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  • 1. Bergstrom, Cecilia
    et al.
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mogren, Ingrid
    Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy: pain status, self-rated health and family situation2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, 48Article in journal (Refereed)
    Abstract [en]

    Background: Pelvic girdle pain (PGP) in pregnancy is distinct from pregnancy-related low back pain (PLBP). However, women with combined PLBP and PGP report more serious consequences in terms of health and function. PGP has been estimated to affect about half of pregnant women, where 25% experience serious pain and 8% experience severe disability. To date there are relatively few studies regarding persistent PLBP/PGP postpartum of more than 3 months, thus the main objective was to identify the prevalence of persistent PLBP and PGP as well as the differences over time in regard to pain status, self-rated health (SRH) and family situation at 12 months postpartum. Methods: The study is a 12 month follow-up of a cohort of pregnant women developing PLBP and PGP during pregnancy, and who experienced persistent pain at 6 month follow-up after pregnancy. Women reporting PLBP/PGP (n = 639) during pregnancy were followed up with a second questionnaire at approximately six month after delivery. Women reporting recurrent or persistent LBP/PGP at the second questionnaire (n = 200) were sent a third questionnaire at 12 month postpartum. Results: A total of 176 women responded to the questionnaire. Thirty-four women (19.3%) reported remission of LBP/PGP, whereas 65.3% (n = 115) and 15.3% (n = 27), reported recurrent LBP/PGP or continuous LBP/PGP, respectively. The time between base line and the 12 months follow-up was in actuality 14 months. Women with previous LBP before pregnancy had an increased odds ratio (OR) of reporting 'recurrent pain' (OR = 2.47) or 'continuous pain' (OR = 3.35) postpartum compared to women who reported 'no pain' at the follow-up. Women with 'continuous pain' reported statistically significant higher level of pain at all measure points (0, 6 and 12 months postpartum). Non-responders were found to report a statistically significant less positive scoring regarding relationship satisfaction compared to responders. Conclusions: The results from this study demonstrate that persistent PLBP/PGP is a major individual and public health issue among women 14 months postpartum, negatively affecting their self-reported health. However, the perceived relationship satisfaction seems to be stable between the groups.

  • 2. Edvardsson, Kristina
    et al.
    Small, Rhonda
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lalos, Ann
    Mogren, Ingrid
    'Ultrasound is an invaluable third eye, but it can't see everything': a qualitative study with obstetricians in Australia2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, 363Article in journal (Refereed)
    Abstract [en]

    Background: Obstetric ultrasound has come to play a significant role in obstetrics since its introduction in clinical care. Today, most pregnant women in the developed world are exposed to obstetric ultrasound examinations, and there is no doubt that the advantages of obstetric ultrasound technique have led to improvements in pregnancy outcomes. However, at the same time, the increasing use has also raised many ethical challenges. This study aimed to explore obstetricians' experiences of the significance of obstetric ultrasound for clinical management of complicated pregnancy and their perceptions of expectant parents' experiences.

    Methods: A qualitative study was undertaken in November 2012 as part of the CROss-Country Ultrasound Study (CROCUS). Semi-structured individual interviews were held with 14 obstetricians working at two large hospitals in Victoria, Australia. Transcribed data underwent qualitative content analysis.

    Results: An overall theme emerged during the analyses, 'Obstetric ultrasound - a third eye', reflecting the significance and meaning of ultrasound in pregnancy, and the importance of the additional information that ultrasound offers clinicians managing the surveillance of a pregnant woman and her fetus. This theme was built on four categories: I:'Everyday-tool' for pregnancy surveillance, II: Significance for managing complicated pregnancy, III: Differing perspectives on obstetric ultrasound, and IV: Counselling as a balancing act. In summary, the obstetricians viewed obstetric ultrasound as an invaluable tool in their everyday practice. More importantly however, the findings emphasise some of the clinical dilemmas that occur due to its use: the obstetricians' and expectant parents' differing perspectives and expectations of obstetric ultrasound examinations, the challenges of uncertain ultrasound findings, and how this information was conveyed and balanced by obstetricians in counselling expectant parents.

