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Wikström, Anna-KarinORCID iD iconorcid.org/0000-0001-6431-3303
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Publications (10 of 102) Show all publications
Skoglund, C., Kallner, H. K., Skalkidou, A., Wikström, A.-K., Lundin, C., Hesselman, S., . . . Sundström Poromaa, I. (2019). Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden. JAMA NETWORK OPEN, 2(10), Article ID e1912463.
Open this publication in new window or tab >>Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden
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2019 (English)In: JAMA NETWORK OPEN, ISSN 2574-3805, Vol. 2, no 10, article id e1912463Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) is associated with a plethora of adverse health outcomes throughout life. While Swedish specialized youth clinics have carefully and successfully targeted risk of unplanned pregnancies in adolescents, important risk groups, such as women and girls with ADHD, might not be identified or appropriately assisted by these interventions. OBJECTIVES To determine whether women and girls with ADHD are associated with increased risk of teenage birth compared with their unaffected peers and to examine the association of ADHD with risk factors for adverse obstetric and perinatal outcomes, such as smoking, underweight or overweight, and substance use disorder. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study included data from 6 national longitudinal population-based registries in Sweden. All nulliparous women and girls who gave birth in Sweden between January 1, 2007, and December 31, 2014, were included. Data analyses were conducted from October 7, 2018, to February 8, 2019. EXPOSURES Women and girls treated with stimulant or nonstimulant medication for ADHD (Anatomic Therapeutic Chemical classification code N06BA) in the Swedish Prescribed Drug Register between July 1, 2005, and December 31, 2014. MAIN OUTCOMES AND MEASURES Maternal age at birth. Secondary outcome measures were body mass index, smoking habits, and psychiatric comorbidities. RESULTS Among 384 103 nulliparous women and girls aged 12 to 50 years who gave birth between 2007 and 2014 included in the study, 6410 (1.7%) (mean [SD] age, 25.0 [5.5] years) were identified as having ADHD. The remaining 377 693 women and girls without ADHD (mean [SD] age, 28.5 [5.1] years) served as the control group. Teenage deliveries were more common among women and girls with ADHD than among women and girls without ADHD (15.3% vs 2.8%; odds ratio [OR], 6.23 [95% CI, 5.80-6.68]). Compared with women and girls without ADHD, those with ADHD were more likely to present with risk factors for adverse obstetric and perinatal outcomes, including smoking during the third trimester (OR, 6.88 [95% CI, 6.45-7.34]), body mass index less than 18.50 (OR, 1.29 [95% CI, 1.12-1.49]), body mass index more than 40.00 (OR, 2.01 [95% CI, 1.60-2.52]), and alcohol and substance use disorder (OR, 20.25 [95% CI, 18.74-21.88]). CONCLUSIONS AND RELEVANCE This study found that women and girls with ADHD were associated with an increased risk of giving birth as teenagers compared with their unaffected peers. The results suggest that standard of care for women and girls with ADHD should include active efforts to prevent teenage pregnancies.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2019
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-400016 (URN)10.1001/jamanetworkopen.2019.12463 (DOI)000497997100014 ()31577361 (PubMedID)
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2019-12-27Bibliographically approved
Fadl, H., Saeedi, M., Montgomery, S., Magnuson, A., Schwarcz, E., Berntorp, K., . . . Simmons, D. (2019). Changing diagnostic criteria for gestational diabetes in Sweden-a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol. BMC Pregnancy and Childbirth, 19(1), Article ID 398.
Open this publication in new window or tab >>Changing diagnostic criteria for gestational diabetes in Sweden-a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 398Article in journal (Refereed) Published
Abstract [en]

Background: The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden (www.cdc4g.se/en) is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches.

Methods: This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January–December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included.

Discussion: The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.

Trial registration: CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017)

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Gestational diabetes mellitus, Pregnancy outcomes, Diagnostic criteria, WHO 2013 criteria, Stepped wedge cluster randomised controlled trial, LGA, Health economics, Obesity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-397640 (URN)10.1186/s12884-019-2547-5 (DOI)000494447700004 ()31675922 (PubMedID)
Funder
Swedish Research Council, 2018-00470
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-11-22Bibliographically approved
Sandström, A., Snowden, J. M., Höijer, J., Bottai, M. & Wikström, A.-K. (2019). Clinical risk assessmentin early pregnancy for preeclampsia in nullipaarous women: a population-based cohort study. PLoS ONE, 14(11), Article ID e0225716.
Open this publication in new window or tab >>Clinical risk assessmentin early pregnancy for preeclampsia in nullipaarous women: a population-based cohort study
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2019 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 11, article id e0225716Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate the capacity of multivariable prediction of preeclampsia during pregnancy, based on detailed routinely collected early pregnancy data in nulliparous women.

