Jakob Nakling

Smoking during pregnancy increases the risk of preterm births among parous women

Background. We wanted to study a possible association between smoking during pregnancy and preterm birth.

Smoking habits among pregnant women in Norway 1994-95

AIMS To investigate the smoking prevalence the last three months before pregnancy and at 18 weeks of gestation among women in Norway and to evaluate the impact of pre-pregnancy smoking habits, maternal age, level of education, civil status and parity on smoking cessation. MATERIAL AND METHODS A prospective, multicenter survey. The study population included 4 766 pregnant women who attended a routine ultrasound examination at 18 weeks of pregnancy in six Norwegian hospitals during the period from September 1994 to March 1995. Smoking habits before and during pregnancy were recorded. RESULTS The point prevalence of self-reported daily smoking among the women three months before the pregnancy was 34%. At 18 weeks of pregnancy, 21% of the women reported smoking daily (p<0.001). A multiple logistic regression analysis revealed that a low number of cigarettes smoked per day during the last three months before pregnancy was the best predictor for smoking cessation. Educational level, maternal age, parity and civil status were also statistically significant contributors to smoking cessation. Eighty percent of the women who were unable to stop smoking, reported a reduction in cigarette consumption. The mean number of cigarettes per day was reduced from 13.9 before pregnancy to 7.3 at 18 weeks of pregnancy (p<0.001). CONCLUSION In a national survey, 21% of the pregnant women reported smoking daily in the second trimester. Thirty-eight percent of the women who were daily smokers before the pregnancy stopped smoking in early pregnancy. A low cigarette consumption prior to the pregnancy was the best predictor for smoking cessation.

A 12-week randomised study comparing intravenous iron sucrose versus oral ferrous sulphate for treatment of postpartum anemia

Objective. To analyze the effect of intravenous ferrous sucrose compared with oral ferrous sulphate on hematological parameters and quality of life in women with postpartum anemia. Design. Open randomised controlled trial. Setting. Multicentre study comprising five obstetrical departments in Norway. Population. Hundred and twenty‐eight postpartum women with hemorrhagic anemia (Hb between 6.5 g/100 ml and 8.5 g/100 ml). The intervention group (59 women) received 600 mg iron sucrose intravenously followed by 200 mg iron sulphate daily from week 5. The control group (70 women) were given 200 mg iron sulphate daily. Methods. Randomisation and start of treatment occurred within 48 hours of the delivery. Participants were followed up at 4, 8 and 12 weeks. Main outcome measures. Hemoglobin, ferritin and quality of life assessed with the Medical Outcomes Study Short Form 36 (SF‐36) and the Fatigue Scale. Results. After 4 weeks the mean hemoglobin values in both groups were similar (11.9g/100ml vs. 12.3g/100ml, p = 0.89). The mean serum ferritin value after 4 weeks was significantly higher in the intervention group with 13.7μg/L vs. 4.2μg/L in the control group (p<0.001). At 8 and 12 weeks the hematological parameters were similar. The total fatigue score was significantly improved in the intervention group at week 4, 8 and 12, whereas SF‐36 scores did not differ. Conclusion. Women who received 600mg intravenous iron sucrose followed by standard oral iron after four weeks, replenished their iron stores more rapidly and had a more favorable development of the fatigue score indicating improved quality of life.

Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination

Background.  Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination.

Pregnancy risk increases from 41 weeks of gestation.

Background. The aim of this study was to evaluate the mortality and morbidity of conservatively managed post‐term pregnancies (gestation 294 days and beyond). Materials and methods. This is a population‐based prospective study. The sample was comprised of all women (N=17 493) with a singleton pregnancy in one Norwegian county from 1989 to 1999, with a second‐trimester ultrasound examination and delivery after 37 completed gestational weeks. Results. One thousand three hundred and thirty‐six (7.6%) of the deliveries were post‐term. In this group, the increase in perinatal mortality reached borderline significance [relative risk (RR) 2.0; 95% confidence interval 0.9–4.6]. Perinatal morbidity expressed as Apgar score <7 at 5min (RR 2.0; 95% confidence interval 1.2–3.3), and transferal to neonatal intensive care unit (RR 1.6; 95% confidence interval 1.3–2.0) were significantly more frequent. However, RR for perinatal death calculated per 1000 ongoing pregnancies increased significantly from 0.2 in week 37–3.7 in week 42, using perinatal mortality in gestational week 41 as a reference. Conclusions Our results indicate that expectant management of post‐term pregnancies allowing pregnancies to continue up to week 43 carries a risk for perinatal mortality and morbidity. The risk increases already from gestational week 41. The guidelines for management of post‐term pregnancies should be revised.

