liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Birth-characteristics, hospitalisations, and childbearing: Epidemiological studies based on Swedish register data
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the past decades there has been an improvement in the medical treatment of children born preterm or with reduced foetal growth. This has resulted in a much higher survival rate of these children, but also in a higher number of surviving children with chronic conditions. These changes have, in turn, increased interest in investigating the connection between birth-characteristics and outcomes in later life. The overall aim of the present thesis was to study the relations between birth-characteristics, subsequent hospitalisations, and childbearing by means of data available in Swedish population-based registries.

The study population in this thesis consisted of women (and men in Paper III) born in 1973-75 according to the Medical Birth Register and the Total Population Register. Information available in other registries, such as the Hospital Discharge Register, was obtained by individual record linkage.

In Paper I, 148,281 women, alive and living in Sweden at 13 years of age, were included. Of the women, 4.1% were born preterm and 5.4% were born small for gestational age, and approximately 30% of all women had given birth between 13 and 27 years of age. We found that reduced foetal growth and possibly preterm birth were related to the likelihood of giving birth during the study period. The intergenerational effects of preterm birth and reduced foetal growth were investigated in Paper II and the study population consisted of 38,720 mother-offspring pairs. An intergenerational effect of reduced foetal growth was found, and reduced foetal growth in the mother also increased the risk for preterm birth in the child.

Paper III was concerned with 304,275 men and women living in Sweden at 13 years of age. Of these men and women, 30% were hospitalised during adolescence and early adulthood (i.e. between 12 and 23 years of age). We found that men and women born small for gestational age or preterm were more likely to be hospitalised, and that those born small for gestational age seemed to be more at risk compared to those born preterm. Finally, in Paper IV, the relation between hospitalisations during adolescence and the likelihood of giving birth was studied in 142,998 women living in Sweden at 20 years of age. We found that a majority of the causes of hospitalisation during adolescence were positively connected to the likelihood of giving birth between 20 and 27 years of age. The relations presented in Papers I-IV were evident although socio-economic characteristics were adjusted for.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin , 2007.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1012
Keyword [en]
Birth rate, Cohort studies, Epidemiology, Hospitalisation, Morbidity, Preterm infant, Reproduction, Small-for-gestational-age infant
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-9660ISBN: 978-91-85831-50-0 (print)OAI: oai:DiVA.org:liu-9660DiVA: diva2:24059
Public defence
2007-10-05, Berzeliussalen, Campus US, Ingång 65, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2009-08-22
List of papers
1. The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study
Open this publication in new window or tab >>The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study
2005 (English)In: American Journal of Epidemiology, ISSN 0002-9262, Vol. 161, no 8, 725-733 p.Article in journal (Refereed) Published
Abstract [en]

The primary aim of this study was to investigate whether women born prematurely or with impaired fetal growth have a reduced probability of giving birth. Using Swedish population-based registries, the authors identified 148,281 women born in 1973–1975 for follow-up until 2001. Of these women, 4.1% were born preterm and 0.32% very preterm, 0.29% were born with a very low birth weight, and 5.4% were small for gestational age. Outcome measures were the hazard ratios for giving birth during the study period. Adjustments were made for socioeconomic factors. Very-low-birth-weight women displayed a reduced probability of giving birth (hazard ratio = 0.74, 95% confidence interval: 0.60, 0.91), most apparent among women aged 25 or more years. There were also tendencies of reduced hazard ratios of giving birth among women born preterm or very preterm in this age interval. Women born small for gestational age (below –2 standard deviations) seemed to be more likely to have given birth (hazard ratio = 1.09, 95% confidence interval: 1.04, 1.14), but when a more extreme group of small-for-gestational-age women (below –3 standard deviations) was defined, the association was less evident (hazard ratio = 1.04, 95% confidence interval: 0.94, 1.16). The results suggest that very-low-birth-weight women and, possibly, women born preterm or very preterm have a reduced probability of giving birth, while the results regarding small for gestational age are less clear.

Keyword
infant, small for gestational age; infant, very low birth weight; premature birth; registries; reproduction; women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14625 (URN)10.1093/aje/kwi096 (DOI)
Available from: 2007-08-24 Created: 2007-08-24
2. Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs
Open this publication in new window or tab >>Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs
2006 (English)In: British Journal of Obstetrics and Gynaecology, ISSN 0306-5456, Vol. 113, no 4, 430-440 p.Article in journal (Refereed) Published
Abstract [en]

Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.

Design Population-based cohort study.

Settings Mother–first-born offspring pairs recorded in the Swedish Medical Birth Registry.

Population Children born before 2001 to 38 720 women born in 1973–75.

Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother–offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520).

Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<−2 SD of the Swedish standard).

Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95–1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11–3.41 and OR 1.30, 95% CI 1.05–1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively.

Conclusions The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

Keyword
preterm infant, registries, reproduction, small-for-gestational-age infant, women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14626 (URN)10.1111/j.1471-0528.2006.00872.x (DOI)
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2009-05-11
3. Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age
Open this publication in new window or tab >>Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age
Show others...
2008 (English)In: Epidemiology, ISSN 1044-3983, Vol. 19, no 1, 63-70 p.Article in journal (Refereed) Published
Abstract [en]

Background: Preterm birth and reduced intrauterine growth appear to be related to morbidity in childhood and later adulthood. We studied whether the risk of all-cause hospitalization in adolescence and early adulthood differed between individuals who were born preterm or small for gestational age (SGA) compared with those bom at term and appropriate for gestational age.

Methods: Using Swedish registries, we followed 304,275 men and women born in 1973-1975 for any hospitalizations occurring in 1987-1996. Preterm birth was defined as <37 weeks of gestation and SGA as babies smaller than 2 standard deviations below the mean weight for gestational length, according to Swedish standards. We created 3 mutually exclusive categories: "preterm" (<37 weeks and not SGA), "SGA" (SGA and not preterm), and "both preterm and SGA." The comparison group was all term births not SGA. Childhood socioeconomic characteristics were accounted for in the analyses.

Results: The overall risk of hospitalization was higher for men and women bom SGA (adjusted odds ratio = 1.16; 95% confidence interval = 1.12-1.21), for those born preterm (1.06; 1.02-1.10), and for those born both preterm and SGA (1.42; 1.26-1.59). In addition to higher risks for previously reported adverse health outcomes, such as neurodevelopment sequelae and congenital anomalies, men and women born SGA or preterm were more likely to be hospitalized due to unspecified symptoms. SGA also appeared to be associated with genitourinary diseases and drug use.

Conclusions: Men and women born SGA or preterm were at higher risk for hospitalization during adolescence and early adulthood, with men and women born SGA more at risk than those bom preterm.

Identifiers
urn:nbn:se:liu:diva-14627 (URN)
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2009-08-17
4. Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.
Open this publication in new window or tab >>Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.
Show others...
2009 (English)In: Acta paediatrica, ISSN 0803-5253 (print) 1651-2227 (online), Vol. 98, no 3, 561-6 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

Methods: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth.

Results: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter.

Conclusion: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

Keyword
Adolescent, Birth Rate, Cohort Studies, Female, Morbidity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16654 (URN)10.1111/j.1651-2227.2008.01120.x (DOI)19006525 (PubMedID)
Note
The definitive version is available at www.blackwell-synergy.com: Katarina Ekholm Selling, John Carstensen, Orvar Finnström, Ann Josefsson and Gunilla Sydsjö, Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study., 2009, Acta paediatrica , (98), 3, 561-6. http://dx.doi.org/10.1111/j.1651-2227.2008.01120.x Licencing: Stiftelsen för Acta Paediatrica and Blackwell Publishing Available from: 2009-02-18 Created: 2009-02-09 Last updated: 2009-08-17Bibliographically approved

Open Access in DiVA

fulltext(253 kB)706 downloads
File information
File name FULLTEXT01.pdfFile size 253 kBChecksum MD5
c6b8396bdb19ebfb016d59bcfaa7b6c8fa69f8463ebcd709e45f5b2aeaf1e8432331a607
Type fulltextMimetype application/pdf
popular summary(16 kB)184 downloads
File information
File name POPULARSUMMARY01.pdfFile size 16 kBChecksum MD5
dd352c9e01f826814ebf1fcf663c90e54215d2641b8596e43b78da9034b3f92fe8823d01
Type popularsummaryMimetype application/pdf

Search in DiVA

By author/editor
Ekholm Selling, Katarina
By organisation
Obstetrics and gynecology Faculty of Health Sciences
Obstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 706 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 1879 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf