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1.
Paediatr Perinat Epidemiol ; 38(3): 183-192, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37658778

RESUMO

BACKGROUND: There is a paucity of data on whether parents' macrosomia (birthweight ≥4500 g) status influences the risk of macrosomia in the offspring. The role of maternal overweight in the generational effect of macrosomia is not known. OBJECTIVE: To estimate the risk of macrosomia by parental birthweight at term and evaluate if this risk varied with maternal body mass index (BMI, kg/m2) early in pregnancy. METHODS: We used data from the Medical Birth Registry of Norway on all singleton term births (37-42 gestational weeks) during 1967-2017. The primary exposure was parental macrosomia, and the outcome was macrosomia in the second generation. The secondary exposure was maternal BMI. We used binomial regression to calculate relative risk (RR) with a 95% confidence interval. We assessed potential unmeasured confounding and selection bias using a probabilistic bias analysis and performed analyses with and without imputation for variables with missing values. RESULTS: The data included 647,957 singleton parent-offspring trios born at term. The prevalence of macrosomia was 3.2% (n = 41,396) in the parental generation and 4.0% (n = 25,673) in the offspring generation. Macrosomia in parents was associated with an increased risk of macrosomia in offspring, with the RR for both parents were born macrosomic being 6.53 (95% confidence interval [CI] 5.31, 8.05), only mother macrosomic 3.37 (95% CI 3.17, 3.57) and only father macrosomic RR 2.22 (95% CI 2.12, 2.33). These risks increased by maternal BMI in early pregnancy: if both parents were born macrosomic, 17% of infants were macrosomic among mothers with normal BMI. If both parents were macrosomic and the mothers were obese, 31% of offspring were macrosomic. Macrosomia-related adverse outcomes did not differ with parental macrosomia status. CONCLUSIONS: Parents' weight at birth and maternal BMI appear to be strongly associated with macrosomia in the offspring delivered at term gestations.


Assuntos
Macrossomia Fetal , Obesidade , Recém-Nascido , Gravidez , Feminino , Lactente , Humanos , Masculino , Peso ao Nascer , Macrossomia Fetal/epidemiologia , Fatores de Risco , Obesidade/epidemiologia , Aumento de Peso , Índice de Massa Corporal , Pai
2.
Artigo em Inglês | MEDLINE | ID: mdl-38186187

RESUMO

INTRODUCTION: Previous studies have established a history of shoulder dystocia as an important risk factor for shoulder dystocia, but studies on shoulder dystocia by severity are scarce. It is unknown if shoulder dystocia tends to be passed on between generations. We aimed to assess the recurrence risk of shoulder dystocia by severity in the same woman and between generations on both the maternal and paternal side. We also assessed the likelihood of a second delivery and planned cesarean section after shoulder dystocia. MATERIAL AND METHODS: This was a population-based cohort study, using data from the Medical Birth Registry of Norway. To study recurrence in the same mother, we identified 1 091 067 pairs of first and second, second and third, and third and fourth births in the same mother. To study intergenerational recurrence, we identified an individual both as a newborn and as a mother or father in 824 323 mother-offspring pairs and 614 663 father-offspring pairs. We used Bayesian log-binomial multilevel regression to calculate relative risks (RR) with 95% credible intervals. RESULTS: In subsequent deliveries in the same woman the unadjusted RR of recurrence was 7.05 (95% credible interval 6.39-7.79) and 2.99 (2.71-3.31) after adjusting for possible confounders, including current birthweight. The RRs were higher with severe shoulder dystocia as exposure or outcome. With severe shoulder dystocia as both exposure and outcome, unadjusted and adjusted RR was 20.42 (14.25-29.26) and 6.29 (4.41-8.99), respectively. Women with severe and mild shoulder dystocia and those without had subsequent delivery rates of 71.1, 68.9 and 69.0%, respectively. However, the rates of planned cesarean section in subsequent deliveries for those without shoulder dystocia, mild and severe were 1.3, 5.2 and 16.0%, respectively. On the maternal side the unadjusted inter-generational RR of recurrence was 2.82 (2.25-3.54) and 1.41 (1.05-1.90) on the paternal side. Corresponding adjusted RRs were 1.90 (1.51-2.40) and 1.19 (0.88-1.61), respectively. CONCLUSIONS: We found a strong recurrence risk of shoulder dystocia, especially severe, in subsequent deliveries in the same woman. The inter-generational recurrence risk was higher on the maternal than paternal side. Women with a history of shoulder dystocia had more often planned cesarean section.

