المؤلفون: Nilsen, Guro Ørndal, Simpson, Melanie Rae, Hanem, Liv Guro Engen, Løvvik, Tone Shetelig, Ødegård, Rønnaug, Stokkeland, Live Marie T, Andersen, Marianne Skovsager, Juliusson, Petur Benedikt, Vanky, Eszter

المصدر: Nilsen , G Ø , Simpson , M R , Hanem , L G E , Løvvik , T S , Ødegård , R , Stokkeland , L M T , Andersen , M S , Juliusson , P B & Vanky , E 2024 , ' Anthropometrics of neonates born to mothers with PCOS with metformin or placebo exposure in utero ' , Acta Obstetricia et Gynecologica Scandinavica , vol. 103 , no. 1 , pp. 176-187 . https://doi.org/10.1111/aogs.14637Test

مصطلحات موضوعية: anthropometry, birth length, birthweight, head circumference, metformin, polycystic ovary syndrome, pregnancy, prenatal exposure, Humans, Androgens/therapeutic use, Randomized Controlled Trials as Topic, Birth Weight, Metformin/therapeutic use, Placenta, Female, Polycystic Ovary Syndrome/drug therapy, Infant, Newborn

الوصف: INTRODUCTION: Fetal growth may be affected by both maternal polycystic ovary syndrome (PCOS) and metformin therapy. Here, we explore the effect of intrauterine metformin exposure on birth anthropometrics of infants born to women with PCOS. We also investigated whether the effect of metformin on birth anthropometrics is modified by maternal pre-pregnancy body mass index, PCOS hyperandrogenic phenotype, serum androgen levels, preconception use of metformin and offspring sex. Additionally, we assessed newborn anthropometrics in relation to a national reference population. MATERIAL AND METHODS: Individual data from three randomized controlled triasl were pooled. The randomized controlled trials investigated the effects of metformin in pregnant women with PCOS. In all, 397 and 403 were randomized to the metformin and placebo groups, respectively. A Scandinavian growth reference was used to calculate sex and gestational age adjusted z-scores. Linear regression models were used to estimate the effect of metformin on offspring z-scores of head circumference, birth length, birthweight, placental weight, body mass index, ponderal index and birthweight:placental weight ratio. S-testosterone, s-androstenedione, and s-sex-hormone binding globulin from four timepoints in pregnancy were analyzed. RESULTS: Compared with the PCOS-placebo group, newborns in the PCOS-metformin group had larger head circumference (head circumference z-score: mean difference = 0.25, 95% CI = 0.11- 0.40). This effect of metformin on head circumference z-score was particularly observed among offspring of overweight/obese mothers and mothers with hyperandrogenic PCOS-phenotype. We observed no difference in other anthropometric measures between the metformin and placebo groups or any clear interaction between maternal androgen levels and metformin. Newborns in the PCOS-placebo group were shorter than in the reference population (birth length z-score: mean = -0.04, 95% CI = -0.05 to -0.03), but head circumference and birthweight were similar. ...

وصف الملف: application/pdf

العلاقة: https://portal.findresearcher.sdu.dk/da/publications/e242136b-6317-4794-822b-650f78433797Test

الإتاحة: https://doi.org/10.1111/aogs.14637Test
https://portal.findresearcher.sdu.dk/da/publications/e242136b-6317-4794-822b-650f78433797Test
https://findresearcher.sdu.dk/ws/files/252584588/Acta_Obstet_Gynecol_Scand_-_2023_-_Nilsen_-_Anthropometrics_of_neonates_born_to_mothers_with_PCOS_with_metformin_or_placebo.pdfTest

المؤلفون: Stensæth, Knut Haakon, Carlsen, Marte Irene Skille, Løvvik, Tone Shetelig, Uleberg, Oddvar, Brede, Jostein Rødseth, Søvik, Edmund

المصدر: Acta Obstetricia et Gynecologica Scandinavica ; volume 103, issue 5, page 965-969 ; ISSN 0001-6349 1600-0412

الوصف: Introduction Postpartum hemorrhage (PPH) remains a global health problem. The introduction of resuscitative endovascular balloon occlusion of the aorta (REBOA) in 2008 sought to enhance the management of hemorrhagic shock during PPH. In this study, we present a single Norwegian center's experience with REBOA as a supportive treatment in combating life threatening PPH. Material and methods This is a historical cohort study from St Olav's University Hospital, with data from period 2008–2021. It includes all patients who underwent REBOA as an adjunct treatment due to life threatening PPH, analyzing the outcomes and trends over a 14‐year period. Results A total of 37 patients received REBOA as an adjunct treatment. All procedures were technically successful, achieving hemodynamic stability with an immediate average increase in systolic blood pressure of 36 ± 22 mmHg upon initial balloon inflation. Additionally, a downward trend was noted in the frequency of hysterectomies and the volume of blood transfusions required over time. No thromboembolic complications were observed. Conclusions Our 14 years of experience at St Olav's Hospital suggests that REBOA serves as a safe and effective adjunct interventional technique for managing life‐threatening PPH. Furthermore, the findings indicate that incorporating a multidisciplinary approach to enable rapid aortic occlusion can potentially reduce the necessity for blood transfusions and hysterectomies.

الإتاحة: https://doi.org/10.1111/aogs.14767Test

المؤلفون: Husby, Anne Engtrø, Simpson, Melanie Rae, Dalbye, Rebecka, Larsen, Marit, Vanky, Eszter, Løvvik, Tone Shetelig

المساهمون: Sykehuset Østfold, Novo Nordisk Fonden, St. Olavs Hospital Universitetssykehuset i Trondheim

المصدر: Acta Obstetricia et Gynecologica Scandinavica ; ISSN 0001-6349 1600-0412

الوصف: Introduction Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. Material and methods This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study ( ClinicalTrials.gov , NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study ( ClinicalTrials.gov , NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann–Whitney U test for women in Robson group 1 with PCOS ( n = 131) and reference women ( n = 3604). CEQ scores were also compared between metformin‐treated ( n = 180) and placebo‐treated ( n = 185) women with PCOS, and for different subgroups of women with PCOS. Results There was no difference in total CEQ score between women with PCOS and reference women—Wilcoxon–Mann–Whitney (WMW)‐odds 0.96 (95% confidence interval [CI] 0.78–1.17). We detected no difference in CEQ scores between the metformin‐ and placebo‐treated women with PCOS (WMW‐odds 1.13, 95% CI 0.89–1.43). Complications in pregnancy did not affect CEQ (WMW‐odds 1, 95% CI 0.76–1.31). Higher body mass index (WMW‐odds 0.75, 95% CI 0.58–0.96), longer duration of labor (WMW‐odds 0.69, 95% CI 0.49–0.96), and cesarean section (WMW‐odds 0.29, 95% CI 0.2–0.42) were associated with lower CEQ ...

الإتاحة: https://doi.org/10.1111/aogs.14800Test

المؤلفون: Skarsgaard, Benedikte Kjetland, Henriksen, Therese Harvold, Dahlberg, Unn, Løvvik, Tone Shetelig, Aune, Ingvild

المصدر: Sexual & Reproductive Healthcare ; volume 40, page 100967 ; ISSN 1877-5756

مصطلحات موضوعية: Maternity and Midwifery, Obstetrics and Gynecology

الإتاحة: https://doi.org/10.1016/j.srhc.2024.100967Test
https://api.elsevier.com/content/article/PII:S1877575624000223?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S1877575624000223?httpAccept=text/plainTest

المؤلفون: Nilsen, Guro Ørndal, Simpson, Melanie Rae, Hanem, Liv Guro Engen, Løvvik, Tone Shetelig, Ødegård, Rønnaug Astri, Stokkeland, Live Marie T, Andersen, Marianne, Juliusson, Pétur Benedikt, Vanky, Eszter Ilona

