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  • 1. Aasheim, V
    et al.
    Waldenström, U
    Hjelmstedt, A
    Rasmussen, S
    Pettersson, H
    Schytt, Erica
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr 9, s. 1108-16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Please cite this paper as: Aasheim V, Waldenström U, Hjelmstedt A, Rasmussen S, Pettersson H, Schytt E. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 2012;119:1108-1116. Objective  To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth. Design  National cohort study. Setting  Norway. Sample  A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units. Methods  Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as ≥32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to ≥40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress. Main outcome measures  Psychological distress measured by SCL-5. Results  Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months. Conclusion  Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years.

  • 2.
    Lindgren, Helena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Transfer in planned home births in Sweden – effects on the experience of birth: A nationwide population-based study2011Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 2, nr 3, s. 101-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective More than 10% of all planned home births in high-income countries are completed in the hospital. The aim of this study was to compare the birth experiences among women who planned to give birth at home and completed the birth at home and women who were transferred to hospital during or immediately after the birth. Methods All women in Sweden who had a planned home birth between 1998 and 2005 (n = 671) were invited to participate in the study. The women who agreed to participate received one questionnaire for each planned home birth. Mixed methods were used for the analysis. Results Women who had been transferred during or immediately after the planned home birth had a more negative birth experience in general. In comparison with women who completed the birth at home, the odds ratio for being less satisfied was 13.5, CI 8.1–22.3. Reasons for being dissatisfied related to organizational factors, the way the women were treated or personal ability. Conclusion Being transferred during a planned home birth negatively affects the birth experience. Treatments as well as organizational factors are considered to be obstacles for a positive birth experience when transfer is needed. Established links between the home birth setting and the hospital might enhance the opportunity for a positive birth experience irrespective of where the birth is completed.

  • 3.
    Schytt, Erica
    et al.
    Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lindmark, Gunilla
    Waldenström, Ulla
    Physical symptoms after childbirth: prevalence and associations with self-rated health2005Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 112, nr 2, s. 210-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aims of the present study were to describe the prevalence of a number of physical symptoms, as described by women themselves, two months and one year after childbirth in a national Swedish sample and to investigate the association between specific symptoms and women's self-rated health.

    DESIGN: Cohort study.

    SETTING: Swedish antenatal clinics.

    POPULATION: A total of 2413 women recruited from 593 antenatal clinics in Sweden during three one-week periods evenly spread over one year (1999-2000), representing 54% of women eligible for the study and 76% of those who consented to participate. The representativity of the sample was assessed by comparison with the total Swedish birth cohort of 1999.

    METHODS: Data were collected by means of questionnaires in early pregnancy, two months and one year after the birth and from the Swedish Medical Birth Register.

    MAIN OUTCOME MEASURES: Self-reported symptoms and self-rated health.

    RESULTS: Tiredness, headache, neck, shoulder and low back pain were common problems at two months as well as one year after childbirth. At two months, pain from caesarean section, dyspareunia and haemorrhoids were frequent problems, whereas stress incontinence was often reported at one year. Ninety-one percent of the women said self-rated health was 'very good' or 'good' at two months after birth, and 86% at one year. Low self-rated health was associated with symptoms that affected general physical functioning and wellbeing, such as tiredness, headache, musculoskeletal problems, mastitis, perineal pain, dysuria, stomachache and nausea. Complaints related to more specific situations, such as dyspareunia, constipation and stress incontinence were not associated with self-rated health.

    CONCLUSION: Despite the fact that physical symptoms were common two months and one year after the birth, the vast majority of women rated their health as 'very good' or 'good'.

  • 4.
    Schytt, Erica
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Lindmark, Gunilla
    Waldenström, Ulla
    Physical symptoms after childbirth: prevalence and associations with self-rated health2004Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Artikel i tidskrift (Refereegranskat)
  • 5.
    Schytt, Erica
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Waldenström, Ulla
    A longitudinal study of women's memory of labour pain-from 2 months to 5 years after the birth2009Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 116, nr 4, s. 577-583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate the memory of labour pain at 2 months, 1 year and 5 years after childbirth and its association with the use of epidural analgesia and overall evaluation of childbirth.

    DESIGN: Longitudinal observational.

    SETTING: All hospitals in Sweden.

    POPULATION: One thousand three hundred eighty-three women, who were recruited at their first antenatal visit and who provided complete data up to 5 years after the birth.

    METHODS: Postal questionnaires in the second trimester and 2 months, 1 year and 5 years after the birth. MAIN OUTCOME MEASURES: Memory of labour pain measured by a seven-point rating scale (1 = no pain at all, 7 = worst imaginable pain).

    RESULTS: Memory of labour pain declined during the observation period but not in women with a negative overall experience of childbirth. Women who had epidural analgesia reported higher pain scores at all time points, suggesting that these women remember 'peak pain'.

    CONCLUSIONS: There was significant individual variation in recollection of labour pain. In the small group of women who are dissatisfied with childbirth overall, memory of pain seems to play an important role many years after the event. These findings challenge the view that labour pain has little influence on subsequent satisfaction with childbirth. In-labour pain and long-term memory of pain are discussed as two separate outcomes involving different memory systems.

  • 6. Waldenström, U
    et al.
    Cnattingius, S
    Vixner, Linda
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Norman, M
    Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study2017Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, nr 8, s. 1235-1244Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate whether advanced maternal age is associated with preterm birth, irrespective of parity.

    DESIGN: Population-based registry study.

    SETTING: Swedish Medical Birth Register.

    POPULATION: First, second, and third live singleton births to women aged 20 years or older in Sweden, from 1990 to 2011 (n = 2 009 068).

    METHODS: Logistic regression analysis was used in each parity group to estimate risks of very and moderately preterm births to women at 20-24, 25-29, 30-34, 35-39, and 40 years or older, using 25-29 years as the reference group. Odds ratios (ORs) were adjusted for year of birth, education, country of birth, smoking, body mass index, and history of preterm birth. Age-related risks of spontaneous and medically indicated preterm births were also investigated.

    MAIN OUTCOME MEASURES: Very preterm (22-31 weeks of gestation) and moderately preterm (32-36 weeks) births.

    RESULTS: Risks of very preterm birth increased with maternal age, irrespective of parity: adjusted ORs in first, second, and third births ranged from 1.18 to 1.28 at 30-34 years, from 1.59 to 1.70 at 35-39 years, and from 1.97 to 2.40 at ≥40 years. In moderately preterm births, age-related associations were weaker, but were statistically significant from 35-39 years in all parity groups. Advanced maternal age increased the risks of both spontaneous and medically indicated preterm births.

    CONCLUSIONS: Advanced maternal age is associated with an increased risk of preterm birth, irrespective of parity, especially very preterm birth. Women aged 35 years and older, expecting their first, second, or third births, should be regarded as a risk group for very preterm birth.

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