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Introduction Identification of pregnant women suffering from depression or other mental disorders is a challenge for antenatal caregivers. The purpose of this case-control study was to describe mental disorders and the risk factors for mental disorders in women with depressive symptoms assessed with the Edinburgh Postnatal Depression Scale during the first trimester and to compare them with pregnant women without depressive symptoms. Material and methods In total, 2271 women answered the Edinburgh Postnatal Depression Scale at the first antenatal visit with a midwife. An Edinburgh Postnatal Depression Scale score of 13 or higher was considered to be screen-positive and these women were further assessed. Screen-negative pregnant women, matched for age and parity, were chosen as controls. Results In total, 149 (6.6%) women were found to be screen-positive. The majority (126, 85%) had at least one mental disorder or risk factor for mental disorder, such as depression (36.0%), anxiety (14.8%), or severe fear of childbirth (20.8%). The screen-positive women were more often smokers (16.1% vs 1.3%), unemployed (19.9% vs 1.3%), or on sick leave (25.3% vs 14.1%) during pregnancy and more often used selective serotonin reuptake inhibitor during pregnancy (14.2% vs 2.7%) compared with the screen-negative women (PFunding Agencies|ALF, Region Ostergotland [LIO-35 9731]

Introduction About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. Material and methods All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. Results Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P amp;lt; 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. Conclusions FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth. Funding Agencies|Medical Research Council of Southeast Sweden, FORSS

BackgroundSleep disorders are known to increase in prevalence during pregnancy, and associations between disturbed sleep during pregnancy and adverse outcomes for mother and child have been reported in a number of studies. However, most of these studies were retrospective and too small to satisfactorily demonstrate the association.Aims To prospectively investigate the development of snoring during pregnancy and assess if there is an association between snoring and sleepiness or adverse pregnancy outcomes.To study the development of restless legs syndrome during and after pregnancy, and whether it is associated with snoring or other pregnancy-related symptoms.To investigate the possible association between depressive symptoms in the postpartum period and sleep related problems during pregnancy, using screening instruments.To objectively evaluate sleep disordered breathing in pregnant women compared to non-pregnant controls and to evaluate differences in Epworth Sleepiness Scale scores between the two groups.MethodsQuestionnaires containing subjective rating of snoring, Epworth Sleepiness Scale and symptoms of restless legs were used in all studies. Information from the medical records of the pregnant women was also utilized. For objective evaluation of sleep disordered breathing, nocturnal respiratory recordings were used. In the research for the first three papers the same cohort of 500 pregnant women was followed on three occasions during pregnancy and also after delivery, and for the last paper, 100 other pregnant women were compared to 80 nonpregnant controls.Results and conclusionsBoth snoring and restless legs syndrome increase during pregnancy, but this had no convincing impact on obstetric outcome. Sleep recordings could not verify an increased prevalence of obstructive sleep apnea among pregnant women. Restless legs syndrome was associated with snoring and could persist after delivery. Women who had high scores on the Epworth Sleepiness Scale in the last trimester of pregnancy showed more depressive symptoms in the postpartum period. No difference in item scoring of the Epworth Sleepiness Scale was found between pregnant women and controls.

Objective. To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric an ...

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI >30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linkoping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained

The objective of this study was to investigate whether pregnancy, delivery, and neonatal outcome among obese pregnant women who took part in an intervention study for weight restriction differed from a group of obese pregnant women attending regular antenatal care. The intervention group consisted of 155 obese pregnant women and 193 obese pregnant women who formed a control group. We found that a weight gain restriction of less than 7 kg during pregnancy is safe for both the mother and the neonate. Original Publication:Ing-Marie Claesson, Jan Brynhildsen, Marie Cedergren, Annika Jeppsson, Adam Sydsjö and Ann Josefsson, Weight gain restriction during pregnancy is safe for both the mother and neonate., 2009, Acta obstetricia et gynecologica Scandinavica, (88), 10, 1158-1162.http://dx.doi.org/10.1080/00016340903214916Copyright: Taylor and Francishttp://www.tandf.co.uk/journals/default.asp

Objective. The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes. Design. A cross-sectional study. Setting. Antenatal care clinics in the southeast region of Sweden. Sample. In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife. Methods. The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored >20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV. Results. Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years. Conclusions. Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.

