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  • 1.
    Allbrand, Marianne
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Dept Obstet & Gynaecol, Örebro Univ Hosp, Örebro, Sweden.
    Björkqvist, Maria
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Region Örebro län. Örebro universitet. 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 women2015Inngår i: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 43, nr 2, s. 159-164Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Austeng, Dordi
    et al.
    Dept Ophthalmol, Uppsala Univ, Uppsala, Sweden.
    Blennow, Mats
    Dept Pediat, Karolinska Univ Hosp Huddinge, Stockholm, Sweden .
    Ewald, Uwe
    Dept Pediat, Uppsala Univ, Uppsala, Sweden.
    Fellman, Vineta
    Dept Pediat, Lund Univ, Lund, Sweden.
    Fritz, Thomas
    Dept Obstet & Gynecol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Hellstrom-Westas, Lena
    Dept Pediat, Uppsala Univ, Uppsala, Sweden .
    Hellstrom, Ann
    Dept Ophthalmol, Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Holmgren, Per Åke
    Dept Clin Sci Obstet & Gynecol, Umeå Univ Hosp, Umeå, Sweden.
    Holmstrom, Gerd
    Dept Ophthalmol, Uppsala Univ, Uppsala, Sweden.
    Jakobsson, Peter
    Dept, Ophthalmol, Linkoping Univ, Linkoping, Sweden.
    Jeppsson, Annika
    Dept Obstet & Gynecol, Linköping Univ, Linköping, Sweden.
    Johansson, Kent
    Dept Ophthalmol, Umeå Univ, Umeå, Sweden.
    Kallén, Karin
    Ctr Reprod Epidemiol, Lund Univ, Lund, Sweden.
    Lagercrantz, Hugo
    Dept Pediat, Karolinska Inst, Astrid Lindgren Childrens Hosp, Stockholm, Sweden.
    Laurini, Ricardo
    Dept Pathol, Bodø Cent Hosp, Bodø, Norway.
    Lindberg, Eva
    Department of Pediatrics, Örebro University, Örebro, Sweden.
    Lundqvist, Anita
    Dept Hlth Sci, Lund Univ, Lund, Sweden.
    Marsal, Karel
    Dept Obstet & Gynecol, Lund Univ, Lund, Sweden.
    Nilstun, Tore
    Dept Med Eth, Lund Univ, Lund, Sweden.
    Norden-Lindeberg, Solveig
    Dept Obstet & Gynecol, Uppsala Univ, Uppsala, Sweden.
    Norman, Mikael
    Dept Clin Sci Intervent & Technol, Karolinska Inst, Stockholm, Sweden; Dept Pediat, Karolinska Univ Hosp, Stockholm, Sweden.
    Olhager, Elisabeth
    Dept Pediat, Linköping Univ, Linköpinging, Sweden; Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden .
    Östlund, Ingrid
    Örebro universitet, Hälsoakademin.
    Serenius, Fredrik
    Dept Pediat, Umeå Univ Hosp, Umeå, Sweden.
    Simic, Marija
    Dept Obstet & Gynecol, Karolinska Univ Hosp Solna, Stockholm, Sweden.
    Sjors, Gunnar
    Dept Pediat, Uppsala Univ, Uppsala, Sweden.
    Stigson, Lennart
    Dept Pediat, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Stjernqvist, Karin
    Dept Psychol, Lund Univ, Lund, Sweden.
    Stromberg, Bo
    Dept Pediat, Uppsala Univ, Uppsala, Sweden.
    Tornqvist, Kristina
    Dept Ophthalmol, Lund Univ, Lund, Sweden.
    Wennergren, Margareta
    Dept Obstet & Gynecol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Wallin, Agneta
    St Erik Eye Hosp, Karolinska Univ, Stockholm, Sweden.
    Westgren, Magnus
    Dept Obstet & Gynecol, Karolinska Univ Hosp Huddinge, Stockholm, Sweden.
    Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)2010Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, nr 7, s. 978-992Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 3.
    Blennow, Mats
    et al.
    Karolinska Univ Hosp, Dept Pediat, Huddinge, Sweden; Karolinska Inst, Dept Clin Invest Intervent & Technol, Stockholm, Sweden.
    Ewald, Uwe
    ppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Fritz, Tomas
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, S-41345 Gothenburg, Sweden.
    Holmgren, Per Åke
    Umea Univ, Dept Clin Sci Obstetr & Gynecol, Umea, Sweden.
    Jeppsson, Annika
    Linkoping Univ, Dept Obstet & Gynecol, Linkoping, Sweden.
    Lindberg, Eva
    Örebro universitet, Hälsoakademin.
    Lundqvist, Anita
    Lund Univ, Dept Hlth Sci, Lund, Sweden.
    Lindeberg, Solveig Nordén
    Uppsala Univ, Dept Obstet & Gynecol, Uppsala, Sweden.
    Olhager, Elisabeth
    Linkoping Univ, Dept Pediat, S-58183 Linkoping, Sweden.
    Östlund, Ingrid
    Orebro Univ Hosp, Dept Obstet & Gynecol, Orebro, Sweden.
    Simic, Marija
    Karolinska Univ Hosp Solna, Dept Obstet & Gynecol, Stockholm, Sweden.
    Sjoers, Gunnar
    Uppsala Univ, Dept Pediat, Uppsala, Sweden.
    Stigson, Lennart
    Sahlgrens Univ Hosp, Dept Pediat, Gothenburg, Sweden.
