Biomedical subjects

M Gissler

Publications and source records attributed to M Gissler.

At least 19 recordsLinked to original sources

PubMed2006

Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project.

OBJECTIVE: To compare rates of preterm birth among multiple births in European countries, to estimate their contribution to overall preterm birth rates and to explore factors which could explain differences between preterm birth rates. DESIGN: Analyses of data from vital statistics, birth registers or national samples of births. SETTING: Eleven member states of the European Union. POPULATION: All live births or representative samples of births at national or regional level for the year 2000 or most recent year. METHODS: Description of rates of preterm birth before 37 and 32 weeks, estimation of population attributable risks (PAR), study of associations between preterm birth rates in multiples and singletons and nonspontaneous labour using Spearman's rank correlation coefficient. MAIN OUTCOME MEASURES: Preterm birth rates, PAR, proportions of deliveries with nonspontaneous onset (caesarean sections before labour or induction of labour). RESULTS: The proportion of multiple births before 37 weeks varied from 68.4% in Austria to 42.2% in the Republic of Ireland. In half of the countries, over 20% of all preterm births were attributable to multiple births. A strong association was found between the proportions of births before 37 weeks among multiple and singleton births (r= 0.81; P < 0.001). An association was observed between the rates of preterm birth and the proportions of deliveries with nonspontaneous onset among twins. CONCLUSIONS: Wide variations in rates of preterm births and deliveries with nonspontaneous onset were found between countries, suggesting marked differences in clinical practice which could have long-term implications for the health of children from multiple births.

Cesarean Section↗

PubMed2005

Use of antimicrobials and risk of type 1 diabetes in a population-based mother-child cohort.

AIMS/HYPOTHESIS: The aim of this study was to investigate whether the use of antimicrobials is associated with the risk of childhood type 1 diabetes. MATERIALS AND METHODS: The study population included all children born in Finland between 1996 and 2000 who were diagnosed with type 1 diabetes by the end of 2002. For each case (n=437), four matched controls were selected. Data on diabetes and the maternal use of antimicrobials was derived from nationwide registries. RESULTS: Maternal use of phenoxymethyl penicillins (odds ratio [OR]=1.70, 95% CI 1.08-2.68, p=0.022) or quinolone antimicrobials (OR=2.43, 95% CI 1.16-5.10, p=0.019) before pregnancy was associated with an increased risk of type 1 diabetes in the child, whereas the use of other specific antimicrobials was not related to the risk. The risk was also higher among mother-child pairs where macrolides were used both by the mother before pregnancy and by the child, compared with pairs where neither used macrolides (OR=1.76, 95% CI 1.05-2.94, p=0.032). Maternal use of antimicrobials during pregnancy was not associated with an increased risk. The high use of antimicrobials by the child (more than seven vs seven or less purchases) was related to greater risk (OR=1.66, 95% CI 1.24-2.24, p=0.001). CONCLUSIONS/INTERPRETATION: Overall, the use of antimicrobials before pregnancy, during pregnancy or during childhood was not related to the risk of childhood type 1 diabetes. However, the use of some specific antimicrobials by the mother before pregnancy and by the child may be associated with an increased risk. Further studies are needed to confirm these associations and to elucidate the underlying mechanisms of action.

Adult↗

PubMed2004

Health care costs resulting from IVF: prenatal and neonatal periods.

BACKGROUND: The use of expensive infertility treatments is increasing rapidly. To compare the prenatal and neonatal health care costs after IVF and spontaneous conception, we conducted a study based on a cohort of IVF and control pregnancies and neonates. METHODS: A cohort of 215 IVF mothers and 255 IVF neonates were compared with a cohort of 662 control mothers and 388 control children, randomly chosen from the Finnish Medical Birth Register and matched for sex, year of birth, area of residence, parity, maternal age, socioeconomic status and plurality. The analyses on prenatal and neonatal costs were performed by plurality. Singletons were also compared with twins. The cost calculations were based on the known level of utilization of maternal and neonatal health care services. RESULTS: The total health care costs for an IVF singleton until the end of the neonatal period were 5780 and 15 580 for an IVF twin. The health care costs were 1.3-fold for IVF singletons and 1.1-fold for IVF twins compared to control singletons and twins. The costs for twins were approximately 3-fold compared to singletons. CONCLUSIONS: The health care costs of an IVF singleton neonate were higher than those of a spontaneously conceived control neonate with similar backgrounds. For twins the health care costs were equal. Multiple births increase the health care costs and therefore the reduction of multiple pregnancies is the most effective way to reduce the health care costs resulting from IVF.

