Adam Sydsjö

Weight gain restriction for obese pregnant women : A case-control intervention study

Objective  To minimise obese women’s total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome.

Impact of pregnancy on gender differences in sickness absence

Women in general have a higher sickness absence than men, and sickness absence is particularly high among pregnant women. Study objectives: To study the level of male sickness absence as compared to female, including and excluding pregnant women. Design: Studies of incidence and length of sickness absence exceeding 7 days using population-based sick-leave records. Setting: The community of Linköping, Sweden, 117,000 inhabitants. Participants: Subjects included in the analysis were all men and women aged 16–44 who in 1985 or 1986 had at least one sick-leave spell exceeding 7 days. Results: Pregnant women had a very high sickness absence. When pregnant women were excluded, the female sick-leave rate decreased from 0.18 (95% C.I. 0.17–0.18) to 0.15 (95% C.I. 0.15–0.16) for all women. The corresponding male sick-leave rate was 0.12 (95% c.i. 0.12–0.13). Gender differences in length of sickness absence decreased to the same extent. The results were similar when restricting the analysis to employed persons. The decrease varied a little with occupational group and was largest in the age-group 25–34. Conclusions: When pregnant women were excluded the excess female sick-leave rate was halved, but still remained 25% higher than the male. The impact of excluding pregnant women was highest in the age group 25–34, where the fertility-rate was highest. Although only 5% of all women aged 16–44 were pregnant, they had a large impact on gender differences in sickness absence.

Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy

Objective. To compare obstetric outcomes for women with fear of childbirth who received counseling during pregnancy with women without fear of childbirth. Design. Descriptive, retrospective case‐control study. Setting. University Hospital, Linköping, Sweden. Sample. 353 women who were referred to a unit for psychosocial obstetrics and gynecology because of fear of childbirth constituted the index group and 579 women without fear of childbirth formed a reference group. Methods. Data were collected from standardized antenatal and delivery records. Main outcome measures. Delivery data. Results. Elective cesarean sections (CS) were more frequent in the index group (p<0.001). Induction of delivery was also more common among the women with fear of childbirth (16.5 compared with 9.6%, p<0.001). Women with fear of childbirth who were scheduled for vaginal delivery were more often delivered by emergency CS (p=0.007). Elective CS was more common among the parous women with fear of childbirth and instrumental delivery was more common among nulliparous women with fear of childbirth. There were no differences in complications during pregnancy, delivery or postpartum between the two groups. Conclusion. Fear of childbirth is a predisposing factor for emergency and elective CS even after psychological counseling. Maximal effort is necessary to avoid traumatizing deliveries and negative experiences, especially for nulliparous women.

Attitudes towards cesarean section in a nationwide sample of obstetricians and gynecologists

Objective. The Swedish cesarean section (CS) rate has increased dramatically over the last decades, but remains relatively low compared to several other countries in the Western world. The reasons for this continuous increase are multifactorial and difficult to investigate. That pregnant women are demanding CS more frequently does not appear to be the major explanatory factor for the increasing CS rate. Since Swedish CS rates are relatively low, it is important to study attitudes to CS in a nationwide population of Swedish obstetricians and gynecologists in order to determine the possible concerns of this group. Methods. In 2006, a study‐specific questionnaire was created and posted to Swedish obstetricians and gynecologists. In total, 1,280 obstetricians and gynecologists received a questionnaire and replied with a response rate of 66%. Results. In general, older and longer work experience physicians had a more positive attitude towards providing CS on maternal request or elective CS for women who fear vaginal delivery. In addition, these colleagues were more positive in expressing their belief that elective CS is as safe as vaginal delivery for the mother and her child. The main difference between female and male physicians was that males were more positive toward providing CS on maternal request (p <0.001). Conclusion. We have shown that female physicians differ from their male colleagues in their attitudes toward providing CS on maternal request. Female physicians were more reluctant than males to provide CS on maternal request.

Sick leave and social benefits during pregnancy--a Swedish-Norwegian comparison.

Background. To analyze the correlation between sickness absence, working conditions, pregnancy outcomes and pregnancy associated social benefits in two urban pregnant populations in Sweden and Norway with different social benefit systems.

Newly delivered women's evaluation of personal health status and attitudes towards sickness absence and social benefits

Background. Unexpectedly high rates of sickness absence have been observed among pregnant women. No clear medical causes for illnesses reported as the basis for sick leave have yet been identified with certainty. An explanation proposed is the pregnant womens own attitudes towards their own states of well being during pregnancy. The aim of this study was to investigate the validity of this hypothesis.

Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition

OBJECTIVE The purpose of this study was to assess whether maternal prepregnancy body mass index was associated with the use of antiemetic drugs in early pregnancy and/or with the occurrence of hyperemesis gravidarum. STUDY DESIGN A retrospective, population-based, cohort study. Women who delivered singleton infants (n = 749,435) from 1995-2003 were evaluated concerning the use of antiemetic drugs in early pregnancy (data available from 1995). Women who delivered singleton infants (n = 942,894) from 1992-2001 were evaluated concerning hospitalization because of hyperemesis gravidarum (data available until 2001). Adjusted odds ratios were determined by Mantel-Haenszel technique and were used as estimates of relative risk (RR). RESULTS Underweight pregnant women were more likely to use antiemetic drugs (RR, 1.19; 95% CI, 1.14-1.24) and to become hospitalized for hyperemesis gravidarum (RR, 1.43; 95% CI, 1.33-1.54) compared with ideal weight women. Obese women were less likely to use antiemetic drugs (RR, 0.93; 95% CI, 0.89-0.97) and less likely to require hospitalization because of hyperemesis (RR, 0.90; 95% CI, 0.85-0.95) compared with women with an ideal body mass index. CONCLUSION The use of antiemetic drugs and the occurrence of hyperemesis gravidarum are related to maternal body composition.

Secondary fear of childbirth prolongs the time to subsequent delivery

Objective. Most pregnant women are anxious about the delivery and up to 30% develop varying degrees of fear of childbirth (FOC). Secondary FOC occurs in parous women who have experienced a traumatic delivery. The aim of this study was to investigate the time to subsequent delivery and delivery outcome in women with secondary FOC, compared with a reference group. Setting. Southeast Sweden. Sample. 356 parous pregnant women with secondary FOC and a reference group of 634 parous women without FOC. Design. Descriptive, retrospective case–control study. Main outcome measures. Time to next pregnancy and delivery outcome. Results. More women with secondary FOC had a longer interval to subsequent delivery compared with parous women without FOC (p = 0.005). Women with secondary FOC had 5.2 times higher probability of having a cesarean section than the reference group. Women with secondary FOC also had on average a 40‐minute longer duration of active labor than women without FOC (p < 0.001). Conclusions. Secondary fear of childbirth prolongs the time to subsequent delivery and the active phase of labor itself, and increases the risk for cesarean section.

Influence of Pregnancy-Related Diagnoses on Sick-Leave Data in Women Aged 16–44

Data on sickness absence frequently are used as a measure of morbidity and its social consequences in the employed population. The effects of sickness absence, as well as any possible differences in diagnoses among pregnant women as compared the sick leave data among the total population of women in fertile age have so far not been studied. The aim of this study was to investigate the relative contribution of pregnant women to the level of sickness absence, in general and in different diagnostic groups, as well as the extent to which sick-listed pregnant women can be identified through diagnoses on sickness certificates. In a cross-sectional study of all sick leave insured women aged 16-44 years (n = 24,481) in Linköping, Sweden (117,000 inhabitants), data from two population-based research registers were used, one of sickness absence for the whole population, one of sickness absence among pregnant women in the same population and year. Pregnant women (5%) had a significantly higher cumulative incidence of sickness absence (0.64) compared with all women (0.18) and accounted for 20% of the women listed as absent because of sickness. The duration of the sickness absence was also significantly longer among pregnant women, 44.8 days compared with 9.7 days among all women. Practically all diagnoses among pregnant women were related to pregnancy or back pain (93%). When using diagnoses on the sickness certificates, only 46% of all sick-listed pregnant women could be identified, suggesting methodological difficulties in studies on sickness absence. Studies on sickness absence among women of fertile age should also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a deep impact on the results and conclusions among all women.

The importance of maternal BMI on infant's birth weight in four BMI groups for the period 1978–2001

Objective. To study whether increased maternal weight and other factors of importance is associated with higher birth weights of the children over a period of almost 25 years. Design. Retrospective cohort study. Setting. Delivery wards in southeast Sweden. Sample. A total of 4,330 delivered women and their children from the years 1978, 1986, 1992, 1997, and 2001. Methods. Analysis of covariance was used to evaluate the importance of the mothers body mass index (BMI) on the childrens birth weights during the study years and smoking, parity, employment, gestational age, and the age of the mothers were adjusted for. Main outcome measures. Weight of the offspring in relation to maternal BMI and possible confounders such as smoking, parity, employment, gestational age, and the age of the mother. Results. Between 1978 and 1992, there was an increase in birth weight in each of the four BMI categories (i.e. BMI<20, 20–24.9, 25–29.9 and ≥30, respectively) even after adjustments were made for relevant background characteristics (p<0.001). However, between 1992 and 2001, the birth weight for children whose mothers had a BMI of less than 20 or between 20 and 24.9 decreased (p<0.001). For almost every study year, the mothers’ BMI was of significant influence on the childrens birth weights. However, the proportion of variance explained by the models (i.e. the adjusted R2) was not substantially altered when the mothers BMI was excluded from the models. Conclusion. Maternal BMI is of significance to explain trends in infants’ birth weight over time, but not of sole importance.