Browsing by Subject "pregnancy"

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  • Karppanen, Tiina; Kaartokallio, Tea; Heinonen, Seppo; Kajantie, Eero; Kere, Juha; Kivinen, Katja; Pouta, Anneli; Staff, Anne Cathrine; Laivuori, Hannele; Klemetti, Miira M. (Helsingfors universitet, 2016)
    Background Preeclampsia is a common and heterogeneous vascular syndrome of pregnancy. Its genetic risk profile is yet unknown and may vary between individuals and populations. The rs4606 3' UTR polymorphism of the Regulator of G-protein signaling 2 gene (RGS2) in the mother has been implicated in preeclampsia as well as in the development of chronic hypertension after preeclampsia. The RGS2 protein acts as an inhibitor of physiological vasoconstrictive pathways, and a low RGS2 level is associated with hypertension and obesity, two conditions that predispose to preeclampsia. We genotyped the rs4606 polymorphism in 1339 preeclamptic patients and in 697 controls from the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort to study the association of the variant with preeclampsia. Results No association between rs4606 and preeclampsia was detected in the analysis including all women. However, the polymorphism was associated with preeclampsia in a subgroup of overweight women (body mass index ≥ 25 kg/m2, and < 30 kg/m2) (dominant model; odds ratio, 1.64; 95% confidence interval, 1.10-2.42). Conclusions Our results suggest that RGS2 might be involved in the pathogenesis of preeclampsia particularly in overweight women and contribute to their increased risk for hypertension and other types of cardiovascular disease later in life.
  • Pfaller, Birgit; Yepes-Nuñez, Juan José; Agache, Ioana; Akdis, Cezmi A.; Alsalamah, Mohammad; Bavbek, Sevim; Bossios, Apostolos; Boyman, Onur; Chaker, Adam; Chan, Susan; Chatzipetrou, Alexia; du Toit, George; Jutel, Marek; Kauppi, Paula; Kolios, Antonios; Li, Carmen; Matucci, Andrea; Marson, Alanna; Bendien, Sarah; Palomares, Oscar; Rogala, Barbara; Szepfalusi, Zsolt; Untersmayr, Eva; Vultaggio, Alessandra; Eiwegger, Thomas (2021)
    Abstract Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scare and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, pre-conception counseling, and health care provider education is crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.
  • Ervaala, Attina (Helsingin yliopisto, 2021)
    Pre-eklampsia on globaali ongelma, mikä komplisoi 2–8 % raskauksista. Pre-eklampsiassa normaalisti sikiötä äidin immuunipuolustukselta suojaavien tekijöiden säätely on häiriintynyt. Tutkimuksen tarkoituksena oli selvittää pre-eklampsian riskiä ja luonnetta luovutetuilla sukusoluilla saavutetuissa raskauksissa. Koska luovutetut sukusolut eroavat immunologisesti normaalia enemmän kantajastaan, hypoteesiksi asetettiin, että näissä raskauksissa pre-eklampsiaa esiintyy enemmän. Myös kirjallisuuden mukaan näissä raskauksissa vaikuttaisi olevan pre-eklampsiaa enemmän (38–20 %). Aineistona oli Finnish Genetics of Preeclampsia Consortium (FINNPEC) kohortti (n=2778). Tässä pre-eklampsia määriteltiin seuraavasti: 1. yli 140 mmHg:n systolinen verenpaine sekä 2. proteinuria (virtsan proteiini ≥0·3 g/24 h tai 0·3 g/L tai kaksi ≥1+ tulosta liuskatestissä) ja 3. näiden ilmeneminen H20 jälkeen. Näillä kriteereillä verrattiin luovutetuilla sukusoluilla saavutettuja raskauksia (n=21) muihin raskauksiin (n=2757). Väestötason esiintyvyys pre-eklampsian suhteen saatiin terveyden ja hyvinvoinnin laitoksen syntyneiden lasten rekisteristä. Tutkimuksen tuloksena todettiin pre-eklampsiaa esiintyvän enemmän luovutetuilla sukusoluilla saavutetuissa raskauksissa. Muita riskitekijöitä olivat muun muassa äidin korkeampi ikä ja sikiön miessukupuoli. Pre-eklampsiaraskauksia vertailtaessa luovutetuilla sukusoluilla saavutetuissa raskauksissa esiintyi enemmän ennenaikaisia synnytyksiä, ja pre-eklampsia diagnosoitiin aiemmin kuin muissa raskauksissa. Luovutettujen sukusolujen raskauksista ei löydetty tilastollisesti merkittäviä eroja raskauksien luonteissa luovutettujen siittiöiden ja munasolujen välillä, mutta näyttäisi siltä, että riskit ovat isommat luovutetuilla munasoluilla alkaneissa raskauksissa. Tulokset tukevat aikaisempia tutkimustuloksia, vaikka otanta olikin pieni. Tilastollisten merkitsevien erojen puuttumisesta huolimatta tutkimus mahdollisti lisätiedon saamisen sikiön sukupuolen ja vieraiden antigeenien merkityksestä.
  • Piltonen, Terhi T.; Giacobini, Paolo; Edvinsson, Asa; Hustad, Steinar; Lager, Susanne; Morin-Papunen, Laure; Tapanainen, Juha S.; Sundström-Poromaa, Inger; Arffman, Riikka K. (2019)
    Objective: To investigate plasma antimullerian hormone (AMH) concentration and its relation to steroid hormone levels in pregnant women with polycystic ovary syndrome (PCOS) and controls at term. Design: Case-control study. Setting: University-affiliated hospital. Patient(s): A total of 74 pregnant women at term: 25 women with PCOS (aged 31.6 +/- 3.9 years [mean +/- standard deviation], body mass index 24.0 +/- 3.9 kg/m2, mean gestational length 279 +/- 9 days) and 49 controls (aged 31.7 +/- 3.3 years, body mass index 24.0 +/- 3.3 kg/m2, mean gestational length 281 +/- 9 days). Intervention(s): None. Main Outcome Measure(s): Plasma AMH and steroid hormone levels. Result(s): Antimullerian hormone, T, and androstenedione levels were higher in women with PCOS at term compared with controls, whereas estrogen and P levels were similar. The differences were pronounced in women carrying a female fetus. Testosterone and AMH levels correlated positively in both groups, but E2 levels only in women with PCOS. Conclusion(s): Pregnant women with PCOS present with elevated AMH and androgen levels even at term, suggesting a hormonal imbalance during PCOS pregnancy. Differences were detected especially in pregnancies with a female fetus, raising the question of whether female pregnancies are more susceptible to AMH and steroid hormone actions. (C) Copyright (C) 2018 The Authors. Published by Elsevier Inc. on behalf of the American Society for Reproductive Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  • Annual Capri Workshop Grp; Glasier, Anna; Bhattacharya, Siladitya; Heikinheimo, Oskari; Volpe, Annibale (2019)
    Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1-2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women
  • Gruzieva, Olena; Merid, Simon Kebede; Chen, Su; Mukherjee, Nandini; Hedman, Anna M.; Almqvist, Catarina; Andolf, Ellika; Jiang, Yu; Kere, Juha; Scheynius, Annika; Soderhall, Cilia; Ullemar, Vilhelmina; Karmaus, Wilfried; Melen, Erik; Arshad, Syed Hasan; Pershagen, Goran (2019)
    There is emerging evidence on DNA methylation (DNAm) variability over time; however, little is known about dynamics of DNAm patterns during pregnancy. We performed an epigenome-wide longitudinal DNAm study of a well-characterized sample of young women from the Swedish Born into Life study, with repeated blood sampling before, during and after pregnancy (n = 21), using the Illumina Infinium MethylationEPIC array. We conducted a replication in the Isle of Wight third-generation birth cohort (n = 27), using the Infinium HumanMethylation450k BeadChip. We identified 196 CpG sites displaying intra-individual longitudinal change in DNAm with a false discovery rate (FDR) P <.05. Most of these (91%) showed a decrease in average methylation levels over the studied period. We observed several genes represented by > 3 differentially methylated CpGs: HOXB3, AVP, LOC100996291, and MicroRNA 10a. Of 36 CpGs available in the replication cohort, 17 were replicated, all but 2 with the same direction of association (replication P <.05). Biological pathway analysis demonstrated that FDR-significant CpGs belong to genes overrepresented in metabolism-related pathways, such as adipose tissue development, regulation of insulin receptor signaling, and mammary gland fat development. These results contribute to a better understanding of the biological mechanisms underlying important physiological alterations and adaptations for pregnancy and lactation.
  • FINNPEC; Lokki, Anna Inkeri; Teirila, Laura L; Triebwasser, M.; Daly, E.; Bhattacharjee, Atreyi; Uotila, Lasse; Llort Asens, Marc; Kurki, M.; Perola, M.; Auro, K.; Salmon, J. E.; Daly, Mark; Atkinson, J. P.; Laivuori, Hannele; Fagerholm, Susanna; Meri, Seppo (2021)
    Objective To study genetic variants and their function within genes coding for complement receptors in pre-eclampsia. Design A case-control study. Setting Pre-eclampsia is a common vascular disease of pregnancy. The clearance of placenta-derived material is one of the functions of the complement system in pregnancy. Population We genotyped 500 women with pre-eclamptic pregnancies and 190 pregnant women without pre-eclampsia, as controls, from the FINNPEC cohort, and 122 women with pre-eclamptic pregnancies and 1905 controls from the national FINRISK cohort. Methods The functional consequences of genotypes discovered by targeted exomic sequencing were explored by analysing the binding of the main ligand iC3b to mutated CR3 or CR4, which were transiently expressed on the surface of COS-1 cells. Main outcome measures Allele frequencies were compared between pre-eclamptic pregnancies and controls in genetic studies. The functional consequences of selected variants were measured by binding assays. Results The most significantly pre-eclampsia-linked CR3 variant M441K (P = 4.27E-4, OR = 1.401, 95% CI = 1.167-1.682) displayed a trend of increased adhesion to iC3b (P = 0.051). The CR4 variant A251T was found to enhance the adhesion of CR4 to iC3b, whereas W48R resulted in a decrease of the binding of CR4 to iC3b. Conclusions Results suggest that changes in complement-facilitated phagocytosis are associated with pre-eclampsia. Further studies are needed to ascertain whether aberrant CR3 and CR4 activity leads to altered pro- and anti-inflammatory cytokine responses in individuals carrying the associated variants, and the role of these receptors in pre-eclampsia pathogenesis. Tweetable abstract Genetic variants of complement receptors CR3 and CR4 have functional consequences that are associated with pre-eclampsia.
  • Burwick, Richard M.; Lokki, A. Inkeri; Fleming, Sherry D.; Regal, Jean F. (2021)
  • Rahnasto, Johanna (Helsingin yliopisto, 2019)
    Preeclampsia is a vascular pregnancy disorder characterized by new-onset hypertension and proteinuria and/or new-onset preeclampsia associated symptoms during the second half of pregnancy. The pathophysiology of the disorder is not fully understood, but incomplete placentation and maternal tolerance towards fetal tissue are known to play a part in the disease pathogenesis. Predisposing factors include nulliparity, obesity, diabetes, chronic hypertension and autoimmune diseases. Furthermore, women who have experienced preeclampsia are more susceptible to cardiovascular disease later in life. One established biomarker for preeclampsia is the increased concentration of the soluble Fms-like tyrosine kinase 1 (sFlt1) in the maternal serum. sFlt1 is frequently overexpressed in preeclampsia and it is linked with angiogenic imbalance and endothelial dysfunction, although its role in the disorder is not completely clear. Preeclampsia has a genetic background. There are protective and predisposing variants in and near the Fms related tyrosine kinase 1 gene (FLT1; coding for sFlt1) that have been associated with preeclampsia either in the mother or in the fetus. In this study, five genetic polymorphisms over a 2.3 kb region in the 3’ untranslated region of FLT1 were genotyped by Sanger sequencing and fragment analysis in altogether 1200 individuals consisting of case and control mother–child pairs of the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort. These polymorphisms were tested for association with various preeclampsia-related phenotypes by Fisher’s exact test. In the maternal genome, the minor alleles of rs17086497 and rs57760154 were associated with extreme hypertension (systolic blood pressure >180 mmHg) (p=0.004, OR=1.77) and obesity (p=0.023, OR=1.63). Homozygosity for these minor alleles was associated with