Possible relation between maternal consumption of added sugar and sugar-sweetened beverages and birth weight--time trends in a population.

BACKGROUND: High birth weight (BW) is a risk factor for later obesity. In Norway, mean BW and proportion of large newborns increased from 1989 to 2000 and subsequently decreased to the 1989 level by 2010. The purpose of the study was to explore causes of this temporary increase. METHODS: From a regional prospective database pregnancy and newborn data were extracted for all 33088 singleton pregnancies resulting in live infants born at term without malformations during 1989-2010. Trends in BW, ponderal index and proportion of large newborns were related to individual prenatal exposures, including pre-pregnancy body mass index (PP-BMI) and gestational weight gain (GWG) for the years 2001-2010, and thereafter related ecologically to national population data on consumption of nutrients and physical activity. RESULTS: For the regional cohort mean (standard deviation) BW increased from 3580 (453) grams in 1989/90 to 3633 (493) grams in 2001/02 (p<0.001), and decreased to 3583 (481) grams in 2009/10 (p<0.001). The proportion with BW>4500 grams increased from 2.6% to 4.8% (p<0.001) and subsequently decreased to 3.3% (p=0.002). The trends remained after adjustment for relevant exposures. For the years 2001/02 to 2009/10 (n= 15240) mean (SD) PP-BMI increased from 24.36 (4.44) to 24.85 (5.02) kg/m2 (p<0.001) while GWG decreased from 14.79 (5.85) to 13.86 (5.79) kg (p<0.001). The estimated net effect of changes in PP-BMI, GWG and other known exposures was a 6 grams reduction in BW from 2001/02 to 2009/10, leaving 44 grams reduction unexplained. National consumption of major nutrients did not change, but consumption of sucrose, in large part as sugar-sweetened beverages (SSB) changed in parallel to the BW trends. CONCLUSION: The temporary increase in BW and large babies in the regional cohort was identical to that reported for Norway. Individual level data on known pregnancy related predictors for BW could not explain these changes, but the parallel time trend in national consumption of sucrose, in particular as SSB, may lend support to a hypothesis that intake of sugar may have a direct effect on BW and infant body proportions independent of effects through PP-BMI and GWG.

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.

Age-specific birth rates in women with epilepsy: a population-based study.

OBJECTIVE: The aim of this study was to investigate birth rates and use of hormonal contraception in different age groups among women with epilepsy (WWE) in comparison to women without epilepsy. MATERIALS AND METHODS: Demographic data and medical information on more than 25,000 pregnant women (40,000 births), representing 95% of all pregnancies in Oppland County, Norway, were registered in the Oppland Perinatal Database in the period 1989-2011. Data were analyzed with respect to epilepsy diagnoses, and 176 women with a validated epilepsy diagnosis (303 pregnancies) were identified. Age-specific birth rates in these women were estimated and compared with age-specific birth rates in women without epilepsy in the same county. RESULTS: In WWE over 25 years of age, birth rates were significantly lower than in those of the same age group without epilepsy. In women below 20 years of age, birth rates were similar in those with and without epilepsy. The use of hormonal contraceptives prior to pregnancy was lower among WWE under 25 years than in the corresponding age group without epilepsy. CONCLUSIONS: Health professionals who counsel WWE who are of fertile age should be aware of the strongly reduced birth rates in WWE over 25 years of age, and the lower rates of use of contraceptives among young WWE.

The biologic error in gestational length related to the use of the first day of last menstrual period as a proxy for the start of pregnancy.

OBJECTIVE: In a large unselected population of normal spontaneous pregnancies, to estimate the biologic variation of the interval from the first day of the last menstrual period to start of pregnancy, and the biologic variation of gestational length to delivery; and to estimate the random error of routine ultrasound assessment of gestational age in mid-second trimester. STUDY DESIGN: Cohort study of 11,238 singleton pregnancies, with spontaneous onset of labour and reliable last menstrual period. The day of delivery was predicted with two independent methods: According to the rule of Nägele and based on ultrasound examination in gestational weeks 17-19. For both methods, the mean difference between observed and predicted day of delivery was calculated. The variances of the differences were combined to estimate the variances of the two partitions of pregnancy. RESULTS: The biologic variation of the time from last menstrual period to pregnancy start was estimated to 7.0 days (standard deviation), and the standard deviation of the time to spontaneous delivery was estimated to 12.4 days. The estimate of the standard deviation of the random error of ultrasound assessed foetal age was 5.2 days. CONCLUSION: Even when the last menstrual period is reliable, the biologic variation of the time from last menstrual period to the real start of pregnancy is substantial, and must be taken into account. Reliable information about the first day of the last menstrual period is not equivalent with reliable information about the start of pregnancy.

Intrauterine growth retardation in foetuses of women with epilepsy.

PURPOSE: Various factors may affect intrauterine foetal growth, amongst which conditions such as epilepsy and the use of anti-epileptic drugs (AED) may play a role. This study investigated intrauterine growth of foetuses in women with epilepsy, as compared with controls, and explored whether intrauterine growth was affected by prenatal exposure to AED. METHOD: Data were obtained from prospectively registered data regarding pregnancy and prenatal and perinatal factors in women in Oppland County in Norway. The final analysis included information from 166 mothers with epilepsy and 287 children. The control group consisted of 40,553 pregnancies in women without epilepsy registered in the same database. RESULTS: There was a significantly higher risk of the ponderal index being below the 10th percentile and infants being small for gestational age (SGA) in the epilepsy group; exposure to AED increased the risk. The frequency of SGA and low ponderal index was highest in Lamotrigine exposed infants. In the AED group, head circumference was significantly smaller among Carbamazepine exposed. CONCLUSION: Impaired intrauterine growth of foetuses in women with epilepsy was identified. The frequency of SGA and low ponderal index was highest in Lamotrigine exposed infants. The epilepsy group had a higher risk profile for having smaller babies, in being younger at age, lower in body weight and more frequent smokers. However despite these differences, the effects of epilepsy and AED exposure were significant. The ponderal index may be a useful supplement to more established measures assessing intrauterine growth in epilepsy.

Term prediction with ultrasound: evaluation of a new dating curve for biparietal diameter measurements.

BACKGROUND: In Norway, routine ultrasound examination with assessment of gestational age was included in the standard antenatal care program in 1985. Until presently, a dating chart introduced in 1983 has been used throughout the country. New national normal values are now developed. The aim of the study was to compare the performance of the two sets of normal values; both are based on measurement of fetal biparietal diameter in the second trimester. MATERIAL AND METHOD: We analyzed a cohort of 11,238 singleton deliveries with spontaneous onset of labor. All had reliable last menstrual period and all had a routine ultrasound examination in the second trimester with measurement of fetal biparietal diameter. We calculated the expected day of delivery both according to the old (method A) and the new (method B) reference values. RESULTS: The prediction error (the difference between observed and expected day of delivery) for the last menstrual period method was -0.1 days, for method A -3.5 days, and for method B -0.7 days. The prediction error for method A increased up to 7 days when ultrasound measurements were obtained in gestational week 14-15. CONCLUSION: The old ultrasound method leads to a systematic underestimation of fetal age, and the prediction error increases notably when the ultrasound measurements are performed in the early second trimester. Gestational age is more precisely assessed with the new reference values.

Pregnancy risk increases from 41 weeks of gestation.

BACKGROUND: The aim of this study was to evaluate the mortality and morbidity of conservatively managed post-term pregnancies (gestation 294 days and beyond). MATERIALS AND METHODS: This is a population-based prospective study. The sample was comprised of all women (N=17,493) with a singleton pregnancy in one Norwegian county from 1989 to 1999, with a second-trimester ultrasound examination and delivery after 37 completed gestational weeks. RESULTS: One thousand three hundred and thirty-six (7.6%) of the deliveries were post-term. In this group, the increase in perinatal mortality reached borderline significance [relative risk (RR) 2.0; 95% confidence interval 0.9-4.6]. Perinatal morbidity expressed as Apgar score <7 at 5 min (RR 2.0; 95% confidence interval 1.2-3.3), and transferal to neonatal intensive care unit (RR 1.6; 95% confidence interval 1.3-2.0) were significantly more frequent. However, RR for perinatal death calculated per 1000 ongoing pregnancies increased significantly from 0.2 in week 37-3.7 in week 42, using perinatal mortality in gestational week 41 as a reference. CONCLUSIONS: Our results indicate that expectant management of post-term pregnancies allowing pregnancies to continue up to week 43 carries a risk for perinatal mortality and morbidity. The risk increases already from gestational week 41. The guidelines for management of post-term pregnancies should be revised.

Routine ultrasound screening and detection of congenital anomalies outside a university setting.

BACKGROUND: To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology. METHODS: Six hundred seventy-six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study. RESULTS: Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% according to the organ system of the fetus. CONCLUSIONS: Our study shows that midtrimester routine ultrasound examination in district hospitals can achieve a detection rate of congenital anomalies comparable with tertiary centers. One-stage ultrasound examination at midtrimester gives acceptable results concerning congenital anomalies with few false-positive results.

Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination.

BACKGROUND: Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination. AIM: To assess the obstetric outcome when the interval between the estimated date of delivery by last menstrual period and the estimated date of delivery by second trimester ultrasound exceeds 14 days. MATERIALS AND METHODS: Population-based prospective cohort study. Included were all women (n = 16 302) with a singleton pregnancy, in one Norwegian county from 1989 to 1999, with a reliable menstrual history and whose second trimester ultrasound examination was conclusive with a 35-60-mm biparietal diameter. RESULTS: Adverse outcome was defined as preterm birth (< 37 weeks), perinatal death, low birthweight (< 2500 g) and small-for-gestational age (< 2 standard deviation). The risk for perinatal death (odds ratio = 2.3), preterm birth (odds ratio = 1.7), low birth weight (odds ratio = 1.5), and small-for-gestational age (odds ratio = 1.5) was highly significantly increased in deliveries where the discrepancy between the two terms was more than 14 days. The increased risk is not explained by differences in parity, maternal age, smoking, fetal malformations, or use of oral contraceptives before pregnancy. CONCLUSION: Fetuses that are smaller than expected at the mid-second trimester ultrasound corresponding to a discrepancy of more than 14 days have an increased risk for adverse obstetric outcome.

[Ultrasonography in primary health care--experiences within obstetrics 1983-99]. / Ultralydundersøkelse i primaerhelsetjenesten--erfaringer innen obstetrikk 1983-99.

BACKGROUND: In 1983 ultrasound for obstetric purposes was introduced in a rural general practice in south-eastern Norway. We wanted to evaluate its systematic use in terms of pregnancy management and birth outcome. MATERIAL AND METHODS: Four sets of data were analysed: All obstetric ultrasound examinations done at the Sel Municipality Health Centre from 1 January 1998 to 28 February 1999; the database at the county hospital covering all obstetric patients and births in its catchment area, including those from the Sel community; all Medical Birth Registry reports on women from Sel from 1983 to 2000; a local register of pregnancy management and events in Sel from 1983 to 2000, organised by the local general practitioner. RESULTS: We found no difference in the accuracy of assessment of date of birth between the general practitioner in Sel and the Lillehammer outpatient obstetric department. The average number of ultrasound scans of individual women was also the same. Obstetric ultrasound in general practice successfully selected out patients who could be managed locally and those who needed referral. INTERPRETATION: Our results indicate true benefits and no definite hazards of obstetric ultrasound in rural general practice. As we have evaluated only one single practice, these results should be confirmed or negated in future studies.