oru.sePublications
Change search
Refine search result
1234 101 - 150 of 165
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 101.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Neovius, Martin
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna , Sweden.
    Söderling, Jonas
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna , Sweden.
    Gudbjörnsdottir, Soffia
    The National Diabetes Register, Centre of Registers Västra Götaland, Sweden; Sahlgrenska Academy, Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Svensson, Ann-Marie
    The National Diabetes Register, Centre of Registers Västra Götaland, Sweden.
    Franzen, Stefan
    The National Diabetes Register, Centre of Registers Västra Götaland, Sweden.
    Stephansson, Olof
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Pasternak, Björn
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
    Periconception Glycemic Control in Women With Type 1 Diabetes and Risk of Major Birth Defects: Population-Based Cohort Study in Sweden2018In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 73, no 12, p. 667-669Article in journal (Other academic)
    Abstract [en]

    Poor glycemic control has been linked to both immediate (eg, ketoacidosis) and long-term (eg, mortality and cardiovascular disease) complications in people with type 1 diabetes. The risk of pregnancy-related complications is of particular relevance to women with type 1 diabetes.

  • 102.
    Ludvigsson, Jonas F.
    et al.
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Ström, Peter
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Lundholm, Cecilia
    Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden .
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Örtqvist, Åke
    Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden.
    Feltelius, Nils
    Medical Products Agency, Uppsala, Sweden.
    Granath, Fredrik
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Stephansson, Olof
    Department of Women's and Children's Health, Karolinska Institutet and Hospital, Stockholm, Sweden .
    Risk for Congenital Malformation With H1N1 Influenza Vaccine: A Cohort Study With Sibling Analysis2016In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 165, no 12, p. 848-855Article in journal (Refereed)
    Abstract [en]

    Background: Earlier studies reporting varying risk estimates for congenital malformation in offspring of mothers undergoing vaccination against H1N1 influenza during pregnancy did not consider the potential role of confounding by familial (genetic and shared environmental) factors.

    Objective: To evaluate an association between maternal H1N1 vaccination during pregnancy and offspring malformation, with familial factors taken into account.

    Design: Population-based prospective study.

    Setting: Sweden.

    Participants: Liveborn offspring born between 1 October 2009 and 1 October 2011 to mothers receiving monovalent AS03-adjuvanted H1N1 influenza vaccine (Pandemrix [GlaxoSmithKline]) during pregnancy. A total of 40 983 offspring were prenatally exposed to the vaccine, 14 385 were exposed within the first trimester (14 weeks), and 7502 were exposed during the first 8 weeks of pregnancy. Exposed offspring were compared with 197 588 unexposed offspring. Corresponding risks in exposed versus unexposed siblings were also estimated.

    Measurements: Congenital malformation, with subanalyses for congenital heart disease, oral cleft, and limb deficiency.

    Results: Congenital malformation was observed in 2037 (4.97%) exposed offspring and 9443 (4.78%) unexposed offspring. Adjusted risk for congenital malformation was 4.98% in exposed offspring versus 4.96% in unexposed offspring (risk difference, 0.02% [95% CI, -0.26% to 0.30%]). The corresponding risk differences were 0.16% (CI, -0.23% to 0.56%) for vaccination during the first trimester and 0.10% (CI, -0.41% to 0.62%) for vaccination in the first 8 weeks. Using siblings as comparators yielded no statistically significant risk differences.

    Limitations: The study was based on live births, and the possibility that data on miscarriage or induced abortion could have influenced the findings cannot be ruled out. Study power was limited in analyses of specific malformations.

    Conclusion: When intrafamilial factors were taken into consideration, H1N1 vaccination during pregnancy did not seem to be linked to overall congenital malformation in offspring, although risk increases for specific malformations could not be ruled out completely.

  • 103.
    Lundell, Inger Wallin
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden; Sophiahemmet Univ, Stockholm, Sweden.
    Poromaa, Inger Sundstrom
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Frans, Orjan
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Helstrom, Lotti
    Dept Clin Sci & Educ, Karolinska Inst, Stockholm, Sweden.
    Hogberg, Ulf
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Moby, Lena
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Nyberg, Sigrid
    Dept Clin Sci Obstet & Gynaecol, Umeå Univ, Umeå, Sweden.
    Sydsjo, Gunilla
    Fac Hlth Sci, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Ohman, Susanne Georgsson
    Stockholm, Sweden; Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden; Sophiahemmet Univ, Stockholm, Sweden.
    Östlund, Ingrid
    Örebro University Hospital. Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Svanberg, Agneta Skoog
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    The prevalence of posttraumatic stress among women requesting induced abortion2013In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 6, p. 480-488Article in journal (Refereed)
    Abstract [en]

    Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime-and point prevalence of PTSD were 7% (95% confi dence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

  • 104.
    Lundell, Inger Wallin
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden; Sophiahemmet Univ, Stockholm, Sweden.
    Öhman, Susanne Georgsson
    Sophiahemmet Univ, Stockholm, Sweden; Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden.
    Frans, Orjan
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Helstrom, Lotti
    Dept Clin Sci & Educ, Karolinska Inst, Stockholm, Sweden.
    Hogberg, Ulf
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Nyberg, Sigrid
    Dept Clin Sci Obstet & Gynaecol, Umeå Univ, Umeå, Sweden.
    Poromaa, Inger Sundstrom
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Sydsjo, Gunilla
    Fac Hlth Sci, Dept Clin & Expt Med, Div Obstet & Gynaecol, Linköping University, Linköping, Sweden.
    Östlund, Ingrid
    Dept Obstet & Gynaecol, Örebro University Hospital, Örebro, Sweden.
    Svanberg, Agneta Skoog
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study2013In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 13, article id 52Article in journal (Refereed)
    Abstract [en]

    Background: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. Methods: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups. Results: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. Conclusion: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

  • 105.
    Lundh, Marie Hoyer
    et al.
    Reg Canc Ctr, Univ Uppsala Hosp, Uppsala, Sweden; Dept Publ Hlth & Caring Sci,Uppsala Univ, Uppsala, Sweden.
    Lampic, Claudia
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Nordin, Karin
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden; Dept Neurobiol Care Sci & Soc, Karolinska Inst, Huddinge, Sweden; Dept Global Publ Hlth & Primary Care, Univ Bergen, Bergen, Norway.
    Ahlgren, Johan
    Department of Oncology, Örebro University Hospital, Örebro, Sweden; Centre for Research and Development, County of Gävleborg, Uppsala University, Gävle, Sweden.
    Bergkvist, Leif
    Dept Surg, Västmanland Cty Hosp, Uppsala Univ, Västerås, Sweden; Clin Res Ctr, Västmanland Cty Hosp, Uppsala Univ, Västerås, Sweden.
    Lambe, Mats
    Reg Canc Ctr, Univ Uppsala Hosp, Uppsala, Sweden; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Berglund, Anders
    Reg Canc Ctr, Univ Uppsala Hosp, Uppsala, Sweden; Dept Surg Sci, Univ Uppsala Hosp, Uppsala Univ, Uppsala, Sweden.
    Johansson, Birgitta
    Dept Radiol Oncol & Radiat Sci, Univ Uppsala Hosp, Uppsala Univ, Uppsala, Sweden.
    Sickness absence and disability pension following breast cancer - A population-based matched cohort study2014In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 23, no 6, p. 844-851Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis.

    Results: Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05).

    Conclusions: Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.

  • 106.
    Maghsoudlou, Siavash
    et al.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Aarabi, Mohsen
    Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Semnani, Shahriar
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Stephansson, Olof
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Wikström, Anna-Karin
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Bahmanyar, Shahram
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran; Clinical Epidemiology Unit, Center for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 10, p. 1095-1101Article in journal (Refereed)
    Abstract [en]

    Introduction: Consanguineous marriage is associated with increased risks for congenital anomalies, low birthweight, and other adverse perinatal outcomes. In this population-based, case-control study we investigated the association between consanguineous marriage (first-cousin marriage) and stillbirth risk, using prospectively collected information from prepregnancy visits.

    Material and methods: From 2007 to 2009, we identified 283 stillbirths (cases) and 2088 randomly selected live control births through prepregnancy visits in rural Golestan, Iran. The associations between consanguinity and prepregnancy maternal characteristics and stillbirth risk were examined using multivariate logistic regression.

    Results: The rate of consanguineous marriage was 19.4% among cases and 13.6% among controls. Consanguinity was associated with increased stillbirth risk [ odds ratio (OR) 1.53; 95% CI 1.10-2.14]. The association was significantly increased for preterm stillbirth (< 37 gestational weeks) (OR 2.43; 95% CI 1.46-4.04) but not for term stillbirth (>= 37 weeks) (OR 1.14; 95% CI 0.75-1.74). Low and high maternal age, underweight, obesity, nulliparity, a history of infertility or miscarriage, previous obstetric complications (preeclampsia, preterm delivery, and stillbirth in previous pregnancies) were also associated with increased stillbirth risks.

