Perinatal risk factors for developmental coordination disorder in children born extremely preterm

Peer reviewe

Risk of Abdominal Surgery in Pregnancy Among Women Who Have Undergone Bariatric Surgery

OBJECTIVE:: To compare the rates of abdominal surgery during pregnancy among women with previous bariatric surgery (women in the case group) and women with first-trimester body mass index (BMI) greater than 35 and no previous bariatric surgery (women in the control group). METHODS:: We conducted a national cohort study, merging data from the Swedish Medical Birth Registry and the Swedish National Patient Registry, comparing women who had bariatric surgery from 1987 to 2011 with women in a control group with first-trimester BMI greater than 35 who had not had bariatric surgery. Primary outcome variables were diagnosis and surgical procedure codes grouped as five outcome categories: 1) intestinal obstruction, 2) gallbladder disease, 3) appendicitis, 4) hernia, and 5) diagnostic laparoscopy or laparotomy without the presence of a diagnosis or surgical code for outcomes in outcome categories 1–4. Odds ratios were computed using multivariate linear regression analysis for each separate pregnancy. For all pregnancies in a given woman, general estimating equations with robust variance estimation were used. Adjustment was made for smoking, year of delivery, maternal age, and previous abdominal surgery. RESULTS:: During the first pregnancy after bariatric surgery, the rate of surgery for intestinal obstruction was 1.5% (39/2,543; 95% confidence interval [CI] 1.1–2.0%) in women in the case group compared with 0.02% (4/21,909; 95% CI 0.0–0.04%) among women in the control group (adjusted odds ratio [OR] 34.3, 95% CI 11.9–98.7). Similarly, the rate of diagnostic laparoscopy or laparotomy was 1.5% (37/2,542; 95% CI 1.0–1.9%) among women in the case group compared with 0.1% (18/21,909; 95% CI 0.0–0.1%) among women in the control group (adjusted OR 11.3, 95% CI 6.9–18.5). CONCLUSION:: Bariatric surgery is associated with an increased risk of abdominal surgery during pregnancy

Neonatal delivery weight and risk of future maternal diabetes

Objective: To investigate associations between neonatal delivery weight and future risk of maternal type 1 or type 2 diabetes. Methods: Data included in the Swedish Medical Birth Registry and Swedish National Diabetes Registry were merged to include all women born during 1930–1989; patients with pre-existing diabetes or gestational diabetes were excluded. Cox regression analyses were performed to identify associations between the neonatal delivery weight from the most recent pregnancy and later occurrence of diabetes. Results: There were 1 873 440 patients included in the analyses. An increased risk of type 1 (hazard ratio 3.60, 95% confidence interval [CI] 3.23–4.01) or type 2 diabetes (hazard ratio 2.77, 95% CI 2.68–2.87) was observed among patients who had a large for gestational age neonate compared with patients who had neonates within one standard definition of the mean weight for gestational age; the odds of developing type 1 (odds ratio 10.27, 95% CI 7.37–14.31) or type 2 diabetes (odds ratio 8.50, 95% CI 6.01–12.02) within 1 year of delivery was also increased compared with patients who had a neonate within one standard deviation of the mean weight for gestational age. Conclusions: Delivering a large for gestational age neonate was a potent risk factor for the later development of maternal type 1 or type 2 diabetes

The number of oocytes retrieved during IVF : A balance between efficacy and safety

STUDY QUESTION: What is the relationship between the number of oocytes collected in fresh IVF treatments and the likelihood of cumulative delivery rate (fresh and frozen) per oocyte aspiration, severe ovarian hyperstimulation syndrome (OHSS) and thromboembolic events? SUMMARY ANSWER: Cumulative delivery rate per aspiration increases up to 20 oocytes retrieved and then evens out while the incidence of severe OHSS increases more rapidly from around 18 oocytes and thromboembolic events, although rare, occurs in particular if 15 or more oocytes are retrieved. WHAT IS KNOWN ALREADY?: Previous studies have shown that the number of oocytes retrieved for IVF is a positive predictor of live birth in fresh cycles. Few studies have investigated cumulative live birth rates and OHSS in relation to the number of aspirated oocytes. STUDY DESIGN, SIZE, DURATION: Retrospective population-based registry study including 39 387 women undergoing 77 956 fresh IVF cycles in the period 2007-2013 and 36 270 consecutive transfers of frozen/thawed embryos in the period 2007-2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data from The Swedish National Quality Registry of Assisted Reproduction (Q-IVF) including all IVF cycles with oocyte retrieval performed in public or private infertility clinics during the study period, was cross-linked to the National Patient Register regarding diagnostic codes (ICD 10) for severe (OHSS) and thromboembolic events. Oocyte donation cycles were excluded. MAIN RESULTS AND THE ROLE OF CHANCE: Live birth delivery rate in fresh cycles increased up to 11 oocytes retrieved and then evened out, where the live birth rate was 30.3% for a 34-year-old woman. The cumulative delivery rate per aspiration, including fresh transfer and all subsequent transfers of frozen-thawed embryos (FET cycles) per oocyte retrieval, increased up to approximately 20 oocytes where it reached 45.8%. The adjusted odds ratio (AOR) for live birth by the number of oocytes was 1.064 (95% CI: 1.061; 1.067). The incidence of severe OHSS increased significantly by the number of oocytes, particularly if more than 18 oocytes were retrieved. The AOR for OHSS by the number of oocytes was 1.122 (95% CI: 1.08; 1.137). Thromboembolic events were rare, a total of 16 events in 14 patients were observed, and occurred in particular if 15 or more oocytes were retrieved. LIMITATIONS, REASONS FOR CAUTION: All FET cycles might not be included. Some embryos cryopreserved between 2010 and 2013 might still result in additional births until 2018. Furthermore the gonadotrophin dose was not included in the Q-IVF Registry in the study period, thus adjustment for dose was not possible. WIDER IMPLICATIONS OF THE FINDINGS: The results suggest a shift at approximately 18-20 oocytes where the cumulative delivery rate per aspiration levels off and, at the same time, the incidence of severe OHSS increases more rapidly. Thromboembolic events, although rare, should also be taken into consideration at stimulation regimes for IVF. Evaluating data taking both efficacy and the most serious safety aspects into account, is a new approach and of crucial importance both for patients undergoing IVF and their physicians. STUDY FUNDING/COMPETING INTEREST: Financial support was received through an agreement relating to research and the education of doctors (ALFGBG-70 940) and grant from the Hjalmar Svensson Research Foundation. None of the authors declares any conflict of interest

Treatment for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden

AIMS: To study various aspects of treatment for retinopathy of prematurity (ROP) in a Swedish population of extremely preterm infants born before 27 weeks of gestation. METHODS: A national, prospective and population-based study was performed in Sweden from April 1, 2004 to March 31, 2007. The criteria for treatment of ROP accorded with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. RESULTS: Twenty percent of the infants (99/506) were treated for ROP. The likelihood of reaching treatment criteria nearly doubled for each week of reduction in gestational age (GA) at birth. The first treatment was performed at an earlier postmenstrual age in the most immature infants. One third of the infants had more than one session of laser treatment. CONCLUSIONS: A high percentage of these extremely preterm infants required treatment for ROP. The likelihood of reaching treatment criteria increased with a decline in GA at birth. Although only a few infants progressed to ROP Stages 4 and 5, our findings indicate a potential for improvement of the treatment routines, both regarding timing and number of laser spots at the first treatment

Cancer in children and young adults born after assisted reproductive technology:a Nordic cohort study from the Committee of Nordic ART and Safety (CoNARTaS)

Do children and young adults born after assisted reproductive technology (ART) have an increased risk of cancer

National Rates of Uterine Rupture are not Associated with Rates of Previous Caesarean Delivery: Results from the Nordic Obstetric Surveillance Study.

To access publisher's full text version of this article click on the hyperlink belowPrevious caesarean delivery and intended mode of delivery after caesarean are well-known individual risk factors for uterine rupture. We examined if different national rates of uterine rupture are associated with differences in national rates of previous caesarean delivery and intended mode of delivery after a previous caesarean delivery.This study is an ecological study based on data from a retrospective cohort in the Nordic countries. Data on uterine rupture were collected prospectively in each country as part of the Nordic obstetric surveillance study and included 91% of all Nordic deliveries. Information on the comparison population was retrieved from the national medical birth registers. Incidence rate ratios by previous caesarean delivery and intended mode of delivery after caesarean were modelled using Poisson regression.The incidence of uterine rupture was 7.8/10 000 in Finland and 4.6/10 000 in Denmark. Rates of caesarean (21.3%) and previous caesarean deliveries (11.5%) were highest in Denmark, while the rate of intended vaginal delivery after caesarean was highest in Finland (72%). National rates of uterine rupture were not associated with the population rates of previous caesarean but increased by 35% per 1% increase in the population rate of intended vaginal delivery and in the subpopulation of women with previous caesarean delivery by 4% per 1% increase in the rate of intended vaginal delivery.National rates of uterine rupture were not associated with national rates of previous caesarean, but increased with rates of intended vaginal delivery after caesarean.NFOG (Nordic Federation of Societies of Obstetrics and Gynaecology) foundation TRYG Fonden, Copenhagen, Denmar