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ABSTRACT: We studied a possible association between pregnancy complications and blood/serum levels of haemoglobin, C-reactive protein, sex hormones and lipids in women with polycystic ovary syndrome.
Twenty-one women with polycystic ovary syndrome were followed prospectively from the first trimester to delivery. Women with pregnancy complications (n=10) were compared to women without complications (n=11). Outcome measures were blood/serum levels of haemoglobin, C-reactive protein, dehydroepiandrosterone sulphate, androstenedione, testosterone, sex hormone binding globulin, free testosterone index, oestrogens and lipids.
Haemoglobin levels were higher in complicated pregnancies compared to uncomplicated pregnancies throughout the complete pregnancy, while C-reactive protein levels were higher for complicated pregnancies at gestational weeks 19 and 32. Serum levels of lipids, androgens and oestrogens did not differ throughout pregnancy.
In women suffering from polycystic ovary syndrome, pregnancy complications were associated with elevated blood/serum levels of haemoglobin and C-reactive protein. Androgen, oestrogen and lipid levels did not differ between groups.
Scandinavian Journal of Clinical and Laboratory Investigation 02/2008; 68(5):421-6. · 1.38 Impact Factor
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ABSTRACT: Beyond term there is increased risk of intrauterine fetal death (IUFD) and perinatal death, and we aimed to assess this risk beyond 41 weeks and estimate numbers needed to treat to avoid 1 fetal or neonatal death.
All singletons births beyond 41 weeks from 1999-2005 registered in the Norwegian Medical Birth Registry were assessed concerning IUFD and perinatal death day by day, and numbers needed to induce to avoid 1 death was estimated.
The perinatal death rate increased with increasing gestational age. NNT for perinatal death was 527 at day 287, and 195 at day 302 + (p-value=0.02). Routine induction of labour at 41 weeks implicates >14,000 inductions per year.
NNT to avoid 1 fetal or neonatal death is high (671-195), but decreases constantly with gestational age beyond 41 weeks.
Acta Obstetricia Et Gynecologica Scandinavica 02/2008; 87(2):247-9. · 1.77 Impact Factor
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ABSTRACT: Pre-eclampsia (PE) is associated with increased oxidative stress and excessive maternal inflammatory response. Heme oxygenase 1 (HMOX1) is an important stress response enzyme and a mediator of cytoprotection against a wide variety of tissue injuries.
In the present study, microarray technology was used to compare the expression of HMOX1 and other genes involved in stress and inflammatory responses in decidua basalis from 16 pregnancies complicated by PE and 17 healthy controls. In addition, the presence of HMOX1 protein in decidua basalis was examined by means of immunohistochemistry, and ELISA was used to measure the maternal serum concentration of HMOX1.
Fifteen transcripts involved in stress response including HMOX1 were up-regulated in cases, using a cut-off value at p=0.01. HMOX1 protein expression in decidua basalis was significantly increased in cases compared to controls reflected by more pronounced intensity of HMOX1 positive decidual cells (1.8+/-0.3 versus 1.5+/-0.4, p=0.02) and an increased proportion of HMOX1 positive decidual leukocytes (31+/-29 versus 9+/-6%, p=0.001). Finally, serum HMOX1 levels were significantly higher among cases compared to controls (3.1+/-1.3 versus 1.9+/-0.5 ng/ml, p=0.008).
Increased decidual and serum HMOX1 levels, together with altered decidual expression of some stress-related genes in cases, support the role of oxidative stress and excessive maternal inflammatory response in the pathogenesis of PE.
Acta Obstetricia Et Gynecologica Scandinavica 02/2008; 87(3):272-9. · 1.77 Impact Factor
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ABSTRACT: The Fas-Fas ligand (FasL) system contributes to immune tolerance at the feto-maternal site and has been ascribed a role in implantation and placental development by regulating trophoblast invasion and spiral artery remodelling. In the present study, we have examined FasL expression in decidual tissue from pregnancies with impaired placental development. Women with pre-eclampsia (PE) and/or fetal growth restriction (FGR) were enrolled as cases (n=33), and women with normal pregnancies were used as controls (n=27). Decidua basalis tissue was obtained by vacuum suction of the placental bed after delivery. FasL expression by extravillous trophoblasts (EVTs) and decidual cells (DeCs), together with EVT apoptosis, were assessed by immunohistochemistry. Levels of soluble FasL in maternal serum and apoptosis-related gene expression in decidual tissue were determined. The proportion of FasL-expressing DeCs was high in controls (72.0+/-10.2%), with a significant reduction among cases (58.1+/-19.7%; p=0.002), especially in those with FGR (54.3+/-19.9%; p<0.001). EVTs had a lower proportion of FasL expression than DeCs, with a less pronounced reduction in cases compared to controls (10.9+/-3.9 and 8.3+/-4.0%, respectively; p=0.02). Decidual FasL expression correlated with placental growth. The EVT apoptosis rate did not differ between cases and controls (1.1+/-1.9 and 1.1+/-1.3%, respectively). These findings indicate a reduction of immune privilege in decidua of PE/FGR pregnancies by reduced FasL expression and that DeCs may have a central role in the Fas-FasL-based feto-maternal immune balance.
Journal of Reproductive Immunology 07/2007; 74(1-2):7-14. · 2.97 Impact Factor
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ABSTRACT: Systemic lupus erythematosus (SLE) often starts in women of fertile age. Due to the unpredictable nature of the disease and the increased risk of the disease flaring up during pregnancy, women with SLE have previously often been advised to avoid pregnancy. This summary reviews current insights in pregnancy management of women with SLE.
Search in the Medline database (period 1980-2005) using keywords: SLE, lupus nephritis, antiphospholipid antibody, neonatal lupus and pregnancy.
Previous studies of pregnant women with SLE have had different designs, sample sizes, selections of patients, definitions and measures of outcome. Women with previous pregnancy losses, an ongoing active disease with nephritis or hypertension and positive antiphospholipid antibodies, have an increased risk of pregnancy loss. The most favourable pregnancy outcomes are achieved when conception takes place during a remission of the disease.
There are few absolute contraindications for pregnancies in women with SLE. Women with SLE may experience uncomplicated pregnancies, but they need to plan their pregnancies as the risk for complications is increased. Best results are achieved through the cooperation of rheumatologists, gynaecologists and nephrologists. Glucocorticosteroids, hydroxychlorocine, azathioprine and anticoagulation may be used during pregnancy.
Tidsskrift for den Norske laegeforening 04/2007; 127(6):725-9.
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ABSTRACT: Tumor necrosis factor (TNF) antagonists are widely used to reduce disease activity and joint damage, and to improve health-related quality of life in patients suffering from rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. To date, no increased risk of embryotoxicity or teratogenicity, or adverse pregnancy outcome (such as birth defects, premature birth, and low birth weight) has been reported in patients with inflammatory arthropathies treated with anti-TNF therapy, compared with the general population. However, the available data are limited, and methotrexate, which is commonly used in combination with anti-TNF drugs, is teratogenic. Until more data are available, no firm conclusions can be reached regarding the safety of anti-TNF therapy in pregnancy. Nevertheless, in selected cases where there is high disease activity, anti-TNF therapy might be recommended, depending on the results of individual risk-benefit analyses. Fully informed consent from the mother is needed in such cases. Anti-TNF agents are not usually used during lactation, although the risk of toxicity is probably negligible.
Nature Clinical Practice Rheumatology 04/2007; 3(3):156-64. · 5.85 Impact Factor
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ABSTRACT: To compare induction of labor at gestational age 41 weeks with expectant management in regard to neonatal morbidity. Secondary aims were to assess the effect of these managements on mode of delivery and maternal complications.
Between September 2002 and July 2004, postterm women with singleton cephalic presentation and no prelabor rupture of membranes were randomly assigned to induction of labor at 289 days or antenatal fetal surveillance every third day until spontaneous labor. Main outcome measures were neonatal morbidity, operative delivery rates, and maternal complications.
Five hundred eight women were randomly assigned, 254 in each group. No differences of clinical importance were observed in women in whom labor was induced compared with women who were expectantly managed with regard to the following outcomes: neonates whose 5-minute Apgar score was less than 7 (three neonates in the induction group compared with four in the monitoring group, P=.72); neonates whose umbilical cord pH was less than 7 (three compared with two, P=.69); prevalence of cesarean delivery (28 compared with 33, P=.50); or prevalence of operative vaginal delivery (32 compared with 27, P=.49). In the induction group more women had precipitate labors (33 compared with 12, P<.01; number needed to treat was 13), and the duration of second stage of labor was more often less than 15 minutes (94 compared with 56, P<.01; number needed to treat was 7).
No differences were found between the induced and monitored groups regarding neonatal morbidity or mode of delivery, and the outcomes were generally good.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00385229.
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Obstetrics and Gynecology 03/2007; 109(3):609-17. · 4.73 Impact Factor
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ABSTRACT: Clinical guidelines for post-term management differ, and studies on women's attitudes are lacking. We aimed to assess the experiences and attitudes among women managed with serial antenatal monitoring or induction of labor, and the effects of post-term pregnancy on self-reports of quality of life.
Women were randomized at 41 weeks to immediate induction of labor or antenatal fetal surveillance every third day. At inclusion women answered a questionnaire about their attitudes towards post-term pregnancy and health-related quality of life. This was repeated in a follow-up phone interview 6 months later, including questions about their experiences of labor and perspective on future deliveries.
A total of 508 women entered the study. At 41 weeks 74% of all women preferred to be induced. Women reported good general and mental health, but physical health and vitality scores were low. In the induction group, 74% of women said they would prefer the same management in future pregnancies; only 38% of women who had serial antenatal monitoring would prefer this option again (p<0.001). In the induction group, contractions were reported as more intense (n=157 versus n=118, p<0.01) and frequent (n=116 versus n=87, p<0.01) compared to the monitored group. The majority (84%) reported a positive labor induction experience.
Women preferred induction of labor to serial antenatal monitoring beyond 41 weeks. Labors were shorter and contractions were reported to be more frequent and intense in the induction group compared with the monitored group. However, their experience with labor induction was positive.
Acta Obstetricia Et Gynecologica Scandinavica 01/2007; 86(8):950-6. · 1.77 Impact Factor
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Tidsskrift for den Norske laegeforening 12/2006; 126(22):2982-3.
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ABSTRACT: The aim of the study was to evaluate pregnancy outcomes by weeks of gestation. A second aim was to assess the outcomes in groups with spontaneous or induced labor.
This was a prospective cohort study of singleton pregnancies delivered after 37 weeks of pregnancy covering a well defined region in Norway from 1990 to 2001 (N = 27,514). Linear regression, chi 2 tests, and multivariable logistic regression analysis were used.
Maternal complications varied with gestational age, and were lowest at 39 weeks and highest postterm (cesarean delivery 12.3-21.6%, operative vaginal delivery 10.7-15.4%, maternal hemorrhage 9.7-14.6%). Poor neonatal outcome varied with gestational age only for spontaneous labors (Apgar at 5 minutes less than 7 1.0-2.3%, pH less than 7.10 3.4-5.2%), whereas induction of labor was a risk factor for delivery complications (odds ratio 1.3-2.8), independent of gestational weeks.
Poor pregnancy outcomes vary with gestational age. Postterm pregnancy and induced labor are prognostic factors for poor outcome.
Obstetrics and Gynecology 10/2006; 108(3 Pt 1):500-8. · 4.73 Impact Factor
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ABSTRACT: Extravillous trophoblasts are major participants in placental development and remodelling of spiral arteries. Trophoblast invasion is regulated by maternal immune cells, and abnormal leucocyte subpopulation composition has been reported in implantation failure. In pre-eclampsia (PE), with or without foetal growth restriction (FGR), superficial trophoblast invasion and insufficient remodelling of spiral arteries are common findings. In the present study, we have compared spiral artery remodelling and leucocyte composition in decidual tissue from 30 cases (PE=8, FGR=5, PE + FGR=17) and 31 controls. Six histological remodelling criteria were established, and each pregnancy obtained a remodelling score. Numbers of natural killer (NK) cells (CD56+), T cells (CD3+) and activated (CD25+ or CD69+) leucocytes were determined and related to total leucocyte (CD45+) numbers in serial sections. Cases demonstrated significantly impaired spiral artery remodelling, inappropriate placental growth and reduced NK cell proportions, as compared to controls (P=0.02, P<0.001 and P=0.01, respectively). Reduced NK cell proportion was primarily found in pregnancies complicated by FGR, with or without PE, and a significant positive correlation was observed between NK cell proportion, trophoblast infiltration and placental growth. Our in vivo observations support the hypothesized association between NK cells, impaired placental development and pathogenesis of PE/FGR.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 03/2006; 448(3):269-76. · 2.49 Impact Factor
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ABSTRACT: There are more families with many children of only one sex than can be explained by unconditional probability.
Data from the Medical Birth Registry of Norway, covering more than 540,000 women with two, three and four births for the period 1967-2003, were used to study how the sex distributions of children already born affected the probability of a new birth and the sex of the next sibling.
Women with two children of the same sex had a higher probability of having more children compared to women with two children of both sexes (RR=1.14, (1.14-1.15)). This also applied to mothers with three children (RR=1.15 (1.13-1.17)). The probability was highest for mothers with boys only. Multiple births and parity affected the probability of giving birth to a boy versus a girl, but the sex composition of already born siblings had no influence.
We have no evidence that some parents may have a probability of having a boy versus a girl that differs from the rest of the population. The fact that there are more siblings of only one sex is mainly behavioural; some mothers with only girls or only boys keep having more children in an attempt to receive a child of the opposite sex.
Tidsskrift for den Norske laegeforening 01/2006; 125(24):3414-7.
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ABSTRACT: Polycystic ovary syndrome is the most common endocrine condition in women of fertile age. The syndrome is associated with insulin resistance, hyperinsulinaemia and diabetes. This paper reviews the association between polycystic ovary syndrome and diabetes; implications for clinical practice are suggested.
The review is based on Medline searches, our own studies, and clinical experience.
Polycystic ovary syndrome is present in one third of women with type 1 diabetes and in almost half of all women with type 2 diabetes. In women with polycystic ovary syndrome, the prevalence of type 2 diabetes is considerably increased and gestational diabetes may occur in as many as 40%. In women with previous gestational diabetes, the risk of type 2 diabetes as well as polycystic ovarian syndrome is increased.
Women with polycystic ovary syndrome are at increased risk of developing type 2 diabetes and gestational diabetes and should be followed up accordingly. Pregnant women with polycystic ovary syndrome should have an oral glucose tolerance test as soon as the pregnancy has been confirmed. The procedure should be repeated at gestational weeks 20 and 32. Treatment with metformin should be initiated in women with type 2 diabetes who want to conceive. For the same reason metformin may also be initiated in women with type 1 diabetes.
Tidsskrift for den Norske laegeforening 11/2005; 125(19):2619-21.
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ABSTRACT: To examine a possible effect on labour of training the muscles of the pelvic floor during pregnancy.
Randomised controlled trial.
Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting.
301 healthy nulliparous women randomly allocated to a training group (148) or a control group (153).
A structured training programme with exercises for the pelvic floor muscles between the 20th and 36th week of pregnancy.
Duration of the second stage of labour and number of deliveries lasting longer than 60 minutes of active pushing among women with spontaneous start of labour after 37 weeks of pregnancy with a singleton fetus in cephalic position.
Women randomised to pelvic floor muscle training had a lower rate of prolonged second stage labour (24%, 95% confidence interval 16% to 33%; 22 out of 105 women were at risk (undelivered) at 60 minutes in the survival analysis) than women allocated to no training (38% (37/109), 28% to 47%). The duration of the second stage was not significantly shorter (40 minutes v 45 minutes, P = 0. 06).
A structured training programme for the pelvic floor muscles is associated with fewer cases of active pushing in the second stage of labour lasting longer than 60 minutes.
BMJ (Clinical research ed.). 09/2004; 329(7462):378-80.
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Kjell A Salvesen
Tidsskrift for den Norske laegeforening 04/2004; 124(6):819-21.
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Kjell A Salvesen
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ABSTRACT: The present paper summarizes some of the epidemiological studies of in utero ultrasound exposure and subsequent childhood development. Emphasis is placed on birth weight, childhood malignancies, neurological development, handedness and speech development. The epidemiological evidence does not indicate any association between diagnostic ultrasound exposure during pregnancy and reduced birth weight, childhood malignancies or neurological development. However, a statistically significant association between ultrasound and left-handedness among males has been found in three studies. Thus, there is still need for more research.
European Journal of Ultrasound 11/2002; 15(3):165-71.
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ABSTRACT: The objective of this study was to compare umbilical cord plasma leptin between infants of mothers who experienced preeclampsia and infants of control subjects and to study the relation between cord plasma leptin and infant obesity, as indicated by ponderal index.
On the basis of a population of approximately 13,000 deliveries, we compared cord plasma leptin from preeclamptic (n = 256 women) and control pregnancies (n = 607 women) after taking the differences in gestational age and ponderal index into account.
Cord plasma leptin increased strongly with gestational age, both in the preeclampsia group and the control subjects (P <.01), but at each gestational age the preeclampsia group had higher leptin levels than control subjects (P <.01). Adjustment for the higher ponderal index among control subjects (P <.05) did not alter the difference in leptin levels between the groups.
We found higher levels of umbilical cord plasma leptin in infants of mothers who had preeclampsia (compared with infants of control subjects) after adjusting for differences in gestational age, gender, and infant ponderal index.
American Journal of Obstetrics and Gynecology 03/2002; 186(3):427-32. · 3.47 Impact Factor
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ABSTRACT: To determine whether preeclampsia influences insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-1 (IGFBP-1), and insulin-like growth factor binding protein-3 (IGFBP-3), independent of its effect on birth weight.
Cord blood was collected in 12,804 consecutive deliveries. We identified 258 preeclamptic pregnancies that were subclassified as mild or severe and early or late. For comparison, 609 control pregnancies were selected. Fetal growth was expressed as the ratio between observed and expected birth weight, with adjustment for gestational age at birth. IGF-I, IGFBP-1, and IGFBP-3 were measured in umbilical plasma. The contribution of preeclampsia and birth weight to each measured factor was assessed by multiple linear regression analyses.
Between mild preeclampsia and controls, there were no differences in IGF-I, IGFBP-1, and IGFBP-3. In severe and early onset preeclampsia, umbilical cord plasma IGF-I was approximately 50% lower, and IGFBP-1 was more than twice as high as in controls (both P <.01). At each birth weight level, IGF-I was lower and IGFBP-1 was higher in severe or early preeclampsia than among controls of similar weight. Birth weight and preeclampsia were, independent of each other, associated with IGF-I, whereas birth weight, but not preeclampsia, was associated with IGFBP-1, after adjustment for gestational age.
Fetal growth restriction caused by severe or early preeclampsia is associated with lower umbilical levels of IGF-I than low birth weight caused by other conditions. Preeclampsia may contribute to the observed IGF-I reduction, either as part of the underlying causes of preeclampsia, or as a consequence of the disease.
Obstetrics and Gynecology 01/2002; 99(1):85-90. · 4.73 Impact Factor
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Kjell A Salvesen
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ABSTRACT: Epidemiological studies have indicated no association between diagnostic ultrasound exposure during pregnancy and childhood malignancies. Diagnostic ultrasound imaging does not seem to influence birth weight, whereas frequent Doppler ultrasound was associated with reduced birth weight in one study. Most experts do not believe that ultrasound exposure during pregnancy is associated with reduced birth weight. There are no confirmed statistically significant associations between ultrasound and dyslexia and neurological development during childhood. However, two randomised controlled trials and two cohort studies have been unable to rule out a possible association between ultrasound and left-handedness among males.
Progress in Biophysics and Molecular Biology 93(1-3):295-300. · 3.20 Impact Factor
