Acta Obstetricia et Gynecologica Scandinavica

In order to estimate whether women with polycystic ovary syndrome (PCOS) have an increased risk of developing myocardial infdrction, a risk factor model was applied on 33 women with PCOS and 132 age matched referents.

The risk factor model was established from independent risk factors for myocardial infarction in a prospective population study of 1462 women in Goteborg, Sweden. The independent risk factors were age. manifest hypertension, manifest diabetes mellitus, central obesity measured as increased waist to hip circumference ratio and serum trigly‐ceride concentration.

A considerably increased risk (relative risk of 7.4) of developing myocardial infarction was observed for women with PCOS compared to age‐matched referents.

Since the risk factors include variables correlated to obesity, the results indicate that advice on dietary restriction is an important part of the treatment once the diagnosis is established.

Background. While active maternal tobacco smoking has well established adverse perinatal outcomes, the effects of passive maternal smoking, also called environmental tobacco exposure (ETS), are less well studied and less consistent. Objective: To determine to the effect of ETS on perinatal outcomes. Search strategy. Medline, EMBASE and reference lists were searched. Selection criteria. Studies comparing ETS‐exposed pregnant women with those unexposed which adequately addressed active maternal smoking. Data collection and analysis. Two reviewers independently assessed titles, abstracts, full studies, extracted data and assessed quality. Dichotomous data were pooled using odds ratios (OR) and continuous data with weighted mean differences (WMD) using a random effects model. Main results. Seventy‐six articles were included with a total of 48,439 ETS‐exposed women and 90,918 unexposed women. ETS‐exposed infants weighed less [WMD –60 g, 95% confidence interval (CI) –80 to –39 g], with a trend towards increased low birthweight (LBW, < 2,500 g; RR 1.16; 95% CI 0.99–1.36), although the duration of gestation and preterm delivery were similar (WMD 0.02 weeks, 95% CI –0.09 to 0.12 weeks and RR 1.07; 95% CI 0.93–1.22). ETS‐exposed infants had longer infant lengths (1.75 cm; 95% CI 1.37–2.12 cm), increased risks of congenital anomalies (OR 1.17; 95% CI 1.03–1.34) and a trend towards smaller head circumferences (–0.11 cm; 95% CI –0.22 to 0.01 cm). Conclusions. ETS‐exposed women have increased risks of infants with lower birthweight, congenital anomalies, longer lengths, and trends towards smaller head circumferences and LBW.

Introduction. The relation of migration to infant outcomes is unclear. There are studies which show that some migrant groups have similar or even better outcomes than those from the receiving country. Equally, raised risk of adverse outcomes for other migrant groups has been reported. Objective. We sought to determine (1) if migrants in western industrialized countries have consistently higher risks of stillbirth, neonatal mortality, or infant mortality, (2) if there are migrant sub‐groups at potentially higher risk, and (3) what might be the explanations for any risk differences found. Design and Setting. Systematic review of the literature on perinatal health outcomes among migrants in western industrialized countries. Methods and Main outcome measures. Drawing on a larger systematic review of perinatal outcomes and migration, we reviewed studies including mortality outcomes (stillbirths and infant deaths). Results. Eligible studies gave conflicting results. Half (53%) reported worse mortality outcomes, one third (35%) reported no differences and a few (13%) reported better outcomes for births to migrants compared to the receiving country population. Refugees were the most vulnerable group. For non‐refugees, non‐European migrants in Europe and foreign‐born blacks in the United States had the highest excess mortality. In general, adjustment of background factors did not explain the increased mortality rate among migrants. Regarding causes of death, higher preterm birth rates explained the increased mortality figures among some migrant groups. The increased mortality from congenital anomalies may be related to restricted access to screening, but also to differing attitudes to screening and termination of pregnancy. Conclusions. Mortality risk among babies born to migrants is not consistently higher, but appears to be greatest among refugees, non‐European migrants to Europe, and foreign‐born blacks in the US. To understand this variation better, more information is needed about migrant background, such as length of time in receiving country and receiving country language fluency. Additional data on demographic, health care, biological, medical, and socioeconomic risk factors should be gathered and analyzed in greater detail.

Abstract  Objective. To study the associations of anxiety and depression with fear of childbirth. Design. A cross‐sectional questionnaire study. Setting. Prenatal public healthcare in Norway. Sample. Pregnant women (n=1642) recruited during November 2008 until April 2010. Methods. Data were collected by a postal questionnaire at pregnancy week 32. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire (W‐DEQ) and by a numeric rating scale. Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL‐25) and symptoms of depression by the Edinburgh Postnatal Depression Scale (EPDS). Main outcome measure. Fear of childbirth. Results. Eight per cent (137 of 1642) of the women had fear of childbirth (W‐DEQ≥85), 8.8% (145 of 1642) had anxiety (SCL‐anxiety≥18) and 8.9% (146 of 1642) had depression (EPDS≥12). More than half (56.2%) of the women with fear of childbirth did not have anxiety or depression; however, presence of anxiety or depression increased the prevalence of fear of childbirth (odds ratio 2.4, 95% confidence interval 1.1–5.2 and odds ratio 8.4, 95% confidence interval 4.8–14.7, respectively). Women with both anxiety and depression had the highest prevalence of fear of childbirth (odds ratio 11.0, 95% confidence interval 6.6–18.3). Similar associations of anxiety and depression were estimated by using the numerical rating scale for measuring fear of childbirth. Conclusions. Presence of anxiety and depression increased the prevalence of fear of childbirth; however, the majority of women with fear of childbirth had neither anxiety nor depression.

Abstract. The etiology of the cyclical mood changes seen in the premenstrual syndrome is still unknown. A close relation to the luteal phase has been shown. One of the differences between the follicular and the luteal phase is the higher plasma progesterone concentration during the luteal phase. The present investigation has been conducted to study the effect of exogenously administered estrogen/gestagen sequential postmenopausal replacement therapy on mood and physical signs.

Twenty‐two women requiring postmenopausal estrogen treatment were recruited and divided into two groups. Eleven women were given estradiol treatment only (Oestro‐gel^R creme 3 mg percutaneously/day) for 21 days with a subsequent break of 7 days. The other 11 women were in addition given progestagen (Lynestrenol, Orgametril^R 5 mg/‐day) during the last 11 days of treatment. The women were asked to keep a daily record of their mood, using a visual analogue scale earlier tested in women with premenstrual syndrome. They also kept a record of physical signs and sexual feelings. The records were kept for between one and 6 months.

The group with estrogen treatment only did not show any cyclical worsening in mood or physical signs during the treatment. The women who in the latter stage of the estrogen treatment cycle also received progestagen, showed significant cyclicity in both moods and physical signs, with a maximum symptom degree during the final days of gestagen treatment. The negative mood change started 1–3 days after the progestagen was added to the treatment. The results suggest that progestagens are involved in the provocation of cyclical symptom changes seen in the premenstrual syndrome.

Background. The aim of this study was to investigate pathologic differences of the placenta in pregnancies complicated by gestational diabetes compared to non‐diabetic pregnancies. Methods. Forty singleton pregnancies complicated by gestational diabetes were recruited and compared to 40 consecutive normal pregnancies. A pathologist, blinded to all clinical data, reviewed all histological samples of the placentas. The histological assessment was carried out with regard to the following aspects: fetal vessel thrombosis, villous immaturity, chorangiosis, presence of nucleated fetal red blood cells (NFRBCs), ischemia, infarction, presence of hydropic or avascular villi, lymphohistiocytic villitis and villous fibrinoid necrosis. Results. The presence of degenerative lesions such as fibrinoid necrosis and vascular lesions like chorangiosis was apparent, mainly in the diabetes group. Villous immaturity and the presence of NFRBC as an indication of chronic fetal hypoxia were significantly increased in the placentas of women with diabetes compared with the control group. Fetal/placental weight ratio was significantly lower in the diabetic group. Conclusion. Histological abnormalities were observed more frequently in the diabetic placentas compared to the controls. These findings support the hypothesis that impaired placental function is one of the main reasons for the increased frequency of fetal complications in diabetic pregnancies.

Background. Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. Methods. Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. Results. Inter‐individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over‐estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r² = 0.13), and in women delivered by elective cesarean section, the correlation was moderate (r² = 0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. Conclusions. The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over‐estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions.