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1.
J Toxicol Environ Health A ; : 1-16, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32077375

RESUMO

Bisphenol A (BPA) and phthalate diesters are ubiquitous environmental contaminants. While these compounds have been reported as reproductive toxicants, their effects may partially be attributed to metabolites. The aim of this study was to examine reproductive organ development in chicken embryos exposed to the BPA metabolite, 4-methyl-2,4-bis(4-hydroxyphenyl)pent-1-ene (MBP; 100 µg/g egg) or a human-relevant mixture of 4 phthalate monoesters (85 µg/g egg). The mixture was designed within the EU project EDC-MixRisk based upon a negative association with anogenital distance in boys at 21 months of age in a Swedish pregnancy cohort. Chicken embryos were exposed in ovo from an initial stage of gonad differentiation (embryonic day 4) and dissected two days prior to anticipated hatching (embryonic day 19). No discernible effects were noted on reproductive organs in embryos exposed to the mixture. MBP-treated males exhibited retention of Müllerian ducts and feminization of the left testicle, while MBP-administered females displayed a diminished the left ovary. In the left testicle of MBP-treated males, mRNA expression of female-associated genes was upregulated while the testicular marker gene SOX9 was downregulated, corroborating a feminizing effect by MBP. Our results demonstrate that MBP, but not the phthalate monoester mixture, disrupts both male and female reproductive organ development in an avian embryo model.

2.
Eur J Contracept Reprod Health Care ; 25(1): 20-27, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31914332

RESUMO

Objectives: The aims of the study were to investigate foreign-born women's lifestyle and health before and during early pregnancy and compare them with those of Nordic-born women.Methods: Women recruited at antenatal clinics in Sweden answered a questionnaire in Swedish, English or Arabic or by telephone interview with an interpreter. Questions covered pregnancy planning and periconceptional lifestyle and health. The responses of women born in or outside Europe were compared with those of Nordic-born women. The impact of religiousness and integration on periconceptional lifestyle and health was also investigated.Results: Twelve percent of participants (N = 3389) were foreign-born (n = 414). Compared with Nordic women, European and non-European women consumed less alcohol before conception (respectively, adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.24, 0.58 and aOR 0.14; 95% CI 0.10, 0.19) and during early pregnancy (respectively, aOR 0.61; 95% CI 0.40, 0.91 and aOR 0.20; 95% CI 0.14, 0.29). Non-European women used less tobacco and were less physically active, but body mass index (BMI) did not differ between groups. Self-perceived health, stress and anxiety during early pregnancy did not differ, but non-European women more often had depressive symptoms (aOR 1.67; 95% CI 1.12, 2.51). Non-European women's healthy lifestyle was associated with religiousness but not with the level of integration.Conclusions: Non-European women were overall less likely to engage in harmful lifestyle habits before and during early pregnancy but were more likely to suffer from depressive symptoms in comparison with Nordic women.

3.
J Matern Fetal Neonatal Med ; 33(5): 799-805, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30373414

RESUMO

Objective: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).Methods: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.Results: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).Conclusions: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.Rationale: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

4.
Chemosphere ; 238: 124584, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31470313

RESUMO

Exposure to endocrine disrupting chemicals has been suggested to contribute to the ongoing globally increasing obesity trend. The complex chemical mixtures that humans and wildlife are exposed to include a number of compounds that may have obesogenic properties. In this study we examined a mixture consisting of phthalate-monoesters, triclosan, and perfluorinated compounds. The mixture was designed within the EDC-MixRisk project based on serum levels of the compounds in pregnant women of a Swedish mother-child cohort. The compounds were negatively associated with birth weight of the children. We assessed whether developmental exposure to this mixture in combination with a calorie-rich diet affected metabolic rate, blood lipids, adipogenesis and lipid storage, and the whole-body level of neutral lipids in zebrafish (Danio rerio). Wildtype zebrafish were exposed to the mixture from 3 h post fertilization to 5, 14 or 17 days post fertilization (dpf) at water concentrations corresponding to 1, 10, 20, or 100 times the geometrical mean of the serum concentration (hsc) in the women. Exposure to the mixture at 20 times hsc lowered metabolic rate at 2-5 dpf, and increased the number of adipocytes and the amount of visceral adipose tissue at 14 and 17 dpf respectively. Also, mRNA expression of fatty acid binding protein 11a was increased at 17 dpf by 10 and 20 times hsc of the mixture. This study shows that a human-relevant mixture of environmental pollutants affects metabolic rate, adipogenesis and lipid storage in young zebrafish fed a calorie-rich diet, thus demonstrating its potential to disrupt metabolism.


Assuntos
Adipogenia/efeitos dos fármacos , Metabolismo Basal/efeitos dos fármacos , Disruptores Endócrinos/toxicidade , Poluentes Químicos da Água/toxicidade , Peixe-Zebra/metabolismo , Animais , Peso ao Nascer/efeitos dos fármacos , Proteínas de Ligação a Ácido Graxo/biossíntese , Proteínas de Ligação a Ácido Graxo/genética , Feminino , Humanos , Hidrocarbonetos Fluorados/toxicidade , Ácidos Ftálicos/toxicidade , Gravidez , Triclosan/toxicidade , Proteínas de Peixe-Zebra/biossíntese , Proteínas de Peixe-Zebra/genética
5.
BMJ ; 367: l6131, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748223

RESUMO

OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN: Multicentre, open label, randomised controlled superiority trial. SETTING: 14 hospitals in Sweden, 2016-18. PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.


Assuntos
Idade Gestacional , Doenças do Recém-Nascido , Trabalho de Parto Induzido , Conduta Expectante/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Análise de Intenção de Tratamento , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Natimorto/epidemiologia , Suécia/epidemiologia , Nascimento a Termo
6.
Sex Reprod Healthc ; 20: 1-6, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084811

RESUMO

BACKGROUND: Despite reported high levels of contraception use in eSwatini, unplanned pregnancies are common. The aims of this study were to investigate prevalence and determinants of contraception use and unplanned pregnancies in a disadvantaged area in the Kingdom of eSwatini (Swaziland), and to investigate the association between unplanned pregnancies and antenatal care attendance. METHODS: This cross-sectional study was conducted at the non-governmental organization Siphilile Maternal and Child Health in Matsapha, a peri-urban industrial area, using data from pre-existing client records. The sample included clients (n = 1436) registered during pregnancy or up to three months postpartum between August 2014 and April 2016. Contraception use before conception and unplanned pregnancies were analysed with logistic regression to find associations with socio-demographic factors and health care utilization. RESULTS: In this population, 59% (n = 737) stated to have used contraception before becoming pregnant. Teenagers and first-time mothers were less likely to have used contraception. Seventy percent (789/1124) of the pregnancies were unplanned. Older women (≥35 years) were less likely while teenagers and multiparas (≥3 children) were more likely to have an unplanned pregnancy. Women with unplanned pregnancies were less likely to attend the recommended number of antenatal care visits compared to women with planned pregnancies. CONCLUSION: The rate of unplanned pregnancies is high in this population, especially among teenagers. Family planning interventions need to focus on preconception care for teenagers to enable pregnancy planning including improved antenatal care attendance.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Gravidez não Planejada , Cuidado Pré-Natal/estatística & dados numéricos , População Suburbana/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Feminino , Humanos , Paridade , Gravidez , Adulto Jovem
7.
J Biomech ; 87: 206-210, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30905404

RESUMO

The study compared the centre of pressure measurements (COP) and vertical ground reaction forces (vGRF) from a pressure insole system to that from force plates (FP) during two flywheel quadriceps resistance exercises: leg press and squat. The comparison was performed using a motion capture system and simultaneous measurements of COP and vGRF from FP and insoles. At lower insole-vGRF (<250 N/insole) COP accuracy deteriorated and those data were excluded from further analysis. The insoles systematically displaced the COP slightly posteriorly and medially compared to the FP measurements. Pearson's coefficient of correlation (r) between insole- and FP-COP showed good agreement in both the anteroposterior (squat: r = 0.96, leg press: r = 0.97) and mediolateral direction (squat: r = 0.84, leg press: r = 0.90), whereas the root-mean-square errors (RMSE) were lower in the mediolateral (squat: 3.9 mm, leg press: 4.5 mm) than the anteroposterior (squat and leg press: 11.8 mm) direction. Vertical GRF was slightly overestimated by the insoles in leg press and RMSE were greater in leg press (8% of peak force) than in squat (6%). Overall, results were within the range of previous studies performed on gait. The strong agreement between insole and FP measurements indicates that insoles may replace FPs in field applications and biomechanical computations during resistance exercise, provided that the applied force is sufficient.

8.
Acta Obstet Gynecol Scand ; 98(8): 988-996, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30767210

RESUMO

INTRODUCTION: The impact of placenta previa on pregnancy, delivery and infant outcomes has been extensively studied. However, less is known about the possible association of placental location other than previa with pregnancy outcomes. The aim of this study was to investigate if placental location other than previa is associated with adverse pregnancy, delivery and infant outcomes. MATERIAL AND METHODS: This is a population-based cohort study, with data from the regional population-based Stockholm-Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The study population included 74 087 nulliparous women with singleton pregnancies resulting in live-born infants, with information about placental location from the second-trimester ultrasound screening. The association between placental location (fundal, lateral, anterior or posterior) and pregnancy outcomes was estimated using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, sex of the infant and in vitro fertilization. Main outcome measures were pregnancy, delivery and infant outcomes. RESULTS: Compared with posterior placental location, fundal and lateral placental locations were associated with a number of adverse pregnancy outcomes, the most important being: very preterm birth (<32 weeks of gestation) (adjusted OR [aOR] 1.78, 95% CI 1.18-2.63 and aOR 2.12, 95% CI 1.39-2.25, respectively), moderate preterm birth (32-36 weeks of gestation) (aOR 1.23, 95% CI 1.001-1.51 and aOR 1.62, 95% CI 1.32-2.00, respectively), small-for-gestational-age birth (aOR 1.67, 95% CI 1.34-2.07 and aOR 1.77, 95% CI 1.39-2.25, respectively) and manual removal of the placenta in vaginal births (aOR 3.27, 95% CI 2.68-3.99 and aOR 3.27, 95% CI 2.60-4.10, respectively). Additionally, lateral placental location was associated with preeclampsia (aOR 1.30, 95% CI 1.03-1.65) and severe postpartum hemorrhage (aOR 1.42, 95% CI 1.27-1.82). CONCLUSIONS: Compared with posterior placental location, fundal and lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes.

9.
Women Birth ; 32(4): 356-363, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30341003

RESUMO

PROBLEM: Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin. BACKGROUND: High- or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak. Aim To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women. Methods Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n=1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion. FINDINGS: 1295 women were included in intention-to-treat analysis (high-dose n=647; low-dose n=648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes. DISCUSSION: Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section. CONCLUSION: We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress.


Assuntos
Trabalho de Parto Induzido/métodos , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Adulto , Cesárea/estatística & dados numéricos , Método Duplo-Cego , Feminino , Sofrimento Fetal/induzido quimicamente , Humanos , Apresentação no Trabalho de Parto , Gravidez , Suécia , Resultado do Tratamento
10.
BMC Pregnancy Childbirth ; 18(1): 387, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285758