    Fellman, Vineta
    Lund Univ, Dept Pediat, S-22100 Lund, Sweden.
    Hellstrom-Westas, Lena
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Norman, Mikael
    Karolinska Inst, Dept Clin Invest Intervent & Technol, Stockholm, Sweden; Karolinska Univ Hosp, Dept Pediat, Huddinge, Sweden.
    Westgren, Magnus
    Karolinska Univ Hosp Huddinge, Dept Obstet & Gynecol, Stockholm, Sweden.
    Holmstrom, Gerd
    Uppsala Univ, Dept Ophthalmol, Uppsala, Sweden.
    Laurini, Ricardo
    Nordland Hosp, Dept Pathol, Bodo, Norway.
    Stjernqvist, Karin
    Lund Univ, Dept Psychol, S-22100 Lund, Sweden.
    Kallén, Karin
    Lund Univ, Ctr Reprod Epidemiol, S-22100 Lund, Sweden.
    Lagercrantz, Hugo
    Karolinska Inst, Dept Women & Child Hlth, Stockholm, Sweden; Astrid Lindgren Childrens Hosp, Stockholm, Sweden.
    Marsal, Karel
    Lund Univ, Dept Obstet & Gynecol, S-22100 Lund, Sweden.
    Serenius, Fredrik
    Umea Univ, Dept Clin Sci, S-90187 Umea, Sweden.
    Wennergren, Margareta
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Gothenburg, Sweden.
    Nilstun, Tore
    Lund Univ, Dept Med Eth, S-22100 Lund, Sweden.
    Olausson, Petra Otterblad
    Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden.
    Stromberg, Bo
    Uppsala Univ, Dept Pediat, Uppsala, Sweden.
    One-year survival of extremely preterm infants after active perinatal care in sweden2009Inngår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 301, nr 21, s. 2225-2233Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 4.
    Fadl, Helena E.
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    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 universitet, Institutionen för hälsovetenskap och medicin. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid K.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hanson, Ulf S. B.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. 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 diabetes2015Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 11, s. 1181-1187Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5.
    Fadl, Helena
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital.
    Östlund, Ingrid
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    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 universitet, Institutionen för hälsovetenskap och medicin.
    Schwarcz, Erik
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Gestational diabetes mellitus is associated with later cardiovascular disease, particularly among overweight women: a Swedish population based case-control studyManuskript (preprint) (Annet vitenskapelig)
  • 6.
    Fadl, Helena
    et al.
    Region Örebro län. Department of Obstetrics and Gynaecology .
    Östlund, Ingrid
    Region Örebro län. Department of Obstetrics and Gynaecology .
    Nilsson, Kerstin
    Region Örebro län. 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 mellitus2007Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, nr 3, s. 373-373Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Fadl, Helena
    et al.
    Region Örebro län. Department of Obstetrics and Gynaecology .
    Östlund, Ingrid
    Region Örebro län. Department of Obstetrics and Gynaecology .
    Nilsson, Kerstin
    Region Örebro län. 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 mellitus2006Inngår i: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, nr 9, s. 1067-71Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Fadl, Helena
    et al.
    Region Örebro län. Department of Obstetrics and Gynaecology.
    Östlund, Ingrid
    Region Örebro län. Department of Obstetrics and Gynaecology.
    Nilsson, Kerstin
    Region Örebro län. Department of Clinical Medicine, Section of Obstetrics and Gynaecology.
    Hanson, U.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus - Author's reply2007Inngår i: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 114, nr 2, s. 238-239Artikkel i tidsskrift (Fagfellevurdert)
  • 9. Falk, Gabriella
    et al.
    Östlund, Ingrid
    Örebro universitet, Institutionen för klinisk medicin.
    Magnuson, Anders
    Schollin, Jens
    Örebro universitet, Institutionen för klinisk medicin.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för klinisk medicin.
    Teenage mothers: a high-risk group for new unintended pregnancies2006Inngår i: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, nr 6, s. 471-475Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies.

