Asthma is the most common chronic disease during pregnancy. Maternal asthma has been associated with a multitude of unwanted pregnancy outcomes, in some studies also with neurodevelopmental disorders. Here we investigated associations between maternal asthma and neurodevelopmental disorders.
Material and Methods
We studied a retrospective population-based cohort of 1 271 439 mother–child pairs from singleton live births in Finland between the years 1996–2018. We used multiple high-cover registers for data collection. Adjusted unconditional Cox regression models were used to investigate associations between maternal asthma, asthma medication used during pregnancy, and offspring's neurodevelopmental disorder diagnoses.
Results
We identified 106 163 mother–child pairs affected by maternal asthma. We found that maternal asthma was associated with offspring neurodevelopmental disorders, but the differences in absolute prevalence between the control and exposure groups were small. Attention-deficit hyperactivity disorder (ADHD) was found in 4114 (3.9%) offspring with maternal asthma and in 32 122 (3.0%) controls (adjusted hazard ratio (HR): 1.49; 95% CI 1.44–1.54); autism in 1617 (1.5%) offspring vs 13 701 (1.3%) controls (HR: 1.33; 95% CI 1.26–1.40); motor-developmental disorder in 1569 (1.5%) offspring vs 12 147 (1.1%) controls (HR: 1.37; 95% CI 1.30–1.45); language disorder in 3057 (2.9%) offspring vs 28 421 (2.7%) controls (HR: 1.13; 95% CI 1.08–1.17), learning disabilities in 849 (0.8%) offspring vs 6534 (0.6%) controls (HR: 1.51; 95% CI 1.41–1.62); mixed developmental disorder in 1633 (1.5%) offspring vs 14 434 (1.3%) controls (HR 1.20; 95% CI, 1.14–1.26); and intellectual disability in 908 (0.9%) vs 9155 (0.9%) controls (HR: 1.12; 95% CI 1.04–1.20). No substantial differences were found between allergic and non-allergic asthma phenotypes, and neither allergic tendency nor respiratory infection was associated with a similar likelihood of neurodevelopmental disorders.
Conclusions
Maternal asthma and allergic and non-allergic phenotypes showed weak associations with the offspring's neurodevelopmental disorders. The association is concerned especially with learning disabilities, ADHD, motor development, and autism.
导言哮喘是孕期最常见的慢性疾病。孕产妇哮喘与多种不良妊娠结局有关，在一些研究中还与神经发育障碍有关。在此，我们研究了孕产妇哮喘与神经发育障碍之间的关系：我们对 1996-2018 年间芬兰单胎活产的 1 271 439 对母子进行了基于人群的回顾性队列研究。我们使用多个高覆盖率登记册收集数据。我们使用调整后的无条件 Cox 回归模型来研究母亲哮喘、孕期使用的哮喘药物和后代神经发育障碍诊断之间的关联：我们确定了 106 163 对母子受母亲哮喘影响。我们发现，母亲哮喘与后代神经发育障碍有关，但对照组和接触组之间的绝对患病率差异很小。在 4114 名（3.9%）患有母体哮喘的后代和 32 122 名（3.0%）对照组中发现了注意力缺陷多动障碍（ADHD）（调整后危险比（HR）：1.49；95% CI 1.44-1.54）；在 1617 名（1.5%）的后代与 13 701（1.3%）的对照（HR：1.33；95% CI 1.26-1.40）；1569（1.5%）的后代与 12 147（1.1%）的对照（HR：1.37；95% CI 1.30-1.45）；3057（3.0%）的后代患有语言障碍。45）；3057例（2.9%）后代与28 421例（2.7%）对照组相比出现语言障碍（HR：1.13；95% CI 1.08-1.17）；849例（0.8%）后代与6534例（0.6%）对照组相比出现学习障碍（HR：1.51；95% CI 1.41-1.62）；1569例（1.5%）后代与12 147例（1.1%）对照组相比出现混合发育障碍（HR：1.37；95% CI 1.30-1.45）。62）；1633 名（1.5%）后代与 14 434 名（1.3%）对照组相比出现混合发育障碍（HR 1.20；95% CI，1.14-1.26）；908 名（0.9%）后代与 9155 名（0.9%）对照组相比出现智力障碍（HR：1.12；95% CI 1.04-1.20）。过敏性哮喘表型与非过敏性哮喘表型之间没有实质性差异，过敏倾向或呼吸道感染都与神经发育障碍的相似可能性无关：结论：母体哮喘、过敏性和非过敏性表型与后代的神经发育障碍关系不大。这种关联尤其与学习障碍、多动症、运动发育和自闭症有关。
{"title":"Maternal asthma during pregnancy and the likelihood of neurodevelopmental disorders in offspring","authors":"Mari Kemppainen, Mika Gissler, Turkka Kirjavainen","doi":"10.1111/aogs.15008","DOIUrl":"10.1111/aogs.15008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Asthma is the most common chronic disease during pregnancy. Maternal asthma has been associated with a multitude of unwanted pregnancy outcomes, in some studies also with neurodevelopmental disorders. Here we investigated associations between maternal asthma and neurodevelopmental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We studied a retrospective population-based cohort of 1 271 439 mother–child pairs from singleton live births in Finland between the years 1996–2018. We used multiple high-cover registers for data collection. Adjusted unconditional Cox regression models were used to investigate associations between maternal asthma, asthma medication used during pregnancy, and offspring's neurodevelopmental disorder diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 106 163 mother–child pairs affected by maternal asthma. We found that maternal asthma was associated with offspring neurodevelopmental disorders, but the differences in absolute prevalence between the control and exposure groups were small. Attention-deficit hyperactivity disorder (ADHD) was found in 4114 (3.9%) offspring with maternal asthma and in 32 122 (3.0%) controls (adjusted hazard ratio (HR): 1.49; 95% CI 1.44–1.54); autism in 1617 (1.5%) offspring vs 13 701 (1.3%) controls (HR: 1.33; 95% CI 1.26–1.40); motor-developmental disorder in 1569 (1.5%) offspring vs 12 147 (1.1%) controls (HR: 1.37; 95% CI 1.30–1.45); language disorder in 3057 (2.9%) offspring vs 28 421 (2.7%) controls (HR: 1.13; 95% CI 1.08–1.17), learning disabilities in 849 (0.8%) offspring vs 6534 (0.6%) controls (HR: 1.51; 95% CI 1.41–1.62); mixed developmental disorder in 1633 (1.5%) offspring vs 14 434 (1.3%) controls (HR 1.20; 95% CI, 1.14–1.26); and intellectual disability in 908 (0.9%) vs 9155 (0.9%) controls (HR: 1.12; 95% CI 1.04–1.20). No substantial differences were found between allergic and non-allergic asthma phenotypes, and neither allergic tendency nor respiratory infection was associated with a similar likelihood of neurodevelopmental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal asthma and allergic and non-allergic phenotypes showed weak associations with the offspring's neurodevelopmental disorders. The association is concerned especially with learning disabilities, ADHD, motor development, and autism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"235-244"},"PeriodicalIF":3.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna Frykman, Emelie Nilsson, Eva Wiberg-Itzel, Tove Wallstrom