المصدر: Acta Obstetricia et Gynecologica Scandinavica

الوصف: Introduction: Fetal growth may be affected by both maternal polycystic ovary syndrome (PCOS) and metformin therapy. Here, we explore the effect of intrauterine metformin exposure on birth anthropometrics of infants born to women with PCOS. We also investigated whether the effect of metformin on birth anthropometrics is modified by maternal pre-pregnancy body mass index, PCOS hyperandrogenic phenotype, serum androgen levels, preconception use of metformin and offspring sex. Additionally, we assessed newborn anthropometrics in relation to a national reference population. Material and methods: Individual data from three randomized controlled triasl were pooled. The randomized controlled trials investigated the effects of metformin in pregnant women with PCOS. In all, 397 and 403 were randomized to the metformin and placebo groups, respectively. A Scandinavian growth reference was used to calculate sex and gestational age adjusted z-scores. Linear regression models were used to estimate the effect of metformin on offspring z-scores of head circumference, birth length, birthweight, placental weight, body mass index, ponderal index and birthweight:placental weight ratio. S-testosterone, s-androstenedione, and s-sex-hormone binding globulin from four timepoints in pregnancy were analyzed. Results: Compared with the PCOS-placebo group, newborns in the PCOS-metformin group had larger head circumference (head circumference z-score: mean difference = 0.25, 95% CI = 0.11– 0.40). This effect of metformin on head circumference z-score was particularly observed among offspring of overweight/obese mothers and mothers with hyperandrogenic PCOS-phenotype. We observed no difference in other anthropometric measures between the metformin and placebo groups or any clear interaction between maternal androgen levels and metformin. Newborns in the PCOS-placebo group were shorter than in the reference population (birth length z-score: mean = −0.04, 95% CI = –0.05 to −0.03), but head circumference and birthweight were similar. ...

وصف الملف: application/pdf

العلاقة: urn:issn:0001-6349; https://hdl.handle.net/11250/3092644Test; https://doi.org/10.1111/aogs.14637Test; cristin:2170478; Acta Obstetricia et Gynecologica Scandinavica. 2023.

الإتاحة: https://doi.org/10.1111/aogs.14637Test
https://hdl.handle.net/11250/3092644Test

المؤلفون: Stensæth, Knut Håkon, Carlsen, Marte Irene Skille, Løvvik, Tone Shetelig, Uleberg, Oddvar, Brede, Jostein Rødseth, Søvik, Edmund

العلاقة: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.14767Test

الإتاحة: https://hdl.handle.net/11250/3112071Test

المؤلفون: Grindheim, Sindre, Ebbing, Cathrine, Karlsen, Henriette Odland, Skulstad, Svein Magne, Real, Francisco Gomez, Lønnebotn, Marianne, Løvvik, Tone Shetelig, Vanky, Eszter, Kessler, Jørg

المصدر: e0262987 ; PLOS ONE ; 17 ; 1

الوصف: Background: Metformin is prescribed to women with polycystic ovary syndrome (PCOS) to prevent pregnancy complications. Children exposed to metformin vs. placebo in utero, have increased head circumference at birth and are more overweight and obese at 8 years of age. Also, maternal PCOS-status seems to alter the long-term cardio-metabolic health of offspring. We hypothesized that the long-term effects of metformin-exposure and/or maternal PCOS may be mediated by circulatory adaptations during fetal life. Material and methods: This is a sub-study of a larger double-blinded, placebo-controlled trial, where women with PCOS were randomized to metformin (2g/day) or placebo in pregnancy, a total of 487 women. A sub-group of participants (N = 58) took part in this sub-study and had an extended ultrasound examination at gestational week 32, including blood flow velocity and diameter measurements of the umbilical vein (UV), the ductus venosus (DV) and the portal vein (PV). Blood flow volume was calculated and adjusted for estimated fetal weight (EFW) (normalized flow). Metformin exposed fetuses were compared to placebo exposed fetuses. Fetuses of mothers with PCOS (metformin [n = 30] and placebo [n = 28]) were compared to a low-risk reference population (N = 160) by z-score statistics. Results: There was no difference in fetal liver flow between metformin vs. placebo-exposed fetuses. Fetuses of mothers with PCOS had higher EFW (0.63 [95% CI 0.44–0.83] p<0.001), lower normalized UV, DV, PV, and lower total venous liver blood flows than the reference population. Conclusion: Metformin during pregnancy did not affect fetal liver blood-flow. In our population, maternal PCOS-status was associated with reduced total venous liver blood-flow, which may explain altered growth and metabolism later in life. ; publishedVersion

وصف الملف: application/pdf

العلاقة: urn:issn:1932-6203; https://hdl.handle.net/11250/3011207Test; https://doi.org/10.1371/journal.pone.0262987Test; cristin:2018930; PLOS ONE. 2022, 17 (1), e0262987.

الإتاحة: https://doi.org/10.1371/journal.pone.0262987Test
https://hdl.handle.net/11250/3011207Test

المؤلفون: Molin, Johanna, Vanky, Eszter, Løvvik, Tone Shetelig, Dehlin, Eva, Bixo, Marie

المصدر: 1-10 ; BJOG: An International Journal of Obstetrics and Gynaecology

الوصف: Objective To explore mechanisms that modulate gestational weight gain (GWG) in women with polycystic ovary syndrome (PCOS) and healthy controls. Design Sub-sample of randomised controlled trials (PCOS) combined with a prospective cohort (controls). Setting Eleven Norwegian, Swedish, and Icelandic hospitals. Population Pregnant women with PCOS treated with metformin (PCOS-M, n = 36) or placebo (PCOS-P, n = 37), and healthy pregnant women (HC, n = 15). Methods Serum levels of the appetite regulating hormones leptin, ghrelin, allopregnanolone, and soluble leptin receptor (sOB-R) were determined in the first and third trimesters. Main Outcome Measures Excessive GWG (eGWG) relative to body mass index according to Institute of Medicine (IOM) guideline. Serum leptin/sOB-R ratio, or free-leptin-index (FLI), as biomarker of leptin sensitivity. Serum ghrelin and allopregnanolone levels. Results The overall prevalence of eGWG was 44% (38/86). Women with eGWG had higher first and third trimester FLI (P < 0.001), and lower third trimester allopregnanolone levels (P = 0.003) versus women with non-eGWG. The prevalence of eGWG was lower in PCOS-M versus PCOS-P (28% versus 62%, odds ratio = 0.4, 95% CI 0.2–0.8, P = 0.005). FLI decreased during pregnancy in PCOS-M (P = 0.01), but remained unaltered in PCOS-P and HC. Ghrelin and allopregnanolone levels were comparable in PCOS-M, PCOS-P and HC throughout pregnancy. Conclusion Excessive GWG is associated with enhanced leptin resistance, and attenuated physiological increase in serum allopregnanolone levels during pregnancy. Metformin reduces the risk for eGWG and improves leptin sensitivity in pregnant women with PCOS. ; publishedVersion

وصف الملف: application/pdf

العلاقة: BJOG: An International Journal of Obstetrics and Gynaecology. 2021, 1-10.; urn:issn:1470-0328; https://hdl.handle.net/11250/2980677Test; https://doi.org/10.1111/1471-0528.17042Test; cristin:1971471

الإتاحة: https://doi.org/10.1111/1471-0528.17042Test
https://hdl.handle.net/11250/2980677Test

المؤلفون: Fougner, Stine Lyngvi, Vanky, Eszter, Løvvik, Tone Shetelig, Carlsen, Sven Magnus

المصدر: PLOS ONE

الوصف: Polycystic ovary syndrome (PCOS) is characterized by the presence of insulin resistance, and women with PCOS have high prevalence of gestational diabetes (GDM). Both conditions have been associated with increased risk for pregnancy complications such as preterm birth, preeclampsia and increased offspring birth weight. We aimed to estimate the prevalence of GDM in women with PCOS using both previous and new diagnostic criteria, and to analyse whether the risk of pregnancy complications increased with the presence of GDM. In addition, we aimed to assess the response to metformin treatment in PCOS women with GDM. We performed post-hoc analysis of three prospective, double blinded studies of altogether 791 pregnant women with PCOS randomized to either metformin or placebo treatment from first trimester to delivery. Glucose data allowing GDM classification after previous (WHO 1999) and new (WHO 2013 and Norwegian 2017) diagnostic criteria were available for 722 of the women. Complications such as preeclampsia, late miscarriage and preterm birth, birth weight and gestational age were correlated to the presence of GDM and metformin treatment. The prevalence of GDM was 28.3% (WHO 1999), 41.2% (WHO 2013) and 27.2% (Norwegian 2017). Having GDM already in first trimester associated with increased risk for late miscarriage (p<0.01). Having GDM according to newer criteria correlated to increased maternal age and BMI (p<0.001). Otherwise, having GDM (any criteria) correlated neither to the development of preeclampsia, nor to birth weight z-score or the proportion of offspring being large for gestational weight. Maternal age and BMI, parity and gestational weight gain, but not GDM or metformin treatment, were determinants for birth weight z-score. Conclusion: in pregnant women with PCOS, having GDM did not increase the risk for other pregnancy complications except for an increased risk for late miscarriage among those with GDM already in the first trimester. ; publishedVersion

وصف الملف: application/pdf

العلاقة: urn:issn:1932-6203; https://hdl.handle.net/11250/2788329Test; https://doi.org/10.1371/journal.pone.0254895Test; cristin:1925001

الإتاحة: https://doi.org/10.1371/journal.pone.0254895Test
https://hdl.handle.net/11250/2788329Test

المؤلفون: Mousa, Aya, Løvvik, Tone Shetelig, Ijas, Hilkka, Carlsen, Sven Magnus, Morin-Papunen, Laure, Tertti, Kristiina, Rönnema, Tapani, Syngelaki, Argyro, Nicolaides, Kypros, Shehata, Hassan, Burden, Chirsty, Rowan, Janet, Norman, Jane E., Dodd, Jodie M., Hague, William, Vanky, Eszter, Teede, Helena J.

المصدر: BMJ Open

الوصف: Introduction: Gestational diabetes mellitus (GDM) is a common disorder of pregnancy and contributes to adverse pregnancy outcomes. Metformin is often used for the prevention and management of GDM; however, its use in pregnancy continues to be debated. The Metformin in Pregnancy Study aims to use individual patient data (IPD) meta-analysis to clarify the efficacy and safety of metformin use in pregnancy and to identify relevant knowledge gaps. Methods and analysis: MEDLINE, EMBASE and all Evidence-Based Medicine will be systematically searched for randomised controlled trials (RCT) testing the efficacy of metformin compared with placebo, usual care or other interventions in pregnant women. Two independent reviewers will assess eligibility using prespecified criteria and will conduct data extraction and quality appraisal of eligible studies. Authors of included trials will be contacted and asked to contribute IPD. Primary outcomes include maternal glycaemic parameters and GDM, as well as neonatal hypoglycaemia, anthropometry and gestational age at delivery. Other adverse maternal, birth and neonatal outcomes will be assessed as secondary outcomes. IPD from these RCTs will be harmonised and a two-step meta-analytic approach will be used to determine the efficacy and safety of metformin in pregnancy, with a priori adjustment for covariates and subgroups to examine effect moderators of treatment outcomes. Sensitivity analyses will assess heterogeneity, risk of bias and the impact of trials which have not provided IPD. ; publishedVersion

وصف الملف: application/pdf

العلاقة: urn:issn:2044-6055; https://hdl.handle.net/11250/2739702Test; https://doi.org/10.1136/bmjopen-2020-036981Test; cristin:1863915

الإتاحة: https://doi.org/10.1136/bmjopen-2020-036981Test
https://hdl.handle.net/11250/2739702Test