Design and setting

A population-based cohort study of 62 562 pregnancies of nulliparous women with deliveries 2008–13 in the Stockholm-Gotland Counties in Sweden.

Methods

Maternal social, reproductive and medical history and medical examinations (including mean arterial pressure, proteinuria, hemoglobin and capillary glucose levels) routinely collected at the first visit in antenatal care, constitute the predictive variables. Predictive models for preeclampsia were created by three methods; logistic regression models using 1) pre-specified variables (similar to the Fetal Medicine Foundation model including maternal factors and mean arterial pressure), 2) backward selection starting from the full suite of variables, and 3) a Random forest model using the same candidate variables. The performance of the British National Institute for Health and Care Excellence (NICE) binary risk classification guidelines for preeclampsia was also evaluated. The outcome measures were diagnosis of preeclampsia with delivery <34, <37, and ≥37 weeks’ gestation.

Results

A total of 2 773 (4.4%) nulliparous women subsequently developed preeclampsia. The pre-specified variables model was superior the other two models, regarding prediction of preeclampsia with delivery <34 and <37 weeks, both with areas under the curve of 0.68, and sensitivity of 30.6% (95% CI 24.5–37.2) and 29.2% (95% CI 25.2–33.4) at a 10% false positive rate, respectively. The performance of these customizable multivariable models at the chosen false positive rate, was significantly better than the binary NICE-guidelines for preeclampsia with delivery <37 and ≥37 weeks’ gestation.

Conclusion

Multivariable models in early pregnancy had a modest performance, although providing advantages over the NICE-guidelines, in predicting preeclampsia in nulliparous women. Use of a machine learning algorithm (Random forest) did not result in superior prediction.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-404640 (URN)10.1371/journal.pone.0225716 (DOI)31774875 (PubMedID)
Available from: 2020-02-24 Created: 2020-02-24 Last updated: 2020-02-25Bibliographically approved
Ankarcrona, V., Altman, D., Wikström, A.-K., Jacobsson, B. & Wendel, S. B. (2019). Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study. Acta Obstetricia et Gynecologica Scandinavica, 98(9), 1195-1203
Open this publication in new window or tab >>Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 9, p. 1195-1203Article in journal (Refereed) Published
Abstract [en]

Introduction The number of women postponing childbirth until an advanced age is increasing. Our aim was to study the outcome of labor in nulliparous women >= 40 years, compared with women 25-29 years, after both spontaneous onset and induction of labor. Material and methods The nationwide population-based Swedish Medical Birth Register was used to study the perinatal outcome in nulliparous women with a singleton, term (gestational weeks 37-44), live fetus in cephalic presentation and a planned vaginal delivery from 1992 to 2011. We included 7796 nulliparous women >= 40 years and 264 262 nulliparous women 25-29 years. Prevalence and risk of intrapartum cesarean section, operative vaginal delivery, obstetric anal sphincter injury and a 5-minute Apgar score <7 were calculated for women >= 40 years stratified for spontaneous onset and induction of labor, using women 25-29 years as the reference in both strata. Crude and adjusted odds ratios (aOR) were calculated by unconditional logistic regression and presented with 95% confidence intervals (CI). Results Overall, 79% of women >= 40 years with a trial of labor reached a vaginal delivery. After spontaneous onset, intrapartum cesarean section was performed in 15.4% of women >= 40 years compared with 5.4% of women 25-29 years (aOR 3.07, 95% CI 2.81-3.35). Operative vaginal delivery was performed in 22.3% of women >= 40 years compared with 14.2% of women 25-29 years (aOR 1.71, 95% CI 1.59-1.85). After induction of labor, an intrapartum cesarean section was performed in 37.2% women >= 40 years compared with 20.2% women 25-29 years (aOR 2.51, 95% CI 2.24-2.81). Operative vaginal delivery was performed in 22.6% of women >= 40 years compared with 18.4% women 25-29 years (aOR 1.45, 95% CI 1.28-1.65). The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased in women >= 40 years, regardless of onset of labor. Conclusions Trial of labor ended in vaginal delivery in 79% of nulliparous women >= 40 years. The risks of intrapartum cesarean section and operative vaginal delivery were higher in women >= 40 years compared with women 25-29 years, after both spontaneous onset and induction of labor. The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
advanced maternal age, induction of labor, intrapartum cesarean section, nulliparous, obstetric anal sphincter injury, operative vaginal delivery
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-394703 (URN)10.1111/aogs.13614 (DOI)000484377700014 ()30901074 (PubMedID)
Funder
Swedish Research Council, 2016-00526
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11Bibliographically approved
Gunnarsdóttir, J., Akhter, T., Högberg, U., Cnattingius, S. & Wikström, A.-K. (2019). Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study. BMC Pregnancy and Childbirth, 19, 1-8, Article ID 186.
Open this publication in new window or tab >>Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, p. 1-8, article id 186Article in journal (Refereed) Published
Abstract [en]

Background: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). Methods: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to midgestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg) in early gestation was estimated. Results: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6–2.0]) and SGA birth (aOR: 1.3 [1.2–1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8–2.8] and 2.3 [1.8–3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. Conclusion: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders

Keywords
Blood pressure, Preeclampsia, Foetal growth restriction, Small-for-gestational-age
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-320672 (URN)10.1186/s12884-019-2319-2 (DOI)000469343400003 ()31138157 (PubMedID)
Funder
Swedish Research Council, 2014–3561Stockholm County Council, 20150118, SCThe Karolinska Institutet's Research Foundation
Available from: 2017-04-23 Created: 2017-04-23 Last updated: 2019-06-24Bibliographically approved
Lindström, L., Ahlsson, F., Lundgren, M., Bergman, E., Lampa, E. & Wikström, A.-K. (2019). Growth patterns during early childhood in children born small for gestational age and moderate preterm. Scientific Reports, 9, Article ID 11578.
Open this publication in new window or tab >>Growth patterns during early childhood in children born small for gestational age and moderate preterm
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 11578Article in journal (Refereed) Published
Abstract [en]

Today we lack knowledge if size at birth and gestational age interacts regarding postnatal growth pattern in children born at 32 gestational weeks or later.

This population-based cohort study comprised 41,669 children born in gestational weeks 32-40 in Uppsala County, Sweden, between 2000 and 2015. We applied a generalized least squares model including anthropometric measurements at 1.5, 3, 4 and 5 years. We calculated estimated mean height, weight and BMI for children born in week 32+0, 35+0 or 40+0 with birthweight 50th percentile (standardized appropriate for gestational age, sAGA) or 3rd percentile (standardized small for gestational age, sSGA).

Compared with children born sAGA at gestational week 40+0, those born sAGA week 32+0 or 35+0 had comparable estimated mean height, weight and BMI after 3 years of age. Making the same comparison, those born sSGA week 32+0 or 35+0 were shorter and lighter with lower estimated mean BMI throughout the whole follow-up period.

Our findings suggest that being born SGA and moderate preterm is associated with short stature and low BMI during the first five years of life. The association seemed stronger the shorter gestational age at birth.

Keywords
Postnatal growth, preterm birth, SGA, pregnancy, epidemiology
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology; Pediatrics; Epidemiology
Identifiers
urn:nbn:se:uu:diva-392437 (URN)10.1038/s41598-019-48055-x (DOI)000480233800030 ()31399623 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2019-09-04 Created: 2019-09-04 Last updated: 2019-12-09Bibliographically approved
Wennerholm, U.-B., Saltvedt, S., Wessberg, A., Alkmark, M., Bergh, C., Wendel, S. B., . . . Hagberg, H. (2019). Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial. BMJ. British Medical Journal, 367, Article ID l6131.
Open this publication in new window or tab >>Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial
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2019 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 367, article id l6131Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN Multicentre, open label, randomised controlled superiority trial. SETTING 14 hospitals in Sweden, 2016-18. PARTICIPANTS 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-400104 (URN)10.1136/bmj.l6131 (DOI)000498841000001 ()31748223 (PubMedID)
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2019-12-19Bibliographically approved
Bergman, L., Torres-Vergara, P., Penny, J., Wikström, J., Nelander, M., Leon, J., . . . Escudero, C. (2019). Investigating Maternal Brain Alterations in Preeclampsia: the Need for a Multidisciplinary Effort. Current Hypertension Reports, 21(9), Article ID 72.
Open this publication in new window or tab >>Investigating Maternal Brain Alterations in Preeclampsia: the Need for a Multidisciplinary Effort
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2019 (English)In: Current Hypertension Reports, ISSN 1522-6417, E-ISSN 1534-3111, Vol. 21, no 9, article id 72Article in journal (Refereed) Published
Abstract [en]

PURPOSE OF REVIEW: To provide insight into the mechanisms underlying cerebral pathophysiology and to highlight possible methods for evaluation, screening, and surveillance of cerebral complications in preeclampsia.

RECENT FINDINGS: The pathophysiology of eclampsia remains enigmatic. Animal studies show that the cerebral circulation in pregnancy and preeclampsia might be affected with increased permeability over the blood-brain barrier and altered cerebral blood flow due to impaired cerebral autoregulation. The increased blood pressure cannot be the only underlying cause of eclampsia and cerebral edema, since some cases of eclampsia arise without simultaneous hypertension. Findings from animal studies need to be confirmed in human tissues. Evaluation of brain alterations in preeclampsia and eclampsia is challenging and demands a multidisciplinary collaboration, since no single method can accurately and fully describe how preeclampsia affects the brain. Cerebral complications of preeclampsia are significant factors in maternal morbidity and mortality worldwide. No single method can accurately describe the full picture of how preeclampsia affects the brain vasculature and parenchyma. We recommend an international and multidisciplinary effort not only to overcome the issue of limited sample availability but also to optimize the quality of research.

Keywords
Biomarkers, Blood-brain barrier, Brain complications, Brain imaging, Eclampsia, Preclinical studies, Preeclampsia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-392990 (URN)10.1007/s11906-019-0977-0 (DOI)000479197200001 ()31375930 (PubMedID)
Available from: 2019-09-12 Created: 2019-09-12 Last updated: 2019-09-25Bibliographically approved
Axfors, C., Eckerdal, P., Volgsten, H., Wikström, A.-K., Ekselius, L., Ramklint, M., . . . Skalkidou, A. (2019). Investigating the association between neuroticism and adverse obstetric and neonatal outcomes. Scientific Reports, 9, Article ID 15470.
Open this publication in new window or tab >>Investigating the association between neuroticism and adverse obstetric and neonatal outcomes
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 15470Article in journal (Refereed) Published
Abstract [en]

Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (Cis) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-397118 (URN)10.1038/s41598-019-51861-y (DOI)000493048400023 ()31664086 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1955Swedish Research Council, 521-2010-3293Swedish Research Council, K2008-54 x - 20642-01-3Marianne and Marcus Wallenberg Foundation, MMW2011.0115Swedish Society of Medicine, SLS-250581
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2019-11-15Bibliographically approved
Maack, H. P., Skalkidou, A., Sjöholm, A., Eurenius-Orre, K., Mulic-Lutvica, A., Wikström, A.-K. & Sundström Poromaa, I. (2019). Maternal body mass index moderates antenatal depression effects on infant birthweight. Scientific Reports, 9, Article ID 6213.
Open this publication in new window or tab >>Maternal body mass index moderates antenatal depression effects on infant birthweight
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 6213Article in journal (Refereed) Published
Abstract [en]

Obesity and depression are two common medical problems that pregnant women present with in antenatal care. Overweight and obesity at the beginning of the pregnancy, and excessive weight gain during pregnancy, are independent explanatory variables for fetal birthweight and independent risk factors for giving birth to a large for gestational age (LGA) infant. However, the effect of co-morbid depression has received little attention. This study set out to investigate if maternal body mass index (BMI) in early pregnancy moderates antenatal depression effects on infant birthweight. 3965 pregnant women participated in this longitudinal cohort study, where cases (n = 178) had Edinburgh Postnatal Depression Scale (EPDS) score >= 17 in gestational week 17 or 32, and remaining women (n = 3787) were used as controls. The influence of maternal BMI and antenatal depressive symptoms on standardized birthweight was evaluated by analysis of covariance, with adjustment for relevant confounders. Depressed women with BMI 25.0 kg/m(2) or more gave birth to infants with significantly greater standardized birthweight than non-depressed overweight women, whereas the opposite pattern was noted in normal weight women (BMI by antenatal depressive symptoms interaction; F(1,3839) = 6.32; p = 0.012. The increased birthweight in women with co-prevalent overweight and depressive symptoms was not explained by increased weight gain during the pregnancy. Maternal BMI at the beginning of pregnancy seems to influence the association between antenatal depressive symptoms and infant birthweight, but in opposite directions depending on whether the pregnant women is normal weight or overweight. Further studies are needed to confirm our finding.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-383196 (URN)10.1038/s41598-019-42360-1 (DOI)000464988500025 ()30996270 (PubMedID)
Available from: 2019-07-23 Created: 2019-07-23 Last updated: 2019-07-23Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-6431-3303

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