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  • 1.
    Axelsson, Daniel
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Ryhov County Hospital, Sweden.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Prevalence of postpartum infections: a population-based observational study2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 10, p. 1065-1068Article in journal (Refereed)
    Abstract [en]

    We investigated the prevalence of postpartum infections among women giving birth during 1year in a population-based observational/questionnaire study at seven hospitals in the southeast region of Sweden. Of the women greater than99% (n=11124) received a questionnaire to inquire if they had endometritis, mastitis, or wound, urinary tract or any other infection within 2months postpartum and whether they received antibiotics for this. Prevalence rates for infections and antibiotic treatment were estimated. The response rate was 60.1%. At least one infectious episode was reported by 10.3% of the women and 7.5% had received antibiotics. The prevalence for infections with and without antibiotics were, respectively, mastitis 4.7% and 2.9%, urinary tract infection 3.0% and 2.4%, endometritis 2.0% and 1.7%, wound infection 1.8% and 1.2%. There was no inter-county difference in infection prevalence. Clinical postpartum infections in a high-resource setting are relatively common.

  • 2.
    Birch Tyrberg, Rasmus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Deliveries among teenage women - with emphasis on incidence and mode of delivery: a Swedish national survey from 1973 to 20102013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, no 204Article in journal (Refereed)
    Abstract [en]

    Background: Since the 1970-ies Sweden has actively developed strategies in social care, education and health care in order to counteract the negative consequences of adolescent parenthood. The aims of this study are to determine the annual incidence of singleton delivery among adolescents 1973-2010 and analyse obstetric and neonatal outcomes. Methods: A retrospective cohort study, using data from the Swedish Medical Birth Register was conducted. All singleton deliveries in Sweden between 1973 and 2010 were included. Totally 1,941,940 women had 3,761,576 deliveries during the period. Analyses of obstetric and neonatal outcome were restricted to 1992-2010. Adolescents were subdivided into three groups: less than16 years (n = 472), 16-17 years (n = 5376), 18-19 years (n = 23560). The reference group consisted of women age 20-30 years (n = 893505). Data were analysed using multivariate logistic regression models adjusted for confounding factors and presented as crude and adjusted odds ratios with 95% confidence interval. Results: The annual incidence of teenage births decreased significantly from 7.7 to 1.6%. Teenagers were more likely to deliver normally vaginally (aOR 1.70 (95% CI 1.64-1.75), less likely to have Caesarean section (aOR 0.61 (95% CI 0.58-0.64), and had a greater risk of delivering prematurely (less than 28 weeks)(aOR 1.61 (95% CI 1.31-2.00), but did not have more small-for-gestational-age babies (aOR 1.07 (95% CI 0.99-1.14). Risks of placenta previa, postpartum haemorrhage greater than 1000 ml and perineal rupture were significantly lower among teenagers. Although the rate with Apgar score less than 7 at 5 minutes was similar the teenagers neonates showed less fetal distress and meconium aspiration. Conclusion: Adolescent births have steadily decreased in Sweden. Adolescents were more likely to be delivered vaginally than the adult women. The risks for obstetric maternal complications for adolescents were lower than for adult women except for the risk of prematurity.

  • 3.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Avoiding the first cesarean section-results of structured organizational and cultural changes2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 5, p. 580-586Article in journal (Refereed)
    Abstract [en]

    IntroductionIn 2006 the overall rates of instrumental deliveries (10%) and cesarean sections (CS) (20%) were high in our unit. We decided to improve quality of care by offering more women a safe and attractive normal vaginal delivery. The target group was primarily nulliparous women at term with spontaneous onset of labor and cephalic presentation. Material and methodsImplementation of a nine-item list of structured organizational and cultural change in Linkoping 2006-15. The nine items include monitoring of obstetric results, recruitment of a midwife coordinator, risk classification of women, introduction of three different midwife competence levels, improved teamwork, obstetrical morning round, fetal monitoring skills, obstetrical skills training, and public promotion of the strategy. ResultsThe CS rate in nulliparous women at term with spontaneous onset of labor decreased from 10% in 2006 to 3% in 2015. During the same period the overall CS rate dropped from 20% to 11%. The prevalence of children born at the unit with umbilical cord pH <7 and Apgar score <4 at 5 min were the same over the years studied. At present, 95.2% of women delivering at our unit are satisfied with their delivery experience. ConclusionsThe CS rates have declined after implementing the nine items of organizational and cultural changes. It seems that a specific and persistent multidisciplinary activity with a focus on the Robson group 1 can reduce CS rates without increased risk of neonatal complications.

  • 4.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Fetma under graviditet ökar risken för både kvinna och barn: Kompetent omhändertagande kan minska riskökningen2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 48, p. 2156-Article in journal (Refereed)
    Abstract [sv]

    Fetma hos en gravid kvinna innebär ökad risk för missbildning hos fostret. Vid screeningultraljud upptäcks färre missbildningar än hos barn till normalviktiga kvinnor, men KUB-metoden för att upptäcka Downs syndrom är lika effektiv i alla BMI-grupper. Fetma hos kvinnan innebär ökad risk för gestationsdiabetes, preeklampsi, prematur förlossning och intrauterin fosterdöd. Öppningsskedet under förlossningen är förlängt hos kvinnor med BMI >30, men krystskedet är snabbt. Det finns ökad risk för atonisk postpartumblödning, vilket kan indicera profylaktisk behandling med uterotonika. Fetma hos kvinnan medför fler allvarliga komplikationer hos barnet under första levnadsveckan oavsett förlossningssätt.

  • 5.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Maternal and Neonatal Outcomes Among Obese Women With Weight Gain Below the New Institute of Medicine Recommendations2011In: OBSTETRICS AND GYNECOLOGY, ISSN 0029-7844, Vol. 117, no 5, p. 1065-1070Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate whether weight loss or low gestational weight gain in class I-III obese women is associated with adverse maternal and neonatal outcomes compared with gestational weight gain within the new Institute of Medicine recommendations. METHODS: This was a population-based cohort study, which included 32,991 obesity class I, 10,068 obesity class II, and 3,536 obesity class III women who were divided into four gestational weight gain categories. Women with low (0-4.9 kg) or no gestational weight gain were compared with women gaining the recommended 5-9 kg concerning obstetric and neonatal outcome after suitable adjustments. RESULTS: Women in obesity class III who lost weight during pregnancy had a decreased risk of cesarean delivery (24.4%; odds ratio [OR] 0.77, 95% confidence interval [CI] 0.60-0.99), large-for-gestational-age births (11.2%, OR 0.64, 95% CI 0.46-0.90), and no significantly increased risk for pre-eclampsia, excessive bleeding during delivery, instrumental delivery, low Apgar score, or fetal distress compared with obese (class III) women gaining within the Institute of Medicine recommendations. There was an increased risk for small for gestational age, 3.7% (OR 2.34, 95% CI 1.15-4.76) among women in obesity class III losing weight, but there was no significantly increased risk of small for gestational age in the same group with low weight gain. CONCLUSION: Obese women (class II and III) who lose weight during pregnancy seem to have a decreased or unaffected risk for cesarean delivery, large for gestational age, pre-eclampsia, excessive postpartum bleeding, instrumental delivery, low Apgar score, and fetal distress. The twofold increased risk of small for gestational age in obesity class III and weight loss (3.7%) is slightly above the overall prevalence of small-for-gestational-age births in Sweden (3.6%).

  • 6.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal Body Mass Index and Risk of Obstetric Anal Sphincter Injury2014In: BIOMED RESEARCH INTERNATIONAL, ISSN 2314-6133, Vol. 2014, no 395803Article in journal (Refereed)
    Abstract [en]

    Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5-24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third-or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28-0.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.

  • 7.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Maternal Obesity and Risk of Postpartum Hemorrhage2011In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 118, no 3, p. 561-568Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate whether maternal obesity was associated with an increased risk for postpartum hemorrhage more than 1,000 mL and whether there was an association between maternal obesity and causes of postpartum hemorrhage and mode of delivery. less thanbrgreater than less thanbrgreater thanMETHODS: A population-based cohort study including 1,114,071 women with singleton pregnancies who gave birth in Sweden from January 1, 1997 through December 31, 2008, who were divided into six body mass index (BMI) classes. Obese women (class I-III) were compared with normal-weight women concerning the risk for postpartum hemorrhage after suitable adjustments. The use of heparin-like drugs over the BMI strata was analyzed in a subgroup. less thanbrgreater than less thanbrgreater thanRESULTS: There was an increased prevalence of postpartum hemorrhage over the study period associated primarily with changes in maternal characteristics. The risk of atonic uterine hemorrhage increased rapidly with increasing BMI. There was a twofold increased risk in obesity class III (1.8%). No association was found between postpartum hemorrhage with retained placenta and maternal obesity. There was an increased risk for postpartum hemorrhage for women with a BMI of 40 or higher (5.2%) after normal delivery (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.04-1.45]) compared with normal-weight women (4.4%) and even more pronounced (13.6%) after instrumental delivery (OR 1.69, 95% CI 1.22-2.34) compared with normal-weight women 8.8%). Maternal obesity was a risk factor for the use of heparin-like drugs (OR 2.86, 95% CI 2.22-3.68). less thanbrgreater than less thanbrgreater thanCONCLUSION: The increased risk for atonic postpartum hemorrhage in the obese group has important clinical implications, such as considering administration of prophylactic postpartum uterotonic drugs to this group.

  • 8.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal Obesity, Mode of Delivery, and Neonatal Outcome2013In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 122, no 1, p. 50-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether adverse neonatal outcome, defined as birth injuries or severe illnesses in the newborn, was associated with maternal body mass index (BMI) in singleton pregnancies overall and depending on mode of delivery. METHODS: This was a cohort study including 1,024,471 women. Data were collected from the Swedish Medical Birth Registry. Women were categorized into six classes of BMI. Obese women were compared with normal weight women regarding adverse neonatal outcome after suitable adjustments. Four modes of delivery were evaluated: vaginal delivery; instrumental vaginal delivery; elective cesarean delivery; and emergency cesarean delivery. RESULTS: Compared with neonates born to women of normal weight, neonates born to women with BMIs of 40 or more (morbidly obese) were at increased risk of birth injury to the peripheral nervous system (odds ratio [OR] 3.80, 95% confidence interval [CI] 2.83-5.12; 0.2% compared with 0.6%), birth injury to the skeleton (OR 2.59, 95% CI 2.10-3.21; 0.5% compared with 1.1%), respiratory distress syndrome (OR 2.08, 95% CI 1.88-2.30; 2.9 compared with 5.8%), bacterial sepsis (OR 2.90, 95% CI 2.43-3.46; 0.6% compared with 1.7%), convulsions (OR 3.43, 95% CI 2.63-4.47; 0.2% compared with 0.8%), and hypoglycemia (OR 3.48, 95% CI 3.20-3.78; 2.4% compared with 7.9%). For morbidly obese women, elective cesarean delivery and vaginal delivery were associated with twice the increased risk of adverse neonatal outcomes when compared with women of normal weight. CONCLUSION: Neonates born to morbidly obese women are at markedly increased risk of adverse neonatal outcome regardless of mode of delivery. Obstetricians should not disregard the neonatal problems associated with elective cesarean delivery for morbidly obese women.

  • 9.
    Blomberg, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Birch Tyrberg, Rasmus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Impact of maternal age on obstetric and neonatal outcome with emphasis on primiparous adolescents and older women: a Swedish Medical Birth Register Study2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 11, p. e005840-Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the associations between maternal age and obstetric and neonatal outcomes in primiparous women with emphasis on teenagers and older women. Design: A population-based cohort study. Setting: The Swedish Medical Birth Register. Participants: Primiparous women with singleton births from 1992 through 2010 (N=798 674) were divided into seven age groups: less than17 years, 17-19 years and an additional five 5-year classes. The reference group consisted of the women aged 25-29 years. Primary outcome: Obstetric and neonatal outcome. Results: The teenager groups had significantly more vaginal births (adjusted OR (aOR) 2.04 (1.79 to 2.32) and 1.95 (1.88 to 2.02) for age less than17 years and 1719 years, respectively); fewer caesarean sections (aOR 0.57 (0.48 to 0.67) and 0.55 (0.53 to 0.58)), and instrumental vaginal births (aOR 0.43 (0.36 to 0.52) and 0.50 (0.48 to 0.53)) compared with the reference group. The opposite was found among older women reaching a fourfold increased OR for caesarean section. The teenagers showed no increased risk of adverse neonatal outcome but presented an increased risk of prematurity less than32 weeks (aOR 1.66 (1.10 to 2.51) and 1.20 (1.04 to 1.38)). Women with advancing age (greater than= 30 years) revealed significantly increased risk of prematurity, perineal lacerations, preeclampsia, abruption, placenta previa, postpartum haemorrhage and unfavourable neonatal outcomes compared with the reference group. Conclusions: For clinicians counselling young women it is of importance to highlight the obstetrically positive consequences that fewer maternal complications and favourable neonatal outcomes are expected. The results imply that there is a need for individualising antenatal surveillance programmes and obstetric care based on age grouping in order to attempt to improve the outcomes in the age groups with less favourable obstetric and neonatal outcomes. Such changes in surveillance programmes and obstetric interventions need to be evaluated in further studies.

  • 10.
    Blomberg, Marie
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Selbing, Anders
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Källén, B.
    Tornblad Institute University of Lund, Lund, Sweden.
    Congenital malformations in the southeast of Sweden: a registry study with validation2000In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 89, no 10, p. 1238-1243Article in journal (Refereed)
    Abstract [en]

    A study was made of the occurrence of congenital malformations in the southeast region of Sweden, utilizing all available relevant health registries. Östergötland county had been pinpointed in a routine surveillance as having an increased malformation risk. Various validations of the register data were undertaken and different types of errors were detected. An increased risk was seen, in Östergötland county compared to the reference counties, for specific types of malformations: preauricular appendices, pylorostenosis, uterine/vaginal malformations, foot deformities, limb reduction defects and cardiovascular malformations. Variable classification or registration artefacts explained the excess among the first four conditions. Limb reduction defects were also mis-coded, but the increased risk in Östergötland county may persist.

    Conclusion: There is an increased risk of major cardiovascular malformations in Östergötland county compared to the reference counties that also shows an uneven distribution within the county.

  • 11.
    Brynhildsen, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Claesson, Ing-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Endocrinology.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Leptin and adiponectin in cord blood from children of normal weight, overweight and obese mothers2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, p. 620-624Article in journal (Refereed)
    Abstract [en]

    Aim To study cord blood concentrations of adiponectin and leptin in children born by normal weight, overweight and obese mothers and to study these parameters in relation to a weight gain intervention programme for obese mothers. Methods Ten millilitre cord blood was collected and analysed for leptin and adiponectin concentrations in children with gestational age andgt;37weeks born by 60 normal weight, 45 overweight and 145 obese mothers. 82 obese mothers took part in a weight gain intervention programme. Results Concentrations of leptin and adiponectin were higher in cord blood from children of overweight and obese mothers compared with children of normal weight mothers (leptin: Md 13.2, 30, 3 and 90.2ng/mL respectively, pandlt;0.001; adiponectin 35.9, 205.4, 213.8ng/L pandlt;0.001). No differences were found between overweight and obese mothers. The weight gain intervention programme for obese pregnant women had significant effects on the weight gain during pregnancy but had no effects on cord blood serum concentrations of leptin and adiponectin. Conclusion Cord blood leptin and adiponectin concentrations were higher in children born by overweight or obese women compared with children of normal weight mothers. A weight gain intervention programme for obese pregnant women did not affect these results. Intrauterine exposition to high concentrations of leptin and adiponectin may play a role in weight development later in life.

