The purpose was to describe utilization of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), including trends in prevalence, characteristics of ...users, drug switching and changes in prescribed doses in a large group of pregnant women across four Nordic countries.
A drug utilization study based on linked individual-level data from the nationwide prescription- and medical birth registers in Denmark, Iceland, Norway and Sweden. The study population comprised all pregnancies in these countries, resulting in a live birth or stillbirth after gestational week 22 from January 1st 2008 to December 31st 2012 (N = 1 162 470). In addition to the main study drugs SSRIs and SNRIs, we included (concurrent) use of other antidepressants, antipsychotics, anxiolytics and hypnotics.
A total of 38 219 (3.3%) pregnancies were exposed to SSRIs and 5 634 (0.5%) to SNRIs. Prevalence of SSRI and SNRI use varied by country (1.8% in Norway to 7.0% in Iceland). Use and prescribed dosages decreased with each passing trimester of pregnancy; prevalence was 2.7% at conception, and 2.1%, 1.7% and 1.3% respectively in 1st, 2nd and 3rd trimester. In 0.6% of pregnancies women filled a prescription before pregnancy and in every trimester. In one third of exposed pregnancies, women were also dispensed anxiolytics, hypnotics or sedatives.
Use of SSRI and SNRI use during pregnancy varied between the Nordic countries, but the overall prevalence remained low and relatively stable from 2008 to 2012. The low prevalence of use and high proportion of women who discontinue treatment in pregnancy raise questions about adequate treatment of depression in pregnant women.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Increasing numbers of infants born preterm survive into adulthood. In this study, we analyzed the effect of having been born preterm on disability and vocational success in young adults.
A Swedish ...national cohort of 522,310 infants born in 1973-1979 were followed up for disabilities and income in national registers in 2002 at the age of 23 to 29. Hypotheses were tested in multivariate analysis with logistic regression models on the log scale for dichotomized outcomes and linear regression for continuous variables.
There was a stepwise increase in disability in young adulthood with increasing degree of preterm birth. A total of 13.2% of children born at 24 to 28 weeks' gestation and 5.6% born at 29 to 32 weeks' gestation received economic assistance from society because of handicap or persistent illness, which is equivalent to nearly 4 corrected times the risk of those born at term after adjustment for socioeconomic and perinatal confounders. Moderate (33-36 weeks' gestation) and marginal (37-38 weeks' gestation) preterm birth also carried significantly increased risks for disability and were responsible for 74% of the total disability associated with preterm birth. Preterm birth was associated with a lower chance of completing a university education and a lower net salary in a stepwise manner. The total economic gain for Swedish society, in terms of taxes and decreased costs for benefits, if all long-term effects of preterm birth could have been prevented in the birth cohorts in this study, would have amounted to 65 million euros in 2002 alone.
The majority of adults who were born very preterm lived an independent and self-supportive life. Moderately preterm birth carries a considerable risk for long-term impairment. There are strong economic incentives for secondary prevention of disability associated with preterm birth.
IMPORTANCE Maternal psychiatric disease is associated with adverse pregnancy outcomes. Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with congenital ...anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown. OBJECTIVE To study risk of stillbirth and infant mortality associated with use of SSRIs during pregnancy. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) at different periods from 1996 through 2007. The study included women with singleton births. We obtained information on maternal use of SSRIs from prescription registries. Maternal characteristics, pregnancy, and neonatal outcomes were obtained from patient and medical birth registries. MAIN OUTCOME MEASURES We used logistic regression to estimate relative risks of stillbirth, neonatal death, and postneonatal death associated with SSRI use during pregnancy taking into account maternal characteristics and previous psychiatric hospitalization. RESULTS Among 1 633 877 singleton births in the study, 6054 were stillbirths; 3609, neonatal deaths; and 1578, postneonatal deaths. A total of 29 228 (1.79%) of mothers had filled a prescription for an SSRI during pregnancy. Women exposed to an SSRI presented with higher rates of stillbirth (4.62 vs 3.69 per 1000, P = .01) and postneonatal death (1.38 vs 0.96 per 1000, P = .03) than those who did not. The rate of neonatal death was similar between groups (2.54 vs 2.21 per 1000, P = .24). Yet in multivariable models, SSRI use was not associated with stillbirth (adjusted odds ratio OR, 1.17; 95% CI, 0.96-1.41; P = .12), neonatal death (adjusted OR, 1.23; 95% CI, 0.96-1.57; P = .11), or postneonatal death (adjusted OR, 1.34; 95% CI, 0.97-1.86; P = .08). Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease. The adjusted OR for stillbirth in women with a previous hospitalization for psychiatric disease was 0.92 (95% CI, 0.66-1.28; P = .62) and was 1.07 (95% CI, 0.84-1.36; P = .59) for those who had not been previously hospitalized. The corresponding ORs for neonatal death were 0.89 (95% CI, 0.58-1.39; P = .62) for women who were hospitalized and 1.14 (95% CI, 0.84-1.56; P = .39) for women who were not. For postneonatal death, the ORs were 1.02 (95% CI, 0.61-1.69; P = .95) for women who were hospitalized and 1.10 (95% CI, 0.71-1.72; P = .66) for women who were not. CONCLUSIONS AND RELEVANCE Among women with singleton births in Nordic countries, no significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or postneonatal mortality. However, decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness.
Objective The aim of this study was to investigate whether the risk of developing ischaemic heart disease (IHD) later in life increases with severity and recurrence of gestational hypertensive ...disease.
Design Cross‐sectional population‐based study.
Setting Sweden.
Population Women (403,550) giving birth to their first child in Sweden, 1973–1982. Of this cohort, 207,054 women who also gave birth to a second child during the same period were analysed separately.
Methods All women were followed up for 15 years, starting 4–14 years after the index pregnancy. Women who suffered from hypertensive disease during pregnancy were compared with women with normal pregnancies with regard to hospitalisation for, or death from, IHD during the follow up period.
Main outcome measures Fatal or non‐fatal IHD.
Results The adjusted incidence rate ratio (IRR) for later development of IHD was 1.6 (95% CI 1.3–2.0) when the first pregnancy was complicated by gestational hypertension without proteinuria, 1.9 (95% CI 1.6–2.2) for mild pre‐eclampsia and 2.8 (95% CI 2.2–3.7) for severe pre‐eclampsia. Women with gestational hypertension in their first pregnancy but not in their second had an adjusted IRR of 1.9 (95% CI 1.5–2.4) for development of IHD. Women with hypertensive disease in both pregnancies had an IRR of 2.8 (95% CI 2.0–3.9) compared with women with two normal pregnancies.
Conclusion Severe hypertensive disease in pregnancy has a stronger association with later development of IHD than has mild hypertensive disease. Recurrent hypertensive disease is more strongly associated with IHD than is non‐recurrent disease.
Objective: To study the incidence, etiologic risk factors, and outcome of biliary atresia. Study design: Register study using Swedish national health databases. The study population consisted of ...1,204,791 children, corresponding to 99% of the entire cohort of Swedish children born between 1987 and 1997, with an end point of follow-up at 2 years of age. Cases with biliary atresia with and without major heart malformations were identified with indicators from various national health databases. Results: Eighty-five cases with biliary atresia were identified, the incidence being 1 in 14,000. A major heart malformation was found in 13 (15%) cases. In a multivariate analysis, 4 independent risk factors were identified: high maternal age (odds ratio OR = 3.0), parity of at least 4 (OR = 2.2), prematurity (OR = 2.9), and low birth weight for gestational age (OR = 4.7). No significant differences were found in the distribution of birth months. The outcome did not differ between the two groups with and without major heart malformations, nor with respect to any of the risk factors. Conclusions: The Swedish incidence of biliary atresia is similar to that found in other European countries. The identified risk factors may suggest the existence of a maternal vulnerability and the importance of viral infections transmitted from mother to fetus/neonate. (J Pediatr 2002;141:217–22)
Objective. To study the benefits of antenatal corticosteroids (ACS) in clinical settings and to evaluate the occurrence of long-term neuro-sensory effects such as epilepsy and cerebral palsy (CP). ...Design. Observational population-based study including all births between gestational weeks 24 and 34 during 1976-1997 in Sweden. Exposure to ACS was evaluated at hospital level. Children were followed up to their ninth birthday. Sample and methods. Seven thousand eight hundred twenty-seven infants of which 5,632 were exposed to ACS. Data on hospital ACS routines was based on questionnaires and interviews with physicians and pharmacy sales. Outcomes were obtained from the national health registers and assessed according to gender of the child. Logistic regression was used to assess associations. Main outcome measures. Neonatal death, low Apgar score, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), CP, and epilepsy. Results. After adjustment, exposed infants had reduced risks of RDS (OR 0.80, 95% CI 0.70-0.92), late neonatal death (OR 0.86, 95% CI 0.57-1.29), BPD (OR 0.87, 95% CI 0.62-1.22), ROP (OR 0.80, 95% CI 0.48-1.32), IVH (OR 0.93, 95% CI 0.67-1.3), and CP (OR 0.82, 95% CI 0.58-1.15). Males had a higher risk of epilepsy (OR 1.74, 95% CI 0.85-3.55) than females (OR 0.50, 95% CI 0.25-1.03). Conclusion. The results confirm the beneficial effect of ACS regarding RDS in clinical settings. Except for a tendency to increased risk of epilepsy among male infants there were no increased risks of neuro-sensory outcomes.
Objective To investigate whether amniocentesis and chorionic villus sampling increase the risk of postural deformities, limb reduction defects, respiratory problems in the newborn, fetal and infant ...mortality, prematurity, low birthweight and fetal distress, 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 Infant outcomes were collected from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register, the Swedish Malformation Register and the Swedish Cause of Death Register. Odds ratios were calculated with logistic regression analyses.
Main outcome measures Crude and adjusted odds ratios of postural deformities, limb reduction defects, respiratory problems in the newborn, fetal and infant mortality, prematurity, low birthweight and fetal distress. Women exposed to amniocentesis or chorionic villus sampling were compared with non‐exposed women.
Results An increased risk of musculoskeletal deformities (OR = 1.32, 95% CI 1.11–1.57) including club foot and hip dislocation was found in the amniocentesis group, especially for amniocentesis prior to 14 weeks of gestation. Respiratory disturbances such as neonatal pneumonia, meconium aspiration, atelectasis and tachypnea were found more often in the amniocentesis group (OR = 1.12, 95% CI 1.02–1.24), with the greatest risk at 14 and 15 weeks of gestation. For the chorionic villus sampling group, no significant associations were found. No increase regarding limb reduction defects, fetal and infant mortality, prematurity, low birthweight and fetal distress was found in either the amniocentesis or the chorionic villus sampling group.
Conclusions Among women aged 35–49 years, amniocentesis before 14 weeks of gestation increases the risk of postural deformities. Amniocentesis at 14 and 15 weeks increases the risk of respiratory disturbances. For chorionic villus sampling, a larger study group is needed before such risks can be ruled out.
Objective
To estimate the effect of low maternal age on late fetal death and infant mortality and to estimate the extent of any increase in infant mortality attributable to higher rates of preterm ...birth among teenagers.
Design
Population‐based cohort study.
Setting
Births recorded in the nationwide Swedish Medical Birth Registry.
Population
All single births to nulliparous women aged 13–24 years (n= 320,174) during 1973–1989.
Methods
Using information recorded in the medical birth registry, linked to a national education register, the effect of low maternal age on adverse outcomes was estimated using logistic regression analysis.
Main outcome measures
Late fetal death, neonatal and postneonatal mortality and preterm birth.
Results
Compared with mothers aged 2CL24 years, adjusted risks of neonatal and postneonatal mortality were significantly increased among mothers aged 13–15 years (odds ratios = 2.7 and 2.6, respectively) and among those aged 16–17 years (odds ratios = 1.4 and 2.0, respectively), while mothers aged 18–19 years had a significant increase in risk of postneonatal mortality only (odds ratio = 1.4). Rates of very preterm birth (≤ 32 weeks), according to maternal age, were: 13–15 years, 5.9%; 16–17 years, 2.5%; 18–19 years, 1.7%; and 20–24 years, 1.1%. The high rates of very preterm birth among young teenagers almost entirely explained the increased risk of neonatal mortality in this group.
Conclusions
The increased risks of neonatal and postneonatal mortality among young teenagers may be related to biological immaturity. The increase in risk of neonatal mortality is largely explained by increased rates of very preterm birth.
Summary
Background
The association between low birth weight and adult disease is well known. Less is known on long‐term effects of high birth weight.
Objective
This study aims to investigate whether ...a high birth weight increases risk for adult metabolic disease.
Methods
Swedish term single births, 1973–1982 (n = 759 999), were studied to age 27.5–37.5 years using Swedish national registers. Hazard ratios (HRs) were calculated in relation to birth weight for type 2 diabetes, obesity, hypertension and dyslipidaemia.
Results
Men with birth weights between 2 and 3 standard deviation score (SDS) had a 1.9‐fold increased risk (HR 1.91, 95% confidence interval CI 1.25–2.90) of type 2 diabetes, whereas those with birth weights above 3 SDS had a 5.4‐fold increased risk (HR 5.44, 95% CI 2.70–10.96) compared to men with birth weights between −2 and 2 SDS. The corresponding HRs for women were 0.60 (95% CI 0.40–0.91) and 1.71 (95% CI 0.85–3.43) for birth weights 2–3 SDS and >3 SDS, respectively. Men with birth weights between 2 and 3 SDS had a 1.5‐fold increased risk (HR 1.47, 95% CI 1.22–1.77) of obesity. The corresponding risk for women was 1.3‐fold increased (HR 1.32, 95% CI 1.19–1.46). For men and women with birth weights above 3 SDS, the risks of adult obesity were higher, HR 2.46 (95% CI 1.63–3.71) and HR 1.85 (95% CI 1.44–2.37), respectively.
Conclusions
A high birth weight, particularly very high, increases the risk of type 2 diabetes in male young adults. The risk of obesity increases with increasing birth weight in both genders.
Summary
Studies based on data from the US have reported that the birthweight distribution at gestational age 28–31 weeks is bimodal with a second peak occurring at approximately 3300 g, suggesting ...that there is misclassification of term infants. In these studies, gestational ages were estimated from the date of the last menstrual period (LMP), and it has been suggested that ultrasound‐based estimates of gestational age would eliminate the problem with bimodal birthweight distributions. Swedish data include both measures, thus offering an opportunity for comparison. All singleton births in Sweden from 1993 to 2002 with information on birthweight were included in the study (n = 917 901). Both LMP‐ and ultrasound‐based estimates of gestational age were available for 75.1% of the births. Two possible sources of misclassification were considered: measurement error, assuming that ultrasound‐based estimates are better, and data entry errors. An algorithm for assessment of data entry errors was developed; 67.4% of the births were left for the analyses of data ‘cleaned’ from data entry errors.
Based on the entire study population, the LMP‐based birthweight curves for lower‐gestational‐age preterm births were bimodal, with a second peak around 3500 g. The bimodal distribution was greatly attenuated when using ultrasound‐based gestational age categories, but did not disappear. After cleaning the data, the LMP‐based birthweight distributions for infants at gestational ages <32 weeks were no longer bimodal, and were very similar to the ultrasound‐based curves. In conclusion, data entry errors are more likely to cause the bimodality in the birthweight distribution among preterm infants than measurement errors in the LMP‐based gestational age estimate.
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