4years after their children were born.

    Conclusions: There was no statistically significant increase in risk of major CAs in children of mothers with coeliac disease overall, compared with the general population.

  • 20.
    Baumgart, Juliane
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Evers, A. Stavreus
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Kallak, T. Kunovac
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Kushnir, M. M.
    ARUP Institute for Clinical and Experimental Pathology, Salt Lake City UT, USA; Department of Pathology, University of Utah School of Medicine, Salt Lake City, USA; Analytical Chemistry/Department of Chemistry, Biomedical Center and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Bergquist, J.
    Department of Pathology, University of Utah School of Medicine, Salt Lake City UT, USA; Analytical Chemistry/Department of Chemistry, Biomedical Center and SciLife Laboratory, Uppsala University, Uppsala, Sweden.
    Poromaa, I. Sundström
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Androgen levels during adjuvant endocrine therapy in postmenopausal breast cancer patients2014In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 17, no 1, p. 48-54Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate plasma steroid hormone levels in postmenopausal breast cancer patients with and without adjuvant endocrine therapy and in healthy postmenopausal women.

    Methods: Steroid hormone levels in postmenopausal breast cancer patients treated with aromatase inhibitors (n = 32) were compared with breast cancer patients treated with tamoxifen (n = 34), breast cancer patients without adjuvant endocrine therapy (n = 15), and healthy postmenopausal women (n = 56). Pregnenolone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, cortisone, dehydroepiandrosterone (DHEA), androstenedione, total testosterone, dihydrotestosterone, estrone and estradiol were measured using liquid chromatography-tandem mass spectrometry. Sex hormone binding globulin was measured by solid-phase chemiluminescent immunometric assays, and the free androgen index was calculated.

    Results: Aromatase inhibitor users did not differ in dihydrotestosterone, total testosterone, androstenedione, DHEA, or free androgen index levels from healthy controls or untreated breast cancer patients. The highest total testosterone levels were found in tamoxifen-treated women, who had significantly higher plasma concentrations than both women treated with aromatase inhibitors and breast cancer patients without adjuvant treatment. Concentrations of cortisol and cortisone were significantly greater in aromatase inhibitor users as well as tamoxifen users, in comparison with healthy controls and untreated breast cancer patients. Aromatase inhibitor users had lower estrone and estradiol plasma concentrations than all other groups.

    Conclusion: Adjuvant treatment with aromatase inhibitors or tamoxifen was associated with increased cortisol and cortisone plasma concentrations as well as decreased estradiol concentrations. Androgen levels were elevated in tamoxifen-treated women but not in aromatase inhibitor users.

  • 21. Bejerot, Susanne
    et al.
    Humble, Mats B.
    D-vitamin och graviditet [Vitamin D and pregnancy]: Etnisk-kulturella riktlinjer efterlyses [Ethnocultural guidelines wanted]2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 35, p. 2343-2344Article in journal (Refereed)
  • 22.
    Bergengren, Lovisa
    et al.
    Örebro University, School of Health Sciences. Department of Women’s Health, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kaliff, Malin
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lillsunde-Larsson, Gabriella
    Örebro University, School of Health Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Karlsson, Mats
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Helenius, Gisela
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Comparison between professional sampling and self-sampling for HPV-based cervical cancer screening among postmenopausal women2018In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 142, no 3, p. 359-364Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether self-sampling is as reliable as professional sampling for HPV testing and genotype detection among postmenopausal women.

    METHODS: In the present prospective cross-sectional study, women in Örebro County, Sweden, who had high-risk HPV (hrHPV) and normal cytology results in exit screening tests conducted in between January 1, 2012, and December 31, 2014, were invited to follow-up screenings between February 24, 2015 and May 15, 2015, that included professional sampling and self-sampling. HPV genotypes were identified by a DNA-based assay that could detect 35 HPV genotypes. Findings between the different sampling methods were compared.

    RESULTS: Of 143 women who participated, 119 returned a self-sample. Completely concordant results were observed in 67 of these samples when both hrHPV and low-risk HPV genotypes were analyzed. Overall, 99 (83.2%) women had the same clinically relevant finding from both sampling methods. Twenty women had discordant hrHPV results (hrHPV detected in 10 self-samples vs 10 professionally collected samples; Cohen κ 0.66, 95% confidence interval 0.53-0.80). There was no significant difference between the two sampling methods for clinically significant infections (P>0.99) or extended genotyping (P=0.827).

    CONCLUSION: Postmenopausal women could be offered self-sampling devices to increase screening-program coverage while maintaining test quality.

  • 23.
    Bohr Mordhorst, Louise
    et al.
    Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Ahlin, Cecilia
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Sorbe, Bengt
    Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Prognostic impact of the expression of Hedgehog proteins in cervical carcinoma FIGO stages I-IV treated with radiotherapy or chemoradiotherapy2014In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 135, no 2, p. 305-311Article in journal (Refereed)
    Abstract [en]

    Objective: Hedgehog signaling proteins were assessed in patients with cervical carcinoma receiving chemoradiation. Associations between five Hedgehog proteins and prognosis were studied.

    Methods: In all, 131 cases of cervical carcinomas (FIGO stages I-IV) were immunohistochemically (IHC) analyzed for Patched (PTCH), Smoothened (SMO), and GLI1, GLI2 and GLI3 protein expression. Associations between Hedgehog protein expressions, clinicopathological factors, and clinical outcome data were examined.

    Results: Positive IHC staining for the five Hedgehog proteins was recorded in 8% to 37% of the tumor cells. The highest frequency was noted for SMO and the lowest for all. There was a significant association between low SMO- and GLI2-expression and KRAS-mutation. Tumors with overexpressed SMO had a higher frequency of residual tumor or local recurrences than tumors with low SMO expression. Patients with tumors expressing PTCH in more than 75% of the cells had significantly (P = 0.023) better recurrence-free survival than patients with tumors with low expression. The opposite situation was true for SMO. For GLI2, there was a statistically significant difference with regard to overall (P = 0.004) and distant (P = 0.015) relapse rate for groups with expression of GLI2 in the range of 5-25% compared to higher rates.

    Conclusions: A predictive and prognostic value was found for PTCH, SMO, and GLI2 with regard to residual carcinoma, local recurrences, and for GLI2 distant relapses. The Hedgehog signaling pathway also seems to play an important role in cervical carcinogenesis together with HPV16-infection and KRAS-mutation.

  • 24.
    Bornehag, Carl-Gustaf
    et al.
    Department of Health, Karlstad University, Karlstad, Sweden; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Lindh, Christian
    Laboratory Medicine, Lund University, Lund, Sweden.
    Reichenberg, Abraham
    Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, USA.
    Wikström, Sverre
    Örebro University, School of Medical Sciences.
    Unenge Hallerback, Maria
    Department of Health, Karlstad University, Karlstad, Sweden.
    Evans, Sarah F.
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Sathyanarayana, Sheela
    Department of Pediatrics, University of Washington, Seattle, USA.
    Barrett, Emily S.
    Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.
    Nguyen, Ruby H. N.
    University of Minnesota, Minneapolis, Minnesota, USA.
    Bush, Nicole R.
    Department of Psychiatry and Pediatrics, Center for Health and Community, University of California, San Francisco, California, USA.
    Swan, Shanna H.
    Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Association of Prenatal Phthalate Exposure With Language Development in Early Childhood2018In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211Article in journal (Refereed)
    Abstract [en]

    Importance: Prenatal exposure to phthalates has been associated with neurodevelopmental outcomes, but little is known about the association with language development.

    Objective: To examine the association of prenatal phthalate exposure with language development in children in 2 population-based pregnancy cohort studies.

    Design, Setting, and Participants: Data for this study were obtained from the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study conducted in prenatal clinics throughout Värmland county in Sweden and The Infant Development and the Environment Study (TIDES) conducted in 4 academic centers in the United States. Participants recruited into both studies were women in their first trimester of pregnancy who had literacy in Swedish (SELMA) or English or Spanish (TIDES). This study included mothers and their children from both the SELMA study (n = 963) and TIDES (n = 370) who had complete data on prenatal urinary phthalate metabolite levels, language delay, and modeled covariables. For SELMA, the data were collected from November 1, 2007, to June 30, 2013, and data analysis was conducted from November 1, 2016, to June 30, 2018. For TIDES, data collection began January 1, 2010, and ended March 29, 2016, and data analysis was performed from September 15, 2016, to June 30, 2018.

    Main Outcomes and Measures: Mothers completed a language development questionnaire that asked the number of words their children could understand or use at a median of 30 months of age (SELMA) and 37 months of age (TIDES). The responses were categorized as fewer than 25, 25 to 50, and more than 50 words, with 50 words or fewer classified as language delay.

    Results: In the SELMA study, 963 mothers, 455 (47.2%) girls, and 508 [52.8%] boys were included. In TIDES, 370 mothers, 185 (50.0%) girls, and 185 (50.0%) boys were included in this analysis. The prevalence of language delay was 10.0% in both SELMA (96 reported) and TIDES (37 reported), with higher rates of delay in boys than girls (SELMA: 69 [13.5%] vs 27 [6.0%]; TIDES: 12 [12.4%] vs 14 [7.6%]). In crude analyses, the metabolite levels of dibutyl phthalate and butyl benzyl phthalate were statistically significantly associated with language delay in both cohorts. In adjusted analyses, a doubling of prenatal exposure of dibutyl phthalate and butyl benzyl phthalate metabolites increased the odds ratio (OR) for language delay by approximately 25% to 40%, with statistically significant results in the SELMA study (dibutyl phthalate OR, 1.29 [95% CI, 1.03-1.63; P = .03]; butyl benzyl phthalate OR, 1.26 [95% CI, 1.07-1.49; P = .003]). A doubling of prenatal monoethyl phthalate exposure was associated with an approximately 15% increase in the OR for language delay in the SELMA study (OR, 1.14; 95% CI, 1.00-1.31; P = .05), but no such association was found in TIDES (OR, 0.98; 95% CI, 0.79-1.23).

    Conclusions and Relevance: In findings from this study, prenatal exposure to dibutyl phthalate and butyl benzyl phthalate was statistically significantly associated with language delay in children in both the SELMA study and TIDES. These findings, along with the prevalence of prenatal exposure to phthalates, the importance of language development, and the inconsistent results from a 2017 Danish study, suggest that the association of phthalates with language delay may warrant further examination.

  • 25.
    Bornehag, Carl-Gustaf
    et al.
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden; SP Technical Research Institute of Sweden, Borås, Sweden.
    Moniruzzaman, Syed
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Larsson, Malin
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Lindström, Cecilia Boman
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden.
    Hasselgren, Mikael
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Bodin, Anna
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    von Kobyletzkic, Laura B.
    Clinical Research, County Council of Värmland, Karlstad, Sweden; Institute of Clinical Research, Lund University, Lund, Sweden.
    Carlstedt, Fredrik
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Lundin, Fredrik
    Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Nånberg, Eewa
    Department of Chemistry and Biomedical Sciences, Karlstad University, Karlstad, Sweden.
    Jönsson, Bo A. G.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Sigsgaard, Torben
    Department of Public Health, Unit of Environmental and Occupational Medicine, University of Aarhus, Aarhus, Denmark.
    Janson, Staffan
    Department of Health and Environmental Sciences, Karlstad University, Karlstad, Sweden; Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    The SELMA study: a birth cohort study in Sweden following more than 2000 mother-child pairs2012In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 26, no 5, p. 456-467Article in journal (Refereed)
    Abstract [en]

    Background:  This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring.

    Methods: The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio-economic status, living conditions, diet and medical history.

    Results: Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non-participants, 2091 women were invited to a non-respondent questionnaire in order to examine possible selection bias. We found a self-selection bias in the established cohort when compared with the non-participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single-family houses (67% vs. 60%).

    Conclusions: These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.

  • 26.
    Bornehag, C.-G.
    et al.
    Karlstad University, Karlstad, Sweden.
    Reichenberg, A.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Unenge Hallerback, M.
    Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Karlstad University, Karlstad, Sweden.
    Koch, H. M.
    Institute of the Ruhr-University, Bochum, Germany.
    Jonsson, B. A.
    Lund University, Lund, Sweden.
    Swan, S. H.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Prenatal exposure to acetaminophen and children's language development at 30 months2018In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 51, p. 98-103Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine prenatal APAP exposure in relation to language development in offspring at 30 months of age.

    METHOD: A population-based pregnancy cohort study including 754 women who enrolled in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study in pregnancy week 8-13. Two exposure measures were used: (1) maternally reported number of APAP tablets taken between conception and enrollment; (2) APAP urinary concentration at enrollment. Language development at 30 months was assessed by nurse's evaluation and parental questionnaire, including the number of words the child used (<25, 25-50 and >50). Main study outcome; parental report of use of fewer than 50 words, termed language delay (LD).

    RESULTS: 59.2% of women enrolled in weeks 8-13 reported taking APAP between conception and enrollment. APAP was measurable in all urine samples and urinary APAP was correlated with the number of APAP taken during pregnancy (P<0.01). Language delay was more prevalent in boys (12.6%) than girls (4.1%) (8.5% in total). Both the number of APAP tablets and urinary APAP concentration were associated with greater LD in girls but not in boys. The adjusted odds ratio (OR) for LD among girls whose mothers reported >6 vs. 0 APAP tablets was 5.92 (95% confidence interval (CI) 1.10-31.94). The OR for LD in girls whose mothers' urinary APAP was in the highest compared to the lowest quartile was 10.34 (95% CI 1.37-77.86). While it cannot be ruled out, our available data do not support confounding by indication.

    CONCLUSIONS: Given the prevalence of prenatal APAP use and the importance of language development, these findings, if replicated, would suggest that pregnant women should limit their use of this analgesic during pregnancy.

  • 27.
    Borneskog, Catrin
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Same, same but different: lesbian couples undergoing sperm donation2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress. 

    List of papers
    1. Relationship quality in lesbian and heterosexual couples undergoing treatment with assisted reproduction
    Open this publication in new window or tab >>Relationship quality in lesbian and heterosexual couples undergoing treatment with assisted reproduction
    2012 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 3, p. 779-786Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND

    One of the major factors impacting on a couple's relationship is the desire to have children. To many couples having a child is a confirmation of their love and relationship and a means to deepen and develop their intimate relationship. At the same time parental stress can impact on relationship quality. Relationship quality in lesbian couples is, currently, sparsely studied. The aim of the present study was to compare lesbian and heterosexual couples' perceptions of their relationship quality at the commencement of assisted reproduction, and to relate this to background data such as educational level, having previous children and, for lesbian couples, the use of a known versus anonymous donor.

    METHODS

    The present study is part of the prospective longitudinal 'Swedish study on gamete donation', including all fertility clinics performing donation treatment in Sweden. Of a consecutive cohort of 214 lesbian couples about to receive donor insemination and 212 heterosexual couples starting regular IVF treatment, 166 lesbian couples (78% response) and 151 heterosexual couples (71% response) accepted participation in the study. At commencement of assisted reproduction participants individually completed questionnaires including the instrument 'ENRICH', which is a standardized measure concerning relationship quality.

    RESULTS

    In general, the couples rated their relationship quality as good, the lesbian couple better than the heterosexuals. In addition, the lesbian women with previous children assessed their relationship quality lower than did the lesbian woman without previous children. For heterosexual couples previous children did not influence their relationship quality. Higher educational levels reduced the satisfaction with the sexual relationship (P = 0.04) for treated lesbian women, and enhanced the rating of conflict resolution for treated lesbian women (P = 0.03) and their partners (P = 0.02). Heterosexual women with high levels of education expressed more satisfaction with communication in their relationship (P = 0.02) than did heterosexual women with lower educational levels.

    CONCLUSIONS

    In this Swedish study sample of lesbian and heterosexual couples' relationships, we found that they were generally well adjusted and stable in their relationships when starting treatment with donated sperm or IVF, respectively. However, where lesbian women had children from a previous relationship, it decreased relationship quality. For the heterosexual couples previous children did not affect relationship quality.

    Keywords
    relationship, sperm donation, lesbian
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:oru:diva-36977 (URN)10.1093/humrep/der472 (DOI)000300510100020 ()22252089 (PubMedID)2-s2.0-84857223530 (Scopus ID)
    Available from: 2012-02-15 Created: 2014-09-18 Last updated: 2018-05-13Bibliographically approved
    2. Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study
    Open this publication in new window or tab >>Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study
    Show others...
    2013 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 7, p. 839-846Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression.

    Design Descriptive: A part of the prospective longitudinal Swedish study on gamete donation'. Setting All university clinics in Sweden performing gamete donation. Population A consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated. Methods Participants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2months after treatment; and time point 3 (T3), 25years after first treatment. Main outcome measures Anxiety and depression (HADS), pregnancy outcome and future reproductive plans.

    Results: The vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P=0.011) and T3 (10% versus 4%, P=0.018), as well as symptoms of depression at T2 (4% versus 0%, P=0.03) and T3 (3% versus 0%, P=0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 25years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building.

    Conclusion: Lesbian women in Sweden reported good psychological health before and after treatment with donated sperm.

    Keywords
    Anxiety and depression, assisted reproduction, lesbian
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:oru:diva-36976 (URN)10.1111/1471-0528.12214 (DOI)000318795500008 ()2-s2.0-84877744201 (Scopus ID)
    Available from: 2013-06-24 Created: 2014-09-18 Last updated: 2018-09-13Bibliographically approved
    3. Parenting stress: comparisons between lesbian couples, heterosexual IVF-couples and spontaneous pregnat couples
    Open this publication in new window or tab >>Parenting stress: comparisons between lesbian couples, heterosexual IVF-couples and spontaneous pregnat couples
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    lesbian, parenting stress, sperm donation, toddlers
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:oru:diva-36979 (URN)
    Available from: 2013-10-29 Created: 2014-09-18 Last updated: 2017-10-17Bibliographically approved
    4. Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction
    Open this publication in new window or tab >>Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Keywords
    lesbian couples, sperm donation, relationships, assisted reproduction
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:oru:diva-36978 (URN)
    Available from: 2013-10-29 Created: 2014-09-18 Last updated: 2017-10-17Bibliographically approved
  • 28.
    Borneskog, Catrin
    et al.
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Lamoic, Claudia
    Karolinska Institutet, Neurobiology, Care Sciences and Society.
    Sydsjö, Gunilla
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University. Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden..
    Bladh, Marie
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University. Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden..
    Skoog Svanberg, Agneta
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproductionManuscript (preprint) (Other academic)
  • 29.
    Borneskog, Catrin
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
    Bladh, Marie
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University, Linköping, Sweden; Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden.
    Sydsjö, Gunilla
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University, Linköping, Sweden; Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden.
    Skoog Svanberg, Agneta
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction: a longitudinal follow-up study2014In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, no 1, article id 154Article in journal (Refereed)
    Abstract [en]

    Background: More and more lesbian couples are planning parenthood through donor insemination and IVF and the number of planned lesbian families is growing in Sweden and other western countries. Research has shown that lesbian couples report as much overall satisfaction in their relationships as do heterosexual couples. However, although parenthood is highly desired, many parents are unaware of the demands of parenthood and the strain on their relationship that the arrival of the baby might bring. The aim of this study was to compare lesbian and heterosexual couples¿ perceptions of relationship satisfaction at a three-year follow up after assisted reproduction.

    Methods: The present study is a part of the Swedish study on gamete donation, a prospective longitudinal cohort study. The present study constitutes a three-year follow up assessment of lesbian and heterosexual couples after assisted reproduction. Participants requesting assisted reproduction at all fertility clinics performing gamete donation in Sweden, were recruited consecutively during 2005-2008. A total of 114 lesbian women (57 treated women and 57 partners) and 126 heterosexual women and men (63 women and 63 men) participated. Participants responded to the ENRICH inventory at two time points during 2005¿2011; at the commencement of treatment (time point 1) and about three years after treatment termination (time point 3). To evaluate the bivariate relationships between the groups (heterosexual and lesbian) and socio-demographic factors Pearson's Chi- square test was used. Kolmogorov-Smirnov test was used for testing of normality, Mann-Whitney U- test to examine differences in ENRICH between the groups and paired samples t-test to examine scores over time.

    Results: Lesbian couples reported higher relationship satisfaction than heterosexual couples, however the heterosexual couples satisfaction with relationship quality was not low. Both lesbian and heterosexual couples would be classified (?) accordingly to ENRICH-typology as vitalized or harmonious couples.

    Conclusions: At a follow-up after assisted reproduction with donated sperm, lesbian couples reported stable relationships and a high satisfaction with their relationships, even when treatment was unsuccessful.

  • 30.
    Borneskog, Catrin
    et al.
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    Karolinska Institutet, Neurobiology, Care Sciences and Society.
    Sydsjö, Gunilla
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University. Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden..
    Bladh, Marie
    Division of Obstetrics and Gynecology, Department of Clinical and experimental Medicine, Faculty of Health and Science, Linköping University. Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden..
    Skoog Svanberg, Agneta
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Parenting stress: comparisons between lesbian couples, heterosexual IVF-couples and spontaneous pregnat couplesManuscript (preprint) (Other academic)
  • 31.
    Borneskog, Catrin
    et al.
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Skoog Svanberg, Agneta
    Department of Women's and Children's Health, Obstetrics and gynecology, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden.
    Sydsjö, Gunilla
    Obstetrics and Gynaecology, Department of Clinical Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Relationship quality in lesbian and heterosexual couples undergoing treatment with assisted reproduction2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 3, p. 779-786Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    One of the major factors impacting on a couple's relationship is the desire to have children. To many couples having a child is a confirmation of their love and relationship and a means to deepen and develop their intimate relationship. At the same time parental stress can impact on relationship quality. Relationship quality in lesbian couples is, currently, sparsely studied. The aim of the present study was to compare lesbian and heterosexual couples' perceptions of their relationship quality at the commencement of assisted reproduction, and to relate this to background data such as educational level, having previous children and, for lesbian couples, the use of a known versus anonymous donor.

    METHODS

    The present study is part of the prospective longitudinal 'Swedish study on gamete donation', including all fertility clinics performing donation treatment in Sweden. Of a consecutive cohort of 214 lesbian couples about to receive donor insemination and 212 heterosexual couples starting regular IVF treatment, 166 lesbian couples (78% response) and 151 heterosexual couples (71% response) accepted participation in the study. At commencement of assisted reproduction participants individually completed questionnaires including the instrument 'ENRICH', which is a standardized measure concerning relationship quality.

    RESULTS

    In general, the couples rated their relationship quality as good, the lesbian couple better than the heterosexuals. In addition, the lesbian women with previous children assessed their relationship quality lower than did the lesbian woman without previous children. For heterosexual couples previous children did not influence their relationship quality. Higher educational levels reduced the satisfaction with the sexual relationship (P = 0.04) for treated lesbian women, and enhanced the rating of conflict resolution for treated lesbian women (P = 0.03) and their partners (P = 0.02). Heterosexual women with high levels of education expressed more satisfaction with communication in their relationship (P = 0.02) than did heterosexual women with lower educational levels.

    CONCLUSIONS

    In this Swedish study sample of lesbian and heterosexual couples' relationships, we found that they were generally well adjusted and stable in their relationships when starting treatment with donated sperm or IVF, respectively. However, where lesbian women had children from a previous relationship, it decreased relationship quality. For the heterosexual couples previous children did not affect relationship quality.

  • 32.
    Broberg, Gudrun
    et al.
    The Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden; Närhälsan Primary Care, Western Health Care Region, Sweden.
    Strander, Björn
    The Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden.
    Ellis, Joy
    The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden; Närhälsan Primary Care, Western Health Care Region, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Attending cervical cancer screening, opportunities and obstacles: a qualitative study on midwives' experiences telephoning non-attendees in Sweden2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 7, p. 691-697Article in journal (Refereed)
    Abstract [en]

    Aim: Aspart of a research project aimed at increasing participation in the cervical cancer screening program (CCS), we explored midwives’ unique experiences of telephoning non-attendees and offering Pap smear appointments.

    Methods: Twenty midwives, in four focus groups, discussed their experiences of a study investigating ways to increase participation in the CCS. The group discussions were tape-recorded and transcribed verbatim and underwent qualitative content analysis.

    Results: Speaking with more than 1000 non-attendees provided the midwives with new perspective on the CCS and they realisedthat improving it might address a number of reasons for not participating. These reasons were often related to logistics, such as scheduling flexibility and appointment booking. The telephone conversations revealed that some women required more individual attention, while it was discovered that others did not require screening. The midwives considered the CCS to be life-saving; participating in this screening activity gave them a sense of satisfaction and pride.

    Conclusions: This study shows that midwives can improve access and prevent non-attendance at the cervical cancer screening program when they are aware of women’s varying requirements for attending screening.

  • 33.
    Broberg, Gudrun
    et al.
    Göteborgs universitet, Göteborg, Sweden.
    Strander, Björn
    Göteborgs universitet, Göteborg, Sweden.
    Ellis, Joy
    Göteborgs universitet, Göteborg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Attending cervical cancer screening, opportunities and obstacles: a qualitative study on midwives’ experiences telephoning non-attendees in Sweden2013In: Barnmorskekonferens 2013 Arlanda Sverige, 2013Conference paper (Refereed)
  • 34.
    Bruni, Mirian Pinheiro
    et al.
    Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Freitas da Silveira, Mariangela
    School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Stauffert, Dulce
    School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Bicca, Guilherme Lucas de Oliveira
    School of Medicine, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Caetano Dos Santos, Carolina
    Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    da Rosa Farias, Nara Amélia
    Biology Institute, Federal University of Pelotas (UFPel), Pelotas, Brazil.
    Golparian, Daniel
    Örebro University, School of Medical Sciences. WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine.
    Unemo, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine.
    Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study2019In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 95, no 2, p. 129-132Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Trichomonas vaginalis (TV) infection is the most common non-viral STI globally and can result in adverse pregnancy outcomes and exacerbated HIV acquisition/transmission. Nucleic acid amplification tests (NAATs) are the most sensitive diagnostic tests, with high specificity, but TV NAATs are rarely used in Brazil. We investigated the TV prevalence and compared the performance of the US Food and Drug Association-cleared Aptima TV assay with microscopy (wet mount and Gram-stained) and culture for TV detection in women in Pelotas, Brazil in an observational study.

    METHODS: From August 2015 to December 2016, 499 consecutive asymptomatic and symptomatic sexually active women attending a Gynaecology and Obstetrics Outpatient Clinic were enrolled. Vaginal fluid and swab specimens were collected and wet mount microscopy, Gram-stained microscopy, culture and the Aptima TV assay performed.

    RESULTS: The median age of enrolled women was 36.5 years (range: 15-77). The majority were white, had a steady sexual partner and low levels of education. The TV detection rate was 4.2%, 2.4%, 1.2% and 0% using the Aptima TV assay, culture, wet mount microscopy and Gram-stained microscopy, respectively. The sensitivity of culture and wet mount microscopy was only 57.1% (95% CI 36.5 to 75.5) and 28.6% (95% CI 13.8 to 50.0), respectively.

    CONCLUSIONS: was found among women in Pelotas, Brazil and the routine diagnostic test (wet mount microscopy) and culture had low sensitivities. More sensitive diagnostic tests (NAATs) and enhanced testing of symptomatic and asymptomatic at-risk women are crucial to mitigate the transmission of TV infection, TV-associated sequelae and enhanced HIV acquisition and transmission.

  • 35.
    Carlsson, Ing-Marie
    et al.
    School of Health and Welfare, Department of Health and Nursing, Halmstad University, Halmstad, Sweden.
    Berg, Marie
    Centre for Person-Centered Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    Sparud Lundin, Carina
    Centre for Person-Centered Care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Reprioritizing life: A conceptual model of how women with type 1 diabetes deal with main concerns in early motherhood2017In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, no Sup. 2, article id 1394147Article in journal (Refereed)
    Abstract [en]

    Purpose: Becoming a mother is related to increased demands for women with type 1 diabetes mellitus, and more research is needed to identify their needs for support in everyday living. Thus, the aim of this study was to explore the main concerns in daily life in early motherhood for women with type 1 diabetes and how they deal with these concerns.

    Method: A grounded theory study was conducted in which 14 women with type 1 diabetes were interviewed individually 7 to 17 months after childbirth.