  • 12.
    Carlhall, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Kallen, Karin
    Lund University, Sweden .
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal body mass index and duration of labor2013In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 171, no 1, p. 49-53Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor. less thanbrgreater than less thanbrgreater thanStudy design: Historical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight. less thanbrgreater than less thanbrgreater thanResults: The median duration of labor was significantly longer in obese women (class I obesity (BMI 30-34.9) = 9.1 h, class II obesity (BMI 35-39.9) = 9.2 h and class III obesity (BMI andgt; 40) = 9.8 h) compared to normal-weight women (BMI 18.5-24.9) = 8.8 h (p andlt; 0.001). The risk of labor lasting more than 12 h increased with increasing maternal BMI: OR 1.04(1.01-1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12 h or emergency cesarean section within 12 h, compared to vaginal deliveries within 12 h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45 h compared to normal weight women, 0.55 h (p andlt; 0.001). less thanbrgreater than less thanbrgreater thanConclusion: In nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it might be reasonable to adapt the considered upper limit for duration of labor, according to maternal BMI.

  • 13.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Effects of gestational weight gain and body mass index on obstetric outcome in Sweden2006In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 93, no 3, p. 269-274Article in journal (Other academic)
    Abstract [en]

    Objective: The objective of this study was to estimate the effects of low and high gestational weight gain, in different maternal Body Mass Index (BMI) classes, on obstetric and neonatal outcomes. Method: A prospective population-based cohort study of 245,526 singleton term pregnancies. Women were grouped in five categories of BMI and in three gestational weight gain categories, < 8 kg (low weight gain), 8-16 kg and > 16 kg (high weight gain). Obstetric and neonatal outcomes were evaluated after adjustments for maternal age, parity, smoking, year of birth. Result: Obese women with low gestational weight gain had a decreased risk for the following outcomes (adjusted odds ratio, 95% confidence interval): preeclampsia (0.52, 0.42-0.62), cesarean section (0.81, 0.73-0.90), instrumental delivery (0.75, 0.63-0.88), and LGA births (0.66, 0.59-0.75). There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain. High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes. Conclusion: The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied. Obese women may benefit from a low weight gain during pregnancy.

  • 14.
    Cedergren, Marie
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Epidemiological studies of congenital heart defects in the Southeast region of Sweden2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In the most recent analysis of Swedish data on congenital malformations, it appeared that in the county of Östergötland, the prevalence of infants with a diagnosed congenital malformation was higher than in the rest of the country. This observation initiated an effort to make a more complete identification of all infants born with a congenital malformation in that county and to compare it with the other two counties in the Southeast region of Sweden (Jönköping and Kalmar), utilising all the relevant Swedish medical health registers available. A total of 10,171 infants with a congenital malformation of any type were identified in the region: 4,698 infants in Östergötland county (6.2%), and 5,473 in the reference counties (5.4%). A 15% excess malformation risk in Östergötland compared with the two reference counties. Various validations of the register data were undertaken and different types of error were detected. Limb reduction defects seemed to occur more often in Östergötland county and there was an increased risk of cardiovascular malformations in Östergötland county (22%).

    The next step comprised an exploration of putative risk factors for cardiac defects in the area. Maternal body mass index (BMI) >29 was found to be a significant risk factor for cardiac defects. Maternal diabetes mellitus and maternal use of antiepileptics were associated with an increased risk of cardiac defects in the offspring.

    To explore if the pregnant women in Östergötland county differed from the women in the reference counties, a comparative analysis of potential risk factors was performed. The only single putative risk factor that could contribute to the excess risk of cardiac defects in Östergötland county was matemal residency in a rural district. Notably, nearly all the potential risk factors studied i.e. spontaneous abortions, involuntary childlessness, maternal disease, high maternal body mass index, matemal medical during use and alcohol use in early pregnancy, parental employment and paternal age were stronger in Östergötland county compared to the reference area. A conceivable explantation is that one or more unidentified factors could activate prevalent and weak teratogenic risk factors for cardiac defects.

    Drinking water could be such a factor. By using a geographical infmmation system (GIS) it was possible to obtain individual data on drinking water characteristics. An increased tisk of a congenital cardiac defect seemed to be associated with the chlorination procedure, in particular the use of chlorine dioxide, and with increasing total trihalomethane concentration.

    List of papers
    1. Congenital malformations in the southeast of Sweden: a registry study with validation
    Open this publication in new window or tab >>Congenital malformations in the southeast of Sweden: a registry study with validation
    2000 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 89, no 10, p. 1238-1243Article in journal (Refereed) Published
    Abstract [en]

    A study was made of the occurrence of congenital malformations in the southeast region of Sweden, utilizing all available relevant health registries. Östergötland county had been pinpointed in a routine surveillance as having an increased malformation risk. Various validations of the register data were undertaken and different types of errors were detected. An increased risk was seen, in Östergötland county compared to the reference counties, for specific types of malformations: preauricular appendices, pylorostenosis, uterine/vaginal malformations, foot deformities, limb reduction defects and cardiovascular malformations. Variable classification or registration artefacts explained the excess among the first four conditions. Limb reduction defects were also mis-coded, but the increased risk in Östergötland county may persist.

    Conclusion: There is an increased risk of major cardiovascular malformations in Östergötland county compared to the reference counties that also shows an uneven distribution within the county.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25854 (URN)10.1111/j.1651-2227.2000.tb00742.x (DOI)10291 (Local ID)10291 (Archive number)10291 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Risk factors for cardiovascular malformation: a study based on prospectively collected data
    Open this publication in new window or tab >>Risk factors for cardiovascular malformation: a study based on prospectively collected data
    2002 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 28, no 1, p. 12-17Article in journal (Refereed) Published
    Abstract [en]

    Objectives The aim of this study was to identify risk factors for cardiovascular malformation.

    Methods In a case-referent study prospectively collected data were obtained from original medical records. The study included 277 woman who had infants with a severe cardiac defect, and for each case two referents (medical records study) were included. Data on parental age, maternal reproductive history, disease in early pregnancy, reported maternal use of drugs and alcohol, smoking habits, parental occupation, and maternal body mass index (BMI) were extracted. When data were available from Swedish medical health registers, a comparison was made (register study) between all infants with cardiovascular defects (2208) and all infants born (175 768).

    Results Maternal diabetes mellitus was associated with an increased risk for cardiovascular malformation [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.36-4.15], as was a high BMI (>29) (OR 1.46, 95%CI 1.12-1.90). A tendency towards an increased risk was found for involuntary childlessness, spontaneous abortion, thyroid drugs, and nonsteroid anti-inflammatory drugs.

    Conclusions Some known risk factors for cardiac defects (eg, maternal diabetes mellitus and the use of antiepileptics) could be identified. Other postulated risk factors could not be verified, for example, paternal age and parental occupation. The use of medicinal drugs seems not to be a major factor in the etiology of cardiac defects. It is possible, however, that there is an association with the use of nonsteroid anti-inflammatory drugs or drugs for thyroid disease. The relationship between a high BMI and cardiovascular malformation observed in this study may be explained by impaired maternal glucose tolerance.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26405 (URN)10.5271/sjweh.641 (DOI)10945 (Local ID)10945 (Archive number)10945 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Geographic variations in possible risk factors for severe cardiac malformations
    Open this publication in new window or tab >>Geographic variations in possible risk factors for severe cardiac malformations
    2002 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, no 2, p. 222-228Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate various putative risk factors in a county in Sweden, described as having a 28% increased prevalence of cardiovascular malformations, and to compare them with the risk factors in two reference counties. Women giving birth in the studied counties differed in age and parity distribution, smoking, and educational level but these differences could not explain the increased risk of cardiovascular malformations in the county, since after stratification for these variables, the risk estimate did not change substantially. A number of potential risk factors were studied in a case/control design: spontaneous abortions, involuntary childlessness, maternal disease, body mass index, medical drug use, alcohol use, parental employment, paternal age, and urban/rural residency. No single factor could be attributed to the increased rate, with the exception of living in a rural district. Nearly all risk factors, however, were stronger in the county studied than those in the reference counties (0.02 > p > 0.01).

    Conclusion: The only single putative risk factor that could have contributed to the increased risk for cardiac defects described in the county studied was maternal residency in a rural district. Notably, nearly all potential risk factors studied were stronger in the county studied compared with those in the reference area. A conceivable explanation is that one or more unidentified factors related to rural residency could potentiate prevalent and weak teratogenic risk factors for cardiac defects.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26404 (URN)10.1111/j.1651-2227.2002.tb01699.x (DOI)10944 (Local ID)10944 (Archive number)10944 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    4. Chlorination Byproducts and Nitrate in Drinking Water and Risk for Congenital Cardiac Defects
    Open this publication in new window or tab >>Chlorination Byproducts and Nitrate in Drinking Water and Risk for Congenital Cardiac Defects
    2002 (English)In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 89, no 2, p. 124-130Article in journal (Refereed) Published
    Abstract [en]

    Drinking water disinfection byproducts have been associated with an increased risk for congenital defects including cardiac defects. Using Swedish health registers linked to information on municipal drinking water composition, individual data on drinking water characteristics were obtained for 58,669 women. Among the infants born, 753 had a cardiac defect. The risk for a cardiac defect was determined for ground water versus surface water, for different chlorination procedures, and for trihalomethane and nitrate concentrations. Ground water was associated with an increased risk for cardiac defect when crude rates were analyzed but after suitable adjustments this excess rate was found to be determined by chlorination procedures including chlorine dioxide. Chlorine dioxide appears itself as an independent risk factor for cardiac defects (adjusted odds ratio 1.61 (95%CI 1.00–2.59)). The risk for cardiac defects increased with increasing trihalomethane concentrations (P=0.0005). There was an indicated but statistically nonsignificant excess risk associated with nitrate concentration. The individual risk for congenital cardiac defect caused by chlorine dioxide and trihalomethanes is small but as a large population is exposed to public drinking water, the attributable risk for cardiac defects may not be negligible.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26406 (URN)10.1006/enrs.2001.4362 (DOI)10946 (Local ID)10946 (Archive number)10946 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
  • 15.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Maternal morbid obesity and the risk of adverse pregnancy outcome2004In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 103, no 2, p. 219-224Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes. METHODS: In a prospective population-based cohort study, 3,480 women with morbid obesity, defined as a body mass index (BMI) more than 40, and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women (BMI 19.8-26). The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments. RESULTS: In the group of morbidly obese mothers (BMI greater than. 40) as compared with the normal-weight mothers, there was an increased risk of the following outcomes (adjusted odds ratio, 95% confidence interval): preeclampsia (4.82, 4.04, 5.74), antepartum stillbirth (2.79, 1.94,4.02), cesarean delivery (2.69, 2.49,2.90), instrumental delivery (1.34, 1.16, 1.56), shoulder dystocia (3.14, 1.86, 5.31), meconium aspiration (2.85, 1.60, 5.07), fetal distress (2.52, 2.12,2.99), early neonatal death (3.41, 2.07,5.63), and large-for-gestational age (3.82, 3.50, 4.16). The associations were similar for women with BMIs between 35.1 and 40 but to a lesser degree. CONCLUSION: Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions. tricians and Gynecologists.

  • 16.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Optimal gestational weight gain for body mass index categories2007In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 110, no 4, p. 759-764Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To establish optimal gestational weight gain for each maternal body mass index (BMI) category based on significant risk estimates of adverse maternal and fetal outcome. METHODS: The study population consisted of 298,648 singleton pregnancies delivered in Sweden between January 1, 1994, and December 31, 2004. The number of individuals in each weight gain class was compared with the number of individuals in all other weight gain classes in the same BMI group with regard to adverse maternal and fetal outcome. Odds ratios were calculated after suitable adjustments. RESULTS: The optimal gestational weight gain in women by prepregnancy BMI was 9-22 lb (4-10 kg) for BMI less than 20, 5-22 lb (2-10 kg) for BMI 20-24.9, less than 20 lb (less than 9 kg) for BMI 25-29.9, and less than 13 lb (less than 6 kg) for BMI of 30 or more. CONCLUSION: The gestational weight gain limits for BMI categories determined in this large population-based cohort study from Swedish Medical Registers showed that a decreased risk of adverse obstetric and neonatal outcomes was associated with lower gestational weight gain limits than was earlier recommended, especially among obese women. © 2007 The American College of Obstetricians and Gynecologists.

  • 17.
    Cedergren, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition2008In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 198, no 4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to assess whether maternal prepregnancy body mass index was associated with the use of antiemetic drugs in early pregnancy and/or with the occurrence of hyperemesis gravidarum. STUDY DESIGN: A retrospective, population-based, cohort study. Women who delivered singleton infants (n = 749,435) from 19952003 were evaluated concerning the use of antiemetic drugs in early pregnancy (data available from 1995). Women who delivered singleton infants (n = 942,894) from 1992-2001 were evaluated concerning hospitalization because of hyperemesis gravidarum (data available until 2001). Adjusted odds ratios were determined by Mantel- Haenszel technique and were used as estimates of relative risk (RR). RESULTS: Underweight pregnant women were more likely to use antiemetic drugs (RR, 1.19, 95% CI, 1.14-1.24) and to become hospitalized for hyperemesis gravidarum (RR, 1.43, 95% CI, 1.33-1.54) compared with ideal weight women. Obese women were less likely to use antiemetic drugs (RR, 0.93, 95% CI, 0.89-0.97) and less likely to require hospitalization because of hyperemesis (RR, 0.90, 95% CI, 0.85-0.95) compared with women with an ideal body mass index. CONCLUSION: The use of antiemetic drugs and the occurrence of hyperemesis gravidarum are related to maternal body composition.

  • 18.
    Cedergren, Marie I
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Non-elective caesarean delivery due to ineffective uterine contractility or due to obstructed labour in relation to maternal body mass index2009In: EUROPEAN JOURNAL OF OBSTETRICS and GYNECOLOGY AND REPRODUCTIVE BIOLOGY, ISSN 0301-2115, Vol. 145, no 2, p. 163-166Article in journal (Refereed)
    Abstract [en]

    Objective: To assess whether non-elective caesarean section due to obstructed labour and/or ineffective uterine contractility was associated with maternal body mass index (BMI). Study design: The prospective dataset from the Swedish Medical Birth Registry consisted of 233,887 nulliparous women with a spontaneous onset of labour categorized in six classes of pre-pregnancy BMI, who delivered in Sweden between, January 1, 1999 and December 31, 2005. The mode of delivery was classified as either vaginal or by caesarean section. The caesarean section was classified as either elective or non-elective. Adjusted risks for non-elective caesarean section due to ineffective uterine contractility, or obstructed labour or fetal distress were determined using Mantel-Haenszel technique. Results: The risk of a non-elective caesarean section due to obstructed about was not significantly associated with maternal BMI. However, ineffective uterine contractility was significantly associated with maternal BMI and the risk of non-elective caesarean delivery due to labour arrest disorders increased with increasing BMI, reaching a 4-fold increased risk among the morbidly obese women. The risk of non-elective caesarean section due to fetal distress also increased significantly with increasing maternal BMI. Conclusions: It appears that ineffective labour could be a factor leading to the increased risk of non-elective caesarean section among obese and morbidly obese women. These findings challenge obstetricians to learn more about how to manage oxytocin infusions during labour in relation to maternal BMI.

  • 19.
    Cedergren, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Källén, Bengt
    Maternal obesity and the risk for orofacial clefts in the offspring2005In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 42, no 4, p. 367-371Article in journal (Refereed)
    Abstract [en]

    Objective: To estimate whether obese women have an increased risk of orofacial clefts in their offspring, compared with average-weight women. Design and Participants: The study was based on information on maternal body mass index (BMI) collected in early pregnancy and on the existence of orofacial clefts in the offspring, ascertained from multiple sources. The study included 1686 women who had infants with an orofacial cleft and as controls all delivered women (n = 988,171) during the study period, 1992 through 2001. Infants with chromosome anomalies were excluded. The women were divided into underweight (BMI <19.8), average weight (reference group, BMI 19.8 to 26), overweight (BMI 26.1 to 29), and obese (BMI >29). Adjustments were made for year of birth, maternal age, parity, and maternal smoking. Results: Obese (BMI >29) mothers had an overall increased risk for having an infant with orofacial clefts: odds ratio 1.30 (95% confidence interval 1.11 to 1.53). This increased risk was higher when the cleft was associated with other major malformations than when it was isolated. There was no statistically significant difference between the risk estimates for cleft lip and cleft palate. Conclusions: In this large sample, a positive association appears between maternal obesity in early pregnancy and orofacial clefts in the offspring. The explanation for this association is not known, but a relationship with undetected type 2 diabetes is one possibility.

  • 20.
    Cedergren, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Källén, Bengt AJ
    Maternal obesity and infant heart defects2003In: Obesity Research, ISSN 1071-7323, E-ISSN 1550-8528, Vol. 11, no 9, p. 1065-1071Article in journal (Refereed)
    Abstract [en]

    Objective: This study determined whether obese women have an increased risk of cardiovascular defects in their offspring compared with average weight women. Research Methods and Procedures: In a case-control study, prospectively collected information was obtained from Swedish medical health registers. The study included 6801 women who had infants with a cardiovascular defect and, as controls, all delivered women (N = 812,457) during the study period (1992 to 2001). Infants with chromosomal anomalies or whose mothers had pre-existing diabetes were excluded. Obesity was defined as BMI >29 kg/m2, and morbid obesity was defined as BMI >35 kg/m2. Comparisons were made with average weight women (BMI = 19.8 to 26 kg/m2). Results: In the group of obese mothers, there was an increased risk for cardiovascular defects compared with the average weight mothers [adjusted odds ratio (OR) = 1.18, 95% CI, 1.09 to 1.27], which was slightly more pronounced for the severe types of cardiovascular defects (adjusted OR = 1.23, 95% CI, 1.05 to 1.44). With morbid obesity, the OR for cardiovascular defects was 1.40 (95% CI, 1.22 to 1.64), and for severe cardiovascular defects, the OR was 1.69 (95% CI, 1.27 to 2.26). There was an increased risk for all specific defects studied among the obese women, but only ventricular septal defects and atrial septal defects reached statistical significance. Discussion: In this sample, a positive association was found between maternal obesity in early pregnancy and congenital heart defects in the offspring. A suggested explanation is undetected type 2 diabetes in early pregnancy, but other explanations may exist.

  • 21.
    Cedergren, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Källén, Bengt AJ
    Lund .
    Obstetric outcome of 6346 pregnancies with infants affected by congenital heart defects2006In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 125, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate whether pregnancies with infants affected by congenital heart defects are associated with adverse obstetric and perinatal outcome. Study design: In a prospective population-based cohort study from Sweden (1992-2001), 6346 singleton pregnancies with infants affected by congenital heart defects were, after suitable adjustments, compared to all delivered women. Results: The prevalence of cardiovascular defects was 9.1 per 1000 births. Among them, mothers of 6346 infants (71%) had information on maternal smoking habits and maternal height and weight in early pregnancy that enabled the calculation of BMI. All cases with known chromosomal abnormalities and/or maternal pre-existing diabetes were excluded. Eighty-four percent (n = 5338) had an isolated cardiovascular defect. Severe types occurred in 21.7% (n = 1378). In the group of pregnancies with infants affected by congenital heart defects as compared to all delivered women, there was an increased risk of the following outcomes (adjusted OR (95%CI)): pre-eclampsia (1.21 (1.06-1.37)), cesarean section (1.91 (1.79-2.03)), instrumental delivery (1.21 (1.10-1.34)), pre-term delivery (2.58 (2.39-2.79)), small-for gestational age (1.96 (1.77-2.16)), meconium aspiration (1.51 (1.28-1.77)), and fetal distress (1.38 (1.17-1.63)). Conclusions: Pregnancies with infants affected by congenital heart defects are associated with several obstetric and neonatal complications. © 2005 Elsevier Ireland Ltd. All rights reserved.

  • 22.
    Cedergren, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Selbing, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Detection of fetal structural abnormalities by an 11-14-week ultrasound dating scan in an unselected Swedish population2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 8, p. 912-915Article in journal (Refereed)
    Abstract [en]

    Background. To determine the detection rate of fetal structural abnormalities by a routine 11-14-week ultrasound scan for dating in an unselected pregnant population. Methods. A prospective observational cohort study of 2,708 unselected pregnant women attending an abdominal ultrasound examination at 11-14 weeks gestation. The number of major fetal structural abnormalities diagnosed after birth was obtained from a computerized database at the same unit. Results. Out of 2,708 pregnant women, 89 (3.3%) were found to have a missed abortion at the time of the ultrasound scan and 33 (1.2%) were diagnosed as twins. Thirteen major structural abnormalities were detected, three cases of anencephaly (one case also had a spina bifida), one case with hydranencephaly, one fetus with Dandy-Walker syndrome, two cases with gastroschisis, one case with a bilateral hydronephrosis, one case with a generalized hydrops, one fetus with multiple malformations, and three cystic hygromas. An additional 19 major structural defects were detected at birth. Four cases of neural tube defects and nine fetuses with congenital heart defects were diagnosed. The antenatal ultrasound detection rate was 40.6% (13/32). Nine patients had a nuchal translucency greater than 3.0 mm (excluding cystic hygromas), two of them had chromosomal abnormalities (trisomy 21 and trisomy 18). Conclusions. Fetal structural abnormalities were detected in 41% (95%CI = 24-59) of the cases in an unselected pregnant population at a routine 11-14-week ultrasound scan for dating purpose. Two out of nine fetuses with a nuchal translucency greater than 3.0 mm had a chromosomal abnormality. © 2006 Taylor & Francis.

  • 23.
    Cedergren, Marie
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Selbing, Anders
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Källén, B.
    Tornblad Institute, University of Lund, Lund, Sweden.
    Geographic variations in possible risk factors for severe cardiac malformations2002In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 91, no 2, p. 222-228Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate various putative risk factors in a county in Sweden, described as having a 28% increased prevalence of cardiovascular malformations, and to compare them with the risk factors in two reference counties. Women giving birth in the studied counties differed in age and parity distribution, smoking, and educational level but these differences could not explain the increased risk of cardiovascular malformations in the county, since after stratification for these variables, the risk estimate did not change substantially. A number of potential risk factors were studied in a case/control design: spontaneous abortions, involuntary childlessness, maternal disease, body mass index, medical drug use, alcohol use, parental employment, paternal age, and urban/rural residency. No single factor could be attributed to the increased rate, with the exception of living in a rural district. Nearly all risk factors, however, were stronger in the county studied than those in the reference counties (0.02 > p > 0.01).

    Conclusion: The only single putative risk factor that could have contributed to the increased risk for cardiac defects described in the county studied was maternal residency in a rural district. Notably, nearly all potential risk factors studied were stronger in the county studied compared with those in the reference area. A conceivable explanation is that one or more unidentified factors related to rural residency could potentiate prevalent and weak teratogenic risk factors for cardiac defects.

  • 24.
    Cedergren, Marie
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Selbing, Anders
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Källén, Bengt AJ
    Tornblad Institute, University of Lund, Lund, Sweden.
    Risk factors for cardiovascular malformation: a study based on prospectively collected data2002In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 28, no 1, p. 12-17Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to identify risk factors for cardiovascular malformation.

    Methods In a case-referent study prospectively collected data were obtained from original medical records. The study included 277 woman who had infants with a severe cardiac defect, and for each case two referents (medical records study) were included. Data on parental age, maternal reproductive history, disease in early pregnancy, reported maternal use of drugs and alcohol, smoking habits, parental occupation, and maternal body mass index (BMI) were extracted. When data were available from Swedish medical health registers, a comparison was made (register study) between all infants with cardiovascular defects (2208) and all infants born (175 768).

    Results Maternal diabetes mellitus was associated with an increased risk for cardiovascular malformation [odds ratio (OR) 2.38, 95% confidence interval (95% CI) 1.36-4.15], as was a high BMI (>29) (OR 1.46, 95%CI 1.12-1.90). A tendency towards an increased risk was found for involuntary childlessness, spontaneous abortion, thyroid drugs, and nonsteroid anti-inflammatory drugs.

    Conclusions Some known risk factors for cardiac defects (eg, maternal diabetes mellitus and the use of antiepileptics) could be identified. Other postulated risk factors could not be verified, for example, paternal age and parental occupation. The use of medicinal drugs seems not to be a major factor in the etiology of cardiac defects. It is possible, however, that there is an association with the use of nonsteroid anti-inflammatory drugs or drugs for thyroid disease. The relationship between a high BMI and cardiovascular malformation observed in this study may be explained by impaired maternal glucose tolerance.

  • 25.
    Cedergren, Marie
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Selbing, Anders
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences. Linköping University, Faculty of Health Sciences.
    Källen, Bengt A. J.
    Tornblad Institute, University of Lund, Lund, Sweden.
    Chlorination Byproducts and Nitrate in Drinking Water and Risk for Congenital Cardiac Defects2002In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 89, no 2, p. 124-130Article in journal (Refereed)
    Abstract [en]

    Drinking water disinfection byproducts have been associated with an increased risk for congenital defects including cardiac defects. Using Swedish health registers linked to information on municipal drinking water composition, individual data on drinking water characteristics were obtained for 58,669 women. Among the infants born, 753 had a cardiac defect. The risk for a cardiac defect was determined for ground water versus surface water, for different chlorination procedures, and for trihalomethane and nitrate concentrations. Ground water was associated with an increased risk for cardiac defect when crude rates were analyzed but after suitable adjustments this excess rate was found to be determined by chlorination procedures including chlorine dioxide. Chlorine dioxide appears itself as an independent risk factor for cardiac defects (adjusted odds ratio 1.61 (95%CI 1.00–2.59)). The risk for cardiac defects increased with increasing trihalomethane concentrations (P=0.0005). There was an indicated but statistically nonsignificant excess risk associated with nitrate concentration. The individual risk for congenital cardiac defect caused by chlorine dioxide and trihalomethanes is small but as a large population is exposed to public drinking water, the attributable risk for cardiac defects may not be negligible.

  • 26.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Cedergren, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Weight gain restriction during pregnancy is safe for both the mother and neonate.2009In: Acta obstetricia et gynecologica Scandinavica, ISSN 1600-0412, Vol. 88, no 10, p. 1158-1162Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate whether pregnancy, delivery, and neonatal outcome among obese pregnant women who took part in an intervention study for weight restriction differed from a group of obese pregnant women attending regular antenatal care. The intervention group consisted of 155 obese pregnant women and 193 obese pregnant women who formed a control group. We found that a weight gain restriction of less than 7 kg during pregnancy is safe for both the mother and the neonate.

  • 27.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Hultgren, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Lifestyle habits and womens attitudes towards discussing them at a visit for contraceptive advice2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 114-118Article in journal (Refereed)
    Abstract [en]

    Objective: The aims of this study was to use visits for contraceptive counselling as opportunities for examining womens actual life style habits with the main focus being placed on alcohol consumption but also to evaluate the womens opinions about discussing their alcohol and tobacco habits and their weight status. Methods: A total of 535/802 (67%) women completed a study-specific anonymous questionnaire after a contraceptive counselling visit with a midwife. Results: A majority of the women thought that a discussion concerning alcohol habits at a contraceptive counselling session was important (85.5%) and not intrusive (86.4%) neither embarrassing (81.7%). Women with high-risk drinking habits were younger, more often tobacco users and more often planning for childbirth in the future, compared with women who did not display high-risk drinking behaviour. A significantly higher percentage of women who practiced high-risk drinking thought that a discussion of alcohol was intrusive (10.9%) and embarrassing (46.7%), compared with women not practicing highrisk alcohol consumption. Most women (72.9%) stated that no other caregiver during the preceding year except the midwife had discussed drinking habits with them. The weight was a good thing that the midwife brought up for discussion according to 82.5% of the women but the discussions about weight was more often found embarrassing (18.4%) than the discussion about alcohol habits. Conclusion: Women who came for contraceptive counselling found the discussion concerning alcohol habits important, not intrusive or embarrassing and a good thing to be brought up by the midwife. (C) 2014 Elsevier B.V. All rights reserved.

  • 28.
    Claesson, Ing-Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Consumer satisfaction with a weight-gain intervention programme for obese pregnant women.2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 2, p. 163-167Article in journal (Refereed)
    Abstract [en]

    Objective: to investigate women's attitudes and satisfaction with a weight-gain intervention programme during pregnancy.

    Design: exploratory, descriptive study. Data were collected via interviews.

    Setting: University hospital.

    Participants: 56 obese pregnant women who attended antenatal care at the University Hospital of Linköping's obstetrical department and took part in an intervention programme aimed at reducing weight gain during pregnancy, between November 2003 and August 2004.

    Findings: the interviews comprised several questions concerning attitudes and opinions of the programme. Most of the women expressed positive experiences with the treatment and would attend the programme if they became pregnant again. Most of the women stated that they had changed their eating and exercise habits during pregnancy, and almost all of them had continued with these new habits. Even though the weight gain goal of a maximum 6.9 kg was reached by less than half of the participants, most of the women were satisfied with their weight gain. A total of 71.4% of the women participated in aqua aerobics classes. They stated that they were most satisfied with this form of exercise, and that it also was a good social experience.

    Key conclusions and implications for practice: a pregnant woman herself must be actively involved in setting her own goals to prevent excessive weight gain during pregnancy. Considerable effort and support must be placed on discussing strategies, pitfalls and risks. In order for the woman to maintain the change in attitude and habits, she must probably be given continuous feedback and reinforcement over the long term.

  • 29.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Blomberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Weight after childbirth: A 2-year follow-up of obese women in a weight-gain restriction program2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 1, p. 103-110Article in journal (Other academic)
    Abstract [en]

    Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth.

    Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum.

    Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018).

    Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.

  • 30.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jeppsson, Annika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Weight gain restriction for obese pregnant women: A case-control intervention study2008In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, no 1, p. 44-50Article in journal (Refereed)
    Abstract [en]

    Objective: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. Design: A prospective case-control intervention study. Setting: Antenatal care clinics in the southeast region of Sweden. Population: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. Methods: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. Main outcome measures: Weight gain in kilograms, delivery and neonatal outcome. Results: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P = 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P = 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. Conclusion: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.

  • 31.
    Hildebrand, Eric
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Sved, Catarina
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Gottvall, Tomas
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Janerot Sjöberg, Birgitta
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Impact of a standardized training program on midwive’s ability to assess fetal heart anatomy by ultrasound2014In: BMC Medical Imaging, ISSN 1471-2342, E-ISSN 1471-2342, Vol. 14, no 20Article in journal (Refereed)
    Abstract [en]

    Background: Studies of prenatal detection of congenital heart disease (CDH) in the UK, Italy, and Norway indicate that it should be possible to improve the prenatal detection rate of CDH in Sweden. These studies have shown that training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve the detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound screening protocol in Sweden.

    Methods: A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a model using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The self-estimated difficulties and knowledge gaps of four midwives were identified. A two-day course with mixed lectures, demonstrations and handson sessions was followed by a feedback session one month later consisting of an interview and check-up. The long-term effects were tested two years later.

    Results: At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative evaluation showed that the color Doppler images were difficult to interpret, but the training seems to have enhanced the familiarity with the new technique. The ability to perform the method remained at the new level at follow-up both three months and two years later.

    Conclusions: Our results indicate that by implementing new imaging modalities and providing hands-on training, uncertainty can be reduced and time decreased, but they also show that continuous on-site training with clinical and technical back-up is important.