    Conclusions: Consanguineous marriage is associated with increased risk of stillbirth, particularly preterm stillbirth. Findings for other maternal risk factors for stillbirth in rural Iran are consistent with previously reported findings from high-income countries.

  • 107.
    Maghsoudlou, Siavash
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden; Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Aarabi, Mohsen
    Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Semnani, Shahriar
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Wikström, Anna-Karin
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden; Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Bahmanyar, Shahram
    Clinical Epidemiology Unit & Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Solna, Sweden.
    Opium use during pregnancy and infant size at birth: a cohort study2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 358Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The reported positive association between opiatic drug use during pregnancy and adverse pregnancy outcomes might be confounded by other factors related to high-risk behaviors, including the use of other harmful substances. In rural areas of Iran, opium use during pregnancy is relatively common among women who otherwise do not have a hazardous lifestyle, which reduces the risk of residual confounding and increasing the possibility to identify its effects. We aimed to examine the association of antenatal exposure to opium with risks of small for gestational age, short birth length, and small head circumference at birth.

    METHOD: In this cohort study in the rural area of the Golestan province, Iran, we randomly selected 920 women who were exposed to opium during pregnancy and 920 unexposed women during 2008-2010. Log-binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI) for the associations between prenatal exposure to opium and risks of small for gestational age, short birth length, and small head circumference at birth.

    RESULTS: Compared with non-use of opium and tobacco during pregnancy, using opium only and dual use of opium and tobacco were associated with increased risks of small for gestational age at births (RR = 1.71; 95% CI 1.34-2.18 and RR = 1.62; 95% CI 1.13-2.30, respectively). Compared with non-use of opium and tobacco, exposure to only opium or dual use of opium and tobacco were also associated with more than doubled increased risks of short birth length, and small head circumference in term infants.

    CONCLUSION: Maternal opium use during pregnancy is associated with increased risks of giving birth to a small for gestational age infant, as well as a term infant with short birth length or small head circumference.

  • 108.
    Maghsoudlou, Siavash
    et al.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Stephansson, Olof
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Aarabi, Mohsen
    Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Semnani, Shahriar
    Golestan University of Medical Sciences, Gorgan, Iran.
    Montgomery, Scott M.
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Research Department of Epidemiology and Public Health, University College London, London, UK.
    Bahmanyar, Shahram
    Golestan University of Medical Sciences, Gorgan, Iran; Clinical Epidemiology Unit & Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Maternal haemoglobin concentrations before and during pregnancy and stillbirth risk: a population-based case-control study2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1, article id 135Article in journal (Refereed)
    Abstract [en]

    Background: Results of previous studies on the association between maternal haemoglobin concentration during pregnancy and stillbirth risk are inconclusive. It is not clear if haemoglobin concentration before pregnancy has a role. Using prospectively collected information from pre-pregnancy and antenatal visits, we investigated associations of maternal haemoglobin concentrations before and during pregnancy and haemoglobin dilution with stillbirth risk.

    Methods: In a population-based case-control study from rural Golestan, a province in northern Iran, we identified 495 stillbirths (cases) and randomly selected 2,888 control live births among antenatal health-care visits between 2007 and 2009. Using logistic regression, we estimated associations of maternal haemoglobin concentrations, haemoglobin dilution at different stages of pregnancy, with stillbirth risk.

    Results: Compared with normal maternal haemoglobin concentration (110-120 g/l) at the end of the second trimester, high maternal haemoglobin concentration (≥140 g/l) was associated with a more than two-fold increased stillbirth risk (OR = 2.31, 95 % CI [1.30-4.10]), while low maternal haemoglobin concentration (<110 g/l) was associated with a 37 % reduction in stillbirth risk. Haemoglobin concentration before pregnancy was not associated with stillbirth risk. Decreased haemoglobin concentration, as measured during pregnancy (OR = 0.61, 95 % CI [0.46, 0.80]), or only during the second trimester (OR = 0.75, 95 % CI [0.62, 0.90]), were associated with reduced stillbirth risk. The associations were essentially similar for preterm and term stillbirths.

    Conclusions: Haemoglobin concentration before pregnancy is not associated with stillbirth risk. High haemoglobin level and absence of haemoglobin dilution during pregnancy could be considered as indicators of a high-risk pregnancy.

  • 109.
    Magnusson, Patrik K. E.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health and Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Rahman, Iffat
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ganna, Andrea
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Viktorin, Alexander
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Walum, Hasse
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Halldner, Linda
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    CELAM (Center for Ethics, Law and Mental Health), University of Gothenburg, Gothenburg, Sweden; R&D Unit, Swedish Prison and Probation Service, Norrköping, Sweden; Gillberg Neuropsychiatry Centre, Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Ullén, Fredrik
    Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; R&D Unit, Swedish Prison and Probation Service, Norrköping, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Nyman, Anastasia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gumpert, Clara Hellner
    Centre for Psychiatry Research & Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Råstam, Maria
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Anckarsäter, Henrik
    CELAM (Center for Ethics, Law and Mental Health), University of Gothenburg, Gothenburg, Sweden.
    Cnattingius, Sven
    Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Johannesson, Magnus
    Department of Economics, Stockholm School of Economics, Stockholm, Sweden.
    Ingelsson, Erik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Klareskog, Lars
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
    de Faire, Ulf
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    The Swedish Twin Registry: establishment of a biobank and other recent developments2013In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 16, no 1, p. 317-329Article in journal (Refereed)
    Abstract [en]

    The Swedish Twin Registry (STR) today contains more than 194,000 twins and more than 75,000 pairs have zygosity determined by an intra-pair similarity algorithm, DNA, or by being of opposite sex. Of these, approximately 20,000, 25,000, and 30,000 pairs are monozygotic, same-sex dizygotic, and opposite-sex dizygotic pairs, respectively. Since its establishment in the late 1950s, the STR has been an important epidemiological resource for the study of genetic and environmental influences on a multitude of traits, behaviors, and diseases. Following large investments in the collection of biological specimens in the past 10 years we have now established a Swedish twin biobank with DNA from 45,000 twins and blood serum from 15,000 twins, which effectively has also transformed the registry into a powerful resource for molecular studies. We here describe the main projects within which the new collections of both biological samples as well as phenotypic measures have been collected. Coverage by year of birth, zygosity determination, ethnic heterogeneity, and influences of in vitro fertilization are also described.

  • 110.
    Malmqvist, Olle
    et al.
    Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Jonsson, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study2018In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, p. 1-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).

    METHODS: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.

    RESULTS: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).

    CONCLUSIONS: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.

    RATIONALE: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

  • 111.
    Martinez-Zamora, M. A.
    et al.
    Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
    Mattioli, L.
    Laboratory of Dioxins, Deparment of Environmental Chemistry, IDAEA-CSIC, Barcelona, Spain.
    Parera, J.
    Laboratory of Dioxins, Deparment of Environmental Chemistry, IDAEA-CSIC, Barcelona, Spain.
    Abad, E.
    Laboratory of Dioxins, Deparment of Environmental Chemistry, IDAEA-CSIC, Barcelona, Spain.
    Coloma, J. L.
    Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Galceran, M. T.
    Department of Analytical Chemistry, University of Barcelona, Barcelona, Spain .
    Balasch, J.
    Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
    Carmona, F.
    Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
    Increased levels of dioxin-like substances in adipose tissue in patients with deep infiltrating endometriosis2015In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 30, no 5, p. 1059-1068Article in journal (Refereed)
    Abstract [en]

    STUDY QUESTION: Are the levels of biologically active and the most toxic dioxin-like substances in adipose tissue of patients with deep infiltrating endometriosis (DIE) higher than in a control group without endometriosis?

    SUMMARY ANSWER: DIE patients have higher levels of dioxins and polychlorinated biphenyls (PCBs) in adipose tissue compared with controls without endometriosis.

    WHAT IS KNOWN ALREADY: Some studies have investigated the levels of dioxin-like substances, in serum samples, in patients with endometriosis, with inconsistent results.

    STUDY DESIGN, SIZE, DURATION: Case-control study including two groups of patients. The study group (DIE group) consisted of 30 patients undergoing laparoscopic surgery because of DIE. In all patients, an extensive preoperative work-up was performed including clinical exploration, magnetic resonance imaging (MRI) and transvaginal sonography. All patients with DIE underwent a confirmatory histological study for DIE after surgery. The non-endometriosis control group (control group), included the next consecutive patient undergoing laparoscopic surgery in our center due to adnexal benign gynecological disease (ovarian or tubal procedures other than endometriosis) after each DIE patient, and who did not present any type of endometriosis.

    PARTICIPANTS/MATERIALS, SETTING, METHODS: During the surgical procedure 1-2 g of adipose tissue from the omentum were obtained. Dioxin-like substances were analyzed in adipose tissue in DIE patients and controls without endometriosis.

    MAIN RESULTS AND THE ROLE OF CHANCE: The total toxic equivalence and concentrations of both dioxins and PCBs were significantly higher in patients with DIE in comparison with the control group (P < 0.05), mainly due to the significantly higher values of the two most toxic dioxins (2,3,7,8-tetrachlorodibenzo-p-dioxin [2,3,7,8-TCDD] and 1,2,3,7,8-pentachlorodibenzo-p-dioxin [1,2,3,7,8-PeCDD]) (P < 0.01 for each compound). The levels of furan 2,3,4,7,8-PeCDF were statistically higher in the DIE group compared with controls. Only four congeners of PCBs had toxic equivalence values and concentrations that were statistically higher in patients with DIE, but these included the most toxic and carcinogenic PCB-126 (PCB-114 P < 0.05; PCB-156 P < 0.05; PCB-189 P = 0.04; PCB-126 P < 0.01).

    LIMITATIONS, REASONS FOR CAUTION: Since fewpatients were recruited, the study is only exploratory. Our results need to be confirmed in larger and more heterogeneous population studies since environmental and even genetic factors involved in determining dioxins and PCBs widely vary in different countries. Furthermore, the strict eligibility criteria used may preclude generalization of the results to other populations and the surgery-based sampling frame may induce a selection bias. Finally, adipose tissue was obtained only from the omentum, and not from other adipose tissue of the body.

    WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest a potential role of dioxin-like substances in the pathogenesis of DIE. Further studies are warranted to confirm our findings.

  • 112. Mol, Femke
    et al.
    Strandell, Annika
    Jurkovic, Davor
    Yalcinkaya, Tamer
    Verhoeve, Harold R.
    Koks, Carolien A. M.
    van der Linden, Paul J. Q.
    Graziosi, Giuseppe C. M.
    Thurkow, Andreas L.
    Hoek, Annemieke
    Hogström, Lars
    Klinte, Ingemar
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    van Mello, Norah M.
    Ankum, Willem M.
    van der Veen, Fulco
    Mol, Ben W. M.
    Hajenius, Petra J.
    The ESEP study: salpingostomy versus salpingectomy for tubal ectopic pregnancy; the impact on future fertility : a randomised controlled trial2008In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 8, p. 11-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: For most tubal ectopic pregnancies (EP) surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy) or radically (salpingectomy) in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP. METHODS/DESIGN: International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF) and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation.The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision analysis framework, based on costs per live birth, including IVF treatment whenever a spontaneous pregnancy does not occur. Patients' preferences will be assessed using a discrete choice experiment. DISCUSSION: This trial will provide evidence on the trade off between salpingostomy and salpingectomy for tubal EP in view of the pros and cons of both interventions and will offer guidance to clinicians in making the right treatment choice. TRIAL REGISTRATION: Current Controlled Trials ISRCTN37002267.

  • 113.
    Mordhorst, Louise Bohr
    et al.
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Karlsson, Leif
    Department of Radiation Physics, Örebro University Hospital, Örebro, Sweden.
    Bärmark, Berit
    Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Sorbe, Bengt
    Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Combined External and Intracavitary Irradiation in Treatment of Advanced Cervical Carcinomas Predictive Factors for Treatment Outcome and Early and Late Radiation Reactions2014In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 24, no 7, p. 1268-1275Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to find out predictive factors of tumor control as well as acute and late radiation reactions in treatment of advanced cervical carcinomas.

    Methods: In a series of 134 primary cervical carcinomas in International Federation of Gynecology and Obstetrics stages I to IV treated with combined external pelvic and intraluminal cervical-vaginal brachytherapy, predictive and prognostic factors were analyzed with regard to tumor control, recurrences, survival data, and adverse effects. Concomitant chemotherapy was given to 48 patients (35.8%). The external beam therapy was given with a 4-field technique (50-60 Gy) and brachytherapy was given with a high-dose rate (iridium-192) afterloading technique using a ring applicator set. A computed tomographically based 3-dimensional dose-planning system was used for the external beam therapy and for the brachytherapy planning. The mean age of the patients was 65 years. A total of 110 tumors were squamous cell carcinomas and 24 were adenocarcinomas or adenosquamous carcinomas. A total of 111 tumors were in International Federation of Gynecology and Obstetrics stages I to II; 23 tumors, in stages III to IV.

    Results: The primary control rate of the complete series was 92.5%. Tumor size, the brachytherapy dose, the combined external and brachytherapy dose, as well as the number of days of interruption (delay) of irradiation were all significant predictive factors for local tumor control. Forty recurrences (30%) were recorded. Early radiation reactions were recorded in 67% (mostly grade 1) and were associated with the widths of the anterior-posterior and lateral pelvic fields. Serious late radiations reactions (grade 3-4) were noted in 11%.

    Conclusions: The width of the lateral pelvic fields, left point A and B doses, dose to the rectal reference point, as well as asymmetry of the dose distribution were associated with late severe reactions. Prior abdominal and pelvic surgery was also a high-risk factor for late tissue reactions. Concomitant chemotherapy did not increase the risk for acute or late toxicity.

  • 114.
    Munk-Olsen, Trine
    et al.
    The National Center for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.
    Liu, Xiaoqin
    The National Center for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
    Viktorin, Alexander
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Brown, Hilary K.
    Interdisciplinary Centre for Health and Society, Scarborough Campus, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
    Di Florio, Arianna
    Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
    D'Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
    Gomes, Tara
    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
    Howard, Louise M.
    Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, London, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Khalifeh, Hind
    Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, London, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Krohn, Holly
    Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Taylor, Clare L.
    Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, London, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Van Kamp, Inge
    Department of Obstetrics, Section of Perinatal Psychiatry, Leiden University Medical Center, Leiden, Netherlands.
    Wesseloo, Richard
    Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands.
    Meltzer-Brody, Samantha
    Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
    Vigod, Simone N.
    Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
    Bergink, Veerle
    Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
    Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies2018In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 5, no 8, p. 644-652Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Concerns about teratogenicity and maternal and offspring complications restrict the use of lithium during pregnancy for the treatment of mood disorders. We aimed to investigate the association between in-utero lithium exposure and risk of pregnancy complications, delivery outcomes, neonatal morbidity, and congenital malformations.

    METHODS: In this meta-analysis, primary data from pregnant women and their children from six international cohorts based in the community (Denmark, Sweden, and Ontario, Canada) and in clinics (the Netherlands, UK, and USA) were analysed. Pregnancies were eligible for analysis if the pregnancy resulted in a liveborn singleton between 1997 and 2015, if health-related information was available for both mother and infant, and if the mother had a mood disorder (bipolar disorder or major depressive disorder) or if she had been given lithium during pregnancy (at least two dispensations of lithium during pregnancy that were dispensed any time from 1 month before conception until the delivery, or a single lithium dispensation during pregnancy when there was at least one other lithium dispensation within 6 months before or after this date). Pregnancies during which the mother had been prescribed known teratogenic drugs were excluded. Pregnancies were grouped into a lithium-exposed group and a mood disorder reference group. The main outcome measures were pregnancy complications, delivery outcomes, neonatal readmission to hospital within 28 days of birth, and congenital malformations (major malformations and major cardiac malformations). Analyses were done at each site by use of a shared protocol. Adjusted odds ratios (aORs) and 95% CIs were calculated by use of logistic regression models, and site-specific prevalence rates and ORs were pooled by use of random-effects meta-analytical models.

    FINDINGS: 22   124 eligible pregnancies were identified across the six cohorts, of which 727 pregnancies were eligible for inclusion in the lithium-exposed group (557 [77%] from register-based cohorts and 170 [23%] from clinical cohorts). Lithium exposure was not associated with any of the predefined pregnancy complications or delivery outcomes. An increased risk for neonatal readmission within 28 days of birth was seen in the lithium-exposed group compared with the reference group (pooled prevalence 27·5% [95% CI 15·8-39·1] vs 14·3% [10·4-18·2]; pooled aOR 1·62, 95% CI 1·12-2·33). Lithium exposure during the first trimester was associated with an increased risk of major malformations (pooled prevalence 7·4% [95% CI 4·0-10·7] vs 4·3% [3·7-4·8]; pooled aOR 1·71, 95% CI 1·07-2·72) but for major cardiac malformations the difference was not significant (2·1% [0·5-3·7] vs 1·6% [1·0-2·1]; pooled aOR 1·54, 95% CI 0·64-3·70).

    INTERPRETATION: Considering both the effect sizes and the precision of the estimates in this meta-analysis, treatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy-in particular those associated with use of lithium during the first trimester-against its effectiveness at reducing relapse.

    FUNDING: None.

  • 115.
    Naimi-Akbar, Aron
    et al.
    Dept Dent Med, Div Dent Biomat & Cariol, Karolinska Institute, Stockholm, Sweden.
    Sandborgh-Englund, Gunilla
    Dept Dent Med, Div Dent Biomat & Cariol, Karolinska Inst, Stockholm, Sweden.
    Ekbom, Anders
    Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Ekstrand, Jan
    Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Näsman, Peggy
    Dept Dent MedDept Dent Med, Div Dent Biomat & Cariol, Karolinska Inst, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University Hospital. Clinical Epidemiology Unit, Karolinska Institutet, Department of Medicine, Stockholm, Sweden.
    Mortality among sons of female dental personnel: a national cohort study2014In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 42, no 5, p. 655-661Article in journal (Refereed)
    Abstract [en]

    Aims: Dental personnel are exposed to mercury when using dental amalgam. This exposure constitutes a potential hazard to offspring of women working in dentistry. The present study examined increased mortality risk in offspring of mothers working in dentistry.

    Methods: Mortality was compared between sons of dental personnel and sons of nondental health-care personnel. Hazard ratios were calculated for three decades (1960s-1980s), when the magnitude of mercury exposure in dentistry was likely to have varied.

    Results: During the 1960s, there was a statistically significant increase in the risk of neonatal mortality for sons of dental nurses when compared with sons of assistant nurses: hazard ratio (HR) 1.82 (95% confidence interval, CI: 1.04-3.22). There was no increased risk in the subsequent decades, but a trend test demonstrated a consistent decrease in the risk over the three decades: HR for trend 0.63 (95% CI: 0.44-0.90). The raised mortality risk was limited to neonatal mortality. The comparison between dentists and physicians had insufficient statistical power.

    Conclusions: There is no increased mortality risk among sons of female dentists after the 1960s. Although the results should be interpreted with caution, they suggest a modestly raised risk of neonatal mortality, during the 1960s, when exposure to mercury was thought to be highest.

  • 116.
    Nelson, G.
    et al.
    Department of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary AB, Canada.
    Altman, A. D.
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB, Canada.
    Nick, A.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston TX, USA.
    Meyer, L. A.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston TX, USA.
    Ramirez, P. T.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston TX, USA.
    Achtari, C.
    Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland.
    Antrobus, J.
    Department of Anesthesiology, Borders General Hospital, Melrose, United Kingdom.
    Huang, J.
    Anesthesiologists of Greater Orlando, Orlando FL, USA.
    Scott, M.
    Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County NHS Foundation Hospital, Guildford, United Kingdom; Surrey Peri-operative Anaesthesia Critical Care Research group (SPACeR) Clinical Academic Group, FHMS, University of Surrey, Guildford, United Kingdom.
    Wijk, Lena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Acheson, N.
    Department of Gynaecologic Oncology, Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, S. C.
    Division of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester MN, USA.
    Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations - Part II2016In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 140, no 2, p. 323-332Article in journal (Refereed)
  • 117.
    Nelson, G.
    et al.
    Department of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
    Altman, A. D.
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg MB, Canada.
    Nick, A.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston TX, United States.
    Meyer, L. A.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston TX, United States.
    Ramirez, P. T.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston TX, United States.
    Achtari, C.
    Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland.
    Antrobus, J.
    Department of Anesthesiology, Borders General Hospital, Melrose, United Kingdom.
    Huang, J.
    Anesthesiologists of Greater Orlando, Orlando FL, United States.
    Scott, M.
    Department of Anaesthesia and Intensive Care Medicine, Royal Surrey County NHS Foundation Hospital, Guildford, United Kingdom; Surrey Peri-operative Anaesthesia Critical Care Research group (SPACeR), Clinical Academic Group, FHMS, University of Surrey, Guildford, United Kingdom.
    Wijk, Lena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics and Gynecology,, Örebro University Hospital, Örebro, Sweden.
    Acheson, N.
    Department of Gynaecologic Oncology, Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, S. C.
    Division of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester MN, United States.
    Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations - Part I2016In: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 140, no 2, p. 313-322Article in journal (Refereed)
  • 118.
    Nelson, Gregg
    et al.
    Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada .
    Bakkum-Gamez, Jamie
    Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
    Kalogera, Eleftheria
    Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
    Glaser, Gretchen
    Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
    Altman, Alon
    Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
    Meyer, Larissa A.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
    Taylor, Jolyn S.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
    Iniesta, Maria
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
    Lasala, Javier
    Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
    Mena, Gabriel
    Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
    Scott, Michael
    Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, Virginia, USA.
    Gillis, Chelsia
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
    Elias, Kevin
    Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
    Wijk, Lena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Huang, Jeffrey
    Department of Anesthesiology, Oak Hill Hospital, Brooksville, Florida, USA.
    Nygren, Jonas
    Departments of Surgery and Clinical Sciences, Ersta Hospital and Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Ramirez, Pedro T.
    Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
    Dowdy, Sean C.
    Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
    Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update2019In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 29, no 4, p. 651-668Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.

    METHODS: A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

    RESULTS: All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.

    CONCLUSIONS: The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

  • 119.
    Nelson, Gregg
    et al.
    ERAS Alberta, ERAS Society, Division of Gynecologic Oncology, Tom Baker Cancer Center, Calgary AB, Canada.
    Ramirez, Pedro T.
    Minimally Invasive Surgical Research and Education, Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston TX, United States.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. ERAS Society, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, Sean C.
    Division of Gynecologic Oncology, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester MN, United States.
    Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial2017In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 129, no 6, p. 1139-1139Article in journal (Refereed)
  • 120.
    Parikh, Nisha I.
    et al.
    Division of Cardiology, Queen's Medical Center, John A. Burns School of Medicine, Honolulu HI, United States.
    Cnattingius, Sven
    Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Mittleman, Murray A.
    Department of Medicine, Cardiovascular Epidemiology and Research Unit, Harvard Medical School, Boston MA, United States.
    Ludvigsson, Jonas F.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Ingelsson, Erik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Subfertility and risk of later life maternal cardiovascular disease2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 2, p. 568-575Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Subfertility shares common pathways with cardiovascular disease (CVD), including polycystic ovarian syndrome, obesity and thyroid disorders. Women with prior 0-1 pregnancies are at an increased risk of incident CVD when compared with women with two pregnancies. It is uncertain whether history of subfertility among women eventually giving birth is a risk factor for CVD.

    METHODS: Among Swedish women with self-reported data on subfertility in the Swedish Medical Birth Register (n = 863 324), we used Cox proportional hazards models to relate a history of subfertility to CVD risk after adjustment for age, birth year, highest income, education, birth country, hypertension, diabetes, preterm birth, small for gestational age (SGA), smoking and for BMI in separate models. In additional analyses, we excluded women with: (i) pregnancy-related or non-pregnancy-related hypertension and/or diabetes; and (ii) preterm births and/or SGA babies.

    RESULTS: Among nulliparous women eventually having a childbirth (between 1983 and 2005, the median follow-up time 11.9; 0-23 years and 9 906 621 person-years of follow-up), there was an increased risk of CVD among women reporting >= 5 years of subfertility versus 0 years (hazard ratio 1.19, 95% confidence interval 1.02-1.39). There were not significantly elevated CVD risks for women with 1-2 or 3-4 years of subfertility versus 0 years. Accounting for BMI did not change results. Excluding women with hypertension and/or diabetes attenuated associations, whereas exclusion of women with preterm and/or SGA births did not change findings.

    CONCLUSIONS: Subfertility among women eventually having a childbirth is a risk factor for CVD even upon accounting for cardiovascular risk factors and adverse pregnancy outcomes. Future studies should explore the mechanisms underlying this association.

  • 121.
    Rejnö, Gustaf
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Obstetrics & Gynaecology Unit, Södersjukhuset, Stockholm, Sweden.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Kjell
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Ind., USA.
    Saltvedt, Sissel
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Obstetrics & Gynaecology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Unit of Pediatric Allergy and Pulmonology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Adverse Pregnancy Outcomes in Asthmatic Women: A Population-Based Family Design Study2018In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 6, no 3, p. 916-922.e6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Asthma is associated with several adverse pregnancy and perinatal outcomes. Familial factors may confound these associations.

    OBJECTIVE: To examine the role of measured and unmeasured confounding by conducting a study that compared differentially exposed cousins and siblings from the same families.

    METHODS: We retrieved data on adverse pregnancy outcomes, prescribed drugs, and physician-diagnosed asthma from nationwide registers for all women in Sweden with singleton births between 2001 and 2013. Logistic and linear regression estimated the association between maternal asthma and several outcomes in the whole population and within differently exposed pregnant relatives.

    RESULTS: In total, 1,075,153 eligible pregnancies were included and 10.1% of the study population had asthma. We identified 475,200 cousin and 341,205 sister pregnancies. Women with asthma had increased risks for preeclampsia (adjusted odds ratio [aOR], 1.17; 95% CI, 1.13-1.21), emergency cesarean section (aOR, 1.24; 95% CI, 1.22-1.27), and having a child small for gestational age (aOR, 1.18; 95% CI, 1.12-1.23). In the conditional regression analyses, after adjustment for familial factors, the associations remained: preeclampsia in cousins (aOR, 1.16; 95% CI, 1.07-1.25) and siblings (aOR, 1.23; 95% CI, 1.08-1.38), emergency cesarean section in cousins (aOR, 1.28) and siblings (aOR, 1.21), and small for gestational age in cousins (aOR, 1.17) and siblings (aOR, 1.13).

    CONCLUSIONS: Factors shared by siblings and cousins do not seem to explain the observed association between maternal asthma and adverse pregnancy outcomes. This implies that targeting the asthma disease will continue to be important in reducing risks for adverse outcomes in pregnancy.

