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  • 201. Campo, S
    et al.
    Campo, V
    Gambadauro, Pietro
    Short-term and long-term results of resectoscopic myomectomy with and without pretreatment with GnRH analogs in premenopausal women2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 8, p. 756-60Article in journal (Refereed)
  • 202. Campo, S
    et al.
    Campo, V
    Zannoni, G F
    Gambadauro, Pietro
    Simultaneous ovarian and endometrial osseous metaplasia - A case report2007In: Journal of reproductive medicine, ISSN 0024-7758, E-ISSN 1943-3565, Vol. 52, no 3, p. 241-2Article in journal (Refereed)
  • 203. Campo, S
    et al.
    Marone, M
    Gambadauro, Pietro
    DeCicco, F
    A comparison between laparoscopic and laparotomic myomectomy2000In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 15, p. 211-211Article in journal (Refereed)
  • 204. Campo, S
    et al.
    Marone, M
    Gambadauro, Pietro
    Garcea, N
    Laparoscopic conservative excision of a rare asymptomatic 11-cm ovarian dermoid cyst containing a mandible with seven teeth2000In: Gynecological Endoscopy, ISSN 0962-1091, E-ISSN 1365-2508, Vol. 9, no 1, p. 65-68Article in journal (Refereed)
  • 205.
    Carde, Patrice P.
    et al.
    Gustave Roussy Canc Campus, Villejuif, France..
    Grynberg, Michael
    Hop Jean Verdier, Bondy, France..
    Poirot, Catherine
    Hop St Louis, Paris, France..
    Glimelius, Bengt
    Univ Uppsala Hosp, Uppsala, Sweden..
    Mounier, Nicolas
    LArchet Hosp, Nice, France..
    How Relevant Is Treatment-Related Infertility for Individual Treatment Selection in Hodgkin Lymphoma?: Reply to C.F. Hess et al2017In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 35, no 3, p. 374-374Article in journal (Other academic)
  • 206.
    Carlander, Alisa
    et al.
    Reg Vastmanland, Dept Obstet & Gynecol, Västerås, Sweden..
    Niemeyer Hultstrand, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Reuterwall, Isa
    Reg Vastmanland, Dept Obstet & Gynecol, Västerås, Sweden..
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Kullinger, Merit
    Reg Vastmanland, Dept Obstet & Gynecol, Västerås, Sweden..
    Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5, article id e0286052Article in journal (Refereed)
    Abstract [en]

    Objectives: Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting.

    Methods: Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression.

    Results: There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture.

    Conclusions :Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.

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  • 207.
    Carlander, Anna-Karin Klint
    et al.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Thorsell, Malin
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Demetry, Youstina
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nikodell, Sky
    Linköping Univ, Med Program, Linköping, Sweden..
    Kallner, Helena Kopp
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, Stockholm, Sweden..
    Skoglund, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Knowledge, challenges, and standard of care of young women with ADHD at Swedish youth clinics2022In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 32, article id 100727Article in journal (Refereed)
    Abstract [en]

    Objectives: Sexual risk-taking and its consequences for young women with ADHD(attention deficit hyperactivity disorder) including sexually transmitted diseases, teenage pregnancies and underage parenthood constitute substantial challenges for individuals and midwives. The aim was to investigate current knowledge and specific challenges in reproductive health and contraceptive counselling for women with ADHD at Swedish youth clinics. Method: Inductive qualitative interview study of ten midwives at six youth health clinics in Stockholm and Uppsala County. We used a semi-structured interview guide. The interviews were transcribed verbatim and analyzed with the NVivo 12 qualitative data analysis software. Results: Three main categories were identified: (1) challenges in provision of care of young women with ADHD, (2) standard of care and active adaptations towards women with ADHD and (3) organizational readiness for change;. Several challenges and frustrations, such as difficulties with attention with or without concomitant impulsivity and overactivity, in provision of reproductive health and contraceptive counselling for young women with ADHD were identified. Midwives reported high organizational readiness for improvement of standard of care. Conclusions: Inadequate contraceptive counseling or lack of knowledge on specific challenges in the sexual and reproductive health of young women with ADHD may contribute to this group failing to access, inadequately respond to, or act upon counseling at youth clinics. Support for midwives with evidence-based interventions specifically developed for these women are imperative. Development of such tools should be a priority for research.

  • 208.
    Carlberg, Niclas
    et al.
    Sahlgrens Univ Hosp, Dept Anesthesiol & Intens Care Med, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Obstet & Gynecol, Gothenburg, Sweden..
    Cluver, Catherine
    Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.;Univ Melbourne, Dept Obstet & Gynaecol, Translat Obstet Grp, Melbourne, VI, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, VI, Australia..
    Hesse, Camilla
    Gothenburg Univ, Inst Biomed, Dept Lab Med, Gothenburg, Sweden..
    Thorn, Sven-Egron
    Sahlgrens Univ Hosp, Dept Anesthesiol & Intens Care Med, Gothenburg, Sweden.;Univ Gothenburg, Inst Clin Sci, Dept Anesthesiol & Intens Care Med, Sahlgrenska Acad, Gothenburg, Sweden..
    Gandley, Robin
    Univ Pittsburgh, Dept Obstet Gynecol & Reprod Sci, Pittsburgh, PA USA.;Univ Pittsburgh, Magee Womens Res Inst, Pittsburgh, PA USA..
    Damen, Tor
    Univ Gothenburg, Inst Clin Sci, Dept Anesthesiol & Intens Care Med, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Sect Cardiothorac Anesthesia & Intens Care, Gothenburg, Sweden..
    Bergman, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Obstet & Gynecol, Gothenburg, Sweden.;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa..
    Circulating concentrations of glycocalyx degradation products in preeclampsia2022In: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 13, article id 1022770Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Preeclampsia is a multisystem disorder that affects maternal endothelium. The glycocalyx lines and protects the endothelial surface. In severe systemic diseases, like sepsis, it is shed and glycocalyx degradation products can be detected in increased concentrations in plasma. The aim of this study was to compare circulating concentrations of glycocalyx degradation products in degrees of preeclampsia severity.Study design: In this observational study, we included women from the South African PROVE biobank. Women were divided into normotensive controls, women with preeclampsia without end-organ complications, women with a single end-organ complication and women with multiple end-organ complications. Plasma samples taken at inclusion after diagnosis (preeclampsia cases) or at admission for delivery (normotensive controls) were analyzed with ELISA for syndecan-1, hyaluronic acid and thrombomodulin and compared between groups.Results: Women with preeclampsia (n = 47) had increased plasma concentrations of hyaluronic acid (100.3 ng/ml IQR 54.2-204 vs. 27.0 ng/ml IQR (13.5-66.6), p < 0,001) and thrombomodulin (4.22 ng/ml IQR 3.55-5.17 vs. 3.49 ng/ml IQR 3.01-3.68, p = 0.007) but not syndecan-1 compared with normotensive women (n = 10). There were no differences in plasma concentration in any of these biomarkers in women with preeclampsia with no end-organ complications (n = 10) compared with women with preeclampsia and one end-organ complication (n = 24). Women with preeclampsia with two or more end-organ complications (n = 13) had increased plasma concentrations of thrombomodulin (5.46 ng/ml, IQR 4.85-7.83 vs. 4.66 ng/ml, IQR 3.45-4.88, p = 0.042) compared with women with preeclampsia and no end-organ complications.Conclusion: Thrombomodulin was associated with disease severity and may be valuable for risk-stratifying women with preeclampsia.

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  • 209.
    Carlsson, Maria E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Strang, Peter M.
    Nygren, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Qualitative analysis of the questions raised by patients with gynecologic cancers and their relatives in an educational support group.1999In: Journal of Cancer Education, ISSN 0885-8195, E-ISSN 1543-0154, Vol. 14, no 1, p. 41-46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    People's knowledge of cancer is generally inadequate to help them cope with a diagnosis of cancer. Educational support groups may allow cancer patients to receive information they want that is normally not covered in the individual clinical encounter. It was desired to identify the content of such information as reflected in the questions asked by cancer patients and their relatives in such support groups.

    METHOD

    The 329 questions asked by 41 patients and 11 of their relatives in 40 group sessions were analyzed and categorized.

    RESULTS

    The categories found are described. Almost 100 questions could be allocated to the category "the illness," of which the most common was, "Is cancer hereditary?" The questions made it clear that the patients had a wish and a need to understand cancer.

    CONCLUSION

    An educational support group provides a complement to, and not a substitute for, the clinical provision of medical information.

  • 210.
    Carlsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Strang, Peter
    Bjurström, Christina
    Treatment modality affects long-term quality of life in gynaecological cancer.2000In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 20, no 1B, p. 563-568Article in journal (Refereed)
    Abstract [en]

    In order to survey the side effects after cancer treatment, quality of life data were collected from females in clinical remission.

    MATERIALS AND METHODS

    The study was cross-sectional; every patient that visited the outpatient clinic during a period of three months was asked to anonymously complete the EORTC QLQ-C30 questionnaire and five additional specific questions related to gynaecological cancer.

    RESULTS

    In total, 235 patients (90%) returned the questionnaire. In general, both the levels of functioning and symptomatology were time-dependent. Patients with short treatment-free intervals reported more problems than the others. When using treatment modality as an independent variable in the statistical calculations, a treatment-related effect on functioning and symptomatology was demonstrated (p < 0.05 to p < 0.001). Patients previously treated with chemotherapy had poorer role- and cognitive functioning and more problems with fatigue, nausea, vomiting, dyspnoea, constipation and financial problems, compared with those not treated with chemotherapy (p < 0.05 to p < 0.01). Those patients who had been treated with external radiotherapy and/or brachytherapy had significantly more problems with flatulence and diarrhoea (p < 0.05 to p < 0.001). In conclusion, patients who underwent treatment for gynaecological cancer reported long-term side effects also many years after finishing treatment. The problems where related to treatment modality which should be considered, especially when planning adjuvant treatment.

  • 211.
    Carlsson, Maria
    et al.
    Department of Gynecological Oncology, University Hospital, Uppsala, Sweden.
    Strang, Peter M.
    How patients with gynecological cancer experience the information process1998In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 19, no 4, p. 192-201Article in journal (Refereed)
    Abstract [en]

    This qualitative study was designed to explore the kind of experiences women with a diagnosis of gynecological cancer have with regard to information given during their illness and how it could be improved. Data were collected through a semistructured interview which focused on the 24 women's experiences of the information given. The interviews were tape-recorded and transcribed verbatim for each participant, and analysed using a content analysis. Two main themes were revealed: to actively address questions, and the right to receive honest information. The results also include a short description on how information was offered, the patients' opinion of it and how the patients had sought information for themselves. When patients address questions they want honest answers. Some effort should also be made to identify patients who do not want information. If it is in accordance with the patient's and next-of-kin's wishes, efforts should be made to provide information at times when both can participate. Information given jointly to the patient and her family lessens the burden for the patient. In Sweden today, as a result of recent political decisions, caregivers must also consider the need to discuss economic issues.

  • 212.
    Carlsson, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Sophiahemmet Univ, Dept Hlth Promoting Sci, Stockholm, Sweden.
    Management of physical pain during induced second-trimester medical abortions: a cross-sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 11, no 1, p. 111-118Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to assess the methodological quality and describe recommendations for pain management in local clinical practice guidelines about induced second‐trimester medical abortions at Swedish university and county hospitals.