  • 32.
    Hildebrand, Eric
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Gottvall, Tomas
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal Obesity and Detection Rate of Fetal Structural Anomalies2013In: Fetal Diagnosis and Therapy, ISSN 1015-3837, E-ISSN 1421-9964, Vol. 33, no 4, p. 246-251Article in journal (Refereed)
    Abstract [en]

    Objective: To estimate the effects of maternal body mass index (BMI) on the sensitivity of detecting fetal anomalies by a routine ultrasound performed either in the first or in the second trimester. Methods: Unselected pregnant women (n = 19,140) were divided into four BMI groups: underweight (less than18.5), normal weight (18.5-24.9, reference group), overweight (25.0-29.9), and obese (greater than= 30.0). Fetal anomaly diagnoses were grouped according to their likely clinical consequences as suggested by the Royal College of Obstetricians and Gynaecologists. Minor anomalies were excluded. The detection rate of fetal anomalies in each BMI group was calculated and compared. Results: The prevalence of infants with structural anomalies in the study population was 4% and the prevalence of material obesity was 10%. The detection rates of fetal structural anomalies were 26% for normal-weight, 29% for overweight (odds ratio (OR) 1.15,95% confidence interval (Cl) 0.68-1.95), and 19% for obese women (OR 0.67, 95% Cl 0.29-1.52). The detection rate of anomalies with long-term handicap was lower in the obese group (27.3%; OR 0.44, 95% Cl 0.11-1.79) compared to normal-weight women (46.3%). Conclusion: The detection rate of fetal anomalies seems to be lower for obese women, but these findings need to be further investigated.

  • 33.
    Hildebrand, Eric
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Källén, Bengt
    Tornblad Institute, University of Lund, Sweden.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gottvall, Tomas
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal obesity and risk of Down syndrome in the offspring2014In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 34, no 4, p. 310-315Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this article is to determine if maternal obesity is associated with an increased risk of Down syndrome in the offspring and whether the risk estimates for trisomy 21 based on combined screening is affected by maternal body mass index (BMI).

    METHODS: Study group I consisted of a nationwide cohort of 168 604 women giving birth; outcome was infants born with Down syndrome. Adjustment was made for maternal age. Study group II consisted of 10 224 women undergoing 1st trimester combined screening. Outcome was risk assessment for Down syndrome. All women were divided into six BMI groups, and outcomes were evaluated over the BMI strata with BMI 18.5 to 24.9 as reference and correcting for maternal age.

    RESULTS: Obese women had an increased risk for giving birth to an infant with Down syndrome compared with normal-weight women, BMI 30 to 34.9 odds ratio (OR) 1.31 [95% confidence interval (CI) 1.10-1.55], BMI 35 to 39.9 OR 1.12 (95% CI 0.82-1.53), BMI ≥ 40 OR 1.56 (95% CI 1.00-2.43). The observed and the expected numbers of women with a risk of Down syndrome >1/300 based on 1st trimester combined screen and maternal age were similar in each BMI group.

    CONCLUSION: Maternal obesity seems to increase the risk for Down syndrome births. The risk estimate for Down syndrome with 1st trimester combined screening is unaffected by BMI. © 2013 John Wiley & Sons, Ltd.

  • 34.
    Hildebrand, Eric
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Selbing, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Comparison of first and second trimester ultrasound screening for fetal anomalies in the southeast region of Sweden2010In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349, Vol. 89, no 11, p. 1412-1419Article in journal (Refereed)
    Abstract [en]

    Objective. To assess and compare the sensitivity for detecting fetal anomalies and chromosomal aberrations by routine ultrasound examination performed in the second trimester with results from an examination performed at 11-14 weeks gestation. Design. Observational study. Setting. Five centers in the southeast region of Sweden. Population. A total of 21,189 unselected pregnant women. Methods. The scan was performed at one center in the first trimester and at the remaining four centers in the second trimester. Outcome measures resulting from first trimester scanning were compared with those from the second trimester scanning. Main outcome measures. Detection rates of fetal structural anomalies and chromosomal aberrations. Results. At the first trimester scan 13% of all anomalies were detected, and at the second trimester scan 29% were detected. Lethal anomalies were detected at a high level at both times: 88% in the first, 92% in the second. The percentage of chromosomal aberrations discovered at the early scan was 71%, in the later 42%. The percentage of heart malformations detected was surprisingly low. Conclusion. The results showed the advantages of the later scan in discovering anomalies of the heart, urinary tract and CNS, and of the early scan in discovering chromosomal aberrations. Lethal malformations were detected at a high level in both groups, but detection of heart malformations needs improvement.

  • 35.
    Josefsson, Ann
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Frederiksen, Sven G
    Lund University Hospital, Lund.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Bariatric surgery in a national cohort of women: sociodemographics and obstetric outcomes2011In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 205, no 3, p. 25-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In a large, prospective Swedish national cohort, we investigated individual birth characteristics for women who had undergone bariatric surgery and their obstetric outcome and made comparisons with all other women during the same period. less thanbrgreater than less thanbrgreater thanSTUDY DESIGN: The cohort consisted of 494,692 women born 19731983 of which 681 women who had undergone bariatric surgery constituted the index group. less thanbrgreater than less thanbrgreater thanRESULTS: The index women more often have parents with lower sociodemographic status and are more often born large for gestational age. The women surgically treated before their first child had a shorter gestational length, their children had lower birthweight, and were more often born small for gestational age compared with the children born to the reference mothers. Women whose child was born before their bariatric surgery more often had a cesarean section, and their children were more often large for gestational age. less thanbrgreater than less thanbrgreater thanCONCLUSION: Preconception bariatric surgery in obese women may be associated with improved obstetric outcomes.

  • 36.
    Lilliecreutz, Caroline
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Cedergren, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Dags att implementera nya rön om graviditetsdiabetes2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Article in journal (Other academic)
    Abstract [en]

    n/a

  • 37.
    Lindholm, Elisabeth S
    et al.
    Division of Obstetrics and Gynecology, Department of Clinical Science, Karolinska Institutet.
    Altman, Daniel
    Division of Obstetrics and Gynecology, Department of Clinical Science, Karolinska Institutet.
    Norman, Margareta
    Division of Obstetrics and Gynecology, Department of Clinical Science, Karolinska Institutet.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Health Care Consumption during Pregnancy in relation to Maternal Body Mass Index: A Swedish Population Based Observational Study2015In: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, Vol. 2015, p. 7-, article id 215683Article in journal (Refereed)
    Abstract [en]

    Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, . Pairwise comparisons among BMI groups are obtained post hoc by Tukey HSD test. Result. Obese women were more often admitted for in-patient care (), had longer antenatal hospital stays (), and were more often sick-listed by an obstetrician () during their pregnancy, compared to women with normal weight women. Preeclampsia was more than four times as common, hypertension five times as common, and gestational diabetes 11 times as common when comparing in-patient care, obese to normal weight women ( for all comparisons). Underweight mothers had longer stay in hospitals () and hydronephrosis and hyperemesis gravidarum were more than twice as common (both ). Conclusion. Obese and underweight mothers consumed significantly more health care resources and obese women were significantly more often sick-listed during their pregnancy when compared to pregnant women of normal weight.

  • 38.
    Lundgren, Cecilia
    et al.
    Department of Obstetrics and Gynecology, Kalmar County Hospital, Kalmar, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical Physiology , Kalmar County Hospital, Kalmar, Sweden.
    Wanby, Anna-Stina
    Department of Obstetrics and Gynecology , Kalmar County Hospital , Kalmar , Sweden.
    Cedergren, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Ante- and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy2018In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 31, no 12, p. 1595-1601Article in journal (Refereed)
    Abstract [en]

    To identify obstetrical risk factors for the diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). A secondary aim was to determine the incidence of HIE.

