Total cost comparison of standard antenatal care with a weight gain restriction programme for obese pregnant women.

OBJECTIVE: To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. STUDY DESIGN: A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. METHODS: In total, 155 women in an intervention group attempted to restrict their gestational weight gain to <7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros (€). RESULTS: Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was € 1283 more per woman/infant in the intervention group compared with the control group (P=0.025). The degree of obesity at programme entry had no bearing on the outcome. CONCLUSIONS: The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to <7 kg, but had a higher total cost compared with standard antenatal care.

Weight gain restriction for obese pregnant women: a case-control intervention study.

OBJECTIVE: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. DESIGN: A prospective case-control intervention study. SETTING: Antenatal care clinics in the southeast region of Sweden. POPULATION: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. METHODS: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. MAIN OUTCOME MEASURES: Weight gain in kilograms, delivery and neonatal outcome. RESULTS: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P= 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P= 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. CONCLUSION: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.

Lipoprotein changes during treatment of pelvic endometriosis with medroxyprogesterone acetate.

Ten women with endometriosis were treated with medroxyprogesterone acetate (MPA), 150 mg intramuscularly every second week. After 2 weeks, there was a significant (8%) decrease in the high-density lipoprotein (HDL) concentration. This reduction became more pronounced after 8 and 24 weeks' medication. The HDL reduction was confined to the HDL2 subfraction, which was decreased by 15%, 33%, and 58% after 2, 8, and 24 weeks, respectively; there was no significant change in the HDL3 concentration. During treatment, there was a continuous increase in the mean MPA plasma level and a strong inverse correlation between this level and the mean HDL and HDL2 cholesterol concentrations. It was concluded that MPA affects HDL metabolism in a dose-dependent way and in the same direction as other progestins.

Increase in sick leave rates caused by back pain among pregnant Swedish women after amelioration of social benefits. A paradox.

STUDY DESIGN: A retrospective population study. OBJECTIVES: To explore whether the increase in social benefits for pregnant women introduced in Sweden between 1978 and in 1986 was associated with a decrease in the use of sick leave caused by back pain during the same period. SUMMARY OF BACKGROUND DATA: Back pain is a common condition among Swedish pregnant women. It may be regarded as a normal discomfort of pregnancy, because at least 50% of pregnant women experience back pain to some extent during pregnancy. METHODS: Participants were women consecutively delivered in 1978 (n = 1524) and in 1986 (n = 1688). Between these two time points, the number of offered days of parental benefit increased and a new benefit, the pregnancy benefit, was introduced. Data were collected from the antenatal care and delivery records and from pregnant women's social insurance files. RESULTS: From 1978 to 1986 the use of sick leave because of back pain during pregnancy increased. The number of pregnant women granted sick leave employed pregnant women because of back pain increased from 11% in 1978 to 29% in 1986 (P < 0.001). The sick leave rate increased in most occupations and especially among young women. CONCLUSIONS: The Swedish society has provided ample social benefits to allow the pregnant woman to take leave from work, without having to be labeled as "ill," because of normal conditions such as back pain during pregnancy. Instead of an expected decrease in sick leave because of back pain during pregnancy, an increase was observed.

[Pregnant women's sick leave is behind the increased sick leave among women of fertile age. A study of pregnant women's sick leave 1978-1997]. / Gravidas sjukfrånaro ligger bakom ökat sjuktal för kvinnor i fertil ålder. Studie av gravida kvinnors sjukfrånvaro 1978-1997.

Sick leave rates among pregnant women have been found to vary substantially over time. 8,884 woman delivered at Linköping and Värnamo Women's Clinics in 1978, 1986, 1988, 1992, 1995 and 1997 were studied. Sick leave nearly doubled between 1978 and 1986, and dropped back to the 1978 level in 1997. The somewhat paradoxical findings in our surveys indicate that attitudes, especially as observed in the youngest age groups, together with a sensible adaptation to the prevailing terms of the social security system, may well be the most plausible explanation. Studies on sick leave among women of fertile age should preferably also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a profound impact on sick leave statistics among all insured women of fertile age.

Attitudes towards mode of birth among Swedish midwives.

OBJECTIVE: to investigate midwives' attitudes and opinions on mode of birth. DESIGN: exploratory descriptive study. Data were collected via study-specific questionnaires during 2006. SETTING: southeastern Sweden. PARTICIPANTS: all midwives working in two counties. FINDINGS: regardless of age, experience and working field, the midwives considered a reasonable caesarean rate to be around 11.5 per cent. None of the participants thought that the caesarean rate was too low. Midwives younger than 50 years tended to consider the current caesarean rate to be too high (p=0.059). Midwives working on labour wards stated that they thought the current caesarean rate was too high compared with midwives working at antenatal care clinics (ACCs) (p<0.001). Midwives working at ACCs agreed with the statements 'one should agree to a woman's right to have an elective caesarean' (p<0.001) and 'elective caesarean is the best choice for a woman with fear of birth' (p=0.046) more often than midwives working on labour wards, regardless of age or working experience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives working at ACCs are more willing to accept caesarean section at the woman's request and for women with fear of birth. It is of importance that ACC caregivers and professionals on labour wards increase their collaboration and have continuous discussions with one another in an attempt to reach consensus about the appropriate caesarean rates on evidence-based grounds.

Influence of obesity on the use of sickness absence and social benefits among pregnant working women.

OBJECTIVE: To evaluate if obesity in early pregnancy has any possible impact on the capacity of pregnant women to engage in gainful employment. METHODS: Register data from a database on sickness absence and pregnancy benefit and parental benefit claims were combined with type of occupation and body mass index (BMI) for 693 women consecutively delivered during the course of one year at a county hospital in Sweden. RESULTS: The results showed the lowest BMI among women who had administrative jobs and the highest BMI in women who undertook more burdensome and heavy types of manual work. A significant increase in BMI was also seen among those pregnant women who were registered as unemployed. The finding that in the manual types of occupation, obese pregnant women took almost twice as many days of leave provided by the parental benefit programme as did women with a BMI of <25, indicates that obese pregnant women perhaps do not have the same physical endurance required to manage the combined demands of work and pregnancy. No differences were found with regard to sickness absence between obese women and pregnant women with normal BMI; however, differences were found between different occupational groups. CONCLUSIONS: Our study indicates that a woman's BMI at the beginning of pregnancy is associated with her occupational status. Obesity among pregnant women may well be used as a psychosocial indicator as obesity correlates with social and economic problems. Any planned weight reduction programme in antenatal care must therefore consider this important psychosocial aspect.

Trends in body mass index during early pregnancy in Swedish women 1978-2001.

OBJECTIVE: To study the body mass index (BMI) in women seeking maternity health care during early pregnancy in Sweden, and to show trends for a period of more than 20 years. STUDY DESIGN: Register study. METHODS: Data from the maternity health programme on consecutively delivered women in two Swedish hospitals were collected for the years 1978, 1986, 1992, 1997 and 2001. All women were weighed at their first midwife visit between 8 and 10 weeks of gestation and height was also measured. RESULTS: Data on 4883 women were collected. Data on weight were available for 4490 (92%) women and data on BMI were available for 4378 (90%) women. The age-adjusted average weight increased from 59.5 kg in 1978 to 68.2 kg in 2001, and the BMI increased from 21.7 in 1978 to 24.7 in 2001. In 2001, 38.6% of the women had a BMI >25 compared with 11.2 in 1978. In 2001, 11.6% of the women were obese compared with 2.2% in 1978. CONCLUSIONS: During the last two decades, an alarming increase in weight has occurred in Swedish women of childbearing age.

Variations in sickness absence and use of social benefits among pregnant women in a Swedish community 1978-1997.

SUBJECT: Pregnancy is a well defined condition. Any possible need for sickness absence should remain unchanged over time. STUDY OBJECTIVE: To investigate the relationship between rates of sickness absence during pregnancy in a long term perspective. SUBJECTS STUDIED: Two thousand nine hundred and thirty-five women consecutively delivered at the University Hospital in Linköping in 1978, 1986, 1992 and 1997. RESULTS: In 1986, after a period of expansion of social benefits, the proportion of sick-listed pregnant women was observed to be significantly higher (78 per cent) than in 1978 (51 per cent). Parallel to cuts in compensation, sickness absence 1997 was observed to decrease (53 per cent). The mean number of days of sickness absence per pregnant woman increased from 18.9 in 1978 to 36.5 in 1986. In 1997 the mean number of days was 18.8. The Parental benefit, available to all pregnant women, was significantly ameliorated during the period of the study. In spite of this, the mean number of sickness absence days used before delivery decreased from 11.7 days in 1978 to 6.6 days in 1997. CONCLUSIONS: Sickness absence among pregnant women is to a high degree sensitive to the levels of compensation in the available social benefits. A high level of reimbursement and expanded social benefits seem paradoxically to increase the sickness absence among pregnant women, but cuts in benefits lower the absence, suggesting an adaptation and a coping strategy to what seems most economically favorable for the pregnant woman and her family.

Sick leave and social benefits during pregnancy--a Swedish-Norwegian comparison.

BACKGROUND: To analyze the correlation between sickness absence, working conditions, pregnancy outcomes and pregnancy associated social benefits in two urban pregnant populations in Sweden and Norway with different social benefit systems. METHODS: Relevant information on 1649 delivered women was manually extracted by the authors from the antenatal care and delivery records as well as from the personal social security files kept in the Värnamo and Hamar communities, and then computerized in a depersonalized form. RESULTS: The reproductive histories and the pregnancy outcomes appeared clinically similar in the two samples. Swedish pregnant women were significantly more often employed outside home (84 vs. 69 per cent). The types of occupations held were similar in Värnamo and Hamar. Swedish pregnant women were significantly more sick-listed during pregnancy than Norwegian women (64 vs. 32 per cent) and with a longer average duration of the sick-leave spells (61 days vs. 44 days). The sick-leave rate among Swedish employed pregnant women was 75 per cent as compared to 48 per cent in Norway. The differences appeared most evident in younger pregnant women (<25 years). The Swedish sick-leave rates were higher within all four occupational subgroups studied. During the observation period the pregnancy associated social benefits were significantly more generous in Sweden. CONCLUSIONS: Sickness absence during pregnancy does not seem to covariate in a simple way with ill health, working conditions or the amount of social benefits available. The increased sick-leave rates in Sweden may possibly be accounted for by a changing attitude towards pregnancy and its natural consequences, especially among younger women.

Influence of pregnancy-related diagnoses on sick-leave data in women aged 16-44.

Data on sickness absence frequently are used as a measure of morbidity and its social consequences in the employed population. The effects of sickness absence, as well as any possible differences in diagnoses among pregnant women as compared the sick leave data among the total population of women in fertile age have so far not been studied. The aim of this study was to investigate the relative contribution of pregnant women to the level of sickness absence, in general and in different diagnostic groups, as well as the extent to which sick-listed pregnant women can be identified through diagnoses on sickness certificates. In a cross-sectional study of all sick leave insured women aged 16-44 years (n = 24,481) in Linköping, Sweden (117,000 inhabitants), data from two population-based research registers were used, one of sickness absence for the whole population, one of sickness absence among pregnant women in the same population and year. Pregnant women (5%) had a significantly higher cumulative incidence of sickness absence (0.64) compared with all women (0.18) and accounted for 20% of the women listed as absent because of sickness. The duration of the sickness absence was also significantly longer among pregnant women, 44.8 days compared with 9.7 days among all women. Practically all diagnoses among pregnant women were related to pregnancy or back pain (93%). When using diagnoses on the sickness certificates, only 46% of all sick-listed pregnant women could be identified, suggesting methodological difficulties in studies on sickness absence. Studies on sickness absence among women of fertile age should also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a deep impact on the results and conclusions among all women.

Changes in sick leave rates and the use of pregnancy-associated social benefits among pregnant Swedish women: an outcomes study.

We attempted to determine if an amended social security system has lessened the rate of sickness absence during pregnancy in Sweden over the period 1978-1989. We studied the records of 3998 women who gave birth in 1978, 1986, 1988, and 1989 at the University Hospital in Linköping and the Värnamo County Hospital. Retrospective collection of all data concerning the rates and durations of sickness absence during pregnancy, drawing of parental benefit, and use of granted pregnancy benefit was performed from Sweden's standardized social security files. Obstetric variables concerning the course and outcome of pregnancy and delivery, as well as the health status of the newborns, were obtained from standardized and antenatal care and delivery files. Between 1978 and 1989, the rate of sickness absenteeism during pregnancy increased by almost 100% for periods of absence not supported by a doctor's certificate and by about 50% for those with a doctor's certificate. During the same time, the average number of days of sick leave per pregnant woman more than doubled. The changes were most apparent among younger pregnant women. During the decade studied, no significant differences were found with regard to antenatal care, modes of delivery, or the health status of the newborns. In spite of the introduction within the Swedish social security system of more generous rules for pregnant women, the changes in the rates of registered sick leave during pregnancy observed over time were most unfavorable. The present study indicates that the rate of sick leave during pregnancy reflects a complex social phenomenon and cannot be explained solely by an increase in the rate of actual illness or sickness. Such a rate is also likely to depend on general attitudes and expectations among pregnant women, which may vary over time. When amendments in social benefits for pregnant women are considered to improve the health status of the pregnant population, society ought to clearly define the precise aim pursued and the consequences expected to escape unintended socioeconomic results.

Impact of pregnancy on gender differences in sickness absence.

UNLABELLED: Women in general have a higher sickness absence than men, and sickness absence is particularly high among pregnant women. STUDY OBJECTIVES: To study the level of male sickness absence as compared to female, including and excluding pregnant women. DESIGN: Studies of incidence and length of sickness absence exceeding 7 days using population-based sick-leave records. SETTING: The community of Linköping, Sweden, 117,000 inhabitants. PARTICIPANTS: Subjects included in the analysis were all men and women aged 16-44 who in 1985 or 1986 had at least one sick-leave spell exceeding 7 days. RESULTS: Pregnant women had a very high sickness absence. When pregnant women were excluded, the female sick-leave rate decreased from 0.18 (95% C.I. 0.17-0.18) to 0.15 (95% C.I. 0.15-0.16) for all women. The corresponding male sick-leave rate was 0.12 (95% c.i. 0.12-0.13). Gender differences in length of sickness absence decreased to the same extent. The results were similar when restricting the analysis to employed persons. The decrease varied a little with occupational group and was largest in the age-group 25-34. CONCLUSIONS: When pregnant women were excluded the excess female sick-leave rate was halved, but still remained 25% higher than the male. The impact of excluding pregnant women was highest in the age group 25-34, where the fertility-rate was highest. Although only 5% of all women aged 16-44 were pregnant, they had a large impact on gender differences in sickness absence.

Prognosis, recurrences and metastases correlated to histologic cell type in carcinoma of the uterine cervix.

An analysis of 230 patients treated with radiotherapy for cervical cancer stages I and II is presented. No positive correlation to cell type was found as regards the number of failures, recurrence rate or the frequency of regional or distant metastases. Although different biological behavior might be shown by cancers of varying cell types, adequate planning and staging before treatment seems to be of better prognostic value.