1
|
Björkman S, Lilliecreutz C, Bladh M, Strömberg T, Östgren CJ, Mahmoud A, Kafashian A, Bergstrand S, Sederholm Lawesson S. Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study. BJOG 2024; 131:433-443. [PMID: 37732494 DOI: 10.1111/1471-0528.17665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP). DESIGN Retrospective population-based cohort study. SETTING Linköping, Sweden. POPULATION Women aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linköping) 2016-18, who underwent microcirculatory assessment (N = 1222). METHODS Forearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP. MAIN OUTCOME MEASURES Skin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak. RESULTS Women with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (β -2.69, 95% CI -4.93 to -0.45). CONCLUSIONS The findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.
Collapse
Affiliation(s)
- Stina Björkman
- Department of Obstetrics and Gynaecology in Norrköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, and CMIV Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | | | - Sara Bergstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Liffner S, Bladh M, Rodriguez-Martinez H, Sydsjö G, Zalavary S, Nedstrand E. Intravaginal exposure to seminal plasma after ovum pick-up does not increase live birth rates after in vitro fertilization or intracytoplasmic sperm injection treatment: a double-blind, placebo-controlled randomized trial. Fertil Steril 2024:S0015-0282(24)00083-9. [PMID: 38342372 DOI: 10.1016/j.fertnstert.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/31/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To detect whether intravaginal exposure to prepared seminal plasma led to an absolute increase in live birth rate (LBR) after in vitro fertilization (IVF) by 10% compared with placebo. It has been suggested that intravaginal deposition of seminal plasma after ovum pick-up (OPU) for IVF treatment, increases pregnancy and LBRs. DESIGN Double-blind, placebo-controlled prospective study. An outcome assessment was made before the type of intervention was unblinded. The outcome data were analyzed according to an intention-to-treat protocol. SETTING University Hospital. PATIENTS Couples scheduled for an IVF treatment cycle: in total, 792 couples (393 in the seminal plasma group and 399 in the control group) were recruited over a 5-year period of inclusion in a single-center setting. INTERVENTION On the day of OPU, the couples were randomized into groups receiving either vaginal deposition of prepared seminal plasma from the partner or saline. Both participants and the physician were blind to the grouping. MAIN OUTCOME MEASURES The primary outcome was a live birth (LB). The secondary outcomes were a positive pregnancy test, defined as human chorionic gonadotropin identified in urine 3 weeks after OPU , and clinical pregnancy, defined as an intrauterine viable pregnancy assessed using transvaginal sonography after 5-7 weeks. RESULTS In the index group, 35.4% had a positive pregnancy test (relative risk [RR],0.93; 95% confidence interval {CI} 0.78-1.10), 28.8% had a clinical pregnancy (RR 1.00, 95% CI 0.97-1.03), and 26.5% had a LB (RR 0.86; 95% CI 0.70-1.07), adjusted for day of transfer, female age, and number of fertilized oocytes. Corresponding rates in the control group were 37.3%, 33.6%, and 29.8%. No statistically significant differences regarding outcomes between the two intervention groups were found. CONCLUSION Prepared seminal plasma applied in the vagina directly after OPU did not increase the rates of LB or clinical pregnancies. The importance of immunological factors to allow the implantation of an embryo is not questioned, but no improvement in the LBRs in IVF treatment by introducing the male partner's prepared seminal plasma after OPU could be found. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov, ID NCT02716753. Registration date 17 March, 2016, first enrollment November, 2016, completed March, 2023.
Collapse
Affiliation(s)
- Susanne Liffner
- Department of Biomedical and Clinical Sciences, BKH/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Marie Bladh
- Department of Biomedical and Clinical Sciences, BKH/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Heriberto Rodriguez-Martinez
- Department of Biomedical and Clinical Sciences, BKH/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Biomedical and Clinical Sciences, BKH/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Stefan Zalavary
- Department of Biomedical and Clinical Sciences, BKH/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Elizabeth Nedstrand
- Department of Biomedical and Clinical Sciences, BKH/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
Lindblad M, Bladh M, Björnsson-Hallgren H, Sydsjö G, Johansson T. No correlation to collagen synthesis disorders in patients with Perthes' disease: a nationwide Swedish register study of 3488 patients. BMC Musculoskelet Disord 2024; 25:42. [PMID: 38195509 PMCID: PMC10775491 DOI: 10.1186/s12891-023-07161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Mutations of the COL2A1 gene have been identified in patients with Perthes' disease. Several studies have hypothesised a connection between Perthes' disease and collagen synthesis disorders, especially COL2A1-related disorders, but no large studies on the subject have been made. The aim of this study was thus to discover if there is a connection between patients presenting with Perthes' disease, and collagen synthesis disorders. A secondary aim was to see if the children with both disorders had less optimal birth characteristics than the rest. METHODS Swedish national registers were used to collect data on children diagnosed with Perthes' disease or a collagen synthesis disorder. These registers include all births in Sweden, and data from both outpatient and in-hospital visits. A wide range of data is included besides diagnoses. All children with follow-up data to the age of 15 years were included. Pearson's chi-square was used for analysis. Statistical significance was further analysed with Fisher's Exact Test. RESULTS In total, 3488 children with either diagnosis were included. 1620 children had only Perthes disease, while 1808 children had only a collagen synthesis disorder. Five children were found to have both the diagnosis Perthes' disease and a collagen synthesis disorder. One child was large for their gestational age and none of the children had a low birthweight. Two of the children were moderately preterm. CONCLUSIONS The distinct lack of overlap in such a large body of material raises doubt about a connection between the presentation of Perthes' disease and collagen synthesis disorders, either COL2A1-related or not. We could not find an overrepresentation of less optimal birth characteristics either.
Collapse
Affiliation(s)
- M Lindblad
- Department of Emergency Medicine, Linköping University, Norrköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - M Bladh
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Linköping University, Linköping, Sweden
| | - H Björnsson-Hallgren
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Linköping University, Linköping, Sweden
| | - G Sydsjö
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Linköping University, Linköping, Sweden
| | - T Johansson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Linköping University, Norrköping, Sweden
| |
Collapse
|
4
|
Bladh M, Sydsjö G, Ekselius L, Vingård E, Agnafors S. Sense of coherence and health in women: a 25-year follow-up study. BMC Womens Health 2023; 23:670. [PMID: 38093276 PMCID: PMC10720174 DOI: 10.1186/s12905-023-02834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Health and Sense of Coherence (SOC) has been shown to be intertwined and argued to have a reciprocal relationship. The theory of SOC implies relatively stable scores during adulthood, however there are few longitudinal studies on the association between SOC and mental and somatic health. The main aim of the present study was to examine how SOC and self-rated health (SRH) are related during 25 years of follow-up. METHODS Using paper questionnaires distributed by postal services, 415 mothers were followed from childbirth and 25 years prospectively. SOC was measured at three, 12 and 25 years after inclusion. Self-reports on health status were obtained at the 25-year follow-up. The association between SOC and self-reported health as well as the effect of sociodemographic factors and experience of stressful life events was assessed through regression models. RESULTS SOC scores increased between three and 12 years after inclusion, and slightly decreased at the 25-year follow-up. Women of good health had a higher SOC-score at all three measurements compared to women of poor health. Multiple logistic regression showed that the likelihood of reporting good health increased with the number of times the women had reported SOC-scores above the 75th percentile. Moreover, women who had not been through a divorce were close to 60% more likely to report good health compared to women who had been through a divorce, whereas women not reporting stressful life events during the past two years were more than twice as likely to report good health. Symptoms below cut-off for postpartum depression and not having been through a divorce were associated with SOC scores above the 75th percentile. CONCLUSION This 25-year follow-up study of a cohort of women reports good stability of SOC assessments in the vast majority of women. There was a stronger and more stable SOC in women with better health. The findings are in line with other studies on the predictive value of SOC and self-perceived health.
Collapse
Affiliation(s)
- Marie Bladh
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58185, Sweden.
| | - Gunilla Sydsjö
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58185, Sweden
| | - Lisa Ekselius
- Women's Mental Health during the Reproductive Lifespan, Department of Women's and Children's Health, Uppsala University, Uppsala, SE-75185, Sweden
| | - Eva Vingård
- Department of Occupational and Environmental Medicine, Uppsala University, Uppsala, SE-75185, Sweden
| | - Sara Agnafors
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-58185, Sweden
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden
| |
Collapse
|
5
|
Sydsjö G, Lampic C, Bladh M, Nedstrand E, Svanberg AS. Long-term follow-up of mental health and satisfaction in a Swedish sample of sperm and egg donors after open-identity donation. Reprod Biomed Online 2023; 47:103417. [PMID: 37931369 DOI: 10.1016/j.rbmo.2023.103417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 11/08/2023]
Abstract
RESEARCH QUESTION How is the mental health of open-identity gamete donors and their satisfaction with their contributions 14-17 years after acceptance as a donor? DESIGN The Swedish Study on Gamete Donation is a longitudinal study comprising women and men who were accepted as donors at seven Swedish university clinics between 2005 and 2008. The latest (fifth) follow-up included 215 open-identity donors (response rate 87%): 123 oocyte donors and 92 sperm donors. The donors answered a questionnaire regarding their perceptions, experiences and expectations after gamete donation 14-17 years previously. RESULTS The donors were satisfied with the experience of donating, and no differences were detected between sperm and oocyte donors. Oocyte donors were more than twice as likely to feel that family and friends were proud of their donation compared with sperm donors (51% versus 23%, P < 0.001). In total, six donors regretted their donation: four oocyte donors and two sperm donors. Sperm donors were more frequently satisfied with the financial compensation compared with oocyte donors (P = 0.005). No difference in the development of symptoms of anxiety or depression was detected 14-17 years post-donation. CONCLUSION Long-term follow-up studies on donors are important for recruiting donors, and for recipients and the children who will be conceived with donated gametes. The results from the current study indicate that donors, generally, have good mental health and do not regret their decision to donate gametes. These findings are reassuring for all parties involved.
Collapse
Affiliation(s)
- Gunilla Sydsjö
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Umeå University, Umeå, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Elizabeth Nedstrand
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | |
Collapse
|
6
|
Agnafors S, Sydsjö G, Svedin CG, Bladh M. Symptoms of depression and internalizing problems in early adulthood - associated factors from birth to adolescence. Nord J Psychiatry 2023; 77:799-810. [PMID: 37688331 DOI: 10.1080/08039488.2023.2254281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE Even though the mechanisms behind the development of depression and internalizing problems remains unknown, many different factors have been shown to increase the risk. Longitudinal studies enable the investigation of exposure during different developmental periods during childhood. This study aims to examine factors associated with depressive and internalizing problems at age 20 in terms of sociodemographic factors, previous mental health problems and stressful life events during childhood, adolescence, and early adulthood. METHODS A birth cohort of 1723 children were followed to age 20. At the 20-year follow-up, n = 731 (44%) participated. Standardized instruments were filled out at baseline and the 3-,12- and 20-year follow-ups. RESULTS Depressive problems at age 20 were associated with female gender, experience of interpersonal life events reported at age 20, bullying victimization and reports on paternal mental health problems. Participants with depressive problems were also less likely to have experienced adolescence as happy and to report that their father had been a good father. Internalizing problems at age 20 were, in addition, associated with internalizing problems at age 12 and reports on maternal mental health problems. Internalizing problems were associated with a lower likelihood of experiencing adolescence as happy in the final model. CONCLUSION Recent events (i.e. interpersonal life events and bullying) seemed to be the most influential factors on the development of internalizing and depressive problems. Internalizing problems during childhood increased the risk for internalizing problems in early adulthood, emphasizing the importance of early intervention. Fewer factors were found to increase the risk for depressive problems compared to internalizing problems.
Collapse
Affiliation(s)
- Sara Agnafors
- Division of Children's and Women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden
| | - Gunilla Sydsjö
- Division of Children's and Women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carl Göran Svedin
- Department of Social Sciences, Marie Cederschiöld University, Sköndal, Sweden
| | - Marie Bladh
- Division of Children's and Women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
7
|
Svedin CG, Donevan M, Bladh M, Priebe G, Fredlund C, Jonsson LS. Associations between adolescents watching pornography and poor mental health in three Swedish surveys. Eur Child Adolesc Psychiatry 2023; 32:1765-1780. [PMID: 35524827 PMCID: PMC10460300 DOI: 10.1007/s00787-022-01992-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/09/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study was to examine the association between watching pornography and poor mental health in three repeated cross-sectional surveys in Sweden (2004, 2009, 2014) among high school seniors (13,277 students) with an average age of 18 years. The same index questions concerning ever having watched pornography and the frequency of watching pornography during the last year were combined with three different measures of psychological health and background control variables in multiple logistic regression and forward stepwise logistic regression models. The repeated cross-sectional surveys did not find any consistent associations across years between poor mental health and ever having watched pornography or the frequency of watching pornography. Having watched deviant pornography (containing violence, children and/or animals) was associated with poor mental health among boys in two surveys but only in one survey among girls. Other characteristics, such as mother's unemployment (especially boys), parenting style (especially high controlling parents among boys) and experiences of sexual abuse (especially penetrating abuse among girls), were more consistently and strongly associated to poor mental health across the three surveys. This study stresses the importance of controlling for multiple background variables when studying the association between watching pornography and mental health, since the association might primarily be explained by underlying confounding variables.
Collapse
Affiliation(s)
- C. G. Svedin
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - M. Donevan
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - M. Bladh
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - G. Priebe
- Department of Psychology, Lund University, Lund, Sweden
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - C. Fredlund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - L. S. Jonsson
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
| |
Collapse
|
8
|
Donevan M, Jonsson L, Bladh M, Priebe G, Fredlund C, Svedin CG. Adolescents' Use of Pornography: Trends over a Ten-year Period in Sweden. Arch Sex Behav 2022; 51:1125-1140. [PMID: 34750776 DOI: 10.1007/s10508-021-02084-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/09/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Using survey data from three nationally representative surveys in 2004, 2009, and 2014 among senior high school students in Sweden, this study investigates trends in adolescents' lifetime prevalence of pornography use, frequency of pornography use, and type of pornography used over time. While almost all boys and a considerable proportion of girls used pornography across the three waves, the lifetime prevalence of pornography use decreased overall for both girls and boys. The share of boys who use pornography frequently increased over the three survey cycles; those who reported using pornography daily increased from 11% in 2004 to 24% in 2014. In contrast, there was no change in girls who reported using pornography daily, while the proportion who never used pornography increased from 40% in 2004 to 51% in 2014. Adolescents appear to use a narrower range of different pornography types over the survey cycles. Multiple logistic regression models were generated to investigate factors associated with pornography use over the 10-year period. The results suggest that rule-breaking behavior, having higher economic status and higher academic achievement were related to boy's pornography use, while rule-breaking behavior, early sexual debut and victimization were associated with girls' pornography use.
Collapse
Affiliation(s)
- Meghan Donevan
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
| | - Linda Jonsson
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Marie Bladh
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gisela Priebe
- Department of Psychology, Lund University, Lund, Sweden
| | - Cecilia Fredlund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carl Göran Svedin
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| |
Collapse
|
9
|
Pettersson ML, Bladh M, Nedstrand E, Svanberg AS, Lampic C, Sydsjö G. Maternal advanced age, single parenthood, and ART increase the risk of child morbidity up to five years of age. BMC Pediatr 2022; 22:39. [PMID: 35031006 PMCID: PMC8759211 DOI: 10.1186/s12887-021-03103-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Advanced maternal age, single status and use of assisted reproductive technology (ART) are increasing in mothers in high-income countries, and all are known risk factors for negative obstetric outcomes. Less is known about their long-term consequences for childhood morbidity. Thus, the aim of this study was to investigate morbidity up to five years of age, in the children of older, single, and/or ART-treated mothers. Methods A cross-sectional using Swedish registers was performed comprising 23 772 children. The prevalence of diagnosis and the number of hospital visits for specialist care, were compared and analyzed in relation to maternal age at childbirth, maternal civil status, and mode of conception. The odds ratio for specialized care within each ICD-chapter were estimated using single and multiple logistic regression. Results Children born to single mothers and children conceived using ART had significantly more outpatient visits for specialist care and significantly more diagnoses compared to children with married/cohabiting mothers, and spontaneously conceived children. Children born to mothers of advanced maternal age (≥40) had fewer in- and outpatient visits. However, they were significantly more often diagnosed within ICD-chapters XVI, XVII i.e., they experienced more morbidity in the neonatal period. Conclusion The results indicate that children born to single mothers and children of ART-treated mothers have a higher morbidity and consume more specialist care than children of married/cohabiting and spontaneously pregnant mothers. We conclude that the use of ART, maternal single status and advanced maternal age are risk factors of importance to consider in pediatric care and when counseling women who are considering ART treatment.
Collapse
Affiliation(s)
- Malin Lindell Pettersson
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Marie Bladh
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Elizabeth Nedstrand
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | | | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85, Linköping, Sweden
| |
Collapse
|
10
|
Fureman AL, Lilja M, Lind T, Särnblad S, Bladh M, Samuelsson U. Comparing continuous subcutaneous insulin infusion and multiple daily injections in children with Type 1 diabetes in Sweden from 2011 to 2016-A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS). Pediatr Diabetes 2021; 22:766-775. [PMID: 33929074 DOI: 10.1111/pedi.13217] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as body mass index standard deviation scores (BMI-SDS) in a nationwide sample of children and adolescents with Type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively. RESEARCH DESIGN AND METHODS Longitudinal data from 2011 to 2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia. RESULTS Data were available from 35,624 patient-years (54% boys). In general, HbA1c decreased approximately 0.5% (2-5 mmol/mol) from 2011 to 2016 (ptrend < 0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7-1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011-2016. CONCLUSIONS There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control.
Collapse
Affiliation(s)
- Anna-Lena Fureman
- Department of Clinical Sciences, Pediatrics, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, Örebro University, Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology and Biomedical and Clinical Sciences, Linköping University Hospital, Linköping University, Linköping, Sweden
| | - Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
11
|
Liffner S, Bladh M, Nedstrand E, Hammar M, Martinez HR, Sydsjö G. Men born small for gestational age or with low birth weight do not improve their rate of reproduction over time: a Swedish population-based study. Fertil Steril 2021; 116:721-730. [PMID: 34187702 DOI: 10.1016/j.fertnstert.2021.05.078] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate whether the reduced reproductive rate among men born small for gestational age (SGA) or with low birth weight (LBW) is present after up to 44 years of follow-up. DESIGN Population-based register study. SETTING National registers in Sweden. PATIENT(S) All men born in Sweden between 1973 and 1993 (n = 1,045,167) followed up to 2018. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Registered fatherhood, infertility diagnoses, and fertility treatments obtained from registers up to 2018 RESULT(S): Men born SGA or with LBW have a lower chance of becoming fathers than men born with normal birth characteristics: hazard ratio (95% confidence interval) 0.91 (0.90-0.92) and 0.88 (0.86-0.90), respectively. The reduction in reproductive rate is more evident after a longer follow-up time. Men born SGA were more likely to receive a diagnosis of infertility. Sperm donation and intracytoplasmic sperm injection were more often used in men born SGA, further strengthening the hypothesis of an association between birth characteristics and male infertility. CONCLUSION(S) Men born SGA or with LBW have a lower chance of becoming fathers, but the reduction in fertility is smaller for the younger cohort. Further studies are needed to determine if this difference is maintained.
Collapse
Affiliation(s)
- Susanne Liffner
- Department of Biomedical and Clinical Sciences (BKV), Division of Children´s and Women´s Health (BKH)/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Marie Bladh
- Department of Biomedical and Clinical Sciences (BKV), Division of Children´s and Women´s Health (BKH)/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Elizabeth Nedstrand
- Department of Biomedical and Clinical Sciences (BKV), Division of Children´s and Women´s Health (BKH)/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Department of Biomedical and Clinical Sciences (BKV), Division of Children´s and Women´s Health (BKH)/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Heriberto Rodriguez Martinez
- Department of Biomedical and Clinical Sciences (BKV), Division of Children´s and Women´s Health (BKH)/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Biomedical and Clinical Sciences (BKV), Division of Children´s and Women´s Health (BKH)/Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
12
|
Stålberg V, Josefsson A, Bladh M, Lilliecreutz C. The risk of postpartum hemorrhage when lowering the oxytocin dose in planned cesarean section, a pilot study. Sex Reprod Healthc 2021; 29:100641. [PMID: 34174496 DOI: 10.1016/j.srhc.2021.100641] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Oxytocin is the drug of choice in preventing postpartum hemorrhage (PPH). The aim was to compare the peroperative- and total blood loss within two hours and PPH after planned cesarean section (CS) when receiving 2.5 IU vs 5.0 IU of oxytocin in different risk groups for PPH. STUDY DESIGN A pilot study including 927 women undergoing planned CS where women receiving 2.5 IU of oxytocin were compared to women receiving 5.0 IU of oxytocin. MAIN OUTCOME MEASURES Data comparing peroperative blood loss, total blood loss within two hours and PPH were analyzed. RESULTS The women receiving 2.5 IU of oxytocin had a slightly higher peroperative blood loss, compared to the 5.0 IU group (476 ml vs 426 ml, p = 0.029). The total blood loss two hours after surgery showed no significant difference between the groups (626 ml vs 595 ml, p = 0.230). In the 2.5 IU group 13% had a blood loss ≥ 1000 ml vs 10% in the 5 IU group (aOR 1.64, 95% CI = 1.05-2.56). When the women considered to be at high risk for postpartum hemorrhage were excluded, we found no difference in the likelihood for postpartum hemorrhage between the groups (aOR 1.13, 95% CI = 0.64-1.99). CONCLUSIONS Women undergoing planned CS and receiving 2.5 IU of oxytocin had a slightly higher risk for postpartum hemorrhage in this study. However, a lower dose of 2.5 IU of oxytocin seems to be a safe option in planned CS for women without known risk factors for postpartum hemorrhage, but further research is needed to confirm these findings.
