The STORK Groruddalen research programme: A population-based cohort study of gestational diabetes, physical activity, and obesity in pregnancy in a multiethnic population. Rationale, methods, study population, and participation rates.

BACKGROUND: Gestational diabetes mellitus (GDM) and obesity may cause adverse pregnancy outcomes for mothers and offspring. We have set up a research programme to identify predictors for GDM and fetal growth in a multiethnic population in Oslo to improve the identification of high risk pregnancies and reduce adverse short and long-term outcomes for mothers and offspring. AIMS: To present the rationale, methods, study population and participation rates. METHODS: Population-based cohort study of pregnant women attending the Child Health Clinics (CHC) in Groruddalen, Oslo, and their offspring. Questionnaire data, blood pressure, anthropometric measurements, and fasting blood and urine samples are collected (gestational weeks 8-20 and 28, and 12 weeks postpartum) and an oral glucose tolerance test (28 weeks). Physical activity is measured, three ultrasound measurements are performed and paternal questionnaire data collected. Routine hospital data are available for all mothers and offspring. Umbilical venous blood and placentas are collected, sampled, and stored and neonatal anthropometric measurements performed. Ethnicity is self-reported country of birth. RESULTS: 823 women were included, 59% of non-Western origin. The participation rate was 74% (64-83% in main ethnic groups), mean age 29.8 years (95% CI 29.5-30.1) and median parity 1 (inter-quartile range 1). The cohort is representative for women attending the CHC with respect to ethnicity and age. A slight selection towards lower parity (South Asians) and age (Africans) was found. Few were lost to follow-up. CONCLUSIONS: Unique information is collected from a representative group of multiethnic women to address important public health problems and mechanisms of disease. Participation rates are high in all ethnic groups.

A 12-week randomised study comparing intravenous iron sucrose versus oral ferrous sulphate for treatment of postpartum anemia.

OBJECTIVE: To analyze the effect of intravenous ferrous sucrose compared with oral ferrous sulphate on hematological parameters and quality of life in women with postpartum anemia. DESIGN: Open randomised controlled trial. SETTING: Multicentre study comprising five obstetrical departments in Norway. POPULATION: Hundred and twenty-eight postpartum women with hemorrhagic anemia (Hb between 6.5 g/100 ml and 8.5 g/100 ml). The intervention group (59 women) received 600 mg iron sucrose intravenously followed by 200 mg iron sulphate daily from week 5. The control group (70 women) were given 200 mg iron sulphate daily. METHODS: Randomisation and start of treatment occurred within 48 hours of the delivery. Participants were followed up at 4, 8 and 12 weeks. MAIN OUTCOME MEASURES: Hemoglobin, ferritin and quality of life assessed with the Medical Outcomes Study Short Form 36 (SF-36) and the Fatigue Scale. RESULTS: After 4 weeks the mean hemoglobin values in both groups were similar (11.9 g/100ml vs. 12.3g/100ml, p=0.89). The mean serum ferritin value after 4 weeks was significantly higher in the intervention group with 13.7 microg/L vs. 4.2 microg/L in the control group (p<0.001). At 8 and 12 weeks the hematological parameters were similar. The total fatigue score was significantly improved in the intervention group at week 4, 8 and 12, whereas SF-36 scores did not differ. CONCLUSION: Women who received 600 mg intravenous iron sucrose followed by standard oral iron after four weeks, replenished their iron stores more rapidly and had a more favorable development of the fatigue score indicating improved quality of life.

Fetal growth trajectories in pregnancies of European and South Asian mothers with and without gestational diabetes, a population-based cohort study.

OBJECTIVE: Our aim was to examine the impact of gestational diabetes (GDM), from before the GDM-diagnosis is made, on fetal growth trajectories, and to compare it in Europeans and South Asians; two ethnic groups with dissimilar fetal growth patterns. METHODS: We studied European (n = 349) and South Asian (n = 184) pregnant women, from the population-based STORK-Groruddalen cohort in Oslo, Norway. Mothers were enrolled in early pregnancy, screened for GDM in gestational week 28 ±2, and classified as "non-GDM", "mild GDM" or "moderate/severe GDM". We measured fetal head circumference, abdominal circumference and femur length by ultrasound, and estimated fetal weight in gestational week 24, 32 and 37, and performed corresponding measurements at birth. RESULTS: In non-GDM pregnancies, South Asian fetuses (n = 156) had a slower growth from gestational week 24, compared with Europeans (n = 310). More than two thirds of the European mothers later diagnosed with GDM were overweight or obese in early pregnancy, while this was not observed in South Asians. Fetuses of GDM mothers tended to be smaller than fetuses of non-GDM mothers in week 24, but thereafter grew faster until birth. This pattern was especially pronounced in fetuses of South Asian mothers with moderate/severe GDM. In week 24 these fetuses had a -0.95 SD (95% CI: -1.53, -0.36) lower estimated fetal weight than their non-GDM counterparts. In contrast, at birth they were 0.45 SD (0.09, 0.81) larger. CONCLUSIONS: Offspring of GDM mothers were smaller in mid pregnancy, but subsequently grew faster until birth, compared with offspring of non-GDM mothers. This pattern was most prominent in South Asian mothers with moderate to severe GDM. However, the most remarkable characteristic of these fetuses was not a large size at birth, but the small size in mid pregnancy, before the GDM diagnosis was set.