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  • 1.
    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 universitet, Institutionen för medicinska vetenskaper. Region Örebro län. 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 weight2017Ingår i: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book, 2017, s. 66-67Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 2. Backman [Fadl], Helena
    Medicinsk ordlista1990Bok (Övrigt vetenskapligt)
  • 3. Devlieger, Roland
    et al.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Deruelle, Philippe
    Assessment of fetal and neonatal growth (including growth pattern in diabetes)2016Ingår i: 2016 AUDIT MEETING: Diabetic Pregnancy Study Group of the EASD, 2016Konferensbidrag (Refereegranskat)
  • 4.
    Fadl, Helena
    Örebro universitet, Hälsoakademin.
    Gestational diabetes mellitus in Sweden: screening, outcomes, and consequences2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Delarbeten
    1. Fasting capillary glucose as a screening test for gestational diabetes mellitus
    Öppna denna publikation i ny flik eller fönster >>Fasting capillary glucose as a screening test for gestational diabetes mellitus
    2006 (Engelska)Ingår i: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, nr 9, s. 1067-71Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    Oxford: Blackwell Publishing, 2006
    Nyckelord
    fasting capillary glucose; gestational diabetes mellitus; screening; sensitivity; specificity
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Forskningsämne
    Obstetrik och gynekologi
    Identifikatorer
    urn:nbn:se:oru:diva-4668 (URN)10.1111/j.1471-0528.2006.01032.x (DOI)000240030600015 ()16956338 (PubMedID)2-s2.0-33748161345 (Scopus ID)
    Anmärkning

    Comment in: BJOG. 2007 Feb;114(2):237-8; author reply 238-9. BJOG. 2007 Mar;114(3):372; author reply 373.

    Tillgänglig från: 2008-11-11 Skapad: 2008-11-11 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
    2. Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to2003
    Öppna denna publikation i ny flik eller fönster >>Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to2003
    2010 (Engelska)Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 27, nr 4, s. 436-441Artikel i tidskrift (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    Malden 02148, MA USA: Wiley-Blackwell, 2010
    Nyckelord
    gestational diabetes mellitus, maternal outcome, neonatal outcome
    Nationell ämneskategori
    Medicin och hälsovetenskap Reproduktionsmedicin och gynekologi
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-21259 (URN)10.1111/j.1464-5491.2010.02978.x (DOI)000276466600011 ()
    Tillgänglig från: 2012-01-23 Skapad: 2012-01-23 Senast uppdaterad: 2019-04-24Bibliografiskt granskad
    3. Outcomes of gestational diabetes in Sweden depending on country of birth
    Öppna denna publikation i ny flik eller fönster >>Outcomes of gestational diabetes in Sweden depending on country of birth
    (Svenska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nyckelord
    Gestational diabetes mellitus (GDM), ethnicity, LGA, maternal and neonatal outcomes, maternal anthropometrics
    Nationell ämneskategori
    Medicin och hälsovetenskap Reproduktionsmedicin och gynekologi
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-21269 (URN)
    Anmärkning

    Funding: Örebro County Council Research Funds, Sweden.

    Tillgänglig från: 2012-01-23 Skapad: 2012-01-23 Senast uppdaterad: 2019-04-24Bibliografiskt granskad
    4. Gestational diabetes mellitus is associated with later cardiovascular disease, particularly among overweight women: a Swedish population based case-control study
    Öppna denna publikation i ny flik eller fönster >>Gestational diabetes mellitus is associated with later cardiovascular disease, particularly among overweight women: a Swedish population based case-control study
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Medicin och hälsovetenskap Reproduktionsmedicin och gynekologi
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-21270 (URN)
    Anmärkning

    Helena Fadl is also affiliated to Maternal Health Care Unit,Primary Care, Örebro, Sweden and to Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden Ulf Hanson is affliated to Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden and to Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden Ingrid Östlund is also affiliated to Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden Scott Montgomery is also affiliated to Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Public Health, Charing Cross Hospital, Imperial College, London, UK Erik Schwarcz is also affiliated to Department of Internal Medicine, Örebro University Hospital, Sweden

