Marianne Wulff

Depression and anxiety during pregnancy and six months postpartum: a follow-up study

Aims. To investigate the relationship between antenatal and postpartum depression and anxiety and to explore associated maternal characteristics. Methods. From a population‐based sample of 1,555 women attending two obstetric clinics in Sweden, all women with an antenatal psychiatric diagnosis (n=220) and a random selection of healthy women (n=500) were contacted for a second assessment three to six months postpartum. The Primary Care Evaluation of Mental Disorders was used for evaluation on both occasions. Results. Fewer cases of depressive and/or anxiety disorders were prevalent postpartum compared with the second trimester screening. Depression and/or anxiety were prevalent in 16.5% of postpartal women versus 29.2% of pregnant women. There was a significant shift from a majority of subthreshold diagnoses during pregnancy to full Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnoses during the postpartum period. A history of previous psychiatric disorder, living single, and obesity were significantly associated with a new‐onset postpartum psychiatric disorder. The absence of a previous psychiatric disorder was significantly associated with a postpartum recovery of depression or anxiety. Conclusions. Depression and anxiety appear to be less common postpartum than during pregnancy.

Implications of antenatal depression and anxiety for obstetric outcome.

OBJECTIVE: To investigate the obstetric outcome and health care consumption during pregnancy, delivery, and the early postpartum period in an unselected population-based sample of pregnant women diagnosed with antenatal depressive and/or anxiety disorders, compared with healthy subjects. METHODS: Participants were 1,495 women attending 2 obstetric clinics in Northern Sweden. The Primary Care Evaluation of Mental Disorders was used to evaluate depressive and anxiety disorders in the second trimester of pregnancy. To assess demographic characteristics, obstetric outcome, and complications, the medical records of the included women were reviewed. RESULTS: Significant associations were found between depression and/or anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy and increased number of visits to the obstetrician, specifically, visits related to fear of childbirth and those related to contractions. Planned cesarean delivery and epidural analgesia during labor were also significantly more common in women with antenatal depression and/or anxiety. CONCLUSION: There is an association between antenatal depressive and/or anxiety disorders and increased health care use (including cesarean deliveries) during pregnancy and delivery. LEVEL OF EVIDENCE: II-2

Human Chorionic Gonadotropin in Pregnancy and Maternal Risk of Breast Cancer

Full-term pregnancies are associated with long-term reductions in maternal risk of breast cancer, but the biological determinants of the protection are unknown. Experimental observations suggest that human chorionic gonadotropin (hCG), a major hormone of pregnancy, could play a role in this association. A case-control study (242 cases and 450 controls) nested within the Northern Sweden Maternity Cohort included women who had donated a blood sample during the first trimester of a first full-term pregnancy. Total hCG was determined on Immulite 2000 analyzer. Odds ratios (OR) and 95% confidence intervals (CI) were estimated through conditional logistic regression. Maternal breast cancer risk decreased with increasing hCG (upper tertile OR, 0.67; CI, 0.46-0.99), especially for pregnancies before age 25 (upper tertile OR, 0.41; CI, 0.21-0.80). The association diverged according to age at diagnosis: risk was reduced after age 40 (upper tertile OR, 0.60; CI, 0.39-0.91) and seemed to increase before age 40 (upper tertile OR, 1.78; CI, 0.72-4.38). Risk was reduced among those diagnosed 10 years or longer after blood draw (upper tertile OR, 0.60; CI, 0.40-0.90), but not so among those diagnosed within 10 years (upper tertile OR, 4.33; CI, 0.86-21.7). These observations suggest that the association between pregnancy hCG and subsequent maternal risk of breast cancer is modified by age at diagnosis. Although the hormone seems to be a determinant of the reduced risk around or after age 50, it might not confer protection against, or it could even increase the risk of, cancers diagnosed in the years immediately following pregnancy.

Human Chorionic Gonadotropin and Alpha-Fetoprotein Concentrations in Pregnancy and Maternal Risk of Breast Cancer: A Nested Case-Control Study

Pregnancy hormones are believed to be involved in the protection against breast cancer conferred by pregnancy. The authors explored the association of maternal breast cancer with human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP). In 2001, a case-control study was nested within the Northern Sweden Maternity Cohort, an ongoing study in which blood samples have been collected from first-trimester pregnant women since 1975. Cases (n = 210) and controls (n = 357) were matched for age, parity, and date of blood donation. Concentrations of hCG and AFP were measured by immunoassay. No overall significant association of breast cancer with either hCG or AFP was observed. However, women with hCG levels in the top tertile tended to be at lower risk of breast cancer than women with hCG levels in the lowest tertile in the whole study population and in subgroups of age at sampling, parity, and age at cancer diagnosis. A borderline-significant decrease in risk with high hCG levels was observed in women who developed breast cancer after the median lag time to cancer diagnosis (> or =14 years; odds ratio = 0.53, 95% confidence interval: 0.27, 1.03; P = 0.06). These findings, though very preliminary, are consistent with a possible long-term protective association of breast cancer risk with elevated levels of circulating hCG in the early stages of pregnancy.

Infertility in an industrial setting:— a population-based study from Northern Sweden

Objective. To analyze the possible environmental effects on infertility among couples living in the immediate neighborhood of a smelter and to study prevalence and risk factors of infertility as well as care seeking behavior among infertile couples in a random sample of a local population.

Home abortion implies radical changes for women

Objective To gain knowledge about womens experiences, views and reactions regarding having a home abortion (medical abortion with the use of misoprostol at home). Methods One hundred women were interviewed one week post-abortion; this yielded both quantitative and qualitative data. Results The overwhelming majority of the women experienced wellbeing and were satisfied with their choice of abortion method. They appreciated the privacy and the comfort of being at home which also allowed the presence of a partner. The intake of mifepristone at the clinic was described by many in existential terms as an emotionally charged act, experienced by some as more difficult than expulsion at home. However, relief was the predominant emotional feeling during the expulsion day. Most women did not find it especially dramatic to see and handle the products of conception although some felt uncomfortable at the sight. Conclusion Given that they choose this method themselves and are well informed, women are able to handle the abortion process by themselves outside a clinical setting. The option to choose home abortion implies a radical change in empowerment for women. Also allowing them the possibility to take mifepristone at home would increase their privacy and personal integrity even more.

Maternal hormones during early pregnancy: a cross-sectional study

BackgroundLittle is known about correlates of first-trimester pregnancy hormones as in most studies maternal hormones have been measured later in gestation. We examined the associations of maternal characteristics and child sex with first-trimester maternal concentrations of four hormones implicated in breast cancer: human chorionic gonadotropin (hCG), α-fetoprotein (AFP), insulin-like growth factor (IGF)-I, and IGF-II.MethodsAbout 338 serum samples donated to the Northern Sweden Maternity Cohort (NSMC), 1975–2001, during the first trimester of uncomplicated pregnancies, were analyzed for the hormones of interest as a part of a case–control study. The associations of maternal characteristics and child sex with hormone concentrations were investigated by correlation, general linear regression, and multivariate regression models.ResultsIn the first trimester, greater maternal age was inversely correlated with IGF-I and IGF-II. In comparison with women carrying their first child, already parous women had higher IGF-I but lower hCG. Greater maternal weight and smoking were inversely correlated with hCG. No differences in hormone levels by child sex were observed.ConclusionsOur analyses indicated that potentially modifiable maternal characteristics (maternal weight and smoking) influence first-trimester pregnancy maternal hormone concentrations.

women's reproductive rights in the amazon basin of ecuador: challenges for transforming policy into practice

Despite advances made by Ecuador in developing policies on reproductive and sexual rights, implementation, and oversight remain a challenge, affecting in particular those living in the Amazon basin. This paper reports on an evaluation of sexual and reproductive health and rights (SRHR) in Orellana, Ecuador, the basis of which was the Health Rights of Women Assessment Instrument, which was altered to focus on government obligations, the reality of access and utilization of services, and the inequities and implementation challenges between the two. A community-based cross-sectional survey conducted in 2006 served to document the current status of SRHR Local female field workers interviewed 2025 women on three areas of womens reproductive health: delivery care, family planning, and pregnancy among adolescent girls age 10-19. The results suggest a reality more dismal than that of the official information for the area. Skilled delivery care, modern contraceptive use, and wanted pregnancies were conspicuously lower among indigenous women living in rural areas. Access to reproductive health services varied between rural and urban women. These significant differences in care--amongst others documented--raise concerns over the utility of national-level data for addressing inequities. The gaps evident in the validity of available information for monitoring policies and programs, and between national policy and action reveal that much still needs to be done to realize SRHR for women in the Amazon basin, and that current accountability mechanisms are inadequate.

Olfactory and chemosomatosensory function in pregnant women assessed with event-related potentials

The purpose of the study was to better understand past findings of nasal chemosensory hypersensitivity in pregnant women by recording chemosensory event-related potentials (CSERPs) for information about cortical neuronal allocation (amplitudes) and temporal processing (latencies) of three concentrations of pyridine ranging from predominantly olfactory to trigeminal in activation in 15 pregnant and 15 non-pregnant women. CSERP components of primarily sensory (N1 and P2) and cognitive (P3) origin were evaluated. The results displayed no group differences in either N1 or P2 amplitudes or latencies, but tendencies of larger amplitudes and shorter latencies for P3 in pregnant women. This implies that pregnant womens hypersensitivity may more likely be referred to cognitive than sensory processing.

The condom in relation to prevention of sexually transmitted infections and as a contraceptive method in Sweden.

Objective To analyze in detail the latest Swedish population survey regarding condom use in order to gain a deeper knowledge of the characteristics of women and men using or not using condoms at a time when the number of sexually transmitted infections (STIs) had started to increase. Methods From a population-based survey of sexual life in Sweden among men and women aged between 18 and 74 years (n = 2810), we investigated the use of condoms in relation to social demographic, lifestyle, sexual and behavioral characteristics. Results In the age group 18–49 years, every third person had experience of a legal abortion and every fourth had had an STI. Overall, use of condoms was 12% in the whole population and 15% in the age group 18–49 years. Using a condom as a method of contraception, as opposed to other methods, was found to be less frequent in six subgroups: when coitus was less frequent, age above 25 years, among those who had had many partners and those with earlier experience of abortion or STI, as well as having a risky behavior. Using a condom as a preventive against contracting an STI occurred less often in women and men older than 25 years and among those having coitus more frequently. Conclusion Even with good information and easy accessibility to condoms, there are still obstacles to their use. To achieve the aim of safer sexual practice, it is a challenge for the couple as well as for counselors to reason about the advantages and disadvantages of not using a condom. Discussions about attitudes, behavior and gender differences must be continued and emphasized in coming generations, both on the individual and on a societal level, in order to achieve safer sexual practice.