Collapse
Affiliation(s)
- Valerie Stålberg
- Department of Obstetrics and Gynecology in Norrköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.
| |
Collapse
|
13
|
Lindell N, Bladh M, Carlsson A, Josefsson A, Aakesson K, Samuelsson U. Size for gestational age affects the risk for type 1 diabetes in children and adolescents: a Swedish national case-control study. Diabetologia 2021; 64:1113-1120. [PMID: 33544169 PMCID: PMC8012313 DOI: 10.1007/s00125-021-05381-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/11/2020] [Indexed: 10/26/2022]
Abstract
AIM/HYPOTHESIS Environmental factors are believed to contribute to the risk of developing type 1 diabetes. The aim of this study was to investigate how size for gestational age affects the risk of developing childhood type 1 diabetes. METHODS Using the Swedish paediatric diabetes quality register and the Swedish medical birth register, children with type 1 diabetes diagnosed between 2000 and 2012 (n = 9376) were matched with four control children (n = 37,504). Small for gestational age (SGA) and large for gestational age (LGA) were defined according to Swedish national standards. Data were initially analysed using Pearson's χ2 and thereafter by single and multiple logistic regression models. RESULTS An equal proportion of children were born appropriate for gestational age, but children with type 1 diabetes were more often born LGA and less often born SGA than control children (4.7% vs 3.5% and 2.0% vs 2.6%, respectively, p < 0.001). In the multiple logistic regression analysis, being born LGA increased (adjusted OR 1.16 [95% CI 1.02, 1.32]) and SGA decreased (adjusted OR 0.76 [95% CI 0.63, 0.92]) the risk for type 1 diabetes, regardless of maternal BMI and diabetes. CONCLUSIONS/INTERPRETATION Size for gestational age of Swedish children affects the risk of type 1 diabetes, with increased risk if the child is born LGA and decreased risk if the child is born SGA. Being born LGA is an independent risk factor for type 1 diabetes irrespective of maternal BMI and diabetes. Thus, reducing the risk for a child being born LGA might to some extent reduce the risk for type 1 diabetes.
Collapse
Affiliation(s)
- Nina Lindell
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karin Aakesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Ulf Samuelsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Linköping University, Linköping, Sweden
| |
Collapse
|
14
|
Leijon I, Bladh M, Finnström O, Gäddlin PO, Hammar M, Nelson N, Theodorsson E, Sydsjö G. [Follow-up study of very low birthweight children in Sweden at the age of 27-28]. Lakartidningen 2020; 117:20084. [PMID: 33259050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Studies show that very low birthweight can be an important risk factor for mental problems, disturbed fertility and neuroendocrine dysregulation. In a regional long-term study 56 of 86 adult individuals 27 to 28 years of age with a very low birthweight were compared with normal birthweight controls. Analyses of self-reported mental health, socio-demographic factors, sex hormone levels, and hair cortisol levels showed no significant differences between the groups. However, in order to analyse subgroups with different risk factors from the newborn period or children with a variety of social background factors, larger patient groups are needed.
Collapse
Affiliation(s)
- Ingemar Leijon
- docent, f d överläkare, avdelningen för barns och kvinnors hälsa, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| | - Marie Bladh
- med dr, statistiker, avdelningen för barns och kvinnors hälsa, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| | - Orvar Finnström
- f d professor och överläkare, avdelningen för barns och kvinnors hälsa, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| | - Per-Olof Gäddlin
- med dr, f d överläkare, , avdelningen för barns och kvinnors hälsa, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| | - Mats Hammar
- professor emeritus, överläkare, avdelningen för barns och kvinnors hälsa, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| | - Nina Nelson
- adjungerad professor, överläkare,, institutionen för biomedicins-ka och kliniska vetenskaper, Linköpings universitet; institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska institutet, Stockholm
| | - Elvar Theodorsson
- professor, överläkare, avdelningen för klinisk kemi, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| | - Gunilla Sydsjö
- professor, avdelningen för barns och kvinnors hälsa, institutionen för biomedicinska och kliniska vetenskaper, Linköpings universitet
| |
Collapse
|
15
|
Wolgast E, Lilliecreutz C, Sydsjö G, Bladh M, Josefsson A. The impact of major depressive disorder and antidepressant medication before and during pregnancy on obstetric and neonatal outcomes: A nationwide population-based study. Eur J Obstet Gynecol Reprod Biol 2020; 257:42-50. [PMID: 33359923 DOI: 10.1016/j.ejogrb.2020.11.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/03/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the impact of major depressive disorder (MDD) and antidepressant medication before and during pregnancy on obstetric and neonatal outcomes. STUDY DESIGN A national register-based cohort study of pregnant women born in Sweden, and their first child born in 2012-2015 (n = 262 329). Women diagnosed with MDD and who had redeemed an antidepressant one year before becoming pregnant ("before pregnancy") and women who were diagnosed with MDD and who had redeemed an antidepressant both before and during pregnancy ("before and during pregnancy") were compared with each other and with women who had neither been diagnosed with MDD nor been prescribed antidepressants (population controls). RESULTS In comparison to population controls, the "before pregnancy" and the "before and during pregnancy" groups had increased likelihoods of operative childbirth (aOR = 1.19, 95 % CI 1.12-1.27, aOR = 1.38, 95 % CI 1.28-1.48 respectively), and with an increased likelihood for the child being admitted to a neonatal intensive care unit (NICU) (aOR = 1.51, 95 % CI 1.17-1.95, aOR = 1.55, 95 % CI 1.14-2.11). Children born to mothers in the "before and during pregnancy" group had an increased likelihood of preterm birth (aOR = 1.72, 95 % CI 1.52-1.95,), while children to mothers in the "before pregnancy" group had an increased likelihood of low birthweight (aOR = 1.15, 95 % CI 1.00-1.33) compared to population controls. Women in the "before and during pregnancy" group had an increased likelihood for hyperemesis during pregnancy (aOR = 1.93, 95 % CI = 1.60-2.32), having an operative childbirth (aOR = 1.17, 95 % CI = 1.06-1.29) or a preterm birth (aOR = 1.53, 95 % CI = 1.28-1.81) compared to the "before pregnancy" group. CONCLUSIONS Women with MDD and antidepressant medication prior to becoming pregnant are at increased risk for adverse obstetric and neonatal outcomes compared to women without an MDD. Continuation of antidepressant medication during pregnancy somewhat increased the risk for adverse obstetric and neonatal outcomes.
Collapse
Affiliation(s)
- Emelie Wolgast
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden.
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynaecology in Linköping and Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Sweden
| |
Collapse
|
16
|
Sydsjö G, Bladh M, Rindeborn K, Hammar M, Rodriguez-Martinez H, Nedstrand E. Being born preterm or with low weight implies a risk of infertility and premature loss of ovarian function; a national register study. Ups J Med Sci 2020; 125:235-239. [PMID: 32532178 PMCID: PMC7720967 DOI: 10.1080/03009734.2020.1770380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Being born with non-optimal birth characteristics has several long-term consequences on health in general but also for the individual's reproductive pattern. In premature ovarian insufficiency (POI) the follicles are depleted or dysfunctional. This results in menopause before the age of 40, and for most of the affected women, it causes infertility. The objective of this study was to evaluate the potential effects of being born with non-optimal birth characteristics on the risk of developing POI.Methods: This population-based cohort register study included all women born in Sweden between 1973 and 1993 who were followed until the end of 2012 (age at the end of follow-up ranged between 39 and 59). Women diagnosed with POI were compared with women without this diagnosis with respect to being born small for gestational age, preterm, or with low birth weight. Data on birth characteristics and diagnosis of POI were collected from national registers.Results: A total of 1,033,878 women were included. Being born small for gestational age was associated with a slightly increased odds ratio of POI with 10%. Preterm birth and low birth weight were associated with somewhat increased ORs of POI after exclusion of those born small for gestational age. Similarly, being born preterm or with a low birth weight was also found to be associated with POI to the same extent.Conclusions: Being born with non-optimal birth characteristics may increase the risk of premature ovarian insufficiency.
Collapse
Affiliation(s)
- Gunilla Sydsjö
- Faculty of Medicine and Health Sciences, Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- CONTACT Gunilla Sydsjö Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85Linköping, Sweden
| | - Marie Bladh
- Faculty of Medicine and Health Sciences, Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katarina Rindeborn
- Faculty of Medicine and Health Sciences, Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Faculty of Medicine and Health Sciences, Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Heriberto Rodriguez-Martinez
- Faculty of Medicine and Health Sciences, Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elizabeth Nedstrand
- Faculty of Medicine and Health Sciences, Division of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
17
|
Liffner S, Nedstrand E, Bladh M, Rodriguez-Martinez H, Hammar M, Sydsjö G. Birth characteristics in men with infertility. Reprod Biomed Online 2020; 41:455-463. [PMID: 32600947 DOI: 10.1016/j.rbmo.2020.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Abstract
RESEARCH QUESTION Are low birth weight, prematurity, being born small for gestational age, or both, associated with a higher risk of male factor infertility in adulthood? DESIGN Retrospective study of a clinical sample of 892 men, diagnosed with an infertility factor (male, female, combined or unexplained) together with their female partner at a University Hospital clinic in Sweden between 2005 and 2010. Data on birth weight and gestational age at birth were retrieved from the Swedish Medical Birth Register. The distribution of non-optimal birth characteristics in relation to infertility factor was described. A control group was created consisting of two men for each index man, born in Sweden in the same year as each index men, as well as a reference group consisting of all men born in Sweden the same years. RESULTS The likelihood of having been born small for gestational age was almost fivefold higher in men with male factor infertility than in men with unexplained infertility (OR 4.84, 95% CI 1.32 to 17.80). Men with male factor infertility were more often born with non-optimal birth characteristics than the control group (14.8% versus 8.5%; P = 0.010) and the reference group (14.8% versus 11.4%; P < 0.001). Men with azoospermia were more often born with non-optimal birth characteristics, compared with men without azoospermia (21.3% versus 12.1%; P = 0.038). CONCLUSIONS The results suggest an association between intrauterine growth restriction and male factor infertility in adulthood.
Collapse
Affiliation(s)
- Susanne Liffner
- Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping SE-581 85, Sweden.
| | - Elizabeth Nedstrand
- Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping SE-581 85, Sweden
| | - Marie Bladh
- Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping SE-581 85, Sweden
| | - Heriberto Rodriguez-Martinez
- Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping SE-581 85, Sweden
| | - Mats Hammar
- Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping SE-581 85, Sweden
| | - Gunilla Sydsjö
- Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping SE-581 85, Sweden
| |
Collapse
|
18
|
Hammar E, Bladh M, Agnafors S. Mental health and experience of being bullied in 12-year-old children with overweight and obesity. Acta Paediatr 2020; 109:1450-1457. [PMID: 31821589 DOI: 10.1111/apa.15131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 01/20/2023]
Abstract
AIM The aim was to study the association between weight, mental health and experience of being bullied in 12-year-old children. Additional aim was to investigate the impact of childhood psychosocial risk factors for overweight and obesity at age 12. METHODS Study participants were members of a Swedish prospective cohort study. A total of 573 children were followed from pregnancy to age 12. IOTF-BMI at 12 years of age was used to categorise normal weight, overweight and obesity. Mothers, children and teachers filled out questionnaires on child mental health and experience of being bullied at age 12. RESULTS In bivariate analysis, girls with obesity reported significantly more behavioural problems than normal weight and overweight peers; however, no significant differences in mental health was noted between different weight categories when controlling for gender, experience of life events and socio-economic factors. Overweight and obesity were associated with experience of being bullied after controlling for gender, experience of life events and socio-economic factors (OR = 2.05, 95% CI = 1.08-3.91). CONCLUSION Children with overweight and obesity are at increased risk of being bullied compared with normal weight peers. No significant differences in mental health were noted between children with obesity, overweight and normal weight in multivariate analysis.