pregnancy complications in general (p=0.026, OR=2.53) and the early-onset form of preeclampsia (p=0.004, OR=3.34). Additionally, the minor alleles of rs9554314, rs3138582 and rs149279513 were associated with extreme hypertension (p=0.045, OR=1.63) and obesity (p=0.023, OR=1.78). Moreover, a suggestive association to severe proteinuria (> 5 g/24h) was found in the maternal genome. In the fetal genome, significant negative associations were reached for rs17086497 and rs57760154 in terms of the serum concentration of sFlt1 in the preeclampsia group (p=0.008, OR=0.23). Overall, the results seem to link the studied region in the maternal genome to preeclampsia with severe features. This supports the idea of preeclampsia as a heterogeneous disorder with varying etiology and mechanisms and thus highlights the importance of differentiating between the various sub-phenotypes. For example, the association of the same allele in the fetal genome with lower maternal sFlt1 levels and in the maternal genome with severe symptoms of preeclampsia suggests that the sFlt1 level might not be a good measure in all patients. Additionally, the observed associations with extreme hypertension and obesity point to the possibility that this region might be relevant for the endothelial damage that is thought to be a central factor in creating the later-in-life disease susceptibility.
  • Malm, Heli; Brown, Alan S.; Gissler, Mika; Gyllenberg, David; Hinkka-Yli-Salomaki, Susanna; McKeague, Ian W.; Weissman, Myrna; Wickramaratne, Priya; Artama, Miia; Gingrich, Jay A.; Sourander, Andre (2016)
    Objective: To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment. Method: This is a cohort study using national register data in Finland between the years 1996 and 2010. Pregnant women and their offspring were categorized into 4 groups: SSRI exposed (n = 15,729); exposed to psychiatric disorder, no antidepressants (n = 9,651); exposed to SSRIs only before pregnancy (n = 7,980); and unexposed to antidepressants and psychiatric disorders (n = 31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) for the 4 groups from birth to 14 years, adjusting for confounders. Results: The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI = 3.1-13.3%) by age 14.9 years, compared with 1.9% (95% CI = 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR] = 1.78; 95% CI = 1.12-2.82; p=.02) and to 2.8% (95% CI = 1.4-4.3%) in the SSRI discontinued group (HR = 1.84; 95% CI = 1.14-2.97; p=.01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed individuals, the HRs were significantly elevated for each outcome. Conclusion: Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression.
  • Hasan, Sayyid; Aho, Velma; Pereira, Pedro; Paulin, Lars; Koivusalo, Saila B.; Auvinen, Petri; Eriksson, Johan G. (2018)
    Introduction An altered gut microbiome composition is shown to be associated with various diseases and health outcomes. We compare the gut microbiota of women who developed gestational diabetes mellitus (GDM) with that of those who did not, and the gut microbiota of their offspring, to determine any differences in the composition and diversity of their gut microbiota, which may be correlated with their GDM state. Material and methods All women were at high risk for GDM and participated in the Finnish Gestational Diabetes Prevention Study (RADIEL). Stool samples were obtained, 5years postpartum, from 60 GDM-positive women, 68 non-GDM control women, and their children (n=109), 237 individuals in total. 16S ribosomal RNA gene sequencing was employed to determine the composition of bacterial communities present. Statistical correlations were inferred between clinical variables and microbiota, while taking into account potential confounders. Results In mothers, no significant differences were observed in microbiota composition between the two groups. Genus Anaerotruncus was increased in children of women with GDM (p
  • Vesikari, Timo; Virta, Miia; Heinonen, Seppo; Eymin, Cécile; Lavis, Nathalie; Chabanon, Anne Laure; Gresset-Bourgeois, Viviane (2019)
    ABSTRACTVaccination against influenza during pregnancy provides direct protection to pregnant women and indirect protection to their infants. Trivalent inactivated influenza vaccines (IIV3s) are safe and effective during pregnancy, but quadrivalent inactivated influenza vaccines (IIV4s) have not been evaluated in pregnant women and their infants. Here, we report the results of a randomized phase IV study to evaluate the immunogenicity and safety of IIV4 vs. IIV3 in pregnant women. Participants aged ≥18 years at weeks 20 to 32 of gestation were randomly assigned in a 2:1 ratio to receive a single dose of IIV4 (n = 230) or IIV3 (n = 116). Between baseline and 21 days after vaccination, hemagglutination inhibition (HAI) antibody titers increased in both groups by similar magnitudes for the two influenza A strains and single B strain common to IIV4 and IIV3. For the additional B strain in IIV4, HAI titers were higher in IIV4 recipients than IIV3 recipients (post-/pre-vaccination geometric mean titer ratio, 6.3 [95% CI: 5.1 ? 7.7] vs. 3.4 [95% CI: 2.7 ? 4.3]). At delivery, in both groups, HAI antibody titers for all strains were 1.5 ? 1.9-fold higher in umbilical cord blood than in maternal blood, confirming active transplacental antibody transfer. Rates of solicited and unsolicited vaccine-related adverse events in mothers were similar between the two groups. Live births were reported for all participants and there were no vaccine-related adverse events in newborns. These results suggest IIV4 is as safe and immunogenic as IIV3 in pregnant women, and that maternal immunization with IIV4 should protect newborns against influenza via passively acquired antibodies.
  • Reinert, Linnea (Helsingfors universitet, 2010)
    Vitamin D is either obtained through synthesis in the skin due to UVB-light (290-315 nm) or from the diet. The hydroxylased metabolite 25-hydroxyvitamin D (25(OH)D) is the metabolite to measure when vitamin D status wants to be determined. The active form of vitamin D is 1,25- dihydroxyvitamin D (1,25(OH)?D) which interacts with a large set of tissue cells (especially bone) through its nuclear receptor the vitamin D receptor (VDR). Vitamin D deficiency can lead to rickets in children and osteoporosis or osteomalacia in adults. Type 1 Diabetes (T1D) is an autoimmune disease which is caused by the destruction of the pancreatic ?-cells. The disease has genetic and environmental features but the whole mechanism of disease development is still unknown. The prevalence of T1D is constantly growing in the whole world. Therefore it is important to study possible environmental factors that can eventually serve as pathogenesis modifiers. Vitamin D and T1D have been associated among others because there is a seasonal and geographical variation in T1D incidence, more cases have been identified in the North and during winter. The aim of this study was to investigate if the serum 25(OH)D status during first trimester of pregnancy is associated with T1D development in the offspring. The subjects where mothers of T1D children (N=310) and the controls were mothers of healthy children (N=310). Serum samples were obtained from the Finnish Maternity Cohort (FMC) and analyzed for S-25(OH)D. S- 25(OH)D measurement was performed with an indirect enzyme immunoassay (EIA). No significant (p>0.05) difference was seen between S-25(OH)D mean concentrations in cases and controls. The mean concentration of cases was 43.3 ± 15.9 nmol/l and 43.0 ± 15.5 nmol/l (mean ± standard deviation (SD)) of controls. Insufficient and deficient S- 25(OH)D status was seen in 72% of the whole study population. As a result of this study it has been shown that the S-25(OH)D status during first trimester of pregnancy is not associated with T1D development in the offspring. Samples from later stages of pregnancy could be analyzed to determine if the overall status during pregnancy has an effect on T1D development in the offspring. Considering the possible health outcomes of vitamin D insufficiency, recommended vitamin D supplementation should be raised to improve maternal and fetal health.
  • Lahti-Pulkkinen, M.; Mina, Theresia H.; Riha, Renata L.; Raikkonen, K.; Pesonen, A. K.; Drake, A. J.; Denison, Fiona C.; Reynolds, Rebecca M. (2019)
    Background The prevalence of sleep problems among pregnant women is over 50%, and daytime sleepiness is among the most common sleep problems. Previous studies have associated antenatal sleep problems with adverse maternal health and neonatal outcomes, but the consequences of antenatal sleep problems and particularly daytime sleepiness on child psychological development have not been assessed prospectively. Methods In this prospective cohort study including 111 mother-child dyads, we examined the associations of maternal daytime sleepiness during pregnancy, assessed at 17 and 28 weeks of gestation using the Epworth Sleepiness Scale, with child neuropsychiatric problems and neuropsychological development, assessed with mother-rated questionnaires and individually administered neuropsychological tests, at child age 2.6-5.7 years (mean = 4.3 years). Results Independently of sociodemographic and perinatal covariates and maternal depressive and anxiety symptoms during and/or after pregnancy, maternal antenatal daytime sleepiness was associated with increased total [unstandardized regression coefficient (B) = 0.25 standard deviation (s.d.) units; 95% confidence interval (CI) 0.01-0.48] and internalizing (B = 0.25 s.d.s: 95% CI 0.01-0.49) psychiatric problems and ADHD symptoms (B = 0.27 s.d.s: 95% CI 0.04-0.50) in children, and with poorer executive function, particularly in the areas of attention, working memory and inhibitory control (B = -0.39 s.d.s: 95% CI -0.69 to -0.10). Conclusions Maternal antenatal daytime sleepiness carries adverse consequences for offspring psychological development. The assessment of sleep problems may be an important addition to standard antenatal care.
  • Mattila, Markus; Hakola, Leena; Niinisto, Sari; Tapanainen, Heli; Takkinen, Hanna-Mari; Ahonen, Suvi; Ilonen, Jorma; Toppari, Jorma; Veijola, Riitta; Knip, Mikael; Virtanen, Suvi M. (2021)
    Our aim was to study the associations between maternal vitamin C and iron intake during pregnancy and the offspring's risk of developing islet autoimmunity and type 1 diabetes. The study was a part of the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) prospective birth cohort including children genetically at risk of type 1 diabetes born between 1997-2004. The diets of 4879 mothers in late pregnancy were assessed with a validated food frequency questionnaire. The outcomes were islet autoimmunity and type 1 diabetes. Cox proportional hazards regression analysis adjusted for energy, family history of diabetes, human leukocyte antigen (HLA) genotype and sex was used for statistical analyses. Total intake of vitamin C or iron from food and supplements was not associated with the risk of islet autoimmunity (vitamin C: HR 0.91: 95% CI (0.80, 1.03), iron: 0.98 (0.87, 1.10)) or type 1 diabetes (vitamin C: 1.01 (0.87, 1.17), iron: 0.92 (0.78, 1.08)), neither was the use of vitamin C or iron supplements associated with the outcomes. In conclusion, no association was found between maternal vitamin C or iron intake during pregnancy and the risk of islet autoimmunity or type 1 diabetes in the offspring.
  • Järvinen, Ilkka (Helsingfors universitet, 2017)
    Both prenatal hyperglycaemia (caused by maternal diabetes mellitus) and neonatal hypoglycaemia pose a risk to the neurocognitive development of the child: Maternal diabetes mellitus in pregnancy has been reported to be associated with impairments in memory functions of the offspring up to adolescence. Also, an association has been reported between neonatal hypoglycaemia and neurodevelopmental impairments in childhood and adolescence. However, to our knowledge, the association of prenatal hyperglycaemia with memory impairments has not previously been studied in adulthood. As for the possible association of neonatal hypoglycaemia with memory impairments, it has not, to our knowledge, been studied at any age. Furthermore, the separate and combined sequelae of the two risk factors are yet to be directly compared. We hypothesized that the two risk factors, separately and combined, would still in middle age be associated with subtle memory impairments. We assessed memory functions in a follow-up study of a cohort born during 1971–1974 and prospectively studied from birth. The sample included participants exposed to prenatal hyperglycaemia (n = 22), neonatal hypoglycaemia (n = 14), or both (n = 7). It also included controls with no early risks (n = 40). We assessed the participants' memory functions comprehensively, including working memory and immediate and delayed recall of both verbal and visual material. We found an interaction of early risk with the type of digit span task, a measure of working memory: The differences between span task scores varied between the groups. However, no pairwise between-group differences were significant. Thus, the interaction was not specific to any particular groups and likely to be clinically irrelevant. The interaction was non-significant when gestational age and birth weight were controlled for. The early risks were unassociated with scores on other memory tasks. Against our hypotheses, our results suggest that prenatal hyperglycaemia, neonatal hypoglycaemia and their combination are relatively benign disorders, especially when not accompanied by other perinatal complications: The association of prenatal hyperglycaemia with neurocognitive impairments appears to be attenuated in adulthood, and neonatal hypoglycaemia appears to have few long-term sequelae.
  • Ikonen, Anne-Mari (Helsingin yliopisto, 2019)
    This study assesses the key factors affecting the resilience of young single mothers in Arusha region, Tanzania. The average age of childbearing in Tanzania remains low. Many socioeconomic difficulties such as poverty, lack of education and sexual- and reproductive services have an impact why many Tanzanian girls give birth during adolescence. Young single mothers often face many challenges in coping with pregnancy and motherhood due to the discrimination they face. This research is based on 22 semi-structured interviews that were conducted with young single mothers, who had given birth between 15 and 20 years old in Arusha region, Tanzania. The data was collected during one month visit to Meru at the end of 2017. The interviews were conducted in two locations. Half of the interviews were conducted in the villages of south-east of Meru and half in two women´s shelters in Arusha town. The interviews were supported by participant observation and informal conversations. The data was transcribed and analysed through qualitative content analysis. This study focuses on assessing the main factors that affect the resilience of young mothers during pregnancy and motherhood. Resilience is assessed through reproductive resilience framework. The meaning of resources (capitals) in the lives of single mothers was also assessed. Moreover, the social discourses regarding gender, sexuality and motherhood were examined in order to gain understanding of how they impact the experience of young single mothers. The findings show that social support operates as a protective factor in building resilience for the young single mothers. However, the findings show that young single mothers struggle to receive support during pregnancy. This is mainly because the negative social discourses regarding girl’s sexuality and pregnancy outside wedlock in Tanzania. The results show that young mothers face strong discrimination during pregnancy, both from their families, friends and community, which operated as a constraining factor for resilience. The discrimination had profound impact on of the resilience of the young mothers during pregnancy, as it often disrupted family relations and sometimes led to separation of the girl from her family. The shame of unmarried pregnancy diminished the support networks the young mothers had. Furthermore, the findings show that young mothers are able to receive more support during motherhood from their families and communities. Young mothers would no longer receive discrimination or verbal abuse in their communities. The findings show that the role of motherhood in the community is highly respect and therefore the young mothers were accepted in the community as any mothers. Motherhood itself operated as both protective and constraining factor for resilience. Becoming mother decreased the shame of unmarried pregnancy and raised the young mothers in highly valued positions of mothers in their societies. Some young mothers had managed to renegotiate their place in the family after the pregnancy experience and were again accepted in their families. Regardless of the financial challenges that young motherhood brought to the informants the mothers who had managed to keep their social support relations were showing positive adjustment to motherhood. Most young mothers embraced their roles as mothers, because it brought them value and made them acceptable members in their communities after the negative pregnancy experiences.
  • Meinilä, Jelena; Koivusalo, Saila B.; Valkama, Anita Johanna; Rönö, Kristiina; Erkkola, Maijaliisa; Kautiainen, Hannu; Stach-Lempinen, Beata; Eriksson, Johan G. (2015)
    Background: The prevalence of gestational diabetes (GDM) has been increasing along with the obesity pandemic. It is associated with pregnancy complications and a risk of type 2 diabetes. Objective: To study nutrient intake among pregnant Finnish women at increased risk of GDM due to obesity or a history of GDM. Design: Food records from obese women or women with GDM history (n = 394) were examined at baseline ( Results: The pregnant women had a mean fat intake of 33 en% (SD 7), saturated fatty acids (SFA) 12 en% (SD 3), and carbohydrate 46 en% (SD 6). Sucrose intake among pregnant women with GDM history was 7 en% (SD 3), which was different from the intake of the other pregnant women, 10 en% (SD 4) (p <0.001). Median intakes of folate and vitamins A and D provided by food sources were below the Finnish national nutrition recommendation, but, excluding vitamin A, supplements raised the total intake to the recommended level. The frequency of use of dietary supplements among pregnant women was 77%. Conclusions: The observed excessive intake of SFA and low intake of carbohydrates among women at high risk of GDM may further increase their risk of GDM. A GDM history, however, seems to reduce sucrose intake in a future pregnancy. Pregnant women at high risk of GDM seem to have insufficient intakes of vitamin D and folate from food and thus need supplementation, which most of them already take.
  • Handal, Marte; Skurtveit, Svetlana; Mahic, Milada; Øhman, Inger; Wikner, Birgitta Norstedt; Tjagvad, Christian; Kieler, Helle; Halmesmäki, Erja; Lund, Ingunn Olea (2020)
    Background: WHO guidelines emphasise the need for descriptions of clinical practice and observational studies on risk and benefits of pharmacotherapies in pregnancy. The aims of the present study were to: (1) Describe opioid maintenance treatment (OMT) in the Scandinavian countries in general, and specifically for pregnant women, (2) Describe a project which utilises a new approach using registry-linkage data to examine associations between prenatal exposure to OMT and child outcomes: a Scandinavian cohort study of pregnant women in OMT during pregnancy (ScopeOMT). Data: Guidelines describing the treatment of persons with opioid use disorders in general, and specifically for pregnant women. Scandinavian registry-linkage data from ScopeOMT. Results: Registry data show that approximately 800 pregnant women received OMT during pregnancy in the period of the ScopeOMT study. Similarities across the Scandinavian countries include access to free healthcare and treatment; multidisciplinary teams trained to support pregnant women in OMT; buprenorphine as the recommended drug when initiating therapy; and a holistic focus on the patients' lives. An important difference is that Norwegian women who use illegal substances that may harm the foetus may be admitted - voluntarily, or against their will - for parts of, or the remainder of the pregnancy to inpatient treatment at specialised clinics. Conclusion: Many similarities in the treatment provided to opioid-dependent persons in the Scandinavian countries place this area in an excellent position to combine the efforts and carry out observational studies concerning the safety of OMT during pregnancy.
  • Hakomäki, Henriikka; Kokki, Hannu; Lehtonen, Marko; Ranta, Veli-Pekka; Räsänen, Juha; Voipio, Hanna-Marja; Kokki, Merja (2021)
    Buprenorphine is a semi-synthetic opioid, widely used in the maintenance treatment for opioid-dependent pregnant women. Limited data exist on the pharmacokinetics of buprenorphine in pregnancy. We conducted a pharmacokinetic study to determine the pharmacokinetics of intravenous buprenorphine in pregnant sheep. Fourteen pregnant sheep in late gestation received 10 mu g/kg of buprenorphine as an intravenous bolus injection. Plasma samples were collected up to 48 h after administration. Buprenorphine and its metabolite, norbuprenorphine, were quantified from plasma using a LC/MS/MS method, with lower limits of quantification of 0.01 mu g/L and 0.04 mu g/L for buprenorphine and norbuprenorphine, respectively. The pharmacokinetic parameters were calculated using noncompartmental analysis. The pharmacokinetic parameters, median (minimum-maximum), were C-max 4.31 mu g/L (1.93-15.5), AUC(inf) 2.89 h*mu g/L (1.72-40.2), CL 3.39 L/h/kg (0.25-6.02), terminal t1/2 1.75 h (1.07-31.0), V-ss 8.04 L/kg (1.05-49.3). Norbuprenorphine was undetected in all plasma samples. The median clearance in pregnant sheep was higher than previously reported for nonpregnant sheep and human (male) subjects. Our sensitive analytical method was able to detect long terminal half-lives for six subjects, and a wide between-subject variability in the study population. Significance statement: Buprenorphine is widely used for the treatment of opioid use disorder in pregnancy. However, limited data exist on the pharmacokinetics of buprenorphine during pregnancy. As this type of study cannot be done in humans due to ethical reasons, we conducted a study in pregnant sheep. This study provides pharmacokinetic data on buprenorphine in pregnant sheep and helps us to understand the pharmacokinetics of the drug in humans.