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Koort K, Sõsa K, Türk S, Lapp E, Talving E, Karits P, Rosenstein K, Jaagura M, Sekavin A, Sõritsa D, Haldre K, Karro H, Korrovits P, Salumets A, Mändar R. Lactobacillus crispatus-dominated vaginal microbiome and Acinetobacter-dominated seminal microbiome support beneficial ART outcome. Acta Obstet Gynecol Scand 2023. [PMID: 37221898 DOI: 10.1111/aogs.14598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Despite the considerable progress made in assisted reproductive technologies (ART), the implantation rate of transferred embryos remains low and in many cases, the reasons for failure remain unclear. We aimed to determine the potential impact of female and male partners' reproductive tract microbiome composition on ART outcome. MATERIAL AND METHODS The ART couples (n = 97) and healthy couples (n = 12) were recruited into the study. The smaller healthy group underwent a careful selection according to their reproductive and general health criteria. Both vaginal and semen samples were subjected to 16S rDNA sequencing to reveal the bacterial diversity and identify distinct microbial community types. Ethics statement The study was approved by the Ethics Review Committee on Human Research of Tartu University, Tartu, Estonia (protocol no. 193/T-16) on 31 May 2010. Participation in the research was voluntary. Written informed consent was obtained from all study participants. RESULTS The men with Acinetobacter-associated community who had children in the past, had the highest ART success rate (P < 0.05). The women with bacterial vaginosis vaginal microbiome community and with L. iners-predominant and L. gasseri-predominant microbiome had a lower ART success rate than women with the L. crispatus-predominant or the mixed lactic-acid-bacteria-predominant type (P < 0.05). The 15 couples where both partners had beneficial microbiome types had a superior ART success rate of 53%, when compared with the rest of the couples (25%; P = 0.023). CONCLUSIONS Microbiome disturbances in the genital tract of both partners tend to be associated with couple's infertility as well as lower ART success levels and may thus need attention before the ART procedure. The incorporation of genitourinary microbial screening as a part of the diagnostic evaluation process may become routine for ART patients if our results are confirmed by other studies.
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Affiliation(s)
- Kairi Koort
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Kristiina Sõsa
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Silver Türk
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Eleri Lapp
- Competence Centre on Health Technologies, Tartu, Estonia
| | | | | | - Karin Rosenstein
- Competence Centre on Health Technologies, Tartu, Estonia
- Nova Vita Clinic, Tallinn, Estonia
| | - Madis Jaagura
- Nova Vita Clinic, Tallinn, Estonia
- Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Aire Sekavin
- Women's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Deniss Sõritsa
- Competence Centre on Health Technologies, Tartu, Estonia
- Women's Clinic, Tartu University Hospital, Tartu, Estonia
- Elite Clinic, Tartu, Estonia
| | - Kai Haldre
- West Tallinn Central Hospital, Tallinn, Estonia
- East Tallinn Central Hospital, Tallinn, Estonia
| | - Helle Karro
- Women's Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Paul Korrovits
- Competence Centre on Health Technologies, Tartu, Estonia
- Andrological Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Reet Mändar
- Competence Centre on Health Technologies, Tartu, Estonia
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
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Haldre K, Rahu M, Allvee K, Rahu K. Trends in teenage delivery and abortion rates in Estonia over more than two decades: a nationwide register-based study. Eur J Public Health 2021; 31:790-796. [PMID: 34473276 DOI: 10.1093/eurpub/ckab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the last 30 years, Estonia has undergone major socio-economic changes, including profound educational and healthcare reforms. The study aimed to analyse trends in teenage delivery and induced abortion rates among younger and older teens, including Estonians and non-Estonians, and to study trends in repeat teenage pregnancies in more detail. METHODS The register-based study included data on 29 818 deliveries (1992-2019) and 25 865 (1996-2019) induced abortions among 15-19-year-old girls. Delivery and abortion rates per 1000 girls were calculated by age group, ethnicity and reproductive history. Poisson regression models were applied to estimate average annual percentage changes in delivery and abortion rates over the whole period and in two sub-periods with change points in the trend in 2007. RESULTS The delivery rate decreased by 5.3% per year, from 49.9 in 1992 to 8.4 in 2019; the abortion rate decreased by 6.0% per year, from 42.4 in 1996 to 8.6 in 2019. A faster decline in delivery rates took place among Estonians than non-Estonians, but the opposite trend occurred in abortion rates. Delivery rates for first and repeat pregnancies decreased nearly at the same pace, while abortion rates for repeat pregnancies decreased faster than those for first pregnancies. CONCLUSIONS A decreasing trend in teenage births is evident in parallel with society becoming wealthier. A remarkable decline in teenage abortions occurs when young people's rights to safe abortion, contraception, mandatory sexuality education and youth-friendly services are ensured. There always remains a small group of adolescents who repeatedly become pregnant.