Collapse
Affiliation(s)
- Ewa Hammar
- Department of Clinical Sciences Malmö and Resident Physician at Berga Health Care Center Lund University Helsingborg Sweden
| | - Marie Bladh
- Division of Children's and Women's Health Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Sara Agnafors
- Division of Children's and Women's Health Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| |
Collapse
|
19
|
Pettersson ML, Nedstrand E, Bladh M, Svanberg AS, Lampic C, Sydsjö G. Mothers who have given birth at an advanced age - health status before and after childbirth. Sci Rep 2020; 10:9739. [PMID: 32546715 PMCID: PMC7298035 DOI: 10.1038/s41598-020-66774-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/19/2020] [Indexed: 11/09/2022] Open
Abstract
Women postpone childbirth to an age when morbidity is higher and fertility has decreased and yet the knowledge of mothers' morbidity related to age remains scarce. Swedish national register data from the Medical Birth Register and National Patient Register was used to investigate the incidence of diseases listed in the International Classification of Diseases, version 10 (ICD-10) in women who gave birth 2007-8. The index group consisted of women 40 years of age or older (n = 8 203) were compared to a control group of women, younger than 40 years (n = 15 569) at childbirth. The period studied was five years before childbirth to five years after. The main outcome measures were incidence of disease diagnosed in specialized hospital care. Demographical data and use of assisted reproduction (ART) were adjusted for. The results showed that older women were more likely to be single; less frequently used tobacco; were educated on a higher level; had a higher BMI and more often had used ART to become pregnant. The older women showed a higher morbidity rate. In the diagnostic groups: Neoplasms, Blood and immune system, Eye and adnexa, Ear and mastoid, Circulatory, Digestive, Skin and subcutaneous tissue, Musculoskeletal and connective tissue, and Genitourinary. The results add to the body of knowledge of a number of specific risks faced by older mothers and may be used to identify preventive actions concerning fertility and morbidity both before and after childbirth.
Collapse
Affiliation(s)
- Malin Lindell Pettersson
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Elizabeth Nedstrand
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Public health and Caring Sciences, Uppsala University, SE-751 22, Uppsala, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
20
|
Wickenbergh E, Nilsson L, Bladh M, Kjølhede P, Wodlin NB. Agreements on perceived use of principles for Enhanced Recovery After Surgery between patients and nursing staff in a gynecological ward. Eur J Obstet Gynecol Reprod Biol 2020; 250:216-223. [PMID: 32470699 DOI: 10.1016/j.ejogrb.2020.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/01/2019] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the agreements between patients and nursing staff in perceived use of the principles of Enhanced Recovery After Surgery (ERAS) in a gynecological ward, both prior to and following an educational session on ERAS guidelines for the nursing staff. STUDY DESIGN This was a prospective observational study conducted in the in-patient gynecological section of the Department of Obstetrics and Gynecology at the University hospital of Linköping during spring 2017. The study groups comprised women scheduled for elective in-patient gynecological surgery due to benign or malignant diseases and the nursing staff at the gynecological ward. The study was performed in three parts with two structured questionnaire interviews of patients and nursing staff, and an intermediate educational session for the nursing staff regarding ERAS principles, conducted between the parts of the interview. Seventy-two patients were included in Interview part 1 and 68 patients in Interview part 2. The results are shown as the degree of inter-rater agreement and reliability of the responses between patients and nursing staff in numbers and percentages, along with the difference (Δ) in agreement between the interview parts, and its corresponding 95% confidence interval (CI). In addition, Cohen's kappa was used to validate the findings. RESULTS Inter-rater agreement in answers to the interview questions was high even before the educational session. The observed agreement was ≥ 70% in 34 out of 42 questions in Interview part 1, and in 38 out of 42 questions in Interview part 2. Thirty of the 42 items (71%) had positive Δ agreement (%) whereas 12 of the 42 (29%) had negative Δ agreement (%). CONCLUSIONS This study showed high inter-rater agreement in perceived adherence to ERAS principles between patients and nursing staff in a gynecological ward. This was further improved by an educational session for the staff concerning ERAS guidelines. This might indicate the importance of repeated educational sessions to maintain high compliance with ERAS principles.
Collapse
Affiliation(s)
- Evelina Wickenbergh
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| |
Collapse
|
21
|
Leijon I, Bladh M, Finnström O, Gäddlin P, Nelson N, Hammar M, Theodorsson E, Sydsjö G. Self-reported mental health and cortisol activity at 27-28 years of age in individuals born with very low birthweight. Acta Paediatr 2020; 109:948-958. [PMID: 31732987 PMCID: PMC7217145 DOI: 10.1111/apa.15093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022]
Abstract
Aim To assess mental health outcomes of very low birthweight (VLBW, <1500 g) subjects to adulthood and to examine salivary cortisol and hair cortisol levels and their relation to birth characteristics and mental health. Methods A Swedish regional cohort of 56 VLBW subjects and 55 full‐term controls were assessed at the ages 27‐28 with adult self‐reported scales and the mean of 2 days diurnal salivary cortisol and hair cortisol. The cohorts had been assessed at 15 years of age with youth self‐reported scales. Results There were no differences between the groups in youth self‐reported scales and adult self‐reported scores. The 24 participating VLBW girls scored lower on youth self‐reported scales externalising and total problem scores than the control girls. In adulthood, the 21 participating VLBW women had significantly higher morning concentrations of salivary cortisol than control women, P = .014. No significant associations were found between cortisol concentrations and adult self‐reported scales internalising, externalising and total scores. Conclusion Self‐reported mental health in VLBW subjects was comparable with normal birthweight controls indicating a satisfying transition from adolescence to adulthood. VLBW females had higher morning salivary cortisol concentrations, suggesting a gender difference. We found no correlations between cortisol and mental health.
Collapse
Affiliation(s)
- Ingemar Leijon
- Division of Children's and Women's Health Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Marie Bladh
- Obstetrics and Gynaecology Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Orvar Finnström
- Division of Children's and Women's Health Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Per‐Olof Gäddlin
- Division of Children's and Women's Health Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Futurum Region Jönköping County Jönköping Sweden
| | - Nina Nelson
- Division of Children's and Women's Health Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
- Department of Quality and Patient Safety Karolinska University Hospital Stockholm Sweden
| | - Mats Hammar
- Obstetrics and Gynaecology Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Elvar Theodorsson
- Department of Clinical Chemistry, and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Gunilla Sydsjö
- Obstetrics and Gynaecology Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| |
Collapse
|
22
|
Samuelsson J, Samuelsson U, Hanberger L, Bladh M, Åkesson K. Poor metabolic control in childhood strongly correlates to diabetes-related premature death in persons <30 years of age-A population-based cohort study. Pediatr Diabetes 2020; 21:479-485. [PMID: 31943577 DOI: 10.1111/pedi.12980] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 11/15/2019] [Accepted: 01/09/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/OBJECTIVE The importance of metabolic control in childhood regarding excess risk of death in young persons has not been well studied. This registry-based study aimed to investigate mortality rates and cause of death related to metabolic control in young persons (≤29 years) in Sweden with type 1 diabetes. METHODS All 12 652 subjects registered in the Swedish pediatric diabetes quality register, from 2006 to 2014, were included. Data were merged with the Swedish Cause of Death Register. Standardized mortality rates were calculated using the official Swedish population register. RESULTS Of 68 deaths identified, 38.2% of the deaths were registered as being due to diabetes whereof the major cause of death was acute complications. Overall standardized mortality ratio was 2.7 (2.1-3.4, 95% CI). Subjects who died from diabetes had a mean HbA1c of 74 ± 19 mmol/mol (8.9 ± 1.7%) during childhood vs 62 ± 12 mmol/mol (7.8 ± 1.1%) in those still alive (P < .001). CONCLUSIONS In this nationwide cohort of young subjects with type 1 diabetes, there was a high mortality rate compared to the general population. Mean HbA1c in childhood was significantly higher in those who died from diabetes, compared to subjects who were still alive. To decrease mortality in young persons with type 1 diabetes it is essential not only to achieve but also to maintain a good metabolic control during childhood and adolescence.
Collapse
Affiliation(s)
- John Samuelsson
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Division of Children's and Women's Health, Linköping University, Linköping, Sweden
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Children's and Women's Health, Linköping University, Linköping, Sweden
| | - Lena Hanberger
- Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Clinical and Experimental Medicine, Division of Children's and Women's Health, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Division of Children's and Women's Health, Linköping University, Linköping, Sweden
| |
Collapse
|
23
|
Tordön R, Bladh M, Sydsjö G, Svedin CG. Improved Intelligence, Literacy and Mathematic Skills Following School-Based Intervention for Children in Foster Care. Front Psychol 2020; 11:718. [PMID: 32390912 PMCID: PMC7194231 DOI: 10.3389/fpsyg.2020.00718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/04/2020] [Accepted: 03/24/2020] [Indexed: 01/13/2023] Open
Abstract
Interventions aimed at improving school performance for children in foster care are few and are generally not implemented. By preventing failure in school, the prospect of reducing the risk for future poor health, substance abuse, unemployment, and other detrimental social conditions are met. This paper focuses on the change of preconditions for compulsory school performance in out-of-home care children, following an intervention called “Skolfam” that aims to improve school performance by individual assessments and school-based interventions. In this study, data were compiled from prospective repeated tests of 475 children in foster care in Sweden. Educational preconditions were analysed for compulsory school performance, such as intelligence (WISC-IV), psychosocial (SDQ) and adaptive behavior (ABAS-II), literacy (Reading Chains) and mathematical skills (Magne Mathematic Diagnoses) before and after the first 2 years of the “Skolfam” intervention. All tests were age-standardized and performed by experienced professionals. The results showed improved skills in complex aspects of literacy, mathematics, and cognitive performance, but no improvement in less complex literacy skills, adaptive behavior or mental health symptoms. In conclusion, higher-order cognitive functions can develop positively when appropriate school support is provided. Affective function, adaptive behavior, and psychosocial well-being present a more pervasive challenge for children in foster care. Implications for future research, practice in social services, and school is that further development of methods to aid future prospects for children in out-of-home care should aim to improve both cognitive higher-order executive-, and affective functions.
Collapse
Affiliation(s)
- Rikard Tordön
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carl Göran Svedin
- Department of Social Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| |
Collapse
|
24
|
Andolf E, Bladh M, Möller L, Sydsjö G. Prior placental bed disorders and later dementia: a retrospective Swedish register-based cohort study. BJOG 2020; 127:1090-1099. [PMID: 32145044 DOI: 10.1111/1471-0528.16201] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association between a history of placental bed disorders and later dementia. DESIGN Retrospective population-based cohort study. SETTING Sweden. SAMPLE All women giving birth in Sweden between 1973 and 1993 (1 128 709). METHODS Women with and without placental bed disorders (hypertensive disorders of pregnancy including pre-eclampsia, fetal growth restriction, spontaneous preterm labour and birth, preterm premature rupture of membranes, abruptio placenta, late miscarriages) and other pregnancy complications were identified by means of the Swedish Medical Birth Register. International classification of disease was used. Data were linked to other National Registers. Participants were followed up until 2013. The Cox proportional hazards model was used to calculate hazard ratios for women with and without pregnancy complications and were adjusted for possible confounders. MAIN OUTCOME MEASURES Diagnosis of vascular dementia and non-vascular dementia. RESULTS Adjusted for cardiovascular disease and socio-demographic factors, an increased risk of vascular dementia was shown in women with previous pregnancy-induced hypertension (Hazard ratio [HR] 1.88, 95% CI 1.32-2.69), pre-eclampsia (HR 1.63, 95% CI 1.23-2.16), spontaneous preterm labour and birth (HR 1.65, 95% CI 1.12-2.42) or preterm premature rupture of membranes (HR 1.60, 95% CI 1.08-2.37). No statistically significant increased risk was seen for other pregnancy complications or non-vascular dementia even though many of the point estimates indicated increased risks. CONCLUSIONS Women with placental bed disorders have a higher risk for vascular disease. Mechanisms behind the abnormal placentation remain elusive, although maternal constitutional factors, abnormal implantation as well as impaired angiogenesis have been suggested. TWEETABLE ABSTRACT Placental bed syndromes associated with vascular dementia even after adjusting for cardiovascular disease.
Collapse
Affiliation(s)
- E Andolf
- Division of Obstetrics and Gynaecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - M Bladh
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - L Möller
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - G Sydsjö
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
25
|
Lindblad M, Josefsson A, Bladh M, Sydsjö G, Johansson T. Risk factors during pregnancy and delivery for the development of Perthes' disease, a nationwide Swedish study of 2.1 million individuals. BMC Pregnancy Childbirth 2020; 20:192. [PMID: 32228493 PMCID: PMC7106730 DOI: 10.1186/s12884-020-2849-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/21/2018] [Accepted: 02/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background To ascertain or disprove a correlation between suboptimal birth characteristics, breech position at delivery and development of Perthes’ disease. Methods Study material was collected from nationwide registers regarding diagnoses, birth statistics and delivery data. As study population were included children with a diagnosis code for Perthes’ disease who were alive and living in Sweden at age 13. Children with missing birth statistics were excluded. All children with no Perthes’ disease diagnosis were used as control group. Both single and multiple logistical regression analyses were used to calculate OR for the included characteristics. Results Children in breech position had a higher risk for developing Perthes’ disease. Children with Perthes’ disease had also a higher probability of having been born pre-term, very pre-term or post-term. Lower than normal birth weight and a lower Apgar-score were also associated with Perthes’ disease. Conclusions There is a correlation between breech birth and development of Perthes’ disease. There is also correlation to suboptimal birth characteristics. Despite our findings this should not be used for screening of Perthes’ disease as the percentage of children who actually develop it is very low. Also, as of yet there is no possibility to diagnose Perthes’ disease before the presence of skeletal changes. Our findings could be important in finding the cause of Perthes’ disease and therefore developing better diagnostics, treatment and prevention.
Collapse
Affiliation(s)
- Maria Lindblad
- Department of Orthopedics, Norrköping, Sweden. .,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Ann Josefsson
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Torsten Johansson
- Department of Orthopedics, Norrköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
26
|
Armuand G, Skoog Svanberg A, Bladh M, Sydsjö G. Adverse obstetric outcomes among female childhood and adolescent cancer survivors in Sweden: A population-based matched cohort study. Acta Obstet Gynecol Scand 2019; 98:1603-1611. [PMID: 31329281 DOI: 10.1111/aogs.13690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/07/2019] [Accepted: 07/17/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cancer treatment during childhood may lead to late adverse effects, such as reduced musculoskeletal development or vascular, endocrine and pulmonary dysfunction, which in turn may have an adverse effect on later pregnancy and childbirth. The aim of the present study was to investigate pregnancy and obstetric outcomes as well as the offspring's health among childhood and adolescent female cancer survivors. MATERIAL AND METHODS This register-based study included all women born between 1973 and 1977 diagnosed with cancer in childhood or adolescence (age <21), as well as an age-matched comparison group. A total of 278 female cancer survivors with their first childbirth were included in the study, together with 829 age-matched individuals from the general population. Logistic regression and analysis of variance were used to investigate associations between having been treated for cancer and the outcome variables, adjusting for maternal age, nicotine use and comorbidity. RESULTS Survivors were more likely to have preeclampsia (adjusted odds ratio [aOR] 3.46, 95% confidence interval [CI] 1.58 to 7.56), undergo induction of labor (aOR 1.66, 95% CI 1.05 to 2.62), suffer labor dystocia (primary labor dystocia aOR 3.54, 95% CI 1.51 to 8.34 and secondary labor dystocia aOR 2.43, 95% CI 1.37 to 4.31), malpresentation of fetus (aOR 2.02, 95% CI 1.12 to 3.65) and imminent fetal asphyxia (aOR 2.55, 95% CI 1.49 to 4.39). In addition, deliveries among survivors were more likely to end with vacuum extraction (aOR 2.53, 95% CI 1.44 to 4.47), with higher risk of clitoral lacerations (aOR 2.18, 95% CI 1.47 to 3.23) and anal sphincter injury (aOR 2.76, 95% CI 1.14 to 6.70) and emergency cesarean section (aOR 2.34 95% CI 1.39 to 3.95). Survivors used pain-reliving methods to a higher extent compared with the comparison group. There was no increased risk of neonate diagnoses and malformations. The results showed that survivors who had been diagnosed with cancer when they were younger than 14 had an increased risk of adverse obstetric outcomes. CONCLUSIONS The study demonstrates increased risk of pregnancy and childbirth complications among childhood and adolescent cancer survivors. There is a need to optimize perinatal care, especially among survivors who were younger than 14 at time of diagnosis.
Collapse
Affiliation(s)
- Gabriela Armuand
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | | | - Marie Bladh
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
27
|
Abstract
BACKGROUND Parenthood is a life transition that can be especially demanding for vulnerable individuals. Young maternal age and maternal single status have been reported to increase the risk for adverse outcomes for both mother and child. The aim of this study was to investigate the effect of young maternal age and maternal single status on maternal and child mental health and child development at age 3. METHODS A birth-cohort of 1723 mothers and their children were followed from birth to age 3. Sixty-one mothers (3.5%) were age 20 or younger, and 65 (4.0%) reported single status at childbirth. The mothers filled out standardized instruments and medical information was retrieved from the standardized clinical assessment of the children at Child Welfare Centers, (CWC). RESULTS Young maternal age was associated with symptoms of postpartum depression whereas single status was not. Young mothers were more prone to report internalizing and externalizing problems in their children, while there was no association between single status and child behavioral problems. No differences were seen on child development (CWC scores). School drop-out was, however, a more influential factor on depressive symptoms postpartum than maternal age. CONCLUSION Young mothers are at increased risk for symptoms of postpartum depression which indicates the need for attention in pre- and postnatal health care programs. Single mothers and their children were not found to be at increased risk for adverse outcomes. The importance of schooling was demonstrated, indicating the need for societal support to encourage adolescents to remain in school.
Collapse
Affiliation(s)
- Sara Agnafors
- Department of Clinical and Experimental Medicine, Division of Children's and Women's health, Linköping University, SE-581 83, Linköping, Sweden.
| | - Marie Bladh
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Division of Children’s and Women’s health, Linköping University, SE-581 83 Linköping, Sweden
| | - Carl Göran Svedin
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Barnafrid, Linköping University, SE-581 83 Linköping, Sweden
| | - Gunilla Sydsjö
- 0000 0001 2162 9922grid.5640.7Department of Clinical and Experimental Medicine, Division of Children’s and Women’s health, Linköping University, SE-581 83 Linköping, Sweden
| |
Collapse
|
28
|
Sydsjö G, Lindell Pettersson M, Bladh M, Skoog Svanberg A, Lampic C, Nedstrand E. Evaluation of risk factors' importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older. BMC Pregnancy Childbirth 2019; 19:92. [PMID: 30866838 PMCID: PMC6416921 DOI: 10.1186/s12884-019-2239-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 05/02/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergone ART while adjusting for marital status across the age groups. METHOD Women of advanced age who had given birth in Sweden during 2007-2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data. RESULTS Women of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate's health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group. CONCLUSIONS Women who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.
Collapse
Affiliation(s)
- Gunilla Sydsjö
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Linköping University, SE-581 85, Linköping, Sweden.
| | - Malin Lindell Pettersson
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Linköping University, SE-581 85, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Linköping University, SE-581 85, Linköping, Sweden
| | | | - Claudia Lampic
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, S-141 83, Huddinge, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, S-171 77, Stockholm, Sweden
| | - Elizabeth Nedstrand
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Linköping University, SE-581 85, Linköping, Sweden
| |
Collapse
|
29
|
Abstract
BACKGROUND The well-known adverse consequences of maternal depression prompts consideration of the importance of learning more about intergenerational transmission in order to identify individuals at risk of developing depressive disorders.AimsTo follow two generations of women with major depressive disorder (MDD) and to examine the risk of MDD in the third-generation children. METHOD A register-based, retrospective cohort study of all women born in Sweden between 1973 and 1982 who had given birth during the study period, their mothers and their children. All generations were followed until 2013. Data was stratified into two cohorts: women born between 1973 and 1977 and those born between 1978 and 1982. RESULTS Second-generation women were twice as likely to be diagnosed with MDD if their mothers had been diagnosed with MDD. If both previous generations had been diagnosed with depression the likelihood of the third-generation child being diagnosed with MDD was markedly increased (odds ratio (OR) = 5.07, 95% CI 4.06-6.34 and OR = 7.20, 95% CI 4.41-11.77 in cohort 1 and cohort 2, respectively). CONCLUSIONS There is a strong intergenerational impact in the transmission of MDD. The risk of MDD is especially high in individuals with MDD in both previous maternal generations.Declaration of interestNone.
Collapse
Affiliation(s)
- Ann Josefsson
- Professor, Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine,Linköping University,Sweden
| | - Josefin Vikström
- Consultant Psychiatrist, Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine,Linköping University,Sweden
| | - Marie Bladh
- Statistician, Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine,Linköping University,Sweden
| | - Gunilla Sydsjö
- Professor, Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine,Linköping University,Sweden
| |
Collapse
|
30
|
Möller L, Josefsson A, Lilliecreutz C, Gunnervik C, Bladh M, Sydsjö G. Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort. Acta Obstet Gynecol Scand 2018; 98:374-381. [PMID: 30431149 DOI: 10.1111/aogs.13503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 08/09/2018] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. MATERIAL AND METHODS All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. RESULTS Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P < 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. CONCLUSIONS FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth.
Collapse
Affiliation(s)
- Louise Möller
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Christina Gunnervik
- Department of Obstetrics and Gynecology, Värnamo County Hospital, Värnamo, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
31
|
Lagergren K, Hammar M, Nedstrand E, Bladh M, Sydsjö G. The prevalence of primary ovarian insufficiency in Sweden; a national register study. BMC Womens Health 2018; 18:175. [PMID: 30359245 PMCID: PMC6202813 DOI: 10.1186/s12905-018-0665-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/15/2018] [Indexed: 11/21/2022]
Abstract
Background The current estimates of the prevalence of primary ovarian insufficiency (POI) are very variable, but are in most studies believed to be around 1%. It is also very likely tat the prevalence of POI differs between countries and over time. We therefore aimed to assess the prevalence of primary ovarian insufficiency in Sweden. Methods All 1,036,918 women born between 1973 and 1993 in Sweden were included. The prevalence of POI was based on data from the Swedish Patient Register through the diagnosis code or through the Prescribed Drug Register. The number of women below 40 years of age diagnosed with the ICD-10 diagnoses E28.3 or E89.4, and women who had been dispensed drugs for treatment of climacteric symptoms were included. Results Out of the 1,036,918 women, 19,253 (1.9%) had POI. The prevalence of spontaneous POI was 1.7% and the prevalence of iatrogenic POI was 0.2%. Most women (98.8%) with POI were identified from the Prescribed Drug Register; only 4.1% were found in the Patient Register, whereas 2.9% were identified in both registers. Conclusions The total prevalence of POI was 1.9%, 95% CI: 1.7–2.1, indicating a higher prevalence than often previously reported.
Collapse
Affiliation(s)
- Katarina Lagergren
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-58185, Linköping, Sweden
| | - Mats Hammar
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-58185, Linköping, Sweden
| | - Elizabeth Nedstrand
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-58185, Linköping, Sweden
| | - Marie Bladh
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-58185, Linköping, Sweden
| | - Gunilla Sydsjö
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-58185, Linköping, Sweden.
| |
Collapse
|
32
|
Hammar M, Larsson E, Bladh M, Finnström O, Gäddlin PO, Leijon I, Theodorsson E, Sydsjö G. A long-term follow-up study of men born with very low birth weight and their reproductive hormone profile. Syst Biol Reprod Med 2018; 64:207-215. [DOI: 10.1080/19396368.2018.1448901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Mats Hammar
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Erika Larsson
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Orvar Finnström
- Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - PO Gäddlin
- Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingemar Leijon
- Pediatrics, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Elvar Theodorsson
- Clinical Chemistry, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
33
|
Möller L, Josefsson A, Bladh M, Lilliecreutz C, Andolf E, Sydsjö G. Mental health after first childbirth in women requesting a caesarean section; a retrospective register-based study. BMC Pregnancy Childbirth 2017; 17:326. [PMID: 28969603 PMCID: PMC5623957 DOI: 10.1186/s12884-017-1514-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/26/2016] [Accepted: 09/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psychiatric illness before delivery increases the risk of giving birth by caesarean section on maternal request (CSMR) but little is known about these women’s mental health after childbirth. In this study we aimed to compare the prevalence of psychiatric disorders five years before and after delivery in primiparae giving birth by CS on maternal request to all other primiparae giving birth, indifferent on their mode of delivery. Methods The study population comprised all women born in Sweden 1973–1983 giving birth for the first time in 2002–2004. Psychiatric diagnoses, in- and outpatient care were retrieved from the National Patient Register in Sweden. The risk of psychiatric care after childbirth was estimated using CSMR, previous mental health and sociodemographic variables as covariates. Results Psychiatric disorders after childbirth were more common in women giving birth by CSMR compared to the other women (11.2% vs 5.5%, p < 0.001). CSMR increased the risk of psychiatric disorders after childbirth (aOR 1.5, 95% CI 1.2–1.9). The prevalence of psychiatric disorders had increased after compared to before childbirth (mean difference 0.02 ± 0.25, 95% CI 0.018–0.022, p < 0.001). Women giving birth by CSMR tended to be diagnosed in the inpatient care more often (54.9% vs. 45.8%, p = 0.056) and were more likely to have been diagnosed before childbirth as well (39.8% vs. 24.2%, p < 0.001). Conclusions Women giving birth by CSMR more often suffer from psychiatric disorders both before and after delivery. This indicates that these women are a vulnerable group requiring special attention from obstetric- and general health-care providers. This vulnerability should be taken into account when deciding on mode of delivery.
Collapse
Affiliation(s)
- Louise Möller
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
| | - Ellika Andolf
- Division of Obstetrics and Gynaecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - G Sydsjö
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden.
| |
Collapse
|
34
|
Armuand G, Skoog-Svanberg A, Bladh M, Sydsjö G. Reproductive Patterns Among Childhood and Adolescent Cancer Survivors in Sweden: A Population-Based Matched-Cohort Study. J Clin Oncol 2017; 35:1577-1583. [PMID: 28350518 DOI: 10.1200/jco.2016.71.0582] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare the probability of a first live birth, age at time of birth, and time between diagnosis/referent date and birth between childhood and adolescent cancer survivors and an age-matched comparison group. Materials and Methods A total of 1,206 survivors was included in the study, together with 2,412 age-matched individuals from the general population. A Cox proportional hazards model was used to investigate first live birth after diagnosis/referent date. Data were stratified by sex, age at diagnosis, and diagnostic era (ie, diagnosis before 1988 v in 1988 or later). Results Overall, the probability of having a first live birth (hazard ratio [HR]) was significantly lower; men had lower HRs than women (HR, 0.65 v 0.79). There were no significant differences in the probability of having a first live birth among women diagnosed during adolescence (HR, 0.89), but the HR was lower among women with childhood cancers (HR, 0.47). Among male survivors, the situation was the opposite; men diagnosed during adolescence had lower HRs than survivors of childhood cancer (HR, 0.56 v 0.70). Examination of the data from the two diagnostic eras (before 1988 and 1988 or later) shows that the HR increased among female survivors after 1988 (HR, 0.71 v 0.90) and decreased among male survivors (HR, 0.72 v 0.59). A shorter time had elapsed between diagnosis/referent date and the birth of a first child among both male and female survivors compared with controls. In addition, female survivors were younger at time of birth. Conclusion The study demonstrates reduced probability of having a first live birth among cancer survivors diagnosed during childhood or adolescence; men were particularly vulnerable.
Collapse
Affiliation(s)
| | | | - Marie Bladh
- All authors: Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
35
|
Liffner S, Hammar M, Bladh M, Nedstrand E, Martinez HR, Sydsjö G. Men becoming fathers by intracytoplasmic sperm injection were more often born small for gestational age. Asian J Androl 2017; 19:103-106. [PMID: 27184547 PMCID: PMC5227657 DOI: 10.4103/1008-682x.178848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age (SGA) and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology (ART) more often are born with low birth weight (LBW), preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection (ICSI) had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization (IVF) successfully could be used. In this retrospective, case–control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 (95% CI = 1.17–2.36) compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 (95% CI = 1.00–1.77). Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF (OR = 2.12; 95% CI = 1.17–3.83). In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.
Collapse
Affiliation(s)
- Susanne Liffner
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Mats Hammar
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Marie Bladh
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Elizabeth Nedstrand
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Heriberto Rodriguez Martinez
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Gunilla Sydsjö
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| |
Collapse
|
36
|
Abstract
Background and purpose - The incidence of Perthes' disease as reported in the literature varies widely between and within countries. The etiology of the disease is still unknown. Both environmental and genetic factors have been suggested to play a part in either causing the disease or increasing the susceptibility of an individual. We determined the incidence of Perthes' disease in Sweden and investigated possible relationships to parental socioeconomic status, ethnicity, marital status, mothers' age when giving birth, parity, number of siblings, and smoking habits. Patients and methods - Six Swedish population-based registers were used, together covering all children born in Sweden from 1973 through 1993. Results - The incidence of Perthes' disease in Sweden was 9.3 per 100,000 subjects. The ratio between boys and girls was 3.1:1. The educational level of the father and the mother of a child with Perthes' disease was lower than in the controls. The incidence was lower when the fathers were in the highest income bracket (above the 90th percentile). A higher proportion of parents of Nordic lineage had children with Perthes' disease than parental pairs with one or both who were not of such lineage. Interpretation - This study confirms that there is an association between the incidence of Perthes' disease and the socioeconomic status of the parents.
Collapse
Affiliation(s)
- Torsten Johansson
- Department of Orthopaedics, Norrköping, and Department of Clinical and Experimental Medicine, Linköping University, Linköping,Correspondence:
| | - Maria Lindblad
- Department of Orthopaedics, Norrköping, and Department of Clinical and Experimental Medicine, Linköping University, Linköping
| | - Marie Bladh
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
37
|
Agnafors S, Svedin CG, Oreland L, Bladh M, Comasco E, Sydsjö G. A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 12. Child Psychiatry Hum Dev 2017; 48:584-596. [PMID: 27628896 PMCID: PMC5487709 DOI: 10.1007/s10578-016-0684-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on preadolescence behavior. Data from 889 children and mothers from a birth cohort were used. An adversity score was created by combining maternal symptoms of depression, psychosocial risk and children's experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament, social functioning, and maternal sense of coherence. The l/l genotype of the serotonin transporter linked polymorphic region was associated with lower internalizing scores, but not mainly related to the level of adversity. An easy temperament was associated with resilience for children exposed to high adversity. Social functioning was found to be promotive independent of the risk level. The results support a multiple-level model of resilience indicating effects, though small, of both biological and psychosocial factors.
Collapse
Affiliation(s)
- Sara Agnafors
- Faculty of Health Sciences, Division of Child and Adolescent Psychiatry, IKE, Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden.
| | - Carl Göran Svedin
- Faculty of Health Sciences, Division of Child and Adolescent Psychiatry, IKE, Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, Sweden
| | - Lars Oreland
- Department of Neuroscience, Uppsala University, 751 24 Uppsala, Sweden
| | - Marie Bladh
- Faculty of Health Sciences, Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, Sweden
| | - Erika Comasco
- Department of Neuroscience, Uppsala University, 751 24 Uppsala, Sweden
| | - Gunilla Sydsjö
- Faculty of Health Sciences, Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University, 581 85 Linköping, Sweden
| |
Collapse
|
38
|
Vikström J, Josefsson A, Hammar M, Bladh M, Sydsjö G. Risk of postpartum psychosis after IVF treatment: a nationwide case-control study. Hum Reprod 2016; 32:139-146. [PMID: 27927846 DOI: 10.1093/humrep/dew302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/06/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is the risk of postpartum psychosis (PPP) increased in women who give birth after IVF treatment compared to after spontaneous conception? SUMMARY ANSWER The risk of PPP is not higher in the group of women who give birth after IVF treatment compared with women who give birth after spontaneous conception. WHAT IS KNOWN ALREADY Women who conceive using IVF treatment can experience higher levels of pregnancy-specific distress and are at increased risk of pre-eclampsia, an immune-related condition which in turn has been linked to PPP, as well as other pregnancy and delivery complications, which also serve as PPP risk factors. It is not known whether the risk of PPP is increased in women who have conceived using IVF treatment. STUDY DESIGN, SIZE, DURATION A nationwide, register-based, case-control study of all primiparous women who had given birth after IVF treatment between 1988 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Information about 10 412 women was collected from the Swedish IVF register. A control group of women who had given birth after spontaneous conception was selected from the Swedish Medical Birth Register (n = 18 624). PPP diagnoses, identified using ICD-10 diagnostic codes F20-31 and F531 the first year postpartum, were collected from the National Patient Register. Associations between PPP and IVF/spontaneous conception were evaluated using chi-square tests and logistic regression analyses while controlling for known risk factors of PPP. MAIN RESULTS AND THE ROLE OF CHANCE There were no differences in PPP prevalence between the IVF group and the control group (0.3%, n = 29 versus 0.4%, n = 77) in the chi-square analysis (P = 0.169) or the multiple logistic regression analyses (P = 0.646; odds ratio (OR): 1.178; 95% CI: 586-2.365). No associations between pregnancy or delivery complications and PPP were found. A history of any psychiatric disorder (P < 0.001; OR = 40.7; 95% CI = 23.9-69.5), or specifically a psychotic (P < 0.001; OR = 324.1; 95% CI = 131.3-800.0), bipolar (P < 0.001; OR = 516.1; 95% CI = 264.3-1008.1), depressive (P < 0.001; OR = 27.5; 95% CI = 16.2-46.5), anxiety (P < 0.001; OR = 12.9; 95% CI = 7.4-22.6) or personality disorder (P < 0.001; OR = 27.3; CI = 11.8-63.0), all significantly increased the risk of PPP. LIMITATIONS REASONS FOR CAUTION PPP is a rare condition, hence the number of individuals was small. Since all women for whom information was available from all registers were included, it was not possible to further increase the power of the study using this design. WIDER IMPLICATIONS OF THE FINDINGS Since this study is the first to examine risk of PPP after IVF treatment, more studies are needed to verify these results. The generalizability is restricted to primiparous women in western countries. This study confirms the results of previous studies in showing a history of mental illness to be the major risk factor for PPP. STUDY FUNDING/COMPETING INTERESTS None. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Josefin Vikström
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology and Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
39
|
Agnafors S, Sydsjö G, Comasco E, Bladh M, Oreland L, Svedin CG. Early predictors of behavioural problems in pre-schoolers - a longitudinal study of constitutional and environmental main and interaction effects. BMC Pediatr 2016; 16:76. [PMID: 27267363 PMCID: PMC4895962 DOI: 10.1186/s12887-016-0614-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 06/01/2016] [Indexed: 02/03/2023] Open
Abstract
Background The early environment is important for child development and wellbeing. Gene-by-environment studies investigating the impact of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the Brain Derived Neurotrophic Factor (BDNF) Val66Met polymorphisms by life events on mental health and behaviour problems have been inconclusive. Methodological differences regarding sample sizes, study population, definitions of adversities and measures of mental health problems obstacle their comparability. Furthermore, very few studies included children. The aim of this study was to examine the associations between a broad range of risk factors covering pregnancy and birth, genetic polymorphism, experience of multiple life events and psychosocial environment, and child behaviour at age 3, using a comparably large, representative, population-based sample. Methods A total of 1,106 children, and their mothers, were followed from pregnancy to age 3. Information on pregnancy and birth-related factors was retrieved from the Medical Birth Register. Questionnaires on depressive symptoms, child behaviour and child experiences of life events were filled in by the mothers. Child saliva samples were used for genotyping the 5-HTTLPR and BDNF Val66Met polymorphisms. Multiple logistic regression was used to investigate the association between psychological scales and genetic polymorphisms. Results Symptoms of postpartum depression increased the risk of both internalizing and externalizing problems. Experience of multiple life events was also a predictor of behavioural problems across the scales. No gene-by-environment or gene-by-gene-by-environment interactions were found. Children of immigrants had an increased risk of internalizing problems and parental unemployment was significantly associated with both internalizing and externalizing type of problems. Conclusion This study shows the importance of the psychosocial environment for psychosocial health in preschool children, and adds to the literature of null-findings of gene-by-environment effects of 5-HTTLPR and BDNF in children. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0614-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sara Agnafors
- Division of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Gunilla Sydsjö
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Erika Comasco
- Department of Neuroscience, Uppsala University, SE-751 24, Uppsala, Sweden
| | - Marie Bladh
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Lars Oreland
- Department of Neuroscience, Uppsala University, SE-751 24, Uppsala, Sweden
| | - Carl Göran Svedin
- Division of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| |
Collapse
|
40
|
Sarberg M, Bladh M, Svanborg E, Josefsson A. Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy. BMC Pregnancy Childbirth 2016; 16:137. [PMID: 27267900 PMCID: PMC4895825 DOI: 10.1186/s12884-016-0917-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/15/2015] [Accepted: 05/25/2016] [Indexed: 12/03/2022] Open
Abstract
Background Postpartum depression is a common condition, which consequences might be harmful for both mother and child. Since sleep and depression are closely related it is possible that women who suffer from sleep related problems during pregnancy are more likely to develop depression in the postpartum period. This study aims to investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy. Methods In this study 293 women in the last trimester of pregnancy answered a questionnaire about symptoms of restless legs, snoring and daytime sleepiness. They also completed the Epworth Sleepiness Scale (ESS). The same women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) four to ten weeks after giving birth. Additional information about social data, pregnancy and delivery was received from the medical charts. Results Women with postpartum depressive symptoms had higher prevalence of excessive daytime sleepiness defined as ESS score ≥10 (OR 3.84, CI 1.57–9.39), and restless legs syndrome (OR 2.837 CI 1.18–6.84) in last trimester of pregnancy, when adjusted for socio-demographic factors and obstetric risk factors. No association was found between postpartum depressive symptoms and snoring. Conclusions Depressive symptoms after childbirth are preceded by sleep related problems such as daytime sleepiness and restless legs, already during pregnancy. The results from Epworth Sleepiness Scale and a questionnaire concerning Restless Legs Syndrome completed during pregnancy might be a valuable contribution for detecting women at risk for postpartum depression, enabling preventive interventions.
Collapse
Affiliation(s)
- Maria Sarberg
- Department of Obstetrics and Gynaecology, University Hospital and Linköping University, SE-581 85, Linköping, Sweden. .,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Marie Bladh
- Department of Obstetrics and Gynaecology, University Hospital and Linköping University, SE-581 85, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Svanborg
- Department of Clinical Neurophysiology, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynaecology, University Hospital and Linköping University, SE-581 85, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
41
|
Carlhäll S, Bladh M, Brynhildsen J, Claesson IM, Josefsson A, Sydsjö G, Thorsell A, Blomberg M. Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study. BMC Obes 2016; 3:28. [PMID: 27257506 PMCID: PMC4875677 DOI: 10.1186/s40608-016-0108-2] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/12/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Maternal obesity is accompanied by maternal and fetal complications during and after pregnancy. The risks seem to increase with degree of obesity. Leptin has been suggested to play a role in the development of obesity related complications. Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described. Neither has the association between maternal leptin levels and gestational weight gain in obese women. The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain. METHODS Prospective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304). Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum. Maternal Body Mass Index (BMI) was calculated from early pregnancy weight. Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight. The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model. Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model. RESULTS The mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured. The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29. There was no difference in mean levels of plasma leptin between the gestational weight gain groups. No significant interaction between BMI and gestational weight gain group was found. CONCLUSIONS Plasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain. These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class. The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity.
Collapse
Affiliation(s)
- Sara Carlhäll
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| | - Ing-Marie Claesson
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| | - Annika Thorsell
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, 58185 Linköping, Sweden
| |
Collapse
|
42
|
Sarberg M, Bladh M, Josefsson A, Svanborg E. Sleepiness and sleep-disordered breathing during pregnancy. Sleep Breath 2016; 20:1231-1237. [DOI: 10.1007/s11325-016-1345-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 12/17/2022]
|
43
|
Svanberg AS, Sydsjö G, Bladh M, Lampic C. Attitudes about donor information differ greatly between IVF couples using their own gametes and those receiving or donating oocytes or sperm. J Assist Reprod Genet 2016; 33:703-10. [PMID: 27059774 PMCID: PMC4889478 DOI: 10.1007/s10815-016-0694-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/26/2015] [Accepted: 03/07/2016] [Indexed: 01/27/2023] Open
Abstract
Objective The objective of the study is to examine attitudes towards aspects of donation treatment based on a national Swedish sample of gamete donors and couples undergoing assisted reproductive techniques (ART). Methods The present study was part of the Swedish study on gamete donation, a prospective longitudinal cohort study including all fertility clinics performing gamete donation in Sweden. The sample comprised 164 oocyte donors, 89 sperm donors, 251 people treated with their own gametes (in vitro fertilisation (IVF)), 213 oocyte recipients and 487 sperm recipients. A study-specific questionnaire was used. Results Attitudes vary widely between couples using their own gametes for IVF and those receiving or donating oocyte or sperm. The groups differed in their responses to most questions. Oocyte and sperm donors were more likely to agree with the statements “The donor should be informed if the donation results in a child” and “Offspring should receive some information about the donor during mature adolescence” than recipients of donated gametes and couples treated with their own gametes. Conclusion Donor recipients, IVF couples and donors expressed different attitudes towards openness and information when it came to gamete donation, and those differences seemed to depend on their current reproductive situation.
Collapse
Affiliation(s)
- Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - G Sydsjö
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden
| | - M Bladh
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden
| | - C Lampic
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| |
Collapse
|
44
|
Kastbom ÅA, Sydsjö G, Bladh M, Priebe G, Svedin CG. Differences in sexual behavior, health, and history of child abuse among school students who had and had not engaged in sexual activity by the age of 18 years: a cross-sectional study. Adolesc Health Med Ther 2016; 7:1-11. [PMID: 26811695 PMCID: PMC4712967 DOI: 10.2147/ahmt.s95493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Empirical research about late sexual debut and its consequences is limited, and further research is needed. Objective To explore how students who had not had intercourse by the age of 18 years differed in terms of sociodemographic factors, physical and psychological health, sexual behavior, and history of sexual abuse from those who had. Materials and methods This is a cross-sectional survey involving 3,380 Swedish 18-year-olds. Descriptive analyses were used to investigate different types of sexual behavior. Ordinal data concerning alcohol consumption, self-esteem, sexual and physical abuse, parental relationships, sense of coherence, and health were analyzed, and multiple regression was carried out to identify the most important factors associated with no sexual debut. Results Just under a quarter of the adolescents had not had oral, anal, or vaginal sex by the age of 18 years, and they comprised the index group. They were characterized by being more likely to have caring fathers, parents born outside Europe, lower pornography consumption, lower alcohol and tobacco consumption, less antisocial behavior, and above all lower sexual desire (sometimes, adjusted odds ratio [aOR] 3.8; never/seldom, aOR 13.3) and fewer experiences of sexual abuse (aOR 25.5). Family structure and culture matters when it comes to the age of sexual debut. Conclusion Adolescents with no sexual debut at 18 years of age seemed to live a more stable and cautious life than more sexual experienced peers, exemplified by fewer antisocial acts, less smoking and alcohol/drug consumption, less sexual desire, and less experience of sexual abuse.