RESUMO

BACKGROUND: About one-third of women report their childbirth as traumatic and up to 10% have severe traumatic stress responses to birth. The prevalence of Posttraumatic stress disorder following childbirth (PTSD FC) is estimated to 3%. Women with PTSD FC report the same symptoms as other patients with PTSD following other types of trauma. The effect of psychological treatment for women with PTSD FC has only been studied in a few trials. Similarly, studies on treatment needs for women not diagnosed as having PTSD FC but who nevertheless face psychological problems are lacking. METHODS/DESIGN: Women who rate their overall birth experience as negative on a Likert scale, and/or had an immediate caesarean section and/or a major postpartum haemorrhage are randomized to either internet delivered cognitive behaviour therapy (iCBT) plus treatment as usual (TAU) or TAU. The iCBT is to be delivered in two steps. The first step consists of six weekly modules for both the woman and her partner (if they wish to participate) with minimal therapeutic support. Step 2 consists of eight weekly modules with extended therapeutic support and will be offered to participants whom after step 1 report PTSD FC. Assessments will be made at baseline, 6 weeks, 14 weeks, and at follow-ups at 1, 2, 3 and 4 years after baseline. The primary outcome measures are symptoms of posttraumatic stress and depression. Secondary outcomes are quality of life, parent-child bonding, marital satisfaction, coping strategies, experience regarding the quality of care received, health-related quality of life, number of re-visits to the clinic and number of appointments for counselling during the 4 years' period after the negative childbirth experience, time until the woman gets pregnant again, and the type of birth in the subsequent pregnancy. A health economic evaluation in the form of a cost utility analysis will be conducted. DISCUSSION: This study protocol describes a randomized controlled trial that will provide information about the effectiveness of iCBT in women with negative experiences, posttraumatic stress, and PTSD FC. TRIAL REGISTRATION: ISRCTN39318241 . Date for registration 12/01/2017, retrospectively registered.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão Pós-Parto/terapia , Parto/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Terapia Assistida por Computador/métodos , Adulto , Parto Obstétrico/psicologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Estudos Longitudinais , Qualidade de Vida , Projetos de Pesquisa , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
11.
Acta Obstet Gynecol Scand ; 97(12): 1463-1470, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30168129

RESUMO

INTRODUCTION: There is a paucity of data on the impact of organ injury on long-term outcomes after a hysterectomy for benign indications. The aim of this study was to investigate fistula formation and patient-reported long-term health outcomes after organ injury at the time of a hysterectomy. MATERIAL AND METHODS: This was a population-based study of 22 538 women undergoing a hysterectomy between 2000 and 2014 in Sweden. Their medical history, characteristics of their surgery, and patient-reported outcomes were retrieved from Swedish national health and quality registers. Predictors for fistula formation were investigated with logistic regression and are presented as odds ratios with a 95% CI. RESULTS: Fistulas were reported in 7% of women with organ injuries, compared with 0.4% of those without organ injuries (adjusted odds ratio 15.29 [9.81-23.85]). Laparotomy and postoperative infection were associated with postoperative fistulas. Most of the women reported having better health 1 year after the hysterectomy, but 7% of those with organ injuries and 24% of those with fistulas reported deteriorated health, compared with 2% of women without injuries. CONCLUSIONS: Organ injury at the time of hysterectomy is associated with the development of fistulas involving the female genital tract and increases the proportion of women reporting deteriorated health 1 year after surgery.


Assuntos
Fístula/etiologia , Doenças dos Genitais Femininos/etiologia , Histerectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Feminino , Fístula/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Humanos , Intestinos/lesões , Modelos Logísticos , Estudos Longitudinais , Pessoa de Meia-Idade , Razão de Chances , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Fatores de Risco , Ureter/lesões , Bexiga Urinária/lesões , Lesões do Sistema Vascular/etiologia
12.
Arthritis Res Ther ; 20(1): 146, 2018 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-30001740

RESUMO

BACKGROUND: Anti-citrullinated protein antibody (ACPA) reactivities precede clinical onset of rheumatoid arthritis (RA), and it has been suggested that ACPA reactivities towards distinct target proteins may be associated with differences in RA phenotypes. We aimed to assess the prevalence of baseline ACPA reactivities in an inception cohort of patients with early RA, and to investigate their associations with disease activity, treatment response, ultrasound findings and radiographic damage. METHODS: Disease-modifying antirheumatic drug (DMARD)-naïve patients with early RA, classified according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria, were included in the ARCTIC trial and assessed in the present analysis. During follow up, patients were monitored frequently and treatment was adjusted according to a predetermined protocol, starting with methotrexate monotherapy with prednisolone bridging. Analysis of 16 different ACPA reactivities targeting citrullinated peptides from fibrinogen, alpha-1 enolase, vimentin, filaggrin and histone was performed using a multiplex chip-based assay. Samples from 0, 3, 12 and 24 months were analysed. Controls were blood donors with similar characteristics to the patients (age, gender, smoking status). RESULTS: A total of 217 patients and 94 controls were included. Median [25, 75 percentile] number of ACPA reactivities in all patients was 9 [4, 12], and were most prevalent in anti-cyclic citrullinated peptide /rheumatoid factor-positive patients 10 [7, 12]. Disease activity measures and ultrasound scores at baseline were lower in ACPA reactivity-positive compared to ACPA reactivity-negative patients. ACPA reactivity levels decreased after 3 months of DMARD treatment, most pronounced for fibrinogenß 60-74 to 62% of baseline antibody level, with least change in filaggrin 307-324 to 81% of baseline antibody level, both p < 0.001. However, outcomes in disease activity measures, ultrasound and radiographic scores after 12 and 24 months were not associated with baseline levels or changes in ACPA reactivity levels and/or seroreversion after 3 months. CONCLUSIONS: The clinical relevance of analysing ACPA reactivities in intensively treated and closely monitored early RA was limited, with no apparent associations with disease activity, prediction of treatment response or radiographic progression. Further studies in larger patient materials are needed to understand the role of ACPA reactivities in patients with RA classified according to the 2010 ACR/EULAR criteria and treated according to modern treatment strategies. TRIAL REGISTRATION: www.ClinicalTrials.gov, NCT01205854 . Registered on 21 September 2010.


Assuntos
Anticorpos Anti-Proteína Citrulinada/imunologia , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Artrite Reumatoide/patologia , Adulto , Idoso , Antirreumáticos/uso terapêutico , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Acta Obstet Gynecol Scand ; 97(11): 1396-1404, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29978451

RESUMO

INTRODUCTION: Our aim was to investigate the risk of moderate to severe hypoxic ischemic encephalopathy (HIE) by obstetric emergencies, with focus on the distribution of obstetric emergencies by parity, taking the history of a previous cesarean into account. MATERIAL AND METHODS: Population-based cohort study of 692 428 live births at ≥ 36 weeks of gestation in Sweden, 2009-2015. Data were retrieved by linking the Swedish Medical Birth Register with the Swedish Neonatal Quality Register. Therapeutic hypothermia served as surrogate for moderate to severe HIE. Logistic regression analysis was used to estimate associations between HIE and placental abruption, eclampsia, cord prolapse, uterine rupture, and shoulder dystocia, presented as adjusted odds ratios (aORs) with 95% CI. RESULTS: An obstetric emergency occurred in 133/464 (29%) of all HIE cases, more commonly in the parous (overall 37%; 48% with and 31% without a previous cesarean) than in the nulliparous (21%). Among nulliparas, shoulder dystocia was the most common obstetric emergency with the strongest association with HIE (aOR 48.2; 95% CI 28.2-82.6). In parous women without a previous cesarean, shoulder dystocia was most common, but placental abruption had the strongest association with HIE. Among parous women with a previous cesarean, uterine rupture was the most prevalent obstetric emergency with the strongest association with HIE (aOR 45.6; 95% CI 24.5-84.6). CONCLUSIONS: Obstetric emergencies are common among cases of moderate to severe HIE. The strong association with shoulder dystocia in nullipara, and with uterine rupture in women with previous cesarean deliveries, implies an opportunity for reducing the incidence of HIE.


Assuntos
Hipóxia-Isquemia Encefálica/etiologia , Complicações do Trabalho de Parto , Paridade , Adulto , Cesárea , Emergências , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença
14.
Aquat Toxicol ; 198: 73-81, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29522952

