ABSTRACT
Aim To study the effects of age, period and cohorts on alcohol‐related mortality trends in Sweden.
Design The study comprises an age‐period‐cohort analysis.
Setting and participants The ...analysis was based on all deaths in the Swedish population between 1969 and 2002.
Measurements Data on alcohol‐related deaths in Sweden from 1969 to 2002 excluding accidental injury and homicide were used. The analysis covered 43 021 deaths.
Findings 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.
Conclusions 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.
Please cite this paper as: Lindgren P, Cederholm M, Haglund B, Axelsson O. Invasive procedures for fetal karyotyping: no cause of subsequent gestational hypertension or pre‐eclampsia. BJOG ...2010;117:1422–1425.
The aim was to estimate the risk of maternal hypertensive complications following first‐ or second‐trimester invasive diagnostic procedures, i.e. chorionic villus sampling (CVS) and amniocentesis (AC). Odds ratios (ORs) for gestational hypertension, mild pre‐eclampsia or severe pre‐eclampsia were calculated for women who underwent CVS (n = 1 984) or AC (n = 21 748) compared with non‐exposed women (n = 47 854). No increase in the development of gestational hypertension, mild pre‐eclampsia or severe pre‐eclampsia was observed. The results do not support an association between invasive procedures for fetal karyotyping and subsequent gestational hypertension or pre‐eclampsia.
Objective The first aim of this study was to investigate the risk of pre‐eclampsia, both mild and severe, in women born small for gestational age (SGA). The second aim was to investigate whether the ...risk is modified by pre‐eclampsia in the previous generation.
Design Population‐based cohort study.
Setting Sweden.
Population A population of 118 634 women registered both as newborns and as mothers in the Swedish Medical Birth Register of 1973–2003. Of these, 6883 had been born SGA. Only primiparas and singletons were included.
Methods The pregnancies that the women were born out of were analysed with regard to presence of pre‐eclampsia, while their own pregnancies were analysed regarding age at delivery, smoking, body mass index and incidence of mild or severe pre‐eclampsia. Multiple logistic regression analysis was used. In a first step, we adjusted for maternal characteristics, and in a second step, for pre‐eclampsia in the previous generation.
Main outcome measures Odds ratio for mild and severe pre‐eclampsia.
Results In women born SGA, the adjusted odds ratio (first step) for mild pre‐eclampsia was 1.19 (95% CI 1.03–1.38), while for severe pre‐eclampsia it was 1.69 (95% CI 1.40–2.02) compared with those not born SGA. After the second‐step adjustment, the odds ratio for mild pre‐eclampsia was 1.16 (95% CI 1.00–1.35) and for severe pre‐eclampsia was 1.62 (95% CI 1.35–1.95). No statistically significant effect modification from pre‐eclampsia in the previous generation was shown.
Conclusions Women born SGA suffer a markedly increased risk of severe pre‐eclampsia. Exposure to pre‐eclampsia during a woman’s own fetal development significantly increases her risk of pre‐eclampsia but does not modify the SGA effect.
Although ultrasound during pregnancy is used extensively, there is little published on adverse fetal effects. We undertook a cohort study including men born in Sweden from 1973 to 1978 who enrolled ...for military service. We estimated relative risks for being born left-handed according to ultrasound exposure in fetal life using logistic regression analysis. Eligible for the study were 6,858 men born at a hospital that included ultrasound scanning in standard antenatal care (exposed) and 172,537 men born in hospitals without ultrasound scanning programs (unexposed). During the introduction phase (1973 to 1975) there was no difference in left-handedness between ultrasound exposed and unexposed (odds ratio = 1.03, 95% confidence interval (CI) = 0.91 to 1.17). When ultrasonography was offered more widely (1976 to 1978), the risk of left-handedness was higher among those exposed to ultrasound compared with those unexposed (odds ratio = 1.32, 95% CI = 1.16 to 1.51). We conclude that ultrasound exposure in fetal life increases the risk of left-handedness in men, suggesting that prenatal ultrasound affects the fetal brain.
Background. The aim of the study was to determine if pregnant women with chronic hypertensive disease have an independent risk for preeclampsia, gestational diabetes or placental abruption. To ...examine if superimposed preeclampsia in this group of women is related to an increased risk of placental abruption.
Methods. This study is a population‐based cohort study using the Swedish Medical Birth Register 1992–98. A population of 681 515 women aged between 15–44 years with singleton pregnancies, excluding women with systemic lupus erythematosus (SLE), diabetes mellitus and chronic renal disease were studied. Among these, 3374 women were diagnosed with chronic hypertensive disease. Multiple logistic regression analysis was performed and the outcome measures of crude and adjusted odds ratios (OR) were presented with 95% confidence intervals (CI).
Results. Chronic hypertensive disease is associated with multiparity, age, high body mass index and Nordic ethnicity. After controlling for confounders, chronic hypertensive disease is an independent risk factor for preeclampsia (OR 3.8; 95% CI 3.4–4.3), gestational diabetes (OR 1.8; 95% CI 1.4–2.4) and placental abruption (OR 2.3; 95% CI 1.6–3.4).
Conclusion. Chronic hypertensive disease is independently associated with an increased incidence of preeclampsia, gestational diabetes and placental abruption.
Introduction. The aim of this report is to present descriptive data from the Swedish Medical Birth Register (MBR) reflecting trends in obstetric and neonatal practices over three decades. Material. ...Since 1973 the MBR at the Swedish National Board of Health and Welfare receives information on all pregnancies in Sweden - around 95,000 annually - that have lead to delivery regarding the pregnancy, delivery and the newborn infant. In this study selected data from the MBR are presented as they have developed between 1973 and 2000. Results. There was a shift in age distribution of childbearing women towards older women. Cigarette smoking in early pregnancy decreased from 30% to 12%. In-hospital time after both vaginal and cesarean (CS) delivery decreased and more than 50% of all women with a vaginal singleton delivery left hospital within 48 hours in 2000. The proportion of CS increased from 5 to 15% at singleton deliveries. The CS rate for breech deliveries increased and was nearly 80% in 2000. The mean birth weight increased, particularly the proportion of heavy infants. The proportion of early neonatal deaths decreased continuously, both for term infants and infants born after short gestational length, whereas no such downward trends was found for stillbirth during the last 10-15 years. Conclusion. Although several of the changes regarding pregnancy and delivery that occurred between 1973 and 2000 could be expected to influence pregnancy outcome negatively, the trends described here generally suggest improvement in maternal and child health.
Abstract Background : Childhood brain tumors are associated with high mortality and morbidity but little is known about its causes. About half of women use medicines when pregnant and some of the ...medicines commonly used might be carcinogenic. Objective : The aim with this population-based case–control study was to analyze associations between specific groups of medicines taken during pregnancy and the risk of brain tumor in the offspring. Methods : All children, up to 15 years of age, born in Sweden between 1975 and 1984 were eligible for the study. Cases ( N = 512) were children diagnosed with brain tumor and controls ( N = 525) were randomly selected from the Medical Birth Register. Exposure data on medicines was extracted blindly from antenatal medical records and grouped according to Anatomical Therapeutic Chemical (ATC) code. Information on maternal reproductive history was received from the Medical Birth Register. We used logistic regression to estimate associations between fetal exposure to medicines and childhood brain tumor. Results : No significant changes in risk were noted after exposure to iron supplementation, antiemetics, analgesics, antibiotics or any other main ATC group. A tendency of protective effect was seen for prenatal exposure to folic acid (adjusted OR 0.6, 95% CI 0.3–1.1). Ten children with a diagnosis of brain tumor had been exposed to β-blocking agents in fetal life as compared to two children without brain tumor (adjusted OR 5.3, 95% CI 1.2–24.8). Conclusions : In this case–control study, an increased risk of brain tumor was seen in children exposed to β-blocking agents during fetal life. However, due to the low number of exposed the interpretation of this finding should be made with caution.
Abstract Objective: To examine differences in late fetal death rates in association with determinants of small for gestational age fetuses. Design: Population based cohort study. Subjects: 1 026 249 ...pregnancies without congenital malformations. Setting: Sweden 1983-92. Main outcome measure: Late fetal death rate. Results: Depending on underlying determinants late fetal death rates were greatly increased in extremely small for gestational age fetuses (range 16 to 45 per 1000) compared with non-small for gestational age fetuses (1.4 to 4.6). In extremely small for gestational age fetuses late fetal death rates were increased from 31 per 1000 in mothers aged less than 35 years to 45 per 1000 in older mothers, and from 22 per 1000 in women <155 cm in height to 33 per 1000 in women ≥175 cm tall. Late fetal death rates were also higher in extremely small for gestational age fetuses in singleton compared with twin pregnancies and in non-hypertensive pregnancies compared with pregnancies complicated by severe pre-eclampsia or other hypertensive disorders. Slightly higher late fetal death rates were observed in nulliparous compared with parous women and in non-smokers compared with smokers. Conclusions: Although the risk of late fetal death is greatly increased in fetuses that are extremely small for gestational age the risk is strongly modified by underlying determinants—for example, there is a lower risk of late fetal death in a small for gestational age fetus if the mother is of short stature, has a twin pregnancy, or has hypertension. Key messages Small for gestational age fetuses are at increased risk of late fetal death regardless of the underlying determinants The effect of birthweight ratio on risk of late fetal death is modified by underlying determinants, except maternal age Regardless of birthweight ratio the rates of late fetal death are higher among women aged 35 years or older compared with younger women In pregnancies of extremely small for gestational age fetuses lower rates of late fetal death are associated with a maternal age of less than 35 years, short maternal stature, multiple births, and hypertensive disorders In pregnancies with non-malformed fetuses late fetal death rates are increased in smokers, in multiple births, and in women with severe pre-eclampsia.
ABSTRACTIn North America, 4% to 10% of pregnant women take selective serotonin reuptake inhibitors (SSRIs) for depression. Some studies have reported an increased risk of congenital cardiovascular ...defects in the infants delivered to women who used SSRIs during pregnancy, although studies on these and other risks have yielded conflicting results. A previous study also reported that venlafaxine, a serotonin-norepinephrine reuptake inhibitor used as an alternative to SSRIs, was associated with some birth defects, but there are limitations in previous study on both SSRIs and venlafaxine, and further study is needed. The current study aimed to evaluate the association between the use of these drugs and risk of specific birth defects.The study population included women who gave birth to a live singleton in Denmark, Finland, Norway, Iceland, and Sweden between 1996 and 2010. Data came from national registries. Exposure in utero was defined as instances when a woman filed a prescription for SSRI from 30 days before the first day of her last period to 97 days after the last period. Birth defects assessed included a range of cardiovascular defects as well as anal atresia, hypospadias, clubfoot, limb reduction defects, craniosynostosis, omphalocele, gastroschisis, and cystic kidneys. Statistical analyses estimated odds ratios (ORs) for these types of birth defects and were adjusted for confounding factors including maternal age at delivery, maternal smoking during pregnancy, concurrent drug use, maternal diabetes, birth order, and country and year of delivery. A sibling-controlled analysis included 2288 singleton live births.Of a full study cohort of 2,303,647 women, 1.6% (36,772) were exposed to SSRIs or venlafaxine during the first trimester. During the study period, the rate of infants exposed to these drugs increased from 0.6% in 1996–2000 to 1.5% in 2001–2005 and then to 2.2% in 2006–2010. Of the 36,772 exposed, 1357 infants (3.7%) had a diagnosis of a major birth defect as compared with 3.2% (71,374 of 2,226,875) of unexposed infants (adjusted OR, 1.13; 95% confidence interval CI, 1.06–1.20). In exposed infants, 1.5% had overall cardiac birth defects, whereas 1.2% of unexposed infants had diagnoses of cardiac birth defects (OR, 1.15; 95% CI, 1.05–1.26). The prevalence of birth defects was associated with in utero exposure to each specific SSRI, as well as venlafaxine, but not including escitalopram (adjusted ORs between 1.13 and 1.34). However, in the sibling cohort analysis, adjusted OR was 1.06 (95% CI, 0.91–1.24).The study did not find a substantial teratogenic effect of SSRIs or venlafaxine. Although the prevalence of some defects were higher in the group of exposed infants, the lack of association in the sibling control group suggest no substantial increase in the prevalence of birth defects among infants exposed to SSRIs or venlafaxine.
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