The interval between pregnancies and the risk of preeclampsia.

BACKGROUND: The risk of preeclampsia is generally lower in second pregnancies than in first pregnancies, but not if the mother has a new partner for the second pregnancy. One explanation is that the risk is reduced with repeated maternal exposure and adaptation to specific antigens from the same partner. However, the difference in risk might instead be explained by the interval between births. A longer interbirth interval may be associated with both a change of partner and a higher risk of preeclampsia. METHODS: We used data from the Medical Birth Registry of Norway, a population-based registry that includes births that occurred between 1967 and 1998. We studied 551,478 women who had two or more singleton deliveries and 209,423 women who had three or more singleton deliveries. RESULTS: Preeclampsia occurred during 3.9 percent of first pregnancies, 1.7 percent of second pregnancies, and 1.8 percent of third pregnancies when the woman had the same partner. The risk in a second or third pregnancy was directly related to the time that had elapsed since the preceding delivery, and when the interbirth interval was 10 years or more, the risk approximated that among nulliparous women. After adjustment for the presence or absence of a change of partner, maternal age, and year of delivery, the odds ratio for preeclampsia for each one-year increase in the interbirth interval was 1.12 (95 percent confidence interval, 1.11 to 1.13). In unadjusted analyses, a pregnancy involving a new partner was associated with higher risk of preeclampsia, but after adjustment for the interbirth interval, the risk of preeclampsia was reduced (odds ratio for preeclampsia with a change of partner, 0.73; 95 percent confidence interval, 0.66 to 0.81). CONCLUSIONS: The protective effect of previous pregnancy against preeclampsia is transient. After adjustment for the interval between births, a change of partner is not associated with an increased risk of preeclampsia.     

Patient education and basic body awareness therapy in hip osteoarthritis – a qualitative study of patients’ movement learning experiences

Background: Osteoarthritis (OA) is associated with pain, dysfunction and reduced quality of life. Patient education (PE) followed by 12 weekly sessions of Basic Body Awareness Therapy (BBAT) was offered to patients with hip OA, aiming to strengthen their ability to move and act functionally in daily life.

Aim: To explore how patients described their experiences and outcome from participating in PE and BBAT.

Method: Individual, semi-structured interviews with five patients, aged 52-78 years, were performed after PE and BBAT at four and ten months. Interview data were analyzed by systematic text condensation.

Results: Three main themes emerged. “Becoming motivated and involved” reflected experiences of encouragement and support from information given and communication with group members. In “Movement awareness learning” patients described becoming aware of and improving functional movement, alleviating symptoms and increasing daily functioning. “Movement and disease in a long-term perspective” reflected patient? experience of increased self-awareness and taking better care of themselves at 10 months after baseline. Practicing basic movement principles, they felt empowered to handle daily life challenges in more functional and energy-economical ways.

Conclusion: PE followed by BBAT in groups may be beneficial to patients with hip OA, and provide lasting benefits regarding daily life function.

• Implications for Rehabilitation

• Insight into disease process and relationship to functional movement gained through patient education may empower patients with hip osteoarthritis in management of daily life

• Movement awareness and exploration of movement quality using principles from Basic Body Awareness Therapy was found to support patients in finding resources for functional movement, implemented in daily actions

• Movement strategies characterized by adjustment rather than force was experienced by the patients to support their general functioning, despite of prevailing hip pain

• Implementing group therapeutic factors (Yalom) in physiotherapy was found to strengthen patients’ motivation and belief in functional improvement

     

Maternal angiotensinogen (<Emphasis Type="Italic">AGT</Emphasis>) haplotypes,fetal renin (<Emphasis Type="Italic">REN</Emphasis>) haplotypes and risk of preeclampsia; estimation of gene-gene interaction from family-triad data

Background  

Preeclampsia is a debilitating disorder affecting approximately 3% of pregnant women in the Western world. Although inconclusive, current evidence suggests that the renin-angiotensin system may be involved in hypertension. Therefore, our objective was to determine whether the genes for placental renin (REN) and maternal angiotensinogen (AGT) interact to influence the risk of preeclampsia.     

First-trimester maternal alcohol consumption and the risk of infant oral clefts in Norway: a population-based case-control study

Although alcohol is a recognized teratogen, evidence is limited on alcohol intake and oral cleft risk. The authors examined the association between maternal alcohol consumption and oral clefts in a national, population-based case-control study of infants born in 1996-2001 in Norway. Participants were 377 infants with cleft lip with or without cleft palate, 196 with cleft palate only, and 763 controls. Mothers reported first-trimester alcohol consumption in self-administered questionnaires completed within a few months after delivery. Logistic regression was used to calculate odds ratios and 95% confidence intervals, adjusting for confounders. Compared with nondrinkers, women who reported binge-level drinking (>or=5 drinks per sitting) were more likely to have an infant with cleft lip with or without cleft palate (odds ratio = 2.2, 95% confidence interval: 1.1, 4.2) and cleft palate only (odds ratio = 2.6, 95% confidence interval: 1.2, 5.6). Odds ratios were higher among women who binged on three or more occasions: odds ratio = 3.2 for cleft lip with or without cleft palate (95% confidence interval: 1.0, 10.2) and odds ratio = 3.0 for cleft palate only (95% confidence interval: 0.7, 13.0). Maternal binge-level drinking may increase the risk of infant clefts.     

Familial patterns of preterm delivery: maternal and fetal contributions

Women who deliver preterm (<37 completed weeks' gestation) are at high risk for recurrence. This has prompted exploration of candidate genes (both maternal and fetal) associated with preterm delivery. Epidemiologists can use recurrence patterns of preterm delivery across generations to assess the relative contributions of maternal and fetal genes. The authors used data from the Medical Birth Registry of Norway (1967-2004) to identify 191,282 mothers and 127,830 fathers who subsequently had at least one singleton offspring. The authors stratified parents according to whether or not they had been born preterm and calculated the risk of preterm delivery among their firstborn. Mothers born preterm had a relative risk for preterm delivery of 1.54 (95% confidence interval (CI): 1.42, 1.67). This association was weaker for fathers born preterm (relative risk (RR) = 1.12, 95% CI: 1.01, 1.25). Among early preterm births (<35 weeks), the effect became stronger for mothers (RR = 1.85, 95% CI: 1.52, 2.27) and weaker for fathers (RR = 1.06, 95% CI: 0.77, 1.44). These data suggest that paternal genes have little, if any, effect on preterm delivery risk. This argues against major contributions of fetal genes inherited from either parent. The increased risk of preterm delivery among mothers born preterm is consistent with heritable maternal phenotypes that confer a propensity to deliver preterm.     

Maternal dietary intake of vitamin A and risk of orofacial clefts: a population-based case-control study in Norway

A population-based case-control study was carried out in Norway between 1996 and 2001. The aim was to evaluate the association between maternal intake of vitamin A from diet and supplements and risk of having a baby with an orofacial cleft. Data on maternal dietary intake were available from 535 cases (188 with cleft palate only and 347 with cleft lip with or without cleft palate) and 693 controls. The adjusted odds ratio for isolated cleft palate only was 0.47 (95% confidence interval: 0.24, 0.94) when comparing the fourth and first quartiles of maternal intake of total vitamin A. In contrast, there was no appreciable association of total vitamin A with isolated cleft lip with or without cleft palate. An intake of vitamin A above the 95th percentile was associated with a lower estimated risk of all isolated clefts compared with the 40th-60th percentile (adjusted odds ratio = 0.48, 95% confidence interval: 0.20, 1.14). Maternal intake of vitamin A is associated with reduced risk of cleft palate only, and there is no evidence of increased risk of clefts among women in our study with the highest 5% of vitamin A intake.     

Outcomes of pregnancies following a birth with major birth defects: a population based study

Background/aim

Parents whose first infant had birth defects may worry about a new pregnancy. Our aim was to study pregnancy outcomes among non-malformed second siblings in families where the first birth had a major birth defect.

Methods

Data were from the Medical Birth Registry of Norway from 1967 to 2004. Births were linked to their mothers through the unique national identification numbers, providing sibship files with the mother as the observation unit. The study was based on 538,669 singleton first and second full siblings. Families were classified as affected families if the first infant had a major birth defect. Pregnancy outcomes for non-malformed second siblings following affected first births were compared with second siblings in families without malformed infants. Subgroup analyses were done for families where first infants had neural tube defects, cleft lip with or without cleft palate, abdominal wall defects, limb reduction defects, pes equinovarus and congenital dysplasia of the hip.

Results

Second siblings in affected families did not differ from those in unaffected families in risk of perinatal death, small for gestational age, preterm birth, placental abruption or preeclampsia. Second siblings following an infant with limb reduction defects had a higher risk of breech presentation than second siblings in unaffected families, also when stratifying on previous siblings in vertex presentation (stratified OR 2.20 [95% C.I. 1.17-4.15]).

Conclusion

Parents who proceed to a new pregnancy after a first birth with birth defects may be reassured that, given no recurring defects, there is in general no increased risk of adverse pregnancy outcomes.     

Suicide and violent deaths in survivors of cancer in childhood,adolescence and young adulthood—A national cohort study

Suicide risk in adult cancer patients is found to be elevated, but limited information exists regarding risks of suicide and non‐suicidal violent deaths when diagnosed with cancer in young age. We investigate suicide and violent deaths in a national cohort including individuals diagnosed with cancer before age 25. Through the linkage of different national registries (Cancer Registry of Norway, Norwegian Causes of Death Registry and the National Registry) a cohort of all live births in Norway during 1965–1985 was defined and followed up through 2008. Individuals diagnosed with cancer before age 25 and the cancer‐free references were compared using an extended Cox proportional hazard regression model. The cohort comprised 1,218,013 individuals, including 5,440 diagnosed with cancer before age 25. We identified 24 suicides and 14 non‐suicidal violent deaths in the cancer group. The hazard ratio (HR) of suicide in the cancer group was 2.5 (95% confidence interval (CI) 1.7–3.8), and was increased both when diagnosed with cancer in childhood (0–14 years of age); HR = 2.3 (95% CI: 1.2–4.6), and during adolescence/young adulthood (15–24 years); HR = 2.6 (95% CI: 1.5–4.2). Survivors of bone/soft tissue sarcomas, CNS tumors and testicular cancer were at particular risk. The risk of non‐suicidal violent death was not increased in the cancer survivors (HR = 1.0; 95% CI: 0.6–1.7). Although based on small numbers and the absolute risk of suicide being low, these are novel findings with important implications for establishing adequate follow‐up including suicide prevention strategies for young cancer survivors.     

Birthweight and perinatal mortality of second births conditional on weight of the first

A woman's successive offspring tend to have similar birthweights. We use data from the Medical Birth Registry of Norway to describe weight and perinatal mortality of second births given the weight of the mother's first birth. Mean weights among second births differ by as much as 1000 grams, depending on the weight of the first. Furthermore, the survival of the second baby at any given weight is strongly affected by its weight relative to the first baby's weight. A baby may be average size compared to the whole population, but small compared to its sibling; such a baby has the increased mortality that goes with being relatively small. For example, an infant of 3250 grams is relatively large if the mother's previous baby was 2250 grams, but relatively small if the previous birth weighed 4250 grams. In the first case, the mortality risk of the 3250-gram baby is 2.2 per thousand, while in the second case, risk for the same weight infant is 9.0, or four times higher. Implications of these observations for the more general analysis of birthweight and perinatal mortality are discussed.