Margrethe Møller

HbA1c in early diabetic pregnancy and pregnancy outcomes : A Danish population-based cohort study of 573 pregnancies in women with type 1 diabetes

OBJECTIVE—To assess the association between first-trimester HbA1c (A1C) and the risk of adverse pregnancy outcomes in type 1 diabetic pregnancies. RESEARCH DESIGN AND METHODS—We identified all pregnant diabetic women in a Danish county from 1985 to 2003. A1C values from first trimester were collected, and pregnancy outcome was dichotomized as good (i.e., babies surviving the 1st month of life without major congenital abnormalities) and adverse (i.e., spontaneous and therapeutic abortion, stillbirth, neonatal death, or major congenital abnormalities detected within the 1st month). The prevalence of adverse outcomes was calculated according to quintiles of A1C. We computed receiver operating characteristic and lowess curve estimates and fitted logistic regression models to calculate prevalence odds ratio while adjusting for confounding by White class and smoking status. RESULTS—Of 573 pregnancies, 165 (29%) terminated with adverse outcomes. The prevalence of adverse outcomes varied sixfold from 12% (95% CI 7.2–17) in the lowest to 79% (60–91) in the highest quintile of A1C exposure. From A1C levels >7%, we found an almost linear association between A1C and risk of adverse outcome, whereby a 1% increase in A1C corresponded to 5.5% (3.8–7.3) increased risk of adverse outcome. CONCLUSIONS—Starting from a first-trimester A1C level slightly <7%, there is a dose-dependent association between A1C and the risk of adverse pregnancy outcome without indication of a plateau, below which the association no longer exits. A1C, however, seems to be of limited value in predicting outcome in the individual pregnancy.

The effect of sterile water blocks on low back labor pain

To evaluate the analgesic effect of intradermal sterile water blocks, 272 women in labor complaining of severe low back pain were randomly assigned to treatment with either sterile water or saline solution blocks. Pain intensity was assessed on a visual analog scale, before the blocks were given and again 1 and 2 hours later. The groups were equal with regard to age, parity, fetal size, progression of labor, and initial pain scoring. Pain scoring 1 and 2 hours after the blocks were given showed a significantly higher degree of analgesia in the sterile water group. No adverse effects were noted, and patient acceptability was high.

Short-term complications after surgically induced abortions: a register-based study of 56 117 abortions

Background.  Performing an induced abortion is a rather simple medical procedure which is frequently done and side‐effects will have public health implications unless they are very rare. We estimated the incidence of side‐effects detected during the stay at the hospital and 2 weeks after the discharge. We only include side‐effects reported by clinics or hospitals.

Smoking, sex of the offspring, and risk of placental abruption, placenta previa, and preeclampsia: a population-based cohort study

Background. Placental abruption, placenta previa, and preeclampsia are serious pregnancy complications with an increased risk of perinatal death. Smoking during pregnancy is associated with increased risk of abruption and placenta previa, and it reduces the risk of preeclampsia. We examined the association between mothers’ smoking habits during pregnancy, taking the sex of the offspring into consideration, and the risk and prognosis of placental abruption, placenta previa, and preeclampsia

Maternal deaths in Denmark 2002–2006

Objective. To describe a method for identification, classification and assessment of maternal deaths in Denmark and to identify substandard care. Design. Register study and case audit based on data from the Registers of the Danish Medical Health Board, death certificates and hospital records. Setting. Denmark 2002–2006. Population. Women who died during a pregnancy or within 42 days after a pregnancy. Methods. Maternal deaths were identified by notification from maternity wards and data from the Danish National Board of Health. A national audit committee assessed hospital records of direct and indirect deaths. Main outcome measures. Maternal mortality ratio, causes of death and suboptimal care. Results. In the study period, 26 women died during pregnancy or within 42 days from direct or indirect causes, leading to a maternal mortality ratio of 8.0/100,000 live births. Causes of death were cardiac disease, thromboembolism, hypertensive disorders of pregnancy, Streptococcus A infections, suicide, amniotic fluid embolism, cerebrovascular hemorrhage, asthma and diabetes. Conclusion. Our method proved valid and can be used for future research. Causes of death could be identified and learning points from the assessments could form the basis of focused education and guidelines. Future complementary ‘near miss’ studies and cooperation with other countries with comparable health systems are expected to improve the benefits of the enquiries, contributing to improved management of life‐threatening conditions in pregnancy and childbirth.