    Tillgänglig från: 2012-01-23 Skapad: 2012-01-23 Senast uppdaterad: 2019-04-24Bibliografiskt granskad
  • 5.
    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 diabetes2015Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 11, s. 1181-1187Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Fadl, Helena E.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Simmons, David
    School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
    Trends in diabetes in pregnancy in Sweden 1998-20122016Ingår i: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 4, nr 1, artikel-id e000221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Diabetes in pregnancy has been shown to increase in parallel with the increasing prevalence of obesity. In this national population-based study, we analyzed the trends for gestational diabetes mellitus (GDM), type 1 diabetes in pregnancy, and type 2 diabetes in pregnancy in Sweden between 1998 and 2012.

    Research design and methods: A population-based cohort study using the Swedish national medical birth registry data. The time periods were categorized into 3-year intervals and adjusted for maternal body mass index (BMI), ethnicity, and age in a logistic regression.

    Results: Each type of diabetes increased over the studied 15-year period. Type 1 diabetes increased by 33.2% (22.2-45.3) and type 2 diabetes by 111% (62.2-174.4) in the adjusted model. Nordic women had the highest prevalence of type 1 diabetes (0.47%) compared with other ethnic groups. The increase in GDM and, to a lesser extent, type 2 diabetes was explained by country of birth, BMI, and maternal age. The prevalence of GDM in Nordic women (0.7-0.8%) did not increase significantly over the time period.

    Conclusions: All types of diabetes in pregnancy increased over the 15-year time period in Sweden. Maternal pre-pregnancy BMI remains the key factor explaining the increase in GDM/type 2 diabetes. How to turn around the growing prevalence of diabetes in pregnancy, with its short-term and long-term health effects on both mother and child, requires population-based interventions that reduce the likelihood of entering pregnancy with a raised BMI.

  • 7.
    Fadl, Helena E.
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    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 to20032010Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 27, nr 4, s. 436-441Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Fadl, Helena E.
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    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 birthManuskript (preprint) (Övrigt vetenskapligt)
  • 9.
    Fadl, Helena
    et al.
    Region Örebro län. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Östlund, Ingrid
    Region Örebro län. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Schwarcz, Erik
    Örebro universitet, Institutionen för hälsovetenskaper. 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 study2014Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, nr 12, s. 1530-1536Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    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) (Övrigt vetenskapligt)
  • 11.
    Fadl, Helena
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Maternal Health Care Unit, Primary Care, Örebro County, Örebro, Sweden; Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid K. M.
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Women’s and Children’ Health, Uppsala University, Uppsala, Sweden.
    Outcomes of gestational diabetes in Sweden depending on country of birth2012Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 11, s. 1326-1330Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non-Nordic women).

    Design: Population-based cohort study using the Swedish Medical Birth register.

    Setting: Data on pregnant women in Sweden with diagnosed GDM.

    Population: All singleton births to women with GDM between 1998 and 2007 (n = 8560).

    Methods: Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi-squared tests or Student's unpaired t-tests were used to analyze differences between maternal and fetal characteristics.

    Main outcome measures: Maternal and neonatal complications.

    Results: GDM incidence was higher at 2.0% among non-Nordic women, compared with 0.7% in the Nordic group. The non-Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non-Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large-for-gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non-Nordic group. Large-for-gestational age was dependent on maternal height [crude odds ratio 0.6 (0.5-0.7) and adjusted odds ratio 0.8 (0.6-0.9)].

    Conclusions: Non-Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large-for-gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.

  • 12.
    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 mellitus2007Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, nr 3, s. 373-373Artikel i tidskrift (Refereegranskat)
  • 13.
    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 mellitus2006Ingår i: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, nr 9, s. 1067-71Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    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 reply2007Ingår i: BJOG: an International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 114, nr 2, s. 238-239Artikel i tidskrift (Refereegranskat)
  • 15.
    Hildén, K.
    et al.
    Department of Obstetrics & Gynaecology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hanson, U.
    School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Persson, M.
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Universitetssjukhuset, Solna, Sweden.
    Magnuson, A.
    Örebro University, Örebro, Sweden.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics & Gynaecology.
    Gestational diabetes and adiposity are independent risk factors for perinatal outcomes: a population based cohort study in Sweden2019Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 36, nr 2, s. 151-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 16.
    Hildén, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Arntyr-Hellgren, Paulina
    Magnuson, Anders
    Hanson, Ulf
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Born over 4500 g: the trends in birth trauma and mode of delivery in women with GDM and type 1 diabetes in Sweden between 1998-20122018Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 17.
    Hildén, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynaecology.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskaper. DeDepartment of Obstetrics and Gynaecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Persson, M.
    Department of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynaecology.
    Overweight and obesity: a remaining problem in women treated for severe gestational diabetes2016Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, nr 8, s. 1045-1051Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To analyse the impact of overweight and obesity on the risk of adverse maternal outcomes and fetal macrosomia in pregnancies of women treated for severe gestational diabetes.

    Methods This was a population-based cohort study including all singleton pregnancies in Sweden without pre-existing diabetes in the period 1998-2012. Only mothers with an early- pregnancy BMI of ≥18.5 kg/m² were included. Logistic regression analysis was used to determine odds ratios with 95% CIs for maternal outcomes and fetal growth. Analyses were stratified by maternal gestational diabetes/non-gestational diabetes to investigate the impact of overweight/obesity in each group.

    Results: Of 1 249 908 singleton births, 13 057 were diagnosed with gestational diabetes (1.0%). Overweight/obesity had the same impact on the risks of caesarean section and fetal macrosomia in pregnancies with and without gestational diabetes, but the impact of maternal BMI on the risk of preeclampsia was less pronounced in women with gestational diabetes. Normal-weight women with gestational diabetes had an increased risk of caesarean section [odds ratio 1.26 (95% CI 1.16-1.37)], preeclampsia [odds ratio 2.03 (95% CI 1.71-2.41)] and large-for-gestational-age infants [odds ratio 2.25 (95% CI 2.06-2.46)]. Risks were similar in the overweight group without gestational diabetes, caesarean section [odds ratio 1.34 (1.33-1.36)], preeclampsia odds ratio [1.76 (95% CI 1.72-1.81)], large-for-gestational-age [odds ratio 1.76 (95% CI 1.74-1.79)].

    Conclusions: Maternal overweight and obesity is associated with similar increments in risks of adverse maternal outcomes and delivery of large-for-gestational-age infants in women with and without gestational diabetes. Obese women with gestational diabetes are defined as a high-risk group. Normal-weight women with gestational diabetes have similar risks of adverse outcomes to overweight women without gestational diabetes.

  • 18.
    Hildén, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics & Gynaecology.
    Hanson, Ulf
    Department of Women’s and Children’s Health, Uppsala University, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Persson, M.
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Universitetssjukhuset Solna, Karolinska Institutet, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, sweden.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics & Gynaecology.
    Are gestational diabetes and adiposity independent risk factors for perinatal outcomes?: A population based cohort study in Sweden2018Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Artikel i tidskrift (Refereegranskat)
  • 19.
    Hildén, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynaecology.
    Magnuson, A.
    Clinical Epidemiology and Biostatistics, Örebro University Hosptial, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Schwarcz, E.
    Department of Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hanson, U.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden .
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. School of Medicine, Western Sydney University, Campbelltown New South Wales, Australia.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynaecology.
    Cardiovascular disease among women with previous preeclampsia and/or gestational diabetes mellitus: a national case control studyManuskript (preprint) (Övrigt vetenskapligt)
  • 20.
    Hildén, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynaecology.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hanson, Ulf
    Clinical Epidemiology and Biostatistics, School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. School of Medicine, Western Sydney University, Campbelltown New South Wales, Australia.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynaecology.
    Trends in pregnancy outcomes for women with gestational diabetes mellitus in Sweden 1998-2012: a nationwide cohort studyManuskript (preprint) (Övrigt vetenskapligt)
  • 21. Kuusela, Phila
    et al.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Wesström, Jan
    Lindgren, Peter
    Hagberg, Henrik
    Jacobsson, Bo
    Wennerholm, Ulla-Britt
    Valentin, Lil
    Intra- and Interrater reliability of Transvaginal Sonographic Measurements of Cervixal length2018Konferensbidrag (Refereegranskat)
  • 22.
    Millbourn, C.
    et al.
    Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Dept of Infectious Diseases, I73, Karolinska University Hospital, Stockholm, Sweden.
    Lybeck, Charlotte
    Örebro universitet, Institutionen för medicinska vetenskaper. Dept of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Dept of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Fredlund, Hans
    Dept Clin Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lindahl, K.
    Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro universitet, Institutionen för medicinska vetenskaper. Dept of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Screening for HCV in pregnant women and their partners2017Ingår i: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 66, nr 1, s. S404-S405Artikel i tidskrift (Refereegranskat)
  • 23.
    Persson, M.
    et al.
    Clinical Epidemiological Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Obstetrics and Gynecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Perinatal outcome in relation to fetal sex in offspring to mothers with pre-gestational and gestational diabetes-a population-based study2014Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, nr 9, s. 1047-1054Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The objective of the present study was to investigate if perinatal outcome differs with fetal sex in pregnancies with maternal Type 1 diabetes, Type 2 diabetes or gestational diabetes.

    Methods: This was a population-based cohort study, with data from the Medical Birth Registry in Sweden throughout the period 1998-2007. Singleton pregnancies with maternal Type 1 diabetes (n = 4092), Type 2 diabetes (n = 412) and gestational diabetes (n = 8602) were identified based on the International Classification of Diseases, 10th edition code. For comparison, 905 565 pregnancies without diabetes were included. The primary outcome was a composite outcome, consisting of any of the following diagnoses: perinatal mortality rate, major malformation, preterm delivery, acute respiratory disorders and neonatal hypoglycaemia. Logistic regression was used to obtain odds ratios for adverse outcomes in male offspring within the diabetic and reference cohorts, respectively.

    Results: In pregnancies with diabetes, maternal characteristics did not differ with fetal sex, except for a higher rate of Caesarean delivery in male offspring of women with Type 1 diabetes. Male infants to mothers with Type 1 diabetes and gestational diabetes had significantly increased odds of respiratory disorders [adjusted odds ratio (confidence interval) Type 1 diabetes: 1.50 (1.12-2.02); gestational diabetes: 1.81 (1.27-2.57)]. Male infants to mothers with gestational diabetes also had significantly increased odds of major malformations [adjusted odds ratio: 1.44 (1.07-1.93)]. In offspring of mothers with Type 2 diabetes, odds ratios of most outcomes were higher in male infants; however, not significantly different from female infants. In pregnancies without diabetes, male infants had significantly higher odds of all adverse outcomes, except perinatal mortality rate.

    Conclusion: The risk of adverse perinatal outcome in offspring of mothers with Type 1 diabetes and gestational diabetes did not differ by sex, except for a higher risk in male infants for respiratory disorders. The risk of major malformations was also significantly increased in male offspring to mothers with gestational diabetes. In offspring of mothers with Type 2 diabetes, no significant differences between sexes were found.

  • 24.
    Persson, Martina
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hanson, Ulf
    Uppsala University, Uppsala, Sweden.
    Pasupathy, Dharmintra
    Kings College London, London, England.
    Disproportionate Body Composition and Neonatal Outcome in Offspring of Mothers With and Without Gestational Diabetes Mellitus2013Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 36, nr 11, s. 3543-3548Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM).

    RESEARCH DESIGN AND METHODSPopulation-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998-2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm(3)) was 90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0-3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes.

    RESULTSThe risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09-1.30]) and hypoglycemia (1.23 [1.11-1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section.

    CONCLUSIONSThe risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA.

  • 25.
    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 trial2015Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, nr 4, s. 537-544Artikel i tidskrift (Refereegranskat)
    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

  • 26.
    Saeedi, Maryam
    et al.
    Örebro university hospital, Örebro, Sweden.
    Hanson, U.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and GynaecologyUmeå University, Umeå, Sweden.
    Evaluation of screening methods for Gestational diabetes mellitus in Sweden2017Ingår i: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book, 2017, s. 79-80Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: The Swedish National Board of Health and Welfare (SNBHW) adopted the IADPSG criteria in 2015. However these criteria have not been implemented by the healthcare regions. In this cross-sectional, population-based study we evaluated the test characteristics of current screening methods in Sweden (risk factors or 2 hour OGTT) and different values of fasting blood glucose as indicators to perform an oral glucose tolerance test for diagnosing GDM. GDM is based on the IADPSG criteria (1.75 odds ratio (OR)) and HAPO data of 2.0 OR for adverse pregnancy outcomes.

    Method: Between 1994-1996 all pregnant women (n= 3616) in Örebro county were offered a 75 g oral glucose tolerance test with determination of fasting capillary blood glucose and 2-hour capillary blood glucose was used to diagnose GDM. Random blood glucose was measured four to six times during pregnancy. Data on traditional risk factors and BMI were registered during the maternal healthcare visits.

    Results: 15.5% women met the IDPSG criteria (1.75 OR) based on only two values in the OGTT, and 9.0% were diagnosed if using an OR of 2.0. Current screening methods in Sweden showed 33 % and 39 % sensitivity when using the IADPSG criteria and HAPO data of 2.0 OR, respectively. A fasting cut-off value of 4.8 mmol/l when using the IADPSG criteria (1.75 OR) showed 92 % sensitivity, 95 % specificity and occurred in 19% of the patients. A fasting cut-off value of 5.1 mmol/l when using the HAPO data of 2.0 OR showed 92 % sensitivity, 98 % specificity and occurred in 10% of the patients.

    Conclusion: Current screening methods for GDM screening in Sweden is poorly predictive of GDM according to the IADPSG criteria (1.75 OR) and HAPO data (2.0 OR), but fasting glucose showed good test characteristics and results in a lower rate of OGTTs.

  • 27.
    Saeedi, Maryam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Örebro University hospital, Örebro, Sweden.
    Hanson, Ulf
    Department of Women's and Children's health, Uppsala University, Uppsala, Sweden; Department of Obstetrics and Gynecology, School of medical health and sciences, Örebro University Hospital, Örebro, Sweden.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynecology, School of medical health and sciences, Örebro University Hospital, Örebro, Sweden; Macarthur Clinical School, Western Sydney University, Campbelltown, Australia.
    Fadl, Helena
    Department of Obstetrics and Gynecology.
    Characteristics of different risk factors and fasting plasma glucose for identifying GDM when using IADPSG criteria: a cross-sectional study2018Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, nr 1, artikel-id 225Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 28.
    Saeedi, Maryam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Magnuson, Anders
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    The CDC4G trial: Impact of Changing Diagnostic Criteria for Gestational diabetes in Sweden – a stepped wedge national cluster randomised controlled trial-study protocol2018Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 29.
    Skogsdal, Yvonne Rosalie Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Karlsson, Jan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Tydén, Tanja
    Department of Women's and Children's Health, Akademiska Sjukhuset, Uppsala, Sweden.
    An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial2019Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, nr 3, s. 203-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 30.
    Skogsdal, Yvonne Rosalie Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Maternal Health Care Unit.
    Karlsson, Jan Åke
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Tydén, Tanja Adele
    Department of Women’s and Children’s Health, Academic Hospital, Uppsala, Sweden.
    Contraceptive use and reproductive intentions among women requesting contraceptive counseling2018Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 11, s. 1349-1357Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 31. Valgeirsdottir, Inga-Ros
    et al.
    Hanson, Ulf
    Simmons, David
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Diet as treatment for GDM: enough for improving outcomes?2018Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

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