Background. Postnatal depression refers to a non-psychotic depressive episode that begins in or extends into the postpartum period. The aims of this study were to examine the prevalence of depressive symptoms in a pregnant and later postnatal population, to determine the natural course of these symptoms and whether there is an association between antenatal and postnatal depressive symptomatology.Methods. A longitudinal study with a total population of 1,558 consecutively registered pregnant women in the southeast region of Sweden. Presence of depressive symptoms was measured with the Edinburgh Postnatal Depression Scale on four occasions namely in gestational week 35–36, in the maternity ward, 6–8 weeks and 6 months postpartum.Results. The prevalence of depressive symptoms during late pregnancy was 17%; in the maternity ward 18%; 6–8 weeks postnatally 13%; and 6 months postnatally, 13%. A correlation between antenatal and postnatal depressive symptoms was found (r=0.50, p

Most pregnant women are anxious about the delivery and up to 30% develop varying degrees of fear of childbirth (FOC). Secondary FOC occurs in parous women who have experienced a traumatic delivery. The aim of this study was to investigate the time to subsequent delivery and delivery outcome in women with secondary FOC, compared with a reference group.Southeast Sweden.356 parous pregnant women with secondary FOC and a reference group of 634 parous women without FOC.Descriptive, retrospective case-control study.Time to next pregnancy and delivery outcome.More women with secondary FOC had a longer interval to subsequent delivery compared with parous women without FOC (p = 0.005). Women with secondary FOC had 5.2 times higher probability of having a cesarean section than the reference group. Women with secondary FOC also had on average a 40-minute longer duration of active labor than women without FOC (p0.001).Secondary fear of childbirth prolongs the time to subsequent delivery and the active phase of labor itself, and increases the risk for cesarean section.

To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms.Prospective study.Antenatal care clinics in the catchment area of Linköping university hospital, Sweden.Five hundred consecutively recruited pregnant women.Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy.Symptoms of RLS in relation to snoring in each trimester.Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery.Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.

To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric and neonatal outcomes of their pregnancies.Population-based register study.All women born in 1973-1983 who were alive and living in Sweden at 13 years of age (n=500 245).Women diagnosed with CHD (n=2 216) were compared with women without CHD (n=492 476). A total of 188 867 mother-firstborn-offspring pairs were identified and available for analysis.Mothers of women with CHD were more often older and single/unmarried. Women with CHD were more often born preterm or small-for-gestational age (SGA) than women without CHD, more likely to have been born with a cesarean section, to have given birth during the study period, and to be younger at the time of their first pregnancy. Women with CHD were also more prone to give birth to children preterm or SGA and their babies were more often delivered by cesarean section with a higher frequency of congenital abnormality.Women with CHD were more likely to have been born preterm or SGA and these outcomes were repeated in the next generation. Women with CHD should not be discouraged from pregnancy. Prenatal diagnostics should be discussed and offered to these women, as there is an increased risk for congenital abnormalities.

To investigate the effects of a weight-gain restriction program on weight development or weight maintenance 2 years after childbirth.A case-control intervention study.Antenatal care clinics in the southeast of Sweden.One hundred and fifty-five obese pregnant women who participated in a weight-gain restriction program with weekly support during pregnancy and every 6 months during the two first years after childbirth. The control group consisted of 193 obese pregnant women.Follow-up weight measurements were done at 12 and 24 months after childbirth.Weight change in kilogram at 12 and 24 months postpartum.A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p= 0.034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p= 0.018). The mean value of weight change in the intervention group was -2.2 kg compared to +0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p= 0.046).An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.

To study whether increased maternal weight and other factors of importance is associated with higher birth weights of the children over a period of almost 25 years.Retrospective cohort study.Delivery wards in southeast Sweden.A total of 4,330 delivered women and their children from the years 1978, 1986, 1992, 1997, and 2001.Analysis of covariance was used to evaluate the importance of the mother's body mass index (BMI) on the children's birth weights during the study years and smoking, parity, employment, gestational age, and the age of the mothers were adjusted for.Weight of the offspring in relation to maternal BMI and possible confounders such as smoking, parity, employment, gestational age, and the age of the mother.Between 1978 and 1992, there was an increase in birth weight in each of the four BMI categories (i.e. BMI20, 20-24.9, 25-29.9 andor =30, respectively) even after adjustments were made for relevant background characteristics (p0.001). However, between 1992 and 2001, the birth weight for children whose mothers had a BMI of less than 20 or between 20 and 24.9 decreased (p0.001). For almost every study year, the mothers' BMI was of significant influence on the children's birth weights. However, the proportion of variance explained by the models (i.e. the adjusted R(2)) was not substantially altered when the mother's BMI was excluded from the models.Maternal BMI is of significance to explain trends in infants' birth weight over time, but not of sole importance.

The Swedish cesarean section (CS) rate has increased dramatically over the last decades, but remains relatively low compared to several other countries in the Western world. The reasons for this continuous increase are multifactorial and difficult to investigate. That pregnant women are demanding CS more frequently does not appear to be the major explanatory factor for the increasing CS rate. Since Swedish CS rates are relatively low, it is important to study attitudes to CS in a nationwide population of Swedish obstetricians and gynecologists in order to determine the possible concerns of this group.In 2006, a study-specific questionnaire was created and posted to Swedish obstetricians and gynecologists. In total, 1,280 obstetricians and gynecologists received a questionnaire and replied with a response rate of 66%.In general, older and longer work experience physicians had a more positive attitude towards providing CS on maternal request or elective CS for women who fear vaginal delivery. In addition, these colleagues were more positive in expressing their belief that elective CS is as safe as vaginal delivery for the mother and her child. The main difference between female and male physicians was that males were more positive toward providing CS on maternal request (p0.001).We have shown that female physicians differ from their male colleagues in their attitudes toward providing CS on maternal request. Female physicians were more reluctant than males to provide CS on maternal request.

Background To evaluate the implementation of nuchal translucency measurement as an additional examination within the first trimester routine ultrasound in an unselected population of women. Methods A prospective study in which all pregnant women during 1994, referred for the first trimester routine ultrasound scan, were asked to participate. Of a total of 1852 women with a viable pregnancy, results from 1444 women were evaluated. When a nuchal translucency of 4 mm or more was found, the woman was offered both a genetic amniocentesis in gestational week 13-15 and an additional ultrasound examination in gestational week 18-19. Results Six fetuses had a nuchal translucency of 4 mm or more and none of these had any chromosomal abnormality. Neither had any of the fetuses in the study, karyotyped for other reasons, any chromosomal defect and nor was there any child born with aneuploidy in the study population. No strong relation between major malformations e.g. abnormalities of the heart and increased nuchal translucency was found. The fetus with the largest nuchal translucency (=6 mm) was born healthy. Conclusion The efficacy of nuchal translucency measurement needs further evaluation before it can be introduced as a screening method in an unselected pregnant population.

Postnatal depression refers to a non-psychotic depressive episode that begins in or extends into the postpartum period. The aims of this study were to examine the prevalence of depressive symptoms in a pregnant and later postnatal population, to determine the natural course of these symptoms and whether there is an association between antenatal and postnatal depressive symptomatology.A longitudinal study with a total population of 1,558 consecutively registered pregnant women in the southeast region of Sweden. Presence of depressive symptoms was measured with the Edinburgh Postnatal Depression Scale on four occasions namely in gestational week 35-36, in the maternity ward, 6-8 weeks and 6 months postpartum.The prevalence of depressive symptoms during late pregnancy was 17%; in the maternity ward 18%; 6-8 weeks postnatally 13%; and 6 months postnatally, 13%. A correlation between antenatal and postnatal depressive symptoms was found (r=0.50, p0.0001).Detection of women at risk for developing postnatal depressive symptoms can be done during late pregnancy. Antenatal care clinics constitute a natural and useful environment for recognition of women with depressive symptoms.

We would like to comment on the short report by Storck Lindholm et al. published in the latest issue of Acta Obstetricia & Gynecologica (2010;89:840–3). The authors have investigated the possibilit...