Introduction
Cesarean sections are increasing worldwide and are associated with altered risks of complications for both mother and child. Vaginal birth after cesarean section is associated with lower maternal and neonatal morbidity than in repeat cesarean section. Only a few studies have considered the indication for the previous cesarean section to be of importance for the outcome of subsequent labor. The aim of this study was to evaluate whether the indication for a previous cesarean section affects the outcomes at a subsequent delivery in women with induction of labor.
Material and Methods
This retrospective cohort study of the four largest delivery units in Stockholm during 2012–2015 included 1150 women with one previous cesarean section with induction of labor. Inclusion criteria: women with induced labor and a previous cesarean section, singleton pregnancy, cephalic presentation, gestational age of ≥34 weeks. The women were grouped by indication for the previous cesarean section. Primary outcome: mode of delivery (vaginal birth after previous cesarean section or repeat cesarean section). Secondary outcomes: induction to delivery time, postpartum hemorrhage, uterine rupture. Neonatal outcomes: birth weight, Apgar score <7, arterial umbilical cord blood gas pH <7.0.
Results
Our study found that the indication of labor dystocia at the previous cesarean section, increased the risk of repeat cesarean section (aOR 5.35; 95% CI: 1.64–17.50) in women with induction of labor. Other risk factors for repeat cesarean section were birth weight >4000 g, maternal BMI ≥30 or if vaginal prostaglandin was used as the method for induction of labor. A previous vaginal delivery and use of oxytocin increased the chance of a vaginal delivery in this group of women.
Conclusions
Our study showed that the indication for the previous cesarean section affects the outcome in the subsequent delivery in women with induction of labor. If the indication for the previous cesarean section was labor dystocia, the risk of repeat cesarean section was increased.
{"title":"May the indication for a previous cesarean section affect the outcome at trial of labor in women with induction of labor? A retrospective cohort study","authors":"Joanna Frykman, Emelie Nilsson, Eva Wiberg-Itzel, Tove Wallstrom","doi":"10.1111/aogs.15005","DOIUrl":"10.1111/aogs.15005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cesarean sections are increasing worldwide and are associated with altered risks of complications for both mother and child. Vaginal birth after cesarean section is associated with lower maternal and neonatal morbidity than in repeat cesarean section. Only a few studies have considered the indication for the previous cesarean section to be of importance for the outcome of subsequent labor. The aim of this study was to evaluate whether the indication for a previous cesarean section affects the outcomes at a subsequent delivery in women with induction of labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study of the four largest delivery units in Stockholm during 2012–2015 included 1150 women with one previous cesarean section with induction of labor. Inclusion criteria: women with induced labor and a previous cesarean section, singleton pregnancy, cephalic presentation, gestational age of ≥34 weeks. The women were grouped by indication for the previous cesarean section. Primary outcome: mode of delivery (vaginal birth after previous cesarean section or repeat cesarean section). Secondary outcomes: induction to delivery time, postpartum hemorrhage, uterine rupture. Neonatal outcomes: birth weight, Apgar score <7, arterial umbilical cord blood gas pH <7.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study found that the indication of labor dystocia at the previous cesarean section, increased the risk of repeat cesarean section (aOR 5.35; 95% CI: 1.64–17.50) in women with induction of labor. Other risk factors for repeat cesarean section were birth weight >4000 g, maternal BMI ≥30 or if vaginal prostaglandin was used as the method for induction of labor. A previous vaginal delivery and use of oxytocin increased the chance of a vaginal delivery in this group of women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study showed that the indication for the previous cesarean section affects the outcome in the subsequent delivery in women with induction of labor. If the indication for the previous cesarean section was labor dystocia, the risk of repeat cesarean section was increased.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"194-202"},"PeriodicalIF":3.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henriette Tautenhahn, Anne Dathan-Stumpf, Noura Kabbani, Holger Stepan, Massimiliano Lia
