Objective
To determine if immigrant women from low‐, middle‐ and high‐income countries have an increased risk of severe maternal morbidity (near‐miss) when they deliver in Sweden.
Design
Population ...register‐based study.
Setting
Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007.
Population
Women with a near‐miss event; all women with a singleton delivery ≥28 weeks of gestation during the same period acted as reference group.
Methods
Near‐miss was defined by a combined clinical and management approach with use of International Classification of Diseases, 10th revision codes for severe maternal morbidity. A woman's country of origin was designated as low‐, middle‐ or high‐income according to the World Bank Classification of 2009. Unconditional logistic regression models were used in the analysis.
Main outcome measures
Maternal near‐miss frequencies per 1000 deliveries and odds ratios with 95% confidence intervals.
Results
There were 914 474 deliveries during the study period and 2655 near‐misses (2.9 per 1000 deliveries). In comparison to Swedish‐born women, those from low‐income countries had an increased risk of near‐miss (odds ratio 2.3, 95% confidence interval 1.9–2.8) that was significant in all morbidity groups except for cardiovascular diseases and sepsis. Women from middle‐ and high‐income countries showed no increased risk of near‐miss.
Conclusions
Women from low‐income countries have an increased risk of maternal near‐miss morbidity compared with women born in Sweden. Although the rate is low it should alert healthcare providers.
Objective: Zinc deficiency has shown to increase the risk for diabetes in diabetes-prone experimental animals. Low concentrations of zinc have also been shown in serum of recent onset cases with ...IDDM. The present study examines the hypothesis that exposure to a low concentration of zinc in drinking water could increase the risk for future onset of IDDM. Research Design and Methods: Using the Swedish childhood diabetes registry and data on residence 3 years before the onset of disease, a case-control study was designed comparing cases and control subjects with estimates of groundwater contents of zinc obtained in biogeochemical samples from areas of residence. Results: A high groundwater concentration of zinc was associated with a significant decrease in risk (odds ration OR = 0.8; 95% CI = 0.7-0.9). The same OR was obtained when the model included information of other metals that might act as possible confounders (chromium, vanadium, cobalt selenium, cadmium, lead, and mercury). In small rural areas, in which drinking water is taken from local wells and thus is closely associated with the groundwater content within the area, an even stronger association between zinc and diabetes (OR = 0.6; 95% CI = 0.7-0.9) was found. Conclusions: It is concluded that this study for the first time provides evidence that a low groundwater content of zinc, which may reflect long-term exposure through drinking water, is associated with later development of childhood onset diabetes
Objective. To investigate the duration of effects and health consequences of earlier antenatal corticosteroid exposure in infants born late preterm or term. Design. Observational cohort study. ...Setting. Children born after gestational week 34 in Sweden, 1976–1997, whose mothers were hospitalized for imminent preterm delivery. The children were followed to their 11th birthday. Sample. The cohort consisted of 11 873 infants, of whom 8620 were exposed. Methods. Exposure was estimated at hospital level. Infants born at a hospital practicing antenatal corticosteroid administration were classified as exposed. Estimation of hospital routines was based on questionnaire data, telephone interviews with physicians and pharmacy sales, validated in a random sample of medical records. Logistic regression was used to assess associations with adjustments for pregnancy length, birth year and hospital level. Main outcome measures. Rates and odds ratios of mortality, respiratory distress syndrome, bronchopulmonary dysplasia, epilepsy, cerebral palsy, childhood diabetes, birthweight, length and head circumference for all infants, and for preterm and term infants, respectively. Results. Exposed infants had reduced risks of respiratory distress syndrome (odds ratio 0.54, 95% confidence interval 0.35–0.83) and small head circumference (odds ratio 0.47, 95% confidence interval 0.36–0.61), and an increased risk of low Apgar scores (odds ratio 1.40, 95% confidence interval 1.01–1.94), most pronounced in infants born after gestational week 37. Conclusions. Infants born after gestational week 34 seem to benefit from earlier antenatal corticosteroid administration, with reduced risks of respiratory distress syndrome. However, the treatment was less beneficial for term infants, because they also had increased risk of low Apgar scores.
Objective
To obtain more accurate calculations of maternal and pregnancy‐related mortality ratios in Sweden from 1988 to 2007 by using information from national registers and death certificates.
...Design
A national register‐based study, supplemented by a review of death certificates.
Setting
Sweden, 1988–2007.
Population
The deaths of 27 957 women of reproductive age (15–49 years).
Methods
The Swedish Cause of Death Register, Medical Birth Register, and National Patient Register were linked. All women with a diagnosis related to pregnancy in at least one of these registers within 1 year prior to death were identified. Death certificates were reviewed to ascertain maternal deaths. Maternal mortality ratio (the number of maternal deaths/100 000 live births, excluding and including suicides), and pregnancy‐related mortality ratio (number of deaths within 42 days after termination of pregnancy, irrespective of cause of death/100 000 live births) were calculated.
Main outcome measures
Direct and indirect maternal deaths and pregnancy‐related deaths.
Results
The maternal mortality ratio in Sweden, based on the current method of identifying maternal deaths, was 3.6. After linking registers and reviewing death certificates, we identified 64% more maternal deaths, resulting in a ratio of 6.0 (or 6.5 if suicides are included). The pregnancy‐related mortality ratio was 7.3. A total of 478 women died within a year after being recorded with a diagnosis related to pregnancy.
Conclusions
By including the 123 cases of maternal death identified in this study, the mean maternal mortality ratio from 1988 to 2007 was 64% higher than reported to the World Health Organization.
Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few ...studies have investigated cause-specific mortality rates in female immigrants.
In this national study, based on the Swedish Cause of Death Register, we studied 27,957 women of reproductive age (aged 15-49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100,000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries.
The total age-standardized mortality rate per 100,000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8-20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6-16.5) for women born in low-income countries, as compared to Swedish-born women.
Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research.
Growing up with one parent has become increasingly common, and seems to entail disadvantages in terms of socioeconomic circumstances and health. We aimed to investigate differences in mortality, ...severe morbidity, and injury between children living in households with one adult and those living in households with two adults.
In this population-based study, we assessed overall and cause-specific mortality between 1991 and 1998 and risk of admission between 1991 and 1999 for 65 085 children with single parents and 921 257 children with two parents. We estimated relative risks by Poisson regression, adjusted for factors that might be presumed to select people into single parenthood, and for other factors, mainly resulting from single parenthood, that might have affected the relation between type of parenting and risk.
Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors, such as socioeconomic status and parents' addiction or mental disease, children in single-parent households had increased risks compared with those in two-parent households for psychiatric disease in childhood (relative risk for girls 2·1 95% CI 1·9–2·3 and boys 2·5 2·3–2·8), suicide attempt (girls 2·0 1·9–2·2, boys 2·3 2·1–2·6), alcohol-related disease (girls 2·4 2·2–2·7, boys 2·2 2·0–2·4), and narcotics-related disease (girls 3·2 2·7–3·7, boys 4·0 3·5–4·5). Boys in single-parent families were more likely to develop psychiatric disease and narcotics-related disease than were girls, and they also had a raised risk of all-cause mortality.
Growing up in a single-parent family has disadvantages to the health of the child. Lack of household resources plays a major part in increased risks. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of single parents still have increased risks of mortality, severe morbidity, and injury.
Gestational diabetes and preeclampsia Östlund, Ingrid; Haglund, Bengt; Hanson, Ulf
European journal of obstetrics & gynecology and reproductive biology,
03/2004, Letnik:
113, Številka:
1
Journal Article
Recenzirano
Objective: To determine whether gestational diabetes mellitus (GDM) increases the risk for preeclampsia independent of other risk factors.
Study design: The association between GDM and preeclampsia ...was analyzed in a population of women who had given birth to singletons registered in Swedish Medical Birth Register from 1992 through 1996 (
n=430,852).
Results: GDM occurred in 0.8% and preeclampsia in 2.9% of all pregnancies. The rate of preeclampsia was higher in the GDM than in the non-GDM group (6.1% versus 2.8%). High age, nullipara, chronic hypertension, kidney disease, and high body mass index (BMI) were all independently associated with increased risk for preeclampsia. Smoking was associated with decreased risk. Adjusted odds ratio for GDM as a risk factor for preeclampsia was 1.61 (95% confidence interval (CI) 1.39–1.86) when prepregnancy BMI, which was a true confounder, was included in the last step of the multiple logistic regression analysis.
Conclusions: There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor but could not explain the total excess risk.
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