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Affiliation(s)
- Kai Haldre
- Centre for Infertility Treatment, East Tallinn Central Hospital Women's Clinic, Tallinn, Estonia.,Sexual Health Clinic of the Estonian Sexual Health Association, Tallinn, Estonia
| | - Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Kärt Allvee
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Kaja Rahu
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
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Donders GGG, Grinceviciene S, Haldre K, Lonnee-Hoffmann R, Donders F, Tsiakalos A, Adriaanse A, Martinez de Oliveira J, Ault K, Mendling W. ISIDOG Consensus Guidelines on COVID-19 Vaccination for Women before, during and after Pregnancy. J Clin Med 2021; 10:jcm10132902. [PMID: 34209801 PMCID: PMC8268868 DOI: 10.3390/jcm10132902] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction. Sars-CoV-2 infection poses particular problems in pregnancy, as the infection more frequently causes severe complications than in unaffected pregnant women or nonpregnant women with SARS-CoV-2 infection. Now that vaccination is available and rapidly being implemented worldwide, the question arises whether pregnant women should be vaccinated, and if so, whether they should receive priority. Methods. Available scientific data and available guidelines about vaccination against SARS-CoV-2 were collected by the Guideline Committee of the International Society of Infectious Diseases in Obstetrics and Gynecology (ISIDOG) and were analyzed, discussed and summarized as guidelines for healthcare workers caring for pregnant women. Concluding statements were graded according to the Oxford evidence-based medicine grading system. Results. There is evidence to consider pregnancy as a risk factor for serious complications of COVID-19 infection, even in the absence of additional risk factors, such as hypertension, diabetes and obesity which increase these risks even more in pregnancy. Currently available data slightly favor mRNA-based vaccines above vector-based vaccines during pregnancy and breastfeeding, until more safety data become available. Conclusion. ISIDOG advises policy makers and societies to prioritize pregnant women to receive vaccination against SARS-CoV-2 and favor the mRNA vaccines until further safety information becomes available.
