The aim of this study was to investigate the association of risk variants for type 2 diabetes (T2D) and hyperglycemia with gestational diabetes (GDM).
Five hundred and thirty-three Finnish women who were diagnosed with GDM and 407 controls with normal glucose tolerance during the pregnancy were genotyped for 69 single-nucleotide polymorphisms (SNPs) which have been previously verified as susceptibility risk variants for T2D and hyperglycemia. All participants underwent an oral glucose tolerance test at the follow-up study after the index pregnancy.
Risk variants rs10830963 and rs1387153 of MTNR1B were significantly associated with GDM (odds ratio (OR)=1.62 (95% CI 1.34-1.96), P=4.5 × 10?7 and 1.38 (1.14-1.66), P=7.6 × 10?4 respectively). Both SNPs of MTNR1B were also significantly associated with elevated fasting glucose level and reduced insulin secretion at follow-up. Additionally, risk variants rs9939609 of FTO, rs2796441 of TLE1, rs560887 of G6PC2, rs780094 of GCKR, rs7903146 of TCF7L2 and rs11708067 of ADCY5 showed nominally significant associations with GDM (OR range from 1.25 to 1.30).
Our study suggests that GDM and T2D share a similar genetic background. Our findings also provide further evidence that risk variants of MTNR1B are associated with GDM by increasing fasting plasma glucose and decreasing insulin secretion.
To investigate links between first trimester Down's syndrome screening markers and adverse pregnancy outcomes; preeclampsia (PE), small for gestational age (SGA), preterm delivery (PD) and placental abruption (PA) in spontaneous, chromosomally normal pregnancies.
Cohort study in a university hospital. Data during pregnancy were routinely collected from a total study population of 2844 pregnant women between 2005 and 2007. Four study groups were pregnancies with PE (N=175), PA (N=17), PD (N=213) and SGA (N=275) plus a reference group with normal outcome (N=2164). The median MOMs of maternal serum concentrations of pregnancy associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fß-hCG) were compared using two-tailed pooled t-tests, continuous variables were compared using Student's two-way t-tests, and Chi-square tests were used to analyse dichotomous variables. Fisher's exact test was used when there were fewer than five units in any of the classes.
The median MOM of maternal serum PAPP-A was significantly lower in women with PE, PD and SGA (0.79, 0.80 and 0.79 MOM, respectively) than in the reference group (0.99 MOM) (p
The influence of unemployment in the family on pregnancy outcome is controversial. Only a few studies have involved investigation of the effect of unemployment of the father on pregnancy. The objective of this study was to assess the effects of unemployment of one or both parents on obstetric outcome in conditions of free antenatal care attended by the entire pregnant population.
The data of 24,939 pregnancies included maternal risk factors, pregnancy characteristics and outcome, and was based on a self administered questionnaire at 20 weeks of pregnancy and on clinical records.
Unemployment was associated with adolescent maternal age, unmarried status and overweight, anemia, smoking, alcohol consumption and prior pregnancy terminations. Multivariate logistic regression analysis indicated that after controlling for these maternal risk factors small differences only were found in pregnancy outcomes between unemployed and employed families. Unemployed women had significantly more often small-for-gestational-age (SGA) infants, at an OR of 1.26 (95% CI: 1.12-1.42) whereas, in families where both parents were unemployed, the risk of SGA was even higher at an OR of 1.43 (95% CI: 1.18-1.73). Otherwise, pregnancy outcome was comparable in the groups studied.
