Marie Bladh

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.

Premature birth and low birthweight are associated with a lower rate of reproduction in adulthood: a Swedish population-based registry study

BACKGROUND The aim of this study was to investigate if individuals born with sub-optimal birth characteristics have reduced probability of reproducing in adulthood. METHODS Using population-based registries, the authors included 522 216 males and 494 692 females born between 1973 and 1983 and examined their reproductive status as of 2006. Outcome measure was the hazard ratio (HR) of reproducing. Adjustments were made for socio-economic factors. RESULTS Males and females born very premature displayed a reduced probability of reproducing [HR = 0.78, 95% confidence interval (CI): 0.70-0.86 for males; HR = 0.81, CI: 0.75-0.88 for females]. Likewise for very low birthweight (HR = 0.83, CI: 0.71-0.95 for males; HR = 0.80, 95% CI: 0.72-0.89 for females). Individuals born large for gestational age (LGA) displayed no significant changes. Males born small for gestational age (SGA) had a 9% lower reproductive rate (CI: 0.89-0.94) and that reduction increased as the individuals aged. Women born SGA tended to start reproducing at an earlier age. CONCLUSION The results suggest that being born with low birthweight, premature or SGA (for males) is associated with a reduced probability of reproducing as an adult. LGA shows no statistically significant relationship with future reproduction.

Bariatric surgery in a national cohort of women: sociodemographics and obstetric outcomes

OBJECTIVE In a large, prospective Swedish national cohort, we investigated individual birth characteristics for women who had undergone bariatric surgery and their obstetric outcome and made comparisons with all other women during the same period. STUDY DESIGN The cohort consisted of 494,692 women born 1973-1983 of which 681 women who had undergone bariatric surgery constituted the index group. RESULTS The index women more often have parents with lower sociodemographic status and are more often born large for gestational age. The women surgically treated before their first child had a shorter gestational length, their children had lower birthweight, and were more often born small for gestational age compared with the children born to the reference mothers. Women whose child was born before their bariatric surgery more often had a cesarean section, and their children were more often large for gestational age. CONCLUSION Preconception bariatric surgery in obese women may be associated with improved obstetric outcomes.

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.

Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life

This study investigated the relationship between sexual debut before 14 years of age and socio‐demographics, sexual experience, health, experience of child abuse and behaviour at 18 years of age.

Risk for congenital malformations in offspring of women who have undergone bariatric surgery. A national cohort

To study the risk for congenital anomalies in the first child of women after bariatric surgery compared with all other women giving birth to their first child and divided by maternal body mass index (BMI) groups.

Voluntary sexual exposure online among Swedish youth - social background, Internet behavior and psychosocial health

Studies have described the phenomenon of voluntary sexual exposure among youth online but only a few focus on the typical young person who has this experience. The purpose of this study was to investigate Swedish youth with experience of voluntary sexual exposure online, with regard to Internet behavior, social background, and psychosocial health including parent-child relationships. A representative sample of 3503 Swedish youths in their third year of high school completed a survey about Internet behavior, Internet-related sexual harassment, sexuality, health, and sexual abuse. Out of those taking part in the survey, 20.9% (19.2% boys and 22.3% girls) reported experiences of voluntary sexual exposure online. Multivariate analysis showed a significant association between voluntary sexual exposure online and a number of different forms of harassment online. Neither poorer psychosocial health nor problematic relationships with parents remained significant in the final model. The results underlined the fact that voluntary sexual exposure online is associated with vulnerability on the Internet among both boys and girls and that there is a need for parents and professionals to better understand what young people do on the Internet and the risks they may incur.

Online sexual behaviours among Swedish youth: associations to background factors, behaviours and abuse

Sexual activity online may result in positive experiences for young people, or lead them to engage in risky behaviours possibly resulting in sexual assault or abuse. The aim of our study was to investigate associations between online sexual behaviours among Swedish youth and background factors as well as aspects of well-being. The behaviours investigated were: having sex online with a contact met online, having sex with an online contact offline, posting sexual pictures online, and selling sex online. We used data from a representative sample of 3,432 Swedish youth who were asked about their lifetime experiences as well as their experiences within the previous year. We hypothesized that more advanced online sexual behaviours were associated with more problematic background factors, worse psychosocial well-being and riskier behaviours in general. Bivariate relationships were evaluated followed by a multiple logistic regression model. Our data suggested that most Swedish youth do not perform any of the assessed online sexual behaviours. Young people who reported online sexual behaviour showed a more problematic background, rated their health as poorer, had a more sexualized life and had experienced more sexual or physical abuse. Professionals who work with young people need to help them better evaluate potential risks online and offer support when needed. Youths who sell sex online are especially at risk and need extra attention, as they might be in greater need of protection and therapeutic support.

Reproductive patterns and pregnancy outcomes in women with congenital heart disease – a Swedish population‐based study

Objective. To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric and neonatal outcomes of their pregnancies. Design. Population‐based register study. Population. All women born in 1973–1983 who were alive and living in Sweden at 13 years of age (n=500 245). Methods. Women diagnosed with CHD (n=2 216) were compared with women without CHD (n=492 476). A total of 188 867 mother‐firstborn‐offspring pairs were identified and available for analysis. Results. Mothers of women with CHD were more often older and single/unmarried. Women with CHD were more often born preterm or small‐for‐gestational age (SGA) than women without CHD, more likely to have been born with a cesarean section, to have given birth during the study period, and to be younger at the time of their first pregnancy. Women with CHD were also more prone to give birth to children preterm or SGA and their babies were more often delivered by cesarean section with a higher frequency of congenital abnormality. Conclusions. Women with CHD were more likely to have been born preterm or SGA and these outcomes were repeated in the next generation. Women with CHD should not be discouraged from pregnancy. Prenatal diagnostics should be discussed and offered to these women, as there is an increased risk for congenital abnormalities.

Psychiatric illness in women requesting caesarean section.

To compare psychiatric in‐ and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period.