  • 122.
    Risberg, Björn
    et al.
    Department of Pathology, The Norwegian Radium Hospital, Oslo, Norway.
    Karlsson, Kerstin
    Abeler, Vera
    Lagrelius, Anders
    Davidson, Ben
    Karlsson, Mats G
    Örebro Medical Center, Örebro, Sweden.
    Dissociated expression of Bcl-2 and Ki-67 in endometrial lesions: diagnostic and histogenetic implications2002In: International Journal of Gynecological Pathology, ISSN 0277-1691, E-ISSN 1538-7151, Vol. 21, no 2, p. 155-160Article in journal (Refereed)
    Abstract [en]

    The objective of the present study was to analyze the expression of the proliferation marker, Ki-67, and the anti-apoptotic protein, bcl-2, in various endometrial lesions. Ki-67 and bcl-2 expressions were studied in 194 specimens of endometrial hyperplasia, polyps, carcinomas, and cyclic endometrium from a defined geographic area. Results were statistically analyzed with respect to marker expression, localization to the stromal or glandular component, and intraglandular topography. The lowest glandular Ki-67 expression was seen in secretory endometrium, in polyps, and in atypical hyperplasia. The Ki-67 score was significantly higher and less heterogeneous in endometrial carcinomas than in hyperplasia (p<0.001). Endometrial hyperplasia of all types was characterized by a markedly heterogeneous glandular expression of Ki-67. The glandular expression of bcl-2 was highest in proliferative endometrium and polyps. Bcl-2 expression was significantly lower in adenocarcinomas than in hyperplastic lesions (p=0.002). Ki-67 and bcl-2 expression showed a significant association in proliferative endometrium (p=0.003). Endometrial polyps demonstrated a unique pattern of very low expression of Ki-67 and high bcl-2 expression in both stroma and glands. Our findings indicate that an imbalance between proliferation and apoptosis may be an important factor in the development of different endometrial lesions, benign as well as malignant. The specific finding of inter- and intraglandular Ki-67 heterogeneity may be valuable as an adjunct to morphology in the differential diagnosis of endometrial hyperplasia.

  • 123.
    Rönnberg, Ann-Kristin
    et al.
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro University, School of Health Sciences. Department of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Effects of an antenatal lifestyle intervention on offspring obesity: a 5-year follow-up of a randomized controlled trial2017In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 9, p. 1093-1099Article in journal (Refereed)
    Abstract [en]

    Introduction: Strategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age five.

    Material and methods: A secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Orebro, Sweden (Clinical Trials.gov Id NCT00451425). Offspring were followed with standardized measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score > 2 standard deviations) was compared between groups. Risk estimates for obesity at age five were analyzed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcome.

    Results: We analyzed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p = 0.242) or at age five (0.34 (I) vs 0.26 (C), p = 0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR = 4.51, p < 0.001) but not at age five. Maternal obesity was an independent risk factor for offspring obesity at age five (OR = 4.81, p = 0.006).

    Conclusions: Our composite antenatal lifestyle intervention did not significantly reduce the risk of obesity in offspring up until age five.

  • 124.
    Rönnberg, AnnKristin
    et al.
    Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro University, School of Health Sciences. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Medical Sciences. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. 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 trial2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 9, p. 999-1007Article in journal (Refereed)
    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.

  • 125.
    Rönnberg, Ann-Kristin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences.
    Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system2010In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, no 11, p. 1327-1334Article in journal (Refereed)
    Abstract [en]

    Background Excessive weight gain during pregnancy is common in developed countries and increases the risk of complications during pregnancy, delivery and the postpartum period, which can affect both maternal and fetal outcome. Interventions to reduce excessive gestational weight gain have previously not been systematically evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Objectives To determine whether published trials of interventions to reduce excessive gestational weight gain are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice in antenatal care. Search strategy A literature search was conducted in the scientific databases PubMed, Cochrane Library, Cinhal and Pedro, and the reference lists of relevant articles were reviewed. The literature search was concluded on 15 August 2009. Selection criteria All randomised controlled trials (RCTs) were considered for inclusion. As the number of published RCTs was limited, we also considered for inclusion all nonrandomised intervention studies that included a control group. Systematic reviews were examined to identify additional original studies. Data collection and analysis Two reviewers independently assessed the quality of the methods and results of all included articles. Extracted data were classified using the GRADE system. Main results Four intervention studies with a randomised controlled design and four intervention trials with a nonrandomised controlled design met the inclusion criteria. As a consequence of important limitations in study design, inconsistency and lack of directness, the overall quality of evidence was judged to be very low using the GRADE system. Authors' conclusions The results of published intervention trials are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in antenatal care.

  • 126.
    Rönnberg, AnnKristin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden .
    Fadl, Helena
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Gottvall, T.
    Department of Obstetrics and Gynaecology, Linköping University Hospital, Linköping, Sweden .
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial2015In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, no 4, p. 537-544Article in journal (Refereed)
    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

  • 127.
    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 University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and GynaecologyUmeå University, Umeå, Sweden.
    Evaluation of screening methods for Gestational diabetes mellitus in Sweden2017In: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book, 2017, p. 79-80Conference paper (Other academic)
    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.

  • 128.
    Saeedi, Maryam
    et al.
    Örebro University, School of Medical Sciences. 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 University, School of Medical Sciences. 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 study2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 225Article in journal (Refereed)
    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.

  • 129.
    Saeedi, Maryam
    et al.
    Örebro University, School of Medical Sciences.
    Simmons, David
    Örebro University, School of Medical Sciences.
    Magnuson, Anders
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    The CDC4G trial: Impact of Changing Diagnostic Criteria for Gestational diabetes in Sweden – a stepped wedge national cluster randomised controlled trial-study protocol2018Conference paper (Refereed)
    Abstract [en]

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

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

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

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

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

  • 130.
    Sandén, Ulrika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Rynning, Elisabeth
    Högsta förvaltningsdomstolen, Stockholm, Sweden.
    Axelsson, Ewa
    Försvarsmaktens högkvarter, Stockholm, Sweden.
    Juridiska aspekter på obstetrik2014In: Obstetrik / [ed] Henrik Hagberg, Karel Maršál, Magnus Westgren, Lund: Studentlitteratur AB, 2014, 2, p. 643-656Chapter in book (Other academic)
  • 131.
    Shemer, E. Wikström
    et al.
    Department of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Marschall, H. U.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Dept Med SoClinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institute, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Clin Epidemiol Unit, Karolinska Univ Hosp & Institute, Stockholm, Sweden; Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Stephansson, O.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital and Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska University Hospital and Institutet, Stockholm, Sweden.
    Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study2013In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 6, p. 717-723Article in journal (Refereed)
    Abstract [en]

    Objective: To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP).

    Design: Population-based cohort study.

    Setting: Swedish Medical Birth Register (MBR) 19972009.

    Population: A total of 1213668 singleton deliveries.

    Methods: Linkage of Hospital Discharge Register for exposure (ICP; n=5477) with MBR for covariates.

    Main outcome measures: Gestational diabetes, pre-eclampsia, prematurity, and stillbirth.

    Results: Intrahepatic cholestasis (ICP) was diagnosed in 0.320.58% of all pregnancies, with an increasing trend until 2005 (P<0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.323.41) and pre-eclampsia (aOR 2.62, 95% CI 2.322.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.471.93) and iatrogenic (aOR 5.95, 95% CI 5.236.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.0411.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.521.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.141.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.022.55).

    Conclusions: Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies.

  • 132.
    Shipitsyna, Elena
    et al.
    Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia.
    Krysanova, Anna
    Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia.
    Khayrullina, Guzel
    Laboratory of Molecular Diagnostics and Epidemiology of Reproductive Tract Infections, Federal Budget Institute of Science “Central Research Institute for Epidemiology”, Moscow, Russia.
    Shalepo, Kira
    Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia.
    Savicheva, Alevtina
    Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia.
    Guschin, Alexander
    Laboratory of Microbiology, D.O. Ott Research Institute of Obstetrics, Gynaecology and Reproductology, St. Petersburg, Russia.
    Unemo, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Sweden.
    Quantitation of all Four Gardnerella vaginalis Clades Detects Abnormal Vaginal Microbiota Characteristic of Bacterial Vaginosis More Accurately than Putative G. vaginalis Sialidase A Gene Count2019In: Molecular Diagnosis & Therapy, ISSN 1177-1062, E-ISSN 1179-2000, Vol. 23, no 1, p. 139-147Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV) is a vaginal disorder characterized by a depletion of the normal lactobacillus-dominant microbiota and overgrowth of mainly anaerobic bacteria.

    Objectives: The study aimed to evaluate the distribution and abundance of the Gardnerella vaginalis clades and sialidase A gene in vaginal samples from Russian women, and investigate if the G. vaginalis sialidase A gene count detects an abnormal vaginal microbiota characteristic of BV more accurately than G. vaginalis load.