3.
Arch Gynecol Obstet ; 306(5): 1807-1814, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-34999924

RESUMO

PURPOSE: This study examines individual aggregation of postpartum hemorrhage (PPH), paternal contribution and how offspring birthweight and sex influence recurrence of PPH. Further, we wanted to estimate the proportion of PPH cases attributable to a history of PPH or current birthweight. METHODS: We studied all singleton births in Norway from 1967 to 2017 using data from Norwegian medical and administrational registries. Subsequent births in the parents were linked. Multilevel logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PPH defined as blood loss > 500 ml, blood loss > 1500 ml, or the need for blood transfusion in parous women. Main exposures were previous PPH, high birthweight, and fetal sex. We calculated adjusted population attributable fractions for previous PPH and current high birthweight. RESULTS: Mothers with a history of PPH had three- and sixfold higher risks of PPH in their second and third deliveries, respectively (adjusted OR 2.9; 95% CI 2.9-3.0 and 6.0; 5.5-6.6). Severe PPH (> 1500 ml) had the highest risk of recurrence. The paternal contribution to recurrence of PPH in deliveries with two different mothers was weak, but significant. If the neonate was male, the risk of PPH was reduced. A history of PPH or birthweight ≥ 4000 g each accounted for 15% of the total number of PPH cases. CONCLUSION: A history of PPH and current birthweight exerted strong effects at both the individual and population levels. Recurrence risk was highest for severe PPH. Occurrence and recurrence were lower in male fetuses, and the paternal influence was weak.


Assuntos
Hemorragia Pós-Parto , Peso ao Nascer , Estudos de Coortes , Pai , Feminino , Humanos , Recém-Nascido , Masculino , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Fatores de Risco
4.
Acta Obstet Gynecol Scand ; 100(12): 2167-2175, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34309849

RESUMO

INTRODUCTION: Cesarean section is the single most important risk factor for postpartum infection. Where the rest of the world shows increasing trends, the cesarean section rates are low in Norway and risk factors for infection after cesarean section may differ in high and low cesarean section settings. The goal of this study was to examine independent risk factors for surgical site infection after cesarean delivery in a setting of low cesarean section rates. MATERIAL AND METHODS: We conducted a hospital-based case-control study at Haukeland University Hospital. We included women who presented to our hospital with surgical site infection after cesarean section during the years 2014-2016 (n = 75). Controls were selected at a ratio of 2:1 (n = 148). Cases and controls were compared with respect to maternal and pregnancy characteristics using uni- and multivariable logistic regression models. Main outcome measures were anticipated risk factors for surgical site infection. RESULTS: The occurrence of surgical site infection was 0.4% and 5.4% after elective and emergency cesarean section, respectively. Compared to women without surgical site infection, women with surgical site infection were almost thrice more obese before pregnancy (OR 2.8, 95% CI 1.2-7.0), four times more likely to have preexisting psychiatric conditions (OR 4.4, 95% CI 1.1-17.6), and five times more likely to receive blood transfusion (OR 5.1, 95% CI 1.4-18.8). Signs of infection during labor was a marginally significant risk factor for surgical site infection (OR 2.0, 95% CI 1.0-5.4). CONCLUSIONS: Emergency cesarean section was a significant risk factor for surgical site infection. Pregestational obesity, preexisting psychiatric conditions, and blood transfusion during or following delivery, were independent risk factors for surgical site infection. Signs of infection during labor was a marginally significant risk factor. Women with either of these risk factors should be carefully monitored and evaluated for signs of infection in the postpartum period.