Free antenatal care was unable to fully overcome the adverse pregnancy outcomes associated with unemployment, SGA risk being highest when both parents are unemployed.
to describe and explain the short-term effects of lateral episiotomy, and determine the factors associated with more/less common use of episiotomy.
prospective cross-sectional survey using a postal questionnaire.
the study was conducted at two university hospitals and one regional hospital in Finland between October and December 2006. The hospitals were chosen using cluster sampling. The sample consisted of 1000 vaginal births, and data were collected using questionnaires which were completed by midwives or student midwives. The overall response rate was 88%.
midwives or student midwives who took care of the women in labour provided information about childbearing women (n=879), obstetric factors and details of staff experience.
episiotomies were more common among primiparous than multiparous women (55% vs 12%, p0.001). More common use of episiotomy was also associated with induced births compared with spontaneous births in primiparous women (66% vs 53%, p=0.036), assisted vaginal births in all women (89% vs 25%, p0.001), and a prolonged active second stage of labour and epidural analgesia (17% vs 10%, p=0.036) in multiparous women. Correspondingly, episiotomies were less common among primiparous (44% vs 57%, p=0.041) and multiparous (7% vs 16%, p=0.003) women using spontaneous pushing compared with coached pushing. In the active second stage of labour, alternative birth positions (lateral, squatting, all fours, sitting) were associated with less common use of episiotomy than half-sitting or lithotomy positions among primiparous women (22% vs 48% vs 85%, p0.001). There were no differences between primiparous women with and without episiotomy in low Apgar score at 1minute (10.6% vs 6.4%, p=0.131) or 5minutes (1.8% vs 1.1%, p=0.557), or between multiparous women with and without episiotomy in low Apgar score at 1minute (1.9% vs 2.2%, p=0.855) or 5minutes (0% vs 0.5%, p=0.603). There were more first- and second-degree perineal injuries as well as injuries to the vagina, labia minora and urethra in births performed without episiotomies among primiparous women (p0.001). Correspondingly, third-degree perineal injuries were more common if episiotomy was performed in both primiparous (2.2% vs 1.6%) and multiparous women (3.7% vs 0%). The maternity hospital was the most significant determinant of the episiotomy rate (odds ratio 1 vs 1.9 vs 2.6, p=0.049).
episiotomy rates can be reduced without causing harm to women or newborn babies. Episiotomies can be avoided if induction and vacuum assistance are used sparingly, and if spontaneous pushing techniques and alternative birth positions (lateral, sitting, squatting, all fours) are used more often during labour.
The objective of this study was to determine the outcome of pregnancy in post-term cases compared with term cases in a well defined population receiving modern obstetric care.
We utilized the population-based birth registry data of the Kuopio University Hospital (1990-2000) to investigate pregnancy outcome in 1,678 post-term singleton pregnancies. The general obstetric population (n=22,712) was used as a reference group in logistic regression analysis.
The overall frequency of post-term pregnancies was 6.9% and the incidence of post-term pregnancies was found to be increased in obese, primiparous, and smoking women, whereas in women with chronic diseases and obstetric risks deliveries were induced earlier. The risks of macrosomia, maternal complications, and operative deliveries were increased in post-term pregnancies. Post-term infants experienced meconium passage (21.2% versus 12.8%) (p
To identify risk factors for true umbilical cord knot and to evaluate its association with fetal death, premature birth, low birth weight, small-for-gestational-age (SGA) infants, low Apgar score at 1 and 5 minutes, fetal venous pH of 7.15 or lower, and need for neonatal intensive care in singleton pregnancies.
The total population of women who delivered at Kuopio University Hospital, Kuopio, Finland, between January 2000 and August 2012 was reviewed. Risk factors for umbilical cord knot and its association with adverse pregnancy outcome were evaluated separately among women with and without true cord knot via logistic regression analysis.
Overall, 340 (1.2%) of 27 537 singleton pregnancies were affected by umbilical cord knot, with increased incidence associated with advanced maternal age, multiparity, previous spontaneous abortion, polyhydramnios, and diabetes mellitus. Umbilical cord knot was associated with a 1.58-, 8.08-, 3.90-, 3.17-, 1.67-, and 2.00-fold increased risk of neonatal intensive care, fetal death, premature birth, SGA infants, and low Apgar score at 1 and 5 minutes, respectively.
True umbilical cord knot is relatively common and is associated with increased incidence of SGA infants, premature birth, need for neonatal intensive care, and fetal death.