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Wikström, Anna-Karin
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Publications (10 of 82) Show all publications
Liljeström, L., Wikström, A.-K., Ågren, J. & Jonsson, M. (2018). Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study. Acta Obstetricia et Gynecologica Scandinavica, 97(5), 615-623
Open this publication in new window or tab >>Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 5, p. 615-623Article in journal (Refereed) Published
Abstract [en]

Introduction

Our aim was to identify antepartum risk factors for neonatal hypoxic ischemic encephalopathy, with a focus on maternal body mass index and height.

Material and methods

National population-based cohort study of 692 428 live-born infants 36 gestational weeks in Sweden, 2009-2015. Data from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register were linked. Short maternal stature was defined as 155 cm, and overweight as body mass index 25 kg/m(2). Therapeutic hypothermia served as surrogate marker of moderate to severe hypoxic ischemic encephalopathy. Associations between maternal and infant characteristics and hypoxic ischemic encephalopathy were calculated with logistic regression analyses, and risks were presented as odds ratios with 95% confidence intervals.

Results

Moderate to severe hypoxic ischemic encephalopathy occurred in 0.67/1000 infants. Nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight were all independently associated with hypoxic ischemic encephalopathy. The risk of hypoxic ischemic encephalopathy increased with decreasing maternal height and increasing body mass index. Compared with non-short women (156 cm) with normal weight (body mass index <25 kg/m(2)), those with both short stature and overweight had increased risk of hypoxic ischemic encephalopathy (odds ratio 3.66; 95% confidence intervals 2.41-5.55). Among parous women with both short stature and overweight, the risk was almost sixfold (odds ratio 5.74; 95% confidence intervals 3.41-9.66).

Conclusions

Antepartum risk factors for moderate to severe hypoxic ischemic encephalopathy included nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight. The combination of maternal short stature and overweight was associated with a more than threefold risk of subsequent hypoxic ischemic encephalopathy.

Keywords
Asphyxia, body mass index, hypoxic ischemic encephalopathy, maternal height, overweight, risk factors, short stature, therapeutic hypothermia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-354099 (URN)10.1111/aogs.13316 (DOI)000430099900014 ()29450878 (PubMedID)
Funder
Swedish Research Council, 20143561Swedish Research Council, 2012-00087
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
Nelander, M., Wikström, A.-K., Weis, J., Bergman, L., Larsson, A., Sundström Poromaa, I. & Wikström, J. (2018). Cerebral osmolytes and plasma osmolality in pregnancy and preeclampsia: a proton magnetic resonance spectroscopy study. American Journal of Hypertension, 31(7), 847-853
Open this publication in new window or tab >>Cerebral osmolytes and plasma osmolality in pregnancy and preeclampsia: a proton magnetic resonance spectroscopy study
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2018 (English)In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 31, no 7, p. 847-853Article in journal (Refereed) Published
Abstract [en]

Background: Cerebral complications contribute substantially to mortality in preeclampsia. Pregnancy calls for extensive maternal adaptations, some associated with increased propensity for seizures, but the pathophysiology behind the eclamptic seizures is not fully understood. Plasma osmolality and sodium levels are lowered in pregnancy. This could result in extrusion of cerebral organic osmolytes, including the excitatory neurotransmitter glutamate, but this remains to be determined. The hypothesis of this study was that cerebral levels of organic osmolytes are decreased during pregnancy, and that this decrease is even more pronounced in women with preeclampsia.

Method: We used proton magnetic resonance spectroscopy to compare levels of cerebral organic osmolytes, in women with preeclampsia (n=30), normal pregnancy (n=32) and non-pregnant controls (n=16). Cerebral levels organic osmolytes were further correlated to plasma osmolality, and plasma levels of glutamate and sodium.

