Background: Ultrasound assessment of gestational length is based on the assumption that fetuses of the same gestational age have equal size at the time of investigation. However, there are detectable ...sex differences in fetal size by the end of the first trimester. We examined whether ultrasound dating introduces sex differences in risks of adverse perinatal outcomes related to post-term birth. Methods: We used the Swedish Medical Birth Register to compare male and female newborns during 1973-1978, when gestational age was based on the last menstrual period, and 1995-2007, when gestational age was based on ultrasound. We included singleton births from 39 to 43 gestational weeks. Results: During the first time period, the newborn male-to-female ratio by gestational age at delivery was constant around 1.0, but in the later time period it consistently increased by gestational age, reaching 1.60 at 43 weeks. In the first time period, post-term females had reduced risk for adverse perinatal outcomes compared with post-term males. After the introduction of ultrasound, post-term females had higher risks of stillbirth (odds ratio = 1.60 95% confidence interval = 1.11 to 2.30) and meconium aspiration (1.39 1.10 to 1.75), compared with post-term males. One-third of still-births among post-term girls today might be due to incorrect calculation of gestational age. Conclusions: Introduction of ultrasound for the estimation of gestational age may be associated with increased risks of adverse perinatal outcomes among females classified as post-term compared with their male counterparts.
Abstract
Objective
To obtain more accurate calculations of maternal and pregnancy‐related mortality ratios in
S
weden 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
S
weden, 1988–2007.
Population
The deaths of 27 957 women of reproductive age (15–49 years).
Methods
The
S
wedish
C
ause of
D
eath
R
egister,
M
edical
B
irth
R
egister, and
N
ational
P
atient
R
egister 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
S
weden, 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
W
orld
H
ealth
O
rganization.
To study the effects of age, period and cohorts on alcohol-related mortality trends in Sweden. The study comprises an age-period-cohort analysis. The analysis was based on all deaths in the Swedish ...population between 1969 and 2002. Data on alcohol-related deaths in Sweden from 1969 to 2002 excluding accidental injury and homicide were used. The analysis covered 43 021 deaths. Time period and birth cohort both influenced alcohol-related mortality. Male cohorts born in the 1930-40s exhibited the highest alcohol-related mortality, while for females those born in the 1940-50s had the highest alcohol-related mortality. For both men and women, those born in the 1960-70s had the lowest age-adjusted alcohol-related mortality. High-risk cohorts were young or in early adulthood during the periods that alcohol became more available in Sweden. The low-risk cohorts of the 1960-70s were brought up during a period when society was concerned with increasing alcohol problems and more emphasis was placed on issuing alcohol awareness information in schools. Cohort effects were found suggesting that the link between alcohol consumption and non-accident alcohol-related mortality at the population level is dependent on other factors that may change over time. One such factor may be that restrictive alcohol policies have a greater effect on drinking in those who are younger at the time they are put into effect. PUBLICATION ABSTRACT
Abstract
Aims/hypothesis. To further investigate the association of cancer occurrence with the use of insulin glargine. Methods. We followed 114 838 individuals using insulin between 1 July and 31 ...December 2005. From 1 January 2006 to 31 December 2008, we noted the occurrence of malignancies (cohort I). Insulin users between 1 July and 31 December 2006 were followed for the occurrence of malignancies in 2007 and 2008 (cohort II). Users of insulin during three consecutive six-month periods from 1 July 2005 to 31 December 2006 were followed for the occurrence of malignancies in 2007 and 2008 (cohort III). The Prescribed Drug Register, the Cancer Register, and the Causes of Death Register were used to obtain information on targeted person-time and outcome. We retrieved variables reflecting potential confounding factors from the Swedish National Diabetes Register, the Prescribed Drug Register, the Patient Register, the Medical Birth Register and the National Education Register. With Poisson regression we evaluated the association between insulin use and malignancy outcome with adjustment for confounders. Results. The adjusted incidence rate ratio (and 95% confidence interval) for women who used insulin glargine alone compared with those who used other types of insulin, was 1.60 (1.10-2.32) for breast cancer but included 1.0 for malignancy outcomes other than breast cancer for men and women when analyzing cohort I with follow-up in 2006-2008. For cohort II and III the corresponding incidence rate ratios were 1.38 (0.87-2.18), and 0.87 (0.41-1.85), respectively. Conclusion/interpretation. We do not see an increased risk during 2008 for breast cancer in the insulin glargine group. We need data for additional years before we can state with reasonable certainty that the increase in breast cancer incidence that we observed in Sweden in 2006 and 2007 was due to a random fluctuation or whether there is an association with the use of insulin glargine.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objective
To investigate whether amniocentesis and chorionic villus sampling increase the risk of bleeding, placental abruption, complications related to amniotic cavity and membranes, abnormal ...labour, operative deliveries and to investigate the impact of gestational length at the time of the procedure.
Design
A population‐based cohort study.
Setting
Sweden, 1991–1996.
Population
All women, 35 to 49 years old, with single births (N= 71,586). The women were classified as exposed to amniocentesis (N= 21,748) or chorionic villus sampling (n= 1984) or not exposed (N= 47,854).
Methods
Maternal outcomes were collected from the Swedish Medical Birth Register and the Swedish Hospital Discharge Register. With Logistic regression analyses odds ratios were calculated.
Main outcome measures
Crude and adjusted odds ratios of bleeding, complications related to amniotic cavity and membranes, abnormal labour and operative deliveries. Women exposed to amniocentesis or chorionic villus sampling were compared with women non‐exposed.
Results
Neither amniocentesis nor chorionic villus sampling was associated with severe pregnancy complications such as placental abruption or placenta praevia. Women in the amniocentesis group had a lower chance of normal delivery (OR = 0.93, 95% CI 0.90–0.97), an increased risk of complications related to amniotic cavity and membranes (OR = 1.15, 95% CI 1.06–1.24) and hypotonic uterine dysfunction (OR = 1.12, 95% CI 1.06–1.18). The risks were higher for amniocentesis before 15 weeks of gestation. Women in the amniocentesis group were more often delivered by forceps or vacuum extractions (OR = 1.11, 95% CI 1.03–1.19) and elective caesarean sections (OR = 1.09, 95% CI 1.02–1.16). For the chorionic villus sampling group, no significant associations were found.
Conclusions
Among women aged 35–49 years, amniocentesis is not associated with important adverse outcomes such as abruption or placenta praevia. Minor associations were found for other maternal complications when amniocentesis was performed before 15 weeks of gestation. Improved methods to identify women with increased risk of chromosomally abnormal pregnancies might minimise the number of women exposed to invasive procedures.
Objective The purpose of this study was to determine whether there is a difference, by gender, in perinatal mortality in chronically hypertensive women compared with normotensive women.
Design ...Population‐based prospective cohort study.
Setting Sweden.
Population A total of 866 188 women with singleton pregnancies registered in the Swedish Medical Birth Registry 1992–2004, of which 4749 were diagnosed with chronic hypertension.
Methods Multivariate logistic regression analysis was performed. In a first step, we adjusted for maternal characteristics and in a second step for mild and severe pre‐eclampsia, gestational diabetes, placental abruption and small for gestational age. An effect modification by gender was included in the model.
Main outcome measures Odds ratios (OR) for intrauterine death, neonatal death and post‐neonatal death with respect to gender of offspring.
Results The unadjusted OR of intrauterine death was 4.12 (95% CI: 2.84–5.96) and 1.29 (95% CI: 0.67–2.48) for male and female offspring, respectively, and of neonatal death, it was 3.45 (95% CI: 2.13–5.59) and 2.17 (95% CI: 1.08–4.35) for male and female offspring, respectively. After multivariate analysis, the OR of intrauterine death was 3.07 (95% CI: 2.12–4.46) and neonatal death was 2.99 (95% CI: 1.84–4.85) for male offspring. For female offspring, the OR of intrauterine death was 0.98 (95% CI: 0.51–1.89) and neonatal death was 1.88 (95% CI: 0.93–3.79).
Conclusion Mothers with chronic hypertension have an increased risk of perinatal mortality of their male offspring.
Background: Hypotheses concerning compression of morbidity have gained support, particularly due to improved lifestyles from 1950 to date, but now the increase is largely due to improvements in ...healthcare. Methods: Survey data from Sweden were used to test whether the older population aged 65-84 years during 1995-2002 had more longstanding illnesses than the older population of 1980-87 or 1988-94. Results: There was an increased prevalence of many longstanding illnesses among the elderly in Sweden between 1988-94 and 1995-2002. The increase was especially pronounced among those with at least three longstanding illnesses. For diabetes, heart disease, and hypertension, the prevalence among elderly men increased by over 20%. However, those reporting these kinds of longstanding illnesses perceive improved health and are less restricted in their daily activities. Conclusions: Results from Sweden indicate that many countries approaching Sweden's life expectancy will have an increased need for care for the oldest population in the future. The compression-of-morbidity hypothesis is being challenged, probably due to improvements in healthcare.
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