Iodine Concentrations in Milk and in Urine During Breastfeeding Are Differently Affected by Maternal Fluid Intake

BACKGROUND Breastfed infants are dependent on iodine transport into breast milk for production of thyroid hormones. Thyroid hormones are important regulators of brain development. It has been considered whether breast milk iodine concentration (MIC) could be predicted by maternal urinary iodine concentration (UIC), but reports on correlations have been inconsistent. We used urinary creatinine concentration as a proxy for maternal fluid intake and speculated if this might differently influence UIC and MIC. METHODS We examined 127 breastfeeding women after the introduction of the mandatory iodine fortification of salt in Denmark. Maternal spot urine and a breast milk sample were obtained at a median of 31 days after delivery (interquartile range: 25-42 days), and the women were asked about intake of iodine containing supplements postpartum. RESULTS Median UIC was 72 μg/L (46-107 μg/L) and higher in iodine-supplemented mothers (47.2% of participants); 83 μg/L (63-127 μg/L) versus 65 μg/L (40-91 μg/L), p=0.004. Median MIC was 83 μg/L (61-125 μg/L) and also higher in iodine-supplemented mothers; 112 μg/L (80-154 μg/L) versus 72 μg/L (47-87 μg/L), p<0.001. There was a weak correlation between UIC and MIC (r=0.28, p=0.015). A strong correlation was present between UIC and urinary creatinine concentration (r=0.76, p<0.001), whereas urinary creatinine concentration was not correlated to MIC (r=-0.049, p=0.58). When UIC and urinary creatinine were used to estimate 24-h urinary iodine excretion, the correlation between this estimate and breast milk iodine excretion was stronger (r=0.48, p<0.001). CONCLUSIONS Intake of an iodine supplement should be recommended in Danish breastfeeding women. Our results indicate that UIC, but not MIC, depends on maternal fluid intake and that maternal estimated 24-h iodine excretion may be a better indicator of iodine supply to the breastfed infant than UIC.

Maternal glycated haemoglobin, pre-gestational weight, pregnancy weight gain and risk of large-for-gestational-age babies: a Danish cohort study of 209 singleton Type 1 diabetic pregnancies.

Aims  To examine the association between maternal glycated haemoglobin in the second half of diabetic pregnancies and the relative risk of delivering large‐for‐gestational‐age (LGA) babies, controlling for maternal body mass index (BMI) before pregnancy, weight gain, age, White class and smoking habits.

Challenges in the Evaluation of Urinary Iodine Status in Pregnancy: The Importance of Iodine Supplement Intake and Time of Sampling

Objectives: Median urinary iodine concentration (UIC) is the recommended method to evaluate iodine status in pregnancy, but several factors may challenge the interpretation of the results. We evaluated UIC in pregnant women according to (1) sampling in the hospital versus at home, (2) time of the most recent iodine supplement intake prior to sampling, and (3) members of their household. Study Design: Danish cross-sectional study in the year 2012. Pregnant women (n = 158), their male partners (n = 157) and children (n = 51) provided a questionnaire with detailed information on iodine supplement intake and a spot urine sample obtained in the hospital and/or at home for measurement of UIC and urinary creatinine concentration. Results: In the pregnant women providing a urine sample both in the hospital and at home (n = 66), individual UIC (p = 0.002) and urinary creatinine concentration (p = 0.042), but not estimated 24-hour urinary iodine excretion (p = 0.79), were higher when sampling was at home. Median UIC was dependent on the time of the most recent iodine supplement intake prior to sampling [same day (n = 79): 150 µg/l (95% CI 131-181 µg/l), the day before (n = 51): 105 µg/l (78-131 µg/l), several days ago/non-user (n = 28): 70 µg/l (56-94 µg/l), p < 0.001]. The pattern was similar in the male partners. Apart from a more frequent iodine supplement intake in pregnancy (87.3% vs. partners 15.9%), no systematic differences were observed in urinary measurements between the pregnant women and their partners. Conclusions: Time of spot urine sampling and time span from iodine supplement intake to spot urine sampling should be considered when evaluating urinary iodine status in pregnancy.

A follow-up study of birth outcome in users of pivampicillin during pregnancy

Background. Pivampicillin is a prodrug which is widely used in Scandinavian countries for oral antibiotic therapy. The pivaloyl moiety has a carnitine depleting effect, which has caused doubts about the safety of administering pivampicillin during pregnancy. The aim of the study was to evaluate the risk of congenital malformations in general, preterm delivery and low birth weight in users of pivampicillin.

Oxytocin‐ or Low‐Dose Prostaglandin F2α‐Infusion for Stimulation of Labor After Primary Rupture of Membranes: A prospective, randomized trial

One hundred consecutive women with singleton pregnancies and primary rupture of membranes (PROM) after 36 weeks of gestation were included in a prospective, randomized trial of intravenous infusion of oxytocin (up to 30 mIU/min) versus low‐dose prostaglandin F2α(PGF2αup to 6.0 μg/min). Cesarean section was performed in 12 patients because of suspected disproportion or intra‐uterine asphyxia. Effective contractions or labor progress failed to become established within 8 hours in another 4 women stimulated with PGF2α and 2 stimulated by oxytocin. The stimulation delivery time (hours) for the remaining 82 women treated with PGF2α or oxytocin, respectively was 8.7 against 12.1 for initial Bishop score <5 (p<0.01), (Mann‐Whitney test), 7.2 vs. 7.1 for Bishop score 5–8 and 5.7 vs. 4.2 for Bishop score >8. Patients with initial Bishop score <5 seemed to need analgetics less often when treated with PGF2α than with oxytocin. Frequencies of side effects and instrumental deliveries as well as the fetal outcome were similar for the two treatment schedules. The results of the study suggest that low‐dose PGF2α infusion may be the more appropriate treatment for women with an unfavorable initial Bishop score.