Pregnancy In Sweden Research Articles

The Impact of Small for Gestational Age Births in Early and Late Preeclamptic Pregnancies for Preeclampsia Recurrence: a Cohort Study of Successive Pregnancies in Sweden.

Results from uterine artery Doppler investigations suggest that the aetiology of late preeclampsia with fetal growth restriction may be more similar to the aetiology of early preeclampsia than with late preeclampsia without fetal growth restriction. We hypothesised that a small-for-gestational-age (SGA) birth in a late preeclamptic pregnancy may be associated with increased subsequent risk of early preeclampsia. We also studied effects of maternal factors on risks of preeclampsia recurrence. In a nation-wide Swedish cohort study of first and second consecutive single births between 1992 and 2012, we identified 22 473 mothers with preeclampsia in their first pregnancy. We calculated relative risks (RR), and 95% confidence intervals (CI), to investigate associations between subtypes of preeclampsia in the first pregnancy and risks of early (<34weeks) and late (≥34weeks) preeclampsia in the second pregnancy. In women with a previous late preeclampsia, a co-occurring SGA birth was associated with an increased risk of subsequent early preeclampsia (adjusted RR 2.85, 95% CI 1.93, 4.20), but not of subsequent late preeclampsia. Among women with a previous early preeclampsia, a co-occurring SGA birth was not associated with increased subsequent risks of early or late preeclampsia. Interpregnancy weight gain was associated with increased risks of early and late preeclampsia in the second pregnancy. Late preeclampsia combined with fetal growth restriction may be regarded as an ischaemic placental disease. Given the high absolute risk of preeclampsia recurrence, preventing weight gain may be especially important in women with previous preeclampsia.

High weight gain during pregnancy increases the risk for emergency caesarean section – Population-based data from the Swedish Maternal Health Care Register 2011–2012

ObjectiveThe aim was to investigate maternal background factors' significance in relation to risk of elective and emergency caesarean sections (CS) in Sweden. Study designPopulation-based, retrospective, cross-sectional study. The Swedish Maternal Health Care Register (MHCR) is a national quality register that collects data on pregnancy, delivery and postpartum period. All women registered in MHCR 2011 to 2012 were included in the study sample (N = 178,716). Main outcomesThe risk of elective and emergency caesarean section in relation to age, parity, education, country of origin, weight in early pregnancy and weight gain during pregnancy was calculated in logistic regression models. ResultsMultiparous women demonstrated a doubled risk of elective CS compared to primiparous women, but their risk for emergency CS was halved. Overweight and obesity at enrolment in antenatal care increased the risk for emergency CS, irrespective of parity. Weight gain above recommended international levels (Institute of Medicine, IOM) during pregnancy increased the risk for emergency CS for women with normal weight, overweight or obesity. ConclusionThere is a need of national guidelines on recommended weight gain during pregnancy in Sweden. We suggest that the usefulness of the IOM guidelines for weight gain during pregnancy should be evaluated in the Swedish context.

Trends in diabetes in pregnancy in Sweden 1998–2012

ObjectiveDiabetes in pregnancy has been shown to increase in parallel with the increasing prevalence of obesity. In this national population-based study, we analyzed the trends for gestational diabetes mellitus (GDM),...

Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden.

To investigate how the first trimester risk evaluation for Down syndrome is offered and performed. Sweden. All 52 known units working with obstetric ultrasound. Study-specific questionnaire and descriptive statistical analyses. Routines for offering combined ultrasound and biochemistry (CUB), questions about information, questions about tests and analysis used for diagnosis. CUB was performed in 28600 (26%) of the expected 110000 pregnancies in Sweden during 2011. Of all pregnant women, 15% were living in a county not offering CUB (only invasive prenatal diagnosis); 44% regardless of age; 15% to women ≥33years; 24% to women ≥35years; and 2% to women ≥38years old. Amniocentesis was the most common method offered when the risk was estimated as high. Of the 47 units that replied, 29 (61.7%) offered only amniocentesis. On the questions about information, 40 (95.2%) stated that they gave verbal information. In addition to verbal information, 17 (40.5%) gave written information. Forty-one of the units (71.9%) stated that the CUB is offered to non-Swedish-speaking women. Without consistent national guidelines, the prenatal diagnostic CUB method is offered in an inequitable manner to pregnant women in Sweden. More than half of all pregnant women live in a county where CUB is not offered or is only offered based on age. The results demonstrate the importance of national consistency before the introduction of new prenatal tests, to enhance equal care for all pregnant women.

Cold ambient temperature in utero and birth outcomes in Uppsala, Sweden, 1915–1929

PurposeAlthough the literature reports adverse birth outcomes following ambient heat, less work focuses on cold. We, moreover, know of no studies of cold that examine stillbirth. We tested the relation between cold ambient temperature during pregnancy in Sweden and four outcomes: stillbirth, preterm, birth weight for gestational age, and birth length. We examined births from 1915 to 1929 in Uppsala, Sweden, which—unlike most societies today—experienced substandard indoor-heating and fewer amenities to provide shelter from cold. MethodsWe retrieved data on almost 14,000 deliveries from the Uppsala Birth Cohort Study. We linked a validated, daily ambient temperature series to all pregnancies and applied Cox proportional hazards (stillbirth and preterm) and linear regression models (birth weight and length). We tested for nonlinearity using quadratic splines. ResultsThe risk of stillbirth rose as ambient temperature during pregnancy fell (hazard ratio for a 1°C decrease in temperature, 1.08; 95% confidence interval, 1.00 to 1.17). Cold extremes adversely affected preterm and birth length, whereas warm extremes increased preterm risk. We observed no relation between cold and birth weight for gestational age. ConclusionIn historical Sweden, cold temperatures during pregnancy increased stillbirth and preterm risk and reduced birth length among live births.

Smoking during pregnancy among immigrants to Sweden, 1992-2008: the effects of secular trends and time since migration

Smoking during pregnancy has been declining in the past decades in high-income countries, including Sweden. Paradoxically, increasing trends associated with duration of residence have been reported among immigrants. We aimed to clarify how these two contrasting trends have shaped smoking patterns among immigrants. We conducted a population-based study of 1 598 433 pregnancies in Sweden in the period 1992-2008. We used multinomial logistic regression to estimate the odds of mild and heavy smoking relative to no smoking associated with year of delivery, years since migration, maternal region of birth and their interaction, after controlling for potential confounders. The prevalence of smoking decreased for the Swedish-born and for immigrants during the study period. Among immigrants, duration of residence was independently associated with increases in smoking and varied according to maternal region of birth (P-value for interaction <0.001). The odds ratio associated with a 10-year increase in duration of residence was weakest for mild smoking among former Yugoslav women (adjusted odds ratio; 95% confidence interval: 1.10; 1.04-1.17) and those from other Nordic countries (1.22; 1.17-1.26) and strongest for heavy smoking among East African (4.46; 3.23-6.16) and sub-Saharan African (3.56; 2.68-4.72) women. The association between duration of residence and smoking was attenuated after stratifying by cohorts of arrival among European but not among non-European immigrants. Declines in smoking during pregnancy among immigrants from various regions of the world were differentially affected by opposite increasing trends throughout their residence in Sweden.

Risk of obstetric anal sphincter lacerations among obese women

To assess the risk for obstetric anal sphincter lacerations in relation to maternal obesity among primiparous women in Sweden. A population-based study. Sweden. All women with vaginal delivery and singleton pregnancy in Sweden in the years 2003-2008 (n = 210,678). The Medical Birth Registry, the National Board of Health and Welfare, was used to identify cases of rupture and body mass index (BMI) classes. The population was categorised into four classes with BMI of <25, 25 to <30, 30 to <35 and >35 kg/m². Odds ratios were estimated with 95% confidence intervals. In order to estimate the effect of BMI on obstetric anal sphincter lacerations, with possible confounders accounted for, uni- and multivariate logistic regressions were performed. In total, 8958 (4.25%) cases of anal sphincter lacerations (grade III-IV) occurred; increasing BMI showed a significant near-dose-response type of protective effect against grade III-IV lacerations when compared with women with BMI <25 kg/m²: BMI 25 to <30 kg/m², 0.89; BMI 30 to <35 kg/m², 0.84; BMI > 35 kg/m², 0.70. Overweight and obesity were associated with a decreased risk for obstetric anal sphincter lacerations.

Preventing anxiety: a qualitative study of fish consumption and pregnancy

Starting from theories of anxiety as social practice, this article explores the contested landscape of health, risks associated with fish consumption and pregnancy in Sweden, and the way risk communicators and pregnant women navigate this landscape. This article argues that the risk analysis by the Swedish National Food Administration is a good example of the practices of definition and annihilation of subjects and objects of anxiety. It shows that the creation of anxious subjects is counteracted by two means in the brochures and on the website of the National Food Administration (NFA): by placing information about pregnancy and fish within a risk discourse, and by liberal governance. This article concludes that, although pregnant women manage and control anxiety during pregnancy by several practices, this strategy by the NFA does not make them feel safe and secure, which is the basic duty of the NFA, but rather bolsters their feeling that you cannot ever feel safe, you always have to anticipate that something bad might happen.

Drug use during pregnancy in Sweden &amp;ndash; assessed by the Prescribed Drug Register and the Medical Birth Register

Purpose:The purpose of this research is to study drug use during pregnancy in Sweden and agreement between use according to antenatal medical records and dispensed drugs from a pharmacy database.Patients and methods:From the Swedish Medical Birth Register (MBR), we established a population-based cohort of 102,995 women who gave birth in 2007. Using the unique personal registration number, information on dispensed drugs from the Prescribed Drug Register (PDR) was obtained prior to, during, and after the pregnancies and compared with MBR information on drug use from standardized antenatal medical records.Results:According to the PDR, 57.6% of the 102,995 women filled a prescription with at least one drug during pregnancy and 50.9% during the lactating period (until 3 months after delivery). The most dispensed drugs during pregnancy were B-lactam antibacterials and penicillins. Agreement between drugs recorded in antenatal medical records and dispensed drugs was highest for drugs used for chronic conditions. The agreement was particularly high for thyroid therapy (85.3%), anti-intestinal inflammatory drugs (80.3%), antiepileptics (69.2%), immunosuppressants (67.4%), and insulin (63.8%). Agreement for drugs used for occasional use was generally lower, ranging between 42.5% for antihistamines and 0.8% for gynecological anti-infectives.Conclusions:A large proportion of women filled a prescription during pregnancy or the lactating period. Agreement between drug use in medical antenatal records and register information from a national pharmacy database was high for drugs used for chronic conditions but low for occasional use. For occasionally used drugs, medical record and register-based data may provide incomplete exposure information because of nonreporting or noncompliance.

Are time-trends of smoking among pregnant immigrant women in Sweden determined by cultural or socioeconomic factors?

BackgroundThe widening socioeconomic gap in smoking during pregnancy remains a challenge to the Swedish antenatal care services. However, the influence of cultural factors in explaining the socioeconomic differences in smoking during pregnancy is not clear among the immigrant women. The aim of this study was to investigate whether the development of smoking prevalence among pregnant immigrant women in Sweden followed the trajectory which could be expected from the stages of the global smoking epidemic model in the women's countries of origin, or not.MethodsDelivery data on pregnancies in Sweden from 1982 to 2001 was collected from the Swedish Medical Birth Registry. From a total of 2,224,469 pregnant women during this period, all immigrant pregnant women (n = 234,731) were selected to this study. A logistic regression analysis and attributable fraction were used to investigate the association between smoking during pregnancy and the socioeconomic differences among immigrant women.ResultsOverall, the prevalence of smoking among pregnant immigrant women decreased from 30.3% in 1982 to 11.0% in 2001, albeit with remarkable differences between educational levels and country of origin. The greatest decline of absolute prevalence was recorded among low educated women (27,9%) and among other Nordic countries (17,9%). In relative terms, smoking inequalities increased between educational levels regardless of country of origin. The odds ratios for low educational level for women from other Nordic countries increased from 4.9 (95% CI 4.4-5.4) in 1982 to 13.4 (95% CI 11.2-16.2) in 2001, as compared to women with high education in the same group. Further, the total attributable fraction for educational difference increased from 55% in 1982 to 62% in 2001, demonstrating the strong effect of educational attainment.ConclusionsOur hypothesis that the socioeconomic time trend of smoking based on the stage of the world wide tobacco epidemic model related to country of origin of the immigrant women was not supported by our analyses. Our findings does not support a call for specific "culture sensitive" antismoking policies or interventions in Sweden or similar countries, but reinforce the existing evidence with a focus on women with a low educational level, regardless of cultural background.

Aortic dissection in pregnancy: A life‐threatening disease and a diagnosis of worth considering

Acute aortic dissection is a life-threatening disease. To increase the awareness of this diagnosis as a cause of feto-maternal mortality during pregnancy, we have analyzed risk factors using information from five pregnant women admitted for acute aortic dissection to the Karolinska University Hospital over an eight-year period (1999-2007). Four of the women died and only one survived. One fetus was stillborn and all newborn infants showed signs of asphyxia at birth. Of the women, who were on average five years above the mean age for delivery in Sweden, three had hypertension, two had first-degree relatives with aortic dissection which had occurred during the second half of pregnancy (gestational age at diagnosis 26-41 weeks). The most common presenting symptoms were severe back, abdominal and leg pain, and confusion. If a rapid diagnosis is not made, the risk of mortality for both mother and fetus is high. The incidence of aortic rupture during pregnancy in Sweden appears to be 14.5/1,000,000 and the case maternal fatality ratio 4.4/1,000,000.

Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies

OBJECTIVETo perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies and the general obstetric population in Sweden between 1991 and 2003.RESEARCH DESIGN AND METHODSThis was a population-based study. Data were obtained from the Medical Birth Registry, covering >98% of all pregnancies in Sweden. A total of 5,089 type 1 diabetic pregnancies and 1,260,207 control pregnancies were included. Odds ratios (ORs) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits, and ethnicity.RESULTSIn type 1 diabetes, preeclampsia was significantly more frequent (OR 4.47 [3.77–5.31]) as was delivery by cesarean section (5.31 [4.97–5.69]) compared with results for the general population. Stillbirth (3.34 [2.46–4.55]), perinatal mortality (3.29 [2.50–4.33]), and major malformations (2.50 [2.13–2.94]) were more common in type 1 diabetic than in control pregnancies. The risk of very preterm birth (<32 gestational weeks) was also higher among type 1 diabetic women (3.08 [2.45–3.87]). The incidence of fetal macrosomia (birth weight ≥2 SD above the mean) was increased in the diabetic group (11.45 [10.61–12.36]).CONCLUSIONSType 1 diabetes in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The eightfold increased risk for fetal macrosomia in type 1 diabetic pregnancies is unexpected and warrants further investigation.

Women's fear of childbirth and preference for cesarean section – a cross‐sectional study at various stages of pregnancy in Sweden

To investigate Swedish women's level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. A cross-sectional study. All antenatal clinics in four geographical areas. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September-October 2006. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). The level of fear of childbirth and preferred mode of delivery. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score > or =85) was 15.8% and very intense fear (tocophobia) (W-DEQ score > or =100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1-22.59 for nulliparous and OR 8.32, 4.36-15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55-35.97), or an instrumental vaginal delivery (OR 2.34, 1.02-5.34). The level of fear of childbirth was not associated with the gestational age. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

Hypospadias and Intake of Nutrients Related to One-Carbon Metabolism

We examined whether hypospadias is associated with maternal intake of folic acid containing vitamin/mineral supplements or dietary intake of nutrients related to one-carbon metabolism (folate, choline, vitamins B12 and B6, thiamine, riboflavin, methionine and zinc). The study included births from October 1997 to December 2003 that were part of the National Birth Defects Prevention Study. Diet was assessed by food frequency questionnaire during maternal telephone interviews. Analyses included 915 cases with second or third degree hypospadias (urethra opened at the penile shaft, scrotum or perineum) and 2,266 male, liveborn, nonmalformed controls. All ORs and 95% CIs were estimated from logistic regression models that included several potential confounders. Nutrient based analyses also included energy intake. Hypospadias risk was not associated with supplement use (adjusted ORs were 1.2, 95% CI 0.9-1.6 for intake beginning in the month before or the first month of pregnancy and 1.1, 95% CI 0.8-1.4 for intake beginning in the second or third month, relative to no intake). Among women who took supplements reduced hypospadias risk was associated with higher dietary intakes of choline, methionine and vitamin B12. The respective ORs (CIs) for the highest vs lowest quartiles were 0.7 (0.5-1.1), 0.6 (0.4-0.9) and 0.7 (0.5-1.0). Among women who did not take supplements increased risk of hypospadias was associated with higher vitamin B12 intake. The OR (CI) for the highest vs lowest quartile was 3.1 (1.1-9.0). This study suggests an association of hypospadias with intake of certain nutrients related to one-carbon metabolism.

Socioeconomic differences in smoking trends among pregnant women at first antenatal visit in Sweden 1982–2001: increasing importance of educational level for the total burden of smoking

Background:There was a decrease in smoking during early pregnancy in Swedish women between 1982 and 2001. We sought to determine whether there was a parallel decrease in socioeconomic inequality in...

Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

BJOG: An International Journal of Obstetrics & GynaecologyVolume 115, Issue 3 p. 415-415 Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden C Spencer, C Spencer Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this authorP Robarts, P Robarts Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this author C Spencer, C Spencer Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this authorP Robarts, P Robarts Department of Obstetrics and Gynaecology, St John’s Hospital, Chelmsford, Essex, UKSearch for more papers by this author First published: 08 January 2008 https://doi.org/10.1111/j.1471-0528.2007.01617.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume115, Issue3February 2008Pages 415-415 RelatedInformation

Author response to: Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

Author response to: Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

Congenital malformations in infants whose mothers reported the use of folic acid in early pregnancy in Sweden. A prospective population study

The use of folic acid prior to conception is generally recommended for the prevention of birth defects, notably neural tube defects. In a previous study from Sweden, based on interviews of women in early pregnancy, no such effect was found on the general malformation rate, but data for neural tube defects were scarce. Using data from the Swedish Medical Birth Register for the years 1995-2004, 20 891 women were identified who reported the use of folic acid in early pregnancy, but not of anticonvulsants. These women were compared to all other women who gave birth during the study period. Malformations in the infants born were identified from multiple sources. No reduction in the general malformation rate was seen among infants born to women who reported the use of folic acid (OR = 1.09, 95% CI 1.02-1.17) and no effect of neural tube defect rate was seen (RR = 1.35, 95% CI 0.82-2.22), based on 16 infants with neural tube defect whose mother reported the use of folic acid. No effect was seen on the rates of other malformations except for cardiac defects, where a statistically significant increased risk (notably for severe defects) was found (OR = 1.19, 95% CI 1.05-1.35). The effect of various deficiencies in data collection is discussed, but is unlikely to explain the lack of protective effect noticed. So far, it has not been possible to demonstrate a beneficial effect of folic acid supplementation on malformation risk in Sweden. A more complete ascertainment and detailed timing and dosage of folic acid use in a prospective study is recommended.

Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population‐based study of successive pregnancies in Sweden

Uterine rupture is a rare but a catastrophic event. The aim of the present study was to explore the risk factors for uterine rupture and associated neonatal morbidity and mortality among a cohort of Swedish women attempting vaginal birth in their second delivery. Population-based cohort study. Sweden. A total of 300,200 Swedish women delivering two single consecutive births between 1983 and 2001. Swedish population-based registers were used to obtain information concerning demographics, pregnancy and birth characteristics, and neonatal outcomes. Logistic regression was used to analyse potential risk factors for uterine rupture and risk of neonatal mortality associated with uterine rupture. Odds ratios were used to estimate relative risks using 95% CI. Uterine rupture and neonatal mortality in the second pregnancy. Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73-57.00). Induction of labour, high (> or = 4000 g) birthweight, postterm (> or = 42 weeks) births, high (> or = 35 years) maternal age, and short (< or = 164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60-132.08). The risk of uterine rupture in subsequent deliveries is not only markedly increased among women with a previous caesarean delivery but also influenced by induction of labour, birthweight, gestational age, and maternal characteristics.

Obstetric Outcome of 6346 Pregnancies With Infants Affected by Congenital Heart Defects

This prospective, population-based, cohort study analyzed 6346 singleton pregnancies in Sweden during the years 1992 to 2001 in which the infant had a congenital heart defect. The prevalence of cardiovascular defects in the study population, totaling 770,355 infants, was 9.1 per 1000 births. Cases with known chromosomal abnormalities or preexisting maternal diabetes were excluded. An isolated cardiovascular defect was present in 84% of infants, and in 22%, it was severe. Case mothers did not differ substantially from control subjects with regard to age, parity, or smoking in early pregnancy. Obesity was more frequent in the case group; the crude odds ratio for having a body mass index of 25 kg/m2 or higher was 1.08 (95% confidence interval, 1.02–1.13). Cesarean delivery occurred more often in the case group, especially in cases with severe cardiac defects. The risk of instrumental delivery also was increased, but only when all cardiac defects were considered. In term infants, labor induction was significantly more frequent in the case group (odds ratio [OR], 1.12; 1.02–1.22), and the risk of preterm delivery was increased 2- to 3-fold. Infants with cardiac defects—especially severe ones—had lower birth weights than expected and were significantly more likely to be small for gestational age (OR, 2.46; 1.98–3.05). Those with milder defects, however, were likelier to be large-for-gestational-age infants (OR, 1.45; 1.28–1.64). Severe cardiac defects occurred in 26% of preterm infants compared with 21% of term infants (P < .001). Fetal distress, meconium aspiration, and low Apgar scores all were significantly more frequent in infants with cardiac defects. The incidence of preeclampsia was higher in case pregnancies (OR, 1.21; 1.06–1.37), but the incidence of stillbirth was the same in cases and control subjects. In this large-scale, population-based study, several obstetric and neonatal complications were more frequent when a fetal heart defect was present. A search for congenital cardiac defects is appropriate in neonates who had complicated pregnancies.