    PURPOSE: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies.

    METHODS: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Orebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained.

    RESULTS: A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group.

  • 10. Jonsson, Maria
    et al.
    Nordén-Lindeberg, Solveig
    Östlund, Ingrid
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Örebro universitet, Hälsoakademin.
    Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor2008Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, nr 7, s. 745-750Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 11.
    Rönnberg, AnnKristin
    et al.
    Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial2016Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, nr 9, s. 999-1007Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 12.
    Rönnberg, AnnKristin
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden .
    Fadl, Helena
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Gottvall, T.
    Department of Obstetrics and Gynaecology, Linköping University Hospital, Linköping, Sweden .
    Nilsson, Kerstin
    Örebro universitet, Institutionen för läkarutbildning. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial2015Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, nr 4, s. 537-544Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

    Design: A randomised controlled interventional design.

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

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

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

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

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

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

  • 13.
    Åman, Jan
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Östlund, Ingrid
    Örebro universitet, Institutionen för klinisk medicin.
    Preventivmedelsrådgivning2008Inngår i: Barn- och ungdomsdiabetes / [ed] Sture Sjöblad, Lund: Studentlitteratur , 2008, 2, s. 195-197Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 14.
    Östlund, Ingrid
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Haglund, Bengt
    Hanson, Ulf
    Gestational diabetes and preeclampsia2004Inngår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 113, nr 1, s. 12-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To determine whether gestational diabetes mellitus (GDM) increases the risk for preeclampsia independent of other risk factors. Study design: The association between GDM and preeclampsia was analyzed in a population of women who had given birth to singletons registered in Swedish Medical Birth Register from 1992 through 1996 (n=430,852). Results: GDM occurred in 0.8% and preeclampsia in 2.9% of all pregnancies. The rate of preeclampsia was higher in the GDM than in the non-GDM group (6.1% versus 2.8%). High age, nullipara, chronic hypertension, kidney disease, and high body mass index (BMI) were all independently associated with increased risk for preeclampsia. Smoking was associated with decreased risk. Adjusted odds ratio for GDM as a risk factor for preeclampsia was 1.61 (95% confidence interval (CI) 1.39–1.86) when prepregnancy BMI, which was a true confounder, was included in the last step of the multiple logistic regression analysis. Conclusions: There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor but could not explain the total excess risk.

  • 15.
    Östlund, Ingrid
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test2003Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 82, nr 2, s. 103-108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT).

    METHODS:

    A prospective population-based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n = 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestational weeks 28-32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting-B-glucose and 2h-B-glucose, were registered.

    RESULTS:

    3616 (73.5%) women agreed to perform the OGTT. Sixty-one (1.7%) of those had GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mellitus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnestic risk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected.

    CONCLUSION:

    Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas.

  • 16.
    Östlund, Ingrid
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Repeated random blood glucose measurements as universal screening test for gestational diabetes mellitus2004Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, nr 1, s. 46-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    To determine the value of repeated random blood glucose (R-B-glucose) measurements alone or in combination with traditional risk factors [family history of diabetes, obesity, prior large-for-gestational-age (LGA) infant or prior gestational diabetes mellitus (GDM)] to predict the outcome of the oral glucose tolerance test (OGTT).

    METHODS:

    A prospective population-based study was undertaken in a Swedish county. All pregnant nondiabetic women (n = 4918) visiting the maternal health care clinics over a 2-year period were offered a 75-g OGTT in gestational weeks 28-32. Traditional risk factors and values of repeated R-B-glucose measurements were registered, as well as the results of the OGTT, in terms of fasting B-glucose and 2-h B-glucose.

    RESULTS:

    A total of 3616 women (73.5%) had an OGTT. Of these, 1.7% had GDM, 1.3% impaired glucose tolerance (IGT) and 0.4% diabetes mellitus (DM). An R-B-glucose cut-off level > or =8.0 mmol/L as the only indicator for an OGTT was optimal for detecting GDM with regard to sensitivity (47.5%) and specificity (97.0%). It has the same sensitivity for detecting GDM as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population. Combined with prior LGA infant or prior GDM as indications for the OGTT in the present study, all women with DM and 44.7% of those with IGT will be identified. Only 7.3% of the population will have to take the OGTT.

    CONCLUSION:

    A random B-glucose level > or = 8.0 mmol/L prior LGA infant or prior GDM as an indicator for taking the OGTT is a simple and effective first step in a two-step screening model for GDM.

  • 17.
    Östlund, Ingrid
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Björklund, Anders
    Hjertberg, Ragnhild
    Eva, Nord
    Nordlander, Elisabeth
    Swahn, Marja-Liisa
    Wager, Jan
    Maternal and fetal outcomes if gestational impaired glucose tolerance is not treated2003Inngår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 26, nr 7, s. 2107-2111Artikkel i tidsskrift (Fagfellevurdert)
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