Assuntos
Cesárea , Adulto , Estudos de Casos e Controles , Feminino , Hospitais , Humanos , Noruega , Gravidez , Fatores de Risco , Infecção da Ferida Cirúrgica
5.
Acta Obstet Gynecol Scand ; 100(12): 2278-2284, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34622946

RESUMO

INTRODUCTION: Studies on the family aggregation of postpartum hemorrhage (PPH) are scarce and with inconsistent results, and to what extent current birthweight influences recurrence between relatives remains to be studied. Further, family aggregation of PPH has been studied from an individual, but not from a public heath perspective. We aimed to investigate family aggregation of PPH in Norway, how birthweight influences these effects, and to estimate the proportion of PPH cases attributable to a family history of PPH and current birthweight. MATERIAL AND METHODS: Using data from the Medical Birth Registry of Norway, Statistics Norway, and Central Population Registry of Norway we identified individuals as newborns, parents, grandparents, and full and half-siblings, and studied 1 002 687 mother-offspring, 841 164 father-offspring, and 761 011 both-parents-offspring pairs. We used multilevel logistic regression to calculate odds ratios (OR) with 95% CI. RESULTS: If the birth of the mother but not of the father involved PPH, then the OR of PPH (>500 mL) in the next generation was 1.44 (95% CI 1.39-1.49). If the birth of the father but not of the mother involved PPH, then OR was 1.12 (95% CI 1.08-1.16). These effects were stronger in severe PPH. Recurrence between siblings was highest between full sisters (OR 1.47, 95% CI 1.41-1.52), followed by maternal half-sisters, paternal half-sisters, and partners of full brothers. A family history of PPH or birthweight of 4000 g or more accounted for ≤5% and 15% of the total number of PPH cases, respectively. CONCLUSIONS: A history of PPH in relatives influenced the recurrence risk of PPH in a dose-response pattern consistent with the anticipated proportion of shared genes. The recurrence was highest through the maternal line.


Assuntos
Família , Hemorragia Pós-Parto/epidemiologia , Peso ao Nascer , Estudos de Coortes , Feminino , Humanos , Masculino , Noruega/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/genética , Sistema de Registros
6.
Acta Obstet Gynecol Scand ; 99(3): 374-380, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31603530

RESUMO

INTRODUCTION: Isolated single umbilical artery (iSUA) refers to single umbilical artery cords with no other fetal malformations. The association of iSUA to adverse outcome of pregnancy has not been consistently reported, and whether iSUA carries increased risk of third stage of labor complications has not been studied. We aimed to investigate the risk of adverse perinatal outcome, third stage of labor complications, and associated placental and cord characteristics in pregnancies with iSUA. A further aim was to assess the risk of recurrence of iSUA and anomalous cord or placenta characteristics in Norway. MATERIAL AND METHODS: This was a population-based study of all singleton pregnancies with gestational age >16 weeks at birth using data from the Medical Birth Registry of Norway from 1999 to 2014 (n = 918 933). Odds ratios (OR) with 95% confidence intervals were calculated for adverse perinatal outcome (preterm birth, perinatal and intrauterine death, low Apgar score, transferral to neonatal intensive care ward, placental and cord characteristics [placental weight, cord length and knots, anomalous cord insertion, placental abruption and previa]), and third stage of labor complications (postpartum hemorrhage and the need for manual placental removal or curettage) in pregnancies with iSUA, and recurrence of iSUA using generalized estimating equations and logistic regression. RESULTS: Pregnancies with iSUA carried increased risk of adverse perinatal outcome (OR 5.06, 95% confidence interval [CI] 4.26-6.02) and perinatal and intrauterine death (OR 5.62, 95% CI 4.69-6.73), and a 73% and 55% increased risk of preterm birth and small-for-gestational-age neonate, respectively. The presence of iSUA also carried increased risk of a small placenta, placenta previa and abruption, anomalous cord insertion, long cord, cord knot and third stage of labor complications. Women with iSUA, long cord or anomalous cord insertion in one pregnancy carried increased risk of iSUA in the subsequent pregnancy. CONCLUSIONS: The presence of ISUA was associated with a more than five times increased risk of intrauterine and perinatal death and with placental and cord complications. The high associated risk of adverse outcome justifies follow up with assessment of fetal wellbeing in the third trimester, intrapartum surveillance and preparedness for third stage of labor complications.