    Conclusions: This study highlights a range of previously rarely acknowledged clinical dilemmas that obstetricians face in relation to the use of obstetric ultrasound. Despite being a tool of considerable significance in the surveillance of pregnancy, there are limitations and uncertainties that arise with its use that make counselling expectant parents challenging. Research is needed which further investigates the effects and experiences of the continuing worldwide rapid technical advances in surveillance of pregnancies.

  • 3. Ellberg, L
    et al.
    Lundman, B
    Persson, Margareta
    Umeå universitet.
    Hogberg, U
    Comparison of health care utilization of postnatal programs in Sweden2005In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 34, no 1, 55-62 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the utilization of health care services, based on number of outpatient visits and readmissions, by mothers and newborns following discharge postnatally after having received various types of maternity care.

    DESIGN: The design was a cohort of Swedish women giving birth at full term. All together, 773 women and 782 newborns were followed using questionnaires, registry data, and medical chart notes. The information served as a basis for analyzing utilization of health care services during the first 28 days post-delivery.

    RESULTS: Of the women, 15% sought medical care and 1.7% were readmitted, whereas 17% of the newborns received medical care and 2.9% were readmitted. At 6 months, about half were exclusively being breastfed. There was no difference in need to seek health care or breastfeeding outcome owing to type of maternity care.

    CONCLUSION: Mothers with newborns sought care relatively frequently but rarely needed to be readmitted after discharge from the maternity care. The risk of readmission during the first month after childbirth was not greater for mothers and children who received care through the family suite or early discharge programs.

  • 4. Estampador, Angela C.
    et al.
    Pomeroy, Jeremy
    Renstrom, Frida
    Nelson, Scott M.
    Mogren, Ingrid
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sattar, Naveed
    Domellof, Magnus
    Franks, Paul W.
    Infant body composition and adipokine concentrations in relation to maternal gestational weight gain2014In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 37, no 5, 1432-1438 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE. To investigate associations of maternal gestational weight gain and body composition and their impact on offspring body composition and adipocytokine, glucose, and insulin concentrations at age 4 months.

    RESEARCH DESIGN AND METHODS. This was a prospective study including 31 mother-infant pairs (N = 62). Maternal body composition was assessed using doubly labeled water. Infant body composition was assessed at 4 months using air displacement plethysmography, and venous blood was assayed for glucose, insulin, adiponectin, interleukin-6 (IL-6), and leptin concentrations.

    RESULTS. Rate of gestational weight gain in midpregnancy was significantly associated with infant fat mass (r = 0.41, P = 0.03); rate of gestational weight in late pregnancy was significantly associated with infant fat-free mass (r = 0.37, P = 0.04). Infant birth weight was also strongly correlated with infant fat-free mass at 4 months (r = 0.63, P = 0.0002). Maternal BMI and maternal fat mass were strongly inversely associated with infant IL-6 concentrations (r = -0.60, P = 0.002 and r = -0.52, P = 0.01, respectively). Infant fat-free mass was inversely related to infant adiponectin concentrations (r = -0.48, P = 0.008) and positively correlated with infant blood glucose adjusted for insulin concentrations (r = 0.42, P = 0.04). No significant associations for leptin were observed.

    CONCLUSIONS. Timing of maternal weight gain differentially impacts body composition of the 4-month-old infant, which in turn appears to affect the infant's glucose and adipokine concentrations.

  • 5. Gradmark, Anna
    et al.
    Pomeroy, Jeremy
    Renström, Frida
    Steiginga, Susanne
    Persson, Margareta
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Wright, Antony
    Bluck, Les
    Domellöf, Magnus
    Kahn, Steven E.
    Mogren, Ingrid
    Franks, Paul W.
    Physical activity, sedentary behaviors, and estimated insulin sensitivity and secretion in pregnant and non-pregnant women2011In: BMC Pregnancy Childbirth, Vol. 44, no 11Article in journal (Refereed)
    Abstract [en]

    Background Overweight and obesity during pregnancy raise the risk of gestational diabetes and birth complications. Lifestyle factors like physical activity may decrease these risks through beneficial effects on glucose homeostasis. Here we examined physical activity patterns and their relationships with measures of glucose homeostasis in late pregnancy compared to non-pregnant women. Methods Normal weight and overweight women without diabetes (N = 108; aged 25-35 years) were studied; 35 were pregnant (in gestational weeks 28-32) and 73 were non-pregnant. Insulin sensitivity and ß-cell response were estimated from an oral glucose tolerance test. Physical activity was measured during 10-days of free-living using a combined heart rate sensor and accelerometer. Total (TEE), resting (REE), and physical activity (PAEE) energy expenditure were measured using doubly-labeled water and expired gas indirect calorimetry. Results Total activity was associated with reduced first-phase insulin response in both pregnant (Regression r2 = 0.11; Spearman r = -0.47; p = 0.007) and non-pregnant women (Regression r2 = 0.11 Spearman; r = -0.36; p = 0.002). Relative to non-pregnant women, pregnant women were estimated to have secreted 67% more insulin and had 10% lower fasting glucose than non-pregnant women. Pregnant women spent 13% more time sedentary, 71% less time in moderate-to-vigorous intensity activity, had 44% lower objectively measured total activity, and 12% lower PAEE than non-pregnant women. Correlations did not differ significantly for any comparison between physical activity subcomponents and measures of insulin sensitivity or secretion. Conclusions Our findings suggest that physical activity conveys similar benefits on glucose homeostasis in pregnant and non-pregnant women, despite differences in subcomponents of physical activity.

  • 6. Lindqvist, Maria
    et al.
    Mogren, Ingrid
    Eurenius, Eva
    Edvardsson, Kristina
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    "An on-going individual adjustment": a qualitative study of midwives' experiences counselling pregnant women on physical activity in Sweden2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, 343Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide.

    Methods: Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis.

    Results: The main theme- "An on-going individual adjustment" was built on three categories: "Counselling as a challenge"; "Counselling as walking the thin ice" and "Counselling as an opportunity" reflecting the midwives on-going need to adjust their counselling depending on each woman's specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective.

    Conclusions: Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman's individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women's motivation for performance of physical activity.

  • 7. Lindqvist, Maria
    et al.
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindkvist, Marie
    Mogren, Ingrid
    No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, 185Article in journal (Refereed)
    Abstract [en]

    Background: Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values.

    Methods: This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011-2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184, 183 women: 88, 140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed.

    Results: Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m(2). Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes.

    Conclusions: There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.

  • 8. Pakbaz, Mojgan
    et al.
    Persson, Margareta
    Umeå universitet.
    Löfgren, Mats
    Mogren, Ingrid
    'A hidden disorder until the pieces fall into place': a qualitative study of vaginal prolapse2010In: BMC women's health, ISSN 1472-6874, Vol. 10, 18- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Vaginal prolapse affects quality of life negatively and is associated with urinary, bowel, and sexual symptoms. Few qualitative studies have explored women's experiences of vaginal prolapse. The objective of the study was to elucidate the experiences of living with prolapse and its impact on daily life, prior to surgical intervention.

    METHODS: In-depth interviews were conducted with 14 women with vaginal prolapse, prior to surgical treatment. Recruitment of the informants was according to 'purposive sampling'. An interview guide was developed, including open-ended questions addressing different themes, which was processed and revised during the data collection and constituted part of a study-emergent design. Data were collected until 'saturation' was achieved, that is, when no significant new information was obtained by conducting further interviews. Interviews were audiotaped, transcribed verbatim, and analyzed according to manifest and latent content analysis.

    RESULTS: The theme defining the process of living with prolapse and women's experiences was labelled 'process of comprehension and action'. The findings constitute two categories: obstacles and facilitators to seeking health care. The category obstacles comprises six subcategories that define the factors restraining women from seeking health care: absence of information, blaming oneself, feeling ignored by the doctor, having a covert condition, adapting to successive impairment, and trivializing the symptoms and de-prioritizing own health. The category facilitators include five subcategories that define the factors promoting the seeking of health care: confirmation and support by others, difficulty in accepting an ageing body, feeling sexually unattractive, having an unnatural body, and reaching the point of action.

    CONCLUSION: The main theme identified was the 'process of comprehension and action'. This process consisted of factors functioning as either obstacles or facilitators to seeking health care. The main obstacles described by the participants were lack of information and confirmation. The main facilitators constituted feeling sexually unattractive and impaired physical ability due to prolapse. Information on prolapse should be easily accessible, to improve the possibility for women to gain knowledge about the condition and overcome obstacles to seeking health care. Health care professionals have a significant role in facilitating the process by confirming and informing women about available treatment.

  • 9.
    Persson, Margareta
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Hälsa och välbefinnande efter graviditet jämförelse av kvinnor med graviditetsdiabetes och med normal graviditet2011In: Svenska Barnmorskeförbundets Jubileumskongress Reproduktiv och perinatal hälsa, Stockholm, 2011Conference paper (Refereed)
    Abstract [sv]

    Background: The risk of developing diabetes mellitus after pregnancy complicated with gestational diabetes mellitus (GDM) is considerable. Furthermore, women with previous GDM report increased prevalence of sick leave and hesitation towards additional pregnancies than women with normal pregnancies. Health and wellbeing after GDM has not previously been studied within a Swedish context. Aim: To compare health and wellbeing in women with GDM and women with normal pregnancy and the prevalence of diabetes mellitus three to four years after pregnancy. Method: The design is a retrospective case-control study. Data consists of register and questionnaire data. Medical outcomes of pregnancy and birth for 890 women who gave birth in 2005 have been obtained from the Medical Birth Register (650 women with normal pregnancies and 240 women with GDM diagnosis). The groups were matched for age and parity. The women were invited to a follow-up study addressing health and wellbeing three to four years after childbirth. Half of the women in the case and control group respectively accepted the invitation and completed a questionnaire consisting of questions regarding health, wellbeing and lifestyle including for example SF-36 form. Data is analyzed using a selection of statistical methods for comparisons of groups. Findings: Preliminary analysis show that significantly more women in the GDM group were born abroad and 17% of women with previous GDM had developed diabetes mellitus compared to none of the women in the control group. Women in the GDM group reported significantly more periods of sick leave exceeding one week, poorer self-rated health and significantly more women do not want additional pregnancies due to the negative effect on their health. The control group reported significantly more use of medication for asthma and allergy as well as anti-depressants. Women in the GDM group showed significantly more use of thyroidal medication and analgesia. The analysis is in progress and further results will be presented at the congress. Conclusion: The analysis of data is in progress; however the preliminary results indicate that women with previous GDM report poorer health and wellbeing compared to women with normal pregnancies. Furthermore, approximately 1 in 6 women with previous GDM have developed diabetes mellitus within three to four years postpartum.

  • 10.
    Persson, Margareta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hornsten, Asa
    Winkvist, Anna
    Mogren, Ingrid
    'Dealing with ambiguity': the role of obstetricians in gestational diabetes mellitus2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 4, 439-446 p.Article in journal (Refereed)
    Abstract [en]

    Objective. Gestational diabetes mellitus is a pregnancy-related complication and therefore obstetricians counsel and manage the maternal health care for these women. This study describes obstetricians experiences of management of pregnant women with gestational diabetes mellitus.

    Design. Interview study. Setting. Hospital-based specialist maternal health care clinics in Sweden. Population. A consecutive purposive national sample of 17 obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus.

    Methods. Interviews were recorded and transcribed. The data were analyzed using qualitative content analysis.

    Result. The overall theme describing the experiences of the obstetricians was labeled Dealing with ambiguity. This ambiguity permeated all aspects of working as an obstetrician within the maternal health care; the role of the obstetrician, the context of organization, the multifaceted maternal and fetal interests to balance, and lack of consensus, recommendations and evidence-based knowledge.

    Conclusions. The study revealed the ambiguous situation experienced and managed by obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus. This indicates a need for national guidelines and standardized maternal health care services regarding gestational diabetes mellitus to fulfill the intentions of the health care system. Such recommendations may be beneficial and supportive for the health care professionals as well as for the mother-to-be and her fetus.

  • 11.
    Persson, Margareta
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Hörnsten, Åsa
    Winkvist, Anna
    Mogren, Ingrid
    “Mission Impossible”? Midwives’ experiences counseling pregnant women with gestational diabetes mellitus2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, 78-83 p.Article in journal (Refereed)
    Abstract [en]

    Objective Since not all pregnancy-related complications require hospitalization midwives often provide these women with antenatal care and counseling. This study explored the experiences of midwives providing antenatal care and counseling to pregnant women with gestational diabetes mellitus (GDM). Methods Twelve midwives participated in the interview study performed in the three northernmost counties in Sweden. Grounded theory was used for analysis. Results The emerging core category was ‘Balancing fear of failure’. The unexpected disease increased the demands and the pressure. Three major conflicting situations were revealed. The midwives believed they were obligated to monitor and control the pregnancy, to initiate and motivate the necessary changes in lifestyle and provide empowering relationships with their patients. The fear of failure with these assignments made the midwives chose different strategies to manage the conflicting situations. Conclusions and practice implications The midwives described conflicting encounters providing antenatal care to pregnant women with GDM. The fear of failing to fulfill the assignments caused by the GDM made the midwives chose strategies to handle the conflicting encounters. Similar conflicting situations might be present for other health care professionals promoting lifestyle changes. The challenges might be addressed with an organization focusing on support and coaching sessions.

  • 12.
    Persson, Margareta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Winkvist, A
    Dahlgren, L
    Mogren, I
    Struggling with daily life and enduring pain: a qualitative study of women's experiences with pelvic girdle pain during pregnancy2013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, 111Article in journal (Refereed)
    Abstract [en]

    Background. Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women’s lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy.

    Methods. A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach.

    Results. The core category that evolved from the analysis of experiences of living with PGP in pregnancy was “struggling with daily life and enduring pain”. Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants’ experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented.

    Conclusions. PGP during pregnancy greatly affects the informant’s experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

  • 13.
    Persson, Margareta
    et al.
    Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    'From stun to gradual balance' - women's experiences of living with gestational diabetes mellitus2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, 454-62 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: In most parts of the western world, screening routines for gestational diabetes mellitus (GDM) are implemented, however, knowledge of the impact GDM has on the experience of pregnancy and life situation is sparse. The aim of this study was to describe pregnant women's experiences of acquiring and living with GDM during pregnancy.

    METHOD: A Grounded Theory approach was used. Ten pregnant women diagnosed with GDM in current pregnancy were interviewed. Data collection was performed in the north of Sweden over two periods; a first set of interviews in 1998-2000 and additional interviews in 2006 to further explore the experience and reach saturation.

    FINDINGS: 'From stun to gradual balance' emerged as the core category, encompassing of the categories 'Struck by lightning', 'Having a personal responsibility', 'Being under surveillance', 'Struggling for protection', 'Feeling socially apart', 'Being sufficiently supported', 'Changing the self-image', 'Adapting to a new situation' and 'Waiting for the 'Moment of truth''. Our findings indicated that the diagnosis of GDM initiated a number of challenges and demands for the pregnant women. Further, being diagnosed with GDM was not only perceived as a medical complication threatening the pregnancy, moreover as an indicator of a future diabetes mellitus.

    CONCLUSION: The experience of being diagnosed with and living with GDM during pregnancy may be understood as a process 'from stun to gradual balance'. The experience comprises positive and negative dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to a lifestyle and balancing the every day life is the prize most of these women are willing to pay in order to secure optimal maternal and foetal health. Knowledge of the experiences of women diagnosed with GDM may enable midwives to provide increased support as well as provide information and preventive measures in order to delay future diabetes mellitus.

  • 14.
    Persson, Margareta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    Lifestyle and health status in a sample of Swedish women four years after pregnancy: a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, Vol. 15, 57Article in journal (Refereed)
    Abstract [en]

    Background: Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. Methods: The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/ delivery. Results: Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Conclusions: Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.

  • 15.
    Persson, Margareta
    et al.
    Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    [No unified guidelines concerning gestational diabetes in Sweden. Noticeable differences between screening, diagnostics and management in maternal health services].2007In: Läkartidningen, ISSN 0023-7205, Vol. 104, no 45, 3365-9 p.Article in journal (Refereed)
    Abstract [en]

    In Sweden, there are noticeable differences between the antenatal health care settings concerning the prevalence of oral glucose tolerance tests (OGTT) to detect gestational diabetes mellitus (GDM). Clinical guidelines for screening, diagnostics and treatment of GDM 2004 were collected from all antenatal health care areas (n=50, 100% of eligible areas) in Sweden. The guidelines were analysed in relation to the available national statistics. The most prominent finding was that there was no consensus on screening, diagnosis and treatment of GDM. In most areas, the well-known risk factors for GDM were used as the criteria for offering OGTT to pregnant women. However, some areas offered OGTT to all pregnant women, resulting in a significantly greater detection of GDM. Hence, it is likely that the reported prevalence of GDM in Sweden is an underestimate. We suggest that national guidelines for screening, diagnosis and treatment of GDM should be developed in order to better fulfil the intentions of the Swedish National Board of Health and Welfare.

  • 16.
    Persson, Margareta
    et al.
    Department of clinical science, Obstetrics and gynecology, Umeå University, Umeå, Sweden.
    Winkvist, Anna
    Mogren, Ingrid
    Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus: A population-based study2009In: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 9, 53- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Screening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT).

    METHODS: This study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed.

    RESULTS: Of the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia.

    CONCLUSION: Surprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.

  • 17. Peterson, Kerstin
    et al.
    Persson, Margareta
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Nilses, Carin
    Haglund, Ingrid
    Skoglund, Yvonne
    Lindkvist, Marie
    Mogren, Ingrid
    Mödrahälsovårdsregistret: studier av intern validitet och registeranvändarnas erfarenheter, uppfattningar samt nyttjande av registret2012Report (Other academic)
  • 18. Petersson, Kerstin
    et al.
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindkvist, Marie
    Hammarstrm, Margareta
    Haglund, Ingrid
    Nilses, Carin
    Skogsdal, Yvonne
    Mogren, Ingrid
    User perspectives on the Swedish Maternal Health Care Register2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, 613Article in journal (Refereed)
    Abstract [en]

    Background: Established in 1999, the Swedish Maternal Health Care Register (MHCR) collects data on pregnancy, birth, and the postpartum period for most pregnant women in Sweden. Antenatal care (ANC) midwives manually enter data into the Web-application that is designed for MHCR. The aim of this study was to investigate midwives? experiences, opinions and use of the MHCR.

    Method: A national, cross-sectional, questionnaire survey, addressing all Swedish midwives working in ANC, was conducted January to March 2012. The questionnaire included demographic data, preformed statements with six response options ranging from zero to five (0 = totally disagree and 5 = totally agree), and opportunities to add information or further clarification in the form of free text comments. Parametric and non-parametric methods and logistic regression analyses were applied, and content analysis was used for free text comments.

    Results: The estimated response rate was 53.1%. Most participants were positive towards the Web-application and the included variables in the MHCR. Midwives exclusively engaged in patient-related work tasks perceived the register as burdensome (70.3%) and 44.2% questioned the benefit of the register. The corresponding figures for midwives also engaged in administrative supervision were 37.8% and 18.5%, respectively. Direct electronic transfer of data from the medical records to the MHCR was emphasised as significant future improvement. In addition, the midwives suggested that new variables of interest should be included in the MHCR ? e.g., infertility, outcomes of previous pregnancy and birth, and complications of the index pregnancy.

    Conclusions: In general, the MHCR was valued positively, although perceived as burdensome. Direct electronic transfer of data from the medical records to the MHCR is a prioritized issue to facilitate the working situation for midwives. Finally, the data suggest that the MHCR is an underused source for operational planning and quality assessment in local ANC centres.

  • 19. Petersson, Kerstin
    et al.
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindkvist, Marie
    Hammarstrom, Margareta
    Nilses, Carin
    Haglund, Ingrid
    Skogsdal, Yvonne
    Mogren, Ingrid
    Internal validity of the Swedish Maternal Health Care Register2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, 364Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish Maternal Health Care Register (MHCR) is a national quality register that has been collecting pregnancy, delivery, and postpartum data since 1999. A substantial revision of the MHCR resulted in a Web-based version of the register in 2010. Although MHCR provides data for health care services and research, the validity of the MHCR data has not been evaluated. This study investigated degree of coverage and internal validity of specific variables in the MHCR and identified possible systematic errors.

    Methods: This cross-sectional observational study compared pregnancy and delivery data in medical records with corresponding data in the MHCR. The medical record was considered the gold standard. The medical records from nine Swedish hospitals were selected for data extraction. This study compared data from 878 women registered in both medical records and in the MHCR. To evaluate the quality of the initial data extraction, a second data extraction of 150 medical records was performed. Statistical analyses were performed for degree of coverage, agreement and correlation of data, and sensitivity and specificity.

    Results: Degree of coverage of specified variables in the MHCR varied from 90.0% to 100%. Identical information in both medical records and the MHCR ranged from 71.4% to 99.7%. For more than half of the investigated variables, 95% or more of the information was identical. Sensitivity and specificity were analysed for binary variables. Probable systematic errors were identified for two variables.

    Conclusions: When comparing data from medical records and data registered in the MHCR, most variables in the MHCR demonstrated good to very good degree of coverage, agreement, and internal validity. Hence, data from the MHCR may be regarded as reliable for research as well as for evaluating, planning, and decision-making with respect to Swedish maternal health care services.

  • 20. Pomeroy, Jeremy
    et al.
    Renström, Frida
    Gradmark, Anna M
    Mogren, Ingrid
    Persson, Margareta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bluck, Les
    Wright, Antony
    Kahn, Steven E
    Domellöf, Magnus
    Franks, Paul W
    Maternal physical activity and insulin action in pregnancy and their relationships with infant body composition2013In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 36, no 2, 267-269 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE We sought to assess the association between maternal gestational physical activity and insulin action and body composition in early infancy.

    RESEARCH DESIGN AND METHODS At 28-32 weeks, gestation, pregnant women participating in an observational study in Sweden underwent assessments of height, weight, and body composition, an oral glucose tolerance test, and 10 days of objective physical activity assessment. Thirty mothers and infants returned at 11-19 weeks, postpartum. Infants underwent assessments of weight, length, and body composition.

    RESULTS Early insulin response was correlated with total physical activity (r = -0.47; P = 0.007). Early insulin response (r = -0.36; P = 0.045) and total physical activity (r = 0.52; P = 0.037) were also correlated with infant fat-free mass. No maternal variable was significantly correlated with infant adiposity.

    CONCLUSIONS The relationships between maternal physical activity, insulin response, and infant fat-free mass suggest that physical activity during pregnancy may affect metabolic outcomes in the mother and her offspring.

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