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 90(th) 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.

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.

Background: Preterm birth defined as birth prior to 37 weeks of gestation is caused by different risk factors and implies an increased risk for disease and early death for the child. The aim of the study was to investigate the effect of maternal stress during pregnancy on the risk of preterm birth. Methods: A case-control study that included 340 women; 168 women who gave birth preterm and 172 women who gave birth at term. Data were manually extracted from standardized medical records. If the medical record contained a psychiatric diagnosis or a self-reported stressor e.g., depression or anxiety the woman was considered to have been exposed to stress during pregnancy. Adjusted odds ratio (AOR) was used to calculate the attributable risk (AR) of maternal stress during pregnancy on preterm birth, both for the women exposed to stress during pregnancy (AR1 = (AOR-1)/AOR) and for the whole study population (AR2 = AR1*case fraction). Results: Maternal stress during pregnancy was more common among women who gave birth preterm compared to women who gave birth at term (p <0.000, AOR 2.15 (CI = 1.18-3.92)). Among the women who experienced stress during pregnancy 54 % gave birth preterm with stress as an attributable risk factor. Among all of the women the percentage was 23 %. Conclusions: Stress seems to increase the risk of preterm birth. It is of great importance to identify and possibly alleviate the exposure to stress during pregnancy and by doing so try to decrease the preterm birth rate.

Background: Maternal prepregnancy obesity (BMI 30kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the childrens BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. Methods: This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. Results: BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, amp;lt;7kg or 7kg, did not affect the offsprings WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. Conclusion: Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

Purpose: To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.

Methods: In a prospective study 293 women in the last trimester of pregnancy answered a questionnaire about sleep related problems in terms of 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 sleep related problems including 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 sociodemographic factors and obstetric risk factors.

Conclusions: Depressive symptoms after childbirth are preceded by disturbed sleep already during pregnancy. The results from Epworth Sleepiness Scale completed during pregnancy might be used for detecting women at risk, enabling preventive interventions.

Study objectives: To investigate if sleep recordings show differences in prevalence of sleep-disturbed breathing among pregnant women compared to non-pregnant controls. To compare the Epworth sleepiness scale (ESS) scores between the two groups. To evaluate obstetric outcomes.

Setting: At one antenatal care center at an outpatient unit in Linköping, Sweden.

Participants: One hundred pregnant women (gestational week 24-34) and 80 non-pregnant women age- and body mass index-matched as controls.

Interventions: Whole-night respiratory recordings were performed in the homes of all participants, who also answered the same questionnaire, including the Epworth Sleepiness Scale.

Measurements and results: Objectively recorded snoring was more common among the pregnant women (median value 10% of total estimated sleep time) than among the non-pregnant controls (2.5% of total sleep time, p<0.001). The prevalence of obstructive events was low and similar in pregnant and non-pregnant women (1% vs. 3% had obstructive apnea-hypopnea index ≥5). The total ESS score was higher among pregnant women than controls (median 9 vs. 7, p<0.001) but no significant differences were found between the two groups in the scores for the separate items of the ESS. Sleep-disturbed breathing and snoring showed no impact on obstetric outcome. There were no significant associations between either subjectively reported or objectively recorded snoring and ESS scores.

Conclusion: Snoring increases during pregnancy, but sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Development of obstructive sleep apnea is not a likely explanation for the increased daytime sleepiness seen in pregnant women.

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 less than 0.001). Mothers with diabetes more often gave birth by CS than mothers without diabetes (78.8% vs 12.7%, p less than 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.

Background: Continuous support by a midwife during childbirth has shown positive effects on the duration of active labour, use of pain relief and frequency of caesarean section (CS) in women without fear of childbirth (FOC). We have evaluated how continuous support by a specially assigned midwife during childbirth affects birth outcome and the subjective experience of women with severe FOC. Methods: A case-control pilot study with an index group of 14 women with severe FOC and a reference group of 28 women without FOC giving birth. In this study the index group received continuous support during childbirth. Results: The women with severe FOC more often had an induction of labour. The parous women with severe FOC had a shorter duration of active labour compared to the parous reference women (p = 0.047). There was no difference in caesarean section frequency between the two groups. Women with severe FOC experienced a very high anxiety level during childbirth (OR = 20.000, 95 % CI: 3.036-131.731). Conclusion: Women with severe FOC might benefit from continuous support by a midwife during childbirth. Midwives should acknowledge the importance of continuous support in order to enhance the experience of childbirth in women with severe FOC.

To date several studies have investigated the intergenerational effect of preterm and small-for-gestational-age births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and small for gestational age (SGA) among twins and singletons.

A prospective population based register study of mother-first-born offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4073 twins and 264,794 singletons born in 1973-1983 and their firstborns born in 1986-2009. Preterm birth was defined as birth <37 weeks of gestation and SGA as < 2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers and mother’s socio-demographic factors in addition to maternal birth- characteristics.

Among mothers born as singletons, being born preterm was associated with an increased risk for delivering a preterm child (adjusted OR 1.39, 95% CI 1.29-1.50) while being born SGA increased the likelihood of a SGA child (adjusted OR 3.04, 95% CI 2.80-3.30) as well as a preterm child (adjusted OR 1.30, 95% CI 1.20-1.40). In twin mothers, the corresponding ORs tended to be lower and the only statistically significant association was between a SGA mother and a SGA child (adjusted OR 2.15, 95% CI 1.40-3.31). A statistically significant interaction between twinning and mother’s size for gestational was identified in a multivariate linear regression analysis indicating that singleton mothers born SGA were associated with a lower birth weight compared to mothers not born SGA.

Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.

Objective To assess self-perceived mental health in women treated with in vitro fertilisation (IVF) 20-23years 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 Linkoping 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 womens 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 (p0.001) 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 20-23years 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.