Search

Introduction It is suggested that birth by elective cesarean section (CS) reduces the risk of birth-related infant mortality and injury. Other studies suggest an increased risk of somatic immune-related diseases among children born by CS such as asthma, type 1 diabetes, and inflammatory bowel disease. The WHO Statement on Cesarean Section Rates 2015 described an increase in CS globally. The statement concluded that the effects of CS on social and psychological outcomes remain unclear and that more research is needed to fully understand the effects of CS, including effects on cognition and intelligence in the child. Therefore, we aimed to investigate the association between delivery by CS (elective and acute) and school performance and intelligence in youth. Material and methods This cohort study included all Danish live-born children in 1978–2000. We retrieved data regarding pregnancies, births, parents, school grades, and intelligence of the children from Danish registers and performed multiple imputations to avoid discarding data. The final cohort after exclusion comprised 1 408 230 children. Associations between CS and school graduation, grades, conscription attendance, and conscription intelligence scores were analyzed using univariate and multivariate logistic and linear regressions. Results Adjusted odds ratio with 95% CI of graduating from lower (LSE) and upper (USE) secondary education and of attending conscription were significantly lower in the CS group: LSE graduation: 0.87 (0.84–0.89), USE graduation: 0.93 (0.92–0.94), attending conscription: 0.95 (0.93–0.98). The CS group had significantly lower grade point averages (GPA) in LSE with adjusted differences in mean total GPA of −0.090 (−0.10 to −0.007), and mean core subject GPA of −0.098 (−0.11 to −0.08), in USE with total GPA difference of −0.091 (−0.11 to −0.075) and lower mean intelligence scores of −0.36 (−0.46 to −0.27) in adjusted linear models. A sub-analysis revealed lower chances of graduating LS, Introduction: It is suggested that birth by elective cesarean section (CS) reduces the risk of birth-related infant mortality and injury. Other studies suggest an increased risk of somatic immune-related diseases among children born by CS such as asthma, type 1 diabetes, and inflammatory bowel disease. The WHO Statement on Cesarean Section Rates 2015 described an increase in CS globally. The statement concluded that the effects of CS on social and psychological outcomes remain unclear and that more research is needed to fully understand the effects of CS, including effects on cognition and intelligence in the child. Therefore, we aimed to investigate the association between delivery by CS (elective and acute) and school performance and intelligence in youth. Material and methods: This cohort study included all Danish live-born children in 1978–2000. We retrieved data regarding pregnancies, births, parents, school grades, and intelligence of the children from Danish registers and performed multiple imputations to avoid discarding data. The final cohort after exclusion comprised 1 408 230 children. Associations between CS and school graduation, grades, conscription attendance, and conscription intelligence scores were analyzed using univariate and multivariate logistic and linear regressions. Results: Adjusted odds ratio with 95% CI of graduating from lower (LSE) and upper (USE) secondary education and of attending conscription were significantly lower in the CS group: LSE graduation: 0.87 (0.84–0.89), USE graduation: 0.93 (0.92–0.94), attending conscription: 0.95 (0.93–0.98). The CS group had significantly lower grade point averages (GPA) in LSE with adjusted differences in mean total GPA of −0.090 (−0.10 to −0.007), and mean core subject GPA of −0.098 (−0.11 to −0.08), in USE with total GPA difference of −0.091 (−0.11 to −0.075) and lower mean intelligence scores of −0.36 (−0.46 to −0.27) in adjusted linear models. A sub-analysis revealed lower chances of graduat

In this study we investigated whether age of men undergoing assisted reproductive technology (ART) treatment was associated with day of transfer, stage, morphology, and initial hCG-rise of the competent blastocyst leading to a live birth? The design was a multicenter historical cohort study based on exposure (age) and outcome data (blastocyst stage and morphology and initial hCG-rise) from men whose partner underwent single blastocyst transfer resulting in singleton pregnancy/birth. The ART treatments were carried out at sixteen private and university-based public fertility clinics. We included 7246 men and women, who between 2014 and 2018 underwent controlled ovarian stimulation (COS) or Frozenthawed Embryo Transfer (FET) with a single blastocyst transfer resulting in singleton pregnancy were identified. 4842 men with a partner giving birth were included, by linking data to the Danish Medical Birth Registry. We showed that the adjusted association between paternal age and transfer day in COS treatments was OR 1.06, 95% CI (1.00;1.13). Meaning that for every increase of one year, men had a 6% increased probability that the competent blastocyst was transferred on day 6 compared to day 5. Further we showed that the mean difference in hCG values when comparing paternal age group 30-34, 35-39 and 40-45 with the age group 25-29 in those receiving COS treatment, all showed significantly lower adjusted values for older men. In conclusion we hypothesize that the later transfer (day 6) in female partners of older men may be due to longer time spent by the oocyte to repair fragmented DNA of the sperm cells, which should be a focus of future research in men.

Background Gestational diabetes mellitus (GDM) complicates up to 10% of pregnancies and is a well-known risk factor for type 2 diabetes mellitus (T2DM) and cardiovascular disease. Little is known about possible long-term risks of other diseases. Background The aim was to review the literature for evidence of associations with morbidity other than T2DM and cardiovascular disease and with long-term mortality. Methods A systematic review based on searches in Medline, Embase, and Cochrane Library until March 31, 2021, using a broad range of keywords. We extracted study characteristics and results on associations between GDM and disease occurrence at least 10 years postpartum, excluding studies on women with diabetes prior to pregnancy or only diabetes prior to outcome. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Newcastle-Ottawa Scale was used to assess risk of bias. Results We screened 3084 titles, 81 articles were assessed full-text, and 15 included in the review. The strongest evidence for an association was for kidney diseases, particularly in Black women. We found indication of an association with liver disease, possibly restricted to women with T2DM postpartum. The association between GDM and breast cancer had been studied extensively, but in most cases based on self-reported diagnosis and with conflicting results. Only sparse and inconsistent results were found for other cancers. No study on thyroid diseases was found, and no study reported on short-term or long-term mortality in women with a history of GDM. Conclusion Given the frequency of GDM, there is a need for better evidence on possible long-term health consequences, in particular, studies based on comprehensive records of diagnosis of GDM and long-term health outcomes.

Introduction: Length of hospital stay after birth has decreased during the last decades, but nationwide data on length of hospital stay after cesarean section are lacking. Elements of Enhanced Recovery Programs were reported to reduce the length of hospital stay. The aim of this nationwide study was to describe the length of hospital stay after cesarean section in Denmark from 2004 to 2016 taking into account birth- and health-related factors as well as demographic changes and, further, to assess potential differences between the five Danish regions. Material and methods: Length of hospital stay was assessed in 164 209 deliveries by cesarean section in Denmark from 2004 to 2016. Data were obtained from the Danish National Patient Register. All deliveries by cesarean section at gestational age <22 weeks were excluded. Median length of hospital stay was reported based on crude and adjusted analyses. Results: The median length of hospital stay was significantly reduced by 39 hours (95% confidence interval [CI] 37.9-40.1), from 97 hours (4.0 days) in 2004 to 58 hours (2.4 days) in 2016. Reductions were observed among both planned and emergency cesarean sections. When birth- and health-related factors as well as demographic changes were accounted for, median length of hospital stay was reduced by 30 hours (95% CI 29.3-30.8) in the period. The decrease in length of hospital stay from 2004 to 2016 varied between the five Danish regions, with adjusted reductions between 19 and 46 hours. Conclusions: A nationwide decrease in length of hospital stay after cesarean section was observed from 2004 to 2016 across all five regions but with significant regional variations. Further studies on the optimal length of hospital stay are needed, especially with regard to implementation of enhanced recovery programs.

Introduction: Despite smoking being a well-established risk factor for adverse pregnancy and neonatal outcomes, a substantial proportion of women of reproductive age smoke. Previously, meta-analyses have indicated a significantly negative impact of female smoking on outcomes of assisted reproduction, yet most of the included studies have several, essential methodological limitations. We aimed to investigate whether female cigarette smoking may affect the chance of achieving a clinical pregnancy and live birth among women and couples receiving medically assisted reproduction treatment. Material and methods: A cohort study with longitudinally and repeatedly collected exposure information from 1 January 2010 to 31 August 2015, including data on 1708 women and potential partners initiating either intrauterine insemination, in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) or frozen embryo transfer treatment cycles at the public Fertility Clinic, Aarhus University Hospital, Denmark. Smoking was assessed from self-reported questionnaires completed before treatment. Outcomes were a clinical pregnancy and a live birth. Information on these was obtained from the Danish national health registries, allowing complete follow up. To evaluate associations between female occasional/daily cigarette smoking and successful medically assisted reproduction treatments, a modified Poisson regression with robust standard errors was used. Results: Female occasional/daily cigarette smoking was not associated with the chance of achieving a clinical pregnancy or a live birth in all intrauterine insemination or IVF/ICSI treatment cycles. When compared with nonsmokers, the adjusted relative risk for obtaining a live birth for those reporting smoking was 1.22 (0.70-2.12) among women initiating 1456 intrauterine insemination treatment cycles. Among women initiating 2788 IVF/ICSI treatment cycles, those reporting occasional/daily smoking had a relative risk for obtaining a liv

Introduction: The demand for fertility treatment with donated oocytes is increasing in many European countries. In order to offer oocyte donors an attractive treatment, it is necessary to understand the views of the donors. Therefore, the aim of this study was to explore how women who donate oocytes describe their motives and attitudes towards oocyte donation, as well as their experiences with oocyte donation. Material and methods: A qualitative study based on individual face-to-face interviews with 12 oocyte donors with a donor identity as either anonymous or open. Oocyte donors who had donated oocytes at least once were recruited from the fertility clinic at Herlev University Hospital, Denmark. Data were collected using a piloted, semi-structured interview guide and were analyzed using qualitative content analysis. The analysis was handled in NVIVO 11 PRO. Results: The analysis resulted in three themes: (1) helping others, (2) the treatment, and (3) being an oocyte donor. The financial compensation had varying degrees of importance for the oocyte donors but was always secondary to the desire to help others. All participants were interested in knowing whether their donation had resulted in pregnancy or birth of a child. Many donors had not gained a full understanding of the realistic outcomes of their donation. Conclusions: Our results suggest that oocyte donors are mainly motivated by altruism, and financial compensation was found to be a secondary motive. Further, political awareness could be directed toward particularly open donors and the need to provide information about the outcome of their donation. Finally, it seems that future oocyte donors, in a treatment with a high need for information, can benefit from clinicians giving more exact information in relation to the probability of the birth of a donor child.

Historically, pregnancy dating has been based on self-reported information on the first day of the last menstrual period. In the 1970s, ultrasound biometry was introduced as an alternative for pregnancy dating and is now the leading method in Nordic countries. The use of ultrasound led to a reduction of post-term births and fewer inductions, and is considered more precise than last menstrual period-based methods for pregnancy dating. Nevertheless, differences in early growth and specific situations, such as maternal obesity, can render its estimates less precise, leading to gestational age misclassification. Clinical implications of ultrasound dating include effect on timely induction in case of post-term pregnancies, treatment with corticosteroids in cases of anticipated preterm delivery and decision on viability in cases of extreme prematurity. Furthermore, gestational age misclassification may influence the numbers and the magnitude of some adverse perinatal outcomes, closely related to gestational age, which are recorded in the Nordic birth registers., Special Issue: SI

Objective: Fetal exposure to maternal rheumatoid arthritis (RA) might impact the long-term risk of disease in the offspring. We examined a possible association between maternal RA and 15 selected groups of chronic diseases in the offspring. Methods: This nationwide cohort study was based on the Danish health registries and included data on all children born alive in Denmark between January 1, 1989 and December 31, 2013. The cohort comprised 2,106 children born by women with RA (exposed), and 1,378,539 children born by women without RA (unexposed). Cox proportional hazards regression models were used, taking a large range of confounders into consideration, and the hazard ratios (HRs) of child and adolescent diseases were calculated. Results: In children exposed to maternal RA in utero, the HR of thyroid diseases was 2.19 (95% confidence interval [95% CI] 1.14–4.21), epilepsy 1.61 (95% CI 1.16–2.25), and RA 2.89 (95% CI 2.06–4.05). The HRs for anxiety and personality disorders and chronic lung disease including asthma were in the range of 1.15–1.16, but these were not statistically significant associations. Conclusion: Our results suggest that in utero exposure to maternal RA is associated with an increased risk of thyroid disease and epilepsy in childhood and adolescence, and in particular an increased risk of RA, compared to children born to mothers without RA. These important findings should encourage pediatricians and general practitioners to have an increased awareness of certain chronic diseases in children exposed to RA in utero.

BACKGROUND: Surgery for rectosigmoid endometriosis carries a substantial risk of short- and long-term complications, which has to be counterbalanced against the potential effect of the procedure. Prospective data are scarce in the field of deep infiltrating endometriosis surgery. OBJECTIVE: The study aimed to assess pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis. DESIGN: The study involved prospectively collected data regarding pelvic pain and quality of life before and after surgery. SETTINGS: It was conducted at a tertiary endometriosis referral unit at Aarhus University Hospital. PATIENTS: A total of 175 women were included. INTERVENTION: Patients underwent laparoscopic bowel resection for endometriosis. MAIN OUTCOME MEASURES: Questionnaires for pain (Numerical Rating Scale) and quality of life (RAND Short Form-36) were answered before and 1 year after surgery. Data on analgesic and hormone treatment were collected. Preoperative and postoperative pelvic pain and quality-of-life scores were compared, and risk factors for improvement/worsening were identified. RESULTS: A total of 97.1% of the women completed the 1-year follow up. A significant decrease (p = 0.0001) was observed on all pelvic pain parameters. Most profound was the decrease in dyschezia. A significant improvement on all quality-of-life scores was observed (p = 0.0001). A surgical complication did not have a negative impact on outcome 1 year after surgery. The postoperative outcome was not related to the type of surgery. LIMITATIONS: This is an observational study without a control group. Risk factor data should be interpreted with caution, because the study was relatively underpowered for some of the rare outcomes. CONCLUSIONS: A significant and clinically relevant improvement in pelvic pain and quality of life 1 year after laparoscopic bowel resection for endometriosis was found. We strongly recommend surgery for rectosigmoid endometri

Introduction: Alcohol binge drinking is common in early pregnancy and is a well-established risk factor for subsequent child health. Yet, very few studies have investigated the effect on fetal growth. Furthermore, it has been speculated that the timing of binge drinking may be a determining factor for neonatal growth. The objective of this study was to assess the potential effect of binge drinking and different drinking patterns (timing and number of binge drinking episodes) in early pregnancy on fetal growth estimated by birthweight and birth length. Material and methods: From 1 March to 31 August 2000, 1836 pregnant Danish women from Aarhus University Hospital and Fredericia Hospital were included in the study and interviewed around the early second trimester about their drinking habits during their pregnancy. Information on anthropometric measures at birth was obtained from the Danish Medical Birth Registry. The potential effect of binge drinking and different drinking patterns was estimated using a multivariate general linear regression model adjusted for potential confounders that were selected a priori based on the currently available scientific literature. Results: The women who reported any binge drinking gave birth to children with a reduction in birth length of −0.02 cm (95% CI −0.23 to 0.18) and an increase in birthweight of 0.2 g (95% CI −42.8 to 43.2). The number of binge episodes and the timing of these episodes were also not associated with fetal growth. Conclusions: The study suggests that binge drinking and different drinking patterns in early pregnancy do not affect fetal growth.

Introduction: Identification of pregnant alcohol risk drinkers is crucial to prevent adverse birth outcomes. The TWEAK screening instrument has shown promising results for identifying risk drinkers. However, as the effectiveness of the screening questionnaire has only been investigated among American women with mainly low socioeconomic status, we aimed to investigate the ability of TWEAK to identify alcohol risk drinkers among pregnant Danish women. Material and methods: During 2000, Danish-speaking women referred to the Midwife Center at Aarhus University Hospital (n = 1554) and Fredericia Hospital (n = 499) for routine antenatal care were invited to participate in the study at their first visit. The women were interviewed about their periconceptional and current drinking habits including average weekly alcohol consumption and binge drinking. Additionally, the women were also asked the questions related to the TWEAK questionnaire. Results: We found that the sensitivity of TWEAK to identify periconceptional risk drinking was quite low, but its ability to identify risk drinkers during pregnancy was marginally higher. Our results suggested that older age (odds ratio 1.46, 95% confidence interval 0.95–2.23), current smoking (odds ratio 2.33, 95% confidence interval 1.63–3.33), being single (odds ratio 2.38, 95% confidence interval 1.38–4.11) and a TWEAK score with a cut-off score of ≥1 (odds ratio 2.75, 95% confidence interval 2.02–3.76) increased the risk of high-risk drinking during pregnancy. Conclusions: In a Danish setting, TWEAK does not seem as an optimal screening tool to identify periconceptional risk drinkers but it may be useful in identifying high-risk drinking during pregnancy.

Cross-sectional studies serve many purposes, and the cross-sectional design is the most relevant design when assessing the prevalence of disease, attitudes and knowledge among patients and health personnel, in validation studies comparing, for example, different measurement instruments, and in reliability studies. This paper describes the use of cross-sectional studies and provides examples within obstetrics and gynecology. Caveats are also described; for example, when cross-sectional data is used for analytical purposes of associations between an exposure and an outcome, authors and readers should be careful not to make causal inferences, unless the exposure may safely be assumed to be stable over time and not influenced by experiencing the outcome. In such cases, analyses are also subject to selection and information bias as well as confounding.

INTRODUCTION: The aim of the study was to assess the intra- and interobserver variability of two- and three-dimensional rectosigmoid nodule size measurements by transvaginal sonography in patients with rectosigmoid endometriosis.MATERIAL AND METHODS: Intra- and interobserver variability was assessed in 10 and 30 patients, respectively. Measurements in two dimensions were performed in real-time during the scan, and three-dimensional measurements of volume were done on a computer. Differences within and between observers were expressed in absolute units (mm) and percentage (%) of average nodule size. Coefficient of repeatability and Bland-Altman plots with limits of agreement were used to evaluate the intra- and interobserver variability.RESULTS: Intra- and interobserver variability in two-dimensional sonography ranged from 11 to 14 mm (46-51%) for length, 3 to 6 mm (32-57%) for depth and 5 to 9 mm (33-58%) for width of the nodule. Results of three-dimensional sonography, with assessment of nodule volume, showed intra- and interobserver variability 0.4 to 2.5 times the average nodule size.CONCLUSIONS: Measurements of rectosigmoid endometriosis nodule size with two- and three- dimensional transvaginal sonography were associated with large intra- and interobserver variability. These techniques should therefore be used with caution in clinical control and research of nodule growth.

Information bias occurs when any information used in a study is either measured or recorded inaccurately. This paper describes some of the most common types of information bias, using examples from obstetrics and gynecology, and describes how information bias may affect results of observational studies. Non-differential misclassification occurs when the degree of misclassification of exposure status among those with and those without the disease is the same; in cohort studies, this type of bias is most likely and will bias estimates toward no association when exposure is dichotomized. Non-differential underreporting of an exposure with more than two categories may mask a true threshold effect as a dose-response relation and, if a true threshold effect exists, the threshold will be set at too low a level, if the exposure is underreported. Differential misclassification may cause bias in either direction and is particularly likely, when exposure status is reported after the outcome occurred. Misclassification of confounders is an issue that needs special attention by researchers, as failure to measure accurately one or more (strong) confounders may seriously bias the observed results. Misclassification of disease status may also cause bias of estimates of association in either direction. Information bias is probably best prevented during planning of data collection, as there are few and insufficient methods available for correcting inaccurate information.

INTRODUCTION: We aimed to investigate the change in prevalence of overweight and obesity in pregnant Danish women from 2004 to 2012, and investigate whether increasing parity was associated with a change in body mass index (BMI) prevalence.MATERIAL AND METHODS: We obtained a population-based cohort from the Danish Medical Birth Registry consisting of all Danish women giving birth in 2004-2012 (n = 572 321). This registry contains information on 99.8% of all births in Denmark. We calculated the overall change in prepregnancy BMI status among pregnant women in Denmark, and a multiple linear regression model with adjustment for several potential confounders was used to examine the change in prepregnancy BMI with increasing parity.RESULTS: In 2004, the prevalence of prepregnancy overweight and obesity (BMI ≥ 25) and obesity alone (BMI ≥ 30) was 31.9 and 11%, respectively. In 2012, the prevalence had reached 34.2 and 12.8%. The mean BMI increased for every additional parity from 23.80 (95% CI 23.77-23.82) in parity group 1 to 26.70 (26.52-26.90) in parity group 5+. A multiple linear regression adjusted for potential confounders showed that women on average gained 0.62 (0.58-0.65) BMI units after every additional birth.CONCLUSIONS: This study showed a 7.2% increase in overweight and obesity (BMI ≥ 25) and a 16.4% increase in obesity alone (BMI ≥ 30) for pregnant women in Denmark from 2004 to 2012. In addition, an increase in interpregnancy BMI was seen at every additional delivery, suggesting that obesity is an increasing challenge in obstetrics.

INTRODUCTION: The aim of this study was to investigate whether consumption of coffee, tea and caffeine affects the risk of primary infertility in women.MATERIAL AND METHODS: We selected nulliparous Danish women aged 20-29 years from a prospective cohort and retrieved information on coffee and tea consumption from a questionnaire and an interview at enrollment. We assessed the women's fertility by linkage to the Danish Infertility Cohort and retrieved information on children and vital status from the Civil Registration System. All 7574 women included for analysis were followed for primary infertility from the date of enrollment (1991-1993) until 31 December 2010. Analyses were performed with Cox proportional hazard models.RESULTS: During follow up, primary infertility was diagnosed in 822 women. Compared with never consumers, the risk of primary infertility among women who drank coffee or tea was not affected. The risk of primary infertility was neither associated with an increasing number of daily servings of coffee (hazard ratio 1.00; 95% confidence interval (CI), 0.97-1.03) or tea (hazard ratio 1.01; 95% CI, 0.99-1.03) in consumers only. Concerning total caffeine consumption (from coffee and tea), the risk of infertility was similar among consumers compared with never consumers. Finally, none of the additional daily 100 mg of caffeine affected the risk among consumers only (hazard ratio 1.00; 95% CI 0.98-1.02).CONCLUSIONS: In this population-based cohort study, not restricted to women seeking pregnancy, we found no association between coffee, tea or total caffeine consumption and the risk of primary infertility in women.

Historically, pregnancy dating has been based on self-reported information on the first day of the last menstrual period. In the 1970s, ultrasound biometry was introduced as an alternative for pregnancy dating and is now the leading method in Nordic countries. The use of ultrasound led to a reduction of post-term births and fewer inductions, and is considered more precise than last menstrual period-based methods for pregnancy dating. Nevertheless, differences in early growth and specific situations, such as maternal obesity, can render its estimates less precise, leading to gestational age misclassification. Clinical implications of ultrasound dating include effect on timely induction in case of post-term pregnancies, treatment with corticosteroids in cases of anticipated preterm delivery and decision on viability in cases of extreme prematurity. Furthermore, gestational age misclassification may influence the numbers and the magnitude of some adverse perinatal outcomes, closely related to gestational age, which are recorded in the Nordic birth registers.