Assuntos
Terceira Fase do Trabalho de Parto , Complicações do Trabalho de Parto/epidemiologia , Artéria Umbilical Única/epidemiologia , Adulto , Feminino , Morte Fetal , Humanos , Recém-Nascido , Noruega/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Sistema de Registros , Fatores de Risco , Artéria Umbilical Única/mortalidade , Ultrassonografia Pré-Natal
7.
Eur J Public Health ; 30(3): 491-498, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32031625

RESUMO

BACKGROUND: Socioeconomic (SE) inequalities have been observed in a number of adverse outcomes of pregnancy and many of the risk factors for such outcomes are associated with a low SE level. However, SE inequalities persist even after adjustment for these risk factors. Less well-off women are more vulnerable, but may also get less adequate health services. The objective of the present study was to assess possible associations between SE conditions in terms of maternal education as well as ethnic background and obstetric care. METHODS: A population-based national cohort study from the Medical Birth Registry of Norway. The study population comprised 2 305 780 births from the observation period 1967-2009. Multilevel analysis was used because of the hierarchical structure of the data. Outcome variables included induction of labour, epidural analgesia, caesarean section, neonatal intensive care and perinatal death. RESULTS: While medical interventions in the 1970s were employed less frequently in women of short education and non-western immigrants, this difference was eliminated or even reversed towards the end of the observation period. However, an excess perinatal mortality in both the short-educated [adjusted relative risk (aRR) = 2.49] and the non-western immigrant groups (aRR = 1.75) remained and may indicate increasing health problems in these groups. CONCLUSION: Even though our study suggests a fair and favourable development during the last decades in the distribution across SE groups of obstetric health services, the results suggest that the needs for obstetric care have increased in vulnerable groups, requiring a closer follow-up.


Assuntos
Analgesia Epidural , Cesárea , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Noruega/epidemiologia , Gravidez , Fatores Socioeconômicos
8.
Acta Obstet Gynecol Scand ; 98(7): 894-904, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30737767

RESUMO

INTRODUCTION: In most pregnancies after a cesarean section, a trial of labor is an option. The objective of the study was to explore trial of labor and its failure in pregnancies with medical risk conditions, in a population with a high trial of labor rate. MATERIAL AND METHODS: In a cohort study (n = 57 109), using data from the Medical Birth Registry of Norway 1989-2014, women with a second delivery after a first pregnancy cesarean section were included. Preterm, multiple, and non-cephalic deliveries were excluded. The outcomes were trial of labor and failed trial of labor, assessed as rates and relative risk, using deliveries without risk conditions as reference. Temporal trends were assessed by 3-year periods. The exposures were selected medical risk conditions, ie previous offspring death, labor dystocia, diabetes, heart conditions, chronic hypertension, chronic kidney disease, rheumatoid arthritis, thyroid disease, asthma, prepregnancy psychiatric conditions, epilepsy, obesity, gestational diabetes, eclampsia and preeclampsia, gestational hypertension, major malformations, second-pregnancy psychiatric conditions, assisted reproduction, macrosomia, and small-for-gestational-age neonates. Induced onset of labor was compared with spontaneous onset of labor for each condition studied. RESULTS: In risk pregnancies (n = 31 994) the trial of labor rate was 64.9% and failure rate was 27.6%, compared with 74.6% and 16.4% in pregnancies without any of the risk conditions studied (n = 25 115). The lowest trial of labor rates were observed in diabetes type 1 (49.5%), diabetes type 2 (46.7%), maternal heart conditions (54.5%), and pregnancy-related psychiatric conditions (19.7%). The highest failure rates were observed in diabetes type 1 (43.1%), diabetes type 2 (40.3%), maternal obesity (36.9%), gestational diabetes (36.0%), and offspring macrosomia (43.0%). Induced labor was associated with failed trial of labor (P < .05), whereas after spontaneous labor, failure rates were less than 40% in all conditions studied. CONCLUSIONS: In conditions with high rates of failed trial of labor, eg diabetes, macrosomia, and obesity, a planned cesarean section might be a better option than a trial of labor, particularly if induction of delivery might be needed.


Assuntos
Recesariana/estatística & dados numéricos , Resultado da Gravidez , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Adulto , Feminino , Humanos , Noruega , Gravidez , Complicações na Gravidez , Gravidez de Alto Risco , Sistema de Registros , Fatores de Risco
9.
Acta Obstet Gynecol Scand ; 98(1): 117-126, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30192982

RESUMO

INTRODUCTION: Trial of labor (TOLAC) is an option in most preganancies after a cesarean section The objective of the study was to compare perinatal outcome in TOLAC and non-TOLAC deliveries in a population with high TOLAC rates. MATERIAL AND METHODS: This was a cohort study based on population data from the Medical Birth Registry of Norway. We included term, cephalic, single, second deliveries, 1989-2009, after a first cesarean section (n = 43 422). TOLAC, TOLAC failure, non-TOLAC deliveries, and after high-risk and low-risk pregnancies (no risk/any risk), were compared with respect to offspring mortality, 5-minute Apgar score Apgar < 7 and < 4, transfer to a neonatal intensive care unit, and neonatal respiratory distress syndrome. RESULTS: Statistically significant differences were observed (P <0.05). In the low-risk group the offspring mortality was 2.3/1000 in TOLAC compared with 0.9/1000 in non-TOLAC. In the high-risk group, the offspring mortality was 3.7/1000 in TOLAC compared with 0.9/1000 in non-TOLAC, and the 5-minute Apgar score < 4 was 3.1/1000 in TOLAC compared with 0.9/1000 in non-TOLAC. In both risk groups, TOLAC delivery had a higher rate of 5-minute Apgar score < 7. In the low-risk group, non-TOLAC deliveries had a higher rate of neonatal respiratory distress syndrome than TOLAC deliveries. CONCLUSIONS: We observed higher risk of offspring mortality and lower 5-minute Apgar score in TOLAC than in non-TOLAC. Possible causes and preventive measures should be explored.


Assuntos
Recesariana/mortalidade , Cesárea/mortalidade , Mortalidade Infantil , Resultado da Gravidez/epidemiologia , Prova de Trabalho de Parto , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Noruega , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Gravidez de Alto Risco , Nascimento Vaginal Após Cesárea/mortalidade , Adulto Jovem
10.
Acta Obstet Gynecol Scand ; 98(1): 101-105, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30168856

RESUMO

INTRODUCTION: Fetal biometry is used for determining gestational age and estimated date of delivery (EDD). However, the accuracy of the EDD depends on the assumed length of pregnancy included in the calculation. This study aimed at assessing the actual pregnancy length and accuracy of EDD prediction based on fetal head circumference measured at the second trimester. MATERIAL AND METHODS: This was a population-based observational study with the following inclusion criteria: singleton pregnancy, head circumference dating in the second trimester, spontaneous onset or induction of delivery ≥ 294 days of gestation, live birth. The EDD was set anticipating a pregnancy length of 282 days. Bias in the prediction of EDD was defined as the difference between the actual date of birth and the EDD. RESULTS: Head circumference measurements were available for 21 451 pregnancies. Ultrasound-dated pregnancies had a median pregnancy length of 283.03 days, corresponding to a method bias of 1.03 days (95% CI; 0.89-1.16). This bias was dependent on the head circumference at dating, ranging from -1.58 days (95% CI; -3.54 to 1.12) to 3.42 days (95% CI; 1.98-4.31). The median pregnancy length, based on the last menstrual period of women with a regular menstrual cycle (n = 12 985), was 283.15 days (95% CI; 282.91-283.31). A total of 5685 (22.9%, 95% CI; 22.4% to 23.4%) and 886 women (3.6%, 95% CI; 3.3%-3.8%) were still pregnant 7 and 14 days after the EDD, respectively. CONCLUSIONS: Second trimester head circumference measurements can be safely used to predict EDD. A revision of the pregnancy length to 283 days will reduce the bias of EDD prediction to a level comparable with other methods.


Assuntos
Estatura Cabeça-Cóccix , Desenvolvimento Fetal/fisiologia , Cabeça/diagnóstico por imagem , Segundo Trimestre da Gravidez/fisiologia , Adulto , Feminino , Idade Gestacional , Cabeça/fisiologia , Humanos , Gravidez , Resultado da Gravidez , Ultrassonografia Pré-Natal/métodos
11.
Acta Obstet Gynecol Scand ; 98(2): 176-182, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30218536

RESUMO

INTRODUCTION: The human yolk sac provides the embryo with stem cells, nutrients, and gas exchange. We hypothesized that more maternal resources, reflected in body size and body composition, would condition a a larger yolk sac, ensuring resources for the growing embryo. Thus, we aimed to determine the relation between maternal size in early pregnancy and yolk sac size. MATERIAL AND METHODS: This subsidiary study was embedded in the multinational World Health Organization fetal growth project that included healthy women with a body mass index of 18-30, reliable information of their regular last menstrual period and singleton pregnancies. Yolk sac diameter, crown-rump length, and maternal height, weight, body mass index, and body composition were assessed before 13 weeks of gestation, and the fetal biometry was repeated during the pregnancy. RESULTS: Of 140 participants, 122 with a successful yolk sac measurement were entered in the present analysis. Maternal weight was negatively associated with the yolk sac diameter (P = 0.007) and so was maternal height (P = 0.011), fat mass (P = 0.037), and lean body mass (P = 0.018), but not body mass index (P = 0.121). Significant effects were predominantly due to the female embryos and could be traced at 24 weeks of gestation. That is, a small yolk sac : crown-rump length ratio in early pregnancy was associated with a high fetal abdominal circumference (P < 0.001) and estimated fetal weight (P = 0.001). CONCLUSIONS: The human yolk sac is involved in the regulation of embryonic growth, but contrary to our hypothesis, the yolk sac has a compensatory capacity, being larger when the mothers are smaller; and the effect can be traced on fetal size at 24 weeks of gestation.


Assuntos
Índice de Massa Corporal , Desenvolvimento Embrionário/fisiologia , Primeiro Trimestre da Gravidez/fisiologia , Saco Vitelino , Adulto , Biometria/métodos , Composição Corporal , Correlação de Dados , Feminino , Desenvolvimento Fetal/fisiologia , Peso Fetal , Idade Gestacional , Humanos , Gravidez , Cuidado Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Saco Vitelino/diagnóstico por imagem , Saco Vitelino/crescimento & desenvolvimento
13.
Acta Obstet Gynecol Scand ; 97(8): 1032-1040, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29752712

RESUMO

INTRODUCTION: Despite adequate glycemic control, the risks of fetal macrosomia and perinatal complications are increased in diabetic pregnancies. Adjustments of the umbilical venous distribution, including increased ductus venosus shunting, can be important fetal compensatory mechanisms, but the impact of pregestational diabetes on umbilical venous and ductus venosus flow is not known. MATERIAL AND METHODS: In this prospective study, 49 women with pregestational diabetes mellitus underwent monthly ultrasound examinations from gestational week 20 to 36. The blood velocity and the mean diameters of the umbilical vein and ductus venosus were used for calculating blood flow volumes. The development of the umbilical venous flow, ductus venosus flow and ductus venosus shunt fraction (% of umbilical venous blood shunted through the ductus venosus) was compared with a reference population, and the effect of HbA1c on the ductus venosus flow was assessed. RESULTS: The umbilical venous flow was larger in pregnancies with pregestational diabetes mellitus than in low-risk pregnancies (p < 0.001) but smaller when normalized for fetal weight (p = 0.036). The distributional pattern of the ductus venosus flow developed differently in diabetic pregnancies, particularly during the third trimester, being smaller (p = 0.007), also when normalized for fetal weight (p < 0.001). Correspondingly, the ductus venosus shunt fraction was reduced (p < 0.0001), most prominently at 36 weeks. There were negative relations between the maternal HbA1c and the ductus venosus flow velocity, flow volume and shunt fraction. CONCLUSIONS: In pregnancies with pregestational diabetes mellitus, prioritized umbilical venous distribution to the fetal liver and lower ductus venosus shunt capacity reduce the compensatory capability of the fetus and may represent an augmented risk during hypoxic challenges during late pregnancy and birth.

14.
BMC Pregnancy Childbirth ; 18(1): 423, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30367607

RESUMO

BACKGROUND: To investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration. METHODS: We included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990-2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education. RESULTS: Preeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49-0.62]), followed by family immigrants (0.62 [0.59-0.65]), immigrant students (0.75 [0.65-0.86]), refugees (0.81 [0.75-0.88]), and immigrants from other Nordic countries (0.87 [0.80-0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02-1.36], and < 34 weeks: 1.41 [1.15-1.72]). CONCLUSIONS: The occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Pré-Eclâmpsia/epidemiologia , Refugiados/estatística & dados numéricos , Adulto , Feminino , Humanos , Incidência , Noruega/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco , Adulto Jovem
16.
Acta Obstet Gynecol Scand ; 96(2): 243-250, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27874979

RESUMO

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) tend to recur from one pregnancy to the next. The aims of the study were to assess the recurrence risk according to type of HDP defined by gestational age at birth and to examine whether recurrence is associated with the following additional risk factors for HDP: maternal age, smoking, inter-delivery interval, diabetes, body mass index, and fetal growth restriction, and to assess temporal trends in these associations. MATERIAL AND METHODS: All women with two singleton births in the Medical Birth Registry of Norway 1967-2012 (n = 742 980) were included in this population-based cohort study. Logistic regression was used to calculate odds ratios for the risk of recurrent HDP according to type of HDP. RESULTS: The highest odds ratio of recurrence was observed for the same type of HDP based on gestational age at delivery. After gestational hypertension and term preeclampsia, the risk for the same type to recur increased 10-fold, whereas after late and early preterm preeclampsia, the risk increased 27- and 97-fold, respectively. The recurrence of early preterm preeclampsia was less influenced by additional risk factors compared with term HDP. Recurrence of early preterm HDP was significantly lower from 1993 onwards. CONCLUSIONS: Recurrent HDP tended to be of the same type as the previous HDP. Risk of recurrence associated with additional risk factors was observed particularly after term. The odds ratio of recurrence of early preterm HDP was significantly lower from 1993 onwards.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Idade Materna , Noruega/epidemiologia , Paridade , Gravidez , Gravidez em Diabéticas/epidemiologia , Gravidez de Alto Risco , Recidiva , Fatores de Risco , Adulto Jovem
17.
Acta Obstet Gynecol Scand ; 96(1): 78-85, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27696344

RESUMO

INTRODUCTION: Anomalous cord insertion is associated with increased risk of adverse maternal and perinatal outcome. Our aim was to study whether anomalous cord insertion is associated with prelabor rupture of membranes (PROM), preterm PROM (pPROM), long or short umbilical cord, and time trend of spontaneous preterm birth (SPTB) and anomalous cord insertion. MATERIAL AND METHODS: A population-based register study using data from the Medical Birth Register of Norway including all singleton births (gestational age >16 weeks and <45 weeks) during 1999-2013 (n = 860 465) to calculate odds ratios (ORs) for PROM, pPROM, SPTB, and cord length (>95th or <5th centile) according to the cord insertion site by logistic regression with adjustment for possible confounders. We also assessed time trends of SPTB and anomalous cord insertion. RESULTS: Velamentous insertion of the cord was associated with an increased risk of PROM (OR 1.6, 95% CI 1.5-1.7), pPROM (OR 2.7, 95% CI 2.4-3.0), SPTB (OR 2.0, 95% CI 1.9-2.2), and a short cord (OR 1.7, 95% CI 1.5-1.8). Marginal insertion was to a lesser extent associated with these complications. Occurrences of SPTB and anomalous insertion declined. The decline in SPTB persisted after including an interaction term between anomalous insertion and time. CONCLUSIONS: Velamentous and, to a lesser extent, marginal cord insertions were associated with increased risk of PROM, pPROM, SPTB, and short cord. This suggests a common pathogenesis behind altered function of the membranes, cord, and placenta. The decline in SPTB could not be explained by the reduction in the occurrence of anomalous cord insertion.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Nascimento Prematuro/epidemiologia , Cordão Umbilical/anormalidades , Adulto , Feminino , Humanos , Masculino , Noruega/epidemiologia , Oligo-Hidrâmnio/epidemiologia , Poli-Hidrâmnios/epidemiologia , Gravidez , Sistema de Registros , Fatores Sexuais , Adulto Jovem
18.
Acta Obstet Gynecol Scand ; 96(9): 1120-1127, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28481411

