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N J Secher

Publications and source records attributed to N J Secher.

At least 19 recordsLinked to original sources
PubMed1996

The relationship between psychological distress during pregnancy and birth weight for gestational age.

BACKGROUND: Fetal growth may be determined by genetic as well as environmental factors. Whether psychological distress during pregnancy influences fetal growth is a matter of debate. MATERIAL AND METHODS: A prospective population-based study with repeated measures of psychological distress (General Health Questionnaire) during pregnancy, based on the use of questionnaires. Danish speaking women with singleton pregnancies attending antenatal care between August 1, 1989 and September 30, 1991 were eligible to the study (n = 8719). Of these women 5868 women (67%) completed all questionnaires. The main outcome measure was fetal growth (assessed as birth weight for gestational age (continuous)) and birth weight below the 10th percentile of birth weight for gestational age (light for gestational age (LGA) (dichotomous). Gestational age was calculated primarily from an early ultrasound scan. Confounders were controlled using multivariate statistical methods. RESULTS: Birth weight for gestational age and risk of delivering a LGA baby were not associated with psychological distress, neither distress in 16th week nor in 30th week of pregnancy. CONCLUSION: To the extent that fetal growth can be explored at birth, the results indicate that psychological distress does not influence fetal growth.

Adult↗
PubMed1995

[Changes in the use of episiotomy--methods and consequences].

The aim of the study was to evaluate the use of feedback by graphical profiles of rates of episiotomy and the impact on clinical practice and perineal state after spontaneous vaginal deliveries assisted by midwives with different attitudes towards episiotomy. We defined an observation period in our labour ward followed by feedback to the midwives concerning their own and the other midwives' use of episiotomies. The periods prior to and following the intervention were compared. All women (n = 3919) delivering during the two periods assisted by one of 30 midwives with at least 20 deliveries during each period were included. The overall rate of episiotomy during the observation period was 37.1%. During the second period the rate was 6.6% lower (95% confidence interval (CI):3.6-9.6%) corresponding to a relative decrease of 17.8% (CI:10.1-24.7%). Higher rates of episiotomy during the observation period were associated with larger reductions in the second period. The decrease could be explained by the less frequent use of episiotomy in deliveries with rigid perineum or impending perineal tear. Compared with the observation period, 3.2% more women (CI:0.3-6.3%) had an intact perineum after delivery in the second period, and 3.4% more women (CI:0.4-6.2%) experienced perineal tears. The overall frequency of tears of the anal sphincter remained unchanged. However, women had slightly reduced frequency of tears of the anal sphincter if they were delivered by midwives who reduced a medium or high initial rate of episiotomy; and a tendency towards increased frequency of tears if they were assisted by midwives who reduced low initial rates (around 20%) of episiotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

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Computer Communication Networks↗
PubMed1995

Gestation length and birth weight in relation to intake of marine n-3 fatty acids.

It has been hypothesized that marine n-3 fatty acids ingested during pregnancy prolong duration of pregnancy and increase fetal growth rate in humans. By a combined self-administered questionnaire and interview applied in the 30th week of gestation we assessed dietary intake of marine n-3 fatty acids and energy in a population-based sample of 965 pregnant Danish women; in a random 14% subsample we also measured marine n-3 fatty acids relative to arachidonic acid (FA-ratio) in erythrocytes. Mean intake of marine n-3 fatty acids was 0.25 (95% range 0-0.75) g/d. We could detect no association between n-3 fatty acid intake and FA-ratio on the one hand, and gestation length, birth weight and birth length on the other. The analyses were adjusted for maternal height, prepregnant weight, parity and smoking. The conclusion from the study was that within the intake range of this population, marine n-3 fatty acids ingested in the weeks prior to the 30th week of pregnancy seem not to be a predictor of gestation length or fetal growth rate.

Adult↗
PubMed1995

Essential fatty acid status in neonates after fish-oil supplementation during late pregnancy.

