Smoking and obesity among pregnant women in Iceland 2001-2010.

BACKGROUND: The prevalence of smoking during pregnancy in Western societies has decreased in the last decades, whereas prevalence of overweight and obesity has increased. Our objective was to study secular trends and patterns of smoking and body weight among pregnant women in Iceland, during a period of dramatic changes in the nation's economy. METHODS: On the basis of the Medical Birth Registry, we used a random sample of 1329 births between 1 January 2001 and 31 December 2010. Information on smoking, body mass index and background factors during pregnancy was retrieved from the Medical Birth Register and maternity records. Trends in smoking, overweight, obesity and body mass index were assessed using logistic and linear regression analyses. Logistic regression analysis was used to examine the annual odds of smoking and obesity and by socio-demographic characteristics. RESULTS: We found a decrease in the prevalence of continued smoking during pregnancy from 12.4% in 2001 to 7.9% in 2010 [odds ratio (OR) = 0.94, 95% confidence interval (CI) (0.88-1.00)], particularly among women with Icelandic citizenship [OR = 0.92, 95% CI (0.86-0.98)], whereas no changes in obesity [OR = 1.02, 95% CI (0.96-1.07)] were observed. The highest prevalence of maternal smoking and obesity was observed in 2005-06. CONCLUSION: Our results indicate that smoking during pregnancy decreased among Icelandic women in 2001-10, whereas an initial increase in obesity prevalence seemed to level off towards the end of the observation period. Interestingly, we found that both of these maternal risk factors reached their highest prevalence in 2005-06, which coincides with a flourishing period in the nation's economy.

Risk factors and health during pregnancy among women previously exposed to sexual violence.

OBJECTIVE: To determine whether women exposed to sexual violence in adolescence or adulthood are at increased risk of adverse maternal characteristics during subsequent pregnancies. DESIGN: Register-based cohort study. SETTING: Iceland. POPULATION: We identified 586 women who attended a Rape Trauma Service (RTS) between 1993 and 2008 and all subsequent births of these women up to April 2011 (n = 915). These pregnancies were compared with 1641 randomly selected pregnancies of women who had not attended the RTS and who gave birth during the same calendar month. METHODS: Information on maternal smoking, body mass index and illicit drug use was obtained from maternal charts. We used Poisson regression to obtain multivariable adjusted relative risks (aRR) with 95% CI contrasting prevalence of outcomes in the two groups. MAIN OUTCOME MEASURES: Characteristics and risk factors during pregnancy, including maternal smoking, body mass index, weight gain during pregnancy, illicit drug use. RESULTS: Compared with unexposed women, sexually assaulted women were younger and more often primiparous in subsequent pregnancy, more likely not to be employed (7.8% vs. 4.3%; aRR 2.42, 95% CI 1.49-3.94), not cohabiting (45.6% vs. 14.2%; aRR 2.15, 95% CI 1.75-2.65), smokers (45.4% vs. 13.5%; aRR 2.68, 95% CI 2.25-3.20), and more likely to have used illicit drugs during pregnancy (3.4% vs. 0.4%; aRR 6.27, 95% CI 2.13-18.43). Exposed primiparas were more likely to be obese (15.5% vs. 12.3%; aRR 1.56, 95% CI 1.15-2.12). CONCLUSIONS: Women with a history of sexual violence are more likely to have risk factors during pregnancy that may affect maternal health and fetal development.

Increased attendance rates and altered characteristics of sexual violence.

OBJECTIVE: To study the attendance rates and characteristics of sexual violence presented at emergency services for rape victims, over a 10-year period. DESIGN: Incidence study. SETTING: Rape Trauma Service, within an emergency department at a tertiary referral university hospital. POPULATION. The total female population in Iceland. METHODS: Medical records on visits were reviewed and systematically coded. Annual attendance rates were calculated over time as number of visits per 10 000 female inhabitants aged 13-49 years. Characteristics of sexual violence, perpetrators and victims were compared between 1998-2002 and 2003-2007. MAIN OUTCOME MEASURES: Annual attendance rates and characteristics of sexual violence. RESULTS: Of 1153 visits, 828 (71.8%) were due to severe sexual violence (penetration). Annual attendance rates of all sexual violence increased from 12.5 to 16.9 per 10 000 women aged 13-49 (p<0.01). Attendance rates due to severe sexual violence increased specifically among women aged 18-25 (p<0.01). The proportion of assaults involving multiple perpetrators increased from 13.9% in 1998-2002 to 18.9% in 2003-2007 (p=0.05). With time, a higher proportion of victims had seriously impaired consciousness due to alcohol consumption (p<0.01) and had used illegal drugs prior to assault (p<0.05). CONCLUSIONS: The findings point towards an increase in women's visits to specialized emergency services for rape victims, particularly in the age group 18-25 years. The increased role of multiple perpetrators, alcohol and illicit drugs in sexual violence calls for further attention.

Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence.

BACKGROUND: There is a scarcity of data on the association of sexual violence and women's subsequent obstetric outcomes. Our aim was to investigate whether women exposed to sexual violence as teenagers (12-19 years of age) or adults present with different obstetric outcomes than women with no record of such violence. METHODS: We linked detailed prospectively collected information on women attending a Rape Trauma Service (RTS) to the Icelandic Medical Birth Registry (IBR). Women who attended the RTS in 1993-2010 and delivered (on average 5.8 years later) at least one singleton infant in Iceland through 2012 formed our exposed cohort (n = 1068). For each exposed woman's delivery, nine deliveries by women with no RTS attendance were randomly selected from the IBR (n = 9126) matched on age, parity, and year and season of delivery. Information on smoking and Body mass index (BMI) was available for a sub-sample (n = 792 exposed and n = 1416 non-exposed women). Poisson regression models were used to estimate Relative Risks (RR) with 95% confidence intervals (CI). RESULTS: Compared with non-exposed women, exposed women presented with increased risks of maternal distress during labor and delivery (RR 1.68, 95% CI 1.01-2.79), prolonged first stage of labor (RR 1.40, 95% CI 1.03-1.88), antepartum bleeding (RR 1.95, 95% CI 1.22-3.07) and emergency instrumental delivery (RR 1.16, 95% CI 1.00-1.34). Slightly higher risks were seen for women assaulted as teenagers. Overall, we did not observe differences between the groups regarding the risk of elective cesarean section (RR 0.86, 95% CI 0.61-1.21), except for a reduced risk among those assaulted as teenagers (RR 0.56, 95% CI 0.34-0.93). Adjusting for maternal smoking and BMI in a sub-sample did not substantially affect point estimates. CONCLUSION: Our prospective data suggest that women with a history of sexual assault, particularly as teenagers, are at increased risks of some adverse obstetric outcomes.