Births in freestanding midwifery-led units in Norway: What women view as important aspects of care

Objective: To describe what women view as important aspects of care when giving birth in freestanding midwifery-led units in Norway. Methods: Data from four open-ended questions in the Babies Born Better survey, Version 1, 2 and 3 was used. We performed inductive content analysis to explore and describe women's experiences with the care they received. Results: In all, 190 women who had given birth in midwifery-led units in Norway between 2010 and 2020 responded to the B3 survey. The final sample comprised 182 respondents. The analysis yielded three main categories: 1) The immediate birth surroundings, 2) Personal and safe support, and 3) Organisational conditions. Conclusion: This study adds valuable knowledge regarding what women describe as important aspects of care in free-standing midwifery-led units. Women experience maternity services in these units as peaceful, flexible and family-friendly. However, some women perceive the freestanding midwifery-led unit as a vulnerable service, mainly due to lack of midwives on call and uncertainty around temporary closure of the freestanding midwifery-led units. This finding points to the importance of staffing of birth facilities to ensure that all women giving birth have available midwifery care at all times, which is recommended in the National guidelines for care during labour and birth. Predictability around place of birth for the upcoming birth is crucial for every woman and her family. These goals might be achieved by a stable, continuous maternity service in all geographical areas of the country.publishedVersio

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Objective Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. Design Nationwide register-based study. Methods We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, identifying pregnant women using thyroid therapy from 2004 to 2018. Results A total of 855,067 pregnancies were included in the analyses. The proportion of women using thyroid hormone replacement therapy during pregnancy increased from 1.46% (n  = 800) in 2004 to 3.57% (n  = 1940) in 2018. The proportion of women using antithyroid medications also increased from 0.04% (n  = 20) in 2004 to 0.10% (n  = 56). During these 15 years, the mean maternal age increased by 0.9 years. When adjusting for age, the risk for being on thyroid hormone replacement therapy during pregnancy increased by an average of 5% per year (odds ratio: 1.05, 95% CI: 1.05–1.05). Conclusion During the recent 15 years, there has been a substantial increase in the use of thyroid hormone therapy in Norwegian pregnant women. We speculate that this could be due to an increased awareness in combination with overdiagnosis because of inappropriate diagnostic criteria. To truly understand the possible causes and consequences of this development, further research is warranted.publishedVersio

Adequate urinary iodine concentration among infants in the inland area of Norway

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Vitamin B12 status in infancy and the effect of a vitamin B12 injection in infants with subclinical vitamin B12 deficiency: study protocol for a register-based randomised controlled trial

Introduction: Vitamin B12 (cobalamin) is crucial for optimal child development and growth, yet deficiency is common worldwide. The aim of this study is twofold; (1) to describe vitamin B12 status and the status of other micronutrients in Norwegian infants, and (2) in a randomised controlled trial (RCT), investigate the effect of vitamin B12 supplementation on neurodevelopment in infants with subclinical vitamin B12 deficiency. Methods and analysis: Infant blood samples, collected at public healthcare clinics, are analysed for plasma cobalamin levels. Infants with plasma cobalamin 6.5 µmol/L, are given an intramuscular injection of hydroxocobalamin (400 µg). The primary outcomes are cognitive, language and motor development assessed using the Bayley Scales of Infant and Toddler Development at 12 months of age. Ethics and dissemination: The study has been approved by the Regional Committee for Medical and Health Research Ethics (ref: 186505). Investigators who meet the Vancouver requirements will be eligible for authorship and be responsible for dissemination of study findings. Results will extend current knowledge on consequences of subclinical vitamin B12 deficiency during infancy and may inform future infant feeding recommendations.publishedVersio

The Reliability of Iodine Concentration in Diaper-Retrieved Infant Urine Using Urine Collection Pads, and in Their Mothers’ Breastmilk

Mild to moderate iodine deficiency is common among women of childbearing age. Data on iodine status in infants are sparse, partly due to the challenges in collecting urine. Urinary iodine concentration (UIC) is considered a good marker for recent dietary iodine intake and status in populations. The aim of this study was to investigate the reliability of iodine concentration measured in two spot-samples from the same day of diaper-retrieved infant urine and in their mothers’ breastmilk. We collected urine and breastmilk from a sample of 27 infants and 25 mothers participating in a cross-sectional study at two public healthcare clinics in Norway. The reliability of iodine concentration was assessed by calculating the intraclass correlation coefficients (ICC) and the coefficient of variation (CV). The ICC for infants’ urine was 0.64 (95% confidence interval (CI) 0.36–0.82), while the ICC for breastmilk was 0.83 (95% CI 0.65–0.92) Similarly, the intraindividual CV for UIC was 0.25 and 0.14 for breastmilk iodine concentration (BIC). Compared to standard methods of collecting urine for measuring iodine concentration, the diaper-pad collection method does not substantially affect the reliability of the measurements

Obstetric outcomes of immigrants in a low-risk maternity ward in Norway

Background: A greater number of individuals are on the move today compared with any other time in human history. The health status of migrants and ethnic minority groups has often been demonstrated to be lower than the average population. Studies have also indicated that immigrants are at increased risks of adverse obstetric outcomes. At the lowrisk maternity ward in Baerum Hospital, Norway, 40% of women who give birth are immigrants, and 63% of this group originate from non-Western countries. Aim: The overall aim of this thesis was to examine the association between country of origin and adverse obstetric outcomes in women who give birth at the low-risk maternity ward in Baerum Hospital. We aimed to determine whether immigrant women had increased risk of adverse obstetric outcomes relative to Norwegians (papers I and III). We also aimed to establish whether originating from countries considered conflict-zones influenced obstetric outcomes (paper II). Finally, we aimed to determine whether there were differences in the obstetric outcomes between first- and second-generation immigrants (paper IV). Material and methods: The study comprised a population-based observational study with a prospective, cohort design. The study population included women who gave birth at Baerum Hospital in Norway between January 1, 2006 and December 31, 2010 (papers IIII) and January 1, 2006 and December 31, 2013 (paper IV). The maternity ward lacks a children’s section (i.e., it has no neonatal intensive care unit) and is referred to as a lowrisk maternity ward. The women who give birth in this ward comprise a particularly lowrisk group, which includes women at more than 35 weeks of gestation, who expect a healthy baby. Data were extracted from information recorded during pregnancy, birth and the early postpartum period and were provided by the Medical Birth Registry of Norway. In addition, Statistics Norway provided information regarding maternal and paternal country of birth, country of origin, immigrant category, and age at immigration, which were obtained from the Population Database, and data regarding maternal education from the National Education Database. The main exposure variables were country of origin/birth. In papers I and III, women were assigned to one of seven groups according to the country of origin: Norway; Eastern Europe; Latin America and the Caribbean; East, Southeast, and Central Asia; South and Western Asia; Africa; and Western Europe, North America, Australia, and New Zealand, which also included Nordic countries. In paper II, ethnic Norwegians and women from Somalia, Iraq, Afghanistan, and Kosovo, which are considered conflict-zones, were included. Paper IV included women of Pakistani origin, who were divided into first- and second-generation immigrants according to the country of birth. We examined differences in the proportions of participants with specific background characteristics and obstetric outcomes using bivariate analyses. Differences in the risk of adverse obstetric outcomes were estimated using multiple regression analysis. The association between country of origin/birth and risk of obstetric outcomes was assessed in reference to ethnic Norwegians, and the analyses controlled for several confounding variables. Results: Paper I: Relative to ethnic Norwegians, women from East, Southeast, and Central Asia were at increased risk of operative vaginal delivery, postpartum bleeding, and low Apgar scores. African women were at increased risk of postterm birth, meconium-stained liquor, episiotomy, operative vaginal delivery, emergency cesarean section, postpartum bleeding, low Apgar scores, and a low birth weight. Women from South and Western Asia were at increased risk of a low birth weight. Paper II: Women from Somalia exhibited the greatest risk of adverse obstetric outcomes and had increased odds ratios for emergency cesarean section, postterm birth, meconiumstained liquor, and a small for gestational age infant. They also had a reduced odds ratio for the use of epidural analgesia and a large for gestational age infant. Women from Iraq and Afghanistan differed in the median gestational age and mean birth weight and had an increased odds ratio for infants regarded as small for gestational age. Women from Kosovo did not differ from ethnic Norwegians in any obstetric outcomes assessed. Paper III: Seven hundred sixty-nine infants were treated for neonatal jaundice. Relative to infants born to ethnic Norwegians, infants born to mothers from East, Southeast, and Central Asia and African mothers were at an increased and decreased risk, respectively, of neonatal jaundice. A substantial number of jaundiced infants of African origin were transferred to neonatal intensive care units relative to jaundiced Norwegian infants. Paper IV: Relative to the first-generation Pakistani immigrants, the second-generation reported more health issues prior to pregnancy and an increased proportion experienced preterm birth (week 350 to 366) relative to Norwegians. An increased number of newborns of first-generation immigrants were transferred to neonatal intensive care units relative to Norwegian newborns. Conclusions and clinical implications: The results of this study suggest that even in a pregnant population that gives birth in a low-risk maternity ward, the obstetric outcomes of immigrants are significantly different from ethnic Norwegians. We introduced a theory that women of African origin, particularly from Somalia, are exposed to stressful pregnancies. The combined results of adverse obstetric outcomes give the impression of a fetus in distress with suboptimal conditions during pregnancy. To reduce stress and suboptimal conditions for these women, antenatal care must adapt to accommodate their needs. This adaption involves a substantial investment in the development of wellfunctioning interpreting services and strengthening midwifery services to facilitate a more individualized approach to high quality antenatal care

Emergency cesarean section among women in Robson groups one and three: A comparison study of immigrant and Norwegian women giving birth in a low-risk maternity hospital in Norway

Researchers have shown that some immigrant groups have an increased risk of emergency cesarean section. The authors' aim was to examine the differences in emergency cesarean section rates among immigrant women in Norway with low obstetric risks by using the Robson classification system. We performed secondary analysis on a Norwegian cohort study, where 10,125 women were classified in Robson groups one and three. Women from East, Southeast, and Central Asia, and from Africa had a higher risk of emergency cesarean section. The Robson classification system was a useful tool in comparing cesarean section rates between immigrant groups and host country populations.This work was supported by Vestre Viken Hospital Trusts research fund under Grant number 2303003, and Innlandet Hospital Trusts research fund under Grant number 150388.publishedVersio

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Objective Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. Design Nationwide register-based study. Methods We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, identifying pregnant women using thyroid therapy from 2004 to 2018. Results A total of 855,067 pregnancies were included in the analyses. The proportion of women using thyroid hormone replacement therapy during pregnancy increased from 1.46% (n  = 800) in 2004 to 3.57% (n  = 1940) in 2018. The proportion of women using antithyroid medications also increased from 0.04% (n  = 20) in 2004 to 0.10% (n  = 56). During these 15 years, the mean maternal age increased by 0.9 years. When adjusting for age, the risk for being on thyroid hormone replacement therapy during pregnancy increased by an average of 5% per year (odds ratio: 1.05, 95% CI: 1.05–1.05). Conclusion During the recent 15 years, there has been a substantial increase in the use of thyroid hormone therapy in Norwegian pregnant women. We speculate that this could be due to an increased awareness in combination with overdiagnosis because of inappropriate diagnostic criteria. To truly understand the possible causes and consequences of this development, further research is warranted

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Objective: Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. Design: Nationwide register-based study. Methods: We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, identifying pregnant women using thyroid therapy from 2004 to 2018. Results: A total of 855,067 pregnancies were included in the analyses. The proportion of women using thyroid hormone replacement therapy during pregnancy increased from 1.46% (n = 800) in 2004 to 3.57% (n = 1940) in 2018. The proportion of women using antithyroid medications also increased from 0.04% (n = 20) in 2004 to 0.10% (n = 56). During these 15 years, the mean maternal age increased by 0.9 years. When adjusting for age, the risk for being on thyroid hormone replacement therapy during pregnancy increased by an average of 5% per year (odds ratio: 1.05, 95% CI: 1.05-1.05). Conclusion: During the recent 15 years, there has been a substantial increase in the use of thyroid hormone therapy in Norwegian pregnant women. We speculate that this could be due to an increased awareness in combination with overdiagnosis because of inappropriate diagnostic criteria. To truly understand the possible causes and consequences of this development, further research is warranted

Inadequate Iodine Intake in Mothers of Young Children in Innlandet County, Norway

Background: Iodine has an essential role in child growth and brain development. Thus, sufficient iodine intake is particularly important in women of childbearing age and lactating women. Objectives: This cross-sectional study aimed to describe iodine intake in a large random sample of mothers of young children (aged ≤2 y) living in Innlandet County, Norway. Methods: From November 2020 to October 2021, 355 mother-child pairs were recruited from public health care centers. Dietary data were obtained using two 24-h dietary recalls (24-HRs) per woman and an electronic FFQ. The Multiple Source Method was used to estimate the usual iodine intake from the 24-HR assessment. Results: Based on the 24-HRs, the median (P25, P75) usual iodine intake from food was 117 μg/d (88, 153) in nonlactating women and 129 μg/d (95, 176) in lactating women. The median (P25, P75) total usual iodine intake (from food combined with supplements) was 141 μg/d (97, 185) in nonlactating women and 153 μg/d (107, 227) in lactating women. Based on the 24-HRs, 62% of the women had a total iodine intake below the recommendations (150 μg/d in nonlactating women and 200 μg/d in lactating women), and 23% of them had an iodine intake below the average requirement (100 μg/d). The reported use of iodine-containing supplements was 21.4% in nonlactating women and 28.9% in lactating women. In regular users of iodine-containing supplements (n = 63), supplements contributed to an average of 172 μg/d of iodine. Among regular iodine supplement users, 81% reached the recommendations compared with 26% of nonsupplement users (n = 237). The iodine intake estimated by FFQ was substantially higher than that estimated by 24-HRs. Conclusions: Maternal iodine intake in Innlandet County was inadequate. This study confirms the need for action to improve iodine intake in Norway, particularly among women of childbearing age. Keywords: 24-h dietary recall; Multiple Source Method; iodine intake; lactating women; women of childbearing age. © 2023 The Authors.publishedVersio