Understanding pregnant women's health literacy strengths and challenges: a cluster-based exploration in the Health Literacy in Pregnancy (HeLP) study.

The aim of this study was to describe prescription use of acetaminophen, a widely used analgesic and antipyretic generally considered safe during pregnancy, among pregnant women from 2000 to 2023 in Denmark with special attention towards variations following the change in over-the-counter (OTC) availability in 2013. In this population-based drug utilization study, individually linked data from nationwide health registries on pregnant women in Denmark between 2000 and 2023 were used to evaluate time trends on prescription use of acetaminophen and describe distributions of maternal characteristics among prescription-based drug users and non-users. Among 1 446 841 eligible pregnancies included, 27 per 1000 pregnant women redeemed at least one prescription for acetaminophen during pregnancy, and among these, 18% redeemed more than one. In 2023, 74 per 1000 pregnancies were exposed to prescription use of acetaminophen. Relative to non-users, prescription-based drug users were generally older and had a higher body mass index. They more frequently presented with pain-related, chronic or psychiatric conditions and used other prescription medications throughout the study period. However, these differences were less pronounced in the cohort restricted to pregnancies ending in 2015-2023 compared to 2000-2012. Prescription use of acetaminophen in the pregnant population in Denmark has increased since 2000, with a notable sharp increase from 2013 onwards, coinciding with the regulatory restriction that reduced over-the-counter pack sizes, alongside a concurrent rise in general-population prescription use. Prescription-based drug users were more likely to have comorbidities and multiple medication use than non-users, although these differences have become less pronounced in recent years.

ABSTRACTWe evaluated trends in antidepressant use among pregnant women in Denmark from 2001 to 2023, comparing them with a matched comparison group from the general population. Data from the Danish Health Data Authority were used to assess annual antidepressant prescription redemption rates per 1000 pregnancies, with a focus on total antidepressant use, selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs). Antidepressant use among pregnant women increased fivefold in the study period. In the comparison group, use increased 2.3‐fold. After a decline following 2011, antidepressant use among pregnant women began to rise again in 2019, driven primarily by sertraline, which accounted for 76% of prescription redemptions in 2023. Other drugs such as escitalopram, duloxetine, mirtazapine and amitriptyline showed modest increases, while the use of most other antidepressants declined or stabilized. This upward trend likely reflects the influence of updated clinical guidelines and greater clinical acceptance of antidepressant use during pregnancy. Our findings emphasize how prescribing practices are sensitive to shifts in public discourse and guideline revisions, highlighting the importance of ongoing pharmacovigilance in managing maternal mental health.

Extensive exposure to di-n-hexyl phthalate with significant seasonal variation across infants, children and adults including pregnant women in Denmark.

The ambivalence of abortion: An explorative study on attitudes towards elective abortion and abortion limits among pregnant women in Denmark.

Placental dysfunction is important to recognize, and more evidence is needed on the dynamics of the placental biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), in early pregnancy. This study aimed to establish reference intervals for placental biomarkers in early pregnancy. This was a retrospective cohort study of pregnant women (n = 702) in the North Denmark Region, 2013, who had blood samples drawn in early pregnancy including measurements of sFlt-1 and PlGF (Kryptor Compact, Thermofisher Scientific). Reference intervals were established, and the association between sFlt-1 and PlGF and maternal characteristics (age, body mass index [BMI], country of birth, and smoking in pregnancy) was evaluated using linear regression analyses and reported as adjusted beta coefficient (aβ) with 95% confidence intervals (CIs). The placental biomarkers showed a dynamic trend with higher levels for increasing week of pregnancy; however, sFlt-1 reached a plateau around week 10 of pregnancy. Higher maternal age associated with higher sFlt-1 and PlGF (sFlt-1: aβ 1.02 [95% CI, 1.01-1.03], PlGF: aβ 1.02 [95% CI, 1.01-1.03]), and higher maternal BMI associated with lower sFlt-1 (aβ 0.97 [95% CI, 0.96-0.98]). Furthermore, the level of PlGF was higher among women born outside of Denmark (aβ 1.17 [95% CI, 1.03-1.34]) compared to women born in Denmark and among smokers (aβ 1.56 [95% CI, 1.38-1.78]) compared to nonsmokers. In a large cohort of pregnant women in Denmark, levels of sFlt-1 and PlGF increased during early pregnancy and were influenced by a series of maternal characteristics.

ABSTRACTAcetaminophen is the most used analgetic drug for pain management during pregnancy. A recent academic controversy concerns the safety of acetaminophen during pregnancy related to a potentially increased risk of adverse neurodevelopmental effects. We investigated the population‐level trends in prescription‐based use of acetaminophen among pregnant women in Denmark between 2001 and 2023. Prescription‐based sals of acetaminophen among pregnant women and comparison groups were retrieved from ‘eSundhed’, a publicly available dataset curated by the Danish Health Authorities. The number of prescription‐based drug users per 1000 pregnant women increased slightly from 2001 to 2012 (3.9 to 6.5 per 1000) and 2015 to 2023 (52 to 76 per 1000), interrupted by a drastic increase in 2013/2014. Acetaminophen use among pregnant women (2023: 76 per 1000) was lower than in women in an age‐matched comparison group (137 per 1000) and in women 12–3 months prior to pregnancy (124 per 1000). Time trends did not notably differ between age groups or comparison groups. Prescription‐based acetaminophen sales among pregnant women increased by 50% from 2015 to 2023. A general shift in the prescription pattern towards a substantial increase in prescription‐based exposure was observed following legislation changes in 2013, restricting sales of large packages to prescription.

All pregnant women in Denmark are offered a first-trimester ultrasound screening examination between 11 and 14 weeks of gestation. Additionally, women are offered a risk assessment for foetal chromosomal abnormalities. The main results in this review are that more than 90% of pregnant women attend the first-trimester screening, and of those, 5% receive a high-risk screening result for trisomy 21. The first-trimester screening detects more than 90% of trisomy 21 cases and a large proportion of severe structural malformations. The Danish Fetal Medicine Database (DFMD) was established in 2008-2010. DFMD is a national clinical research and quality database.

The prevalence of vegetarian and vegan diets among pregnant women in Denmark is rising. This paper reviews the maternal and neonatal outcomes associated with such diets, highlighting considerations for supplementation and potential risks, including B12-vitamin deficiency. Recommendations include early dietary assessment, B12-supplementation, and monitoring of key nutrients such as protein and iron. Despite potential challenges, with proper guidance and supplementation, vegetarian and vegan diets can be compatible with a healthy pregnancy and sufficient lactation.

ObjectivesThe objective was to investigate if high physical workload during pregnancy is associated with adverse pregnancy outcomes.MethodsThe register-based cohort, DOC*X-Generation included employed pregnant women in Denmark (1977–2018). A summary score...

BackgroundIn 2021, 15% of pregnant women in Denmark had a Body Mass Index (BMI) of 30 kg/m2 or more, which is associated with complications for both mothers and children. Healthcare professionals often feel insecure when discussing weight with pregnant women with high body weight, and people with high body weight are exposed to stigmatisation. To counter this, different tools have been developed to support respectful weight-related conversations, often recommending asking permission to talk about weight. This study explored the experiences of both pregnant women living with a BMI equally or above 30 kg/m2 and midwives when asking for permission to discuss weight during the initial midwife consultation.MethodsWe observed nine midwifery consultations and, by way of purposive sampling, interviewed six pregnant women with high body weight, while nine midwives participated in two focus group interviews. A hermeneutic-phenomenological approach by Max van Manen was applied for the analysis.ResultsWe identified three themes in this study. “Addressing weight triggers risk and ambivalence”, which explores the lived experiences of pregnant women, their personal history with their body weight and midwives’ hesitancy to initiate weight-related conversations with pregnant women who have a high body weight. “Asking for permission - for whose sake?” highlights the experiences of asking permission among midwives and that pregnant women with a high body weight did not perceive the question as an opportunity to decrease weight-related conversations. “Weight conversation – a cue to feel wrong and guilty or to feel recognised as an individual?” emphasising that trust and shared decision-making are crucial factors for a relevant weight-related conversation but also that the conversation might trigger feelings such as guilt and self-doubt.ConclusionPregnant women with high body weight had a long history with their body weight that affected all aspects of their lifeworld and influenced weight-related conversations in the midwifery consultation. Some midwives hesitated to address weight, but seeking permission eased this challenge. Despite the midwife asking for permission, some of the pregnant women felt uneasy during the conversation, leaving them with a feeling of self-doubt. Relevant conversations occurred when women engaged in decision-making and trusted the midwife.

IntroductionIntimate partner violence against women is a global health issue. Exposure to intimate partner violence during pregnancy leads to health‐related problems for both the mother and the newborn. However, current knowledge on its occurrence varies widely and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital screening tools.Material and MethodsA cross‐sectional design was used to systematically screen for intimate partner violence among pregnant women attending antenatal care by using standardized digital screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen.ResultsA total of 17 220 pregnant women in Denmark and 2222 pregnant women in Spain were invited to participate. The response rate was high in both countries (77.3% and 92.5%, respectively). Overall, 6.9% (n = 913) and 13.7% (n = 282) screened positive in Denmark and Spain, respectively. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and intimate partner violence. In both countries, being unmarried and lacking social support were risk factors of intimate partner violence. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, not having a partner at the time of questionnaire completion and having at least one child prior to the current pregnancy were risk factors of intimate partner violence.ConclusionsPrevalence results and found associated factors contribute to a more comprehensive understanding of the occurrence of intimate partner violence during pregnancy in Denmark and Spain, while highlighting the feasibility of digital systematic screening in antenatal settings.

The Danish national haemoglobinopathy screening programme offers screening to at-risk pregnant women. Despite efforts to increase awareness of the screening programme, most women in the target population remain unscreened. In contrast,>90% of pregnant women in Denmark attend a screening for chromosomal abnormalities by combined first-trimester screening (cFTS). This study aimed to improve adherence to the Danish national haemoglobinopathy screening programme by offering screening to at-risk unscreened pregnant women in relation to their cFTS. During a 27-week intervention period, 3254 women attended cFTS at Copenhagen University Hospital-Amager Hvidovre Hospital. Of these, 938 women (28.8%) were identified as at risk of carrying haemoglobinopathy variants based on their ethnic origins. Of the 938 women at risk, 539 (57.5%) were unscreened prior to their cFTS and were targeted for the intervention. These women were contacted with an offer of haemoglobinopathy screening. Subsequently, 253/539 (46.9%) of the at-risk unscreened women were tested for haemoglobinopathies, of these 4/253 (1.6%) carried haemoglobinopathy variants necessitating partner screening. No partners carried haemoglobinopathy variants necessitating testing of the fetus. The study increased the proportion of at-risk pregnant women tested for haemoglobinopathies from 42.5% to 69.5% and made haemoglobinopathy screening more readily available to women attending cFTS.

We examined the prevalence of lifetime physical and any recent violence and related maternal characteristics and health in pregnant women. We used Patient Reported Outcomes data retrieved from the Copenhagen Pregnancy Cohort (n = 7,361). The prevalence of lifetime physical and any recent violence was 4.0 % and 1.6 %, respectively. For both lifetime and any recent violence, the highest prevalence rates were seen among women aged 18–24, non-cohabiting, smokers, low levels of educational attainment, and women with chronic medical and psychiatric disease and lower psychological well-being. The prevalence may potentially be underestimated in this study, highlighting the need for improving screening for violence.

The aim of this cross-sectional questionnaire study was to investigate motivation to participate in a possible new screening for preeclampsia in the first trimester of pregnancy among Danish pregnant women through a questionnaire based on Theory of Planned Behavior developed for this specific purpose. The new screening combines maternal characteristics with mean arterial pressure, uterine artery pulsatility index and biochemical markers to predict the risk of preeclampsia, whereas the current Danish screening uses maternal characteristics alone. Participation was offered to a proportion of women attending a first or a second trimester screening scan at two University Hospitals in Copenhagen. The questionnaire was set up in REDCap® and answers were entered directly into the database, which was accessed via a QR-code. We invited 772 pregnant women to participate in the questionnaire survey between November 2021 and April 2022 at Copenhagen University Hospital Rigshospitalet (study site one) (n = 238) and Copenhagen University Hospital Hvidovre (study site two) (n = 534). The response rate was 71.8% (171/238) at study site one and 33.9% (181/534) at study site two. A total of 352 women were included in the study (total participation rate 45.6%). Most women had a positive attitude towards preeclampsia screening in pregnancy, and 99.4% said they would participate in a risk assessment for preeclampsia if given the opportunity. A total of 97.4% answered "yes" to whether a first trimester preeclampsia screening should be offered to all pregnant women in Denmark. Positive motivation to participate in preeclampsia screening was correlated with having a network with a positive attitude towards preeclampsia screening. The results of this study indicate that Danish pregnant women have a positive attitude towards participation in a first trimester screening for preeclampsia. This observation might be useful in relation to possible future implementation in Denmark.

