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Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives' attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n = 7) and Örebro County, Sweden (n = 9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional's role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives' attitudes around risks with prenatal alcohol use. [ABSTRACT FROM AUTHOR]

Following a restructuring of Swedish healthcare in the 1990s - moving from a welfare model to one inspired by New Public Management - maternity care in Sweden is increasingly centralised to bigger towns. This has led to several units being relocated or forced to close, and to a bigger distance to maternity care for women living in smaller towns and rural areas. In the present article, I analyse the media reporting on the recent closure of the maternity ward in Sollefteå, a small town in Sweden’s northern region. Using intersectional risk theory, I explore how pregnancy-related risks are articulated in Swedish newspapers, and how such articulations relate to power and ideology. Articles from three Swedish newspapers, published during a 4-month period, have been analysed using critical discourse analysis. I conclude that the newspaper articles were most likely to stress the family as the main ‘risk victim’, while the pregnant woman was rarely the focus of risk articulations. When she was, risks were described as ‘worry’ or ‘unworthiness’, and never in medical terms. When such articulations appeared within an individualist ideological discourse, they were naturalised and as such, disconnected from the political decision to close the maternity ward. My contention is that a feminist perspective is largely missing in the media articles and that a bigger focus on the effect that maternity ward closures have for women living outside urban centres is needed. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have shown an increased risk of obstetric complications in pregnancies after oocyte donation (OD). The present study includes all singletons born after OD over 10 years in Sweden.Material and Methods: This was a retrospective population-based cohort study. Data from all Swedish in vitro fertilization (IVF) clinics between 2003 and 2012 were collected. Data were cross-linked with the Swedish Medical Birth Registry. The study included 388 OD singletons, 26 696 IVF/ICSI singletons and 999 804 spontaneously conceived (SC) singletons. An adjusted odds ratio (aOR) was calculated with adjustment for relevant confounders.Results: Singleton OD pregnancies had a significantly increased risk of preeclampsia compared with IVF (aOR 3.05; 95% CI 2.23-4.16) and SC (aOR 2.84; 95% CI 2.10-3.84), and increased risk of postpartum hemorrhage (>1000 mL) compared with IVF (aOR 2.66; 95% CI 2.04-3.49) and SC (aOR 2.87; 95% CI 2.20-3.71), a higher risk of preterm birth (<37 weeks) compared with IVF (aOR 1.79; 95% CI 1.30-2.46) and SC (aOR 1.58; 95% CI 1.15-2.16) and a higher risk of low birthweight (<2500 g) compared with IVF (aOR 1.67; 95% CI 1.15-2.42) and SC (aOR 1.46; 95% CI 1.01-2.11). The rate of large-for-gestational age was significantly increased in singletons born after OD with frozen cycles than with fresh cycles (odds ratio 5.29, 95% CI 1.30-21.54).Conclusions: Singleton pregnancies conceived after OD are associated with increased maternal and perinatal risks compared with IVF/ICSI pregnancies using the woman's own oocytes and with SC. [ABSTRACT FROM AUTHOR]

Background: Overweight or obesity is detrimental during pregnancy. We studied time trends in the educational gradient of overweight and obesity among pregnant women. Differences in overweight and obesity by area of residence and country of birth were also examined. Methods: The study was based on the Swedish Medical Birth Register between 1992 and 2010 and included 1,569,173 singleton pregnancies. Weight and height were registered during the first visit at the antenatal-care clinic. Data on education, country of birth, and area of residence were derived from registers with national coverage. Results: In 2008-2010, 32% of Swedish nulliparous pregnant women were overweight or obese. The relative risk of obesity among lower educated women compared to women with higher education increased from 1.91 (95% confidence interval: 1.85-1.97) in 1992-1995 to 2.09 (95% confidence interval: 2.05-2.14) in 2008-2010. There was an inverse linear relationship between risks of overweight or obesity, and population density and type of residence municipality. An excessive gestational weight gain according to the American Institute of Medicine was observed among 57-63% of the overweight or obese women, but there were small differences by education. Pregnant women born in Africa, Middle East or Latin America had higher risks of being overweight or obese compared to women born in Sweden. Conclusions: The prevalence of obesity as well as the social inequalities in obesity during pregnancy increased in Sweden between 1992 and 2010. Further understanding of social inequalities and geographical differentials in health behaviours of pregnant women is needed when planning public health interventions. [ABSTRACT FROM AUTHOR]

Antenatal anxiety symptoms are not only a health problem for the expectant mother. Research has found that maternal anxiety may also have an impact on the developing baby. Therefore, it is important to estimate the prevalence of maternal anxiety and associated factors. The current study aims to estimate the prevalence of anxiety symptoms during the first trimester of pregnancy and to identify associated risk factors. Secondly, to investigate other factors associated with anxiety during early pregnancy including fear of childbirth and a preference for cesarean section. In a population-based community sample of 1,175 pregnant women, 916 women (78 %) were investigated in the first trimester (gestation week 8-12). The Hospital Anxiety Depression Scale (HADS-A) was used to measure anxiety symptoms. The prevalence of anxiety symptoms (HADS-A scores ≥8 during pregnancy) was 15.6 % in early pregnancy. Women under 25 years of age were at an increased risk of anxiety symptoms during early pregnancy (OR 2.6, CI 1.7-4.0). Women who reported a language other than Swedish as their native language (OR 4.2, CI 2.7-7.0), reported high school as their highest level of education (OR 1.6, CI 1.1-2.3), were unemployed (OR 3.5, CI 2.1-5.8), used nicotine before pregnancy (OR 1.7, CI 1.1-2.5), and had a self-reported psychiatric history of either depression (OR 3.8, CI 2.6-5.6) or anxiety (OR 5.2, CI 3.5-7.9) before their current pregnancy were all at an increased risk of anxiety symptoms during early pregnancy. Anxiety symptoms during pregnancy increased the rate of fear of birth (OR 3.0, CI 1.9-4.7) and a preference for cesarean section (OR 1.7, CI 1.0-2.8). Caregivers should pay careful attention to history of mental illness to be able to identify women with symptoms of anxiety during early pregnancy. When presenting with symptoms of anxiety, the women might need counseling and or treatment in order to decrease her anxiety. [ABSTRACT FROM AUTHOR]

Background The infant microbiota may play a pathogenic role in coeliac disease (CD). Antibiotic treatment in pregnancy is common and could significantly impact the infant microbiota. In this study, we aimed to investigate the association between antibiotic exposure during pregnancy and CD in offspring. Methods Prospective questionnaire data on antibiotic exposure in pregnancy were available in 8729 children participating in the All Babies in Southeast Sweden (ABIS) cohort study, and of these 46 developed CD until December 2006. Cox regression estimated hazard ratios (HRs) for CD in the offspring among mothers exposed to antibiotics during pregnancy, with adjustment for parent-reported diary data on breastfeeding, age at gluten introduction and number of infections in the child's first year of life. Results Of the 1836 children exposed to antibiotics during pregnancy, 12 (0.7%) children developed CD as compared with 34/6893 (0.5%) unexposed children (HR = 1.33; 95%CI = 0.69-2.56). Risk estimates remained unchanged after adjustment for breastfeeding, age at gluten introduction and infection load in the child's first year of life (HR = 1.28; 95%CI = 0.66- 2.48). Conclusions We found no statistically significant association between antibiotic exposure during pregnancy and CD in offspring. This lack of association may either be true or the result of limited statistical power. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were: (i) to investigate stillbirth risk in offspring to foreign-born women by region of birth; (ii) if disparities in risks can be explained by socio-economic factors, pregnancy complications or maternal morbidity; and (iii) if the risk varies by time since immigration. Methods: This was a population-based register study with data from the Swedish Medical Birth Register and socio-economic variables from national income and population registers. We studied single births from 1992 to 2005, and included 219 832 births to foreign-born women and 1 094 146 births to Swedish-born women. Logistic regression analysis was used to calculate odds ratios (ORs), using 95% confidence intervals (CIs). Results: In all, 4104 antepartal and 255 intrapartal stillbirths occurred. Compared with births to Swedish women, the OR of stillbirth was 2.27 (95% CI 1.84–2.80) for births to women from Africa and 1.41 (95% CI 1.22–1.64) for births to women from Middle East, after adjustment for confounding factors. The risk of stillbirth was higher in immigrants who had been in Sweden for a short time period (<5 years) compared with those who had been in Sweden for a longer period, OR 1.21 (95% CI 1.05–1.40). Conclusions: The risk of stillbirth in immigrant women varies by region of birth and time since immigration, being highest in women from Africa and the Middle East, and the recently settled. Further studies are needed to identify the mechanisms behind these patterns. [ABSTRACT FROM AUTHOR]

BACKGROUND: The knowledge about air pollution effects on birth weight, prematurity, and small for gestational age (SGA) in low-exposure areas is insufficient. OBJECTIVES: The aim of this birth cohort study was to investigate whether low-level exposure to air pollution was associated with prematurity and fetal growth and whether there are sex-specific effects. Method: We combined high-quality registry information on 81,110 births with individually modeled exposure data at residence for nitrogen oxides (NOx) and proximity to roads with differing traffic density. The data were analyzed by logistic and linear regression with and without potential confounders. RESULTS: We observed an increased risk for babies being SGA when we compared highest and lowest NOx quartiles, adjusting for maternal age, smoking, sex, and year of birth. After additional adjustment for maternal country of origin and parity (which were highly intercorrelated), the increase was no longer statistically significant. However, in subgroup analyses when we compared highest and lowest NOx quartiles we still observed an increased risk for SGA for girls [odds ratio (OR) = 1.12; 95% confidence interval (CI), 1.01-1.24); we also observed increased risk among mothers who had not changed residency during pregnancy (OR = 1.09; 95% CI, 1.01-1.18). The confounders with the greatest impact on SGA were parity and country of origin. Concerning prematurity, the prevalence was lower in the three higher NOx exposure quartiles compared with the lowest category. CONCLUSION: For future studies on air pollution effects on birth outcomes, careful control of confounding is crucial. [ABSTRACT FROM AUTHOR]