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1.
Prim Care Diabetes ; 17(1): 79-84, 2023 02.
Article in English | MEDLINE | ID: mdl-36464621

ABSTRACT

AIMS: To evaluate the association between the exposure of particulate matter with an aerodynamic diameter of ≤ 2.5µm (PM2.5) and with an aerodynamic diameter of ≤ 10µm (PM10) over the first trimester and the risk of gestational diabetes mellitus (GDM), and to assess whether maternal pre-pregnancy body mass index (BMI) modified the GDM risk. METHODS: All Finnish primiparous women without previously diagnosed diabetes who delivered between 2009 and 2015 in the city of Vantaa, Finland, composed the study cohort (N = 6189). Diagnosis of GDM was based on a standard 75 g 2-hour oral glucose tolerance test. The average daily concentration of PM2.5 and PM10 over the first trimester was calculated individually for each woman. The relationship between exposure of PM2.5 and PM10 and GDM was analyzed with logistic models. RESULTS: No association was observed between the average daily concentrations of PM2.5 and PM10 over the first trimester and the GDM risk. When simultaneously taking BMI and PM10 into account both mean daily PM10 concentration (p = 0.047) and pre-pregnancy BMI (p = 0.016) increased GDM risk independently and an interaction (p = 0.013) was observed between PM10 concentration and pre-pregnancy BMI. CONCLUSIONS: Even globally low PM10 exposure level together with elevated maternal pre-pregnancy BMI seems to increase the GDM risk.


Subject(s)
Diabetes, Gestational , Pregnancy , Female , Humans , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Particulate Matter/adverse effects , Particulate Matter/analysis , Finland/epidemiology , Adiposity , Obesity , Cohort Studies
2.
J Int Med Res ; 50(11): 3000605221138455, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36446764

ABSTRACT

OBJECTIVE: Some drugs have adverse effects on glucose metabolism, but it is unknown whether prescription drugs used prior to conception influence the future risk of gestational diabetes mellitus (GDM). Our study evaluated whether the purchase of prescription drugs 6 months prior to conception was associated with the occurrence of GDM. METHODS: This cohort study enrolled women with a Finnish background who delivered between 2009 and 2015 in the city of Vantaa, Finland (N = 10,455). Data on maternal characteristics and prescription drug purchases were obtained from national health registers. The use of a unique personal identification number enabled us to combine the register data on an individual level. RESULTS: Six months prior to conception, women who had pregnancies complicated by GDM purchased more prescription drugs than women without GDM (1.38 ± 2.04 vs. 1.11 ± 1.80). The GDM risk was higher in women with higher numbers of prescription purchases and those with more than three deliveries. CONCLUSIONS: Multiparous women who purchase several prescription drugs should be given personalized counseling to prevent GDM.


Subject(s)
Diabetes, Gestational , Drug-Related Side Effects and Adverse Reactions , Prescription Drugs , Pregnancy , Female , Humans , Diabetes, Gestational/drug therapy , Diabetes, Gestational/epidemiology , Prescription Drugs/adverse effects , Cohort Studies , Parity
3.
Front Public Health ; 10: 880339, 2022.
Article in English | MEDLINE | ID: mdl-35910895

ABSTRACT

Background: One in four women of childbearing age has some degree of mental disorders and are, therefore, prone to both pregnancy complications and adverse health outcomes in their offspring. We aimed to evaluate the impact of preconception severe mental disorders on pregnancy outcomes in primiparous women. Methods: The study cohort was composed of 6,189 Finnish primiparous women without previously diagnosed diabetes, who delivered between 2009 and 2015, living in the city of Vantaa, Finland. Women were classified to have a preconception severe mental disorder if they had one or more outpatient visits to a psychiatrist or hospitalization with a psychiatric diagnosis 1 year before conception. Data on pregnancies, diagnoses, and pregnancy outcomes were obtained from national registers at an individual level. Results: Primiparous women with preconception severe psychiatric diagnosis were younger, more often living alone, smokers, and had lower educational attainment and lower taxable income than women without psychiatric diagnosis (for all p < 0.001). Of all women, 3.4% had at least one psychiatric diagnosis. The most common psychiatric diagnoses were depression and anxiety disorders. The most common comorbidity was the combination of depression and anxiety disorders. There were no differences in the need for respiratory treatments, admissions to the neonatal intensive care unit, or antibiotic treatments between the offspring's groups. Conclusion: Although primiparous women had severe mental disorders, the well-being of newborns was good. The most common severe mental health disorders were depression and anxiety disorders, and psychiatric comorbidity was common. Women with severe mental disorders more often belonged to lower socioeconomic groups.


Subject(s)
Mental Health , Pregnancy Complications , Anxiety Disorders , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Outcome/epidemiology , Social Class
4.
Sci Rep ; 11(1): 4467, 2021 02 24.
Article in English | MEDLINE | ID: mdl-33627788

ABSTRACT

Our aim was to evaluate maternal use of sedative drugs before, during, and after pregnancy and to assess the influence of use of these drugs on pregnancy outcomes. The study cohort (N = 6231) consists of all primiparous women, who lived in the city of Vantaa, Finland, and who delivered a singleton between 2009 and 2015. Data were obtained from Finnish national health registers. Of the women, 3.2% (n = 202) purchased at least once sedative drugs within 90 days before conception, during pregnancy and/or within 90 days after delivery. Sedative drug users were older, less likely to cohabitate, more often smokers, had lower educational attainment and had more mental diseases (for all p < 0.001) compared with non-users. Sedative drug users purchased more often antidepressants and drugs for the alimentary tract, musculoskeletal and nervous system than non-users (for all p < 0.001). No adverse birth or pregnancy outcomes were found in the group using sedative drugs compared with the non-users. Studies in larger cohorts are needed to confirm our study findings.


Subject(s)
Hypnotics and Sedatives/adverse effects , Adult , Antidepressive Agents/adverse effects , Cohort Studies , Educational Status , Female , Finland , Humans , Mental Disorders/drug therapy , Musculoskeletal System/drug effects , Nervous System/drug effects , Pregnancy , Pregnancy Outcome , Risk Factors
5.
Int Breastfeed J ; 16(1): 19, 2021 02 16.
Article in English | MEDLINE | ID: mdl-33593367

ABSTRACT

BACKGROUND: The impact of gestational diabetes mellitus (GDM) on the duration of breastfeeding varies between shortening and no impact. Breastfeeding seems to reduce both maternal and offspring risk for type 2 diabetes and offspring risk for overweight or obesity later in life. The aim of our study was to evaluate in primiparous women whether GDM had an influence on the duration of breastfeeding, and further, to evaluate the factors that influenced on the duration of breastfeeding. METHODS: The study cohort (N = 1089) consisted of all primiparous women with a Finnish background excluding women with pre-existing diabetes mellitus who lived in the city of Vantaa, Finland, gave birth to a singleton living child between 2009 and 2015, and with valid data on breastfeeding available. The diagnosis of GDM was based on a standard 75 g 2-h oral glucose tolerance test. Data were obtained from Finnish national registers and from the medical records of the city of Vantaa. RESULTS: No differences were observed in the duration of breastfeeding between women diagnosed with GDM and without GDM, 7.5 (Standard Deviation [SD] 3.7) months versus 7.9 (SD 3.5) months (p = 0.17). Women diagnosed with GDM breastfed boys for a longer duration than girls (maternal age, pre-pregnancy body mass index, marital status, educational attainment, duration of pregnancy, and smoking habits adjusted p = 0.042). Women who breastfed < 6 months were younger, were more likely smokers, had shorter education, and higher pre-pregnancy body mass index than women who breastfed over 6 months (p <  0.001 for linearity). CONCLUSIONS: In primiparous women GDM did not influence breastfeeding duration. The positive health effects of breastfeeding should be emphasized especially in young, overweight and less educated women in order to minimize the risk of obesity and type 2 diabetes for themselves and their offspring.


Subject(s)
Diabetes Mellitus, Type 2 , Diabetes, Gestational , Breast Feeding , Cohort Studies , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/etiology , Diabetes, Gestational/epidemiology , Female , Humans , Male , Pregnancy , Risk Factors
6.
Acta Obstet Gynecol Scand ; 99(12): 1632-1639, 2020 12.
Article in English | MEDLINE | ID: mdl-32463146

ABSTRACT

INTRODUCTION: Smoking has been shown to affect glucose homeostasis and increase the risk for type 2 diabetes mellitus. Further, gestational diabetes mellitus (GDM) and smoking are known to influence offspring birthweight. The effect of smoking on glucose homeostasis in pregnancy is less studied and the findings are inconsistent. The aim of this study was to evaluate the effect of smoking on risk for GDM and to evaluate the impact of smoking and GDM on offspring birthweight. MATERIAL AND METHODS: This is an observational cohort study encompassing 4111 Finnish primiparous women from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data were obtained from Finnish national registers. Study participants had complete oral glucose tolerance test results and were divided into three groups according to smoking status: non-smokers (I), smokers who quit during first trimester (II), and smokers who continued after first trimester (III). RESULTS: Prevalence of GDM was 19.8%, 24.3%, and 26.6% in non-smokers, those who quit, and those who continued after the first trimester, respectively (P = .004 for differences between groups). The odds ratio for GDM in smokers who continued after the first trimester compared with non-smokers was 1.65 (95% CI 1.09-2.57) after adjustments for age, prepregnancy body mass index, education, and cohabitation. In women without GDM, offspring birthweight was lowest in those who continued smoking after the first trimester (P = .010 for differences between groups). In women with GDM, smoking status did not influence offspring birthweight. CONCLUSIONS: Smoking during pregnancy is associated with an increased risk for GDM. Offspring birthweight is lowest in women who continue smoking after the first trimester. If pregnancy is complicated by GDM, offspring birthweight is not influenced by smoking.


Subject(s)
Diabetes, Gestational , Infant, Low Birth Weight , Prenatal Exposure Delayed Effects , Smoking , Adult , Body Mass Index , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Educational Status , Female , Finland/epidemiology , Glucose Tolerance Test/methods , Humans , Infant, Newborn , Male , Parity , Pregnancy , Prenatal Exposure Delayed Effects/diagnosis , Prenatal Exposure Delayed Effects/epidemiology , Prenatal Exposure Delayed Effects/etiology , Risk Factors , Smoking/adverse effects , Smoking/epidemiology
7.
Int J Circumpolar Health ; 79(1): 1703882, 2020 12.
Article in English | MEDLINE | ID: mdl-31833822

ABSTRACT

There is a lack of data about the influence of sunshine hours on the prevalence for gestational diabetes mellitus (GDM). The aim of this study was to evaluate whether the prevalence of GDM varied according to hours of daily sunshine during the first trimester. The study cohort (N = 6189) consists of all primiparous women with a Finnish background who delivered between 2009 and 2015 living in Vantaa city, Finland. Data on births and maternal characteristics were obtained from National Health Registers. Data on sunshine hours were obtained from the Finnish Meteorological Institute. Individual daily sunshine hours during the first trimester of pregnancy were calculated for each woman. Diagnosis of GDM was based on a standard 75-g 2-h glucose tolerance test (OGTT). No relationship was observed between month of conception and GDM. Daily sunshine hours during the first trimester and GDM showed a U-shaped association (adjusted p-value 0.019). In OGTT, a U-shaped association was observed between 0-h glucose value and daily sunshine hours during the first trimester (p = 0.039) as well as with the 1-h glucose value (p = 0.012), respectively. In primiparous women daily sunshine hours during the first trimester showed a U-shaped association with the prevalence of GDM independent of pre-pregnancy risk factors.Abbreviations: BMI: body mass index; GDM: gestational diabetes mellitus; OGTT: standard 75 g 2-h glucose tolerance test; SD: standard deviation.


Subject(s)
Diabetes, Gestational/diagnosis , Health Status , Sunlight/adverse effects , Adult , Diabetes, Gestational/etiology , Female , Finland , Glucose Tolerance Test , Humans , Pregnancy , Prenatal Care/methods , Risk Factors , Ultraviolet Rays , Young Adult
8.
Pharm. pract. (Granada, Internet) ; 17(4): 0-0, oct.-dic. 2019. tab, graf
Article in English | IBECS | ID: ibc-191953

ABSTRACT

BACKGROUND: The study was carried out as part of the European Network for Patient Safety (EUNetPas) project in 2008-2010. OBJECTIVE: To investigate facilitators and barriers in implementation process of selected medication safety practices across hospitals within European Union countries. METHODS: This was an implementation study of seven selected medication safety practices in 55 volunteering hospitals of 11 European Union (EU) member states. The selected practices were: two different versions of medicine bed dispensation; safety vest; discharge medication list for patients; medication reconciliation at patient discharge; medication reconciliation at patient admission and patient discharge, and sleep card. The participating hospitals submitted an evaluation report describing the implementation process of a chosen practice in their organisation. The reports were analysed with inductive content analysis to identify general and practice-specific facilitators and barriers to the practice implementation. RESULTS: Altogether 75 evaluation reports were submitted from 55 hospitals in 11 EU member states. Implementation of the medication safety practices was challenging and more time consuming than expected. The major reported challenge was to change the work process because of the new practice. General facilitators for successful implementation were: existence of safety culture, national guidelines and projects, expert support, sufficient resources, electronic patient records, interdisciplinary cooperation and clinical pharmacy services supporting the practice implementation. CONCLUSIONS: The key for the successful implementation of a medication safety practice is to select the right practice for the right problem, in the right setting and with sufficient resources in an organization with a safety culture


No disponible


Subject(s)
Humans , Safety Management/organization & administration , Drug-Related Side Effects and Adverse Reactions/prevention & control , Inappropriate Prescribing/prevention & control , Pharmaceutical Services/organization & administration , Drug Information Services/organization & administration , Pharmacy Service, Hospital/organization & administration , European Union/statistics & numerical data , Patient Safety/standards , Medication Reconciliation/standards , Health Care Surveys/statistics & numerical data , Health Records, Personal , Hospital Records/standards , Delivery of Health Care/organization & administration , Patient Admission/standards , Health Plan Implementation/organization & administration , Patient Discharge Summaries/standards , Continuity of Patient Care/organization & administration
9.
Pharmacoepidemiol Drug Saf ; 28(9): 1239-1245, 2019 09.
Article in English | MEDLINE | ID: mdl-31286617

ABSTRACT

PURPOSE: To evaluate the use of opioids in pregnant primiparous women and study the effect of opioid use on maternal and offspring delivery outcomes. METHODS: The study cohort (N = 6231) consists of all primiparous women with a Finnish background who delivered a singleton between 2009 and 2015 in the city of Vantaa, Finland. Data on births, maternal characteristics, pregnancy outcomes, and purchases of prescription drugs were obtained from National Health Registers. RESULTS: Of the primiparous women, 5.1% used opioids during pregnancy. Of these, 95.9% used codeine. No differences were observed in purchases of opioids between the different trimesters but more women purchased opioids as pregnancy progressed (.002). Users of opioids more often also purchased other prescription drugs compared with non-users of opioids, 89% versus 58% (P < .001); age, smoking, education, and body mass index adjusted odds ratio 5.66 (95% confidence interval 3.96 to 8.09). Caesarean sections were more common in users of opioids than in non-users, 28.3% versus 21.9% (.007). Before the age of 7 days, the offspring of users of opioids more often needed respirator treatment compared with the offspring of non-users, 3.1% versus 1.6% (.044). CONCLUSIONS: One out of 20 pregnant women used opioids. Use of opioids during pregnancy was associated with the risk for deliveries by caesarean sections and need for respiratory treatment among the offspring during the first week of life. Further safety evaluations are needed.


Subject(s)
Analgesics, Opioid/adverse effects , Intensive Care Units, Neonatal/statistics & numerical data , Pain/drug therapy , Pregnancy Complications/drug therapy , Pregnancy Outcome/epidemiology , Adult , Cesarean Section/statistics & numerical data , Codeine/adverse effects , Cohort Studies , Drug Prescriptions/statistics & numerical data , Female , Finland/epidemiology , Humans , Infant, Newborn , Pregnancy , Registries/statistics & numerical data , Respiration, Artificial/instrumentation , Respiration, Artificial/statistics & numerical data , Ventilators, Mechanical , Young Adult
10.
Diabetes Res Clin Pract ; 148: 110-118, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30641170

ABSTRACT

AIMS: To evaluate the impact of gestational diabetes mellitus (GDM) and maternal height on offspring birthweight. METHODS: This is an observational cohort study, encompassing 4 111 Finnish primiparous women from Vantaa city, Finland, with singleton deliveries between 2009 and 2015. Data were obtained from the Finnish Medical Birth Register. The study population was divided into five groups according to maternal height. Cut-offs for height levels were I ≤ 158 cm, II 159-163 cm, III 164-167 cm, IV 168-172 cm, V ≥ 173 cm. The main outcome measure was offspring birthweight, expressed as Z-scores according to sex and gestational age. RESULTS: Independently, both maternal height and GDM increased offspring birthweight (p < 0.001 for height and GDM). When studying the interaction, a significant increase in offspring birthweight was noted only in extreme height categories; group I ≤ 158 cm (p = 0.011), group IV 168-172 cm (p = 0.010) and group V ≥ 173 cm (p < 0.001) and the impact was similar in both sexes. Maternal height had no impact on offspring ponderal index (p = 0.20 for trend). CONCLUSIONS: In extreme height categories, short and tall primiparous women with GDM are at risk for delivering larger offspring compared to women without GDM of similar height.


Subject(s)
Birth Weight/physiology , Body Height/physiology , Diabetes, Gestational/epidemiology , Mothers , Adult , Body Mass Index , Cohort Studies , Delivery, Obstetric/statistics & numerical data , Diabetes, Gestational/diagnosis , Diabetes, Gestational/etiology , Female , Finland/epidemiology , Gestational Age , Humans , Infant, Newborn , Male , Pregnancy , Risk Factors , Young Adult
11.
Pharm Pract (Granada) ; 17(4): 1583, 2019.
Article in English | MEDLINE | ID: mdl-31897250

ABSTRACT

BACKGROUND: The study was carried out as part of the European Network for Patient Safety (EUNetPas) project in 2008-2010. OBJECTIVE: To investigate facilitators and barriers in implementation process of selected medication safety practices across hospitals within European Union countries. METHODS: This was an implementation study of seven selected medication safety practices in 55 volunteering hospitals of 11 European Union (EU) member states. The selected practices were two different versions of medicine bed dispensation; safety vest; discharge medication list for patients; medication reconciliation at patient discharge; medication reconciliation at patient admission and patient discharge, and sleep card. The participating hospitals submitted an evaluation report describing the implementation process of a chosen practice in their organisation. The reports were analysed with inductive content analysis to identify general and practice-specific facilitators and barriers to the practice implementation. RESULTS: Altogether 75 evaluation reports were submitted from 55 hospitals in 11 EU member states. Implementation of the medication safety practices was challenging and more time consuming than expected. The major reported challenge was to change the work process because of the new practice. General facilitators for successful implementation were existence of safety culture, national guidelines and projects, expert support, sufficient resources, electronic patient records, interdisciplinary cooperation and clinical pharmacy services supporting the practice implementation. CONCLUSIONS: The key for the successful implementation of a medication safety practice is to select the right practice for the right problem, in the right setting and with sufficient resources in an organization with a safety culture.

12.
Ann Med ; 51(1): 51-57, 2019 02.
Article in English | MEDLINE | ID: mdl-30299166

ABSTRACT

INTRODUCTION: Preterm birth is a major cause of infant mortality. It is unknown whether body mass index (BMI) influences the risk of preterm birth in women, who prenatally use antidepressants. MATERIALS AND METHODS: The study cohort (N = 6920) consists of all primiparous European born women without previously diagnosed diabetes from the city of Vantaa, Finland, who delivered a singleton child between 2009 and 2015. Data on births, pre-pregnancy BMI and purchases of antidepressants from 12 months before conception until delivery were obtained from Finnish National Registers. RESULTS: Of the primiparous women, 9.9% used antidepressants. The overall prevalence of preterm birth was 5.2%. In women with a pre-pregnancy BMI <18.5 kg/m2, the Odds Ratio (OR) for preterm birth among antidepressant users compared with those who were non-users was 1.91 (95% confidence intervals [CI] 0.40 to 9.15, adjusted for age, smoking, education, use of fertility treatments and number of previous pregnancies) while in women with a pre-pregnancy BMI ≥30 kg/m2, the OR was 0.53 (95% CI 0.21-1.36), respectively. DISCUSSION: Primiparous women using antidepressants, who were underweight before conception should be closely monitored and provided tailored care in a maternity clinic to minimize the risk of preterm birth. Key messages In primiparous women, one in ten used antidepressant medications before pregnancy and/or during pregnancy. In primiparous women, the prevalence of preterm birth was 5%. Underweight primiparous women using antidepressants should be closely monitored and provided tailored care in a maternity clinic.


Subject(s)
Antidepressive Agents/adverse effects , Parity/drug effects , Premature Birth/epidemiology , Thinness/complications , Adult , Antidepressive Agents/therapeutic use , Body Mass Index , Female , Finland/epidemiology , Humans , Infant , Infant Mortality/trends , Pregnancy , Premature Birth/mortality , Prenatal Care/methods , Prevalence , Risk Factors , Thinness/epidemiology
13.
Acta Obstet Gynecol Scand ; 97(2): 187-194, 2018 02.
Article in English | MEDLINE | ID: mdl-29194561

ABSTRACT

INTRODUCTION: Data on risk factors for gestational diabetes mellitus (GDM) in primiparous women is limited. The aim of this study was to assess the prevalence of GDM and simultaneously evaluate the impact of age and adiposity in primiparous women at risk of GDM risk. MATERIAL AND METHODS: This observational register-based cohort study from the city of Vantaa, Finland, included all 7750 primiparous women giving birth between 2009 and 2015 without previously diagnosed diabetes mellitus. RESULTS: In primiparous women the prevalence of GDM was 16.5% and mean age was 28.2 years (5.2 SD). Primiparous women aged ≥35 years had a significantly higher risk for GDM than women aged <25 years [odds ratio (OR) 2.67, 95% confidence interval (CI) 2.13-3.34]. Primiparous women with a pre-pregnancy body mass index (BMI) ≥30.0 kg/m2 had a significantly higher risk for GDM than women with a pre-pregnancy BMI <25 kg/m2 (OR 5.36, 95% CI 4.53-6.36). The risk of developing GDM showed an increasing trend with increasing age in all BMI categories except the category BMI ≥35 kg/m2 . Normal weight women (BMI 20.0-24.9 kg/m2 ) aged 40 years had a significantly higher risk for GDM than normal weight women aged 28 years (OR 1.48, 95% CI 1.01-2.19). CONCLUSIONS: The prevalence of GDM is high in primiparous women. Both age and degree of adiposity influenced the risk for GDM. To reduce GDM risk, adiposity should be prevented already in childhood and primiparity should be encouraged at a younger age.


Subject(s)
Body Mass Index , Diabetes, Gestational/diagnosis , Maternal Age , Obesity/epidemiology , Adult , Age Factors , Cohort Studies , Comorbidity , Diabetes, Gestational/epidemiology , Female , Finland/epidemiology , Humans , Parity , Pregnancy , Prenatal Care/methods , Prenatal Diagnosis/methods , Risk Factors , Young Adult
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