RESUMO

Antifungal azoles are widely used in medicine, agriculture, and material protection and several antifungal azoles have been found in environmental samples. Although these compounds were designed to inhibit fungal enzymes such as lanosterol-14-demethylase (cytochrome P450 (CYP) 51), it is well established that the inhibitory actions of azoles are not specific for fungal CYP isozymes. We refined a gill filament assay to determine the inhibition of CYP1, measured as reduced 7-ethoxyresorufin-O-deethylase (EROD) activity, in rainbow trout (Oncorhynchus mykiss) gill tissue ex vivo. The advantage of this method is that both induction and inhibition of EROD are performed ex vivo. Among thirteen azoles studied, the five that caused the strongest inhibition of gill EROD activity at a concentration of 5 µM were selected for concentration-response assessment. These compounds (bifonazole, clotrimazole, imazalil, miconazole, and prochloraz) showed IC50 values ranging from 0.1 to 1.5 µM. CYP19 (aromatase) inhibition was measured using microsomes from rainbow trout brains. Concentration-response curves for CYP19 inhibition were determined for letrozole, bifonazole, clotrimazole, imazalil, miconazole and prochloraz, which gave IC50 values ranging from 0.02 to 3.3 µM. It was further found that mixtures of the five most potent azoles reduced both CYP1 and 19 catalytic activity in an additive fashion (IC50 = 0.7 µM and 0.6 µM, in the respective assay). Bifonazole (IC50 = 0.1 µM) is not previously known to inhibit CYP1 activity. The additive inhibition of CYP1 and CYP19 catalytic activity is an important finding of the present study. We conclude that this additive action of azoles could mediate adverse impacts on CYP regulated physiological functions in environmentally exposed fish.


Assuntos
Inibidores da Aromatase/farmacologia , Aromatase/metabolismo , Azóis/farmacologia , Citocromo P-450 CYP1A1/antagonistas & inibidores , Oncorhynchus mykiss/metabolismo , Animais , Inibidores da Aromatase/química , Azóis/química , Brânquias/efeitos dos fármacos , Brânquias/enzimologia , Concentração Inibidora 50 , Poluentes Químicos da Água/toxicidade
15.
Acta Obstet Gynecol Scand ; 97(5): 615-623, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29450878

RESUMO

INTRODUCTION: Our aim was to identify antepartum risk factors for neonatal hypoxic ischemic encephalopathy, with a focus on maternal body mass index and height. MATERIAL AND METHODS: National population-based cohort study of 692 428 live-born infants ≥36 gestational weeks in Sweden, 2009-2015. Data from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register were linked. Short maternal stature was defined as ≤155 cm, and overweight as body mass index ≥25 kg/m2 . Therapeutic hypothermia served as surrogate marker of moderate to severe hypoxic ischemic encephalopathy. Associations between maternal and infant characteristics and hypoxic ischemic encephalopathy were calculated with logistic regression analyses, and risks were presented as odds ratios with 95% confidence intervals. RESULTS: Moderate to severe hypoxic ischemic encephalopathy occurred in 0.67/1000 infants. Nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight were all independently associated with hypoxic ischemic encephalopathy. The risk of hypoxic ischemic encephalopathy increased with decreasing maternal height and increasing body mass index. Compared with non-short women (≥156 cm) with normal weight (body mass index <25 kg/m2 ), those with both short stature and overweight had increased risk of hypoxic ischemic encephalopathy (odds ratio 3.66; 95% confidence intervals 2.41-5.55). Among parous women with both short stature and overweight, the risk was almost sixfold (odds ratio 5.74; 95% confidence intervals 3.41-9.66). CONCLUSIONS: Antepartum risk factors for moderate to severe hypoxic ischemic encephalopathy included nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight. The combination of maternal short stature and overweight was associated with a more than threefold risk of subsequent hypoxic ischemic encephalopathy.


Assuntos
Hipóxia-Isquemia Encefálica/etiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adulto , Estatura , Índice de Massa Corporal , Feminino , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico , Hipóxia-Isquemia Encefálica/epidemiologia , Recém-Nascido , Modelos Logísticos , Masculino , Sobrepeso/complicações , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Suécia/epidemiologia
17.
BMC Pregnancy Childbirth ; 17(1): 377, 2017 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-29137599

RESUMO

BACKGROUND: To examine the impact of occiput posterior position, compared to occiput anterior position, on neonatal outcomes in a setting where delayed pushing is practiced. The specific aim was to estimate the risk of acidaemia. METHODS: Cohort study from a university hospital in Sweden between 2004 and 2012. Information was collected from a local database of 35,546 births. Umbilical artery sampling was routine. Outcomes were: umbilical artery pH < 7.00 and <7.10 and short-term neonatal morbidity. The association between occiput posterior position and neonatal outcomes was examined using logistic regression analysis, presented as adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS: Of 27,648 attempted vaginal births, 1292 (4.7%) had occiput posterior position. Compared with occiput anterior, there was no difference in pH < 7.00 (0.4% vs. 0.5%) but a higher rate of pH < 7.10 in occiput posterior births (3.8 vs. 5.5%). Logistic regression analysis showed no increased risk of pH < 7.10 (AOR 1.28 95% CI 0.93-1.74) when occiput posterior was compared with occiput anterior births but, an increased risk of Apgar score < 7 at 5 min (AOR 1.84, 95% CI 1.11-3.05); neonatal care admission (AOR 1.68, 95% CI 1.17-2.42) and composite morbidity (AOR 1.66, 95% CI 1.19-2.31). CONCLUSIONS: With delayed pushing, birth in occiput posterior compared with anterior position is not associated with acidaemia. The higher risk of neonatal morbidity is of concern and any long-term consequences need to be investigated in future studies.


Assuntos
Doenças do Recém-Nascido/etiologia , Apresentação no Trabalho de Parto , Segunda Fase do Trabalho de Parto/fisiologia , Doenças Metabólicas/etiologia , Complicações do Trabalho de Parto/etiologia , Índice de Apgar , Bases de Dados Factuais , Parto Obstétrico , Feminino , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Modelos Logísticos , Razão de Chances , Gravidez , Estudos Retrospectivos , Suécia , Artérias Umbilicais/química
18.
Ann Rheum Dis ; 76(12): 2031-2037, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28814431

RESUMO

OBJECTIVES: Calprotectin is an inflammatory marker of interest in rheumatoid arthritis (RA). We evaluated whether the level of calprotectin was associated with disease activity, and if it was predictive of treatment response and radiographic progression in patients with early RA. METHODS: Plasma from disease-modifying antirheumatic drug (DMARD)-naïve patients with RA fulfilling 2010 American College of Rheumatology/European League Against Rheumatism classification criteria with symptom duration <2 years was analysed for calprotectin at baseline, and after 1, 3 and 12 months. All patients received treat-to-target therapy, as part of a randomised controlled strategy trial (ARCTIC). The association between calprotectin, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) and measures of disease activity were assessed by correlations. We used likelihood ratios and logistic regression models to assess the predictive value of the baseline inflammatory markers for treatment response and radiographic damage. RESULTS: 215 patients were included: 61% female, 82% anti-citrullinated peptide antibody positive, mean (SD) age 50.9 (13.7) years and median (25, 75 percentile) symptom duration 5.8 (2.8, 10.5) months. Calprotectin was significantly correlated with Clinical Disease Activity Index (r=0.32), ESR (r=0.50) and ultrasonography power Doppler (r=0.42) before treatment onset. After 12 months of treatment, calprotectin, but not ESR and CRP, was significantly correlated with power Doppler (r=0.27). Baseline levels of calprotectin, ESR and CRP were not predictive of treatment response, but high levels of calprotectin were associated with radiographic progression in multivariate models. CONCLUSIONS: Calprotectin was correlated with inflammation assessed by ultrasound before and during DMARD treatment, and was also associated with radiographic progression. The data support that calprotectin may be of interest as an inflammatory marker when assessing disease activity in different stages of RA. TRIAL REGISTRATION NUMBER: NCT01205854; Post-results.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/sangue , Complexo Antígeno L1 Leucocitário/sangue , Adolescente , Adulto , Idoso , Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Inflamação/sangue , Inflamação/diagnóstico por imagem , Inflamação/tratamento farmacológico , Complexo Antígeno L1 Leucocitário/efeitos dos fármacos , Funções Verossimilhança , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler , Adulto Jovem
19.
Am J Obstet Gynecol ; 217(5): 564.e1-564.e8, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28735704