Routine ultrasound screening and detection of congenital anomalies outside a university setting

Background.  To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology.

Term prediction in routine ultrasound practice

Study objective. Evaluation of the precision of routine ultrasound term prediction.

Advantages of the population-based approach to pregnancy dating: results from 23,020 ultrasound examinations.

To confirm the results from two previous evaluations of term prediction models, including two sample‐based models and one population‐based model, in a third population.

Possible relation between maternal consumption of added sugar and sugar-sweetened beverages and birth weight - time trends in a population

BackgroundHigh birth weight (BW) is a risk factor for later obesity. In Norway, mean BW and proportion of large newborns increased from 1989 to 2000 and subsequently decreased to the 1989 level by 2010. The purpose of the study was to explore causes of this temporary increase.MethodsFrom a regional prospective database pregnancy and newborn data were extracted for all 33088 singleton pregnancies resulting in live infants born at term without malformations during 1989–2010. Trends in BW, ponderal index and proportion of large newborns were related to individual prenatal exposures, including pre-pregnancy body mass index (PP-BMI) and gestational weight gain (GWG) for the years 2001–2010, and thereafter related ecologically to national population data on consumption of nutrients and physical activity.ResultsFor the regional cohort mean (standard deviation) BW increased from 3580 (453) grams in 1989/90 to 3633 (493) grams in 2001/02 (p<0.001), and decreased to 3583 (481) grams in 2009/10 (p<0.001). The proportion with BW>4500 grams increased from 2.6% to 4.8% (p<0.001) and subsequently decreased to 3.3% (p=0.002). The trends remained after adjustment for relevant exposures. For the years 2001/02 to 2009/10 (n= 15240) mean (SD) PP-BMI increased from 24.36 (4.44) to 24.85 (5.02) kg/m2 (p<0.001) while GWG decreased from 14.79 (5.85) to 13.86 (5.79) kg (p<0.001). The estimated net effect of changes in PP-BMI, GWG and other known exposures was a 6 grams reduction in BW from 2001/02 to 2009/10, leaving 44 grams reduction unexplained. National consumption of major nutrients did not change, but consumption of sucrose, in large part as sugar-sweetened beverages (SSB) changed in parallel to the BW trends.ConclusionThe temporary increase in BW and large babies in the regional cohort was identical to that reported for Norway. Individual level data on known pregnancy related predictors for BW could not explain these changes, but the parallel time trend in national consumption of sucrose, in particular as SSB, may lend support to a hypothesis that intake of sugar may have a direct effect on BW and infant body proportions independent of effects through PP-BMI and GWG.

Intrauterine growth retardation in foetuses of women with epilepsy

PURPOSE Various factors may affect intrauterine foetal growth, amongst which conditions such as epilepsy and the use of anti-epileptic drugs (AED) may play a role. This study investigated intrauterine growth of foetuses in women with epilepsy, as compared with controls, and explored whether intrauterine growth was affected by prenatal exposure to AED. METHOD Data were obtained from prospectively registered data regarding pregnancy and prenatal and perinatal factors in women in Oppland County in Norway. The final analysis included information from 166 mothers with epilepsy and 287 children. The control group consisted of 40,553 pregnancies in women without epilepsy registered in the same database. RESULTS There was a significantly higher risk of the ponderal index being below the 10th percentile and infants being small for gestational age (SGA) in the epilepsy group; exposure to AED increased the risk. The frequency of SGA and low ponderal index was highest in Lamotrigine exposed infants. In the AED group, head circumference was significantly smaller among Carbamazepine exposed. CONCLUSION Impaired intrauterine growth of foetuses in women with epilepsy was identified. The frequency of SGA and low ponderal index was highest in Lamotrigine exposed infants. The epilepsy group had a higher risk profile for having smaller babies, in being younger at age, lower in body weight and more frequent smokers. However despite these differences, the effects of epilepsy and AED exposure were significant. The ponderal index may be a useful supplement to more established measures assessing intrauterine growth in epilepsy.