Pregnancy complications and fetal growth
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Health problems and risk factors during pregnancy can have both short- and long-term direct negative effects on the mother and the baby. This research focuses on different methods that can be used for fetal imaging, how different ART methods affect intrauterine and postnatal growth, and the consequences different pregnancy dating methods.
Dating and fetal growth in IVF pregnancies
Studies have shown differences in birth weight between children born after IVF and spontaneous pregnancies. In general, IVF is associated with an increased rate of low birth weight and premature deliveries. More recent studies have shown a higher incidence of low birthweight and small for gestational age in after fresh embryo transfer, while after frozen embryo transfer there is a higher incidence of large for gestational age. One prospective study will compare fetal growth after fresh and frozen embryo transfer to normal pregnancies using serial biometrical measurements. One registry study will compare the same groups in a larger material by several combined registries. The same database will be used in a third study to get a better understanding in the most proper way to date IVF-pregnancies, a question that is still unclear.
Collaborators
Örebro University
Funding
Uppsala-Örebro, FoU Region Uppsala, Swedish Society of Medicine
Responsible researcher/contact person
Eva Bergman, eva.bergman@kbh.uu.se
Mårten Ageheim, marten.ageheim@kbh.uu.se
Viral infections and the pregnancy complications of preeclampsia
Preeclampsia is a serious complication that affects approximately one in twenty pregnant women. We currently do not know what causes preeclampsia. In this research project, we investigate whether viral infections can be an underlying cause of preeclampsia. To answer this research question, we have several different approaches: registry-based information, samples collected from pregnant women and in vitro models.
Financing
The Swedish Research Council, Petrus and Augusta Hedlund's Foundation, Jane and Dan Olsson's Foundation for Scientific Purposes, Maud and Birger Gustavsson's Foundation
Responsible researcher/contact person
Susanne Lager, susanne.lager@kbh.uu.se
Completed projects
Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries
Systematic misclassification of gestational age by ultrasound biometry: implications for clinical practice and research methodology in the Nordic countries - Alkistis Skalkidou 1, Merit Kullinger 1 2, Marios K Georgakis 1, Helle Kieler 3, Ulrik S Kesmodel 4
Historically, pregnancy dating has been based on self-reported information on the first day of the last menstrual period. In the 1970s, ultrasound biometry was introduced as an alternative for pregnancy dating and is now the leading method in Nordic countries. The use of ultrasound led to a reduction of post-term births and fewer inductions, and is considered more precise than last menstrual period-based methods for pregnancy dating. Nevertheless, differences in early growth and specific situations, such as maternal obesity, can render its estimates less precise, leading to gestational age misclassification. Clinical implications of ultrasound dating include effect on timely induction in case of post-term pregnancies, treatment with corticosteroids in cases of anticipated preterm delivery and decision on viability in cases of extreme prematurity. Furthermore, gestational age misclassification may influence the numbers and the magnitude of some adverse perinatal outcomes, closely related to gestational age, which are recorded in the Nordic birth registers.
Ultrasound pregnancy dating leads to biased perinatal morbidity and neonatal mortality among post-term-born girls
Ultrasound pregnancy dating leads to biased perinatal morbidity and neonatal mortality among post-term-born girls - Alkistis Skalkidou 1, Helle Kieler, Olof Stephansson, Nathalie Roos, Sven Cnattingius, Bengt Haglund
Background: Ultrasound assessment of gestational length is based on the assumption that fetuses of the same gestational age have equal size at the time of investigation. However, there are detectable sex differences in fetal size by the end of the first trimester. We examined whether ultrasound dating introduces sex differences in risks of adverse perinatal outcomes related to post-term birth.
Methods: We used the Swedish Medical Birth Register to compare male and female newborns during 1973-1978, when gestational age was based on the last menstrual period, and 1995-2007, when gestational age was based on ultrasound. We included singleton births from 39 to 43 gestational weeks.
Results: During the first time period, the newborn male-to-female ratio by gestational age at delivery was constant around 1.0, but in the later time period it consistently increased by gestational age, reaching 1.60 at 43 weeks. In the first time period, post-term females had reduced risk for adverse perinatal outcomes compared with post-term males. After the introduction of ultrasound, post-term females had higher risks of stillbirth (odds ratio = 1.60 [95% confidence interval = 1.11 to 2.30]) and meconium aspiration (1.39 [1.10 to 1.75]), compared with post-term males. One-third of stillbirths among post-term girls today might be due to incorrect calculation of gestational age.
Conclusions: Introduction of ultrasound for the estimation of gestational age may be associated with increased risks of adverse perinatal outcomes among females classified as post-term compared with their male counterparts.