Collapse
Affiliation(s)
- Åsa A Kastbom
- Child and Adolescent Psychiatry, Linköping University Hospital, Linköping University, Linköping, Sweden; Division of Child and Adolescent Psychiatry and Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, Linköping, Sweden
| | - Gisela Priebe
- Department of Psychology, Linnæus University, Växjö, Sweden; Department of Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Carl Göran Svedin
- Division of Child and Adolescent Psychiatry and Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University, Linköping, Sweden
| |
Collapse
|
45
|
Vikström J, Sydsjö G, Hammar M, Bladh M, Josefsson A. Risk of postnatal depression or suicide after in vitro fertilisation treatment: a nationwide case-control study. BJOG 2015; 124:435-442. [PMID: 26663705 DOI: 10.1111/1471-0528.13788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether women who undergo in vitro fertilisation (IVF) treatment are at greater risk of postnatal suicide or postnatal depression (PND) requiring psychiatric care, compared with women who conceive spontaneously. DESIGN Case-control study using data from national registers. SETTING Sweden during the period 2003-2009. POPULATION Cases were 3532 primiparous women who had given birth following IVF treatment. An aged-matched control group of 8553 mothers was randomly selected from the medical birth register. METHODS Logistic regression analyses were performed with PND as the outcome, and with known risk factors of PND as well as IVF/spontaneous birth as covariates. MAIN OUTCOME MEASURES Postnatal depression (PND), defined as diagnoses F32-F39 of the tenth edition of the International Classification of Diseases (ICD-10), within 12 months of childbirth. RESULTS Initial analyses showed that PND was more common in the control group than in the IVF group (0.8 versus 0.4%; P = 0.04); however, these differences disappeared when confounding factors were controlled for. A history of any psychiatric illness (P = 0.000; odds ratio, OR = 25.5; 95% confidence interval, 95% CI = 11.7-55.5), any previous affective disorder (P = 0.000; OR = 26.0; 95% CI = 10.5-64.0), or specifically a personality disorder (P = 0.028; OR = 3.8; 95% CI = 1.2-12.7) increased the risk of PND. No woman in either group committed suicide during the first year after childbirth. CONCLUSIONS Whereas mothers who receive IVF treatment are not at increased risk of PND, the risk is increased among mothers with a history of mental illness. TWEETABLE ABSTRACT A Swedish study on 3532 women showed that IVF treatment does not increase the risk of postnatal depression.
Collapse
Affiliation(s)
- J Vikström
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - G Sydsjö
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - M Hammar
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - M Bladh
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - A Josefsson
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
| |
Collapse
|
46
|
Sydsjö G, Vikström J, Bladh M, Jablonowska B, Skoog Svanberg A. Men report good mental health 20 to 23 years after in vitro fertilisation treatment. BMC Public Health 2015; 15:1175. [PMID: 26607065 PMCID: PMC4660772 DOI: 10.1186/s12889-015-2398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility and infertility treatment are known to have negative short-term psychological consequences for men and women, with more long-term consequences for women. The long-term wellbeing and mental health of men who have experienced in vitro fertilisation (IVF) treatment has not been extensively described in the literature. Therefore, the aim of this study was to analyse the mental health of men 20 to 23 years after IVF treatment. METHOD The Symptom Checklist 90 tool was used to assess the self-perceived mental health of men who were part of a couple that underwent IVF treatment at Linköping University Hospital, Sweden, 20 to 23 years earlier. We enrolled 292 out of the 490 men who took part in the hospital's IVF programme from 1986 to 1989 and compared them to an aged-matched control group. In addition, the men who had remained childless were compared to those who had fathered biological children and those who had adopted children. RESULTS The overall mental health of the men who had received IVF was good. We found that 54% of the men had fathered their own biological children, 21% were childless and the remainder were part of a couple that had gone on to adopt. The childless men displayed more mental health problems than the other men in the study, as did men who were unemployed, single or divorced. CONCLUSION This study carried out 20 to 23 years after IVF treatment showed that the majority of the men who took part were in good mental health. Those who remained childless faced an increased risk of negative psychological symptoms and men who were single showed more symptoms of depression and anxiety disorders.
Collapse
Affiliation(s)
- Gunilla Sydsjö
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Josefin Vikström
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Marie Bladh
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Barbara Jablonowska
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, S-751 85, Uppsala, Sweden.
| |
Collapse
|
47
|
Samuelsson U, Lindell N, Bladh M, Åkesson K, Carlsson A, Josefsson A. Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish population-based study. Diabetologia 2015; 58:2517-24. [PMID: 26298452 DOI: 10.1007/s00125-015-3716-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/25/2015] [Indexed: 01/10/2023]
Abstract
AIMS/HYPOTHESIS Some studies have revealed a relationship between Caesarean section (CS) and type 1 diabetes, while other studies have not. By using the Swedish paediatric quality register we investigated whether birth by CS is related to the risk of developing type 1 diabetes during childhood. METHODS All children diagnosed with type 1 diabetes from 2000 to 2012 and included in the register (n = 9,376) were matched with four controls by year, day of birth, sex and county of birth from the Swedish Medical Birth Register. RESULTS Overall, 13.5% of deliveries were by CS. By group, 14.7% of children who developed type 1 diabetes were delivered by CS compared with 13.3% of control children (p < 0.001). Mothers with diabetes more often gave birth by CS than mothers without diabetes (78.8% vs 12.7%, p < 0.001). In a logistic regression model adjusting for maternal age, maternal diabetes and BMI in early pregnancy, the OR for CS was 1.0. A child who developed type 1 diabetes and had a mother with type 1 diabetes at the time of delivery had the highest OR to have been born by CS. Children of mothers without diabetes, delivered by CS, had no increased risk of developing type 1 diabetes. Maternal diabetes was the strongest predictor of childhood diabetes (OR 3.4), especially if the mother had type 1 diabetes (OR 7.54). CONCLUSIONS/INTERPRETATION CS had no influence on the risk of type 1 diabetes during childhood or adolescence. However, maternal diabetes itself strongly increased the risk of offspring developing type 1 diabetes.
Collapse
Affiliation(s)
- Ulf Samuelsson
- Department of Paediatrics and Department of Clinical and Experimental Medicine, Linköping University, S-581 85, Linköping, Sweden.
| | - Nina Lindell
- Department of Paediatrics and Department of Clinical and Experimental Medicine, Linköping University, S-581 85, Linköping, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Åkesson
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden
- Futurum - Academy for Health and Care, Jönköping, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annelie Carlsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
48
|
Abstract
OBJECTIVE To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23 years previously, while comparing them to a reference group, and to determine any differences in mental health between those who had given birth, those who had adopted a child, those who had given birth and adopted a child and those who remained childless. DESIGN A cross-sectional study. SETTING A Center of Reproductive Medicine (RMC) at a Swedish University hospital. PARTICIPANTS 520 women who had undergone at least one IVF cycle at the University Hospital in Linköping between 1986 and 1989. 504 of 520 women (97%) were eligible for follow-up. While 34 women declined, 93 per cent (n=470) of the women agreed to participate. The reference group consisted of 150 women of the Swedish population included in a study that was used to validate the Symptom CheckList (SCL)-90. INTERVENTIONS Follow-up was conducted in 2008-2009. The SCL-90 was used to measure the women's self-perceived mental health and a questionnaire specific for this study was used to retain demographic information. OUTCOME MEASURES The SCL-90 assesses 9 primary dimensions; somatisation, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. There is also a global index of distress. RESULTS Women who had previously undergone IVF treatment were at increased risk of symptoms of depression (p=0.017), obsessive-compulsion (p=0.02) and somatisation (p≤0.001) when compared to a reference group. In addition, the women who have remained childless are at increased risk of symptoms of depression (p=0.009) and phobic anxiety (p=0.017). CONCLUSIONS The majority of the women who have been treated with IVF 20-23 years previously appear to be in good mental health. However, women who remain childless and/or without partner after unsuccessful infertility treatment constitute a vulnerable group even later on in life.
Collapse
Affiliation(s)
- J Vikström
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - A Josefsson
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - M Bladh
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - G Sydsjö
- Faculty of Health Sciences, Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden
| |
Collapse
|
49
|
Jonsson LS, Bladh M, Priebe G, Svedin CG. Online sexual behaviours among Swedish youth: associations to background factors, behaviours and abuse. Eur Child Adolesc Psychiatry 2015; 24:1245-60. [PMID: 25589438 DOI: 10.1007/s00787-015-0673-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
Sexual activity online may result in positive experiences for young people, or lead them to engage in risky behaviours possibly resulting in sexual assault or abuse. The aim of our study was to investigate associations between online sexual behaviours among Swedish youth and background factors as well as aspects of well-being. The behaviours investigated were: having sex online with a contact met online, having sex with an online contact offline, posting sexual pictures online, and selling sex online. We used data from a representative sample of 3,432 Swedish youth who were asked about their lifetime experiences as well as their experiences within the previous year. We hypothesized that more advanced online sexual behaviours were associated with more problematic background factors, worse psychosocial well-being and riskier behaviours in general. Bivariate relationships were evaluated followed by a multiple logistic regression model. Our data suggested that most Swedish youth do not perform any of the assessed online sexual behaviours. Young people who reported online sexual behaviour showed a more problematic background, rated their health as poorer, had a more sexualized life and had experienced more sexual or physical abuse. Professionals who work with young people need to help them better evaluate potential risks online and offer support when needed. Youths who sell sex online are especially at risk and need extra attention, as they might be in greater need of protection and therapeutic support.
Collapse
Affiliation(s)
- Linda S Jonsson
- Department of Child and Adolescent Psychiatry and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Marie Bladh
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Gisela Priebe
- Department of Psychology, Linnæus University, SE-351 95, Växjö, Sweden
| | - Carl Göran Svedin
- Department of Child and Adolescent Psychiatry and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| |
Collapse
|
50
|
Sydsjö G, Kvist U, Bladh M, Nordgaard A. The optimal number of offspring per gamete donor. Acta Obstet Gynecol Scand 2015; 94:1022-6. [PMID: 26014908 DOI: 10.1111/aogs.12678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/05/2015] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Abstract
Our aim was to create a mathematical basis to calculate the risks for unintended matings of consanguineous half-siblings from a donor in a society with approximately 10 million inhabitants. The Curie-Cohen model for calculation of the risk for consanguineous mating was used. When the number of offspring per donor is limited to 10, then the model gives a yearly risk for consanguineous matings below 1%. Thus 10 offspring gives a risk for consanguineous matings of 0.9% per year, or approximately once in every 100 years. The risk increases exponentially: with 15 offspring it exceeds 2% and with 25 it reaches up above 5%.
Collapse
Affiliation(s)
- Gunilla Sydsjö
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrik Kvist
- Center for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Instituet, Huddinge, Stockholm, Sweden
| | - Marie Bladh
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Nordgaard
- Swedish Police Authority - National Forensic Centre, Linköping, Sweden.,Department of Computer and Information Science, Linköping University, Linköping, Sweden
| |
Collapse
|