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Ekstrand Ragnar, M., Grandahl, M., Stern, J. & Mattebo, M. (2018). Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health. European journal of contraception & reproductive health care, 23(4), 265-273
Open this publication in new window or tab >>Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health
2018 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, no 4, p. 265-273Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group.

Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis.

Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given.

Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Adolescents, fertility awareness, focus group discussion, preconception health
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-368770 (URN)10.1080/13625187.2018.1481942 (DOI)000446985600004 ()30010448 (PubMedID)
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2019-10-18Bibliographically approved
Fooladi, E., Weller, C., Salehi, M., Abhari, F. R. & Stern, J. (2018). Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial. Midwifery, 67, 77-86
Open this publication in new window or tab >>Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial
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2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 77-86Article in journal (Refereed) Published
Abstract [en]

Objectives: Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women.

Design: A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60).

Setting: A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran.

Participants: Women of reproductive age who were able to conceive.

Interventions: The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up.

Findings: At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful.

Key conclusions: Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established.

Implications for practice: The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2018
Keywords
Family planning, Preconception care, Health education, Reproductive health, Fertility, Knowledge
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-369030 (URN)10.1016/j.midw.2018.09.011 (DOI)000447751500011 ()30267937 (PubMedID)
Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2018-12-14Bibliographically approved
Salih Joelsson, L., Tydén, T., Wanggren, K., Georgakis, M. K., Stern, J., Berglund, A. & Skalkidou, A. (2017). Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women. European psychiatry, 45, 212-219
Open this publication in new window or tab >>Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women
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2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 212-219Article in journal (Refereed) Published
Abstract [en]

Background

Infertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.

Methods

Four hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.

Results

The prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise < 2 h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09–1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04–1.49).

Conclusions

Women pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.

Keywords
anxiety, depression, infertility, assisted reproductive technology, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-338378 (URN)10.1016/j.eurpsy.2017.07.004 (DOI)000414461300029 ()28957789 (PubMedID)
Funder
Swedish Research Council
Available from: 2018-01-08 Created: 2018-01-08 Last updated: 2018-06-04Bibliographically approved
Bodin, M., Käll, L., Tydén, T., Stern, J., Drevin, J. & Larsson, M. (2017). Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden. Upsala Journal of Medical Sciences, 122(2), 127-135
Open this publication in new window or tab >>Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden
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2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 127-135Article in journal (Refereed) Published
Abstract [en]

Introduction: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers. Material and methods: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility. Results: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n=128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education. Conclusion: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Fathers, fertility knowledge, gender equality, lifestyle, preconception health, pregnancy planning
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-323499 (URN)10.1080/03009734.2017.1316531 (DOI)000401756500009 ()28471260 (PubMedID)
Available from: 2017-06-21 Created: 2017-06-21 Last updated: 2018-03-27Bibliographically approved
Drevin, J., Kristiansson, P., Stern, J. & Rosenblad, A. (2017). Measuring pregnancy planning: A psychometric evaluation and comparison of two scales. Journal of Advanced Nursing, 73(11), 2765-2775
Open this publication in new window or tab >>Measuring pregnancy planning: A psychometric evaluation and comparison of two scales
2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2765-2775Article in journal (Refereed) Published
Abstract [en]

Aims: To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale. Background: The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level. Design: Cross-sectional design. Methods: In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation. Results: All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability. Conclusion: The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
antenatal care, confirmatory factor analysis, instrument development, midwives, nursing, pregnancy planning, psychometrics, reproducibility of results, reproductive health, unplanned pregnancy
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-339704 (URN)10.1111/jan.13364 (DOI)000418363000027 ()28620936 (PubMedID)
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2019-03-21Bibliographically approved
Stern, J., Salih Joelsson, L., Tydén, T., Berglund, A., Ekstrand, M., Hegaard, H., . . . Kristiansson, P. (2016). Is pregnancy planning associated with background characteristics and pregnancy planning behavior?. Acta Obstetricia et Gynecologica Scandinavica, 95(2), 182-189
Open this publication in new window or tab >>Is pregnancy planning associated with background characteristics and pregnancy planning behavior?
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2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 2, p. 182-189Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Prevalence of planned pregnancies varies between countries but is often measured in a dichotomous manner. The aim of this study was to investigate to what level pregnant women had planned their pregnancies and whether pregnancy planning was associated with background characteristics and pregnancy planning behavior.

MATERIAL AND METHODS: A cross-sectional study that utilized the baseline measurements from the Swedish Pregnancy Planning (SWEPP) study. Pregnant women (n= 3390) recruited at antenatal clinics answered a questionnaire. Data were analyzed with multinomial logistic regression, Kruskal-Wallis H and χ(2) tests.

RESULTS: Three out of four pregnancies were very or fairly planned and 12 % fairly or very unplanned. Of women with very unplanned pregnancies, 32 % had considered an induced abortion. Women with planned pregnancies were more likely to have a higher level of education, higher household income, to be currently working ≥50 %, and to have longer relationships than women with unplanned pregnancies. The level of pregnancy planning was associated with planning behavior, such as information seeking and intake of folic acid, but without a reduction in alcohol consumption. One third of all women took folic acid one month prior to conception, 17 % used tobacco daily and 11 % used alcohol weekly three months before conception.

CONCLUSIONS: A majority rated their pregnancy as very or fairly planned, with socio-economic factors as explanatory variables. The level of pregnancy planning should be queried routinely to enable individualized counselling, especially for women with unplanned pregnancies. Preconception recommendations need to be established and communicated to the public to increase health promoting planning behavior.

Keywords
Planned pregnancy; unplanned pregnancy; preconception care; folic acid; health behavior
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-270500 (URN)10.1111/aogs.12816 (DOI)000368004300007 ()26566076 (PubMedID)
Available from: 2015-12-29 Created: 2015-12-29 Last updated: 2018-01-19Bibliographically approved
Mogilevkina, I., Stern, J., Melnik, D., Getsko, E. & Tydén, T. (2016). Ukrainian medical students’ attitudes to parenthood and knowledge of fertility. European journal of contraception & reproductive health care, 21(2), 189-194
Open this publication in new window or tab >>Ukrainian medical students’ attitudes to parenthood and knowledge of fertility
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2016 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 21, no 2, p. 189-194Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of our study was to investigate Ukrainian medical students’ intentions andattitudes in relation to future parenthood, and their knowledge about fertility. Methods: Aclassroom survey was carried out of randomly selected groups among 3568 Russian-speakingmedical students. The response rate was 88.8%; 858 were female and 407 were male; the mean agewas 20.6 (standard deviation [SD] 2.4) years. Results: One in four male and 16% of femalerespondents did not want to have children, 3.3% had children and 17% wanted one child only.Female respondents wished to have their first child when they were 24.4 (SD 2.4) years of age, andmale respondents when they were 26.8 (SD 3.4) years of age. Around 60% of respondents reportedthere was a pronounced decline in female fertility after the age of 45 years. Conclusions: The desireto have children in the future is not apparent among medical students, especially not among men.Gaps in students’ knowledge about fertility need to be addressed by sexual and reproductiveeducation.

Keywords
Contraception; fertility; medical students; parenthood; survey
National Category
Obstetrics, Gynecology and Reproductive Medicine Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-282257 (URN)10.3109/13625187.2015.1130221 (DOI)000375025700011 ()26796521 (PubMedID)
Available from: 2016-04-04 Created: 2016-04-04 Last updated: 2017-11-30Bibliographically approved
Tydén, T., Verbiest, S., van Achterberg, T., Larsson, M. & Stern, J. (2016). Using the Reproductive Life Plan in contraceptive counselling. Upsala Journal of Medical Sciences, 121(4), 299-303
Open this publication in new window or tab >>Using the Reproductive Life Plan in contraceptive counselling
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2016 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 4, p. 299-303Article in journal (Refereed) Published
Abstract [en]

Having children or not is one of the most important decisions that a person will make in his or her lifetime. The Reproductive Life Plan (RLP) is a protocol that aims to encourage both women and men to reflect on their reproductive intentions and to find strategies for successful family planning, for example to have the wanted number of children and to avoid unwanted pregnancies as well as ill-health that may threaten reproduction. The RLP was developed in an American context for promotion of reproductive health in a life cycle perspective. Few studies have systematically evaluated the effectiveness of using an RLP protocol in clinical practice. This article describes the application of using the RLP protocol in contraceptive counselling in Sweden.

