Ulf Hanson

Obstetric and Perinatal Outcomes in Type 1 Diabetic Pregnancies: A large, population-based study

OBJECTIVE To perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies and the general obstetric population in Sweden between 1991 and 2003. RESEARCH DESIGN AND METHODS This was a population-based study. Data were obtained from the Medical Birth Registry, covering >98% of all pregnancies in Sweden. A total of 5,089 type 1 diabetic pregnancies and 1,260,207 control pregnancies were included. Odds ratios (ORs) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits, and ethnicity. RESULTS In type 1 diabetes, preeclampsia was significantly more frequent (OR 4.47 [3.77–5.31]) as was delivery by cesarean section (5.31 [4.97–5.69]) compared with results for the general population. Stillbirth (3.34 [2.46–4.55]), perinatal mortality (3.29 [2.50–4.33]), and major malformations (2.50 [2.13–2.94]) were more common in type 1 diabetic than in control pregnancies. The risk of very preterm birth (<32 gestational weeks) was also higher among type 1 diabetic women (3.08 [2.45–3.87]). The incidence of fetal macrosomia (birth weight ≥2 SD above the mean) was increased in the diabetic group (11.45 [10.61–12.36]). CONCLUSIONS Type 1 diabetes in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The eightfold increased risk for fetal macrosomia in type 1 diabetic pregnancies is unexpected and warrants further investigation.

Associations between pornography consumption and sexual practices among adolescents in Sweden

Pornography consumption and sexual behaviour were studied, with an aim to investigate any associations. Participants were 718 students from 47 high school classes, mean age 18 years, in a medium-sized Swedish city. More men (98%) than women (72%) had ever consumed pornography. More male high consumers than low consumers or women got sexually aroused by, fantasized about, or tried to perform acts seen in a pornographic film (P<0.001). Three-quarters of the sample had had sexual intercourse, of which 71% reported contraceptive use at first intercourse. Anal intercourse was reported by 16%, with infrequent condom use (39%). Intercourse with a friend (adjusted odds ratio (adj. OR) 2.29; 95% confidence interval (CI) 1.27–4.12) was significantly associated with high consumption of pornography among men, while anal intercourse (adj. OR 1.99; 95% CI 0.95-4.16) and group sex (adj. OR 1.95; 95% CI 0.70-5.47) tended to be associated. A significant confounder was early age of sexual debut (adj. OR 1.49; 95% CI 1.18-1.88).

Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003.

Diabet. Med. 27, 436–441 (2010)

Sex behavior among high school students in Sweden : improvement in contraceptive use over time.

PURPOSE To investigate sexual behavior and attitudes toward sexuality among first-year high school students in Sweden in 1999 and to compare the sexual behavior with that reported from similar studies in 1979 and 1989. METHODS In Spring 1999, a questionnaire with 47 questions mainly of multiple-choice nature was administered to a random sample of 20 classes in senior high school in two medium-sized cities in Sweden. The median age of the students was 16 years. Differences in sexual behavior and attitudes were evaluated with the Chi-square and Students t-test. RESULTS Almost half of the students (46%) had had intercourse, showing that the age of coitarche had not decreased during the past two decades. The median age at intercourse of those who had had intercourse was 15 years in both genders. More students in practical (vocational-technical) programs (60%) than in theoretical (college preparatory) ones (37%) had had sexual intercourse. More teenagers in theoretical (90%) than in practical programs (64%) had used contraceptives at their first intercourse, an increase from 65% in 1979 to 76% in 1999. One-fourth of the teenagers were under the influence of alcohol at the first intercourse, a decrease, compared with 1979. CONCLUSIONS Contraceptive use at coitarche has increased and alcohol use decreased over the 20-year-period. The tendency noted 10 years ago that students attending practical programs put themselves at more health risk than students in theoretical programs continues. This fact should be considered when planning for counseling and sex education.

The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn: a 12 year study in central Sweden.

Background All maternal red cell antibodies found during pregnancy in a 12 year period have been compiled. The efficacy of the current antenatal screening and management programme has been ascertained by reviewing the outcome of all newborns to these immunized mothers.