Results: Compared to non-pregnant women, women with normal pregnancy and preeclampsia had lower levels of the cerebral osmolytes myo-inositol, choline and creatine (p=0.001 or less), and all these metabolites correlated with each other (p<0.05). Women with normal pregnancies and preeclampsia had similar levels of osmolytes, except for glutamate, which was significantly lower in preeclampsia. Cerebral and plasma glutamate levels were negatively correlated with each other (p<0.008), and cerebral myo-inositol, choline and creatine levels were all positively correlated with both plasma osmolality and sodium levels (p<0.05).

Conclusion: Our results indicate that pregnancy is associated with extrusion of cerebral organic osmolytes. This includes the excitatory neurotransmitter glutamate, which may be involved in the pathophysiology of seizures in preeclampsia.

Keywords
Preeclampsia, eclampsia, proton magnetic resonance spectroscopy, cerebral osmolytes, glutamate
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-341642 (URN)10.1093/ajh/hpy019 (DOI)000435458800015 ()29415199 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-08-29Bibliographically approved
Eckerdal, P., Georgakis, M. K., Kollia, N., Wikström, A.-K., Högberg, U. & Skalkidou, A. (2018). Delineating the association between mode of delivery and postpartum depression symptoms: A  longitudinal study. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 301-311, Article ID 29215162.
Open this publication in new window or tab >>Delineating the association between mode of delivery and postpartum depression symptoms: A  longitudinal study
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 301-311, article id 29215162Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Although a number of perinatal factors have been implicated in the etiology of postpartum depression, the role of mode of delivery remains controversial. Our aim was to explore the association between mode of delivery and postpartum depression, considering the potentially mediating or confounding role of several covariates. MATERIAL AND METHODS: In a longitudinal-cohort study in Uppsala, Sweden, with 3888 unique pregnancies followed up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, emergency cesarean section) on self-reported postpartum depression symptoms (Edinburgh Postnatal Depression Scale >/=12) at 6 weeks postpartum was investigated through logistic regression models and path analysis. RESULTS: The overall prevalence of postpartum depression was 13%. Compared with spontaneous vaginal delivery, women who delivered by emergency cesarean section were at higher risk for postpartum depression 6 weeks after delivery in crude (odds ratio 1.45, 95% confidence interval 1.04-2.01) but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of postpartum depression, by leading to postpartum complications, self-reported physical symptoms postpartum, and therefore a negative delivery experience. In contrast, history of depression and fear of delivery increased the odds of postpartum depression and led more frequently to elective cesarean section; however, it was associated with a positive delivery experience. CONCLUSIONS: Mode of delivery has no direct impact on risk of postpartum depression; nevertheless, several modifiable or non-modifiable mediators are present in this association. Women delivering in an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery, constitute a high-risk group for postpartum depression.

Keywords
Postpartum depression, cesarean section, delivery experience, mode of delivery, vacuum extraction
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-343030 (URN)10.1111/aogs.13275 (DOI)000426055500009 ()
Projects
Basic
Funder
Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation
Available from: 2018-02-25 Created: 2018-02-25 Last updated: 2018-10-08Bibliographically approved
Hutcheon, J. A., Stephansson, O., Cnattingius, S., Bodnar, L. M., Wikström, A.-K. & Johansson, K. (2018). Pregnancy Weight Gain Before Diagnosis and Risk of Preeclampsia: A Population-Based Cohort Study in Nulliparous Women. Hypertension, 72(2), 433-441
Open this publication in new window or tab >>Pregnancy Weight Gain Before Diagnosis and Risk of Preeclampsia: A Population-Based Cohort Study in Nulliparous Women
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2018 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 72, no 2, p. 433-441Article in journal (Refereed) Published
Abstract [en]

Weight gain in early pregnancy may influence a woman's risk of developing preeclampsia. However, the consequences of weight gain throughout pregnancy up to the diagnosis of preeclampsia are unknown. The aim of this study was to determine whether pregnancy weight gain before the diagnosis of preeclampsia is associated with increased risks of preeclampsia (overall and by preeclampsia subtype). The study population included nulliparous pregnant women in the Swedish counties of Gotland and Stockholm, 2008 to 2013, stratified by early pregnancy body mass index category. Electronic medical records were linked with population inpatient and outpatient records to establish date of preeclampsia diagnosis (classified as any, early preterm <34 weeks, late preterm 34-36 weeks, or term 37 weeks). Antenatal weight gain measurements were standardized into gestational age-specific z scores. Among 62705 nulliparous women, 2770 (4.4%) developed preeclampsia. Odds of preeclampsia increased by approximate to 60% with every 1 z score increase in pregnancy weight gain among normal weight and overweight women and by 20% among obese women. High pregnancy weight gain was more strongly associated with term preeclampsia than early preterm preeclampsia (eg, 64% versus 43% increased odds per 1 z score difference in weight gain in normal weight women, and 30% versus 0% in obese women, respectively). By 25 weeks, the weight gain of women who subsequently developed preeclampsia was significantly higher than women who did not (eg, 0.43 kg in normal weight women). In conclusion, high pregnancy weight gain before diagnosis increases the risk of preeclampsia in nulliparous women and is more strongly associated with later-onset preeclampsia than early-onset preeclampsia.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2018
Keywords
obesity, overweight, preeclampsia, pregnancy, weight gain
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-361037 (URN)10.1161/HYPERTENSIONAHA.118.10999 (DOI)000438231100030 ()29915016 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 20140073Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00251Swedish Research Council, 2013-2429Swedish Research Council, 20143561Stockholm County Council, 2013-2429Stockholm County Council, 20143561The Karolinska Institutet's Research Foundation
Available from: 2018-09-21 Created: 2018-09-21 Last updated: 2018-09-21Bibliographically approved
Gunnarsdottir, J., Cnattingius, S., Lundgren, M., Ekholm Selling, K., Högberg, U. & Wikström, A.-K. (2018). Prenatal exposure to preeclampsia is associated with accelerated height gain in early childhood. PLoS Medicine, 13(2), Article ID e0192514.
Open this publication in new window or tab >>Prenatal exposure to preeclampsia is associated with accelerated height gain in early childhood
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2018 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 13, no 2, article id e0192514Article in journal (Refereed) Published
Abstract [en]

Background Preeclampsia is associated with low birth weight, both because of increased risks of preterm and of small-for-gestational-age (SGA) births. Low birth weight is associated with accelerated childhood height gain and cardiovascular diseases later in life. The aim was to investigate if prenatal exposure to preeclampsia is associated with accelerated childhood height gain, also after adjustments for SGA-status and gestational age at birth. Methods In a cohort of children prenatally exposed to preeclampsia (n = 865) or unexposed (n = 22,898) we estimated height gain between birth and five years of age. The mean difference in height gain between exposed and unexposed children was calculated and adjustments were done with linear regression models. Results Children exposed to preeclampsia were on average born shorter than unexposed. Exposed children grew on average two cm more than unexposed from birth to five years of age. After adjustments for maternal characteristics including socioeconomic factors, height, body mass index (BMI) and diabetes, as well as for parents smoking habits, infant's breastfeeding and childhood obesity, the difference was 1.6 cm (95% CI 1.3-1.9 cm). Further adjustment for SGA birth only slightly attenuated this estimate, but adjustment for gestational age at birth decreased the estimate to 0.5 cm (95% CI 0.1-0.7 cm). Conclusion Prenatal exposure to preeclampsia is associated with accelerated height gain in early childhood. The association seemed independent on SGA-status, but partly related to shorter gestational age at birth.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-348920 (URN)10.1371/journal.pone.0192514 (DOI)000425083400026 ()
Funder
Swedish Research Council, 2014-3561
Available from: 2018-04-25 Created: 2018-04-25 Last updated: 2018-04-25Bibliographically approved
Endler, M., Cnattingius, S., Granfors, M. & Wikström, A.-K. (2018). The inherited risk of retained placenta: a population based cohort study.. British Journal of Obstetrics and Gynecology, 125(6), 737-744
Open this publication in new window or tab >>The inherited risk of retained placenta: a population based cohort study.
2018 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, no 6, p. 737-744Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate whether retained placenta in the first generation is associated with an increased risk of retained placenta in the second generation.

Design: Population‐based cohort study.

Setting: Sweden.

Population: Using linked generational data from the Swedish Medical Birth Register 1973–2012, we identified 494 000 second‐generation births with information on the birth of the mother (first‐generation index birth). For 292 897 of these births there was information also on the birth of the father.

Methods: Risk of retained placenta in the second generation was calculated as adjusted odds ratios (aOR) by unconditional logistic regression with 95% confidence intervals (95% CI) according to whether retained placenta occurred in a first generation birth or not.

Main outcome: Retained placenta in the second generation.

Results: The risk of retained placenta in a second‐generation birth was increased if retained placenta had occurred at the mother's own birth (aOR 1.66, 95% CI 1.52–1.82), at the birth of one of her siblings (aOR 1.58, 95% CI 1.43–1.76) or both (aOR 2.75, 95% CI 2.18–3.46). The risk was slightly increased if retained placenta had occurred at the birth of the father (aOR 1.23, 95% CI 1.07–1.41). For preterm births in both generations, the risk of retained placenta in the second generation was increased six‐fold if retained placenta had occurred at the mother's birth (OR 6.55, 95% CI 2.68–16.02).

Conclusion: There is an intergenerational recurrence of retained placenta on the maternal and most likely also on the paternal side. The recurrence risk seems strongest in preterm pregnancies.

Tweetable abstract: A population‐based cohort study suggests that there is an intergenerational recurrence of retained placenta.

Keywords
inherited risk, retained placenta
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-336792 (URN)10.1111/1471-0528.14828 (DOI)000431000400022 ()28731581 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2017-12-17 Created: 2017-12-17 Last updated: 2018-08-10Bibliographically approved
Stephansson, O., Petersson, K., Björk, C., Conner, P. & Wikström, A.-K. (2018). The Swedish Pregnancy Register - for quality of care improvement and research. Acta Obstetricia et Gynecologica Scandinavica, 97(4), 466-476
Open this publication in new window or tab >>The Swedish Pregnancy Register - for quality of care improvement and research
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2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 4, p. 466-476Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The objective was to present the Swedish Pregnancy Register and to explore regional differences in maternal characteristics, antenatal care, first trimester combined screening and delivery outcomes in Sweden.

MATERIAL AND METHODS: The Pregnancy Register (www.graviditetsregistret.se) collects data on pregnancy and childbirth, starting at the first visit to antenatal care and ending at the follow-up visit to the antenatal care, which usually occurs at around 8-16 weeks postpartum. The majority of data is collected directly from the electronic medical records. The Register includes demographic, reproductive and maternal health data, as well information on prenatal diagnostics, and pregnancy outcome for the mother and the newborn.

RESULTS: Today the Register covers more than 90% of all deliveries in Sweden, with the aim to include all deliveries within 2018. The care providers can visualize quality measures over time and compare results with other clinics, regionally and nationally by creating reports on an aggregated level or using case-mix adjusted Dash Boards in real time. Detailed data can be extracted after ethical approval for research. In this report, we showed regional differences in patient characteristics, antenatal care, fetal diagnosis and delivery outcomes in Sweden.

CONCLUSIONS: Our report indicates that quality in antenatal and delivery care in Sweden varies between regions, which warrants further actions. The Swedish Pregnancy Register is a new and valuable resource for benchmarking, quality improvement and research in pregnancy, fetal diagnosis and delivery.

Keywords
Pregnancy register, delivery, pregnancy, prenatal care, prenatal diagnosis, training
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-336796 (URN)10.1111/aogs.13266 (DOI)000427561800014 ()29172245 (PubMedID)
Funder
Stockholm County Council
Available from: 2017-12-17 Created: 2017-12-17 Last updated: 2018-05-17Bibliographically approved
Simic, M., Wikström, A.-K. & Stephansson, O. (2017). Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant: a cohort study in a low-risk population. Acta Obstetricia et Gynecologica Scandinavica, 96(10), 1261-1268
Open this publication in new window or tab >>Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant: a cohort study in a low-risk population
2017 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 10, p. 1261-1268Article in journal (Refereed) Published
Abstract [en]

Introduction: Our objective was to examine the association between fetal growth in early pregnancy and risk of severe large-for-gestational-age (LGA) and macrosomia at birth in a low-risk population.

Material and methods: Cohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on an electronic database on pregnancies and deliveries in Stockholm-Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5-24.9 kg/m(2)).

Results: When adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second-trimester scan (adjusted odds ratio 1.80; 95% CI 1.23-2.64 and adjusted odds ratio 2.15; 95% CI 1.55-2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second-trimester ultrasound was at least 7 days.

Conclusions: In a low-risk population, ultrasound-estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
Early pregnancy, fetal growth, large-for-gestational-age, macrosomia, ultrasound
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-336435 (URN)10.1111/aogs.13189 (DOI)000411689100015 ()28683173 (PubMedID)
Funder
Swedish Research Council, 2013-2429, 2014-356
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-01-24Bibliographically approved
Akhter, T., Wikström, A.-K., Larsson, M., Larsson, A., Wikström, G. & Naessén, T. (2017). Association between angiogenic factors and signs of arterial aging in women with pre-eclampsia. Ultrasound in Obstetrics and Gynecology, 50, 93-99
Open this publication in new window or tab >>Association between angiogenic factors and signs of arterial aging in women with pre-eclampsia
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2017 (English)In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 50, p. 93-99Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Pre-eclampsia (PE) is associated with an increased risk of cardiovascular disease (CVD) later in life. In PE there is a substantial increase in levels of the anti-angiogenic factor soluble fms-like tyrosine kinase-1 (sFlt1) and decreased levels of the pro-angiogenic factor placental growth factor (PlGF). Elevated levels of sFlt1 are also found in individuals with CVD. The aims of this study were to assess sFlt1, PlGF and the sFlt1/PlGF ratio and their correlation with signs of arterial aging by measuring common carotid artery (CCA) intima and media thicknesses and their ratio (I/M ratio) in women with and without PE.

METHODS: Serum sFlt1 and PlGF levels were measured using commercially available enzyme-linked immunosorbent assay kits, and CCA intima and media thicknesses were estimated using high-frequency (22 MHz) ultrasonography in 55 women at PE diagnosis and 64 women with normal pregnancies at a similar gestational age, with reassessment one year postpartum. A thick intima, thin media and a high I/M ratio indicate a less healthy arterial wall.

RESULTS: During pregnancy, higher levels of sFlt1, lower levels of PlGF and thicker intima, thinner media and higher I/M ratios were found in women with PE vs. controls (all p < 0.0001). Further, sFlt1 and the sFlt1/PlGF ratio were positively correlated with intima thickness and I/M ratio (all p < 0.0001), but negatively correlated with media thickness (p = 0.002 and 0.03, respectively). About one year postpartum, levels of sFlt1 and the sFlt1/PlGF ratio had decreased in both groups, but compared with controls women in the PE group still had higher levels (p = 0.001 and 0.02, respectively). Further, sFlt1 levels and the sFlt1/PlGF ratio were still positively correlated with intima thickness and I/M ratio.

CONCLUSIONS: Higher sFlt1 levels and sFlt1/PlGF ratios in women with PE were positively associated with signs of arterial aging during pregnancy. About one year postpartum sFlt1 levels and the sFlt1/PlGF ratios were still higher in the PE group, and also associated with the degree of arterial aging.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-296005 (URN)10.1002/uog.15981 (DOI)000404985500012 ()27256927 (PubMedID)
Available from: 2016-06-12 Created: 2016-06-12 Last updated: 2018-04-09Bibliographically approved
Razaz, N., Tomson, T., Wikström, A.-K. & Cnattingius, S. (2017). Association Between Pregnancy and Perinatal Outcomes Among Women With Epilepsy. JAMA Neurology, 74(8), 983-991
Open this publication in new window or tab >>Association Between Pregnancy and Perinatal Outcomes Among Women With Epilepsy
2017 (English)In: JAMA Neurology, ISSN 2168-6149, E-ISSN 2168-6157, Vol. 74, no 8, p. 983-991Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE To date, few attempts have been made to examine associations between exposure to maternal epilepsy with or without antiepileptic drug (AED) therapy and pregnancy and perinatal outcomes.

OBJECTIVES To investigate associations between epilepsy in pregnancy and risks of pregnancy and perinatal outcomes as well as whether use of AEDs influenced risks.

DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted on all singleton births at 22 or more completed gestational weeks in Sweden from 1997 through 2011; of these, 1 424 279 were included in the sample. Information on AED exposure was available in the subset of offspring from July 1, 2005, to December 31, 2011. Data analysis was performed from October 1, 2016, to February 15, 2017.

MAIN OUTCOMES AND MEASURES Pregnancy, delivery, and perinatal outcomes. Multivariable Poisson log-linear regression was used to estimate adjusted risk ratios (aRRs) and 95% CIs, after adjusting for maternal age, country of origin, educational level, cohabitation with a partner, height, early pregnancy body mass index, smoking, year of delivery, maternal pregestational diabetes, hypertension, and psychiatric disorders.

RESULTS Of the 1 429 652 births included in the sample, 5373 births were in 3586 women with epilepsy; mean (SD) age at first delivery of the epilepsy cohort was 30.54 (5.18) years. Compared with pregnancies of women without epilepsy, women with epilepsy were at increased risks of adverse pregnancy and delivery outcomes, including preeclampsia (aRR 1.24; 95% CI, 1.07-1.43), infection (aRR, 1.85; 95% CI, 1.43-2.29), placental abruption (aRR, 1.68; 95% CI, 1.18-2.38), induction (aRR, 1.31; 95% CI, 1.21-1.40), elective cesarean section (aRR, 1.58; 95% CI, 1.45-1.71), and emergency cesarean section (aRR, 1.09; 95% CI, 1.00-1.20). Infants of mothers with epilepsy were at increased risks of stillbirth (aRR, 1.55; 95% CI, 1.05-2.30), having both medically indicated (aRR, 1.24; 95% CI, 1.08-1.43) and spontaneous (aRR, 1.34; 95% CI, 1.20-1.53) preterm birth, being small for gestational age at birth (aRR, 1.25; 95% CI, 1.13-1.30), and having neonatal infections (aRR, 1.42; 95% CI, 1.17-1.73), any congenital malformation (aRR, 1.48; 95% CI, 1.35-1.62), major malformations (aRR, 1.61; 95% CI, 1.43-1.81), asphyxia-related complications (aRR, 1.75; 95% CI, 1.26-2.42), Apgar score of 4 to 6 at 5 minutes (aRR, 1.34; 95% CI, 1.03-1.76), Apgar score of 0 to 3 at 5 minutes (aRR, 2.42; 95% CI, 1.62-3.61), neonatal hypoglycemia (aRR, 1.53; 95% CI, 1.34-1.75), and respiratory distress syndrome (aRR, 1.48; 95% CI, 1.30-1.68) compared with infants of unaffected women. In women with epilepsy, using AEDs during pregnancy did not increase the risks of pregnancy and perinatal complications, except for a higher rate of induction of labor (aRR, 1.30; 95% CI, 1.10-1.55).

CONCLUSIONS AND RELEVANCE Epilepsy during pregnancy is associated with increased risks of adverse pregnancy and perinatal outcomes. However, AED use during pregnancy is generally not associated with adverse outcomes.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2017
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-334323 (URN)10.1001/jamaneurol.2017.1310 (DOI)000407688300019 ()28672292 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0073Swedish Research Council, 2014-3561
Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2017-11-22Bibliographically approved
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