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Affiliation(s)
- Gilbert G. G. Donders
- Femicare VZW Clinical Research for Women, 3300 Tienen, Belgium;
- Department Obstetrics and Gynecology, University Hospital Antwerp, 2650 Edegem, Belgium
- President International Society Infectious Diseases (ISIDOG), 3300 Tienen, Belgium
- Correspondence: ; Tel.: +32-16-80-81-02
| | - Svitrigaile Grinceviciene
- Department Biothemodynamics and Drug Design, Institute of Biotechnology and Life Sciences Center, Vilnius University, 01513 Vilnius, Lithuania;
| | - Kai Haldre
- East Tallin Central Hospital Women’s Clinic, 10138 Tallin, Estonia;
| | | | | | - Aristotelis Tsiakalos
- LETO-Obstetrician Gynecological & Surgical Center, Department Obstetrics and Gynecology, 11525 Athens, Greece;
| | - Albert Adriaanse
- Medisch Centrum Alkmaar, Department Obstetrics and Gynecology, 1814 Alkmaar, The Netherlands;
| | | | - Kevin Ault
- Department Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Werner Mendling
- German Center for Infections in Obstetrics and Gynceology, Department Obstetrics and Gynecology, 42283 Wupperthal, Germany;
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Allvee K, Rahu M, Haldre K, Karro H, Rahu K. Quality of IVF status registration in the Estonian Medical Birth Registry: a national record linkage study. Reprod Health 2018; 15:133. [PMID: 30089492 PMCID: PMC6083506 DOI: 10.1186/s12978-018-0575-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Information regarding in vitro fertilization (IVF) as a pregnancy risk factor (yes/ no) is stored in each birth record of the Estonian Medical Birth Registry (EMBR). This study aimed to assess the validity of registration of newborns’ IVF status in the EMBR. Methods To identify the newborns conceived by IVF, the birth records in the EMBR were compared to individual records on the embryo transfer procedures in the Estonian Health Insurance Fund (EHIF) database as a reference. Maternal age was restricted to 40 years, the age limit for IVF treatment covered by the EHIF. The embryo transfer procedures, that dated up to eight weeks before pregnancy, were additionally checked in the infertility treatment clinics. The validity of IVF status was measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV). Relative risk (RR) of unrecorded IVF status among IVF mothers by socio-demographic characteristics and birth plurality was estimated using modified Poisson regression models. Results There were 3198 newborns identified as conceived by IVF in the EMBR in 2005–2014. Eight of them were incorrectly entered as born after IVF. The record linkage with the EHIF database revealed 1014 newborns with unrecorded IVF status in the EMBR. A total of 4204 newborns were verified as conceived by IVF, 24.1% of them were not categorized as born after IVF. The sensitivity of the IVF status registration was poor (75.9%), specificity (100.0%), PPV (99.8%) and NPV (99.3%) were high. The misclassifications were significantly more common among mothers of younger age or non-Estonians or with singleton birth. Conclusion Information based on mother’s self-report or her antenatal chart does not accurately identify the newborn’s IVF status. The lack of a specialized country-wide assisted reproductive technology register in Estonia requires routine record linkage of the EMBR, EHIF and the infertility treatment clinics’ databases to obtain adequate information regarding IVF status in the EMBR. Electronic record linkages between databases would help considerably to improve the validity of data to be used in medical decision making, in research and for statistical purposes.
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Affiliation(s)
- Kärt Allvee
- Estonian Medical Birth Registry, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Kai Haldre
- Centre for Reproductive Medicine, West Tallinn Central Hospital Women's Clinic, Sõle 23, 10614, Tallinn, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia.,Tartu University Hospital's Women's Clinic, L. Puusepa 8, 51014, Tartu, Estonia
| | - Kaja Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
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Merki-Feld GS, Apter D, Bartfai G, Grandi G, Haldre K, Lech M, Lertxundi R, Lete I, Lobo Abascal P, Raine S, Roumen F, Serfaty D, Shulman LP, Skouby S, Bitzer J. ESC expert statement on the effects on mood of the natural cycle and progestin-only contraceptives. EUR J CONTRACEP REPR 2017; 22:247-249. [PMID: 28728451 DOI: 10.1080/13625187.2017.1353075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hormonal fluctuations during the natural cycle, as well as progestins used for hormonal contraception, can exert effects on mood especially in vulnerable women. Negative effects of levonorgestrel-releasing intrauterine contraception on mood are rare.
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Affiliation(s)
- G S Merki-Feld
- a Department of Gynecology and Obstetrics, Clinic for Reproductive Endocrinology , University Hospital Zürich , Zürich , Switzerland
| | - D Apter
- b VL-Medi Oy Clinical Research Center , Helsinki , Finland
| | - G Bartfai
- c Department of Obstetrics and Gynaecology , University of Szeged , Szeged , Hungary
| | - G Grandi
- d Department of Medical and Surgical Sciences for Mother, Child and Adult , University of Modena, and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - K Haldre
- e Sexual Health Clinic of the Estonian Sexual Health Association , Tallinn , Estonia
| | - M Lech
- f AD REM Fertility and Sterility Research Centre , Warsaw , Poland
| | - R Lertxundi
- g Department of Sexual and Reproductive Health , Clinica Euskalduna , Bilbao , Spain
| | - I Lete
- h Araba University Hospital , Vitoria , Spain
| | - P Lobo Abascal
- i Infanta Sofía University Hospital, San Sebastián de los Reyes , Madrid , Spain
| | - S Raine
- j Nurse Specialist in Contraception , Bournemouth , UK
| | - F Roumen
- k Zuyderland Medical Centre , Heerlen-Sittard , The Netherlands
| | - D Serfaty
- l Saint-Louis Hospital , Paris , France
| | - L P Shulman
- m Department of Obstetrics and Gynecology , Feinberg School of Medicine of Northwestern University , Chicago , IL , USA
| | - S Skouby
- n Endocrinological and Reproductive Unit, Department of Obstetrics and Gynaecology , Herlev/Gentofte Hospital, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - J Bitzer
- o University Hospital , Basel , Switzerland
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Altmäe S, Tamm-Rosenstein K, Esteban FJ, Simm J, Kolberg L, Peterson H, Metsis M, Haldre K, Horcajadas JA, Salumets A, Stavreus-Evers A. Endometrial transcriptome analysis indicates superiority of natural over artificial cycles in recurrent implantation failure patients undergoing frozen embryo transfer. Reprod Biomed Online 2016; 32:597-613. [PMID: 27090967 DOI: 10.1016/j.rbmo.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
Little consensus has been reached on the best protocol for endometrial preparation for frozen embryo transfer (FET). It is not known how, and to what extent, hormone supplementation in artificial cycles influences endometrial preparation for embryo implantation at a molecular level, especially in patients who have experienced recurrent implantation failure. Transcriptome analysis of 15 endometrial biopsy samples at the time of embryo implantation was used to compare two different endometrial preparation protocols, natural versus artificial cycles, for FET in women who have experienced recurrent implantation failure compared with fertile women. IPA and DAVID were used for functional analyses of differentially expressed genes. The TRANSFAC database was used to identify oestrogen and progesterone response elements upstream of differentially expressed genes. Cluster analysis demonstrated that natural cycles are associated with a better endometrial receptivity transcriptome than artificial cycles. Artificial cycles seemed to have a stronger negative effect on expression of genes and pathways crucial for endometrial receptivity, including ESR2, FSHR, LEP, and several interleukins and matrix metalloproteinases. Significant overrepresentation of oestrogen response elements among the genes with deteriorated expression in artificial cycles (P < 0.001) was found; progesterone response elements predominated in genes with amended expression with artificial cycles (P = 0.0052).
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Affiliation(s)
- Signe Altmäe
- Competence Centre on Health Technologies, Tartu, Estonia; Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain.
| | | | | | - Jaak Simm
- Department of Gene Technology, Tallinn University of Technology, Tallinn, Estonia
| | - Liis Kolberg
- Institute of Computer Science, University of Tartu, Estonia
| | - Hedi Peterson
- Institute of Computer Science, University of Tartu, Estonia; Quretec Ltd., Tartu, Estonia
| | - Madis Metsis
- Competence Centre on Health Technologies, Tartu, Estonia; School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Kai Haldre
- Centre for Reproductive Medicine, West Tallinn Central Hospital Women's Clinic, Tallinn, Estonia
| | | | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia; Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
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Haldre K, Part K, Ketting E. Youth sexual health improvement in Estonia, 1990–2009: The role of sexuality education and youth-friendly services. EUR J CONTRACEP REPR 2012; 17:351-62. [DOI: 10.3109/13625187.2012.696751] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laanpere M, Rahu K, Part K, Haldre K, Rahu M, Karro H. P777 Contraceptive counselling in primary health care - what do young women prefer? Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haldre K, Rahu K, Karro H, Rahu M. Previous history of surgically induced abortion and complications of the third stage of labour in subsequent normal vaginal deliveries. J Matern Fetal Neonatal Med 2009; 21:884-8. [DOI: 10.1080/14767050802320324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haldre K, Rahu K, Rahu M, Karro H. Individual and familial factors associated with teenage pregnancy: an interview study. Eur J Public Health 2009; 19:266-70. [DOI: 10.1093/eurpub/ckn143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Haldre K, Rahu K, Karro H, Rahu M. Is a poor pregnancy outcome related to young maternal age? A study of teenagers in Estonia during the period of major socio-economic changes (from 1992 to 2002). Eur J Obstet Gynecol Reprod Biol 2007; 131:45-51. [PMID: 16797827 DOI: 10.1016/j.ejogrb.2006.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2005] [Revised: 03/21/2006] [Accepted: 05/01/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the risk of low birth weight, preterm birth, stillbirth, neonatal and postneonatal death among primiparous teenagers having singleton births, compared to a similar group of women aged 20-24 years in Estonia during the period of major socio-economic changes. STUDY DESIGN Registry study using the data from the Estonian Medical Birth Registry (EMBR) for years 1992-2002; EMBR data were linked with infant deaths in the Estonian Mortality Database. Study population included 51,890 women aged 13-24 years, arranged into three groups: < or =17, 18-19, and 20-24. Crude odds ratios (OR), adjusted ORs and their 95% confidence intervals (CI) for the different outcomes were estimated using multiple logistic regression analysis. RESULTS Compared with women aged 20-24 years, the risk of low birth weight and preterm birth was higher among teenagers. The risk of low birth weight and preterm birth within the study group as a whole did not change during the study period. Increased risks in neonatal and postneonatal death among younger teenagers of an age of 17 years and less seem to be a result of prematurity. CONCLUSIONS Despite major socio-economic changes resulting in improvements in obstetric care and growth in incomes, teenagers remained a higher risk group.
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Affiliation(s)
- Kai Haldre
- Tartu University Women's Clinic, Lossi 36, 51003 Tartu, Estonia.
| | - Kaja Rahu
- Tartu University Women's Clinic, Lossi 36, 51003 Tartu, Estonia
| | - Helle Karro
- Tartu University Women's Clinic, Lossi 36, 51003 Tartu, Estonia
| | - Mati Rahu
- Tartu University Women's Clinic, Lossi 36, 51003 Tartu, Estonia
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Abstract
BACKGROUND Major socio-economic changes, including health care reforms and changes in the school curriculum, took place in Estonia after the country regained its independence in 1991. These changes affected people's reproductive behavior in many ways. In this article, the impact of the changes on the reproductive behavior of teenage girls, measured by adolescent fertility and abortion rates between 1992 and 2001, is analyzed. METHODS National data on abortions and births were obtained from official medical statistics, particularly from the Estonian Abortion Registry and the Estonian Medical Birth Registry. Female population denominators for the age group 15-19 were obtained from the Statistical Office of Estonia. RESULTS In teenagers, the birth rate decreased more than two times, from 49.7 per 1000 in 1992 to 23.8 per 1000 in 2001. The abortion rate per 1000 decreased from 55.5 in 1992 to 30.4 in 2001. Compared with all women of fertile age (15-49 years), at the beginning of the decade, teenagers decided more often to have a baby, and, at the end of the decade, they decided more often to terminate the pregnancy. Two-thirds of all pregnancies in teenagers end in abortion--either legally induced abortion (legal abortion and therapeutic abortion) or spontaneous abortion. In 2001, the abortion ratio was 116.4 among ethnic Estonians and 147.9 among non-Estonians. CONCLUSIONS The case in Estonia again proves that the availability of information, contraceptives, services and education, and the existence of other goals in life besides childbearing, have an impact on teenage birth and abortion rates. Successful health promotion activities should take into consideration the differences in the reproductive behavior of different ethnic groups.
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Affiliation(s)
- Kai Haldre
- Tartu University Women's Clinic, Tartu, Estonia.
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