Browsing by Subject "premature"

Sort by: Order: Results:

Now showing items 1-4 of 4
  • Kajantie, Eero; Osmond, Clive; Eriksson, Johan G. (2017)
    BACKGROUND: Women with hypertensive disorders in pregnancy are at an increased risk of cardiovascular disease and type 2 diabetes later in life. Offspring born from these hypertensive pregnancies have increased levels of cardiovascular risk factors; whether they are at an increased risk of type 2 diabetes is not known. OBJECTIVE: The objective of the investigation was to study the risk of type 2 diabetes in the adult offspring exposed to maternal preeclampsia or gestational hypertension in utero. STUDY DESIGN: We studied 5335 members of the Helsinki Birth Cohort Study, who were born between 1934 and 1944 and who lived in Finland in 1995 when the National Medication Purchase Register was initiated. We ascertained gestational hypertension and preeclampsia according to modern criteria by using maternal and birth records. We defined type 2 diabetes through purchases of antidiabetic medication recorded in the comprehensive National Medication Purchase Register, excluding the 31 subjects who had purchased only insulin. We used Cox regression to assess hazard ratios for type 2 diabetes. RESULTS: A total of 590 men (21.6%) and 433 women (16.9%) had purchased medication for diabetes. The hazard ratio for type 2 diabetes for offspring exposed to any maternal hypertension in pregnancy was 1.13 (95% confidence interval, 1.00-1.29; n = 1780). For maternal gestational hypertension, it was 1.15 (95% confidence interval, 1.00-1.33; n = 1336) and for preeclampsia 0.98 (95% confidence interval, 0.71-1.34; n = 231). For type 2 diabetes with first medication purchase before 62 years, the corresponding hazard ratios were 1.25 (95% confidence interval, 1.04-1.51); 1.28 (95% confidence interval, 1.05-1.58), and 1.18 (95% confidence interval, 0.75-1.84). The hazard ratios were similar when adjusted for birthweight SD score for gestation, length of gestation, maternal body mass index in late pregnancy, height, age, and parity and for childhood or adult socioeconomic position. An increased risk of type 2 diabetes was also associated with low birthweight SD score, independent of the association with gestational hypertension. CONCLUSION: Offspring exposed to maternal gestational hypertension in utero have an increased risk of type 2 diabetes in late adult life. This finding underlines the role of the whole spectrum of hypertensive disorders of pregnancy as risk factors of offspring disease throughout life. It also reinforces previous suggestions that adult health care providers should incorporate birth histories when evaluating an individual's risk to develop type 2 diabetes.
  • Mettänen, Ritva (Helsingfors universitet, 2017)
    The risk for a very preterm child to develop cerebral palsy is significantly higher than for child born at term or later than 32 weeks of gestation. Doyle et al. published an updated systematic review of five RCT's in 2009 in which they proved, that antenatal magnesium sulfate administration markedly decreased the risk of cerebral palsy and substantial gross motor dysfunction in preterm infants. In a research of Magee et al. it was noted, that the NNT to prevent 1 CP or death was 43 and NNT to prevent one CP only was 50 at 32 weeks of gestation. The use of antenatal magnesium sulfate for fetal neuroprotection was launched in HUCH on June 7 th, 2012. After the pilot period of approximately two months, the implementation was evaluated and the decision to set-up the upper gestational age of 31+6 weeks for the fetal neuroprotection has been done (August 21st, 2012). Our main objective was to compare the implementation of antenatal magnesium sulfate for fetal neuroprotection, the proximity of the magnesium exposure to delivery and the determination of the delivery-related blood loss in those that received MgSO4 compared to the cohort of the same gestational age that have not received MgSO4. Pregnancy characteristics and fetal neuroprotection data were collected retrospectively and retrieved from the hospital records. The overall implementation rate during both periods was 83,7%. The rate of 86.2% in period 2012-2016 was higher than expected with an increase of 8,56% compared to the period A. To determine the accurate implementation rate (83,0%) we excluded those with elective CS. The implementation rate was found very successful and higher than that in any of the previous published study. Mean duration of magnesium administration was 7,13 hours and mean dose of MgSO4 was 17,61g. There was a decrease of 33% in women who did not receive magnesium sulfate even though indicated from period A to period B. The decrease of 77,9% from period A to period B with those who did not receive magnesium sulfate for an unknown reason is a huge accomplishment. We found the proximity of the magnesium exposure to delivery to be on a very satisfying level. Altogether 68,0% of women gave birth <12 hours after the exposure to MgSO4 had ceased, and as much as 58,4% delivered <6 hours after the exposure to magnesium. With 29,6% of those eligible for magnesium treatment, magnesium administration time was miscalculated (maintenance dose shorter 30 minutes). This non-adherence to the local guidelines has been noted and an auditing with midwives will be made. In conclusion, MgSO4 administration for fetal neuroprotection has been successfully and safely implemented in our institution.
  • Matinolli, Hanna-Maria; Hovi, Petteri; Levälahti, Esko; Kaseva, Nina; Silveira, Patricia P.; Hemiö, Katri; Järvenpää, Anna-Liisa; Eriksson, Johan G.; Andersson, Sture; Lindström, Jaana; Männistö, Satu; Kajantie, Eero (2017)
    Epidemiological studies and animal models suggest that early postnatal nutrition and growth can influence adult health. However, few human studies have objective recordings of early nutrient intake. We studied whether nutrient intake and growth during the first 9 weeks after preterm birth with very low birth weight (VLBW,
  • Ahrapalo, Lotta (Helsingin yliopisto, 2018)
    Tämän tutkielman tarkoituksena on systemaattisen kirjallisuuskatsauksen kautta tarkastella vastasyntyneiden hengitysvaikeuksien non-invasiiviseen hoitoon liittyvää tutkimusnäyttöä. Suomessa syntyy vuosittain noin 50 000 lasta, joista 5-6 % ennenaikaisena. Täysiaikaisten ja keskosten tavallisimpia sairaalahoitoon johtavia syitä ovat hengitysvaikeudet, kuten keskosen hengitysvaikeusoireyhtymä tai täysiaikaisen ohimenevä hengitysvajaus. Hengitysvajaus johtuu keskosella keuhkojen ja hengityskeskuksen epäkypsyydestä ja täysiaikaisella syynä on usein keuhkonesteen hidas poistuminen. Hengitystä voidaan tukea joko invasiivisesti hengityskoneen avulla tai non-invasiivisin keinoin. Tämän katsauksen kannalta keskeisimpiä non-invasiivisia hengitystukimuotoja ovat nasaalinen ylipainetuki, nasaaliventilaattori ja korkeavirtausviikset. Hengityskonehoito on tehokas tapa avustaa hengitystä, mutta siihen liittyy vakavia haittoja, kuten hengitysteiden vaurioituminen, sepsis ja krooniset keuhkomuutokset. Nykysuositukset ohjaavat valitsemaan ensisijaisesti non-invasiivinen hengitystukimuodon, mikäli vastasyntyneen oma hengitys on riittävää. Non-invasiivisen tuen avulla voidaan lyhentää hengityskonehoidon kestoa käyttämällä sitä apuna koneesta vieroittumisessa tai tiettyjen potilaiden kohdalla konehoito pystytään välttämään kokonaan. Tutkimuksissa pyritään määrittämään ne potilaat, jotka kustakin hoitomuodosta hyötyvät. Tämän katsauksen tutkimukset osoittavat ylipaineen helpottavan ennenaikaisen vieroittumista hengityskonehoidosta pelkkää lisähappea paremmin. Nasaaliventilaattori vaikuttaa ylipainetta tehokkaammalta ja korkeavirtausviikset yhtä tehokkaalta hoidolta kuin ylipaine estämään hengityskoneeseen joutumista uudelleen. Keskosen hengitysvaikeusoireyhtymän ensilinjan hoidossa vastasyntyneisyyskaudella nasaaliventilaattori vaikutti ylipainetta tehokkaammalta, kun taas korkeavirtausviikset johtivat useammin hoidon epäonnistumiseen. Korkeavirtausviikset vaikuttivat soveltuvan parhaiten 30 raskausviikon jälkeen syntyneille, joiden lisähapentarve oli enintään 30 %. (194 sanaa)