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.

Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.

AIM: To examine the effect of hospitalization during adolescence on the likelihood of giving birth. METHODS: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth. RESULTS: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter. CONCLUSION: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

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.

Use of healthcare resources, family function, and socioeconomic support during the first four years after preterm birth.

OBJECTIVES: To assess the use of healthcare resources for preterm infants and to evaluate family function and socioeconomic support in a defined population from birth to 4 years of age. METHODS: In a prospective case-control study, 39 singleton preterm infants without prenatal abnormalities born during an 18 month period were studied together with their families. The population consisted of 19 very preterm infants (less than 32 weeks) and 20 randomised moderate preterm infants (32-35 weeks), and the control group comprised 39 full term infants. Contacts with medical services, child health services, and the social welfare system were registered, and family function and life events were studied. RESULTS: The preterm children were more often readmitted to hospital (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.0 to 22.1) and had more outpatient attendances (OR 5.6, 95% CI 2.1 to 15.0) during their first year of life. Mothers in the preterm group more often used temporary parental allowance than the control mothers (p < 0.001). The number of contacts with the child health services and the social welfare system did not differ significantly from the controls. Neither was there any significant difference with regard to family function or life events at 4 years of age. CONCLUSIONS: A large proportion of the premature children used specialist care during the first years of life. However, the families of the preterm infants were socially well adapted up to four years after birth compared with the control families.

Evaluation of an intervention programme to support mothers and babies at psychosocial risk: assessment of mother/child interaction and mother's perceptions of benefit.

The outcome of a short-term intervention programme for mothers at psychosocial risk was evaluated. The study included 63 mothers and their 0-6-month-old babies who participated in a 6-week intensive treatment programme. Mother-child interaction was assessed in the beginning and at the end of treatment by two independent staff members based on direct observation, and by two control raters who observed video recordings which were arranged in blind order. The mothers were interviewed about the treatment retrospectively. A positive change in several aspects of mother-child interaction, according to the assessments made by the raters and according to the mothers themselves. The number of mothers who were positive toward the treatment rose from 34 in the beginning of the treatment to 56 at the end. In conclusion, a short but intensive intervention seems to have a positive outcome on mother-child interaction, and was in most cases linked to a positive attitude.

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.

[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.

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.

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.

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.

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.

Children of mothers who are at psycho-social risk. Mental health, behaviour problems and incidence of child abuse at age 8 years.

Of the 1575 pregnant women registered at the public Antenatal Health Care Service in the city of Linköping, Sweden, during 1983, an index-group of 78 women were identified who met specific well-defined psychosocial risk-criteria related to drug addiction, mental insufficiency, and particular social circumstances of possible relevance to problems of pregnancy and early child development. Seventy-eight pregnant women who did not meet the inclusion criteria were used as a reference group. The present study was an 8-year follow up in which 47 of the original index children and 57 of the original reference children were examined on indices of mental health, and the presence of child abuse. Their mental health was assessed on the basis of a Symptom and Behaviour Interview (SBI) with the mother and a Child Behaviour Checklist (CBCL) completed by the mothers and the teachers. The incidence of child abuse was obtained from Social Welfare records. The index children displayed significantly poorer mental health as assessed by the SBI and the CBCL, had a more negative self-image, and child abuse had been investigated in 30% of the index families compared to 1% in the reference families. The study suggests, based on the suboptimal development of the risk children, that screening for early psychosocial risk factors should be done routinely and be combined with early interventions.