Keywords
Counselling, preconception care, preconception health, reproduction, reproductive life plan
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-310572 (URN)10.1080/03009734.2016.1210267 (DOI)000387292600018 ()
Available from: 2017-01-02 Created: 2016-12-16 Last updated: 2017-11-29Bibliographically approved
Drevin, J., Stern, J., Annerbäck, E.-M., Peterson, M., Butler, S., Tydén, T., . . . Kristiansson, P. (2015). Adverse childhood experiences influence development of pain during pregnancy.. Acta Obstetricia et Gynecologica Scandinavica, 94(8), 840-846
Open this publication in new window or tab >>Adverse childhood experiences influence development of pain during pregnancy.
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2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 8, p. 840-846Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the association between adverse childhood experiences (ACE) and pain with onset during pregnancy.

DESIGN: Cross-sectional study.

SETTING: Eighteen antenatal clinics in southern Mid-Sweden.

SAMPLE: Of 293 women invited to participate, 232 (79%) women agreed to participate in early pregnancy and were assessed in late pregnancy.

METHODS: Questionnaires were distributed in early and late pregnancy. The questionnaires sought information on socio-demography, ACE, pain location by pain drawing and pain intensity by visual analogue scales. Distribution of pain was coded in 41 predetermined areas.

MAIN OUTCOME MEASURES: Pain in third trimester with onset during present pregnancy: intensity, location and number of pain locations.

RESULTS: In late pregnancy, 62% of the women reported any ACE and 72% reported any pain location with onset during the present pregnancy. Among women reporting any ACE the median pain intensity was higher compared with women without such an experience (p = 0.01). The accumulated ACE displayed a positive association with the number of reported pain locations in late pregnancy (rs  = 0.19, p = 0.02). This association remained significant after adjusting for background factors in multiple regression analysis (p = 0.01). When ACE was dichotomized the prevalence of pain did not differ between women with and without ACE. The subgroup of women reporting physical abuse as a child reported a higher prevalence of sacral and pelvic pain (p = 0.0003 and p = 0.02, respectively).

CONCLUSIONS: Adverse childhood experiences were associated with higher pain intensities and larger pain distributions in late pregnancy, which are risk factors for transition to chronic pain postpartum.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-256150 (URN)10.1111/aogs.12674 (DOI)000357983900005 ()25965273 (PubMedID)
Available from: 2015-06-22 Created: 2015-06-22 Last updated: 2019-03-21Bibliographically approved
Bodin, M., Stern, J., Käll, L. F., Tydén, T. & Larsson, M. (2015). Coherence of pregnancy planning within couples expecting a child. Midwifery, 31(10), 973-978
Open this publication in new window or tab >>Coherence of pregnancy planning within couples expecting a child
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2015 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 10, p. 973-978Article in journal (Refereed) Published
Abstract [en]

Background: joint planning and decision-making within couples have evident effects on the well-being of the family. The purpose of this study was to investigate the level of pregnancy planning among pregnant women and their partners and to compare the coherence of pregnancy planning within the couples. Methods: pregnant women and their partners were recruited from 18 antenatal clinics in seven Swedish counties between October 2011 and April 2012. Participants, 232 pregnant women and 144 partners, filled out a questionnaire with questions about pregnancy planning, lifestyle and relationship satisfaction. 136 couples were identified and the women's and partners' answers were compared. Results: more than 75% of the pregnancies were very or rather planned and almost all participants had agreed with their partner to become pregnant There was no significant difference in level of pregnancy planning between women and partners, and coherence within couples was strong. Level of planning was not affected by individual socio-demographic variables. Furthermore, 98 % of women and 94 % of partners had non distressed relationships. Conclusion: one of the most interesting results was the strong coherence between partners concerning their pregnancy and relationship. Approaching these results from a social constructivist perspective brings to light an importance of togetherness and how a sense and impression of unity within a couple might be constructed in different ways. As implications for practice, midwives and other professionals counselling persons in fertile age should enquire about and emphasise the benefits of equality and mutual pregnancy planning for both women and men.

Keywords
Pregnancy planning, Relationship satisfaction, Gender
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine Gender Studies
Identifiers
urn:nbn:se:uu:diva-265689 (URN)10.1016/j.midw.2015.06.009 (DOI)000362093300012 ()26165170 (PubMedID)
Available from: 2015-11-09 Created: 2015-11-02 Last updated: 2018-03-27Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-2753-9140

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