Lone Schmidt

Overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes.

CONTEXT In animal studies, exposure to intrauterine hyperglycemia increases the risk of cardiovascular disease through only partly understood epigenetic mechanisms. Human long-term follow-up studies on the same topic are few. OBJECTIVE The aim was to study the risk of overweight and the metabolic syndrome in adult offspring of women with diet-treated gestational diabetes mellitus (GDM) or type 1 diabetes, and additionally to study associations between estimates of maternal hyperglycemia and outcome in the offspring. DESIGN AND SETTING We conducted a follow-up study of 1066 primarily Caucasian women aged 18-27 yr in the Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark. PARTICIPANTS Offspring of women with diet-treated GDM (n = 168) and an unexposed reference group (n = 141) participated, as well as offspring of women with type 1 diabetes (n = 160) and offspring from the background population representing an unexposed reference group (n = 128). The follow-up rate was 56% (597 of 1066). MAIN OUTCOME MEASURES Women with body mass index of at least 25 kg/m(2) were considered overweight. The metabolic syndrome was determined by the International Diabetes Federation 2006 criteria. RESULTS The risk of overweight was doubled in offspring of women with diet-treated GDM or type 1 diabetes compared with offspring from the background population, whereas the risk of the metabolic syndrome was 4- and 2.5-fold increased, respectively. Offspring risk of the metabolic syndrome increased significantly with increasing maternal fasting blood glucose as well as 2-h blood glucose (during oral glucose tolerance test). CONCLUSIONS Adult offspring of women with diet-treated GDM or type 1 diabetes are risk groups for overweight and the metabolic syndrome. Intrauterine hyperglycemia may in addition to genetics and other factors contribute to the pathogenesis of overweight and the metabolic syndrome.

Demographic and medical consequences of the postponement of parenthood

BACKGROUND Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement. METHODS Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy (TTP), fetal death, outcome of medically assisted reproduction (MAR) and mental well-being. RESULTS Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged TTP, infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect >40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity. CONCLUSIONS In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.

Length and variation in the menstrual cycle—a cross‐sectional study from a Danish county

Objective To investigate the current epidemiology of menstrual patters among women of fertile age.

Infertility and the seeking of infertility treatment in a representative population

Objective To investigate lifetime prevalence of infertility, the seeking of infertility treatment and outcomes of treatment.

Prospective longitudinal cohort study on cumulative 5-year delivery and adoption rates among 1338 couples initiating infertility treatment

BACKGROUND The objective was to assess crude 5-year delivery rates after assisted reproductive technology (ART) treatment, intrauterine inseminations (IUI), spontaneous conceptions (SC) and adoptions in a large infertile cohort. METHODS A prospective longitudinal survey comprised 1338 infertile couples starting public infertility programmes offering IUIs and three free ART cycles during 2000-2001. The cohort was cross-linked with the National Medical Birth Register to obtain delivery rates for all 1338 couples. More detailed data were available from 817 women responding to a 5-year follow-up questionnaire (response rate 74.7%). Fifty-seven percent (466/817) of the couples had received treatment prior to inclusion in the study with an average of 4.1+/-2.8 infertility treatments before referral. RESULTS Of the 1338 couples, 69.4% had at least one delivery within 5-years of follow-up. For women <35 years 74.9% had delivered compared with 52.2% of those aged > or =35 years. The mean number of children was 1.6, and 52.1% had more than one child. Of the 817 women who provided questionnaire data, 18.2% (149/817) delivered after SC, two-thirds of these after a previous ART delivery. Adoption of a child occurred for 5.9% (48/817) of the women. Positive prognostic factors for delivery were male infertility, female age <35 years, <3 years of infertility and less than three previous treatment cycles. CONCLUSIONS A crude delivery rate of 69.4% in the total population 5 years after referral to tertiary hospital centres with 6.6% deliveries after SC in the subpopulation responding to the questionnaire indicates a high efficacy of modern infertility treatments.

Infertility, involuntary infecundity, and the seeking of medical advice in industrialized countries 1970–1992: a review of concepts, measurements and results

Several new methods of infertility treatment have been developed. There is therefore an increasing interest among physicians in gaining knowledge about the occurrence of infertility in order to estimate the need for treatment. This article examines epidemiological studies in industrialized countries 1970-1992 on the prevalences of infertility, involuntary infecundity, and the seeking of medical advice for infertility. The studies are compared on the basis of study design, definitions, methods of measurement and results. Comparison of the studies is difficult, as researchers use different concepts and there is a large variation in the delineation of the populations involved. The current prevalence of infertility among women in the fertile age group varies from 3.6 to 14.3%, the life-time prevalence varies from 12.5 to 32.6%, the prevalence of involuntary infecundity from 2.6 to 5.9%, and medical contact for infertility from 3.6 to 17%. It is probable that these large differences in prevalences are mainly due to differences in definitions and methods of measurement. We recommend that future studies be carried out in representative population groups, and that only couples who have tried to have children should be included in the estimated prevalences.

Psychosocial burden of infertility and assisted reproduction

Population-based studies from industrialised countries show that the lifetime prevalence of infertility is 17-26%. About a half of infertile couples seek medical help. For many couples infertility and its treatment cause serious strains on interpersonal relationships personal distress reduced self-esteem and periods of existential crisis. Compared with men women in infertile couples have lower self-esteem are more depressed report lower life-satisfaction are more likely to blame themselves for their infertility and are more likely to regard childlessness as being unacceptable. However couples starting in-vitro fertilisation treatment (IVF) are psychologically well adjusted compared with the general population. (excerpt)

Influence of female bodyweight on IVF outcome: a longitudinal multicentre cohort study of 487 infertile couples

This study investigated the impact of womens body mass index (BMI) on the outcome after consecutive IVF/intracytoplasmic sperm injection cycles in 487 patients initiating treatment with 5-year follow-up. The total number of cycles was 1417. In total 103 (21.1%) were overweight (BMI 25-29.9 kg/m²) and 59 (12.1%) were obese (BMI ≥ 30 kg/m²). Number of initiated cycles/woman (P=0.01), number of cancelled cycles/woman (P < 0.01) and the total dose of gonadotrophin used/cycle (P < 0.01) rose with increasing BMI. A negative linear association between BMI and the number of retrieved oocytes (B=-0.243, P < 0.001) and an inverse U-shaped relationship between BMI and the number of developed embryos was seen, with less embryos available among underweight and obese women (P=0.03). The number with positive serum human chorionic gonadotrophin/cycle decreased significantly with increasing BMI (P < 0.01). The ongoing pregnancy rate/cycle among the obese women was lower (20.8% versus 28.3% in normal-weight women; P=0.04). Live-birth rate per cycle was 15.2% versus 21.5%. Multiple logistic regression analysis showed that the only independent predictors of live birth were womens age (P=0.037), womens BMI (P=0.034) and mens age (P=0.040).

Maternal risks and perinatal outcome in a Danish national cohort of 1005 twin pregnancies: the role of in vitro fertilization

Background.  Twin pregnancies constitute 25% of all in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies. There is a lack of knowledge on maternal risks and perinatal outcome of IVF/ICSI twin pregnancies.

The longitudinal impact of partner coping in couples following 5 years of unsuccessful fertility treatments.

BACKGROUND Because there is a lack of longitudinal research examining the impact of partner coping in couples experiencing infertility, we know very little about the long-term nature of coping with infertility and how partner coping strategies impact personal, marital and social distress. METHODS Participants were Danish men and women about to start a cycle of assisted reproduction treatment who were followed for a 5 year period of unsuccessful treatments. Multilevel modeling using the actor-partner interdependence model was used to examine the couple as the unit of analysis. RESULTS Active and passive avoidance coping strategies were significantly related to increased personal, marital and social distress at the individual and partner level. Meaning-based coping strategies were related to decreases in a womans individual distress and her partners marital distress. CONCLUSIONS Partner coping strategies have a significant impact on the other member of the couple over time in men and women undergoing infertility treatments over a 5 year period. Physicians and mental health professionals can educate men and women regarding the ineffectiveness of avoidance coping strategies as well as the beneficial nature of finding new meaning and life goals while experiencing the stress of infertility.