    Methods: Vaginal samples from 299 non-pregnant patients of gynecological clinics were examined using Nugent scores and G. vaginalis clade and sialidase A gene quantitative real-time polymerase chain reactions (PCRs). Discriminatory power for BV microbiota was evaluated with receiver operating characteristic (ROC) analysis.

    Results: The vaginal microbiota was characterized by Nugent scores as normal, intermediate, and BV microbiota in 162, 58, and 79 women, respectively. G. vaginalis clades 1, 2, 3, 4, and the sialidase A gene were detected in 56% (51-62%), 40% (34-45%), 20% (16-25%), 94% (91-96%), and 70% (64-75%) of vaginal samples, respectively. The frequency and abundance of clades 1, 2, 4, and the sialidase A gene as well as clade multiplicity were significantly associated with abnormal microbiota. The sialidase A gene was present in all multi-clade samples, in all single-clade samples comprising clades 1, 2, and 3, and in four of 84 (5% [2-12%]) samples comprising clade 4 only. Total G. vaginalis load showed significantly higher discriminatory power for abnormal microbiota than sialidase A gene count (areas under ROC curves 0.933 vs. 0.881; p = 0.0306).

    Conclusions: Quantifying all four G. vaginalis clades discriminates between BV microbiota and normal microbiota more accurately than measuring G. vaginalis sialidase A gene. Clade 4 is strongly associated with BV microbiota, despite most clade 4 strains lacking the sialidase A gene.

  • 133.
    Shu, Huan
    et al.
    Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden; Dept. of Health Sciences, Karlstad University, Karlstad, Sweden.
    Lindh, Christian H.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Wikström, Sverre
    Örebro University, School of Medical Sciences.
    Bornehag, Carl-Gustaf
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America.
    Temporal trends and predictors of perfluoroalkyl substances serum levels in Swedish pregnant women in the SELMA study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0209255Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Perfluoroalkyl substances (PFAS) are used in numerous consumer products. They are persistent, bioaccumulating, and suspected to be endocrine disrupting chemicals (EDCs). A growing body of research has reported the association between PFAS exposure and adverse health effects. Concerns have been raised with special focus in childhood development.

    METHODS: Perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorododecanoic acid (PFDoDA), perfluorohexane sulfonate (PFHxS) and perfluorooctane sulfonate (PFOS) were analyzed by LC/MS/MS in serum from 1,616 pregnant women in the Swedish SELMA study. The serum samples were collected in the first trimester (median week 10). Least square geometric means (LSGM) of PFAS were estimated for each year period for, adjusted for potential determinants including parity, fish intake in the family, and mother's age.

    RESULTS: Six PFAS (PFNA, PFDA, PFUnDA, PFHxS, PFOA, and PFOS) were detected above levels of detection (LOD) in more than 99% of the SELMA women, while PFHpA, and PFDoDA were detected above LOD in 73.4% and 46.7% respectively. Parity, maternal age, maternal smoking, and fish intake during pregnancy were found to be significantly associated (p<0.05) with serum PFAS levels in the pregnant women. Finally, serum concentration of six PFAS (PFNA, PFDA, PFHxS, PFHpA, PFOA and PFOS) were significantly decreasing (range 14-31%) during the period of 30 months from 2007-2010.

    CONCLUSIONS: Our analysis shows that six out of eight PFAS could be identified in serum of more than 99% of SELMA subjects with a significant slightly decreasing trend for five of these compounds. Furthermore, parity, higher fish intake and mothers age are determinants for serum levels of PFAS in pregnant women.

  • 134.
    Sillanpää, Elina
    et al.
    Gerontology Research Centre, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Niskala, Paula
    Gerontology Research Centre, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Laakkonen, Eija K.
    Gerontology Research Centre, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Ponsot, Elodie
    Örebro University, School of Health Sciences.
    Alén, Markku
    Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland.
    Kaprio, Jaakko
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Kadi, Fawzi
    Örebro University, School of Health Sciences.
    Kovanen, Vuokko
    Gerontology Research Centre, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Sipilä, Sarianna
    Gerontology Research Centre, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Leukocyte and Skeletal Muscle Telomere Length and Body Composition in Monozygotic Twin Pairs Discordant for Long-term Hormone Replacement Therapy2017In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 20, no 2, p. 119-131Article in journal (Refereed)
    Abstract [en]

    Estrogen-based hormone replacement therapy (HRT) may be associated with deceleration of cellular aging. We investigated whether long-term HRT has effects on leukocyte (LTL) or mean and minimum skeletal muscle telomere length (SMTL) in a design that controls for genotype and childhood environment. Associations between telomeres, body composition, and physical performance were also examined. Eleven monozygotic twin pairs (age 57.6 ± 1.8 years) discordant for HRT were studied. Mean duration of HRT use was 7.3 ± 3.7 years in the user sister, while their co-twins had never used HRT. LTL was measured by qPCR and SMTLs by southern blot. Body and muscle composition were estimated by bioimpedance and computed tomography, respectively. Physical performance was measured by jumping height and grip strength. HRT users and non-users did not differ in LTL or mean or minimum SMTL. Within-pair correlations were high in LTL (r = 0.69, p = .020) and in mean (r = 0.74, p = .014) and minimum SMTL (r = 0.88, p = .001). Body composition and performance were better in users than non-users. In analyses of individuals, LTL was associated with BMI (r 2 = 0.30, p = .030), percentage total body (r 2 = 0.43, p = .014), and thigh (r 2 = 0.55, p = .004) fat, while minimum SMTL was associated with fat-free mass (r 2 = 0.27, p = .020) and thigh muscle area (r 2 = 0.42, p = .016). We found no associations between HRT use and telomere length. Longer LTLs were associated with lower total and regional fat, while longer minimum SMTLs were associated with higher fat-free mass and greater thigh muscle area. This suggests that telomeres measured from different tissues may have different associations with measures of body composition.

  • 135.
    Silventoinen, Karri
    et al.
    Department of Social Research, University of Helsinki, Helsinki, Finland; Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Kaprio, Jaakko
    Institute for Molecular Medicine FIMM, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
    Education in Twins and Their Parents Across Birth Cohorts Over 100 years: An Individual-Level Pooled Analysis of 42-Twin Cohorts2017In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 20, no 5, p. 395-405Article in journal (Refereed)
    Abstract [en]

    Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990-1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.

  • 136.
    Silventoinen, Karri
    et al.
    Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland; Graduate School of Medicine, Osaka University, Osaka, Japan.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Kaprio, Jaako
    Department of Public Health, University of Helsinki, Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine FIMM, Helsinki, Finland.
    The CODATwins Project: The Cohort Description of Collaborative Project of Development of Anthropometrical Measures in Twins to Study Macro-Environmental Variation in Genetic and Environmental Effects on Anthropometric Traits2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 4, p. 348-360Article in journal (Refereed)
    Abstract [en]

    For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m(2)) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.

  • 137.
    Skogsdal, Yvonne Rosalie Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Karlsson, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. 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 trial2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 3, p. 203-212Article in journal (Refereed)
    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.

  • 138.
    Skogsdal, Yvonne Rosalie Elisabeth
    et al.
    Örebro University, School of Health Sciences. Maternal Health Care Unit.
    Karlsson, Jan Åke
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. 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 counseling2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 11, p. 1349-1357Article in journal (Refereed)
    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.

  • 139.
    Sorbe, Bengt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andersson, H
    Boman, K
    Rosenberg, P
    Kalling, M
    Treatment of primary advanced and recurrent endometrial carcinoma with a combination of carboplatin and paclitaxel-long-term follow-up2008In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, Vol. 18, no 4, p. 803-808Article in journal (Refereed)
    Abstract [en]

    There is no generally accepted standard chemotherapy in treatment of advanced and recurrent endometrial carcinoma. Cisplatin and doxorubicin with or without cyclophosphamide are widely used. Response rates have improved with combination chemotherapy compared with single-agent therapy. A platinum analog seems to be an important part of the chemotherapy regimen. Since few patients are cured from their disease and since the duration of response is short, further improvement of this therapy is warranted. During the past years, the taxanes (paclitaxel) are being added to prior evaluated regimens and not only improved response rates are reported but also increased toxicity is observed. In a prospective, phase II, multicenter study, carboplatin (area under the curve = 5) and paclitaxel (175 mg/m(2)) were evaluated in treatment of primary advanced and recurrent endometrial carcinoma. In total, 66 patients were recruited during the years 2000-2004. Eighteen primary advanced tumors and 48 recurrences were treated. All histologic types and tumor grades were allowed. The median follow-up was 57 months (range 37-69 months). The overall response rate was 67% (95% CI 55-78). The complete response rate was 29% and the partial response rate 38%. Primary advanced and recurrent tumors as well as endometrioid and nonendometrioid tumors showed similar response rates. The median response duration was 14 months. The 1- and 3-year survival rates were 82% and 33%, respectively. The main toxicities were hematologic and neurologic (sensory neuropathy). The response rates were encouraging, superior to prior platinum-containing regimens, but response duration and the long-term survival rate were still short. The neurologic toxicity was frequent and was a substantial problem in this series of patients. Further research is highly needed to improve the treatment of advanced and recurrent endometrial cancer.

  • 140.
    Stenberg, Erik
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery.
    Ruoqing, Chen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hildén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Fall, Katja
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pregnancy As a Risk Factor for Small Bowel Obstruction After Laparoscopic Gastric Bypass Surgery2018In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery.

    BACKGROUND: Small bowel obstruction is a common and feared long-term complication to laparoscopic gastric bypass surgery that may be more common during pregnancy. It is unclear if the risk truly increases during pregnancy.

    METHODS: Women, 18 to 55 years, operated with a primary laparoscopic gastric bypass procedure from 2010 until 2015 were identified through the Scandinavian Obesity Surgery Registry (n = 25,853). Through record-linkage to the Medical Birth Registry, the National Patient Registry, and review of hospital charts, information on pregnancy periods and outcome were obtained. The main outcome was operation due to small bowel obstruction after the laparoscopic gastric bypass procedure.

    RESULTS: Pregnancy was associated with increased risk for small bowel obstruction following laparoscopic gastric bypass surgery (incidence rates 46.5, 95% CI 38.0-56.9/1000 person-years, vs 20.9 95% CI 19.9-22.0; adjusted-HR 1.72, 95% CI 1.39-2.12, P < 0.001). While no excess risk was observed during the first trimester, the second (adjusted-HR 1.67, 95% CI 1.17-2.39, P = 0.005) and third (adjusted-HR 2.69, 95% CI 2.02-3.59, P < 0.001) conferred increased risk. The incidence rate of small bowel obstruction during pregnancy was 42.9 (95% CI 32.4-57.0/1000 person-years) among women for whom the mesenteric defects had been closed during the primary procedure, and 53.2 (95% CI 38.9-72.8/1000 person-years) for women in whom they had been left open.

    CONCLUSION: Pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery during the second and third trimesters.

  • 141.
    Stygar, Denis
    et al.
    Division for Reproductive Endocrinology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Muravitskaya, Natalia
    Division for Reproductive Endocrinology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Britt
    Division for Reproductive Endocrinology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Håkan
    Division for Reproductive Endocrinology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Sahlin, Lena
    Division for Reproductive Endocrinology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Effects of SERM (selective estrogen receptor modulator) treatment on growth and proliferation in the rat uterus2003In: Reproductive Biology and Endocrinology, ISSN 1477-7827, E-ISSN 1477-7827, Vol. 1, article id 40Article in journal (Refereed)
    Abstract [en]

    Background: Selective estrogen receptor modulators (SERMs) have been developed in order to create means to control estrogenic effects on different tissues. A major drawback in treatment of estrogen receptor (ER) positive breast cancer with the antagonist tamoxifen (TAM) is its agonistic effect in the endometrium. Raloxifene (RAL) is the next generation of SERMs where the agonistic effect on the endometrium has been reduced.

    Methods: The aim of the present study was to determine the effect of SERM treatment on the uterus, as assessed by proliferation markers and several factors involved in uterine growth. Ovariectomized (ovx) rats were treated with estradiol (E2), tamoxifen (TAM), RAL, ICI182780 (ICI) or vehicle (OVX-controls). We studied the effects on mRNA levels of the growth hormone (GH) receptor, insulin-like growth factor-I (IGF-I), ERalpha and ERbeta. In addition, by immunohistochemistry the proliferation markers PCNA and Ki-67, as well as ERalpha and ERbeta, were detected.

    Results: The uterine weight of the rats treated with E2 or TAM was increased as compared to OVX-controls. The uterine GH-receptor mRNA level was highest in the E2 treated animals. In ICI treated rats no GH-receptor mRNA could be detected. The IGF-I mRNA level increased 16-fold in uteri of the TAM treated group and 9-fold in the E2 treated rats as compared to OVX-controls. The ERalpha mRNA level was increased in the E2 treated rats, while the ERbeta mRNA level was increased after TAM treatment. The proliferation, as assessed by PCNA, was lowest in ICI treated animals.

    Conclusions: The uterine wet weight, the LE height and the GH-receptor mRNA levels showed similar patterns, indicating that GH is involved in the regulation of uterine weight. Tamoxifen, which has been related to increased incidence of endometrial carcinoma in women, dramatically increased IGF-I mRNA levels in rat uterus. Since proliferation was not higher in TAM and E2 treated rats than in OVX controls, this assay of simple, early proliferation does not give the full explanation of why TAM should enhance the risk of developing endometrial cancer.

  • 142.
    Sujan, Ayesha C.
    et al.
    Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America.
    Quinn, Patrick D.
    Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, United States of America.
    Rickert, Martin E.
    Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America.
    Wiggs, Kelsey K.
    Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Öberg, A. Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, T.H. Chan School of Public Health, Harvard, Boston, United States of America.
    D'Onofrio, Brian M.
    Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study2019In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 12, article id e1002980Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes using a large population-based dataset, multiple definitions of POA exposure, and several methods to evaluate the influence of both measured and unmeasured confounding factors.

    METHODS AND FINDINGS: We obtained data by linking information from several Swedish registers and conducted a retrospective cohort study on a population-based sample of 620,458 Swedish births occurring between 2007 and 2013 (48.6% female; 44.4% firstborn). We evaluated associations between prenatal POA exposure and risk for preterm birth (PTB; <37 gestational weeks) and small for gestational age (SGA; birth weight 2 standard deviations below the expected weight for gestational age or lower). We evaluated the influence of confounding by adjusting for a wide range of measured covariates while comparing exposed and unexposed infants. Additionally, we adjusted for unmeasured confounding factors by using several advanced epidemiological designs. Infants exposed to POAs anytime during pregnancy were at increased risk for PTB compared with unexposed infants (6.4% exposed versus 4.4% unexposed; adjusted odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.31-1.45, p < 0.001). This association was attenuated when we compared POA-exposed infants with acetaminophen-exposed infants (OR = 1.18, 95% CI 1.07-1.30, p < 0.001), infants born to women who used POAs before pregnancy only (OR = 1.05, 95% CI 0.96-1.14, p = 0.27), and unexposed siblings (OR = 0.99, 95% CI 0.85-1.14, p = 0.92). We also evaluated associations with short-term versus persistent POA use during pregnancy and observed a similar pattern of results, although the magnitudes of associations with persistent exposure were larger than associations with any use or short-term use. Although short-term use was not associated with SGA (adjusted ORsingle-trimester = 0.95, 95% CI 0.87-1.04, p = 0.29), persistent use was associated with increased risk for SGA (adjusted ORmultiple-trimester = 1.40, 95% CI 1.17-1.67, p < 0.001) compared with unexposed infants. The association with persistent exposure was attenuated when we used alternative comparison groups (e.g., sibling comparison OR = 1.22, 95% CI 0.60-2.48, p = 0.58). Of note, our study had limitations, including potential bias from exposure misclassification, an inability to adjust for all sources of confounding, and uncertainty regarding generalizability to countries outside of Sweden.

    CONCLUSIONS: Our results suggested that observed associations between POA use during pregnancy and risk of PTB and SGA were largely due to unmeasured confounding factors, although we could not rule out small independent associations, particularly for persistent POA use during pregnancy.

  • 143.
    Sujan, Ayesha C.
    et al.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, United States.
    Rickert, Martin E.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, United States.
    Öberg, A. Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, United States.
    Quinn, Patrick D.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, United States.
    Hernandez-Diaz, Sonia
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, United States.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Associations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring2017In: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 72, no 9, p. 523-524Article in journal (Refereed)
    Abstract [en]

    While antidepressant use during pregnancy has been associated with adverse birth and neurodevelopmental outcomes, these associations may be attributed to confounding factors, such as genetic influences, maternal stress, or poor health practices during pregnancy. This study used 4 observational designs to investigate these associations, including sibling and paternal information.

    The study used multiple national Swedish registries. First-trimester exposures, defined as at least 1 dispensation between 90 days before estimated conceptions and 90 days after estimated conception, to any antidepressants and selective serotonin reuptake inhibitors, reported through either maternal self-report or dispensation records, were the main exposures evaluated. The main outcomes were small for gestational age, defined as birth weight less than 2 SDs below the mean for gestational age; preterm birth, defined as less than 37 gestational weeks; and diagnosis of autism spectrum disorder or attention-deficit/hyperactivity disorder (ADHD). Maternal and paternal covariates included age of childbearing, highest level of completed education, history of criminal conviction, history of psychiatric illnesses, history of suicide attempts, and country of origin (Sweden or outside Sweden). Parity and year of birth were pregnancy covariates. Population-wide baseline models were assessed adjusting only for pregnancy covariates. Then, population-wide associations were adjusted for maternal and paternal covariates as well. A third model compared exposure-and outcome-discordant offspring within families.

    After exclusion of multiple births, missing father identifiers, or other missing information, a final cohort of 1,580,629 offspring born to 943,776 was used. Of these, 26,477 offspring had first-trimester maternal antidepressant dispensations, 22,125 of which were selective serotonin reuptake inhibitor dispensations. Preterm births accounted for 6.98% of exposed and 4.78% of unexposed offspring. In the baseline models, first-trimester exposure was associated with all 4 outcomes (preterm birth odds ratio [OR], 1.47; 95% confidence interval [CI], 1.40-1.55]; small for gestational age OR, 1.15 [95% CI, 1.06-1.25]; ADHD HR, 2.21 [95% CI, 2.04-2.39]). After adjusting for pregnancy and maternal and paternal traits and comparing sibling data, first-trimester antidepressant exposure was associated with only a small increased risk of preterm birth (OR, 1.34 [95% CI, 1.18-1.52]) and was not associated with small for gestational age (OR, 1.01 [95% CI, 0.81-1.25]), ADHD (HR, 0.99 [95% CI, 0.79-1.25]), or autism spectrum disorder (HR, 0.83 [95% CI, 0.62-1.13]).

    Unexposed and exposed siblings were found to be at equal risk of small for gestational age, ADHD, and autism spectrum disorder as one another, whereas exposed siblings had a slightly increased risk of preterm birth. Both autism spectrum disorder and ADHD were associated with paternal first-trimester antidepressant dispensations, supporting the idea that familial confounding may explain associations between exposure and neurodevelopmental disorders.

  • 144.
    Sundelin, Heléne EK
    et al.
    University Hospital, Linköping, Sweden.
    Stephansson, Olof
    Karolinska University Hospital and Institutet, Stockholm, Sweden; University of California, Berkeley, USA .
    Hultman, Christina M
    Karolinska Institutet, Stockholm, Sweden; Icahn School of Medicine at Mt Sinai, New York, NY, USA .
    Ludvigsson, Jonas F.
    Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden; University of Nottingham, Nottingham, UK; Columbia University College of Physicians and Surgeons, New York, New York, USA .
    Pregnancy outcomes in women with autism: A Nationwide populationbased cohort studyManuscript (preprint) (Other academic)
  • 145.
    Sundelin, Heléne EK
    et al.
    University Hospital, Linköping, Sweden.
    Stephansson, Olof
    Karolinska Institutet, Stockholm, Sweden.
    Johansson, Stefan
    Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Karolinska Institutet, Stockholm, Sweden; University of Nottingham, Nottingham, UK; Columbia University College of Physicians and Surgeons, New York, New York, USA .
    Pregnancy outcome in women with cerebral palsy: A nationwide population-based cohort studyManuscript (preprint) (Other academic)
  • 146.
    Sundelin, Heléne
    et al.
    Örebro University, School of Medical Sciences. University Hospital, Linköping, Sweden.
    Stephansson, Olof
    Karolinska University Hospital and Institute, Stockholm, Sweden; University of California, Berkeley CA, USA .
    Johansson, Kari
    Karolinska University Hospital and Institute, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, University Hospital, Örebro, Sweden; School of Medicine, University of Nottingham, Nottingham, UK .
    Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome2017In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 1, p. 114-119Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected.

    MATERIAL AND METHODS: In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes.

    RESULTS: Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome.

    CONCLUSION: Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome.

  • 147.
    Thomtén, Johanna
    Örebro University, School of Law, Psychology and Social Work. Avdelningen för psykologi, Mittuniversitetet, Östersund, Sweden.
    Living with genital pain: sexual function, satisfaction, and help-seeking among women living in Sweden2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Background and aims: Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women.

    Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study.

    Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain.

    Conclusions: The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women' life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes.

    Implications: Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women' life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain.

    © 2013 Scandinavian Association for the Study of Pain.

  • 148.
    Thomtén, Johanna
    et al.
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, Mid Sweden University, Östersund, Sweden .
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    When sex hurts: female genital pain with sexual consequences deserves attention: A position paper2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 3, p. 202-205Article in journal (Refereed)
    Abstract [en]

    Background and aims: The problem of sexual pain is an area that has been shamefully ignored by both the pain community and the health service authorities. Although about 40% of women report such pain and 30% report it during their last intercourse, sexual pain has historically not even been considered a pain problem. The objectives of the present study was to present a background to the problem of female sexual pain, further elaborate on the problem and offer some direction for how advances might be concretely made.

    Discussion: Genital pain is common and many women describe pain during several non-sexual activities. Therefore describing the pain strictly as a sexual problem, threatens to lose important information about the experience of pain which will be misleading both in assessment and treatment. Instead, seeing the problem as a multidimensional pain condition with debilitating sexual consequences is suggested. It has become apparent that although biological aspects are central in the experience of genital pain, psychological and social aspects may play a major role. The fear avoidance model which has played a major role in our understanding of the development of chronic musculoskeletal pain, also seems to be applicable in genital pain conditions. However, one has to be aware of certain differences when comparing genital pain from musculoskeletal conditions. In addition, there is a lack of established guidelines for assessing or treating unexplained genital pain conditions, and there is a risk of not acknowledging the role of socio-cultural context on how female sexuality is viewed. The problem of recurrent sexual pain is a highly volatile, personal, and socially weighted experience. Because of the lack of understanding of the mechanisms, it is a risk of over-emphasizing the role of vaginal penetration in the assessment and treatment of female sexual pain and clinicians may simply fail to investigate sexual function from a broader perspective. Conclusions and implications: There is a growing interest in the problem of female genital pain and associated problems with sexual pain. However, research predominately refers to the field of sex research, and the involvement from the pain community has to date been relatively low. There is an immediate need to identify the psychosocial mechanisms involved in the transition from acute to chronic genital pain in women and to address these components in treatment using established methods. Since sexual pain is far more than pain during vaginal penetration, there is a risk of treatment interventions being oriented towards performance in terms of a narrowly defined sexual behavior instead of focusing on valued activities, meaning and pleasure for the individual. Assessment and treatment have to include a broad perspective on pain and on sex. © 2014 Scandinavian Association for the Study of Pain.

  • 149.
    Thorell, Eva
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine unit, Uppsala University, Uppsala, Sweden.
    Kristiansson, Per
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine unit, Uppsala University, Uppsala, Sweden.
    Pregnancy related back pain, is it related to aerobic fitness?: A longitudinal cohort study2012In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, article id 30Article in journal (Refereed)
    Abstract [en]

    Background: Low back pain with onset during pregnancy is common and approximately one out of three women have disabling pain. The pathogenesis of the pain condition is uncertain and there is no information on the role of physical fitness. Whether poorer physical conditioning is a cause or effect of back pain is also disputed and information from prospective studies needed.

    Methods: A cohort of pregnant women, recruited from maternal health care centers in central Sweden, were examined regarding estimated peak oxygen uptake by cycle ergometer test in early pregnancy, reported physical activity prior to pregnancy, basic characteristics, back pain during pregnancy and back pain postpartum.

    Results: Back pain during the current pregnancy was reported by nearly 80% of the women. At the postpartum appointment this prevalence was 40%. No association was displayed between estimated peak oxygen uptake and incidence of back pain during and after pregnancy, adjusted for physical activity, back pain before present pregnancy, previous deliveries, age and weight. A significant inverse association was found between estimated peak oxygen uptake and back pain intensity during pregnancy and a direct association post partum, in a fully adjusted multiple linear regression analysis.

    Conclusions: Estimated peak oxygen uptake and reported physical activity in early pregnancy displayed no influence on the onset of subsequent back pain during or after pregnancy, where the time sequence support the hypothesis that poorer physical deconditioning is not a cause but a consequence of the back pain condition. The mechanism for the attenuating effect of increased oxygen uptake on back pain intensity is uncertain.

  • 150.
    Tingström, Joanna
    et al.
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Barimani, Mia
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Sonesson, Sven-Erik
    Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Wahren-Herlenius, Marie
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Henriksson, Elisabet Welin
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    The experiences of pregnancy in women with SSA/Ro52 autoantibodies2010In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 8, no 4, p. 215-223Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:  Congenital heart block may develop in the foetus during pregnancy in SSA/Ro52 autoantibody-positive women. The aim of this study was to investigate how women with SSA/Ro52 autoantibodies experience their pregnancy in terms of the risk of developing foetal heart block, and in undergoing serial ultrasound Doppler echocardiography to detect early signs of congenital heart block.

    METHODS:  Data were collected through individual semi-structured interviews with SSA/Ro52-positive women post-pregnancy (n = 14). The interviews were audio-taped, transcribed verbatim and analysed according to qualitative content analysis.

    RESULTS:  Three categories emerged from the responses: information, emotional response and support. The information received prior to and during early pregnancy was focused on the need for attending a specialized antenatal clinic, and information on the risk for congenital heart block was scarce or missing. During gestational weeks 18-24, when the ultrasound/Doppler examinations were performed, all women described increased stress. However, the interaction with the caregivers made the women feel more safe and secure. Several women also said that they did not emotionally acknowledge the pregnancy until after gestational week 24. None had been offered psychological support.

    CONCLUSION:  There is a need for structured information and organized programmes for the surveillance of women who are SSA/Ro52 positive during their pregnancy. Further, offering psychological support to the women and their families to manage the stress and to facilitate the early attachment to the child should be considered.

1234 101 - 150 of 165
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf