Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway.

OBJECTIVE: To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth. DESIGN: Population-based registry study. SETTING: Medical Birth Registry of Norway and Statistics Norway. POPULATION: Women (n = 213 335) who gave birth to their first and second singleton child during 1999-2014 (total n = 426 670 births). METHODS: Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors. MAIN OUTCOME MEASURES: Extremely preterm (<28+0 weeks), very preterm (28+0 -33+6 weeks) and late preterm (34+0 -36+6 weeks) second birth. RESULTS: Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47-22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59-17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11-7.70). Placental disorders contributed 30-40% of recurrent extremely and very preterm births and 10-20% of recurrent late preterm birth. CONCLUSION: A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%). TWEETABLE ABSTRACT: Preterm first birth is a major risk factor for subsequent preterm birth, regardless of maternal, obstetric or fetal risk factors.

Hyperemesis gravidarum and long-term mortality: a population-based cohort study.

OBJECTIVE: To investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long-term mortality. DESIGN: Population-based cohort study. SETTING: Medical Birth Registry of Norway (1967-2002) linked to the Cause of Death Registry. POPULATION: Women in Norway with singleton births in the period 1967-2002, with and without HG. Women were followed until 2009 or death. METHODS: Cox proportional hazard regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI). MAIN OUTCOME MEASURES: The primary outcome was all-cause mortality during follow up. Secondary outcomes were cause-specific mortality (cardiovascular mortality, deaths due to cancer, external causes or mental and behavioural disorders). RESULTS: Of 999 161 women with singleton births, 13 397 (1.3%) experienced HG. During a median follow up of 26 years (25 902 036 person-years), 43 470 women died (4.4%). Women exposed to HG had a lower risk of long-term all-cause mortality compared with women without HG (crude HR 0.82; 95% CI 0.75-0.90). When adjusting for confounders, this reduction was no longer significant (adjusted HR 0.92; 95% CI 0.84-1.01). Women exposed to HG had a similar risk of cardiovascular death as women not exposed (adjusted HR 1.04; 95% CI 0.83-1.29), but a lower long-term risk of death from cancer (adjusted HR 0.86; 95% CI 0.75-0.98). CONCLUSION: In this large population-based cohort study, HG was not associated with an increased risk of long-term all-cause mortality. Women exposed to HG had no increase in mortality due to cardiovascular disease, but had a reduced risk of death from cancer. TWEETABLE ABSTRACT: Population-based cohort study: Hyperemesis was not associated with an increased risk of long-term mortality.

Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry.

OBJECTIVE: To study associations between hyperemesis gravidarum (HG) and birth outcomes. DESIGN: Population-based cohort study. SETTING: Norway. SAMPLE: Singleton births in the Norwegian Birth Registry, 1967-2009 (n = 2 270 363). METHODS: Multiple logistic regression was applied to study associations between HG and dichotomous outcomes; multiple linear regression to study associations between HG, birthweight and gestational length. Generalised estimating equations were applied to obtain valid standard errors. Sub-analysis on data with available information on smoking was conducted (1999-2009). MAIN OUTCOME MEASURES: Small and large for gestational age (SGA/LGA), Apgar score after 5 minutes, very preterm and preterm birth (VPTB/PTB), perinatal death, stillbirth, neonatal death, birthweight and gestational length. RESULTS: No associations between HG and adverse pregnancy outcomes were observed in crude analyses, except for VPTB (odds ratio [OR] 0.79, 95% CI 0.67-0.93). In adjusted analysis, HG was associated with perinatal death (OR 1.27, 95% CI 1.08-1.48). Inverse associations were observed between HG and VPTB (OR 0.80, 95% CI 0.68-0.94) and LGA (OR 0.95, 95% CI 0.90-0.99). Sub-analyses showed no associations between HG and perinatal death (OR 1.29, 95% CI 0.91-1.83). The inverse associations between HG, VPTB and LGA were strengthened (OR 0.66, 95% CI, 0.48-0.91 and OR 0.86, 95% CI 0.79-0.93, respectively). Exposed babies had reduced birthweight and gestational length compared with unexposed, adjusted difference - 21.4 g and - 0.5 days, respectively. Adjustment for smoking slightly strengthened the impact of HG on birthweight. CONCLUSIONS: Inverse associations for HG and VPTB and LGA were observed. HG was associated with slight reductions in birthweight and gestational age.

Is hyperemesis gravidarum associated with placental weight and the placental weight-to-birth weight ratio? A population-based Norwegian cohort study.

INTRODUCTION: Studies have suggested a link between placental weight, placental weight-to-birth weight ratio (PW/BW) and adult health. Hyperemesis gravidarum (HG) may also have implications for adult health. No studies on HG and placental characteristics have been identified. We therefore explored the relationship between HG, placental weight and the PW/BW-ratio in a population-based cohort. METHODS: Singleton births to primiparous women between 1999 and 2009 with data on HG, placental weight and birth weight in the Medical Birth Registry of Norway (MBRN) comprised the study base (n = 200,390). HG was defined through ICD-10 code 021.0, 021.1 and 021.9. Gender and gestational age specific percentile curves for placenta weight and PW/BW ratio were used to define those below the 10th and above the 90th percentile of both outcomes. Associations between HG and dichotomous outcomes were studied by multiple logistic regression. Multiple linear regression was applied to study placental weight as a continuous variable. Male and female offspring were analyzed separately. RESULTS: The prevalence of HG was 1.2%. Women with HG and female offspring had significantly higher risk of a PW/BW-ratio above the 90th percentile (OR = 1.17, 95% CI: 1.03-1.34). HG and PW/BW-ratio below the 10th percentile were inversely associated (OR = 0.70, 95% CI: 0.56-0.89). For male offspring no association was observed for HG and PW/BW-ratio below the 10th or above the 90th percentile. DISCUSSION/CONCLUSIONS: We observed positive associations between HG and high PW/BW ratio limited to female offspring only. The high PW/BW-ratio suggests that there may be a possible link between HG and adult health.

Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study.

OBJECTIVE: To investigate primarily the dietary intake, as well as demographics and selected lifestyle factors, of women experiencing nausea and vomiting in pregnancy, nausea only, or women who are symptom free. DESIGN: Prospective cohort study. SETTING: The Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. SAMPLE: Analyses were based on 51 675 Norwegian pregnancies. METHODS: Dietary intake was assessed by a self-reported food frequency questionnaire answered in the first trimester of pregnancy, as were data regarding nausea and vomiting. Chi-squared tests, one-way analysis of variance, and multiple linear regression were used. MAIN OUTCOME MEASURES: Nausea and vomiting in pregnancy (NVP), gestational weight gain (GWG), and dietary intake. RESULTS: We found that 17 070 (33%) women experienced NVP, 20 371 (39%) experienced only nausea, and 14 234 (28%) were symptom free. Women with NVP were younger and heavier at pregnancy onset, with the lowest GWG and highest energy intake during pregnancy, primarily from carbohydrates and added sugars, compared with the other groups (P < 0.001). In multiple linear regression analysis of GWG and group adjusted for body mass index (BMI), gestational length, smoking during pregnancy, and energy intake, a significant interaction was found between BMI and group (P < 0.001). A significant effect of group (P < 0.001) was found in all BMI strata, except among underweight women (P = 0.65). CONCLUSIONS: Our study suggests that women with NVP are characterised by high intakes of carbohydrates and added sugar, primarily from sugar-containing soft drinks. Whether higher intakes of carbohydrates are a response aimed to alleviate symptoms, or are actually provoking the condition, is not known.

[Medical undergraduate education is outdated. From the interns' point of view]. / Medisinsk grunnutdanning i utakt. Grunnutdanninga slik turnuskandidaten opplever ho.

This survey is based on a questionnaire sent to all 517 interns in Norway in December 1990, of whom 93% replied. Ten interns were interviewed personally. The majority felt they received a good theoretical basis during their medical studies, but less than a third stated that the education had adequate vocational orientation. Students from the University of Tromsø, were the exception in this respect. They were more positive towards the vocational aspects of their studies. Most interns had high expectations with regard to learning during internship, and half of them to have to face various traumatic experiences during this period. One out of two stated that, so far, their internship training had been inspiring for their career as medical practitioner. About a third replied that they doubted whether they would choose the same profession if they were to make this decision again. The results of this study emphasize the importance of the current changes in the curriculum at all four medical faculties in Norway. The results also suggest a need for better coordination of university studies and internship, and more structured teaching during the internship.

[Professionalization without management? A study of the scientific content during the internship]. / Profesjonalisering uten styring? En undersøkelse om det faglige innholdet i turnustjenesten.

The basic medical education in Norway ends with one year as house physician or surgeon and six months as assistant to general practitioner. This internship is an important period in the course of education leading to a medical degree. According to a new national standard issued in 1989 all interns should have a personal supervisor and a formal curriculum covering this period. The present survey was carried out in order to evaluate the quality of learning during internship as experienced by the trainees. A questionnaire was sent to all 517 Norwegian interns as of December 1990. 93% replied. Ten of the interns were interviewed personally. 34% of the house officers had an appointed supervisor compared with 54% in primary care. Few of the interns had a formal curriculum. Many of them felt the need for constructive feedback on their professional performance, but few received it. They nevertheless claimed that it was easy both to raise questions and to obtain assistance in solving medical problems. One out of six interns had been severely depressed during the period of internship and related this to experiences at work. Women were generally more sensitive than men in this respect and were more critical of the interpersonal relationships experienced during this period. Despite the new standard, which sets realistic and necessary goals for this part of the medical education, learning during internship is still much a matter of chance. It is a major challenge to the medical profession to take the needs of young medical practitioners seriously.