Staffan Nilsson

Routine ultrasound screening in pregnancy and the children's subsequent handedness.

OBJECTIVE To study a possible association between ultrasound screening in early pregnancy and altered cerebral dominance measured by the prevalence of non-right handedness among children, particularly boys. METHODS Follow-up of 8 to 9 year old children to women who participated in a randomised controlled trial on ultrasound screening during pregnancy in 1985-87. The children were followed up through a questionnaire sent to their mothers. The dominant hand of the child was assessed by eleven questions. The dominant foot by one question. RESULTS No differences were found in non-right handedness between children in the screening and non-screening group. In separate analyses on ultrasound exposure and non-right handedness among boys a significant difference was found (odds ratio 1.33; 95% confidence interval 1.02-1.74). CONCLUSION This study could not rule out a possible association between non-right handedness among boys and ultrasound exposure in early fetal life. The association was, however, confined to analyses comparing exposed and non-exposed boys and no associations were found when the comparisons were performed according to the randomised groups.

Contraceptive use in women with bacterial vaginosis

The aim of the study was to investigate if bacterial vaginosis (BV) is associated with use of specific contraceptives. Women at family planning and youth clinics (n = 956), among whom 131 had BV, were subjects for structured in-depth interviews including current and previous contraceptive use. Variables measuring sexual risk-taking were ascertained. Current users of contraceptives were compared with non-users. Both oral contraceptive (OC) and condom use showed a significant protective effect against BV, adjusted for possible confounders (odds ratios were 0.4 and 0.3, respectively). Intrauterine device use (IUD) showed no association with BV. Women with BV had less often used any contraceptives, including condom, at their sexual debut than the women in the comparison group. In this study, OC and condom use seemed to exert a protective effect against BV, whereas no effect for IUD use was found.

Restless legs syndrome among women: prevalence, co-morbidity and possible relationship to menopause

Objectives Restless legs syndrome (RLS) is a common neurological movement disorder with a female preponderance and an increasing prevalence with age. During the menopausal transition, sleep is affected. Prior studies suggest that female hormones are associated with the clinical manifestation of RLS. Methods A random sample of 5000 women aged 18–64 years was selected from the general Swedish population. They were sent questions on RLS, general health, sleep problems, reproductive health and menopausal state. Results The response rate was 70.3%; 15.7% of the women were diagnosed with RLS. Prevalence increased with age. RLS subjects more often had symptoms of affected sleep and depressed mood. Co-morbidity with heart disease was more common among RLS subjects, whereas hypertension and diabetes mellitus were not. There was a strong association between vasomotor symptoms and RLS but no statistical relationship between use of hormone replacement therapy, postmenopausal state and RLS. Conclusion The prevalence of RLS among Swedish women is high. RLS sufferers more often suffered from depression and heart disease, whereas no such associations were noted for diabetes or hypertension. We found an increased prevalence of RLS among women with vasomotor symptoms (night sweats) during the menopausal transition but not among women using hormone replacement therapy.

Breast cancer incidence after hormonal infertility treatment in Sweden: a cohort study

OBJECTIVE To assess the impact of infertility treatment with causes of infertility on incidence of breast cancer. STUDY DESIGN Historical prospective cohort study of 1135 women attending major university clinics for treatment of infertility in Sweden, 1961-1976. Women were classified as users of clomiphene citrate or gonadotropins, or a combination of both therapies. Standardized incidence ratios were calculated to estimate relative risk of breast cancer. RESULTS We observed 54 cases of breast cancer during 1961-2004, which did not significantly exceed those expected. Users of high-dose clomiphene citrate had an almost 2-fold increased risk (standardized incidence ratio, 1.90; 95% confidence interval, 1.08-3.35). This association was more pronounced among women referred for nonovulatory factors, with 3-fold increased risk (standardized incidence ratio, 3.00; 95% confidence interval, 1.35-6.67). CONCLUSION No overall increased risk for breast cancer was shown with infertility treatment. Women with nonovulatory causes treated with high-dose clomiphene citrate therapy may have an elevated risk for breast cancer.

Smoking and Cervical Intraepithelial Neoplasia: An Association Independent of Sexual and Other Risk Factors?

The connection between smoking and cervical neoplasia has been questioned. the association demonstrated has been suspected to depend on a correlation between smoking and sexual behavior or other risk factors for cervical neoplasia. This case‐control study included 140 women with cervical intraepithelial neoplasia diagnosed during pregnancy. For each case, 2 healthy, age‐matched women, who simultaneously attended for a pregnancy check at the same maternity clinic, served as controls. Information was obtained on obstetrical and gynecological history, sexual behavior, contraceptive methods, female and male smoking habits and socioeconomic status, using both an interview and a questionaire. the patients were significantly younger at first intercourse and first pregnancy, had more sexual partners, showed a higher frequency of both female and male smokers and had a different pattern of contraceptive use vis‐á‐vis the controls. Analyses of covariance were used to identify and check for possible confounding before a log‐linear regression analysis was ultimately carried out. Two factors remained closely associated with cervical intraepithelial neoplasia: number of sexual partners, and female smoking. We conclude that smoking seems to be a genuine risk factor for cervical intraepithelial neoplasia.

Long-term use of oral contraceptives and cervical neoplasia an association confounded by other risk factors?

One-hundred-and-forty women with cervical intraepithelial neoplasia (CIN) found during pregnancy were compared to 280 pregnant age-matched controls. Information was obtained on obstetrical and gynecological history, sexual behaviour, contraceptive use and smoking of the female and of the male partner. Oral contraceptive use for 60 months or more was significantly associated with CIN. This significance vanished when the effect of confounding factors was controlled for in a log-linear analysis. According to these results, long-term oral contraceptive use does not seem to be a causal factor of CIN, but these women constitute a high risk group due to sexual history and smoking habits and should thus be referred for a regular cytological screening.

Megestrol acetate concentrations in plasma and milk during administration of an oral contraceptive containing 4 mg megestrol acetate to nursing women.

An oral contraceptive containing 4 mg megestrol acetate + 50 mcg ethinyl estradiol was given to 5 fully lactating and nursing women, starting 2 months postpartum. Milk and blood samples were collected simultaneously to allow a comparison between plasma and milk levels of megestrol acetate. Megestrol acetate was estimated by radioimmunoassay. The plasma:milk ratio of megestrol acetate was found to be 100:80. About 2 mcg of megestrol acetate was calculated by be transferred with 600 ml of milk/day corresponding to about .1% of the given dose to the mother.

Conservative Management of the Abnormal Smear During Pregnancy: A long-term follow-up

One hundred and thirty‐two pregnant women who had a smear suggestive of cervical intra‐epithelial neoplasia (CIN) II or more during the 10th to 12th gestational week, were followed with repeated smears and colposcopy every month and, when indicated, a colposcopically guided biopsy. Post‐partum follow‐up included cytology, colposcopy, portio biopsies and endocervical curettage. Seventy‐nine women with normal findings post partum were checked once a year in a long‐term study.

Vaginal microbiological flora and sexually transmitted diseases in women with recurrent or current vulvovaginal candidiasis.

SummaryA history of recurrent vulvovaginal candidiasis (RVVC) was reported by 102 women, while current vulvovaginal candidiasis (VVC) was diagnosed in 83 of the same 996 women. They had all attended two family planning and one youth clinic, respectively. Two women, without RVVC or VVC, matched for age for each case of RVVC, were selected as a comparison group (COMP). Recurrent, but not current VVC, was associated with a history of sexually transmitted disease. Those with current, but not with recurrent, VVC had significantly more often genital warts and bacteriuria (> 105 bacteria/ml), but significantly less often bacterial vaginosis than the COMP women. Both VVC and RVVC were inversely correlated to a vaginal flora change with a mixed anaerobic vaginal flora. Those with VVC had a greater number of lactobacilli on vaginal cultures, than those with RVVC and the women in the COMP group. VVC and a history of RVVC both occurred more frequently in women with a lactobacilli-predominated vaginal flora, as compared with those with a flora change with a mixture of anaerobic and facultative anaerobic bacteria.ZusammenfassungIn einer Gruppe von insgesamt 996 Frauen wurde in 102 Fällen eine rezidivierende und in 83 Fällen eine akute vulvovaginale Kandidose diagnostiziert. Alle Frauen hatten zwei Familienplanungskliniken und eine Klinik für Jugendmedizin aufgesucht. Zwei altersgleiche Frauen ohne rezidivierende oder aktuelle vulvovaginale Kandidose wurden für jeden Fall von rezidivierender Kandidose als Kontrollen in die Vergleichsgruppe aufgenommen. Eine Assoziation zu venerischen Krankheiten ergab sich für die rezidivierende aber nicht für die aktuelle Kandidosc. Genitale Warzen und Bakteriurie (> 105 Bakterien/ml) fanden sich im Vergleich zu den Kontrollen signifikant häufiger bei Frauen mit aktueller, aber nicht bei den Frauen mit rezidivierender Kandidose. Zwischen beiden Formen der Kandidose fand sich eine inverse Beziehung zu Veränderungen der vaginalen Flora zu gemischter anaerober Flora. Frauen mit akuter vulvovaginaler Kandidose hatten in den Scheidenkulturen eine größere Zahl an Laktobazillen als Frauen mit rezidivierender Kandidose und Frauen der Vergleichsgruppe. Sowohl die aktuelle Kandidose als auch eine Vorgeschichte von rezidivierender vulvovaginaler Kandidose waren bei Frauen mit einer von Laktobazillen bestimmten Vaginalflora häufiger zu finden als bei Frauen, bei denen sich eine veränderte Mischflora aus anaeroben und fakultativ anaeroben Bakterien eingestellt hatte.A history of recurrent vulvovaginal candidiasis (RVVC) was reported by 102 women, while current vulvovaginal candidiasis (VVC) was diagnosed in 83 of the same 996 women. They had all attended two family planning and one youth clinic, respectively. Two women, without RVVC or VVC, matched for age for each case of RVVC, were selected as a comparison group (COMP). Recurrent, but not current VVC, was associated with a history of sexually transmitted disease. Those with current, but not with recurrent, VVC had significantly more often genital warts and bacteriuria (> 105 bacteria/ml), but significantly less often bacterial vaginosis than the COMP women. Both VVC and RVVC were inversely correlated to a vaginal flora change with a mixed anaerobic vaginal flora. Those with VVC had a greater number of lactobacilli on vaginal cultures, than those with RVVC and the women in the COMP group. VVC and a history of RVVC both occurred more frequently in women with a lactobacilli-predominated vaginal flora, as compared with those with a flora change with a mixture of anaerobic and facultative anaerobic bacteria. In einer Gruppe von insgesamt 996 Frauen wurde in 102 Fällen eine rezidivierende und in 83 Fällen eine akute vulvovaginale Kandidose diagnostiziert. Alle Frauen hatten zwei Familienplanungskliniken und eine Klinik für Jugendmedizin aufgesucht. Zwei altersgleiche Frauen ohne rezidivierende oder aktuelle vulvovaginale Kandidose wurden für jeden Fall von rezidivierender Kandidose als Kontrollen in die Vergleichsgruppe aufgenommen. Eine Assoziation zu venerischen Krankheiten ergab sich für die rezidivierende aber nicht für die aktuelle Kandidosc. Genitale Warzen und Bakteriurie (> 105 Bakterien/ml) fanden sich im Vergleich zu den Kontrollen signifikant häufiger bei Frauen mit aktueller, aber nicht bei den Frauen mit rezidivierender Kandidose. Zwischen beiden Formen der Kandidose fand sich eine inverse Beziehung zu Veränderungen der vaginalen Flora zu gemischter anaerober Flora. Frauen mit akuter vulvovaginaler Kandidose hatten in den Scheidenkulturen eine größere Zahl an Laktobazillen als Frauen mit rezidivierender Kandidose und Frauen der Vergleichsgruppe. Sowohl die aktuelle Kandidose als auch eine Vorgeschichte von rezidivierender vulvovaginaler Kandidose waren bei Frauen mit einer von Laktobazillen bestimmten Vaginalflora häufiger zu finden als bei Frauen, bei denen sich eine veränderte Mischflora aus anaeroben und fakultativ anaeroben Bakterien eingestellt hatte.

Plasma levels of d-norgestrel and sex hormone binding globulin during oral d-norgestrel medication immediately after delivery and legal abortion.

Abstract To investigate the concentration of d-Norgestrel (d-Ng) in plasma when d-Ng is administered to women with physiologically high concentration of Sex Hormone Binding Globulin (SHBG), 30 μg d-Ng tablets were given daily starting 0–1 day after delivery or abortion. During the first 3–4 days of treatment d-Ng increased to levels 6–8 times higher than found during the same medication to women not recently pregnant. Thereafter, the d-Ng concentration in plasma decreased despite continuous medication in parallel with decreasing levels of SHBG until SHBG reached its normal level after 2–4 weeks. The decrease rate for SHBG after delivery or abortion corresponded to a half life of about nine days. The results indicate an in vivo binding of d-Ng to SHBG and a SHBG influence on the metabolic clearance rate of d-Ng. The in vivo binding of d-Ng to SHBG may have importance in hormonal contraception during lactation.