Explore the vast range of titles available.

AbstractObjectivesTo estimate the burden of miscarriage in the Norwegian population and to evaluate the associations with maternal age and pregnancy history.DesignProspective register based study.SettingMedical Birth Register of Norway, the Norwegian Patient Register, and the induced abortion register.ParticipantsAll Norwegian women that were pregnant between 2009-13.Main outcome measureRisk of miscarriage according to the woman’s age and pregnancy history estimated by logistic regression.ResultsThere were 421 201 pregnancies during the study period. The risk of miscarriage was lowest in women aged 25-29 (10%), and rose rapidly after age 30, reaching 53% in women aged 45 and over. There was a strong recurrence risk of miscarriage, with age adjusted odds ratios of 1.54 (95% confidence interval 1.48 to 1.60) after one miscarriage, 2.21 (2.03 to 2.41) after two, and 3.97 (3.29 to 4.78) after three consecutive miscarriages. The risk of miscarriage was modestly increased if the previous birth ended in a preterm delivery (adjusted odds ratio 1.22, 95% confidence interval 1.12 to 1.29), stillbirth (1.30, 1.11 to 1.53), caesarean section (1.16, 1.12 to 1.21), or if the woman had gestational diabetes in the previous pregnancy (1.19, 1.05 to 1.36). The risk of miscarriage was slightly higher in women who themselves had been small for gestational age (1.08, 1.04 to 1.13).ConclusionsThe risk of miscarriage varies greatly with maternal age, shows a strong pattern of recurrence, and is also increased after some adverse pregnancy outcomes. Miscarriage and other pregnancy complications might share underlying causes, which could be biological conditions or unmeasured common risk factors.

Introduction Induction of labor is often performed to prevent adverse perinatal and maternal outcomes, and has become increasingly common. We studied whether changes in prevalence of labor induction in gestational weeks 37–42 weeks were accompanied by changes in adverse pregnancy outcomes or mode of delivery. Material and methods We used data from the Medical Birth Registry of Norway, and included all singleton births in gestational weeks 37–42 in Norway, 1999–2019 (n = 1 127 945). We calculated the prevalence of labor induction and outcome measures according to year of birth. We repeated these calculations for each gestational week at birth. Results The prevalence of labor induction increased from 9.7% to 25.9%, and the increase was particularly high in gestational week 41. A modest decline in fetal deaths was observed in all gestational weeks, except gestational week 41. The overall decline was from 0.18% in 1999–2004 to 0.13% during 2015–2019. There were no overall changes in other perinatal outcomes. The prevalence of postpartum hemorrhage ≥500 ml increased from 11.4% in 1999 to 30.1% in 2019, and operative deliveries increased slightly. The prevalence of acute cesarean section increased from 6.5% to 9.3%, whereas vacuum and/or forceps assisted deliveries increased from 7.8% to 10.4%. Conclusions A high increase in labor inductions was accompanied by a modest decline in fetal deaths, but no decline in other adverse perinatal outcomes. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs. Despite a large increase in induction of labor, we found only a modest decrease in fetal deaths and no decrease in other adverse perinatal outcomes. The prevalence of excess postpartum hemorrhage increased dramatically. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs.

Introduction Over the past five decades, antenatal screening programs have evolved significantly, primarily through advancements in ultrasound technology and the shift from invasive to non‐invasive prenatal testing methods. This study aimed to evaluate the impact of these developments in prenatal screening for Down syndrome (DS) on the prevalence of live and stillbirths, as well as terminations of pregnancy (TOP) with DS. Material and Methods This population‐based registry study included all pregnancies in Norway from 1967 to 2021, with data on TOPs available from 1999. Information on DS pregnancies was obtained from the Medical Birth Registry of Norway. Logistic regression models were applied to evaluate time trends and maternal characteristics associated with TOP. Results Among 3 231 159 pregnancies, 4764 (0.147%) were affected by DS. The prevalence of DS pregnancies increased from 0.165% in 1999 to 0.251% in 2021. During this period, the proportion of TOP rose from 20% to 55%, while prenatal detection rates improved from 18% to 70%. Despite increased detection, the proportion of TOP following prenatal diagnosis remained stable at approximately 80%. The prevalence of live births with DS remained stable at approximately 0.106%, while the prevalence of stillbirths was around 0.008%. Maternal age, parity, country of birth, and region of residence were associated with TOP decisions. Mean gestational age at termination decreased from 17.5 to 15.7 weeks. Conclusions Over recent decades, prenatal detection and termination of DS pregnancies have increased. However, the proportion of women continuing pregnancies after a prenatal diagnosis and the prevalence of live‐ and stillbirths with DS have remained stable. Over the past two decades, pregnancies with DS, prenatal diagnosis, and subsequent terminations have increased. Yet, the proportion continuing pregnancy after diagnosis and the prevalence of live‐ and stillbirths with DS have remained stable throughout the same period.

Introduction Randomized trials have shown that progesterone treatment in mothers with a short cervix may reduce the risk of preterm birth, but the optimal time window for treatment remains unknown. We aimed to investigate progesterone treatment for the prevention of preterm birth by gestational age at diagnosis and initiation of treatment. Material and Methods This was a population‐based historical cohort study of 1162 mothers with singleton pregnancies diagnosed with a cervix <20 mm from 16 to 31 gestational weeks receiving progesterone treatment (n = 390) or no preventive treatment (n = 772). Data were collected from the Medical Birth Registry of Norway from 2014 to 2020 and linked to national health registries providing demographic, diagnostic, and prescription information. Risks of preterm birth <28, <34, and <37 gestational weeks were compared between mothers with and without progesterone treatment in the full study sample and in three periods of gestational age at diagnosis (16–21, 22–27, and 28–31 weeks) using log‐binomial regression analyses. Results The absolute risk of preterm birth <28 gestational weeks was 0.8% in mothers treated with progesterone and 3.4% in mothers who did not receive treatment (adjusted relative risk (aRR) 0.25, 95% confidence interval (CI) 0.08–0.81). The strongest protective association was observed in mothers diagnosed from 16 to 21 weeks (aRR 0.13, 95% CI 0.02–0.98). Preterm birth <34 weeks occurred in 8.7% of mothers in the progesterone group and 11.1% in the untreated group (aRR 0.80, 95% CI 0.54–1.17), and the relative risk reduction associated with treatment diminished with increasing gestational age at diagnosis: aRR 0.27 (95% CI 0.08–0.96) from 16 to 21 weeks; aRR 0.68 (95% CI 0.38–1.23) from 22 to 27 weeks; and aRR 1.30 (95% CI 0.71–2.39) from 28 to 31 weeks. There was no difference in the risk of birth <37 weeks in mothers treated with progesterone (23.1%) and untreated mothers (22.3%), and the risk estimates were similar in the three periods of gestational age at diagnosis. Conclusions Compared to no treatment, progesterone treatment is associated with a reduced risk of preterm birth <28 gestational weeks in pregnancies with a short cervix. The preventive effect of treatment may extend to 34 weeks if treatment is initiated early in the second trimester. Progesterone treatment initiated before 22 gestational weeks in mothers with a short cervix may prevent preterm birth before 28 and possibly 34 weeks. No benefit is observed when treatment begins after 28 weeks or for preterm birth before 37 weeks.

Background Pregnant women who request a cesarean section in the absence of obstetric indication have become a highly debated issue in academic as well as popular literature. In order to find adequate, targeted treatment and preventive strategies, we need a better understanding of this phenomenon. The aim of this study is to provide a qualitative exploration of maternal requests for a planned cesarean section in Norway, in the absence of obstetric indications. Methods A descriptive qualitative study was conducted consisting of 17 semi-structured, in-depth interviews with women requesting cesarean section and six focus group discussions with 20 caregivers (nine midwives, 11 obstetricians) working at a university hospital in Norway. Data were analyzed with Systematic Text Condensation, a method for thematic cross-case analysis. Results Fear of birth emerged most commonly as a result of a previous traumatic birth experience that prompted a preference for a planned cesarean to avoid a repetition of the trauma. For some women in our study, postnatal care and the puerperal period were their crucial past experiences, and giving birth by planned cesarean was seen as a way to ensure mental rather than physical capability to care for the expected child after birth. Others were under the impression of being at high risk for an emergency C-section, and requesting a planned one was based on their perceived risk. Such perceptions included having a narrow pelvis, hereditary factors or previous birth outcomes. Some primiparas requested a planned cesarean based on a deep-seated fear since their early teens, accompanied by alienation towards the idea of giving birth. Some obstetricians participating in our study also experienced requests that lacked what they regarded as any well-grounded reason or significant fear. Conclusions Behind a maternal request for a planned cesarean section are various rationales and life experiences needing carefully targeted attention and health care. Previous births are an important driver; thus, maternally requested cesareans should be regarded partly as an iatrogenic problem.

Introduction Cesarean delivery has been shown to increase the risk of preterm delivery in future pregnancies. The association could be a direct result of the procedure, or because the indications that led to the cesarean delivery also increase the risk of preterm delivery in later pregnancies. Material and Methods 298 901 mothers with first and second singleton deliveries from 1999 to 2020 were investigated using data from the Medical Birth Registry of Norway linked with Statistics Norway. The mothers were categorized by mode of cesarean delivery (total, emergency and planned) and vaginal delivery at term in the first pregnancy. We used log‐binomial regression models to estimate relative risks with 95% confidence intervals (CI) of iatrogenic and spontaneous preterm delivery <37 gestational weeks in the second pregnancy. Second, we explored the role of recurrent placental disease in preterm delivery by comparing estimates in mothers with placental disease in neither or both pregnancies. Results 8243 mothers (2.8%) had a preterm delivery in the second pregnancy. The adjusted relative risk (aRR) of preterm delivery was 1.24 (95% CI 1.17–1.32) after cesarean compared with vaginal delivery in the first pregnancy. The association was stronger in previous planned compared with emergency cesarean delivery (aRR 1.52, 95% CI 1.30–1.77 and aRR 1.21, 95% CI 1.14–1.29, respectively). Spontaneous preterm delivery was not associated with the previous mode of delivery; the risk was confined to iatrogenic preterm delivery after both emergency and planned cesarean delivery (aRR 1.69, 95% CI 1.52–1.87 and aRR 2.65, 95% CI 2.12–3.30, respectively). Mothers with placental disease in both pregnancies had a sixfold increased risk of preterm delivery in the second pregnancy compared with mothers with no placental disease, however, the association between mode of delivery and subsequent preterm delivery was similar in mothers with and without placental disease in the pregnancies. Conclusions Compared with vaginal term delivery in the first pregnancy, cesarean delivery increases the risk of iatrogenic, but not spontaneous preterm delivery in the next pregnancy. Although strongly associated with preterm delivery, placental disease had limited influence on the estimates. Cesarean delivery at term is an independent risk factor for iatrogenic preterm delivery in future pregnancies. Preterm interventions may be indicated by complications from previous surgery, maternal requests, or attempts to avoid the recurrence of complications by intervening at earlier gestations.

Introduction Most studies on factors affecting the risk of preeclampsia have not separated preterm from term preeclampsia, and we still know little about whether the predisposing conditions have a differentiated effect on the risk of preterm and term preeclampsia. Our aim was to assess whether diabetes type 1 and 2, chronic kidney disease, asthma, epilepsy, rheumatoid arthritis and chronic hypertension were differentially associated with preterm and term preeclampsia. Material and methods This is a nationwide, population‐based cohort study containing all births registered in the Medical Birth Registry of Norway from 1999 to 2016. Multinomial logistic regression analysis was used to estimate relative risk ratios (RRRs) with 95% confidence intervals (95% CIs), adjusting for maternal age, parity, multiple gestation and all other studied maternal risk factors. Results We registered 1 044 860 deliveries, of which 9533 (0.9%) women had preterm preeclampsia (<37 weeks) and 26 504 (2.5%) women had term preeclampsia (>37 weeks). Most of the assessed maternal risk factors were associated with increased risk for both preterm and term preeclampsia, with adjusted RRRs ranging from 1.2 to 10.5 (preterm vs no preeclampsia) and 0.9–5.7 (term vs no preeclampsia). Diabetes type 1 and 2 (RRR preterm vs term preeclampsia 2.89, 95% CI 2.46–3.39 and RRR 1.68, 95% CI 1.25–2.25, respectively), chronic kidney disease (RRR 1.55, 95% CI 1.11–2.17) and chronic hypertension (RRR 1.85, 95% CI 1.63–2.10) were more strongly associated with preterm than term preeclampsia in adjusted analyses. For asthma, epilepsy and rheumatoid arthritis, RRRs were closer to one and not significant when comparing risk of preterm and term preeclampsia. Main results were similar when using a diagnosis at <34 weeks to define preterm preeclampsia. Conclusions Diabetes type 1 and 2, chronic kidney disease and chronic hypertension were more strongly associated with preterm than term preeclampsia. Preterm and term preeclampsia may differ in terms of pregestational risk factors. A population‐based cohort study was carried out. Diabetes type 1 and 2, chronic kidney disease and chronic hypertension were more strongly associated with preterm than term preeclampsia.

Introduction The prevalence of Down syndrome (DS) is approximately 1 per 1000 births and is influenced by increasing maternal age over the last few decades. DS is strongly associated with congenital heart defects (CHDs), especially atrioventricular septal defect (AVSD). Our objectives were to investigate the prevalence of live‐born infants with DS having a severe CHD in the Norwegian population over the last 20 years and compare outcomes in infants with AVSD with and without DS. Material and Methods Information on all births from January 1, 2000 to December 31, 2019 was obtained from the Medical Birth Registry of Norway. We also obtained data on all infants with severe CHDs in Norway registered in Oslo University Hospital's Clinical Registry for Congenital Heart Defects during 2000–2019 and accessed individual‐level patient data from the electronic hospital records of selected cases. Infants with AVSD and DS were compared to infants with AVSD without chromosomal defects. Crude and adjusted odds ratios (ORs) of infant mortality and need for surgery during the first year of life, with associated 95% confidence intervals (CIs), were estimated by logistic regression. Results A total of 1 177 926 infants were live‐born in Norway during the study period. Among these, 1456 (0.1%) had DS. The prevalence of infants with DS having a severe CHDs was relatively stable, with a mean of 17 cases per year. The most common CHD associated with DS was AVSD (44.4%). Infants with AVSD and DS were more likely to have cardiac intervention during their first year of life compared to infants with AVSD without chromosomal defects (adjusted OR [aOR]: 2.52; 95% CI 1.27, 4.98). However, we observed no difference in infant mortality during first year of life between the two groups (aOR: 1.08; 95% CI 0.43, 2.70). Conclusions The prevalence of live‐born infants with severe CHDs and DS has been stable in Norway across 20 years. Infants with AVSD and DS did not have higher risk of mortality during their first year of life compared to infants with AVSD without chromosomal defects, despite a higher risk of operative intervention. The rate of live‐born children with DS and AVSD has remained stable during the last 20 years. Notably, infants with DS and AVSD needed more cardiac interventions during the first year of life, but they did not seem to have increased risk of mortality compared to infants with AVSD without chromosomal defects. This information is important for the counseling of expectant parents of a child with a prenatal diagnosis of AVSD with DS.

Increased risk of miscarriage has been reported for women with specific chronic health conditions. A broader investigation of chronic diseases and miscarriage risk may uncover patterns across categories of illness. The objective of this study was to study the risk of miscarriage according to various preexisting chronic diseases. We conducted a registry-based study. Registered pregnancies (n = 593,009) in Norway between 2010 and 2016 were identified through 3 national health registries (birth register, general practitioner data, and patient registries). Six broad categories of illness were identified, comprising 25 chronic diseases defined by diagnostic codes used in general practitioner and patient registries. We required that the diseases were diagnosed before the pregnancy of interest. Miscarriage risk according to underlying chronic diseases was estimated as odds ratios (ORs) using generalized estimating equations adjusting for woman's age. The mean age of women at the start of pregnancy was 29.7 years (SD 5.6 years). We observed an increased risk of miscarriage among women with cardiometabolic diseases (OR 1.25, 95% CI 1.20 to 1.31; p-value <0.001). Within this category, risks were elevated for all conditions: atherosclerosis (2.22; 1.42 to 3.49; p-value <0.001), hypertensive disorders (1.19; 1.13 to 1.26; p-value <0.001), and type 2 diabetes (1.38; 1.26 to 1.51; p-value <0.001). Among other categories of disease, risks were elevated for hypoparathyroidism (2.58; 1.35 to 4.92; p-value 0.004), Cushing syndrome (1.97; 1.06 to 3.65; p-value 0.03), Crohn's disease (OR 1.31; 95% CI: 1.18 to 1.45; p-value 0.001), and endometriosis (1.22; 1.15 to 1.29; p-value <0.001). Findings were largely unchanged after mutual adjustment. Limitations of this study include our inability to adjust for measures of socioeconomic position or lifestyle characteristics, in addition to the rareness of some of the conditions providing limited power. In this registry study, we found that, although risk of miscarriage was largely unaffected by maternal chronic diseases, risk of miscarriage was associated with conditions related to cardiometabolic health. This finding is consistent with emerging evidence linking cardiovascular risk factors to pregnancy complications.