Human exposure to lipophilic persistent organic pollutants (lipPOP) is ubiquitous and life-long, beginning during foetal development. Exposure to lipPOP elicits a number of species and tissue specific responses including dioxin-like activity which involve the activation of aryl hydrocarbon receptor (AhR). This study aims i) to describe the combined dioxin-like activity in serum from Danish pregnant women collected during 2011–2013; ii) to assess the association between maternal serum dioxin-like activity, gestational age at birth and foetal growth indices.The serum lipPOP fraction was extracted using Solid Phase Extraction and cleaned-up on Supelco multi-layer silica and florisil columns. The combined dioxin-like activity of the extract was determined using the AhR reporter gene bioassay, expressed as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) toxic equivalent (TEQ) [AhR-TEQ (pg/g lipid)]. The associations of AhR-TEQ and foetal growth indices (birth weight, birth length and head circumference) and gestational age were assessed by linear regression models.We detected AhR-TEQ in 93.9 % of maternal first trimester serum samples, with a median level of 185 pg/g lipid. Each ln-unit increase in AhR-TEQ was associated with an increase in birth weight of 36 g (95 % CI: 5; 68), birth length of 0.2 cm (95 % CI: 0.01; 0.3) and pregnancy duration of 1 day (95 % CI: 0; 1.5). In women who never smoked, higher AhR-TEQ values were associated with higher birth weight and longer duration of gestation, while in smokers the association was the opposite. Mediation analyses suggested that gestational age may mediate the association of AhR-TEQ with foetal growth indices.We conclude that AhR activating substances are present in the bloodstream of almost all pregnant women in Denmark and the AhR-TEQ level was around four times higher than previously reported. The AhR-TEQ was associated with slightly longer gestational duration and thereby higher birth weight and birth length.

BackgroundThe emergence of the COVID-19 pandemic and the derived changes in maternity care have created stress and anxiety among pregnant women in different parts of the world. In times of stress and crisis, spirituality, including spiritual and religious practices, may increase. ObjectiveTo describe if the COVID-19 pandemic influenced pregnant women's considerations and practises of existential meaning-making and to investigate such considerations and practices during the early pandemic in a large nationwide sample. MethodsWe used survey data from a nationwide cross-sectional study sent to all registered pregnant women in Denmark during April and May 2020. We used questions from four core items on prayer and meditation practices. ResultsA total of 30,995 women were invited, of whom 16,380 participated (53%). Among respondents, we found that 44% considered themselves believers, 29% confirmed a specific form of prayer, and 18% confirmed a specific form of meditation. In addition, most respondents (88%) reported that the COVID-19 pandemic had not influenced their responses. ConclusionIn a nationwide Danish cohort of pregnant women, existential meaning-making considerations and practices were not changed due to the COVID-19 pandemic. Nearly one in two study participants described themselves as believers, and many practised prayer and/or meditation.

Background Isolation was a consequence of the COVID-19 lockdowns, which led to increased incidence of intimate partner violence (IPV). During antenatal care, it is possible to screen pregnant women for IPV; this offers a unique opportunity for early intervention. During the pandemic, we designed and implemented a digital IPV intervention tailored to pregnant women in Denmark and Spain. Objective This study aimed to identify pregnant women exposed to IPV through digital screening and offer video counseling as well as a safety planning app to those who screened positive. Methods Pregnant women attending antenatal care were screened for IPV through a digital questionnaire. Women who screened positive were offered 6 video consultations with an IPV counselor and provided with access to a dedicated safety planning app. In-depth interviews inspired by the Model for Assessment of Telemedicine Applications were conducted with counselors and participants. The intervention was cocreated with women who have been exposed to IPV, nongovernmental organizations, and health care providers. Results Despite the COVID-19 shutdowns, more than 15,000 pregnant women have been screened for IPV since January 2021. Qualitative interviews with women who completed the intervention as well as IPV counselors show broad acceptance of the video counseling, particularly the ability to participate from a safe environment and talk to a stranger about sensitive and stigmatizing issues. Preliminary findings show that both women and counselors find the video counseling highly supportive, empowering, and aligned with the needs for safety. The majority indicate improved well-being after the intervention, and neither counselors nor participants see video counseling as a barrier toward talking about sensitive topics such as IPV. The safety app was not perceived as effective. Conclusions The preliminary results show that video counseling conducted during the COVID-19 pandemic supports pregnant women exposed to IPV and is highly feasible and accepted in both Denmark and Spain. Conflicts of Interest None declared.

369. Lifestyle habits among pregnant women in denmark during the first covid-19 lockdown compared with a historical period – a hospital-based cross-sectional study

BackgroundThe outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted (‘freebirth’) due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth.MethodsWe conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020.ResultsThe response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners’ attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41).ConclusionDanish pregnant womens’ concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.