    Results: A conceptual model was identified with the core category “reprioritizing life”, and three related categories: adjusting to motherhood, taking command of the diabetes, and seeking like-minded women. Becoming a mother was a turning point towards a greater awareness and acceptance of prioritizing diabetes management and health, and thus, life. There was a gap in provision of diabetes care after birth and during the time of early motherhood compared with during pregnancy.

    Conclusions: Healthcare contacts already planned before delivery can promote person-centred care during the whole period from pregnancy to motherhood. Moreover, providing alternative sources for health information and peer support could improve the life situation during early motherhood.

  • 36.
    Cnattingius, S.
    et al.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Kramer, M. S.
    Department of Pediatrics, McGill University Faculty of Medicine, Montreal QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal QC, Canada.
    Norman, M.
    Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Neonatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Fang, F.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lu, D.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Investigating fetal growth restriction and perinatal risks in appropriate for gestational age infants: using cohort and within-sibling analyses2019In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 126, no 7, p. 842-850Article in journal (Refereed)
    Abstract [en]

    Objective: Fetal growth restriction refers to fetuses that fail to reach their growth potential. Studies within siblings may be useful to disclose fetal growth restriction in appropriate for gestational age (AGA) infants. We analysed associations between birthweight percentiles and perinatal risks in AGA infants, using both population-based and within-sibling analyses.

    Design: Population-based cohort study. Setting and sample Using nation-wide Swedish registries (1987-2012), we identified 2 134 924 singleton AGA births (10th-90th birthweight percentile for gestational age), of whom 1 377 326 were full siblings.

    Methods: Unconditional Poisson regression was used for population analyses, and conditional (matched) Poisson regression for within-sibling analyses. We estimated associations between birthweight percentiles and stillbirth, neonatal mortality, and morbidity, using incidence rate ratios (IRRs) with 95% confidence intervals (CIs).

    Results: Stillbirth and neonatal mortality risks declined with increasing birthweight percentiles, but the declines were larger in within-sibling analyses. Compared with the reference group (40th to <60th percentile), IRRs (95% CIs) of stillbirth for the lowest and highest percentile groups (10th to <25th and 75th-90th percentiles, respectively) were 1.87 (1.72-2.03) to 0.76 (0.68-0.85) in population analysis and 2.60 (2.27-2.98) and 0.43 (0.36-0.50) in within-sibling analysis. Neonatal morbidity risks in term non-malformed infants with low birthweight percentiles were generally only increased in within-sibling analyses.

    Conclusion: Using birthweight information from siblings may help to define fetal growth restriction in AGA infants.

  • 37.
    Crafoord, Kristina
    et al.
    Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology, University Hospital, Örebro, Sweden.
    Brynhildsen, J.
    Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology, County Council of Östergötland, Linköping, Sweden.
    Hallböök, O.
    Department of Surgery, University Hospital, Linköping, Sweden.
    Kjølhede, P.
    Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology, County Council of Östergötland, Linköping, Sweden.
    Pelvic organ prolapse and anorectal manometry: A prospective study2012In: Urogynaecologia International Journal, ISSN 1121-3086, E-ISSN 2038-8314, Vol. 26, no 1, p. 12-16Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate associations between anal sphincter pressure and stage of prolapse and bowel and prolapse symptoms among women undergoing prolapse surgery and to determine whether anal sphincter pressure could predict symptomatic and anatomical outcomes of prolapse surgery. Fortytwo women with pelvic organ prolapse (POP) stage 2-3 were included in this prospective longitudinal study. Pre- and postoperative evaluation by means of a symptom questionnaire, clinical examination and anorectal manometry. The vaginal prolapse surgery included at the very least posterior colporrhaphy. Analysis of variance and covariance and logistic regression models were used for statistical analyses. The anal sphincter pressure at rest and squeeze was significantly lower in women with the symptom vaginal protrusion than in the women without the symptom. No associations were found between anal sphincter pressure and the extent or degree of prolapse or subjective and anatomical outcomes of POP surgery. The prolapse symptom vaginal protrusion is associated with a low anal sphincter pressure but the anal sphincter pressure does not seem to predict the outcome of POP surgery, neither regarding symptoms nor anatomy. © Copyright K. Crafoord et al., 2012.

  • 38. Crafoord, Kristina
    et al.
    Sydsjö, Adam
    Nilsson, Kerstin
    Örebro University, Department of Clinical Medicine.
    Kjølhede, Preben
    Primary surgery of genital prolapse: a shift in treatment tradition2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 9, p. 1104-1108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period. METHODS: A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data. RESULTS: The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001). CONCLUSION: The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.

  • 39.
    Dahmoun, Marju
    et al.
    Department of Obstetrics and Gynecology, Mid Sweden Research and Development Center, Sundsvall Hospital, Sundsvall, Sweden; Department of Obstetrics and Gynecology, University of Umeå, Umeå, Sweden.
    Odmark, Inga-Stina
    Department of Obstetrics and Gynecology, University of Umeå, Umeå, Sweden.
    Risberg, Björn
    Department of Pathology, The Norwegian Radium Hospital, Oslo, Norway.
    Karlsson, Mats G
    Department of Pathology, Örebro University Hospital, Örebro, Sweden.
    Pavlenko, Tatjana
    Department of Obstetrics and Gynecology, Mid Sweden Research and Development Center, Sundsvall Hospital, Sundsvall, Sweden.
    Bäckström, Torbjörn
    Department of Obstetrics and Gynecology, University of Umeå, Umeå, Sweden.
    Apoptosis, proliferation, and sex steroid receptors in postmenopausal endometrium before and during HRT2004In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 49, no 2, p. 114-123Article in journal (Refereed)
    Abstract [en]

    Objectives: Endometrial homeostasis, indicated as the balance between apoptosis and proliferation, was studied with regard to endometrial safety and bleeding disturbances.

    Materials and Methods: The quantitatively sufficient endometrial biopsies of 92 postmenopausal women enrolled in the study were investigated. The participants were divided into two groups, each receiving a continuous combined HRT regimen with either conjugated estrogen (CE) 0.625 mg + 5 mg medroxyprogesterone acetate (MPA) (=CE/MPA) or 17-beta-estradiol (E2) 2 mg + 1 mg norethisterone acetate (NETA) (=E2/NETA). These were evaluated according to apoptotic index (Ai) and proliferation marker Ki-67 index. Estrogen receptor alpha (ER) and progesterone receptor (PR) expression were also monitored, as well as endometrial thickness. Quantitative in situ techniques were used.

    Results: Ai and Ki-67 index were unchanged in epithelial glands of endometrium from baseline to second biopsy obtained after 1 year of combined continuous HRT. In stromal tissue, Ki-67 index was increased, while Ai was on the same level. PR expression in both epithelium and stroma was unchanged. Endometrial thickness was unaffected during therapy, and the histopathological evaluation showed no development of hyperplasia or carcinoma.

    Conclusions: The unaffected homeostasis in endometrial epithelium contributes to endometrial safety and is in accordance with the histopathological findings of no hyperplasia. The homeostasis of stroma was transformed to be more proliferative. Increased stromal proliferation may be of importance for stromal support of the veins and for decreasing breakthrough bleeding during HRT. The increased stromal proliferation, as well as the decreased ER expression both in epithelium and stroma, could be an effect of progesterone.

  • 40.
    Derakhshan, Arash
    et al.
    Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
    Shu, Huan
    Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden.
    Broeren, Maarten A. C.
    Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run, The Netherlands.
    de Poortere, Ralph A.
    Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run, The Netherlands.
    Wikström, Sverre
    Örebro University, School of Medical Sciences.
    Peeters, Robin P.
    Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
    Demeneix, Barbara
    Laboratoire d'Evolution des Régulations Endocriniennes, Muséum National d'Histoire Naturelle, Paris, France.
    Bornehag, Carl-Gustaf
    Division of Public Health Sciences, Karlstad University, Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, New York City NY, USA.
    Korevaar, Tim I. M.
    Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
    Reference ranges and determinants of thyroid function during early pregnancy: the SELMA study2018In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 103, no 9, p. 3548-3556Article in journal (Refereed)
    Abstract [en]

    Context: Establishing reference ranges as well as identifying and quantifying the determinants of thyroid function during pregnancy is important for proper clinical interpretation and optimizing research efforts. However, such data are sparse, specifically for (F)T3 measurements and most studies do not take into account thyroid antibodies or hCG.

    Objective: To determine reference ranges and to identify/quantify determinants of TSH, FT4, FT3, TT4 and TT3.

    Design, Setting and Participants: This study included 2,314 participants of the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study, a population-based prospective pregnancy cohort of mother-child pairs. Reference ranges were calculated by 2.5-97.5th percentiles after excluding TPOAb and/or TgAb positive women.

    Intervention: None.

    Main Outcome Measures: TSH, FT4, FT3, TT4 and TT3 in prenatal serum.

    Results: After exclusion of TPOAb positive women, reference range were: TSH: 0.11-3.48 mU/L, FT4: 11.6-19.4 pmol/L, FT3: 3.72-5.92 pg/mL, TT4: 82.4-166.2 pmol/L and TT3: 1.28-2.92 nmol/L. Additional exclusion of TgAb positive women did not change the reference ranges substantially. Exposure to tobacco smoke, as assessed by questionnaires and serum cotinine, was associated with lower TSH and higher FT3 and TT3. BMI and gestational age were the main determinants of TSH (only for BMI), FT4, FT3, TT4 and TT3.

    Conclusions: We show that the exclusion of TgAb positive women on top of excluding TPOAb positive women hardly affects clinical reference ranges. We identified various relevant clinical determinants of TSH, FT4, FT3, TT4 and TT3 which could reflect endocrine disrupting effects and/or effects on thyroid hormone transport or deiodination.

  • 41.
    Ekström, Linnea
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ericson, Henrik
    Högskolan i Skövde, Skövde, Sweden.
    Poutakidis, Georgios
    Skaraborgs Sjukhus, Skövde, Sweden.
    Charonis, Georgios
    Larsson, Per-Göran
    Örebro University, School of Medicine, Örebro University, Sweden.
    Vaginal flora and urinary and vaginal group B streptococci in early pregnancy2013In: Gynecology, ISSN 2052-6210, Vol. 1Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV) is a risk factor for premature birth and group B streptococci (GBS) colonizing the vagina are etiological agents of neonatal infections. Significant growth of GBS in the vagina has been assumed to be detectable through urinary culture. The aim was to investigate the correlation between BV and the presence of GBS in qualitative vaginal or quantitative urinary culture, since this could predict a higher risk for perinatal morbidity.

    Design and setting: A consecutive prospective study of women in early pregnancy included 3101 women between 2007 and 2010, in a region of south-western Sweden.

    Methods: Vaginal and urine samples were obtained from women in early pregnancy at maternity health care clinics. BV was diagnosed according to the Ison/Hay classification. GBS in urine were detected in amounts as low as 100 CFU/ml. Vaginal culturing for GBS was obtained from a selected group of 481 women.

    Results: There was no difference in the prevalence of GBS in the urine among women with BV compared with women with lactobacilli flora (OR 0.7; 95% CI 0.4-1.1). Vaginal presence of GBS was found among 17.3% of women with BV and among 23.5% of women with lactobacilli flora (OR 0.7; 95% CI 0.3-1.4). Among the 105 women who had vaginal GBS, the urine culture of GBS was positive in only 21.9% of cases.

    Conclusions: Even though women with BV. have much higher concentration of bacteria in the vagina, they do not necessarily have more GBS in the vagina or urine. The modest correlation between positive vaginal culture and positive urine culture of GBS question the value of urinary culture for detection of vaginal GBS.

  • 42.
    Eriksson, Katarina
    et al.
    Hälsouniversitetet i Linköping, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Forsum, Urban
    Hälsouniversitetet Linköping, Sweden.
    Larsson, Per-Göran
    Skaraborgs Sjukhus, Skövde, Sweden.
    Prevalens och incidens av BV hos Ålands befolkning under fem år2008Conference paper (Refereed)
  • 43.
    Eriksson, Katarina
    et al.
    Hälsouniversitetet i Linköping, Linköping, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Larsson, Per-Göran
    Skaraborgs Sjukhus, Skövde, Sweden.
    Forserum, Urban
    BV är ett tillstånd som för vissa individer är konstant under lång tid2008Conference paper (Refereed)
  • 44.
    Fadl, Helena E.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gärdefors, Susanne
    Department of Obstetrics and Gynecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hjertberg, Ragnhild
    UltraGyn Clinic, Stockholm, Sweden.
    Nord, Eva
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Persson, Bengt
    Karolinska Institute, Stockholm, Sweden.
    Schwarcz, Erik
    Department of Internal Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Åman, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid K.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hanson, Ulf S. B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Children’s and Women’s Health, Uppsala University, Uppsala, Sweden.
    Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, p. 1181-1187Article in journal (Refereed)
    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.

  • 45.
    Fadl, Helena E.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Östlund, I. K. M.
    Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A. F. K.
    Statistical and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden.
    Hanson, U. S. B.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to20032010In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 27, no 4, p. 436-441Article in journal (Refereed)
    Abstract [en]

    Aims To determine maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden during 1991–2003, and to compare the outcomes in the two time periods.

    Methods This is a population-based cohort study using the Swedish Medical Birth Register data for the period 1991–2003. There were 1 260 297 women with singleton pregnancies registered during this time, of whom 10 525 were diagnosed with GDM, based on a 75 g oral glucose tolerance test. The main diagnostic criteria were fasting capillary whole blood glucose ≥ 6.1 mmol⁄l and 2 h blood glucose ≥ 9.0 mmol⁄l.

    Results Maternal characteristics differed significantly between the GDM and non-GDM group. Adjusted odds ratios (OR) were as follows: for pre-eclampsia, 1.81 (95% confidence interval (CI) 1.64–2.00); for shoulder dystocia, 2.74 (2.04–3.68); and for Caesarean section, 1.46 (1.38–1.54).No difference was seen in perinatal mortality, stillbirth rates, Apgar scores, fetal distress or transient tachypnoea. There was a markedly higher risk of large for gestational age,OR3.43 (3.21–3.67), and Erb’s palsy, OR 2.56 (1.96–3.32), in the GDMgroup, and statistically significant differences in prematurity < 37 weeks, birthweight > 4.5 kg, and major malformation, OR 1.19–1.71. No statistically significant improvement in outcomes was seen between the two study periods.

    Conclusions Women with GDM have higher risks of pre-eclampsia, shoulder dystocia and Caesarean section. Their infants are often large for gestational age and have higher risks of prematurity, Erb’s palsy and major malformations. These outcomes did not improve over time.

  • 46.
    Fadl, Helena E.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Östlund, Ingrid K. M.
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf S. B.
    Department of Women’s and Children’ Health, Uppsala University, Uppsala County, Sweden.
    Outcomes of gestational diabetes in Sweden depending on country of birthManuscript (preprint) (Other academic)
  • 47.
    Fadl, Helena
    et al.
    Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Östlund, Ingrid
    Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Hanson, Ulf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Schwarcz, Erik
    Örebro University, School of Health Sciences. Department of Internal Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study2014In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, no 12, p. 1530-1536Article in journal (Refereed)
    Abstract [en]

    Objective: To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups.

    Design: Population-based matched case-control study.

    Setting: National Swedish register data from 1991 to 2008.

    Population: A total of 2639 women with a cardiovascular event and matched controls.

    Methods: Conditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role.

    Main outcome measures: Inpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease.

    Results: The adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07-2.14), 2.23 (2.01-2.48) for smoking, 1.98 (1.71-2.29) for obesity and 5.10 (3.18-8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI 25, with an odds ratio of 2.39 (1.39-4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13-3.52).

    Conclusions: In the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29.

  • 48.
    Fadl, Helena
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Montgomery, Scott
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Sweden; Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Public Health, Charing Cross Hospital, Imperial College, London, UK.
    Hanson, Ulf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Schwarcz, Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gestational diabetes mellitus is associated with later cardiovascular disease, particularly among overweight women: a Swedish population based case-control studyManuscript (preprint) (Other academic)
  • 49.
    Fadl, Helena
    et al.
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Östlund, Ingrid
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Nilsson, Kerstin
    Örebro University Hospital. Department of Clinical Medicine, Section of Obstetrics and Gynaecology.
    Hanson, U.
    Department of Woman’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus2007In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, no 3, p. 373-373Article in journal (Refereed)
  • 50.
    Fadl, Helena
    et al.
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Östlund, Ingrid
    Örebro University Hospital. Department of Obstetrics and Gynaecology .
    Nilsson, Kerstin
    Örebro University Hospital. Department of Obstetrics and Gynaecology and Department of Clinical Medicine, Section of Obstetrics and Gynecology.
    Hanson, U
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus2006In: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, no 9, p. 1067-71Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.

    Design: Cross-sectional, population-based study.

    Setting: Maternal Health Care Clinics in Orebro County, Sweden.

    Population: An unselected population of women without diabetes.

    Methods: Fasting capillary glucose levels were measured at gestational weeks 28-32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test.

    Main outcome measures: Sensitivity, specificity, likelihood ratios.

    Results: In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone.

    Conclusion: In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.

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