RESUMO

BACKGROUND: Cesarean delivery is performed frequently worldwide, and follow-up studies that report complications at subsequent surgery are warranted. OBJECTIVES: The aim of the study was to investigate the association between a previous abdominal delivery and complications during a subsequent hysterectomy and to estimate the fraction of complications that are driven by the presence of adhesions. STUDY DESIGN: This was a longitudinal population-based register study of 25354 women who underwent a benign hysterectomy at 46 hospital units in Sweden 2000-2014. RESULTS: Adhesions were found in 45% of the women with a history of cesarean delivery. Organ injury affected 2.2% of the women. The risk of organ injury (adjusted odds ratio, 1.74; 95% confidence interval, 1.41-2.15) and postoperative infection (adjusted odds ratio, 1.26; 95% confidence interval, 1.15-1.39) was increased with previous cesarean delivery, irrespective of whether adhesions were present or not. The direct effect on organ injury by a personal history of cesarean delivery was estimated to 73%, and only 27% was mediated by the presence of adhesions. Previous cesarean delivery was a predictor of bladder injury (adjusted odds ratio, 1.86; 95% confidence interval, 1.40-2.47) and bowel injury (adjusted odds ratio, 1.83; 95% confidence interval, 1.10-3.03), but not ureter injury. A personal history of other abdominal surgeries was associated with bowel injury (adjusted odds ratio, 2.27; 95% confidence interval, 1.37-3.78), and the presence of endometriosis increased the risk of ureter injury (adjusted odds ratio, 2.15; 95% confidence interval, 1.34-3.44). CONCLUSION: Previous cesarean delivery is associated with an increased risk of complications during a subsequent hysterectomy, but the risk is only partly attributable to the presence of adhesions. Previous cesarean delivery and presence of endometriosis were major predisposing factors of organ injury at the time of the hysterectomy, whereas background and perioperative characteristics were of minor importance.


Assuntos
Cesárea/estatística & dados numéricos , Endometriose/epidemiologia , Histerectomia , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Perda Sanguínea Cirúrgica , Estudos de Coortes , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia Vaginal , Intestinos/lesões , Complicações Intraoperatórias/etiologia , Laparoscopia , Laparotomia , Estudos Longitudinais , Pessoa de Meia-Idade , Razão de Chances , Duração da Cirurgia , Tamanho do Órgão , Dor Pélvica/cirurgia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Suécia/epidemiologia , Ureter/lesões , Bexiga Urinária/lesões , Hemorragia Uterina/cirurgia , Neoplasias Uterinas/cirurgia , Útero/patologia
20.
J Perinat Med ; 45(1): 121-127, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27768584

RESUMO

OBJECTIVE: To investigate the maternal complications associated with cesarean section (CS) in the extremely preterm period according to the gestational week (GW) and to indication of delivery. STUDY DESIGN: This is a retrospective case-referent study with a review of medical records of women who delivered at 22-27 weeks of gestation (n=647) at two level III units in Sweden. For abdominal delivery, gestational length was stratified into 22-24 (n=105) and 25-27 (n=301) weeks. For comparison, data on women who underwent a CS at term were identified in a register-based database. RESULTS: The rate of CS in extremely preterm births was 62.8%. There was no difference in the complication rates, but types of incisions other than the low transverse incision were required more often at 22-24 (18.1%) weeks than at 25-27 GWs (9.6%) (P=0.02). Major maternal complications occurred in 6.6% compared with 2.1% in the extremely preterm and term CS, respectively (P<0.01). A maternal indication of extremely preterm CS increased the risk of complications. CONCLUSIONS: Almost two-thirds of the births at 22-27 GWs had an abdominal delivery. No increase in short-term morbidity was observed at 22-24 weeks compared to 25-27 weeks. CS performed extremely preterm had more major complications recorded than cesarean at term. The complications are driven by the underlying maternal condition.


Assuntos
Cesárea/efeitos adversos , Nascimento Prematuro , Adulto , Feminino , Humanos , Lactente Extremamente Prematuro , Gravidez , Estudos Retrospectivos
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