<div> <section> <h3> Introduction</h3> <p>Optimal counseling of women for vaginal breech birth requires consideration of both established and emerging risk factors for adverse perinatal outcomes. Currently, rising prevalences of maternal obesity and impaired glucose tolerance challenge obstetric care. We aimed to investigate the effects of these parameters on the outcome of vaginal breech birth to improve counseling practices.</p> </section> <section> <h3> Material and Methods</h3> <p>A total of 361 women (without previous vaginal births) attending vaginal birth of a singleton fetus in breech presesntation between 01/2015 and 11/2021 were included in this retrospective single-center study. Data were derived from the hospital data base. We analyzed the effect of the maternal body mass index (BMI) at birth (compared to pre-pregnancy BMI), excessive weight gain, gestational diabetes, and neonatal birthweight on obstetrical and neonatal short-term outcomes (intrapartum cesarean delivery, performance of obstetric maneuvers (Løvset-, Bracht-, Veit-Smellie maneuver and Bickenbach's arm delivery), admission to the neonatal unit, Apgar score after 5 minutes <7, and arterial cord pH-value <7.10). Multivariable logistic regression was used for analysis and adjustment of variables.</p> </section> <section> <h3> Results</h3> <p>Overall, 246 women (68.1%) had a successful vaginal birth. Intrapartum cesarean delivery (<i>n</i> = 115/361; 31.9%) was independently associated with maternal BMI at birth (<i>p</i> = 0.0283, aOR = 1.87 (1.19–3.97)) if birthweight was ≥3800 g. The rate of intrapartum cesarean delivery was also higher in women with gestational diabetes (<i>p</i> = 0.0030, aOR = 10.83 (2.41-60.84)). A significantly higher risk of neonatal acidosis (arterial pH-value <7.10) was observed in women with BMI at birth ≥30 kg/m<sup>2</sup> (<i>p</i> = 0.0345, aOR = 1.84 (1.04–3.22)) without affecting other outcomes. Pre-pregnancy BMI, gestational weight gain and BMI-gain did not significantly affect the obstetrical and neonatal birth outcomes.</p> </section> <section> <h3> Conclusions</h3> <p>When neonatal birthweight is ≥3800 g, maternal BMI at birth (<i>p</i> = 0.0283; aOR = 1.87 (1.19–3.97)) is independently associated with the rate of intrapartum cesarean delivery. However, pre-pregnancy BMI and BMI-gain during pregnancy were not associated with the need for intrapartum cesarean delivery or other adverse outcomes. Consequently, BMI at the time of birth could be more informative than pre-pregnancy BMI and may improve counseling of women attempting va
{"title":"The interplay of body mass index, gestational weight gain, and birthweight over 3800 g in vaginal breech birth: A retrospective study","authors":"Henriette Tautenhahn, Anne Dathan-Stumpf, Noura Kabbani, Holger Stepan, Massimiliano Lia","doi":"10.1111/aogs.15002","DOIUrl":"10.1111/aogs.15002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Optimal counseling of women for vaginal breech birth requires consideration of both established and emerging risk factors for adverse perinatal outcomes. Currently, rising prevalences of maternal obesity and impaired glucose tolerance challenge obstetric care. We aimed to investigate the effects of these parameters on the outcome of vaginal breech birth to improve counseling practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A total of 361 women (without previous vaginal births) attending vaginal birth of a singleton fetus in breech presesntation between 01/2015 and 11/2021 were included in this retrospective single-center study. Data were derived from the hospital data base. We analyzed the effect of the maternal body mass index (BMI) at birth (compared to pre-pregnancy BMI), excessive weight gain, gestational diabetes, and neonatal birthweight on obstetrical and neonatal short-term outcomes (intrapartum cesarean delivery, performance of obstetric maneuvers (Løvset-, Bracht-, Veit-Smellie maneuver and Bickenbach's arm delivery), admission to the neonatal unit, Apgar score after 5 minutes <7, and arterial cord pH-value <7.10). Multivariable logistic regression was used for analysis and adjustment of variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 246 women (68.1%) had a successful vaginal birth. Intrapartum cesarean delivery (<i>n</i> = 115/361; 31.9%) was independently associated with maternal BMI at birth (<i>p</i> = 0.0283, aOR = 1.87 (1.19–3.97)) if birthweight was ≥3800 g. The rate of intrapartum cesarean delivery was also higher in women with gestational diabetes (<i>p</i> = 0.0030, aOR = 10.83 (2.41-60.84)). A significantly higher risk of neonatal acidosis (arterial pH-value <7.10) was observed in women with BMI at birth ≥30 kg/m<sup>2</sup> (<i>p</i> = 0.0345, aOR = 1.84 (1.04–3.22)) without affecting other outcomes. Pre-pregnancy BMI, gestational weight gain and BMI-gain did not significantly affect the obstetrical and neonatal birth outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When neonatal birthweight is ≥3800 g, maternal BMI at birth (<i>p</i> = 0.0283; aOR = 1.87 (1.19–3.97)) is independently associated with the rate of intrapartum cesarean delivery. However, pre-pregnancy BMI and BMI-gain during pregnancy were not associated with the need for intrapartum cesarean delivery or other adverse outcomes. Consequently, BMI at the time of birth could be more informative than pre-pregnancy BMI and may improve counseling of women attempting va","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"174-184"},"PeriodicalIF":3.5,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodrigo Fernández-López, Karen Andreasen, Lea Ankerstjerne, Stella Martín-de-las-Heras, Vibeke Rasch, Jesús L. Megías, Ditte S. Linde, Sabina de-León-de-León, Berit Schei, Chunsen Wu, Alba Oviedo-Gutiérrez, Antonella Ludmila Zapata-Calvente
Introduction
Intimate partner violence against women is a global health issue. Exposure to intimate partner violence during pregnancy leads to health-related problems for both the mother and the newborn. However, current knowledge on its occurrence varies widely and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital screening tools.
Material and Methods
A cross-sectional design was used to systematically screen for intimate partner violence among pregnant women attending antenatal care by using standardized digital screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen.
Results
A total of 17 220 pregnant women in Denmark and 2222 pregnant women in Spain were invited to participate. The response rate was high in both countries (77.3% and 92.5%, respectively). Overall, 6.9% (n = 913) and 13.7% (n = 282) screened positive in Denmark and Spain, respectively. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and intimate partner violence. In both countries, being unmarried and lacking social support were risk factors of intimate partner violence. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, not having a partner at the time of questionnaire completion and having at least one child prior to the current pregnancy were risk factors of intimate partner violence.
Conclusions
Prevalence results and found associated factors contribute to a more comprehensive understanding of the occurrence of intimate partner violence during pregnancy in Denmark and Spain, while highlighting the feasibility of digital systematic screening in antenatal settings.
{"title":"Prevalence and associated factors of intimate partner violence against pregnant women who attend antenatal care in Denmark and Spain: A digital screening approach","authors":"Rodrigo Fernández-López, Karen Andreasen, Lea Ankerstjerne, Stella Martín-de-las-Heras, Vibeke Rasch, Jesús L. Megías, Ditte S. Linde, Sabina de-León-de-León, Berit Schei, Chunsen Wu, Alba Oviedo-Gutiérrez, Antonella Ludmila Zapata-Calvente","doi":"10.1111/aogs.15000","DOIUrl":"10.1111/aogs.15000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intimate partner violence against women is a global health issue. Exposure to intimate partner violence during pregnancy leads to health-related problems for both the mother and the newborn. However, current knowledge on its occurrence varies widely and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital screening tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A cross-sectional design was used to systematically screen for intimate partner violence among pregnant women attending antenatal care by using standardized digital screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 17 220 pregnant women in Denmark and 2222 pregnant women in Spain were invited to participate. The response rate was high in both countries (77.3% and 92.5%, respectively). Overall, 6.9% (<i>n</i> = 913) and 13.7% (<i>n</i> = 282) screened positive in Denmark and Spain, respectively. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and intimate partner violence. In both countries, being unmarried and lacking social support were risk factors of intimate partner violence. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, not having a partner at the time of questionnaire completion and having at least one child prior to the current pregnancy were risk factors of intimate partner violence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prevalence results and found associated factors contribute to a more comprehensive understanding of the occurrence of intimate partner violence during pregnancy in Denmark and Spain, while highlighting the feasibility of digital systematic screening in antenatal settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"139-150"},"PeriodicalIF":3.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Jeppegaard, Maria Kongerslev Frølich, Liv Cecilie Vestrheim Thomsen, Anna Heino, Eileen Liu, Johanna Gunnarsdottir, Rupali Rajendra Akerkar, Lene Friis Eskildsen, Karin Källén, Mikael Ohlin, Kari Klungsøyr, Mika Gissler, Lone Krebs
Introduction
Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age.
Material and Methods
Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0–23 + 6 and 24 + 0–27 + 6), very preterm (GA 28 + 0–31 + 6), moderate preterm (GA 32 + 0–33 + 6), late preterm (GA 34 + 0–36 + 6), term (GA 37 + 0–40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions.
Results
The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000–2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden.
Conclusions
The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.
{"title":"Perinatal death in the Nordic countries in relation to gestational age: The impact of registration practice","authors":"Maria Jeppegaard, Maria Kongerslev Frølich, Liv Cecilie Vestrheim Thomsen, Anna Heino, Eileen Liu, Johanna Gunnarsdottir, Rupali Rajendra Akerkar, Lene Friis Eskildsen, Karin Källén, Mikael Ohlin, Kari Klungsøyr, Mika Gissler, Lone Krebs","doi":"10.1111/aogs.14950","DOIUrl":"10.1111/aogs.14950","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0–23 + 6 and 24 + 0–27 + 6), very preterm (GA 28 + 0–31 + 6), moderate preterm (GA 32 + 0–33 + 6), late preterm (GA 34 + 0–36 + 6), term (GA 37 + 0–40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000–2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 12","pages":"2381-2391"},"PeriodicalIF":3.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joan Hansen, Lise Qvirin Krogh, Jens Fuglsang, Sidsel Boie, Tine Brink Henriksen, Katja Albert Taastrøm, Anne Cathrine Maqving Kjeldsen, Julie Glavind, Stina Lou
Introduction
Timing of induction of labor (IOL) at term has been investigated in multiple settings. In Denmark, the ‘When to INDuce for OverWeight’ (WINDOW) study compares IOL at 39 weeks of gestation vs expectant management in low-risk women with obesity. However, knowledge on women's expectations of and experience with IOL is sparse. The aim of this study was to explore women's motivation to join the WINDOW study and their experience when randomized to IOL at 39 gestational weeks.
Material and Methods
A qualitative interview study of 25 pregnant women with obesity randomized in the WINDOW study to IOL at 39 weeks of gestation was conducted. Participants were recruited from four hospitals in Central Denmark Region and were interviewed four to six weeks after giving birth. A thematic analysis was performed using a phenomenological approach.
Results
The analysis resulted in three main themes, (1) Motivation for IOL, (2) The IOL process, and (3) IOL in recollection and in the future. Participants perceived inclusion into the WINDOW study as a “great opportunity,” as they hoped to be randomized to IOL at 39 weeks of gestation. Their main motivation for participating was physical discomfort in late pregnancy and a wish for “knowing” the timing of the birth. BMI-related risk factors were mentioned by few as a motivating factor. Some participants described the IOL process as a team effort between the couple and the midwives and were positive towards future IOL. Others associated the IOL process with prolonged labor or described the body as “reluctant” to respond to the induction regime. A desire to experience spontaneous onset of labor in a future pregnancy was mentioned.
Conclusions
Physical discomfort and wanting to “control” the onset of labor were main motivations for women's decision to participate in the WINDOW study, hoping they would be allocated for IOL. Comprehensive information and being supported by midwives through the IOL process was crucial for a positive IOL experience. Some participants were positive towards a future IOL. Others speculated if their body was not ready for birth in 39 weeks of gestation and/or associated the IOL process with a challenging labor.
{"title":"Motivations for and experience with labor induction at 39 weeks in women with obesity—A qualitative study","authors":"Joan Hansen, Lise Qvirin Krogh, Jens Fuglsang, Sidsel Boie, Tine Brink Henriksen, Katja Albert Taastrøm, Anne Cathrine Maqving Kjeldsen, Julie Glavind, Stina Lou","doi":"10.1111/aogs.14993","DOIUrl":"10.1111/aogs.14993","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Timing of induction of labor (IOL) at term has been investigated in multiple settings. In Denmark, the ‘When to INDuce for OverWeight’ (WINDOW) study compares IOL at 39 weeks of gestation vs expectant management in low-risk women with obesity. However, knowledge on women's expectations of and experience with IOL is sparse. The aim of this study was to explore women's motivation to join the WINDOW study and their experience when randomized to IOL at 39 gestational weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A qualitative interview study of 25 pregnant women with obesity randomized in the WINDOW study to IOL at 39 weeks of gestation was conducted. Participants were recruited from four hospitals in Central Denmark Region and were interviewed four to six weeks after giving birth. A thematic analysis was performed using a phenomenological approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis resulted in three main themes, (1) Motivation for IOL, (2) The IOL process, and (3) IOL in recollection and in the future. Participants perceived inclusion into the WINDOW study as a “great opportunity,” as they hoped to be randomized to IOL at 39 weeks of gestation. Their main motivation for participating was physical discomfort in late pregnancy and a wish for “knowing” the timing of the birth. BMI-related risk factors were mentioned by few as a motivating factor. Some participants described the IOL process as a team effort between the couple and the midwives and were positive towards future IOL. Others associated the IOL process with prolonged labor or described the body as “reluctant” to respond to the induction regime. A desire to experience spontaneous onset of labor in a future pregnancy was mentioned.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Physical discomfort and wanting to “control” the onset of labor were main motivations for women's decision to participate in the WINDOW study, hoping they would be allocated for IOL. Comprehensive information and being supported by midwives through the IOL process was crucial for a positive IOL experience. Some participants were positive towards a future IOL. Others speculated if their body was not ready for birth in 39 weeks of gestation and/or associated the IOL process with a challenging labor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"215-224"},"PeriodicalIF":3.5,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xuan Zhao, Alice Poskett, Marie Stracke, Siobhan Quenby, Dieter Wolke
Introduction
Early induction of labor (37+0–38+6 gestational weeks) in large-for-gestational-age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long-term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large-for-gestational-age children born early term vs full term (combined or independent exposures).
Material and Methods
The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large-for-gestational-age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double-checked the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta-analyses were conducted where possible.
Results
Of the 2505 identified articles, no study investigated early-term delivery in large-for-gestational-age babies. Seventy-six studies involving 11 460 016 children investigated the effects of either early-term delivery or large-for-gestational-age. Children born at 37 weeks of gestation (standard mean difference, −0.13; 95% confidence interval, −0.21 to −0.05), but not at 38 weeks (standard mean difference, −0.04; 95% confidence interval, −0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large-for-gestational-age children had slightly higher cognitive scores than appropriate-for-gestational-age children (standard mean difference, 0.06; 95% confidence interval, 0.01–0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance.
Conclusions
No study has investigated the combined effect of early-term delivery on cognitive scores in large-for-gestational-age babies. Early-term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required.
{"title":"Cognitive and academic outcomes of large-for-gestational-age babies born at early term: A systematic review and meta-analysis","authors":"Xuan Zhao, Alice Poskett, Marie Stracke, Siobhan Quenby, Dieter Wolke","doi":"10.1111/aogs.15001","DOIUrl":"10.1111/aogs.15001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Early induction of labor (37<sup>+0</sup>–38<sup>+6</sup> gestational weeks) in large-for-gestational-age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long-term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large-for-gestational-age children born early term vs full term (combined or independent exposures).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large-for-gestational-age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double-checked the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta-analyses were conducted where possible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 2505 identified articles, no study investigated early-term delivery in large-for-gestational-age babies. Seventy-six studies involving 11 460 016 children investigated the effects of either early-term delivery or large-for-gestational-age. Children born at 37 weeks of gestation (standard mean difference, −0.13; 95% confidence interval, −0.21 to −0.05), but not at 38 weeks (standard mean difference, −0.04; 95% confidence interval, −0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large-for-gestational-age children had slightly higher cognitive scores than appropriate-for-gestational-age children (standard mean difference, 0.06; 95% confidence interval, 0.01–0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>No study has investigated the combined effect of early-term delivery on cognitive scores in large-for-gestational-age babies. Early-term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"288-301"},"PeriodicalIF":3.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ragnheidur Valdimarsdottir, Eszter Vanky, Evangelia Elenis, Fredrik Ahlsson, Linda Lindström, Katja Junus, Anna-Karin Wikström, Inger Sundström Poromaa
<div> <section> <h3> Introduction</h3> <p>It is well known that both women with polycystic ovary syndrome (PCOS) and women with gestational diabetes mellitus (GDM) have increased risks of adverse pregnancy outcomes, but little is known whether the combination of these two conditions exacerbates the risks. We explored risk estimates for adverse pregnancy outcomes in women with either PCOS or GDM and the combination of both PCOS and GDM.</p> </section> <section> <h3> Material and Methods</h3> <p>Nationwide register-based historical cohort study in Sweden including women who gave birth to singleton infants during 1997–2015 (<i>N</i> = 281 806). The risks of adverse pregnancy outcomes were estimated for women exposed for PCOS-only (<i>n</i> = 40 272), GDM-only (<i>n</i> = 2236), both PCOS and GDM (<i>n</i> = 1036) using multivariable logistic regression analyses. Risks were expressed as odds ratios with 95% confidence intervals (CIs) and adjusted for maternal characteristics, including maternal BMI. Women with neither PCOS nor GDM served as control group. Maternal outcomes were gestational hypertension, preeclampsia, postpartum hemorrhage, and obstetric anal sphincter injury. Neonatal outcomes were preterm birth, stillbirth, shoulder dystocia, born small or large for gestational age, macrosomia, low Apgar score, infant birth trauma, cerebral impact of the infant, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress.</p> </section> <section> <h3> Results</h3> <p>Based on non-significant PCOS by GDM interaction analyses, we found no evidence that having PCOS adds any extra risk beyond that of having GDM for maternal and neonatal outcomes. For example, the adjusted odds ratio for preeclampsia in women with PCOS-only were 1.18 (95% CI 1.11–1.26), for GDM-only 1.77 (95% CI 1.45–2.15), and for women with PCOS and GDM 1.86 (95% CI 1.46–2.36). Corresponding adjusted odds ratio for preterm birth in women with PCOS-only were 1.34 (95% CI 1.28–1.41), GDM-only 1.64 (95% CI 1.39–1.93), and for women with PCOS and GDM 2.08 (95% CI 1.67–2.58). Women with PCOS had an increased risk of stillbirth compared with the control group (aOR 1.52, 95% CI 1.29–1.80), whereas no increased risk was noted in women with GDM (aOR 0.58, 95% CI 0.24–1.39).</p> </section> <section> <h3> Conclusions</h3> <p>The combination of PCOS and GDM adds no extra risk beyond that of having GDM alone, for a number of maternal and neonatal outcomes. Nevertheless, PCOS is still an unrecognized risk factor in pregnancy, exemplified by the increased risk of stillbirth.</p>
导言：众所周知，患有多囊卵巢综合征（PCOS）和妊娠糖尿病（GDM）的妇女发生不良妊娠结局的风险都会增加，但这两种疾病同时存在是否会加剧这种风险却鲜为人知。我们探讨了患有多囊卵巢综合征或妊娠糖尿病的妇女以及同时患有多囊卵巢综合征和妊娠糖尿病的妇女不良妊娠结局的风险估计值：瑞典全国范围内基于登记的历史队列研究，包括 1997-2015 年间生育单胎婴儿的妇女（N = 281 806）。使用多变量逻辑回归分析估算了仅暴露于多囊卵巢综合征（n = 40 272）、仅暴露于 GDM（n = 2236）、同时暴露于多囊卵巢综合征和 GDM（n = 1036）的女性的不良妊娠结局风险。风险以带有 95% 置信区间 (CI) 的几率表示，并根据产妇特征（包括产妇体重指数）进行调整。既无多囊卵巢综合征也无 GDM 的妇女作为对照组。产妇结局为妊娠高血压、子痫前期、产后出血和产科肛门括约肌损伤。新生儿结局为早产、死产、肩难产、出生时胎龄过小或过大、巨大儿、低 Apgar 评分、婴儿出生创伤、婴儿脑损伤、新生儿低血糖、胎粪吸入综合征和呼吸窘迫：根据多囊卵巢综合征与 GDM 的非显著交互分析，我们没有发现任何证据表明多囊卵巢综合征会增加 GDM 对产妇和新生儿预后的额外风险。例如，仅患有多囊卵巢综合征的产妇发生子痫前期的调整后几率比为 1.18（95% CI 1.11-1.26），仅患有 GDM 的产妇发生子痫前期的调整后几率比为 1.77（95% CI 1.45-2.15），患有多囊卵巢综合征和 GDM 的产妇发生子痫前期的调整后几率比为 1.86（95% CI 1.46-2.36）。仅患有多囊卵巢综合症的妇女早产的相应调整后几率为 1.34（95% CI 1.28-1.41），仅患有 GDM 的妇女为 1.64（95% CI 1.39-1.93），患有多囊卵巢综合症和 GDM 的妇女为 2.08（95% CI 1.67-2.58）。与对照组相比，患有多囊卵巢综合征的妇女死产的风险增加（aOR 1.52，95% CI 1.29-1.80），而患有 GDM 的妇女死产的风险没有增加（aOR 0.58，95% CI 0.24-1.39）：结论：合并多囊卵巢综合征和 GDM 的产妇和新生儿在一系列结果方面的风险不会比单独患有 GDM 的产妇和新生儿增加。然而，多囊卵巢综合症仍然是一个未被认识到的妊娠风险因素，死胎风险的增加就是一个例证。
{"title":"Polycystic ovary syndrome and gestational diabetes mellitus association to pregnancy outcomes: A national register-based cohort study","authors":"Ragnheidur Valdimarsdottir, Eszter Vanky, Evangelia Elenis, Fredrik Ahlsson, Linda Lindström, Katja Junus, Anna-Karin Wikström, Inger Sundström Poromaa","doi":"10.1111/aogs.14998","DOIUrl":"10.1111/aogs.14998","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>It is well known that both women with polycystic ovary syndrome (PCOS) and women with gestational diabetes mellitus (GDM) have increased risks of adverse pregnancy outcomes, but little is known whether the combination of these two conditions exacerbates the risks. We explored risk estimates for adverse pregnancy outcomes in women with either PCOS or GDM and the combination of both PCOS and GDM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Nationwide register-based historical cohort study in Sweden including women who gave birth to singleton infants during 1997–2015 (<i>N</i> = 281 806). The risks of adverse pregnancy outcomes were estimated for women exposed for PCOS-only (<i>n</i> = 40 272), GDM-only (<i>n</i> = 2236), both PCOS and GDM (<i>n</i> = 1036) using multivariable logistic regression analyses. Risks were expressed as odds ratios with 95% confidence intervals (CIs) and adjusted for maternal characteristics, including maternal BMI. Women with neither PCOS nor GDM served as control group. Maternal outcomes were gestational hypertension, preeclampsia, postpartum hemorrhage, and obstetric anal sphincter injury. Neonatal outcomes were preterm birth, stillbirth, shoulder dystocia, born small or large for gestational age, macrosomia, low Apgar score, infant birth trauma, cerebral impact of the infant, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on non-significant PCOS by GDM interaction analyses, we found no evidence that having PCOS adds any extra risk beyond that of having GDM for maternal and neonatal outcomes. For example, the adjusted odds ratio for preeclampsia in women with PCOS-only were 1.18 (95% CI 1.11–1.26), for GDM-only 1.77 (95% CI 1.45–2.15), and for women with PCOS and GDM 1.86 (95% CI 1.46–2.36). Corresponding adjusted odds ratio for preterm birth in women with PCOS-only were 1.34 (95% CI 1.28–1.41), GDM-only 1.64 (95% CI 1.39–1.93), and for women with PCOS and GDM 2.08 (95% CI 1.67–2.58). Women with PCOS had an increased risk of stillbirth compared with the control group (aOR 1.52, 95% CI 1.29–1.80), whereas no increased risk was noted in women with GDM (aOR 0.58, 95% CI 0.24–1.39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combination of PCOS and GDM adds no extra risk beyond that of having GDM alone, for a number of maternal and neonatal outcomes. Nevertheless, PCOS is still an unrecognized risk factor in pregnancy, exemplified by the increased risk of stillbirth.</p>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"119-129"},"PeriodicalIF":3.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sanna Eteläinen, Elina Keikkala, Shilpa Lingaiah, Matti Viljakainen, Tuija Männistö, Anneli Pouta, Risto Kaaja, Johan G. Eriksson, Hannele Laivuori, Mika Gissler, Eero Kajantie, Marja Vääräsmäki
Introduction
Gestational diabetes mellitus (GDM) is defined by one or more abnormal values in an oral glucose tolerance test (OGTT). The significance/importance of the number of abnormal values in relation to adverse perinatal and neonatal outcomes is unclear. We assessed the association of these outcomes with the number of abnormal glucose values in a 2-h 75 g OGTT in a large register-based cohort.
Material and Methods
This sub-study of the Finnish Gestational Diabetes Study was based on the Finnish Medical Birth Register 2009 supplemented with OGTT laboratory data of 4869 pregnant women from six Finnish hospitals. The diagnostic cut-offs in OGTT according to the Finnish guidelines for plasma samples were ≥5.3 mmol/L (fasting), ≥10.0 mmol/L 1 h or ≥8.6 mmol/L 2 h after the glucose load. As per the guidelines, women with one or several abnormal OGTT values received diet and lifestyle counseling in the primary care, self-monitored their glucose values and received pharmacological therapy as needed. Women with GDM were categorized according to the number of abnormal glucose values. The primary outcomes, composites of adverse perinatal (pre-eclampsia, preterm delivery, macrosomia or primary cesarean section) and neonatal outcomes (birth trauma, neonatal hypoglycemia, hyperbilirubinemia or stillbirth/perinatal mortality), were analyzed by logistic regression adjusted for maternal age, pre-pregnancy body mass index, parity, socio-economic status and smoking.
Results
Of all the women, 877 (18.0%) had one, 278 (5.7%) two and 79 (1.6%) three abnormal OGTT values, while 3635 (74.7%) women were normoglycemic. Women with at least two abnormal OGTT values had higher proportions of adverse perinatal composite (35.0% vs. 27.5%, adjusted odds ratio 1.36; 95% confidence interval 1.03–1.81) and neonatal composite outcomes (31.1% vs. 18.9%, adjusted odds ratio 1.88; 95% confidence interval 1.40–2.52) compared to women with one abnormal value. The risks of delivery induction and neonatal hypoglycemia were increased regardless of the number of abnormal values when compared with normoglycemic women.
Conclusions
The risk of adverse perinatal and neonatal outcomes is significantly higher in women with two or more abnormal OGTT values than in those with one abnormal value.
{"title":"Perinatal and neonatal outcomes in gestational diabetes: The importance of the number of abnormal values in an oral glucose tolerance test","authors":"Sanna Eteläinen, Elina Keikkala, Shilpa Lingaiah, Matti Viljakainen, Tuija Männistö, Anneli Pouta, Risto Kaaja, Johan G. Eriksson, Hannele Laivuori, Mika Gissler, Eero Kajantie, Marja Vääräsmäki","doi":"10.1111/aogs.14999","DOIUrl":"10.1111/aogs.14999","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gestational diabetes mellitus (GDM) is defined by one or more abnormal values in an oral glucose tolerance test (OGTT). The significance/importance of the number of abnormal values in relation to adverse perinatal and neonatal outcomes is unclear. We assessed the association of these outcomes with the number of abnormal glucose values in a 2-h 75 g OGTT in a large register-based cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This sub-study of the Finnish Gestational Diabetes Study was based on the Finnish Medical Birth Register 2009 supplemented with OGTT laboratory data of 4869 pregnant women from six Finnish hospitals. The diagnostic cut-offs in OGTT according to the Finnish guidelines for plasma samples were ≥5.3 mmol/L (fasting), ≥10.0 mmol/L 1 h or ≥8.6 mmol/L 2 h after the glucose load. As per the guidelines, women with one or several abnormal OGTT values received diet and lifestyle counseling in the primary care, self-monitored their glucose values and received pharmacological therapy as needed. Women with GDM were categorized according to the number of abnormal glucose values. The primary outcomes, composites of adverse perinatal (pre-eclampsia, preterm delivery, macrosomia or primary cesarean section) and neonatal outcomes (birth trauma, neonatal hypoglycemia, hyperbilirubinemia or stillbirth/perinatal mortality), were analyzed by logistic regression adjusted for maternal age, pre-pregnancy body mass index, parity, socio-economic status and smoking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of all the women, 877 (18.0%) had one, 278 (5.7%) two and 79 (1.6%) three abnormal OGTT values, while 3635 (74.7%) women were normoglycemic. Women with at least two abnormal OGTT values had higher proportions of adverse perinatal composite (35.0% vs. 27.5%, adjusted odds ratio 1.36; 95% confidence interval 1.03–1.81) and neonatal composite outcomes (31.1% vs. 18.9%, adjusted odds ratio 1.88; 95% confidence interval 1.40–2.52) compared to women with one abnormal value. The risks of delivery induction and neonatal hypoglycemia were increased regardless of the number of abnormal values when compared with normoglycemic women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of adverse perinatal and neonatal outcomes is significantly higher in women with two or more abnormal OGTT values than in those with one abnormal value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"130-138"},"PeriodicalIF":3.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ping Cao, Ganesh Acharya, Andres Salumets, Masoud Zamani Esteki
We evaluated the efficacy of large language models (LLMs), specifically, generative pre-trained transformer-4 (GPT-4), in predicting pregnancy following in vitro fertilization (IVF) treatment and compared its accuracy with results from an original published study. Our findings revealed that GPT-4 can autonomously develop and refine advanced machine learning models for pregnancy prediction with minimal human intervention. The prediction accuracy was 0.79, and the area under the receiver operating characteristic curve (AUROC) was 0.89, exceeding or being at least equivalent to the metrics reported in the original study, that is, 0.78 for accuracy and 0.87 for AUROC. The results suggest that LLMs can facilitate data processing, optimize machine learning models in predicting IVF success rates, and provide data interpretation methods. This capacity can help bridge the knowledge gap between data scientists and medical personnel to solve the most pressing clinical challenges. However, more experiments on diverse and larger datasets are needed to validate and promote broader applications of LLMs in assisted reproduction.
{"title":"Large language models to facilitate pregnancy prediction after in vitro fertilization","authors":"Ping Cao, Ganesh Acharya, Andres Salumets, Masoud Zamani Esteki","doi":"10.1111/aogs.14989","DOIUrl":"10.1111/aogs.14989","url":null,"abstract":"<p>We evaluated the efficacy of large language models (LLMs), specifically, generative pre-trained transformer-4 (GPT-4), in predicting pregnancy following in vitro fertilization (IVF) treatment and compared its accuracy with results from an original published study. Our findings revealed that GPT-4 can autonomously develop and refine advanced machine learning models for pregnancy prediction with minimal human intervention. The prediction accuracy was 0.79, and the area under the receiver operating characteristic curve (AUROC) was 0.89, exceeding or being at least equivalent to the metrics reported in the original study, that is, 0.78 for accuracy and 0.87 for AUROC. The results suggest that LLMs can facilitate data processing, optimize machine learning models in predicting IVF success rates, and provide data interpretation methods. This capacity can help bridge the knowledge gap between data scientists and medical personnel to solve the most pressing clinical challenges. However, more experiments on diverse and larger datasets are needed to validate and promote broader applications of LLMs in assisted reproduction.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"6-12"},"PeriodicalIF":3.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号