  • 39.
    Mernelius, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences. Ryhov County Hospital, Sweden .
    Lofgren, Sture
    Ryhov County Hospital, Sweden .
    Lindgren, Per-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Olhager, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Gunnervik, Christina
    Varnamo Hospital, Sweden .
    Lenrick, Raymond
    Ryhov County Hospital, Sweden .
    Tiefenthal Thrane, Malena
    Hoglands Hospital Eksjo, Sweden .
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Microbiology.
    Matussek, Andreas
    Ryhov County Hospital, Sweden .
    The effect of improved compliance with hygiene guidelines on transmission of Staphylococcus aureus to newborn infants: The Swedish Hygiene Intervention and Transmission of S aureus study2013In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 41, no 7, p. 585-590Article in journal (Refereed)
    Abstract [en]

    Background: Newborn infants are often colonized with Staphylococcus aureus originating from health care workers (HCWs). We therefore use colonization with S aureus of newborn infants to determine the effect of an improved compliance with hygiene guidelines on bacterial transmission. Methods: Compliance with hygiene guidelines was monitored prior to (baseline) and after (follow-up) a multimodal hygiene intervention in 4 departments of obstetrics and gynecology. spa typing was used to elucidate transmission routes of S aureus collected from newborn infants, mothers, fathers, staff members, and environment. Results: The compliance with hygiene guidelines increased significantly from baseline to follow-up. The transmission of S aureus from HCWs to infants was however not affected. Fathers had the highest colonization rates. Persistent carriage was indicated in 18% of the HCWs. The most commonly isolated spa type was t084, which was not detected in a previous study from the same geographic area. Conclusion: It is possible to substantially improve the compliance with hygiene guidelines, by using multimodal hygiene intervention. The improved compliance did not decrease the transmission of S aureus from sources outside the own family to newborn infants. Furthermore, we show the establishment of a new spa type (t084), which now is very common in our region. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  • 40.
    Nilsen, Per
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Holmqvist, Marika
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Hultgren, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Cedergren, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Is Questionnaire-Based Alcohol Counseling More Effective for Pregnant Women Than Standard Maternity Care?2010In: JOURNAL OF WOMENS HEALTH, ISSN 1540-9996, Vol. 19, no 1, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Objective: To compare current standard maternity care in Sweden concerning provision of alcohol advice with a more comprehensive questionnaire-based counseling model. Methods: The study population included pregnant women in Linkoping who were registered at a maternity care center during a 2-year period and whose pregnancies resulted in liveborn infants without birth defects, representing 93% of all pregnant women. Anonymous questionnaires were mailed to the women. The first cohort (registered April 2005 1, to March 31, 2006) received standard care according to a procedure that is common practice in Sweden. The second cohort (April 1, 2006 to March 31, 2007) received alcohol advice based on a comprehensive counseling model, incorporating the use of the three-item Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire and tailored counseling based on the AUDIT-C score. Results: The response rate was 61% in the first cohort (standard care) and 70% in the second cohort (questionnaire-based counseling). The cohorts were similar in sociodemographic variables and prepregnancy drinking characteristics. The proportion of women who continued drinking alcohol during the pregnancy was 6.0% in cohort 1 and 5.8% in cohort 2. Women in cohort 2 were more favorable to the advice and, to a larger extent, perceived the main message to be abstinence from drinking during pregnancy. Conclusions: The questionnaire-based counseling model was more favorably perceived than the standard care model, but the new model was not more effective in terms of its impact on the proportion of women who abstained from drinking during pregnancy.

  • 41.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hultgren, Eva
    Department of Clinical and Experimental Medicine Linlöping University.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Alcohol use before and during pregnancy and factors influencing change among Swedish women2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 768-774Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate alcohol intake during pregnancy among women, to assess health cares providers' advice to the women and the relative importance of different factors on changes in the women's drinking. Design. Questionnaire study. Setting. Linkoping, Sweden. Population. A total number of 1,533 women registered at a maternity health care center in Linkoping during a one-year period, from 1 April 2005 to 31 March 2006. Methods. Mailed anonymous questionnaire with a response rate of 61%. Main outcome measures. Drinking behavior and information sources. Results. During pregnancy, 94% (n=869) of the responding women abstained from alcohol, including 13% (n=117) who were already abstainers. Six percent (n=55) continued drinking during the pregnancy. Those who continued drinking during pregnancy were older, had more often given birth and drank more frequently before pregnancy than the women who abstained. Half of the respondents (n=428) believed that decreases in alcohol intake during pregnancy reported in previous studies could be due to inaccurate self-reporting. The main message from maternity health care providers was perceived to be complete abstinence from alcohol during pregnancy (85%, n=777), although 8% (n=76) claimed that they had not received any advice regarding this. Media attention concerning risks associated with drinking during pregnancy was seen as slightly more important to achieve reduced alcohol intake during pregnancy than advice from maternity health care providers. Conclusions. A majority of women in this study reported abstaining from alcohol during pregnancy. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS).

  • 42.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Skagerström, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hultgren, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 6, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Objective. To compare an earlier Swedish antenatal care counseling routine concerning alcohol consumption with an expanded model in terms of effectiveness in achieving abstinence in pregnancy. A further objective was to assess the womens perceptions of the alcohol counseling. Design. Cohort study. Setting. Antenatal care center in a provincial Swedish university town. Population. Women who received alcohol counseling; 1533 in cohort 1 (routine counseling) and 1476 in cohort 2 (expanded model). Approximately 93% of all pregnant women in Linkoping are registered at this center. Methods. Data were collected by means of an anonymous questionnaire. Thirteen questions in the questionnaire were analysed for this study. Main outcome measures. Replies from three questions concerning pre-pregnancy drinking and three questions on drinking during pregnancy. Results. The response rate was 60% for cohort 1 and 64% for cohort 2. Perceptions of the advice from the antenatal care center were generally favorable. Similar proportions of women, approximately 6%, in both cohorts drank at least once during the pregnancy (after pregnancy recognition). There were four predictors for drinking during pregnancy: older age; having previously given birth to a child; frequency of pre-pregnancy drinking; and perceiving the message from antenatal care as small amounts of alcohol during pregnancy dont matter.Conclusions. An expanded counseling model implemented in Swedish antenatal care did not reduce the proportion of women who continued drinking during pregnancy in comparison with a previous counseling model, although the advice provided in the new model was perceived more favorably.

  • 43.
    Skagerström, Janna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Asking about alcohol consumption during pregnancy: how prevalence rate is affected by the formulation of the questionManuscript (preprint) (Other academic)
    Abstract [en]

    Studies of alcohol consumption during pregnancy in Sweden have reported prevalence rates from 6% to 30%. The reason for these differences is unknown. The aim of this study was to compare how alcohol consumption is reported by pregnant women when asked explicitly to report drinking after pregnancy recognition compared with asking about drinking during pregnancy without stating if the time before pregnancy recognition should be included. Data were collected from two groups of women. The women in group A were asked to estimate their alcohol consumption during pregnancy and the women in group B were asked to estimate their alcohol consumption during pregnancy, after pregnancy recognition. There was a significant difference in the reported prevalence rate between the cohorts: 9.3% in cohort A (n=1041) and 6.8% in cohort B (n=933). The results from this study may explain some of the variations in previously reported prevalence rates. To be able to compare different studies, it is important to be clear about the methodological aspects.

  • 44.
    Svenvik, Maria
    et al.
    Kalmar County Hospital, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Kalmar County Hospital, Sweden.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Preterm Birth: A Prominent Risk Factor for Low Apgar Scores2015In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 978079Article in journal (Refereed)
    Abstract [en]

    Objective. To determine predictive risk factors for Apgar scores less than 7 at 5 minutes at two hospitals providing tertiary care and secondary care, respectively. Methods. A retrospective registry cohort study of 21126 births (2006-2010) using data from digital medical records. Risk factors were analyzed by logistic regression analyses. Results. AS(5min) less than 7 was multivariately associated with the following: preterm birth; gestational week 32 + 0-36 + 6, OR = 3.9 (95% CI 2.9-5.3); week 28 + 0-31 + 6, OR = 8 (5-12); week less than 28 + 0, OR = 15 (8-29); postterm birth, OR = 2.0 (1.7-2.3); multiple pregnancy, OR = 3.53 (1.79-6.96); previous cesarean section, OR = 3.67 (2.31-5.81); BMI 25-29, OR = 1.30 (1.09-1.55); BMI greater than= 30 OR = 1.70 (1.20-2.41); nonnormal CTG at admission, OR = 1.98 (1.48-2.66). greater than= 1-para was associated with a decreased risk for AS(5min) less than 7, OR = 0.34 (0.25-0.47). In the univariate logistic regression analysis AS(5min) less than 7 was associated with tertiary level care, OR = 1.48 (1.17-1.87); however, in the multivariate analysis there was no significant difference. Conclusion. A number of partially preventable risk factors were identified, preterm birth being the most evident. Further, no significant difference between the two hospital levels regarding the risk for low Apgar scores was detected.

  • 45.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Palmquist, Sofie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Angerbjörn, Louise
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Effects of continuous midwifery labour support for women with severe fear of childbirth2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 115Article in journal (Refereed)
    Abstract [en]

    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.

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