Healthy pregnant women (n 23) were supplemented with fish-oil capsules (2.7 g n-3 polyunsaturated fatty acids/d) from the 30th week of gestation until delivery. Subjects in a control group were either supplemented with olive-oil capsules (4 g/d, n 6) or received no supplementation (n 10). Fatty acid compositions of the phospholipids isolated from umbilical plasma and umbilical arterial and venous vessel walls were determined. Fatty acid compositions of maternal venous plasma phospholipids were determined as well. Maternal plasma phospholipids of the fish-oil-supplemented group contained more n-3 fatty acids and less n-6 fatty acids. Moreover, the amounts of the essential fatty acid deficiency markers Mead acid (20:3n-9) and Osbond acid (22:5n-6) were significantly lower. The extra amount of n-3 fatty acids consumed by the mothers resulted in higher contents of n-3 fatty acids, and of docosahexaenoic acid (22:6n-3) in particular, in the phospholipids of umbilical plasma and vessel walls. It is, indeed, possible to interfere with the docosahexaenoic acid status at birth: children born to mothers supplemented with fish oil in the last trimester of pregnancy start with a better docosahexaenoic acid status at birth, which may be beneficial to neonatal neurodevelopment.

Adult↗
PubMed1995

Bias in studies of preterm and postterm delivery due to ultrasound assessment of gestational age.

Ultrasound measurement of fetal dimensions is widely used for estimating gestational age. A little-discussed limitation of this method is that variations in fetal size at a given stage of pregnancy are converted to differences in gestational age. Factors that affect pregnancy duration often affect fetal size also. We explore how the effect of such factors may be biased when gestational age is determined by ultrasound. We selected 3,606 women with singleton pregnancies (1989-1991) who had an early ultrasound measurement of fetal biparietal diameter (BPD) and a good-quality history of last menstrual period (LMP). Using the two measures of gestational age, we estimated risk of preterm and postterm delivery for female babies vs males and for smoking women vs nonsmoking women. There was a 13% excess of preterm delivery among female babies when gestational age was determined by ultrasound, but no excess when gestational age was defined by LMP. For postterm delivery, female babies had a 19% lower risk with ultrasound-defined age, but no deficit with LMP-defined age. We found a similar bias with ultrasound in the analysis of maternal smoking. Thus, factors that reduce fetal size inflate the risk of preterm delivery and deflate the risk of postterm delivery when gestational age is based on ultrasound measurement of the fetus. This bias can distort the relative risk of preterm or postterm delivery by 10-20%.

Adult↗
PubMed1995

Standing at work and preterm delivery.

OBJECTIVE: Guidelines in some European countries and the United States suggest that pregnant women should avoid prolonged standing and heavy lifting in the workplace during the second and third trimester of pregnancy. However, results from epidemiological studies on this topic are ambiguous. The aim of this study was to evaluate the influence of standing and walking at work in the second trimester on preterm delivery in a population with a low frequency of other workplace hazards. SUBJECTS AND DESIGN: A prospective cohort of 8711 women with singleton pregnancies was established during 1989 through 1991. Information was collected during the 16th week of pregnancy about medical and obstetrical history, general lifestyle factors and exposures at work. The analyses were restricted to 4259 respondents who worked at the 16th week. Potential confounders and effect modifiers were evaluated by stratification and multivariate analyses. RESULTS: After adjustment for confounders, women standing more than five hours per work day had an odds ratio (OR) for preterm delivery of 1.2 (95% CI 0.6 to 2.4) compared with women standing two hours or less. For walking, the OR was 1.4 (95% CI 0.7 to 2.5). Many women were unable to separate periods of standing from periods of walking; a combined measure of these two exposures was created to reflect exposure intensity. Women who reported more than five hours of both standing and walking had an adjusted OR of 3.3 (95% CI 1.4 to 8.0) compared with women who reported two hours or less on either of the exposures. No adverse effects were seen for lifting or other types of physical exertion. CONCLUSIONS: Our findings suggest that standing and walking at work during the second trimester may present a particular risk for preterm delivery, and workplace guidelines are justified. Further research is needed to address the specific mechanisms by which physical exertion, including standing and walking, might cause preterm delivery.

Cohort Studies↗
PubMed1995

Standing and walking at work and birthweight.

OBJECTIVES: To study the influence of standing and walking at work on birthweight for gestational age. METHODS: A prospective cohort of 8711 women with singleton pregnancies was established (1989-91). Information about medical and obstetrical history, lifestyle factors and work related exposures were collected at 16 gestational weeks. The 4249 respondents who worked during pregnancy formed the basis of the analyses. RESULTS: After adjustment for confounders and gestational age at delivery, infants of women standing > 5 hours per workday had birthweights 49 g lower (95% confidence interval (CI): -108 to 10) than those of women standing < or = 2 hours. Infants of women walking > 2 but < or = 5 hours per workday had higher birthweights (35 g, CI: 8-63) than those of women with both shorter and longer hours of walking per day. Some women were unable to separate periods of standing from walking; a combined measure of these two exposures was created to reflect exposure intensity. Women who reported > 5 hours of both standing and walking had infants with significantly lower birthweight (-119 g, CI: -230 to -8) compared to those of women who reported < or = 2 hours on either of the exposures. CONCLUSIONS: Our study suggests that standing at work affects birthweight. Prolonged hours of walking and standing decrease birthweight for gestational age, whereas some degree of walking seems beneficial in terms of increased birthweight.

Adult↗
PubMed1995

Perturbed (procoagulant) endothelium and deviations within the fibrinolytic system during the third trimester of normal pregnancy. A possible link to placental function.

PURPOSE: To evaluate the endothelial cell state and the possible relation to placental function in the third trimester of normal pregnancy by an indirect assessment of endothelial cell function. STUDY-DESIGN. Twenty-six pregnant women entered the study in the 30th week of pregnancy. Von Willebrand Factor, urate and key hemostatic variables were quantified at entry, and during the 33rd and 37th weeks of pregnancy. RESULTS: Levels of von Willebrand Factor, PAI-1 antigen, t-PA antigen; variables produced by the endothelial cell, increased during the third trimester of pregnancy. Serum urate, which is correlated with clinical outcome of pregnancy, increased during the study period and correlated directly with von Willebrand Factor and PAI-1 antigen, respectively. There was an inverse correlation between the concentrations of placenta-derived PAI-2 antigen and urate. CONCLUSIONS: In healthy human pregnancy the markers of endothelial related processes of coagulation and fibrinolysis pointed towards a procoagulatory state of the endothelial cell. However, the balance between fibrin formation and resolution seemed to be maintained in uncomplicated pregnancy. Our study indicated an association between this change of endothelial cell function and placental function.

Adult↗
PubMed1994

Methods and consequences of changes in use of episiotomy.

OBJECTIVES: To evaluate the use of feedback by graphical profiles of rates of episiotomy and the impact on clinical practice and perineal state after spontaneous vaginal deliveries assisted by midwives with different attitudes towards episiotomy. DESIGN: Observation period in labour ward followed by feedback to midwives about their own and other midwives' use of episiotomies. The periods before and after the intervention were compared. SUBJECTS: All women (n = 3919) delivering during the two periods who had been assisted by one of 30 midwives; each midwife supervised at least 20 deliveries during each period. MAIN OUTCOME MEASURES: Overall rates of episiotomies and indications, incidence of intact perineums, perineal lacerations, and tears of anal sphincter. RESULTS: The overall rate of episiotomy during the observation period was 37.1% (615). During the second period the rate was 6.6% lower (95% confidence interval 3.6% to 9.6%), corresponding to a relative decrease of 17.8% (10.1% to 24.7%). Higher rates of episiotomy during the observation period were associated with larger reductions in the second period. The decrease could be explained by less use of episiotomy in deliveries with rigid perineum or impending perineal tear. Compared with the observation period, in the second period 3.2% more women (0.3% to 6.3%) had an intact perineum after delivery and 3.4% (0.4% to 6.2%) experienced perineal tears. The overall incidence of tears of the anal sphincter remained unchanged. Women had a slightly reduced incidence of tears of the anal sphincter, however, if they were delivered by midwives who reduced a medium or high initial rate of episiotomy and a tendency towards an increased incidence of tears if they were assisted by midwives who reduced low initial rates (around 20%) of episiotomy. CONCLUSIONS: Changes in the use of episiotomy induced by awareness of clinical practice among midwives seem to increase the incidence of parturients with intact perineum without a concomitant rise in tears of the anal sphincter. To avoid the increase of such tears these changes should probably be restricted to midwives with rates of episiotomies above 30%.

Adult↗
PubMed1994

[Strategies for smoking cessation among pregnant women].

Smoking during pregnancy is harmful to the health of the fetus and the newborn. Smoking increases the risk of low birthweight, preterm delivery and perinatal death. In developed countries smoking during pregnancy is regarded as the single most important risk factor for which it is possible to intervene. We reviewed the Scandinavian and English randomized controlled intervention studies directed towards smoking cessation during pregnancy. The intervention studies were classified according to the method of intervention namely antismoking advice, self-help manuals, measurements of smoking dependent chemical factors and multifactorial methods. We conclude that it is possible to reduce smoking during pregnancy only by an efficient and personal effort performed by a committed person towards each pregnant woman.

Clinical Trials as Topic↗
PubMed1994

[Episiotomy and perineal lesions in spontaneous vaginal delivery].

The purpose of the study was to evaluate the influence of mediolateral episiotomy on the perineal state after spontaneous, singleton vaginal deliveries with the foetus in the occiput anterior position. The design was that of a population based, observational study. Two approaches were used in the analyses: Initially, we considered the parturients as quasi-randomised to one of three equally sized groups of midwives with different attitudes towards episiotomy. Secondly, we studied the effect of episiotomy on the state of the anal sphincter, controlling for birth weight, parity, and duration of second stage of labour. The subjects were 2188 pregnant women delivering consecutively, and the main outcome measures were perineal lacerations and tearing of the anal sphincter. Women allocated to the group of midwives with the lowest rate of episiotomy were more likely to have an intact perineum after delivery (OR = 1.8 (1.4-2.2)), had a slight tendency towards more perineal lacerations (OR = 1.3 (1.0-1.5)), but no increased risk of tearing of the anal sphincter, compared with the women allocated to the two groups of midwives with higher frequencies of episiotomy. The second approach showed that episiotomy was related to an increased risk of tearing of the anal sphincter (OR = 2.3 (1.2-4.6)). However, this relation was not found among the group of parturients delivered by the midwives with the lowest rate of episiotomy (22%). Our results encourage a conservative approach to the use of mediolateral episiotomy, and in the light of previous findings, it seems reasonable to suggest that episiotomy should ideally be used in about one in five spontaneous vaginal deliveries.

Adult↗
PubMed1994

[Fish oil supplementation and duration of pregnancy. A randomized controlled trial].

It was hypothesised from previous observational studies in the Faroes and Denmark that dietary marine n-3 fatty acids would prolong the duration of pregnancy and thereby increase the birth weight, by influencing the production of prostaglandins involved in the process of parturition. Five hundred and thirty-three healthy Danish women were randomly assigned in the 30th week of pregnancy to fish oil (2.7 g n-3 fatty acids (4 1-g capsules Pikasol oil) per day), olive oil (4 1-g capsules per day) or no oil supplementation. The three groups differed in mean gestational age at birth (ANOVA, p = 0.006), with the fish oil group ranking highest and the olive oil group lowest. Babies born to women allocated fish oil had on average 4.0 (95% confidence interval 1.5;6.4) days higher gestational age and 107 (95% confidence interval 1;214) g higher weight at birth than babies born to women allocated olive oil; the difference in gestational age depended on the level of fish intake at enrollment, with a low fish intake enhancing the difference. Fish oil supplementation in the third trimester seems to prolong gestation while allowing continued growth of the foetus; this effect seems to explain the difference between the Faroes and Denmark in pregnancy duration.

Adult↗
PubMed1994

The relation between psychosocial job strain, and preterm delivery and low birthweight for gestational age.

BACKGROUND: The aim of this cohort study was to evaluate the relationship between psychosocial job demands and job control during pregnancy and risk of small-for-gestational age (SGA) and preterm delivery. METHODS: We studied 8711 Danish women with singleton pregnancies between 1989 and 1991. Information about medical and obstetric history, general psychosocial and lifestyle factors and occupational exposures were collected at 16 weeks gestation. The analyses were restricted to 3503 respondents who worked at least 30 hours per week during the first trimester. The women's scores on both the job demand and job control questionnaire were initially dichotomized at the median score, and combined into four exposure categories: relaxed jobs (low demands and high control), active jobs (high demands and high control), passive jobs (low demands and low control), and high-strain jobs (high demands and low control). RESULTS: After adjustment for confounders, women with relaxed jobs had the lowest risk of SGA and preterm delivery. Compared to this group the odds ratio (OR) for SGA delivery among women with passive jobs was 1.3 (95% confidence interval [CI]: 0.9-1.9), with high-strain jobs 1.1 (95% CI: 0.7-1.6), and with active jobs 1.1 (95% CI: 0.8-1.7). Compared to women with relaxed jobs, the OR for preterm delivery among women with passive jobs was 1.4 (95% CI: 0.8-2.3), high-strain jobs 1.3 (95% CI: 0.7-2.2) and active jobs 1.2 (95% CI: 0.7-2.2). All risks were consistently increased in women with low job control. The risks were higher for preterm than for SGA deliveries. However, none of the findings were statistically significant. CONCLUSIONS: The influence of work-related psychosocial strain on the risk of SGA and preterm delivery seems to be small in countries with highly developed social support systems and few other work-related hazards.

Adult↗
PubMed1994

Employment during pregnancy in relation to risk factors and pregnancy outcome.

OBJECTIVE: To describe the relation of employment status during pregnancy to potential demographic, behavioural and obstetrical risk factors for adverse late pregnancy outcome, as well as the risks of having a preterm delivery and a small for gestational age infant. DESIGN: Cohort study. SETTING: A university hospital. SUBJECTS: Of 8,711 women with singleton pregnancies (1989-91), 5,875 returned questionnaires about risk factors and employment status at 16 and 30 weeks gestation. Of the respondents 5,552 were analysed in five groups: (1) women working throughout pregnancy, (2) women working in the first, but unemployed during the second trimester, (3) women on sick leave in the first and second trimester, (4) women unemployed throughout pregnancy, and (5) students. The association between employment status and having a small for gestational age infant and preterm delivery was evaluated, accounting for other risk factors. RESULTS: Working women and students had the most and unemployed women the least favourable demographic risk factors. Women on sick leave had the least favourable obstetrical and medical history, followed by unemployed women. No clear pattern of the behavioural risk factors was found. Differences in risk of having a small for gestational age infant were a function of parity, smoking and maternal height. Adjustment for these factors plus education yielded a lower risk of preterm delivery in partially unemployed women and higher risk among women on sick leave compared to working women, accounted for by different risks of bleeding in the second and third trimester. CONCLUSIONS: Comparison of pregnancy outcome among women with different work status should consider the differences in risk factor profile. Adjusting for such risk factors, we found no evidence that work per se had any detrimental or beneficial effects on the risk of having a small for gestational age infant or preterm delivery.

Adolescent↗
PubMed1994

Cesarean section in twin pregnancies in two Danish counties with different cesarean section rates.

OBJECTIVE: Based on a comparison of the clinical indications for cesarean section (CS) in two Danish counties and a review of the literature regarding this issue the aim of this study was to discuss possible explanations for variations in CS rates in twin pregnancies. The comparison of indications for CS in twin pregnancies was made between two Danish counties, one with a high and one with a low overall CS rate in twin deliveries, taking into account the distribution of parity, mother's age, gestational age at birth, and birth weight. DESIGN: A population based, historic follow-up study based on antecedent data. SETTING: Two Danish counties, with a CS rate in twin pregnancies of 57% and 28%, respectively. SUBJECTS: All women with twin pregnancies who delivered in 1989 in the two counties. MAIN OUTCOME MEASURES: Comparison of the CS rates in the two counties according to indications and fetal presentation. SECONDARY MEASURES: Perinatal and maternal outcome. RESULTS: The difference in CS rates between the two counties could not be explained by different distributions of background characteristics. Different attitudes were found towards CS in cases with previous CS, with twin A in breech presentation and in cases with vertex-breech deliveries. These differences could explain less than two thirds of the overall 29% (CI: 12-46%) difference in risk of CS between the two counties, indicating more subtle reasons for the discrepancy. No difference between the two counties in perinatal morbidity and mortality was seen. CONCLUSION: In order to understand and discuss regional variations in the use of CSs in twin deliveries the subjects must be addressed in different ways: the unequivocal indications related to fetal presentations and previous CS can be subjected to randomised controlled trials or large scaled follow-up studies regarding maternal and perinatal morbidity and mortality. Other more subtle determinants of the physicians' and the pregnant women's attitude towards CS, however, seem quantitatively important, and these can only be evaluated in observational studies and through discussions.

Adult↗