    Methods: In 2017, Swedish university and county hospitals that provided abortion care in the second trimester of pregnancy were contacted (n = 29), and guidelines from 25 were received (university: n = 6, county: n = 19). Guideline quality was assessed according to two systematic instruments. Recommendations were systematically assessed regarding frequency and tools for pain measurement, prophylactic pharmacologic treatment, as needed pharmacologic treatment and nonpharmacologic treatment.

    Results: Overall methodological quality was poor across both instruments, as the majority of the guidelines did not fulfil the investigated quality criteria. For pain measurements, no guideline recommended measurement frequency and four recommended specific measurement tools. Prophylactic pharmacologic treatment, described in 23 (92%) guidelines, included paracetamol (n = 23, 92%), anti‐inflammatory drugs (n = 23, 92%) and opioids (n = 18, 72%). As needed pharmacologic treatment, described in 23 (92%) guidelines, included anaesthetics (n = 21, 84%), opioids (n = 21, 84%) and paracetamol (n = 1, 4%). Recommendations for as needed anaesthetics included paracervical block (n = 21, 84%), epidural analgesia (n = 16, 64%) and inhalation of nitrous oxide (n = 5, 20%). Nonpharmacologic treatments were recommended in nine (36%) guidelines.

    Conclusions: The findings indicate that local clinical practice guidelines about induced second‐trimester medical abortions are of inadequate methodological quality and that a large majority lack recommendations concerning systematic pain measurements. Although most recommend prophylactic and as needed pharmacologic management, national inconsistencies exist in Sweden with regard to recommendations of epidural analgesia, nitrous oxide and nonpharmacologic methods. In Sweden, there is room for improvement in the development of these guidelines.

  • 213.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues2017In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 19, no 1, article id e8Article in journal (Refereed)
    Abstract [en]

    Background: Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites.

    Objective: Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations.

    Methods: We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues.

    Results: The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42).

    Conclusions: The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites.

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  • 214.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Sophiahemmet Univ, Box 5605, SE-11486 Stockholm, Sweden.
    Balbas, Banaz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Ersta Skondal Bracke Univ Coll, Dept Hlth Care Sci, Stockholm, Sweden.
    Written narratives from immigrants following a prenatal diagnosis: qualitative exploratory study2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 154Article in journal (Refereed)
    Abstract [en]

    Background

    Expectant parents often have optimistic expectations of the obstetric ultrasound examination and are unprepared for a diagnosis of foetal anomaly. Research that gives voice to the experiences of immigrants faced with a prenatal diagnosis is scarce, and there is a need for more exploratory research that provides insights into the experiences of these persons. The aim of this study was to explore narratives of experiences of immigrants with Arabic or Sorani interpreter needs when presented with a prenatal diagnosis of foetal anomaly.

    Methods

    A web-based tool with open-ended questions was distributed via Arabic and Kurdish non-profit associations and general women's associations in Sweden. Responses were received from six women and analysed with qualitative content analysis.

    Results

    The analysis resulted in three themes: (1) an unexpected hurricane of emotions, (2) trying to understand the situation though information in an unfamiliar language, and (3) being cared for in a country with accessible obstetric care and where induced abortion is legal.

    Conclusions

    Immigrant women described an unexpected personal tragedy when faced with a prenatal diagnosis of foetal anomaly, and emphasised the importance of respectful and empathic psychological support. Their experiences of insufficient and incomprehensible information call attention to the importance of tailored approaches and the use of adequate medical interpreting services. There is a need for more descriptive studies that investigate decision-making and preparedness for induced abortion among immigrants faced with a prenatal diagnosis.

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  • 215.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Landqvist, Mats
    Södertörn Univ, Sch Culture & Educ, Stockholm, Sweden.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Ersta Skondal Univ Coll, Dept Hlth Care Sci, Stockholm, Sweden.
    Communication of support and critique in Swedish virtual community threads about prenatal diagnoses of fetal anomalies2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 199Article in journal (Refereed)
    Abstract [en]

    Background: A prenatal diagnosis of a fetal anomaly involves acute grief and psychological distress. The Internet has the potential to provide virtual support following the diagnosis. The overall aim was to explore communication of support and critique in Swedish virtual community threads about prenatal diagnoses of fetal anomalies.

    Methods: Systematic searches in Google resulted in 117 eligible threads. Fifteen of these were purposefully selected and subjected to deductive content analysis.

    Results:The virtual support involved mainly emotional support (meaning units n = 1,992/3,688, 54 %) and was described as comforting and empowering. Posters with experience of a prenatal diagnosis appreciated the virtual support, including the opportunity to gain insight into other cases and to write about one’s own experience. Critique of the decision to continue or terminate the pregnancy occurred, primarily against termination of pregnancy. However, it was met with defense.

    Conclusions: Peer support, mainly emotional, is provided and highly appreciated in threads about prenatal diagnoses of a fetal anomaly. Critique of the decision to terminate the pregnancy occurs in virtual community threads about prenatal diagnoses, but the norm is to not question the decision. Future studies need to investigate if virtual peer support promotes psychosocial function following a prenatal diagnosis and what medium would be most suitable for these types of supportive structures.

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  • 216.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Melander Marttala, Ulla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Department of Women’s and Children’s Health, Karolinska Institutet.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Involvement of persons with lived experience of a prenatal diagnosis of congenital heart defect: An explorative study to gain insights into perspectives on future research2016In: Research Involvement and Engagement, E-ISSN 2056-7529, Vol. 2, no 35Article in journal (Refereed)
    Abstract [en]

    Background

    A prenatal diagnosis of a congenital heart defect in the fetus is a traumatic life event for pregnant women and their partners. Previous research indicates a need for research that takes steps to support these individuals following the diagnosis. Patient and public involvement is a proposed method of identifying relevant research topics, leading to patient-focused research protocols and relevant support interventions.The overarching aim of this study was to gain insights into relevant future research topics among persons faced with a prenatal diagnosis of congenital heart defect in the fetus.

    Methods

    One group of parents to prenatally diagnosed children with a congenital heart defect (n = 5) and one group of individuals with experience of termination of a pregnancy following a prenatal diagnosis of a congenital heart defect (n = 5) were purposefully recruited. Each group of representatives was involved in a face-to-face focus group discussion, analyzed through qualitative content analysis.

    Results

    The representatives suggested a need for future research that addresses informational support in the forms as supplemental written information or follow-up consultations. Moreover, interventions that offer emotional support were suggested, in the forms of peer support or additional professional psychosocial support.

    Conclusion

    Several interventions were suggested by patient representatives, indicating a need for multiple intervention studies to be conducted in the context of a prenatal diagnosis of a congenital heart defect in the fetus. We recommend that future studies test supplemental written information, follow-up consultations, peer support, and additional professionals psychosocial support following the diagnosis.

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  • 217.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Sophiahemmet Univ Coll, Stockholm, Sweden.;Swedish Red Cross Univ Coll, Huddinge, Sweden..
    Ulfsdottir, Hanna
    Sophiahemmet Univ Coll, Stockholm, Sweden.;Karolinska Univ Hosp, PO Pregnancy & Birth, Stockholm, Sweden..
    Waterbirth in low-risk pregnancy: An exploration of women's experiences2020In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, no 5, p. 1221-1231Article in journal (Refereed)
    Abstract [en]

    Aims To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths. Design A qualitative study. Methods Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015-October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N = 155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analysed with qualitative content analysis. Results Two themes were identified related to benefits: (a) physical benefits: the water eases labour progression while offering buoyancy and pain relief; and (b) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (a) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (b) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated. Conclusion Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water. Impact Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

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  • 218.
    Carlsson, Ylva
    et al.
    Center of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden..
    Sandström, Anna
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden..
    Bergman, Lina
    Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden..
    Conner, Peter
    Department of Women's Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden..
    Hansson, Stefan
    Department of Clinical Sciences Lund, Obstetrics and Gynecology, Lund University and Skåne University Hospital, Lund/Malmö, Sweden..
    Kublicka, Marius
    Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden..
    Görmüş, Uzay
    PerkinElmer Genomics, Stockholm, Sweden..
    Lindgren, Peter
    Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden..
    Oleröd, Göran
    Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden..
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Comparing the results from a Swedish pregnancy cohort using data from three automated placental growth factor immunoassay platforms intended for first-trimester preeclampsia prediction.2023In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, no 8, p. 1084-1091Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Risk evaluation for preeclampsia in early pregnancy allows identification of women at high risk. Prediction models for preeclampsia often include circulating concentrations of placental growth factor (PlGF); however, the models are usually limited to a specific PlGF method of analysis. The aim of this study was to compare three different PlGF methods of analysis in a Swedish cohort to assess their convergent validity and appropriateness for use in preeclampsia risk prediction models in the first trimester of pregnancy.

    MATERIAL AND METHODS: First-trimester blood samples were collected in gestational week 11+0 to 13+6 from 150 pregnant women at Uppsala University Hospital during November 2018 until November 2020. These samples were analyzed using the different PlGF methods from Perkin Elmer, Roche Diagnostics, and Thermo Fisher Scientific.

    RESULTS: There were strong correlations between the PlGF results obtained with the three methods, but the slopes of the correlations clearly differed from 1.0: PlGFPerkinElmer  = 0.553 (95% confidence interval [CI] 0.518-0.588) * PlGFRoche -1.112 (95% CI -2.773 to 0.550); r = 0.966, mean difference -24.6 (95% CI -26.4 to -22.8). PlGFPerkinElmer  = 0.673 (95% CI 0.618-0.729) * PlGFThermoFisher -0.199 (95% CI -2.292 to 1.894); r = 0.945, mean difference -13.8 (95% CI -15.1 to -12.6). PlGFRoche  = 1.809 (95% CI 1.694-1.923) * PlGFPerkinElmer +2.010 (95% CI -0.877 to 4.897); r = 0.966, mean difference 24.6 (95% CI 22.8-26.4). PlGFRoche  = 1.237 (95% CI 1.113-1.361) * PlGFThermoFisher +0.840 (95% CI -3.684 to 5.363); r = 0.937, mean difference 10.8 (95% CI 9.4-12.1). PlGFThermoFisher  = 1.485 (95% CI 1.363-1.607) * PlGFPerkinElmer +0.296 (95% CI -2.784 to 3.375); r = 0.945, mean difference 13.8 (95% CI 12.6-15.1). PlGFThermoFisher  = 0.808 (95% CI 0.726-0.891) * PlGFRoche -0.679 (95% CI -4.456 to 3.099); r = 0.937, mean difference -10.8 (95% CI -12.1 to -9.4).

    CONCLUSION: The three PlGF methods have different calibrations. This is most likely due to the lack of an internationally accepted reference material for PlGF. Despite different calibrations, the Deming regression analysis indicated good agreement between the three methods, which suggests that results from one method may be converted to the others and hence used in first-trimester prediction models for preeclampsia.

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  • 219.
    Castro, Rita Amiel
    et al.
    Univ Zurich, Inst Psychol, Dept Clin Psychol & Psychotherapy, Binzmuhlestr 14-26, CH-8050 Zurich, Switzerland..
    Kunovac Kallak, Theodora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Lager, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Ehlert, Ulrike
    Univ Zurich, Inst Psychol, Dept Clin Psychol & Psychotherapy, Binzmuhlestr 14-26, CH-8050 Zurich, Switzerland..
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Pregnancy-related hormones and COMT genotype: Associations with maternal working memory2021In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 132, article id 105361Article in journal (Refereed)
    Abstract [en]

    Women experience different degrees of subjective cognitive changes during pregnancy. The exact mechanism underlying these changes is unknown, although endocrine alterations and genetics may be contributing factors. We investigated whether multiple pregnancy-related hormones were associated with working memory function assessed with the Digit Span Test (DST) in late pregnancy. Moreover, we examined whether the catechol-Omethyltransferase (COMT) genotype, previously related to working memory, was an effect modifier in this association. In this population-based panel study, we recorded psychiatric history, medication use, socio-demographic characteristics, and psychological well-being, gathered blood and saliva samples, and administered the DST at gestational weeks 35-39 (N = 216). We conducted multivariate linear regressions with DST as outcome, with different hormones and COMT genotype, adjusting for covariates including maternal age, BMI, education, depressive symptoms, and parity. We repeated these analyses excluding women with elevated depressive symptoms. Higher DST total scores were associated with increased free estradiol concentrations (B = 0.01, p = 0.03; B = 0.01, p = 0.02) in all participants and in participants without depressive symptoms, respectively, whereas DST forward was positively associated with free estradiol only in women without depressive symptoms (B = 0.01, p = 0.04). Lower total testosterone concentrations (B = -0.03, p = 0.01) enhanced DST backward performance in non-depressed women. Maternal higher education was significantly associated with the DST subscales in all participants. No significant differences emerged when considering the COMT genotype. Our results suggest differential associations of free estradiol and total testosterone levels with working memory function in late pregnancy.

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  • 220.
    Catalano, Ralph
    et al.
    Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA USA.;Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA..
    Bruckner, Tim A.
    Univ Calif Irvine, Program Publ Hlth, Irvine, CA USA.;Univ Calif Irvine, Ctr Populat Inequal & Policy, Irvine, CA USA..
    Gemmill, Alison
    Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA..
    Casey, Joan A.
    Columbia Univ, Environm Hlth Sci, Mailman Sch Publ Hlth, New York, NY USA..
    Margerison, Claire
    Michigan State Univ, Epidemiol & Biostat, E Lansing, MI USA..
    Hartig, Terry
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Institute for Housing and Urban Research.
    A novel indicator of selection in utero2023In: EVOLUTION MEDICINE AND PUBLIC HEALTH, ISSN 2050-6201, Vol. 11, no 1, p. 244-250Article in journal (Refereed)
    Abstract [en]

    Background and objectives: Selection in utero predicts that population stressors raise the standard for how quickly fetuses must grow to avoid spontaneous abortion. Tests of this prediction must use indirect indicators of fetal loss in birth cohorts because vital statistics systems typically register fetal deaths at the 20th week of gestation or later, well after most have occurred. We argue that tests of selection in utero would make greater progress if researchers adopted an indicator of selection against slow-growing fetuses that followed from theory, allowed sex-specific tests and used readily available data. We propose such an indicator and assess its validity as a dependent variable by comparing its values among monthly birth cohorts before, and during, the first 10 months of the COVID-19 pandemic in Sweden.

    Methodology: We apply Box-Jenkins methods to 50 pre-pandemic birth cohorts (i.e., December 2016 through January 2020) and use the resulting transfer functions to predict counterfactual values in our suggested indicator for selection for ten subsequent birth cohorts beginning in February 2020. We then plot all 60 residual values as well as their 95% detection interval. If birth cohorts in gestation at the onset of the pandemic lost more slow-growing fetuses than expected from history, more than one of the last 10 (i.e. pandemic-exposed) residuals would fall below the detection interval.

    Results: Four of the last 10 residuals of our indicator for males and for females fell below the 95% detection interval.

    Conclusions and implications: Consistent with selection in utero, Swedish birth cohorts in gestation at the outset of the COVID-19 pandemic included fewer than expected infants who grew slowly in utero. Lay Summary Our findings suggest that the risk of spontaneously aborting a slow-growing fetus will increase during relatively stressful times.

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  • 221.
    Catalano, Ralph
    et al.
    School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
    Bruckner, Tim
    Program in Public Health and Center for Population, Inequality and Policy, University of California, Irvine, Irvine, CA, USA.
    Casey, Joan A.
    Environmental Health Sciences, Columbia University, New York, NY, USA.
    Gemmill, Alison
    Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
    Margerison, Claire
    Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA.
    Hartig, Terry
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Institute for Housing and Urban Research.
    Twinning during the pandemic: Evidence of selection in utero2021In: Evolution, Medicine, and Public Health, E-ISSN 2050-6201, Vol. 9, no 1, p. 374-382Article in journal (Refereed)
    Abstract [en]

    Background and objectives: The suspicion that a population stressor as profound as the COVID-19 pandemic would increase preterm birth among cohorts in gestation at its outset has not been supported by data collected in 2020. An evolutionary perspective on this circumstance suggests that natural selection in utero, induced by the onset of the pandemic, caused pregnancies that would otherwise have produced a preterm birth to end early in gestation as spontaneous abortions. We test this possibility using the odds of a live-born twin among male births in Norway as an indicator of the depth of selection in birth cohorts.

    Methodology: We apply Box-Jenkins methods to 50 pre-pandemic months to estimate counterfactuals for the nine birth cohorts in gestation in March 2020 when the first deaths attributable to SARS-CoV-2 infection occurred in Norway. We use Alwan and Roberts outlier detection methods to discover any sequence of outlying values in the odds of a live-born twin among male births in exposed birth cohorts.

    Results: We find a downward level shift of 27% in the monthly odds of a twin among male births beginning in May and persisting through the remainder of 2020.

    Conclusions and implications: Consistent with evolutionary theory and selection in utero, birth cohorts exposed in utero to the onset of the COVID-19 pandemic yielded fewer male twins than expected.

    Lay Summary: Our finding of fewer than expected male twin births during the onset of the COVID-19 pandemic provides more evidence that evolution continues to affect the characteristics and health of contemporary populations.

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  • 222.
    Cato, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Breastfeeding – Initiation, duration, attitudes and experiences2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to increase knowledge about factors that influence breastfeeding initiation and duration, as well as about women’s attitudes towards breastfeeding during pregnancy.

    The first two studies were a part of the UPPSAT project, a population-based cohort study conducted in Uppsala, Sweden. The women answered questionnaires five days, six weeks and six months postpartum, including questions on breastfeeding initiation and duration. Eight hundred and seventy-nine women and 679 women were included in the first study (Paper I) and second study (Paper II), respectively. The third study (Paper III) was part of the BASIC study, a large cohort following women from pregnancy and up to one year postpartum. In BASIC, the women completed web-questionnaires, and 1217 women participated during mid-pregnancy and postpartum. The fourth study (Paper IV) was part of a qualitative project, “Narratives of breastfeeding”, and included 11 women, interviewed individually in late pregnancy.

    The prevalence of the hands-on approach was 38%. Women who received the hands-on approach were more likely to report a negative experience of the first breastfeeding session (Paper I). Seventy-seven percent of the women reported exclusive breastfeeding up to, at least, two months postpartum. Being a first-time mother, reporting emotional distress during pregnancy, and giving birth by cesarean section were factors independently associated with exclusive breastfeeding lasting less than two months postpartum (Paper II). Women with depressive symptoms during pregnancy who breastfed for the first time later than two hours postpartum had the highest odds of not breastfeeding exclusively at six weeks postpartum (Paper III). When pregnant women thought about their future breastfeeding, they were balancing between social norms and personal desires (Paper IV).

    These results can help to develop clinical practice to improve women’s experience of the first breastfeeding session. Additionally, the results may facilitate identifying women in need for targeted support, in order to promote longer exclusive breastfeeding duration. By acknowledging pregnant women’s thoughts and attitudes about breastfeeding, breastfeeding information and support, health care professionals can meet the needs and desires of women.

     

    List of papers
    1. Experience of the First Breastfeeding Session in Association with the Use of the Hands-On Approach by Healthcare Professionals: A Population-Based Swedish Study
    Open this publication in new window or tab >>Experience of the First Breastfeeding Session in Association with the Use of the Hands-On Approach by Healthcare Professionals: A Population-Based Swedish Study
    2014 (English)In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 9, no 6, p. 294-300Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of this study was to investigate the prevalence of healthcare professionals' use of the hands-on approach during the first breastfeeding session postpartum and its possible association with the mothers' experience of their first breastfeeding session. Materials and Methods: This was a population-based longitudinal study conducted at Uppsala University Hospital, Uppsala, Sweden, of all women giving birth at the hospital from May 2006 to June 2007. Six months postpartum, a questionnaire including questions regarding breastfeeding support, caregiving routines, depressive symptoms, and the woman's experience of the first breastfeeding session was sent to the mothers. The main outcome measures were use of the hands-on approach during the first breastfeeding session and the mother's experience of the breastfeeding session. Results: In total, 879 women participated in the study. Thirty-eight percent of the women received the hands-on approach during the first breastfeeding session. High body mass index, primiparity, and having the first breastfeeding session postponed were all independently associated with the hands-on approach. Women who received the hands-on approach were more likely to report a negative experience of the first breastfeeding session (odds ratio = 4.48; 95% confidence interval, 2.57-7.82), even after adjustment for possible confounders (odds ratio = 2.37; 95% confidence interval, 1.02-5.50). Conclusions: This study indicates that the hands-on approach is commonly used during the first breastfeeding session and is associated with a more negative experience of the first breastfeeding session. Consequently, caregivers need to question the use of this method, and further research about breastfeeding support is required.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-229427 (URN)10.1089/bfm.2014.0005 (DOI)000338135200005 ()
    Available from: 2014-08-08 Created: 2014-08-07 Last updated: 2023-09-07Bibliographically approved
    2. Risk factors for exclusive breastfeeding lasting less than two months-Identifying women in need of targeted breastfeeding support
    Open this publication in new window or tab >>Risk factors for exclusive breastfeeding lasting less than two months-Identifying women in need of targeted breastfeeding support
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    2017 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 6, article id e0179402Article in journal (Refereed) Published
    Abstract [en]

    Background: Breastfeeding rates in Sweden are declining, and it is important to identify women at risk for early cessation of exclusive breastfeeding.

    Objective: The aim of this study was to investigate factors associated with exclusive breastfeeding lasting less than two months postpartum.

    Methods: A population-based longitudinal study was conducted at Uppsala University Hospital, Sweden. Six hundred and seventy-nine women were included in this sub-study. Questionnaires were sent at five days, six weeks and six months postpartum, including questions on breastfeeding initiation and duration as well as several other background variables. The main outcome measure was exclusive breastfeeding lasting less than two months postpartum. Multivariable logistic regression analysis was used in order to calculate adjusted Odds Ratios (AOR) and 95% Confidence Intervals (95% CI).

    Results: Seventy-seven percent of the women reported exclusive breastfeeding at two months postpartum. The following variables in the multivariate regression analysis were independently associated with exclusive breastfeeding lasting less than two months postpartum: being a first time mother (AOR 2.15, 95% CI 1.32 +/- 3.49), reporting emotional distress during pregnancy (AOR 2.21, 95% CI 1.35 +/- 3.62) and giving birth by cesarean section (AOR 2.63, 95% CI 1.34 +/- 5.17).

    Conclusions: Factors associated with shorter exclusive breastfeeding duration were determined. Identification of women experiencing emotional distress during pregnancy, as well as scrutiny of caregiving routines on cesarean section need to be addressed, in order to give individual targeted breastfeeding support and promote longer breastfeeding duration.

    Place, publisher, year, edition, pages
    PUBLIC LIBRARY SCIENCE, 2017
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-329674 (URN)10.1371/journal.pone.0179402 (DOI)000403280900048 ()28614419 (PubMedID)
    Funder
    Swedish Research Council, 523-2014-2342Marianne and Marcus Wallenberg Foundation, MMW2011.0115Åke Wiberg Foundation
    Available from: 2017-09-19 Created: 2017-09-19 Last updated: 2021-06-14Bibliographically approved
    3. Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding 6 weeks postpartum: a longitudinal population-based study
    Open this publication in new window or tab >>Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding 6 weeks postpartum: a longitudinal population-based study
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    (English)In: Article in journal (Refereed) Submitted
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-348654 (URN)
    Available from: 2018-04-16 Created: 2018-04-16 Last updated: 2018-04-19
    4. Breastfeeding as a balancing act: pregnant Swedish women’s voices on breastfeeding
    Open this publication in new window or tab >>Breastfeeding as a balancing act: pregnant Swedish women’s voices on breastfeeding
    2020 (English)In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 15, article id 16Article in journal (Refereed) Published
    Abstract [en]

    Background: Breastfeeding provides health benefits to both women and children. The rationale behind an individual woman's decision to breastfeed or not can depend on several factors, either independently or in combination. The aim of the current study was to explore attitudes towards breastfeeding among pregnant women in Sweden who intend to breastfeed.

    Methods: Eleven mothers-to-be, one of whom had previous breastfeeding experience, participated in the study. The women were interviewed either by telephone or face-to-face during late pregnancy, with the aim of exploring their attitudes towards breastfeeding. A semi-structured interview-guide was used, and the transcripts of the interviews were analyzed using thematic analysis. The social ecological model of health is the theory-based framework underpinning this study. The model provides a comprehensive approach to understanding the factors that influence breastfeeding intention.

    Results: When interviewed during pregnancy, women described breastfeeding as a balancing act between societal norms and personal desires. The women perceived a societal pressure to breastfeed, however it was accompanied by boundaries and mixed messages. This perceived pressure was balanced by their own knowledge of breastfeeding, in particular their knowledge of other women's experience of breastfeeding. When envisioning their future breastfeeding, the women made uncertain and preliminary plans, and negotiated the benefits and drawbacks of breastfeeding. There was a wish for individual breastfeeding support and information.

    Conclusions: Pregnant Swedish women perceive their future breastfeeding as a balancing act between societal norms and personal desires. These findings suggest that while discussing breastfeeding during pregnancy, it could be of interest to collect information from pregnant women on their knowledge of breastfeeding and from where they have gained this knowledge, since stories from family and friends may make them question their own capacity to breastfeed. A thorough review of the woman's experiences and attitudes of breastfeeding is important in order to offer the best evidence-based breastfeeding support.

    National Category
    Nursing
    Identifiers
    urn:nbn:se:uu:diva-348655 (URN)10.1186/s13006-020-00257-0 (DOI)000519017900001 ()32138725 (PubMedID)
    Funder
    Swedish Research Council
    Available from: 2018-04-16 Created: 2018-04-16 Last updated: 2020-04-06Bibliographically approved
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  • 223.
    Cato, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The first breastfeeding session: studies on caregivers' support and breastfeeding duration2015Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Abstract

    Cato, K. 2015 The first breastfeeding session: studies on caregivers’ support and breastfeeding duration. 33pp. Uppsala. ISBN 978-91-506-2494-6

     

    It is well-known that the first breastfeeding session can be essential for breastfeeding duration. The hands-on approach given by health care professionals, where health care professionals touch the woman’s breast and the baby in order to stimulate latch on and breastfeeding, has been described as awkward and disturbing.

     

    The aim of this thesis was to increase knowledge on the first breastfeeding session postpartum, as to frequency and experience of the hands-on approach, and possible correlates of shorter breastfeeding duration.

     

    Questionnaires were sent five days, six weeks and six months postpartum, including questions regarding breastfeeding initiation and duration. Eight hundred and fifty-four women and 679 women were included in Study I and Study II, respectively.

     

    The prevalence of the hands-on approach was 38%. Women who received the hands-on approach were more likely to report a negative experience of the first breastfeeding session (Study I). Seventy-seven percent of the women reported exclusive breastfeeding at two months postpartum. Being a first time mother, reporting emotional distress during pregnancy and giving birth by cesarean section were factors independently associated with exclusive breastfeeding less than two months postpartum (Study II).

     

    These results can help to develop clinical practice, in order to improve women’s experience of the first breastfeeding session and identifying women in need of targeted, individualized support, to be able to promote longer exclusive breastfeeding duration.

     

    List of papers
    1. Experience of the First Breastfeeding Session in Association with the Use of the Hands-On Approach by Healthcare Professionals: A Population-Based Swedish Study
    Open this publication in new window or tab >>Experience of the First Breastfeeding Session in Association with the Use of the Hands-On Approach by Healthcare Professionals: A Population-Based Swedish Study
    2014 (English)In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 9, no 6, p. 294-300Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of this study was to investigate the prevalence of healthcare professionals' use of the hands-on approach during the first breastfeeding session postpartum and its possible association with the mothers' experience of their first breastfeeding session. Materials and Methods: This was a population-based longitudinal study conducted at Uppsala University Hospital, Uppsala, Sweden, of all women giving birth at the hospital from May 2006 to June 2007. Six months postpartum, a questionnaire including questions regarding breastfeeding support, caregiving routines, depressive symptoms, and the woman's experience of the first breastfeeding session was sent to the mothers. The main outcome measures were use of the hands-on approach during the first breastfeeding session and the mother's experience of the breastfeeding session. Results: In total, 879 women participated in the study. Thirty-eight percent of the women received the hands-on approach during the first breastfeeding session. High body mass index, primiparity, and having the first breastfeeding session postponed were all independently associated with the hands-on approach. Women who received the hands-on approach were more likely to report a negative experience of the first breastfeeding session (odds ratio = 4.48; 95% confidence interval, 2.57-7.82), even after adjustment for possible confounders (odds ratio = 2.37; 95% confidence interval, 1.02-5.50). Conclusions: This study indicates that the hands-on approach is commonly used during the first breastfeeding session and is associated with a more negative experience of the first breastfeeding session. Consequently, caregivers need to question the use of this method, and further research about breastfeeding support is required.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-229427 (URN)10.1089/bfm.2014.0005 (DOI)000338135200005 ()
    Available from: 2014-08-08 Created: 2014-08-07 Last updated: 2023-09-07Bibliographically approved
    2. Risk factors of exclusive breastfeeding less than two months: identifying women in need of targeted breastfeeding support
    Open this publication in new window or tab >>Risk factors of exclusive breastfeeding less than two months: identifying women in need of targeted breastfeeding support
    Show others...
    (English)Article in journal (Other academic) Submitted
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-268114 (URN)
    Available from: 2015-12-02 Created: 2015-12-02 Last updated: 2016-06-21
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  • 224.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindbäck, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Risk factors of exclusive breastfeeding less than two months: identifying women in need of targeted breastfeeding supportArticle in journal (Other academic)
  • 225.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sylvén, Sara M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Georgakis, Marios K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Univ Athens, Dept Hyg Epidemiol & Med Stat, Athens, Greece.
    Kollia, Natasa
    Harokopio Univ, Sch Hlth Sci & Educ, Dept Nutr & Dietet, Athens, Greece.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding six weeks postpartum: a longitudinal population-based study2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 49Article in journal (Refereed)
    Abstract [en]

    Background

    Depressive symptoms negatively impact on breastfeeding duration, whereas early breastfeeding initiation after birth enhances the chances for a longer breastfeeding period. Our aim was to investigate the interplay between depressive symptoms during pregnancy and late initiation of the first breastfeeding session and their effect on exclusive breastfeeding at six weeks postpartum.

    Methods

    In a longitudinal study design, web-questionnaires including demographic data, breastfeeding information and the Edinburgh Postnatal Depression Scale (EPDS) were completed by 1217 women at pregnancy weeks 17–20, 32 and/or at six weeks postpartum. A multivariable logistic regression model was fitted to estimate the effect of depressive symptoms during pregnancy and the timing of the first breastfeeding session on exclusive breastfeeding at six weeks postpartum.

    Results

    Exclusive breastfeeding at six weeks postpartum was reported by 77% of the women. Depressive symptoms during pregnancy (EPDS> 13); (OR:1.93 [1.28–2.91]) and not accomplishing the first breastfeeding session within two hours after birth (OR: 2.61 [1.80–3.78]), were both associated with not exclusively breastfeeding at six weeks postpartum after adjusting for identified confounders. Τhe combined exposure to depressive symptoms in pregnancy and late breastfeeding initiation was associated with an almost 4-fold increased odds of not exclusive breastfeeding at six weeks postpartum.

    Conclusions

    Women reporting depressive symptoms during pregnancy seem to be more vulnerable to the consequences of a postponed first breastfeeding session on exclusive breastfeeding duration. Consequently, women experiencing depressive symptoms may benefit from targeted breastfeeding support during the first hours after birth.

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  • 226.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Experience of the First Breastfeeding Session in Association with the Use of the Hands-On Approach by Healthcare Professionals: A Population-Based Swedish Study2014In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 9, no 6, p. 294-300Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to investigate the prevalence of healthcare professionals' use of the hands-on approach during the first breastfeeding session postpartum and its possible association with the mothers' experience of their first breastfeeding session. Materials and Methods: This was a population-based longitudinal study conducted at Uppsala University Hospital, Uppsala, Sweden, of all women giving birth at the hospital from May 2006 to June 2007. Six months postpartum, a questionnaire including questions regarding breastfeeding support, caregiving routines, depressive symptoms, and the woman's experience of the first breastfeeding session was sent to the mothers. The main outcome measures were use of the hands-on approach during the first breastfeeding session and the mother's experience of the breastfeeding session. Results: In total, 879 women participated in the study. Thirty-eight percent of the women received the hands-on approach during the first breastfeeding session. High body mass index, primiparity, and having the first breastfeeding session postponed were all independently associated with the hands-on approach. Women who received the hands-on approach were more likely to report a negative experience of the first breastfeeding session (odds ratio = 4.48; 95% confidence interval, 2.57-7.82), even after adjustment for possible confounders (odds ratio = 2.37; 95% confidence interval, 1.02-5.50). Conclusions: This study indicates that the hands-on approach is commonly used during the first breastfeeding session and is associated with a more negative experience of the first breastfeeding session. Consequently, caregivers need to question the use of this method, and further research about breastfeeding support is required.

  • 227.
    Cea-Soriano, Lucia
    et al.
    Spanish Ctr Pharmacoepidemiol Res CEIFE, Madrid, Spain.;Univ Complutense Madrid, Fac Med, Dept Prevent Med & Publ Hlth, Madrid, Spain..
    Wallander, Mari-Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Garcia Rodriguez, Luis Alberto
    Spanish Ctr Pharmacoepidemiol Res CEIFE, Madrid, Spain..
    Prescribing patterns of combined hormonal products containing cyproterone acetate, levonorgestrel and drospirenone in the UK2016In: Journal of family planning and reproductive health care, ISSN 1471-1893, E-ISSN 2045-2098, Vol. 42, no 4, p. 247-+Article in journal (Refereed)
    Abstract [en]

    Background There are limited data to show the levels of prescribing of combined oral contraceptives (COCs) and other hormonal products containing estrogen/progestogen combinations that may be outside the product licence. Aims To determine the diagnosis/indication recorded at the time of prescription of cyproterone acetate/ethinylestradiol (CPA/EE) and two COCs, levonorgestrel/EE (LNG/EE) and drospirenone/EE (DRSP/EE). Design and setting Retrospective study using a primary care database, The Health Improvement Network (THIN). Methods Women in THIN aged 12-49 years prescribed CPA/EE, LNG/EE or DRSP/EE in 2002-2010 were identified. Overall use of each product and proportion of new users each year were determined. Among new users, database codes were analysed to infer the reason for prescription. Results The proportion of new users of each product in 2002 and 2010, respectively, were: LNG/EE, 2.03% and 2.40%; CPA/EE, 0.45% and 0.27%; and DRSP/EE, 0.27% and 0.56%. Most new users prescribed CPA/EE had a record of acne (51.0% and 79.2% in 2002 and 2010, respectively) or hirsutism (3.0% and 5.0% in 2002 and 2010, respectively); the proportion of new users with a record only for contraception decreased from 32.9% in 2002 to 8.6% in 2010. Among new users prescribed DRSP/EE or LNG/EE in 2010, 43.2% and 30.8% of women, respectively, did not have a record indicating use for contraception. Conclusions Adherence to prescribing guidelines for CPA/EE has improved over time. A substantial proportion of women using DRSP/EE or LNG/EE had records for hormone-responsive conditions only, suggesting that many women were prescribed these therapies for non-contraceptive use.

  • 228.
    Cederholm, Maria
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Consequences of amniocentesis and chorionic villus sampling for prenatal diagnosis2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Amniocentesis (AC) and chorionic villus sampling (CVS) are the principal methods for fetal karyotyping. The aim of this thesis was to evaluate psychological reactions and risks associated with the procedures.

    A semi-randomised study was made on 321 women, where AC (147) and CVS (174) at 10-13 weeks’ gestation were done trans-abdominally. Spontaneous fetal loss occurred in 6.8% and 1.7% of the women in the AC and CVS groups, respectively. Repeat testing was required more often in the AC (19.0%) than in the CVS (5.2%) group.

    A subgroup of 94 women answered a questionnaire prior to the procedure. Anxiety was stated as reason for invasive testing in 38% of the women. Mean scores according to the Hospital Anxiety and Depression Scale for anxiety and depression were low. Likewise, mean scores for the Impact of Event Scale, evaluating the psychological distress evoked by the procedure, were low. Yet, a number of women had higher scores, indicating a risk of clinical anxiety and depression or psychological distress. The women worried most about miscarriage, fetal injury by the procedure and waiting for the result.

    Fetal, infant and maternal outcomes were evaluated in a cohort of 71 586 women aged 35 to 49 years old, with single births in Sweden during 1991 to 1996. Altogether, 21 748 were exposed to AC and 1984 to CVS. Women exposed to AC and CVS were compared with non-exposed. Outcomes were extracted from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register, and the Swedish Malformation Register. An increased risk of musculo-skeletal deformities, such as club foot (OR=1.45) and hip dislocation (OR=1.22), and respiratory disturbances such as neonatal pneumonia (OR=1.29), was found for infants born in the AC group. Risk increased with earlier gestation at the procedure. Fewer women in the AC group had a normal delivery and more had a Caesarean section. Complications related to the amniotic cavity and membranes (OR=1.15), hypotonic uterine dysfunction (OR=1.12) and instrumental vaginal deliveries (OR=1.11) were more common in the AC group. No significant differences were found for the CVS group.

    CVS is the method of choice for prenatal karyotyping in the first trimester. AC should not be performed before 15 weeks’ gestation. Further research to develop methods to better identify women at increased risk of chromosomal abnormal pregnancies and to develop non-invasive tests for prenatal diagnosis is needed. Thereby, the number of women exposed to invasive procedures and the adverse effects caused by these procedures can be minimised.

    List of papers
    1. A prospective comparative study on transabdominal chorionic villus sampling and amniocentesis performed at 10-13 weeks' gestation
    Open this publication in new window or tab >>A prospective comparative study on transabdominal chorionic villus sampling and amniocentesis performed at 10-13 weeks' gestation
    1997 In: Prenatal Diagnosis, Vol. 17, no 4, p. 311-317Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-89630 (URN)
    Available from: 2002-02-11 Created: 2002-02-11Bibliographically approved
    2. Women's knowledge, concerns and psychological reactions before undergoing an invasive procedure for prenatal karyotyping
    Open this publication in new window or tab >>Women's knowledge, concerns and psychological reactions before undergoing an invasive procedure for prenatal karyotyping
    1999 In: Ultrasound Obstet Gynecol, Vol. 14, p. 267-72Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-89631 (URN)
    Available from: 2002-02-11 Created: 2002-02-11Bibliographically approved
    3. Infant morbidity following amniocentesis and chorionic villus sampling for prenatal karyotyping
    Open this publication in new window or tab >>Infant morbidity following amniocentesis and chorionic villus sampling for prenatal karyotyping
    Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-89632 (URN)
    Available from: 2002-02-11 Created: 2002-02-11Bibliographically approved
    4. Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping
    Open this publication in new window or tab >>Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping
    Article in journal (Refereed) Submitted
    Identifiers
    urn:nbn:se:uu:diva-89633 (URN)
    Available from: 2002-02-11 Created: 2002-02-11Bibliographically approved
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  • 229.
    Cederlund, Frida
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Desmond, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Amini, Hashem
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Neuroradiologi.
    Magnetic resonance imaging in the second trimester as a complement to ultrasound for diagnosis of fetal anomalies2024In: Acta Radiologica Open, E-ISSN 2058-4601, Vol. 13, no 5, article id 20584601241248820Article in journal (Refereed)
    Abstract [en]

    Background

    Fetal ultrasound has limitations, especially if the patient is obese or in cases with oligohydramnios. Magnetic resonance imaging (MRI) can then be used as a complement, but only few studies have focused on examinations in the second trimester.

    Purpose

    To validate MRI as a complement to diagnose fetal anomalies in the second trimester.

    Material and Methods

    This retrospective study retrieved data from January 2008 to July 2012 from the Fetal Medicine Unit and Department of Radiology at Uppsala University Hospital. Ultrasound and MRI findings were reviewed in 121 fetuses in relation to the final diagnosis, including postpartum follow-up and autopsy results.

    Results

    Of the 121 fetuses, 51 (42%) had a CNS anomaly and 70 (58%) a non-CNS anomaly diagnosed or suspected. MRI provided additional information in 21% of all cases without changing the management and revealed information that changed the management of the pregnancy in 13%. When a CNS anomaly was detected or suspected, the MRI provided additional information in 22% and changed the management in 10%. The corresponding figures for non-CNS cases were 21% and 16%, respectively. The proportion of cases with additional information that changed the management was especially high in patients with a BMI >30 kg/m2 (25%) and in patients with oligohydramnios (38%). In five cases in category III, false-positive ultrasound findings were identified.

    Conclusions

    MRI in the second trimester complements ultrasound and improves diagnosis of fetal CNS- and non-CNS anomalies especially when oligohydramnios or maternal obesity is present.

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  • 230.
    Cederlöf, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lundgren, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Christersson, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Pregnancy Complications and Risk of Cardiovascular Disease Later in Life: A Nationwide Cohort Study2022In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 11, no 2, article id e023079Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the associations between pregnancy complications and cardiovascular mortality and hospitalizations of cardiovascular disease (CVD) after adjustment for major confounding.

    Methods and Results: In a nationwide register‐based cohort study, women with singleton births between 1973 and 2014 were included from the Swedish Medical Birth Register. Outcomes of mortality and hospitalizations of CVD were collected from the Cause of Death Register and the National Inpatient Register. The cohort was followed from the date of the first delivery until death or end of follow‐up, whichever occurred first. The pregnancy complications studied were preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, small for gestational age, and stillbirth. Among the 2 134 239 women (mean age at first pregnancy, 27.0 [SD, 5.1] and mean parity 1.96 [SD, 0.9]), 19.1% (N=407 597) had 1 of the studied pregnancy complications. All pregnancy complications were associated with all‐cause and cardiovascular mortality and hospitalization for CVD (ischemic heart disease, ischemic stroke, and peripheral artery disease) after adjustment for major confounding in a Cox proportional hazard regression model. The adjusted hazard ratio for cardiovascular mortality was 1.84 (95% CI, 1.38–2.44) for preterm birth and 3.14 (95% CI, 1.81–5.44) for stillbirth.

    Conclusions: In this large cohort study, pregnancy complications were associated with all‐cause mortality, cardiovascular mortality, and hospitalizations for CVD, also after adjusting for confounding, including overweight, smoking, and comorbidities. The study highlights that less established pregnancy complications such as preterm birth and stillbirth are also associated with cardiovascular mortality and CVD.

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  • 231.
    Cederlöf, Elin Täufer
    et al.
    Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden.
    Lager, Susanne
    Department of Women's and Children's Health Uppsala Univers.
    Larsson, Anders
    Department of Medical Sciences, Clinical Chemistry Uppsala University Uppsala Sweden.
    Sundström Poromaa, Inger
    Department of Women's and Children's Health Uppsala University Uppsala Sweden.
    Lindahl, Bertil
    Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden;Uppsala Clinical Research Center Uppsala University Uppsala Sweden.
    Wikström, Anna‐Karin
    Department of Women's and Children's Health Uppsala University Uppsala Sweden.
    Christersson, Christina
    Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden.
    Biomarkers associated with cardiovascular disease in women with spontaneous preterm birth: A case–control study2024In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 103, no 5, p. 970-979Article in journal (Refereed)
  • 232.
    Cesta, Carolyn E.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12a, S-17177 Stockholm, Sweden..
    Johansson, Anna L. V.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12a, S-17177 Stockholm, Sweden..
    Hreinsson, Julius
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Reprod Med, Stockholm, Sweden..
    Rodriguez-Wallberg, Kenny A.
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Reprod Med, Stockholm, Sweden.;Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden..
    Olofsson, Jan I.
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Reprod Med, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Holte, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Carl von Linne Clin, Uppsala, Sweden ; Univ Agr Sci Uppsala, Ctr Reprod Biol Uppsala, Uppsala, Sweden; Uppsala Univ, Uppsala, Sweden..
    Wramsby, Håkan
    St Gorans Sjukhus, IVF Kliniken Stockholm, Stockholm, Sweden..
    Wramsby, Margareta
    Fertilitetsctr Stockholm, Stockholm, Sweden..
    Cnattingius, Sven
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden..
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Iliadou, Anastasia Nyman
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12a, S-17177 Stockholm, Sweden..
    A prospective investigation of perceived stress, infertility-related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 258-268Article in journal (Refereed)
    Abstract [en]

    Introduction

    Women undergoing fertility treatment experience high levels of stress. However, it remains uncertain if and how stress influences in vitro fertilization (IVF) cycle outcome. This study aimed to investigate whether self-reported perceived and infertility-related stress and cortisol levels were associated with IVF cycle outcomes.

    Material and methods

    A prospective cohort of 485 women receiving fertility treatment was recruited from September 2011 to December 2013 and followed until December 2014. Data were collected by online questionnaire prior to IVF start and from clinical charts. Salivary cortisol levels were measured. Associations between stress and cycle outcomes (clinical pregnancy and indicators of oocyte and embryo quality) were measured by logistic or linear regression, adjusted for age, body mass index, education, smoking, alcohol and caffeine consumption, shiftwork and night work.

    Results

    Ultrasound verified pregnancy rate was 26.6% overall per cycle started and 32.9% per embryo transfer. Stress measures were not associated with clinical pregnancy: when compared with the lowest categories, the adjusted odds ratio (OR) and 95% confidence interval (CI) for the highest categories of the perceived stress score was 1.04 (95% CI 0.58-1.87), infertility-related stress score was OR = 1.18 (95% CI 0.56-2.47), morning and evening cortisol was OR = 1.18 (95% CI 0.60-2.29) and OR = 0.66 (95% CI 0.34-1.30), respectively.

    Conclusions

    Perceived stress, infertility-related stress, and cortisol levels were not associated with IVF cycle outcomes. These findings are potentially reassuring to women undergoing fertility treatment with concerns about the influence of stress on their treatment outcome.

  • 233. Cesta, Carolyn E
    et al.
    Viktorin, Alexander
    Olsson, Henrik
    Johansson, Viktoria
    Sjölander, Arvid
    Bergh, Christina
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Nygren, Karl-Gösta
    Cnattingius, Sven
    Iliadou, Anastasia N
    Depression, anxiety, and antidepressant treatment in women: association with in vitro fertilization outcome2016In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 105, no 6, p. 1594-U285Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate associations between depression, anxiety, and antidepressants before in vitro fertilization (IVF) and IVF cycle outcomes, including pregnancy, live birth, and miscarriage.

    DESIGN: Nationwide register-based cohort study.

    SETTING: Not applicable.

    PATIENT(S): Nulliparous women undergoing their first IVF cycle recorded in the Swedish Quality Register of Assisted Reproduction, January 2007 to December 2012 (n = 23,557).

    INTERVENTION(S): Not applicable.

    MAIN OUTCOME MEASURE(S): Associations between diagnoses of depression/anxiety, antidepressants, and IVF cycle outcome evaluated using logistic regression to produce adjusted odds ratios (AOR) and 95% confidence intervals (CI).

    RESULT(S): In total, 4.4% of women had been diagnosed with depression/anxiety and/or dispensed antidepressants before their IVF first cycle. The odds for pregnancy and live birth were decreased (n = 1,044; AOR = 0.86; 95% CI, 0.75-0.98; and AOR = 0.83; 95% CI, 0.72-0.96, respectively). For women with a prescription for a selective serotonin reuptake inhibitor (SSRI) only (n = 829), no statistically significant associations were found. Women with non-SSRI antidepressants (n = 52) were at reduced odds of pregnancy (AOR = 0.41; 95% CI, 0.21-0.80) and live birth (AOR = 0.27; 95% CI, 0.11-0.68). Women with a depression/anxiety diagnosis with no antidepressant (n = 164) also had reduced odds of pregnancy (AOR = 0.58; 95% CI, 0.41-0.82) and live birth (AOR = 0.60; 95% CI, 0.41-0.89). Among the women who became pregnant (39.7%), there were no statistically significant associations between exposure and miscarriage except for the women taking non-SSRI antidepressants (AOR = 3.56; 95% CI, 1.06-11.9).

    CONCLUSION(S): A diagnosis of depression/anxiety and/or treatment with antidepressants before IVF was slightly associated with reduced odds of pregnancy and live birth. Women with the presence of depression/anxiety without antidepressants had a more pronounced reduction in odds, implying that the underlying disorder is important for the observed association.

  • 234.
    Chaireti, Roza
    et al.
    Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm.
    Lindahl, Tomas L
    Department of Clinical and Experimental Medicine , Linköping University , Linköping.
    Byström, Birgitta
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology , Karolinska Institutet , Stockholm.
    Bremme, Katarina
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology , Karolinska Institutet , Stockholm.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Inflammatory and endothelial markers during the menstrual cycle.2016In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 76, no 3, p. 190-194Article in journal (Refereed)
    Abstract [en]

    Background The menstrual cycle exhibits a pattern of repeated inflammatory activity. The present study aims to evaluate inflammatory and endothelial markers during the two phases of a menstrual cycle.

    Methods The study cohort consisted of 102 women with regular menstrual cycles. Inflammatory and endothelial markers (interleukin-6 [IL-6], pentraxin-3 [PTX-3], hs-C reactive protein [hs-CRP], sE-selectin, sP-selectin, intracellular and vascular cell adhesion molecules [ICAM-1 and VCAM-1] and cathepsins L, B and S) were measured during the early follicular and the late luteal phase of a normal menstrual cycle.

    Results Pentraxin-3 (PTX-3) and hs-CRP were significantly higher during the follicular phase compared to the luteal phase (p < 0.001 respectively p = 0.025). The other inflammatory and endothelial markers, with the exception of cathepsin B, were higher, albeit not significantly, during the follicular phase.

    Conclusions Inflammatory activity, expressed mainly by members of the pentraxin family, is higher during the early follicular compared to the luteal phase. This could be associated to menstruation but the exact mechanisms behind this pattern are unclear and might involve the ovarian hormones or an effect on hepatocytes.

  • 235. Chapman, L
    et al.
    Sharma, M
    Papalampros, P
    Gambadauro, Pietro
    Polyzos, D
    Papadopoulos, N
    A new technique for temporary ovarian suspension - Temporarily displacing the ovaries anterior to the uterus facilitates pelvic side wall access in the laparoscopic treatment of endometriosis2007In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 196, no 5, p. 494.e1-3Article in journal (Refereed)
  • 236.
    Cheng, Liqin
    et al.
    Karolinska Inst, Ctr Translat Microbiome Res CTMR, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden..
    Kazmierczak, Dominika
    Karolinska Inst, Dept Oncol & Pathol, Stockholm, Sweden..
    Norenhag, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive biology.
    Hamsten, Marica
    Karolinska Inst, Ctr Translat Microbiome Res CTMR, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden..
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Karolinska Inst, Ctr Translat Microbiome Res CTMR, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden.
    Schuppe-Koistinen, Ina
    Karolinska Inst, Ctr Translat Microbiome Res CTMR, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden.;Karolinska Inst, Sci Life Lab, Stockholm, Sweden..
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive biology.
    Engstrand, Lars
    Karolinska Inst, Ctr Translat Microbiome Res CTMR, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden.;Karolinska Inst, Sci Life Lab, Stockholm, Sweden..
    Hydbring, Per
    Karolinska Inst, Dept Oncol & Pathol, Stockholm, Sweden..
    Du, Juan
    Karolinska Inst, Ctr Translat Microbiome Res CTMR, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden..
    A MicroRNA Gene Panel Predicts the Vaginal Microbiota Composition2021In: mSystems, E-ISSN 2379-5077, Vol. 6, no 3, article id e00175-21Article in journal (Refereed)
    Abstract [en]

    The vaginal microbiota plays an essential role in vaginal health. The vaginas of many reproductive-age women are dominated by one of the Lactobacillus species. However, the vaginas of a large number of women are characterized by the colonization of several other anaerobes. Notably, some women with the non-Lactobacillus-dominated vaginal microbiota develop bacterial vaginosis, which has been correlated with sexually transmitted infections and other adverse outcomes. However, interactions and mechanisms linking the vaginal microbiota to host response are still under investigation. There are studies suggesting a link between human microRNAs and gut microbiota, but limited analysis has been carried out on the interplay of microRNAs and vaginal microbiota. In this study, we performed a microRNA expression array profiling on 67 vaginal samples from young Swedish women. MicroRNAs were clustered into distinct groups according to vaginal microbiota composition. Interestingly, 182 microRNAs were significantly elevated in their expression in the non-Lactobacillus-dominated community, suggesting an antagonistic relationship between Lactobacillus and microRNAs. Of the elevated microRNAs, 10 microRNAs displayed excellent diagnostic potential, visualized by receiver operating characteristics analysis. We further validated our findings in 34 independent samples where expression of top microRNA candidates strongly separated the Lactobacillus-dominated community from the non-Lactobacillus-dominated community in the vaginal microbiota. Notably, the Lactobacillus crispatus-dominated community showed the most profound differential microRNA expression compared with the non-Lactobacillus-dominated community. In conclusion, we demonstrate a strong relationship between the vaginal microbiota and numerous genital microRNAs, which may facilitate a deeper mechanistic interplay in this biological niche. IMPORTANCE Vaginal microbiota is correlated with women's health, where a non-Lactobacillus-dominated community predisposes women to a higher risk of disease, including human papillomavirus (HPV). However, the molecular relationship between the vaginal microbiota and host is largely unexplored. In this study, we investigated a link between the vaginal microbiota and host microRNAs in a group of young women. We uncovered an inverse correlation of the expression of microRNAs with the abundance of Lactobacillus species in the vaginal microbiota. Particularly, the expression of microRNA miR-23a-3p and miR-130a-3p, displaying significantly elevated levels in non-Lactobacillus-dominated communities, predicted the bacterial composition of the vaginal microbiota in an independent validation group. Since targeting of microRNAs is explored in the clinical setting, our results warrant investigation of whether microRNA modulation could be used for treating vaginosis recurrence and vaginosis-related diseases. Conversely, commensal bacteria could be used for treating diseases with microRNA aberrations.

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  • 237.
    Cheng, Liqin
    et al.
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Norenhag, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive biology.
    Hu, Yue O. O.
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Brusselaers, Nele
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Ährlund-Richter, Andreas
    Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
    Guðnadóttir, Unnur
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Angelidou, Pia
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Zha, Yinghua
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Hamsten, Marica
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Schuppe-Koistinen, Ina
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden; Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive biology.
    Engstrand, Lars
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden; Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden.
    Du, Juan
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden.
    Vaginal microbiota and human papillomavirus infection among young Swedish women2020In: npj Biofilms and Microbiomes, E-ISSN 2055-5008, Vol. 6, no 1, article id 39Article in journal (Refereed)
    Abstract [en]

    Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases. To define the HPV-associated microbial community among a high vaccination coverage population, we carried out a cross-sectional study with 345 young Swedish women. The microbial composition and its association with HPV infection, including 27 HPV types, were analyzed. Microbial alpha-diversity was found significantly higher in the HPV-infected group (especially with oncogenic HPV types and multiple HPV types), compared with the HPV negative group. The vaginal microbiota among HPV-infected women was characterized by a larger number of bacterial vaginosis-associated bacteria (BVAB), Sneathia, Prevotella, and Megasphaera. In addition, the correlation analysis demonstrated that twice as many women with non-Lactobacillus-dominant vaginal microbiota were infected with oncogenic HPV types, compared with L. crispatus-dominated vaginal microbiota. The data suggest that HPV infection, especially oncogenic HPV types, is strongly associated with a non-Lactobacillus-dominant vaginal microbiota, regardless of age and vaccination status.

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  • 238.
    Chiavaroli, Valentina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health). Liggins Institute, University of Auckland, Auckland, New Zealand.
    Cutfield, Wayne S
    Liggins Institute, University of Auckland, Auckland, New Zealand.
    Derraik, José G. B.
    Liggins Institute, University of Auckland, Auckland, New Zealand.
    Pan, Zengxiang
    Liggins Institute, University of Auckland, Auckland, New Zealand.
    Ngo, Sherry
    Liggins Institute, University of Auckland, Auckland, New Zealand.
    Sheppard, Allan
    Liggins Institute, University of Auckland, Auckland, New Zealand.
    Craigie, Susan
    Liggins Institute, University of Auckland, Auckland, New Zealand.
    Stone, Peter
    Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
    Sadler, Lynn
    National Women's Health, Auckland District Health Board, Auckland, New Zealand.
    Ahlsson, Fredrik
    Liggins Institute, University of Auckland, New Zealand.
    Infants born large-for-gestational-age display slower growth in early infancy, but no epigenetic changes at birth2015In: Scientific Reports, E-ISSN 2045-2322, Vol. 5, article id 14540Article in journal (Refereed)
    Abstract [en]

    We evaluated the growth patterns of infants born large-for-gestational-age (LGA) from birth to age 1 year compared to those born appropriate-for-gestational-age (AGA). In addition, we investigated possible epigenetic changes associated with being born LGA. Seventy-one newborns were classified by birth weight as AGA (10(th)-90(th) percentile; n = 42) or LGA (>90(th) percentile; n = 29). Post-natal follow-up until age 1 year was performed with clinical assessments at 3, 6, and 12 months. Genome-wide DNA methylation was analysed on umbilical tissue in 19 AGA and 27 LGA infants. At birth, LGA infants had greater weight (p < 0.0001), length (p < 0.0001), ponderal index (p = 0.020), as well as greater head (p < 0.0001), chest (p = 0.044), and abdominal (p = 0.007) circumferences than AGA newborns. LGA infants were still larger at the age of 3 months, but by age 6 months there were no more differences between groups, due to higher length and weight increments in AGA infants between 0 and 6 months (p < 0.0001 and p = 0.002, respectively). Genome-wide analysis showed no epigenetic differences between LGA and AGA infants. Overall, LGA infants had slower growth in early infancy, being anthropometrically similar to AGA infants by 6 months of age. In addition, differences between AGA and LGA newborns were not associated with epigenetic changes.

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  • 239.
    Chisari, Claudia
    et al.
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Psychol Sect, London, England..
    McCracken, Lance
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Cruciani, Federico
    Ulster Univ, Sch Comp, Belfast, Antrim, North Ireland..
    Moss-Morris, Rona
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Psychol Sect, London, England..
    Scott, Whitney
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Psychol Sect, London, England.;Guys & St Thomas NHS Fdn Trust, INPUT Pain Management Unit, London, England..
    Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online2022In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 23, p. 15-30Article in journal (Refereed)
    Abstract [en]

    Introduction: Vulvodynia is a condition characterised by persistent vulval pain and includes particular impacts on sexual and emotional functioning. Acceptance and Commitment Therapy (ACT) has been successfully applied in persistent pain but has not been tested in this population. This single-case experimental design (SCED) study aimed to evaluate whether an online ACT programme improves clinical outcomes in women with Vulvodynia. We also evaluated whether the intervention led to changes in hypothesised processes of therapeutic change.

    Methods: This study applied a nonconcurrent multiple baseline SCED method to assess ACT in women with Vulvodynia. During baseline and treatment phases, participants completed daily self-report outcomes of pain severity and interference, sexual functioning and satisfaction, depression, and hypothesised process-variables: pain-acceptance, present-moment-awareness, committed-action, perceived injustice, and body-exposure anxiety during sexual activities. Full-length assessments of these variables were also completed before and after treatment. The intervention comprised a six-week online ACT programme, combined with a Vulvodynia-specific manual. Visual and statistical analyses were conducted.

    Results: Seven participants, mostly with mixed Vulvodynia, provided baseline and treatment phase data, and completed the intervention and diaries. Based on the visual inspection, and Tau and Tau-U values as effect sizes from the daily data, all participants showed moderate size improvements in two or more outcomes. However, participants had highly individual treatment effects. Limited improvement was found in depression. Pain acceptance, committed-action, and perceived injustice also demonstrated change for some participants.

    Discussion: The results suggest online ACT may improve pain and sexual outcomes for some women with Vulvodynia. Pain-acceptance, committed-action, and perceived injustice are highlighted as potential processes of change for some participants. In general, responses to treatment appear highly individual. Further application of the SCED approach to ACT for Vulvodynia is recommended.

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  • 240.
    Chisari, Claudia
    et al.
    Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College, London, London, UK.
    Monajemi, Mani B
    Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College, London, London, UK.
    Scott, Whitney
    Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College, London, London, UK; INPUT Pain Management Unit, NHS Foundation Trust, London, UK.
    Moss-Morris, Rona
    Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College, London, London, UK.
    McCracken, Lance
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Psychosocial factors associated with pain and sexual function in women with Vulvodynia: A systematic review.2021In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 25, no 1, p. 39-50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Vulvodynia is a prevalent chronic vulval pain condition affecting 10%-28% of women, and significantly impacting their health and quality of life. It is currently poorly understood and biomedical treatments achieve only modest benefits for pain and sexual functioning. A wider psychosocial conceptualization of this condition may improve outcomes. There is currently no coherent understanding of how psychosocial factors may contribute to outcomes in Vulvodynia. The aim of this review is to identify and systematically review psychosocial factors associated with pain and sexual outcomes and to inform a psychosocial model of Vulvodynia.

    DATABASES AND DATA TREATMENT: Observational/experimental studies reporting on the association between psychosocial factors and pain/sexual outcomes in adult women with Vulvodynia were eligible. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. Twenty-one studies were included, all focused on women with Provoked Vestibulodynia (PVD). Most of the studies were low-to-medium quality.

    RESULTS/CONCLUSION: A range of general/pain-related distress and avoidance processes, and sex/intimacy avoidance or engagement processes were significantly associated with pain, sexual functioning or sexual distress and sexual satisfaction, supporting the role of a psychosocial approach to PVD. Depression, anxiety, catastrophizing, pain-anxiety, pain acceptance, body-exposure anxiety, attention to sexual cues, partner hostility and solicitousness, self-efficacy and penetration cognitions are highlighted as potentially important treatment targets in PVD. Due to the limited data available, developing a psychosocial model was not possible. Directions for future research include examining the replicability and generalizability of the factors identified, exploring differences/similarities across Vulvodynia subsets and testing tailored theoretically based treatments.

    SIGNIFICANCE: The systematic review highlights the role of psychosocial factors associated with pain and sexual functioning in Vulvodynia. The review findings reveal that Vulvodynia presents both similar and unique cognitive, behavioural and interpersonal features compared to other chronic pain conditions. There may be important roles for negative sexual cues, body image-related factors during intercourse, partner factors, self-efficacy beliefs and penetration cognitions, in relation to pain and sexual functioning.

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  • 241.
    Chowdhury, Nishat Nailah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mother's weight gain during pregnancy and its effect on the gene expression of lipoprotein lipase in the placenta2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    It has been found in previous studies that there is a correlation between the placenta regulatory genes and the weight gain of the mother, Body Mass Index (BMI) as well as the birthweight of the fetus. When the mother gains weight / is overweight, this will affect the gene expression in the placenta, and in turn this triggers the weight gain of the fetus. The aim of the study was to investigate the correlation between the lipoprotein lipase gene and the mother's BMI, weight gain and the child's birth weight by extracting RNA from the placentas and analysing its quality and concentration. cDNA was generated from RNA using reverse transcription and gene expression was amplified using real-time PCR. The data from real-time PCR was used in the comparative Ct-method to calculate a 2˄(-ΔΔCt)-value which represents the RNA-level of the LPL-gene. Lastly this value was analysed by using the two-statistic methods, Pearson's rank correlation and Spearman's correlation, which showed that the value of the correlation coefficient for all the variables was close to the value of zero. The closer the value is to zero, the weaker the association becomes between the different variables. The correlation was 0.045, 0.112 and 0.044 for the child's birth weight, mother's BMI respective weight gain. The results from this study shows that there is no correlation between LPL and the mother's weight gain, BMI, or the child's birth weight.

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  • 242. Chuong, Nguyen Canh
    et al.
    Duc, Duong Minh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Reproductive Health, Hanoi University of Public Health, Hanoi, Vietnam.
    Anh, Nguyen Duy
    Vui, Le Thi
    Cuong, Le Pham Sy
    Duong, Doan Thi Thuy
    Ha, Bui Thi Thu
    Amniocentesis test uptake for congenital defects: Decision of pregnant women in Vietnam2018In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 39, no 4, p. 493-504Article in journal (Refereed)
    Abstract [en]

    Our study aimed to identify the knowledge, attitude, and factors associated with uptake of amniocentesis test amongst pregnant women of advanced maternal age (35+ years old). A cross-sectional survey was performed on 481 participants in 2016. Women with higher educational attainment, higher income level, having a baby with congenital defects, and women with better knowledge and/or attitude about amniocentesis test were more likely to accept the test. Our study suggested the importance of counseling for women and more time should be given for them to absorb information before they make their decision to uptake the amniocentesis test.

  • 243.
    Ciray, H N
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Fu, X
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ahlsen, G
    Shuman, C
    Lindblom, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ulmsten, U
    Presence and localization of connexins 43 and 26 in cell cultures derived from myometrial tissues from nonpregnant and pregnant women and from leiomyomas2000In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 182, no 4, p. 926-930Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Our objective was to study the appearance and distribution of connexins 43 and 26 in various human myometrial cell cultures.

    STUDY DESIGN:

    Scrape loading, Western blotting, and immunohistochemical techniques were applied to cultured cells derived from myometrial tissues obtained from nonpregnant and pregnant women (upper and lower uterine segments) and from leiomyomas (tumor and analogous myometrial tissues).

    RESULTS:

    Scrape loading revealed the presence of metabolic coupling in all tissues. Indirect immunohistochemical studies showed membrane localization of connexin 43 in all myometrial cultures. Western blots and indirect immunohistochemical studies showed the presence and localization of the connexin 26 protein and associated gap junctions in tissues from myomas and from nonpregnant and pregnant women except for those derived from the upper segment of the pregnant uterus.

    CONCLUSION:

    These results show that human myometrial cultures express various gap junction proteins and that there are regional differences in expression of connexins in tissues from pregnant women.

  • 244.
    Clausson, Britt
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Risk factors and adverse pregnancy outcomes in small-for-gestational-age births2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The studies were undertaken to evaluate risk factors and outcomes in small-for-gestational-age (SGA) births, in cohort studies using the population-based Swedish Birth, Twin and Education Registers. A cohort study of pregnant women from Uppsala County evaluated the effect on birthweight by caffeine.

    Maternal anthropometrics influence risks of SGA at all gestational ages. Smoking increases risks of moderately preterm and term SGA, while hypertensive disorders foremost increase the risk of preterm SGA. Monozygotic twin mothers have higher concordance rates in offspring birthweight-for-gestational length than dizygotic twin mothers, indicating genetic effects on fetal growth. Caffeine is not associated with a reduction in birthweight or birthweight-for-gestational age.

    The increased risk of stillbirth in postterm pregnancies is explained by increased rates of SGA in postterm pregnancies. Births with malformations account for a large part of the SGA-related increased risk of infant death. SGA, as defined by an individualised birth-weight standard, is a better predictor of adverse pregnancy outcomes than the commonly used population-based birthweight standard.

    Risk factors for SGA, as well as the prognosis for the SGA infant, vary with gestational age. However, the commonly used definition of SGA is probably a poor predictor of intrauterine growth retardation.

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  • 245.
    Cleeve, Amanda
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Karolinska Univ Hosp, WHO Ctr Human Reprod, Stockholm, Sweden..
    Oguttu, Monica
    Kisumu Med & Educ Trust, Kisumu, Kenya..
    Ganatra, Bela
    WHO, Dept Reprod Hlth & Res, Geneva, Switzerland..
    Atuhairwe, Susan
    Makerere Univ, Coll Hlth Sci, Mulago Hosp, Dept Obstet & Gynecol, Kampala, Uganda.;Makerere Univ, Coll Hlth Sci, Dept Obstet & Gynaecol, Kampala, Uganda..
    Larsson, Elin C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Makenzius, Marlene
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth, Stockholm, Sweden.;Univ Nairobi, Coll Hlth Sci, Sch Nursing, Kenyatta Natl Hosp, Nairobi, Kenya..
    Klingberg-Allvin, Marie
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Paul, Mandira
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kakaire, Othman
    Makerere Univ, Coll Hlth Sci, Mulago Hosp, Dept Obstet & Gynecol, Kampala, Uganda.;Makerere Univ, Coll Hlth Sci, Dept Obstet & Gynaecol, Kampala, Uganda..
    Faxelid, Elisabeth
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth, Stockholm, Sweden..
    Byamugisha, Josaphat
    Makerere Univ, Coll Hlth Sci, Mulago Hosp, Dept Obstet & Gynecol, Kampala, Uganda.;Makerere Univ, Coll Hlth Sci, Dept Obstet & Gynaecol, Kampala, Uganda..
    Gemzell-Danielsson, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Karolinska Univ Hosp, WHO Ctr Human Reprod, Stockholm, Sweden..
    Time to act-comprehensive abortion care in east Africa2016In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 4, no 9, p. E601-E602Article in journal (Other academic)
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  • 246. Cleverly, K
    et al.
    Gambadauro, Pietro
    Navaratnarajah, R
    Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis: have you checked the ovaries?2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 7, p. 712-5Article in journal (Refereed)
  • 247.
    Cluver, C. A.
    et al.
    Stellenbosch Univ, Dept Obstet & Gynaecol, Francie van Zyl Dr, ZA-7505 Cape Town, South Africa;Mercy Hosp Women, Mercy Perinatal, Melbourne, Vic, Australia; Univ Melbourne, Translat Obstet Grp, Melbourne, Vic, Australia.
    Charles, W.
    Stellenbosch Univ, Dept Obstet & Gynaecol, Cape Town, South Africa.
    van der Merwe, C.
    Stellenbosch Univ, Dept Psychiat, Cape Town, South Africa; Tygerberg Hosp, Cape Town, South Africa.
    Bezuidenhout, H.
    Tygerberg Hosp, Cape Town, South Africa; Stellenbosch Univ, Dept Biomed Sci, Div Mol Biol & Human Genet, Cape Town, South Africa.
    Nel, D.
    Stellenbosch Univ, Ctr Stat Consultat, Stellenbosch, South Africa.
    Groenewald, C.
    Stellenbosch Univ, Dept Obstet & Gynaecol, Cape Town, South Africa.
    Brink, L.
    Stellenbosch Univ, Dept Obstet & Gynaecol, Cape Town, South Africa.
    Hesselman, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Bergman, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Stellenbosch Univ, Dept Obstet & Gynaecol, Cape Town, South Africa; Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Obstet & Gynaecol, Gothenburg, Sweden.
    Odendaal, H.
    Stellenbosch Univ, Dept Obstet & Gynaecol, Cape Town, South Africa.
    The association of prenatal alcohol exposure on the cognitive abilities and behaviour profiles of 4-year-old children: a prospective cohort study2019In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 126, no 13, p. 1588-1597Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the association of prenatal alcohol exposure (PAE) on cognitive abilities and behaviour profiles of 4‐year‐old children.

    Design: Prospective cohort study.

    Setting: Cape Town, South Africa.

    Population: A cohort of 500 children.

    Methods: Children from the Safe Passage Study, which prospectively collected PAE, were included. Cognition and behavioural profiles were assessed. Children with and without PAE were compared. Mean scores were compared, with P ≤ 0.05 considered significant. Results were adjusted for confounding factors.

    Main outcome measures: The Kaufman Assessment Battery for children measured intellectual and mental ability; the NEPSY‐II instrument assessed neurocognitive performance. The caregiver completed the Preschool Child Behaviour checklist to rate the child’s problem behaviours and competencies.

    Results: Two hundred children had no PAE, 117 children had mild to moderate PAE (with no binge episodes), 113 children had heavy PAE (with one or two binge episodes), and 70 children had very heavy PAE (with three or more binge episodes). Women who binge drank had significantly higher rates of smoking, marijuana use, and methamphetamine use. Low to moderate PAE had no effect on cognitive ability and behaviour. Very heavy PAE was associated with problems performing simultaneous as well as sequential functions, lower scores in the language and sensorimotor domain, and more attention and pervasive developmental problems.

    Conclusions: Low to moderate PAE was not associated with cognitive processing or developmental problems. Women who had many binge drinking episodes during pregnancy were the most at risk for cognitive processing, neurocognitive, and behaviour problems in their children at 4 years of age.

    Tweetable abstract: Low to moderate prenatal alcohol use was not associated with cognitive or behavioural problems in 4‐year‐olds.

     

  • 248.
    Comasco, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neuro-psycho-pharmacology.
    Hellgren, Chorlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Poromaa, Inger Sundström
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pregnancy, anxiety symptoms and catecholaminergic genotype are associated with prepulse inhibition of the startle response in women2015In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 25, p. S216-S216Article in journal (Other academic)
  • 249.
    Comasco, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health. Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Comasco: Neuropsychopharmacology.
    Kallner, Helena Kopp
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, Stockholm, Sweden..
    Bixo, Marie
    Umeå Univ, Dept Clin Sci, Umeå, Sweden..
    Hirschberg, Angelica L.
    Karolinska Univ Hosp, Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Gynecol & Reprod Med, Stockholm, Sweden..
    Nyback, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    De Grauw, Haro
    Epperson, C. Neill
    Univ Colorado, Sch Med, Dept Psychiat, Aurora, CO USA..
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Ulipristal Acetate for Treatment of Premenstrual Dysphoric Disorder: A Proof-of-Concept Randomized Controlled Trial2021In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 178, no 3, p. 256-265Article in journal (Refereed)
    Abstract [en]

    Objective: Premenstrual dysphoric disorder (PMDD) is a common mood disorder, characterized by distressing affective, behavioral, and somatic symptoms in the late luteal phase of the menstrual cycle. The authors investigated continuous treatment with a selective progesterone receptor modulator, ulipristal acetate (UPA), as a potential treatment for PMDD. Methods: The authors conducted an investigator-initiated, multicenter, double-blind, randomized, parallel-group clinical trial in which women with PMDD (N=95) were treated with either 5 mg/day of UPA or placebo during three 28-day treatment cycles. The primary outcome was the change in premenstrual total score on the Daily Record of Severity of Problems (DRSP) from baseline to end of treatment. DRSP scores were captured by daily ratings using a smartphone application and were analyzed with linear mixed models for repeated measures. Results: The mean improvement in DR SP score after 3 months was 41% (SD=18) in the UPA group, compared with 22% (SD=27) in the placebo group (mean difference 18%; 95% CI = -29, -8). Treatment effects were also noted for the DRSP depressive symptom subscale (42% [SD=22]compared with 22% [SD=32]) and the DRSP anger/irritability subscale (47% ISD=21) compared with 23% (SD=35I), but not for the DRSP physical symptom subscale. Remission based on DRSP score was attained by 20 women in the UPA group (50.0%) and eight women in the placebo group (21.1%) (a statistically significant difference). Conclusions: If these results are replicated, UPA could be a useful treatment for PMDD, particularly for the psychological symptoms associated with the disorder.

  • 250.
    Cruickshank, Tess
    et al.
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    MacDonald, Teresa M.
    Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Walker, Susan P.
    Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Keenan, Emerson
    Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    Dane, Kirsten
    Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Middleton, Anna
    Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Kyritsis, Valerie
    Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Myers, Jenny
    Univ Manchester, St Marys Hosp, Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England..
    Cluver, Catherine
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia.;Univ Stellenbosch, Tygerberg Hosp, Dept Obstet & Gynecol, Cape Town, South Africa..
    Hastie, Roxanne
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Bergman, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Univ Stellenbosch, Tygerberg Hosp, Dept Obstet & Gynecol, Cape Town, South Africa.;Sahlgrenska Acad Univ Gothenburg, Dept Obstet, Gothenburg, Sweden.;Sahlgrenska Acad Univ Gothenburg, Inst Clin Sci, Gothenburg, Sweden..
    Garcha, Damanpreet
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    Cannon, Ping
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    Murray, Elizabeth
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    Nguyen, Tuong-Vi
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    Hiscock, Richard
    Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia..
    Pritchard, Natasha
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Hannan, Natalie J.
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Tong, Stephen
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Kaitu'u-Lino, Tu'uhevaha J.
    Mercy Hosp Women, Translat Obstet Grp, Heidelberg, Vic, Australia.;Mercy Hosp Women, Dept Obstet & Gynaecol, Heidelberg, Vic, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia..
    Circulating Growth Differentiation Factor 15 Is Increased Preceding Preeclampsia Diagnosis: Implications as a Disease Biomarker2021In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 10, no 16, article id e020302Article in journal (Refereed)
    Abstract [en]

    Background We investigated the biomarker potential of growth differentiation factor 15 (GDF-15), a stress response protein highly expressed in placenta, to predict preeclampsia. Methods and Results In 2 prospective cohorts (cohort 1: 960 controls, 39 women who developed preeclampsia; cohort 2: 950 controls, 41 developed preeclampsia), plasma concentrations of GDF-15 at 36 weeks' gestation were significantly increased among those who developed preeclampsia (P<0.001), area under the receiver operating characteristic curves (AUC) of 0.66 and 0.71, respectively. In cohort 2 a ratio of sFlt-1/PlGF (a clinical biomarker for preeclampsia) had a sensitivity of 61.0% at 83.2% specificity to predict those who will develop preeclampsia (AUC of 0.79). A ratio of GDF-15xsFlt-1/PlGF yielded a sensitivity of 68.3% at 83.2% specificity (AUC of 0.82). GDF-15 was consistently elevated across a number of international cohorts: levels were higher in placenta and blood from women delivering <34 weeks' gestation due to preterm preeclampsia in Melbourne, Australia; and in the blood at 26 to 32 weeks' gestation among 57 women attending the Manchester Antenatal Vascular Service (MAViS, UK) who developed preeclampsia (P=0.0002), compared with 176 controls. In the Preeclampsia Obstetric adVerse Events biobank (PROVE, South Africa), plasma GDF-15 was significantly increased in women with preeclampsia with severe features (P=0.02; n=14) compared to controls (n=14). Conclusions We conclude circulating GDF-15 is elevated among women more likely to develop preeclampsia or diagnosed with the condition. It may have value as a clinical biomarker, including the potential to improve the sensitivity of sFlt-1/PlGF ratio.

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