Follow-Up of Women With Previous GDM: Insulin, C-Peptide, and Proinsulin Responses to Oral Glucose Load

Gestational diabetes mellitus (GDM) is a strong predictor of glucose intolerance later in life. Former GDM (n = 145) and control (n = 41) subjects were studied 3–4 yr after the index pregnancy. They were subjected to a 75-g oral glucose tolerance test (OGTT) with measurements of insulin, C-peptide, and proinsulin in the basal state and every 30 min for 180 min. In the former GDM group, 5 subjects (3.4%) had developed non-insulin-dependent diabetes mellitus (NIDDM), and 32 (22%) had developed impaired glucose tolerance (IGT; by World Health Organization criteria). In the control group, 2 (4%) had IGT. In the GDM group, IGT or NIDDM was significantly associated with obesity (body mass index [BMI] ≥25 kg/m2) and earlier diagnosis of GDM during pregnancy (P < 0.001). Nonobese (BMI <25 kg/m2) GDM subjects with normal glucose tolerance at follow-up had significantly higher mean glucose(P < 0.01), insulin (P < 0.05), and proinsulin (P < 0.001) values during the OGTT than control subjects, whereas there was no significant difference in C-peptide values. A comparison between control subjects with normal OGTT and BMI <25 kg/m2 (n = 39) and GDM subjects (n = 39) selected to have a comparable area under the glucose curve, BMI, and age demonstrated no group differences in glucose, C-peptide, or insulin levels, whereas the proinsulin levels were significantly higher (P < 0.001) during the glucose load. The molar ratio between proinsulin and insulin was also significantly higher among the former GDM subjects. We speculate that an elevated proinsulin-insulin ratio in women with previous GDM could be a marker for later development of NIDDM.

Epidemiology of pregnancy-induced hypertension and preeclampsia in Type 1 (insulin-dependent) diabetic pregnancies in Sweden

BACKGROUND The object of this study was to examine if there is an association between pregnancy-induced hypertension (PIH) and/or preeclampsia (PE) and glycemic control assessed by HbA1c in early type 1 diabetic pregnancy, as well as factors such as maternal age, parity, duration of diabetes, presence of diabetes microangiopathy. METHODS The nationwide collaborative study included 491 type 1 diabetic pregnancies corresponding to about 80%, of the diabetic pregnancies during the study period 1983-1985. A blood sample for determination of HbA1c was obtained in early gestation (median 9 (5-16) weeks). RESULTS The rate of PIH/PE was 20.6% in the type 1 diabetic pregnancies compared to 5.0% in the background population. The type 1 diabetic pregnancies complicated by PIH/PE were associated with significantly longer duration of diabetes, higher initial HbA1c (8.1% vs 7.4%, p < 0.01), higher rate of nephropathy and retinopathy, while there were no significant differences in maternal age or parity compared to those without PIH/PE. Discriminant analysis revealed that occurrence of nephropathy (p<0.001), retinopathy (p<0.01) and high HbA1c (p<0.01) in early pregnancy were independently and significantly associated with occurrence of PIH/PE. Among the 463 patients without prepregnancy proteinuria 38 (8.2%) had PIH and 53 (11.5%) PE. The group with PE had, compared to the no PIH/PE group, significantly higher HbA1c (8.2% vs 7.4%, p<0.01). HbA1c was not significantly different between the PIH and the no PIH/PE group (7.5% vs 7.4%). Both the PIH and the PE group had significantly higher rate of retinopathy compared to the no PIH/PE group. If early HbA1c was equal to or above control mean by +8 s.d., i.e. > or =10.1% the PI rate was 31.0% compared to 10.2% in those with HbA1c below that value. CONCLUSIONS We conclude that poor glycemic control in early pregnancy is associated with increased risk of PE in non-proteinuric type 1 diabetic pregnancies.

ECLAMPSIA IN SWEDEN

Objective: Assess the actual rate of eclampsia in Sweden, describe the clinical picture of the disease and the maternal and perinatal outcomes. Methods: Analysis of data regarding incidence of eclampsia registered in the Swedish Medical Birth Register 1991–1992. The records of all the cases with the diagnosis of eclampsia in Sweden during 1991–1992 were retrospectively evaluated regarding maternal and fetal outcomes. Results: The incidence of eclampsia after case review was 3.3/10,000 births. There was no maternal mortality. Severe maternal complications occurred in 30%. Recurrent fits were reported in 41%. Antenatal eclampsia was usually either not preceded by symptoms or signs of preeclampsia or by just a very short period of prodromal symptoms. Among intrapartum and postnatal cases of eclampsia, preeclampsia or high blood pressure was more frequently noted when convulsions occurred. Perinatal mortality rate was 4/80 (4.7%). Of the infants, 13% were small for gestational age. Conclusion: Compared with earlier studies, the incidence of eclampsia has increased significantly. It is questionable whether the incidence of eclampsia could be reduced by earlier diagnosis and treatment of preeclampsia. The risk of severe complications and recurrent fits was substantial, which underlines the importance of adequate treatment of eclampsia.

Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test.

Background. The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT).

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Objective  To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin.