Riitta Luoto

Preventing excessive weight gain during pregnancy - a controlled trial in primary health care.

Objective:To investigate whether individual counselling on diet and physical activity during pregnancy can have positive effects on diet and leisure time physical activity (LTPA) and prevent excessive gestational weight gain.Design:A controlled trial.Setting:Six maternity clinics in primary health care in Finland. The clinics were selected into three intervention and three control clinics.Subjects:Of the 132 pregnant primiparas, recruited by 15 public health nurses (PHN), 105 completed the study.Interventions:The intervention included individual counselling on diet and LTPA during five routine visits to a PHN until 37 weeks’ gestation; the controls received the standard maternity care.Results:The counselling did not affect the proportion of primiparas exceeding the weight gain recommendations or total LTPA when adjusted for confounders. The adjusted proportion of high-fibre bread of the total weekly amount of bread decreased more in the control group than in the intervention group (difference 11.8%-units, 95% confidence interval (CI) 0.6–23.1, P=0.04). The adjusted intake of vegetables, fruit and berries increased by 0.8 portions/day (95% CI 0.3–1.4, P=0.004) and dietary fibre by 3.6 g/day (95% CI 1.0–6.1, P=0.007) more in the intervention group than in the control group. There were no high birth weight babies (⩾4000 g) in the intervention group, but eight (15%) of them in the control group (P=0.006).Conclusions:The counselling helped pregnant women to maintain the proportion of high-fibre bread and to increase vegetable, fruit and fibre intakes, but was unable to prevent excessive gestational weight gain.

Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial

In a cluster-randomized trial, Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing gestational diabetes mellitus (GDM), but fail to find an effect on GDM.

Tallness and overweight during childhood have opposing effects on breast cancer risk

Using birth and school health records we studied how weight and height during childhood affect breast cancer risk among 3447 women born during 1924–33 at the University Hospital of Helsinki, Finland. Through linkages with the National Hospital Discharge Registry and the Cause of Death Registry we identified177 women who during 1971–1995 had been admitted to hospital with breast cancer, of whom 49 had died from the disease. Of these, 135 (76%) were aged 50 years or more at the time of diagnosis, and therefore likely to have been post-menopausal. Hazard ratios for breast cancer rose with increasing weight and length at birth, though neither trend was statistically significant. At each age, from 7 to 15 years, the girls who later developed breast cancer were on average taller and had lower body mass than the other girls. Unadjusted hazard ratios rose across the range of height (P = 0.01 at age 7 years) and fell across the range of body mass index (P = 0.009 at age 7 years). In a simultaneous analysis the hazard ratio for breast cancer was 1.27 (95% CI 0.97–1.78, P = 0.08) for every kilogram increase in birth weight and 1.21 (95% CI 1.06–1.38, P = 0.004) for every kg/m2 decrease in body mass index at 7. Our findings indicate that tallness in childhood is associated with increased risk of developing breast cancer. One possible explanation is persisting high plasma concentrations of insulin-like growth factors in talll women. In contrast, we found that being overweight in childhood reduces breast cancer risk. The increased adipose tissue-derived oestrogen levels in overweight children could induce early breast differentiation and eliminate some targets for malignant transformation.

Advance information improves user satisfaction with the levonorgestrel intrauterine system.

OBJECTIVE To evaluate parameters associated with and the impact of advance information given in a regular outpatient setting on user satisfaction with the levonorgestrel‐releasing intrauterine system. METHODS A questionnaire was sent to 23,885 women in Finland who had had a levonorgestrel intrauterine system inserted between 1990 and 1993. The number of returned questionnaires was 17,914 (response rate 75%). Cumulative logistic regression analysis was based on the five‐grade scale of satisfaction as a dependent variable. RESULTS Most users of the levonorgestrel‐releasing intra‐uterine system (74%) were very or fairly satisfied with it, although over 70% of them had chosen it because of dissatisfaction with their previous method of contraception. User satisfaction increased with age and was associated with the amount of information about different symptoms (menstrual, greasiness of hair/skin, pregnancy, pelvic inflammatory disease, and missed periods) regardless of whether the symptom in question was actually experienced. The women who received information about the possibility of absence of menstruation were more satisfied than the less informed women (odds ratio 5.0, 95% confidence interval 4.1, 5.9). CONCLUSION Information received at the insertion visit is strongly associated with increased user satisfaction among the users of the levonorgestrel intrauterine system. The association between high user satisfaction and advance information was strongest regarding the possibility of missing periods.

Occasional smoking increases total and cardiovascular mortality among men

The aim was to study whether occasional smoking increases mortality risk. The mortality of random samples of the Finnish Adult Health Behavior surveys from 1978 to 1991 were followed for 18 years from 1978 to 1995. Poisson models were used to determine the risk of total and cardiovascular mortality. It was found that occasional smokers were less often sedentary and had less often unhealthy diet than other smoking status groups. Occasional smoking among men was significantly related to the risk of both total (age-adjusted relative risk, RR, 1.6, 95% confidence interval, CI, 1.3-2.1) and cardiovascular mortality (age-adjusted RR 1.5, 95% CI 1.0-2.3). Controlling for education, period and chronic morbidity did not change results. Among women no significant associations could be established; when adjusted for age, period, education and morbidity the RR for cardiovascular mortality was 1.4 (95% CI 0.6-3.4) and total mortality 1.0 (95% CI 0.6-1.6). Occasional smoking is associated with increased risk of premature death, at least among men. Although occasional smoking is a less dangerous practice than regular smoking, it is not a safe alternative for daily smoking.

Heritability and risk factors of uterine fibroids — The Finnish Twin Cohort Study

OBJECTIVES Our aim was to study heritability, risk factors and hospitalization for uterine fibroids. METHODS A random sample of 80 MZ and 80 DZ twins from the Finnish Twin Cohort were invited and 51% of the eligible women (n=82, 17 MZ and 16 DZ pairs, 40-47 years, mean age 43.0), underwent a transvaginal ultrasound. The entire cohort of 13872 women was linked to the national hospital discharge registry 1972-1990. RESULTS Prevalence of fibroids was 66% and the average number of fibroids 1.7. The casewise concordance for being hospitalized for uterine fibroids was higher in MZ (0.31, 95% CI 0.24-0.37) than in DZ pairs (0.18, 95% CI 0.14-0.22). The proportion of variance in liability to fibroid hospitalization accounted for by genetic factors was 54.8% (95% CI 46.2-62.7%). Women with fibroids had higher body mass index (23.7 vs 21.7, P=0.0086), lower age at first birth (25.7 vs 29.3, P=0.012) and higher parity (3+ children 48.2 vs 29.6%, P=0.009) than women without fibroids. Risk ratio (RR) for fibroids in a MZ twin whose sister had been diagnosed with fibroids was 1.1 (95% CI 0.08;15), for a DZ twin 1.1 (95% CI 0.16;8.8) and for all twins 1.3 (95% CI 0.3; 6.1). Intraclass correlation for the number of fibroids was 0.24 for MZ and 0.11 for DZ twins, yielding an heritability estimate of 0.26. CONCLUSION Reproductive and anthropometric factors may have at least as large role in pathogenesis of fibroids than genetic factors.

Reducing postpartum weight retention – a pilot trial in primary health care

BackgroundPostpartum weight retention may contribute to the development of obesity. We studied whether individual counselling on diet and physical activity from 2 to 10 months postpartum has positive effects on diet and leisure time physical activity and increases the proportion of primiparas returning to their pre-pregnancy weight.MethodsA controlled trial including ninety-two postpartum primiparas was conducted in three intervention and three control child health clinics in primary health care in Finland. The intervention included individual counselling on diet and physical activity during five routine visits to a public health nurse; the controls received the usual care.ResultsIn total, 50% of the intervention group and 30% of the control group returned to their pre-pregnancy weight (weight retention ≤ 0 kg) by 10 months postpartum (p = 0.06). The confounder-adjusted odds ratio for returning to pre-pregnancy weight was 3.89 (95% CI 1.16–13.04, p = 0.028) for the intervention group compared with the controls. The mean proportion of high-fibre bread (of total weekly amount of bread) increased by 16.1% (95% CI 4.3–27.9) by 10 months postpartum in the intervention group compared with the controls when adjusted for confounders (p = 0.008). No significant differences were observed in changes in leisure time physical activity between the groups.ConclusionThe intervention increased the proportion of primiparas returning to pre-pregnancy weight and the proportion of high-fibre bread in their diet. Larger randomized controlled trials are needed to show whether counselling can improve dietary and leisure time physical activity habits in postpartum women and also to confirm the results concerning the effect on reducing postpartum weight retention.Trial registrationCurrent Controlled Trials ISRCTN21512277

Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women

BACKGROUND AND AIM OF THE STUDY The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle (smoking, use of alcohol, physical activity) and body mass index (BMI). MATERIAL AND METHODS Health 2000 is a nationally representative population-based study of Finnish adults. Data were collected by home interview, three self-administered questionnaires and a clinical examination by a physician. This study included women aged 45-64 years (n=1427). All symptoms included menopause-specific symptoms. Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group. Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors (age, education, smoking, alcohol use, physical activity, BMI, use of hormonal replacement therapy (HRT) and chronic disease status). RESULTS Over one-third (38%) of the premenopausal, half of the perimenopausal, and 54% of both postmenopausal and hysterectomized women reported bothersome symptoms. The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes. Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle. Smoking was not related to vasomotor symptoms. CONCLUSION Bothersome symptoms are common in midlife, regardless of menopausal status. Inverse association between physical activity and menopausal symptoms needs to be confirmed in randomized trials.

Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation‐wide study of 17,360 users

Objective To establish the continuation rates of the levonorgestrel intrauterine system (LNG IUS) and symptoms associated with its premature removal.

The effect of physical activity on breast cancer risk: A cohort study of 30,548 women

Background: In epidemiological studies abundant physical activity has been related to decreased breast cancer risk, though the results have been inconsistent. The purpose of this paper was to study the association of physical activity at leisure and commuting to work and incidence of breast cancer. Methods: The study cohort consisted of 30,548 female participants of the Finnish adult health behaviour survey, based on annual random samples of Finns aged 15–64, collected in 1978–1993. By the end of 1995, 332 breast cancer cases had been diagnosed in the cohort. Relative risks of breast cancer were adjusted for age at survey, body mass index (BMI), education, length of follow-up, parity and age at first birth using Poisson regression models. Results: Compared to women exercising less than once a week, the adjusted relative risk of breast cancer for women exercising once a week was 0.80 (95% confidence interval (CI): 0.58–1.10), for women exercising 2–3 times per week 0.92 (95% CI: 0.78–1.22) and for women exercising daily 1.01 (95% CI: 0.72–1.42). Women who reported commuting, walking or bicycling to work 30 min or more daily had slightly lower adjusted risk of breast cancer (RR: 0.87, 95% CI: 0.62–1.24) than women working at home, being unemployed or driving a car to working place. Conclusion: Although a small protective effect of regular physical activity for breast cancer incidence was found in physical activity when commuting to work, the role of the physical activity in breast cancer prevention is still an open question.