Effect of the New Nordic Diet compared with usual care on glucose control in gestational diabetes mellitus: Study protocol for the randomized controlled trial intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO).

BACKGROUND: Gestational diabetes mellitus (GDM) is a pregnancy complication associated with short- and long-term health consequences for mother and child. First line treatment is diet and exercise but there is a recognized knowledge gap as to what diet treatment is optimal. A healthy Nordic diet has been associated with improved health but no studies in women with GDM exist. The New Nordic Diet (NND) is an initiative with the purpose to develop a healthy Nordic diet including foods with the potential to grow in Nordic countries; including fruit, berries, vegetables, whole-grain cereal products, nuts, fish, and rapeseed oil. The purpose of the intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO) is to test if the NND compared with usual care improves glucose control in women with GDM. METHODS: The iNDIGO study is a randomized parallel controlled trial where 50 women with GDM will be randomized to either an NND or usual care for 14 days (30-32 weeks of gestation). Participants in the NND group will receive menus and food bags containing foods to be consumed. Primary outcome is glycemic control (time in target) measured using continuous glucose monitoring. Compliance to the dietary intervention will be tested using dietary biomarkers and adherence questionnaires. CONCLUSION: Diet treatment represents first line treatment in GDM but it remains unclear what type of diets are effective. iNDIGO is an efficacy study and will provide evidence as to whether a healthy Nordic diet can improve glucose control in women with GDM. TRIAL REGISTRATION: ClinicalTrials.gov registration Number: NCT04169243. Registered 19 November 2019, https://clinicaltrials.gov/ct2/show/NCT04169243.

Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia

Objective. To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. Design. A cross-sectional study. Setting. Labour Ward; Muhimbili National Hospital; Dar es Salaam; Tanzania. Methods. The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measu- red. Data on socio-demographic characteristics; iron supplementation; malaria prophylaxis; blood transfusion during current pregnancy; and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb =11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - Hb 7.0 - 8.9 g/dl; and severe - Hb 7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (37 weeks); Apgar score; stillbirth; early neonatal death; low birth weight (LBW) (2 500 g) and very low birth weight (VLBW) (1 500 g). Results. A total of 1 174 anaemic and 547 non-anaemic women were enrolled. Their median age was 24 years (range 14 - 46 years) and median parity was 2 (range 0 - 17). The prevalence of anaemia and severe anaemia was 68and 5.8; respectively. The risk of preterm delivery increased significantly with the severity of anaemia; with odds ratios of 1.4; 1.4 and 4.1 respectively for mild; moderate and severe anaemia. The corresponding risks for LBW and VLBW were 1.2 and 1.7; 3.8 and 1.5; and 1.9 and 4.2 respectively. Conclusion. The risks of preterm delivery and LBW increased in proportion to the severity of maternal anaemia

Reproductive tract infections including sexually transmitted infections: a population-based study of women of reproductive age in a rural district of Vietnam.

OBJECTIVES: To investigate the prevalences of reproductive tract infections (RTI)/sexually transmitted infections (STI) among married women in a rural district of Vietnam, and analyse the influence of socioeconomic, sociodemographic, and other determinants possibly related to RTI/STI. METHODS: A community-based cross-sectional study. Married women aged 18-49 years (n = 1012) were interviewed and underwent a gynaecological examination. Specimens were collected for laboratory diagnosis of chlamydia, gonorrhoea, trichomonas, bacterial vaginosis (BV), candidiasis, hepatitis B, HIV, and syphilis. RESULTS: In total, 37% of the women were clinically diagnosed with an RTI/STI. Aetiologically confirmed RTI/STI was identified in 39% of the women (including 6% with STI). Endogenous infections were most prevalent (candidiasis 26%, BV 11%) followed by hepatitis B 8.3%, Chlamydia trachomatis 4.3%, Trichomonas vaginalis 1%, Neisseria gonorrhoeae 0.7%, genital warts 0.2%, and HIV and syphilis 0%. Fifty per cent of the STI cases were asymptomatic. Younger age and intrauterine devices were significantly associated with an increased risk of BV. Determinants of candidiasis were vaginal douching, high education level and low economic status, whereas a determinant of chlamydia was high economic status. Outmigration of the husband was associated with an increased risk of hepatitis B surface antigen seroposivity among women. CONCLUSIONS: RTI/STI were prevalent among married women in a rural population of Vietnam. Syndromic algorithms should be consistently supplemented by risk assessment in order to reduce under and overtreatment. Microscopic diagnosis could be applied in primary care settings to achieve more accurate diagnoses. The promotion of health education aimed at reducing RTI/STI prevalences is an important tool in STI/HIV control programmes. Vaccination to prevent hepatitis B for migrants should be considered.

Fetal exposure, heredity and risk indicators for cardiovascular disease in a Swedish welfare cohort.

BACKGROUND: The overall aim was to test whether low birthweight (LBW) in newborns is associated with the risk indicators for cardiovascular disease in early middle age, even in a welfare society. Further, a possible interaction of LBW and heredity for myocardial infarction or stroke was investigated. METHODS: Overall, subjects were identified as newborns in a local birth register, and as adult participants, in the Västerbotten Intervention Program (n = 7876). Outcome measures such as systolic (SBP) and diastolic blood pressures (DBP), body mass index (BMI), cholesterol, triglycerides and anthropometrics were investigated (at age 29-41 years) in relation to LBW. RESULTS: Low birthweight was associated with increased SBP and DBP. Triglycerides were elevated among women with LBW and total cholesterol was elevated in men with LBW. Heredity for myocardial infarction or stroke interacted with LBW, and indicated a synergistic effect on the level of SBP. The BMI did not differ between LBW and normal birthweight subjects. CONCLUSIONS: Our interpretation is that the 'fetal origins' hypothesis' is valid for middle-age subjects who grow up in a welfare society. The population attributable proportions that result from different exposures to LBW were relatively small overall; from a public health perspective, heredity was more important than LBW for elevated SBP.

Long-term impact of reproductive factors on the risk of cervical, endometrial, ovarian and breast cancer.

The influence of maternal age, parity, low or high birthweight, multiple births, and pre-eclampsia on the risk of cervical, endometrial, ovarian and breast cancers was studied. Data on 40951 women and the outcomes of their deliveries between 1955 and 1995 were obtained from birth registers. For the mothers, data from the Swedish Cancer Registry and the Cause of Death Register were added. The sample was evaluated using Cox's regression in univariate and bivariate analyses where the relative risk and its 95% confidence interval were calculated. Increasing maternal age at first birth was associated with an increasing relative risk of endometrial, ovarian, and breast cancers, and with a decreased risk of cervical cancer. Multiparity was a protective factor for all gynaecological cancers, including cervical and breast cancers. Multiple births were associated with an increased risk of endometrial cancer.

Familial occurrence of preeclampsia.

We conducted a cohort study on whether preeclampsia during the pregnancy of a mother is a risk factor for preeclampsia during the pregnancy of her daughter. Data from the Medical Birth Registry were combined with data from a local registry of births from 1955 to 1990. We could identify the births of 22,768 elder daughters and 2,959 younger daughters. These daughters had also experienced at least one delivery. If the mother had preeclampsia during her pregnancy with an elder daughter, then the elder daughter had an increased risk for preeclampsia in her first pregnancy (relative risk (RR) = 1.7; 95% confidence interval (CI) = 1.3-2.2). This increased risk persisted into the elder daughter's second pregnancy (RR = 1.7; 95% CI = 1.1-2.6). The risks for the daughters were also increased to a similar level if the mother had experienced preeclampsia in any other pregnancy. Furthermore, the risks were similarly elevated if only mothers with firstborn children were included in the analyses. Hence, preeclampsia during the pregnancy of a mother was a risk factor for development of preeclampsia during the pregnancy of her daughters; however, owing to a relatively small population attributable proportion, genetic predisposition explained only a minor part of the occurrence of preeclampsia in this population.

Characteristics of pregnancy and birth and malignancy in the offspring (Sweden).

OBJECTIVES: The aim of the study was to investigate whether factors of pregnancy and birth influence the risk of malignancy in the offspring. METHODS: Data on all deliveries (248,701 births) in two counties in Sweden 1955-90 were extracted from two birth registries. The follow-up period closed at the end of 1994 and the subjects were followed up to early middle-age at most (39 years). Incidence rates of malignancy were obtained from the Cancer Register 1958-1994. Standardized incidence ratios (SIR) and relative risks (RR) were calculated. RESULTS: Overall, few associations were detected. A significantly increased standardized incidence ratio (SIR) of 50.00 (95% CI = 13.45-99.99) was found for the relationship between Down's syndrome and lymphatic leukaemia. Elder maternal age (> or =35 years) and lymphatic leukaemia were associated with a significantly enhanced risk (SIR = 2.00; 95% CI, 1.16-3.20). Maternal age 25-34 years, compared to younger age, was associated with a reduced risk of cervical cancer (RR = 0.47; 95% CI = 0.26-0.86). CONCLUSIONS: Although some associations, the consistent pattern of non-association indicated a low impact of intrauterine environment or changed genetic material on the future development of malignancy in the offspring up to early middle-age.

Recurrence of prolonged pregnancy.

BACKGROUND: We conducted a cohort study in an attempt to determine whether prolonged pregnancy in mother is a risk factor for prolonged pregnancy in daughter, and if previous prolonged pregnancy is a risk factor for prolonged pregnancy in subsequent pregnancy. METHODS: Data from the Swedish Medical Birth Registry were combined with a local registry of births (1955-1990). Mother-daughter pairs (with events of delivery in each generation) were identified. Relative risk (RR) and its 95% confidence interval (CI) were calculated and population attributable proportion was estimated when appropriate. RESULTS: If mother had had prolonged pregnancy at delivery of daughter the relative risk (RR) of prolonged pregnancy in daughter was moderately raised (RR = 1.3; CI : 1.0-1.7) with population attributable proportions ranging between 2.1% and 4.6%. If previous pregnancy had been prolonged, the RR of prolonged pregnancy at subsequent birth was increased 2-3 fold with population attributable proportions of 12.5% to 15.8%. Possible confounders such as mother's parity, age and maternal age did not alter the risks. CONCLUSIONS: Although moderate, prolonged pregnancy in mother may be a risk factor for prolonged pregnancy in daughter. A previous prolonged pregnancy increases the risk of prolonged pregnancy in a subsequent birth. However, the familial factor of prolonged pregnancy explains just a minor part of its occurrence in the population (due to small population attributable proportions).

Familial patterns in birth characteristics: impact on individual and population risks.

BACKGROUND: Familial patterns in reproductive outcome have been suggested previously, but few studies have comprehensively evaluated both length of gestation and types of growth retardation. METHODS: Information on intrauterine period and birth characteristics for a cohort of Swedish women born 1955-1972 was linked with information on these women's own reproductive experiences during 1973-1990. Familial trends in preterm deliveries, small-for-gestational age (SGA) births and two types of growth retardation were evaluated for mothers relative to their own birth characteristics (n = 4746), relative to their older sisters' deliveries (n = 2931) and among consecutive deliveries of the mothers (n = 14,209). Adjusted relative risks (RR) were calculated from logistic regression analyses. RESULTS: Mothers who had themselves been preterm at birth were not at increased risk of any of the outcomes studied. Mothers who had themselves been SGA at birth had an almost 50% higher risk (NS) of giving birth to either a preterm or an SGA infant than had mothers who had not been SGA at birth. Mothers tended to repeat the same patterns in subsequent deliveries: RR was 3.7 for a second preterm delivery given a previous one and 7.8 for a second SGA delivery given a previous one. Among SGA siblings, chronic growth retardation was more often repeated than was acute growth retardation. Mothers with an older sister who had given birth to a preterm infant had an 80% higher risk of giving birth to a preterm infant. CONCLUSIONS: Familial trends in gestational age and body proportions at birth were demonstrated; however, the relatively small population attributable risk per cents in Sweden are discussed.