RESUMO

INTRODUCTION: A validation of data regarding the placenta, cord and membranes in Medical Birth Registry of Norway (MBRN) is lacking. Here we investigate the inter- and intra-observer agreement of observations regarding the placenta, cord and membranes to the MBRN in two institutions. MATERIAL AND METHODS: We conducted a dual center validation study of data regarding placenta, cord and membranes. In the inter-observer study, 196 placentas in two institutions were examined by the attending midwife and a blinded colleague, whereas in the intra-observer study registrations by the attending midwife on 195 placentas were compared with her own registrations to the MBRN. In a separate sample consisting of 51 placental pathology reports, midwives' registrations to the MBRN were compared with the pathology report. For categorical and continuous variables, agreement was assessed by kappa value and paired sample t-test, respectively. RESULTS: Inter-observer agreement between two midwives for cord insertion site and bi-placenta, cord knots and vessel anomalies were good (kappa values >0.79 and >0.96, respectively). The inter- and intra-observer study showed no significant differences regarding placental weight and cord length (p = 0.31 and 0.28, p = 0.71 and 0.39, respectively). The inter-observer agreement between the pathology reports and midwives' registrations was good for gross placental and cord variants (kappa 0.73-1.0), but there were significant differences in placental weight and cord length (p < 0.0001). CONCLUSIONS: The results suggest that the validity of data regarding placenta and cord in the MBRN is sufficiently high to justify future large-scale epidemiologic research based on this database.


Assuntos
Parto Obstétrico , Sistemas de Informação Administrativa/normas , Tocologia , Placenta/patologia , Sistema de Registros , Cordão Umbilical/patologia , Feminino , Humanos , Noruega/epidemiologia , Gravidez , Reprodutibilidade dos Testes
19.
Acta Obstet Gynecol Scand ; 96(7): 892-897, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28196281

RESUMO

INTRODUCTION: Trial of labor (TOL) is an option in most deliveries after a previous cesarean section (CS). The Medical Birth Registry of Norway (MBRN) has received compulsory notification of all deliveries in the country since 1967, including data that could identify TOL in epidemiologic research. The objective of this study was to validate MBRN data for identification of TOL deliveries after a previous cesarean section (CS). MATERIAL AND METHODS: The MBRN provided a random national sample of 500 birth order two deliveries during 1989-2012 in women with a registered birth order one CS delivery. The reporting maternity units were asked to complete a questionnaire on data items in both deliveries, using hospital record data as the gold standard. RESULTS: Completed questionnaires were returned for 477 women (95.5%) with data on both deliveries. An algorithm to identify TOL using MBRN data from the birth order two delivery had a positive predictive value of 93.2%, a negative predictive value of 93.5%, a sensitivity of 96.1%, and a specificity of 88.8%. Validity of MBRN data on mode and onset of delivery, CS subtype, and planned mode of delivery is also reported. CONCLUSIONS: MBRN data on planned and actual mode of delivery, CS subtype, and the algorithm to identify TOL in deliveries after a previous CS had satisfactory quality for a registry-based study of TOL.


Assuntos
Recesariana/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Avaliação de Resultados em Cuidados de Saúde , Sistema de Registros , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Algoritmos , Feminino , Humanos , Recém-Nascido , Noruega/epidemiologia , Gravidez , Reprodutibilidade dos Testes , Inquéritos e Questionários
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