Abortion, Spontaneous↗

PubMed2004

What is the most relevant standard of success in assisted reproduction?: The value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten.

The most relevant standard of success in IVF has been discussed widely. An optimal standard should reflect both the risk aspects and the effectiveness of the treatment. The most important parameter for the couple is the ultimate cumulative delivery rate per started cycle. Even if the long-term follow-up of the treatment cycles is difficult in practice, we would stress that more emphasis should be given to embryo freezing, in order to maximize the efficiency of the IVF/ICSI cycles. The contribution of embryo cryopreservation in elective single embryo transfer cycle programmes may result in a cumulative delivery rate of >50%. In Finland, the implementation of single embryo transfer has been possible with good cryopreservation programmes. The effect of this strategy has been seen in a decrease in the proportion of twin deliveries after assisted reproduction, being 13.9% for 2002, as well as a reduction of the proportion of multiple births in the nationwide Medical Birth Registry.

Cryopreservation↗

PubMed2003

Pregnancy weight gain from 1960s to 2000 in Finland.

OBJECTIVE: To study secular trends in average pregnancy weight gain between the 1960s and 2000 in Finland, and whether the changes were related to body mass index (BMI), age or parity. DESIGN: Three cross-sectional population surveys in Finland from three different periods. SUBJECTS: Women who were pregnant in Helsinki in the period 1954-1963 (N=2262), or in Tampere in the period 1985-1986 (N=1771) or in 2000-2001 (N=371). MEASUREMENTS: Pregnancy weight gain was determined from self-reported prepregnancy weight and measured weights during pregnancy. RESULTS: The mean age and prepregnancy BMI of all pregnant women increased between the 1960s and 2000 (from 26.5 to 29.6 y, from 21.9 to 23.7 kg/m(2)). The mean pregnancy weight gain, adjusted for mother's age, BMI and parity, increased from the 1960s to the mid-1980s from 13.2 to 14.3 kg. The increase was observed in all BMI categories. Compared to the 1960 cohort, the proportion of women with a pregnancy weight gain of less than 10 kg decreased and the proportion of women with a weight gain of 15 kg or more increased in the 1980 cohort. After the mid-1980s, the average pregnancy weight gain remained the same. In all cohorts, overweight women gained least weight during pregnancy, but age and parity were not associated with BMI and parity-/age-adjusted pregnancy weight gain. Higher pregnancy weight gain was associated with higher mean child's birthweight and higher proportion of high birthweight babies in all cohorts. CONCLUSIONS: The mean pregnancy weight gain has increased since the 1960s, which may be of importance with regard to the development of later obesity. Factors other than changes in prepregnancy BMI, age and parity must explain the increased pregnancy weight gain over time.

Adult↗

PubMed2003

Growth, psychomotor development and morbidity up to 3 years of age in children born after IVF.

BACKGROUND: To examine the long-term child outcome after IVF until the age of 3 years in Northern Finland, we conducted a population-based cohort study. METHODS: First, a cohort of 299 IVF children born in 1990-1995 was compared with a cohort of 558 controls representing the general population in terms of a multiple birth rate of 1.2%, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class (full sample analyses). Second, IVF singletons (n = 150) were compared with singleton controls (n = 280). Third, a plurality matched control cohort (n = 100) for IVF twins (n = 100) was randomly chosen, matched as above, from the FMBR and analysed separately. Infant mortality rate was compared with the national rate from the FMBR. RESULTS: Infant mortality in the IVF group was >2-fold higher compared to the national rate in the general population. The risk (OR, 95% CI) of low weight and height, below the lowest quartile, at 1 year of age (1.6, 1.1-2.2; 1.6, 1.1-2.4) and 2 years of age (1.5, 1.1-2.4; 1.7, 1.2-2.5) was significantly higher in the IVF group when compared with the general population control group. No statistically significant differences were found in the psychomotor development between the cohorts. Cumulative incidence of different diseases up to 3 years of age was significantly higher among IVF children in the full sample and singleton analyses (OR, 95% CI: 2.3, 1.7-3.2; 2.1, 1.3-3.3 respectively) especially regarding respiratory diseases (3.5, 1.9-6.5; 3.1, 1.0-9.4) and diarrhoea (3.7, 2.2-6.2; 5.7, 2.6-12.7), but not in twin comparisons. CONCLUSIONS: The growth of IVF children was behind that of control children during the first 3 years of life, but their psychomotor development was similar. Their postnatal health was worse, probably reflecting the problems in the neonatal period.

Body Height↗

PubMed2003

Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health.

STUDY OBJECTIVE: Several studies on differences in infant outcome by socioeconomic position have been done, but these have usually been based on ad hoc data linkages. The aim of this paper was to investigate whether socioeconomic differences in perinatal health in Finland could be regularly monitored using routinely collected data from one single register. DESIGN AND SETTING: Since October 1990, the Finnish Medical Birth Register (MBR) has included data on maternal occupation. A special computer program that converted the occupation name into an occupational code and into a socioeconomic position was prepared. Perinatal health was measured with five different indicators. The Finnish MBR data for years 1991 to 1999 (n=565 863 newborns) were used in the study. The study period was divided into three, three year periods to study time trends. RESULTS: An occupational code was derived for 95% of women, but it was not possible to define a socioeconomic position for 22% of women, including, for example, students and housewives (the group "Others"). For the rest, the data showed socioeconomic differences in all perinatal health indicators. Maternal smoking explained up to half of the excess risk for adverse perinatal outcome in the lowest socioeconomic group. The socioeconomic differences narrowed during the 1990s: infant outcome improved in the lowest socioeconomic group, but remained at the same level or even deteriorated in other groups. When comparing the lowest group with the highest group, the odds ratios (OR) adjusted for maternal background characteristics at least halved for prematurity (from 1.32 (95% confidence intervals 1.24 to 1.43) in 1991-1993 to 1.16 (1.08 to 1.25) in 1997-1999), for low birth weight (from 1.49 (1.36 to 1.63) to 1.25 (1.17 to 1.40)), and for perinatal mortality (from 1.79 (1.44 to 2.21) to 1.33 (1.07 to 1.66)). CONCLUSIONS: Social inequality in perinatal health outcomes exists in Finland, but seems to have diminished in the 1990s. These data showed that routinely collected birth register data provide a good source for studies on socioeconomic health differences in the perinatal period, but that uncertainty, mainly attributable to the large group of women with difficult to classify socioeconomic status, remains.

Birth Certificates↗

PubMed2002

Congenital anomalies and first life year surveillance in Type 1 diabetic births.

AIMS: To evaluate the rate of congenital anomalies (CA) and the reasons for mortality from 22 weeks of gestation until 1 year of age in births by Type 1 diabetic mothers. METHODS: Population-based cohort study using combined data from four national health registers in Finland during 1991-1995, including 954 singleton pregnancies complicated by Type 1 diabetes. RESULTS: Sixty births (629/10 000) involved registered major CA, of which 68% (n = 41) were isolated and 22% (n = 13) multiple anomalies, and in six cases, a syndrome was diagnosed (10%). After the exclusion of syndromes, the total number of anomalies was 73. Of the malformed infants, 63% were boys. The total rate of deaths among births until 1 year of age was higher in diabetic than in non-diabetic mothers (19.9/1000 vs. 8.1/1000): especially the rates of stillborns (odds ratio 2.4; 95% confidence interval 1.2-4.7) and post-neonatal deaths (3.8; 1.6-9.2) were higher. Of perinatal mortality (PNM) from the 22nd gestational week to the age of 7 days (13.6/1000), 23% were due to CA, 23% to prematurity, and the rest were intrauterine, mostly unexplained, deaths. Respiratory distress syndrome was the main cause of death among infants. CONCLUSIONS: The rate of CAs in Type 1 diabetic pregnancies is still high, but their proportion as a cause of PNM has decreased. Though PNM rate was low, post-neonatal mortality was significantly increased, reflecting the shift of deaths from the perinatal period to a later age.

Adult↗

PubMed2002

Obstetric outcome among women with unexplained infertility after IVF: a matched case-control study.

BACKGROUND: Infertility itself and also assisted reproductive treatment increase the incidence of some obstetric complications. Women with unexplained infertility are reported to be at an increased risk of intrauterine growth restriction during pregnancy, but not for other perinatal complications. METHODS: A matched case-control study was performed on care during pregnancy and delivery, obstetric complications and infant perinatal outcomes of 107 women with unexplained infertility, with 118 clinical pregnancies after IVF or ICSI treatment. These resulted in 90 deliveries; of these, 69 were singleton, 20 twin and one triplet. Two control groups were chosen from the Finnish Medical Birth Register, one group for spontaneous pregnancies (including 445 women and 545 children), matched according to maternal age, parity, year of birth, mother's residence and number of children at birth, and the other group for all pregnancies after IVF, ICSI or frozen embryo transfer treatment (FET) during the study period (including 2377 women and 2853 children). RESULTS: Among singletons, no difference was found in the mean birthweight, and the incidence of low birthweight (<2500 g) was comparable with that of the control groups. No differences were found in gestational duration, major congenital malformations or perinatal mortality among the groups studied. Among singletons in the study group, there were more term breech presentations (10.1%) compared with both spontaneously conceiving women and all IVF women (P < 0.01). The rate of pregnancy-induced hypertension was significantly lower among singletons in the study group (P < 0.05) compared with other IVF singletons. The multiple pregnancy rate was 23.3% in the study group. The obstetric outcome of the IVF twins was similar to both control groups. CONCLUSIONS: The overall obstetric outcome among couples with unexplained infertility treated with IVF was good, with similar outcome compared with spontaneous pregnancies and IVF pregnancies generally.

Adult↗

PubMed2001

IVF treatments and their outcomes in Finland in the 1990s.

BACKGROUND: In vitro fertilization and its variants have become routine infertility treatments in industrialized countries. Our purpose is to summarize the procedures and treatment outcomes in Finland in the 1990s and to compare the results between public and private clinics. METHODS: The data came from the Finnish IVF statistics for 1992 to 1999. Most analyses were done for the years 1994 to 1998 for which identical data-collection sheets were used. RESULTS: In 1999, 12 of the 19 clinics offering assisted reproductive treatments were private. The number of treatments increased from 2,331 in 1992 to 7,213 in 1999. In total 58% were performed in the private sector. Most treatments were given for women aged 30 to 39 years, but in the private sector women were up to on average two years older. Most often care was given due to tubal factor or unexplained infertility (IVF) and due to male factor or multiple causes (ICSI). The number of transferred embryos decreased during the study period, but the transfer of two embryos was still most frequent. Three out of four IVF and ICSI pregnancies, and two out of three FET pregnancies ended in a live birth. The success rates improved for IVF and for ICSI after adjustment for the number of transferred embryos, but not for FET. Small but inconsistent differences were observed in the success rates between the private and public sectors. There was noticeable variation between clinics. CONCLUSION: The number of treatment cycles stabilized in the late 1990s. The success rates improved only slightly and the differences in outcome measures between private and public clinics were small. However, neither this nor the large clinical variation could be investigated more thoroughly without collecting individual register data.

Adult↗

PubMed2001

A uniform regimen enables decentralized care of diabetic pregnancies.

AIMS: A nationwide recommendation to standardize the care of diabetic pregnancies in different hospitals was given in Finland in 1993. The Medical Birth Register (MBR) was used to investigate whether these recommendations have been accepted and how they have affected the outcome of newborns. METHODS: Data on 1442 singleton pregnancies complicated by insulin-treated diabetes in 1991-1995 were obtained from the MBR. RESULTS: The incidence of insulin treatment during pregnancy was 4.5 per 1000 births. Sixty-six per cent (n = 954) of all women had Type 1 diabetes. During the study period, the number of deliveries managed in tertiary centres decreased from 59% to 47% (95% confidence interval [CI] 39-58%) and care was more often carried out on an out-patient basis. The perinatal mortality rate (>or= 28 weeks of gestation) declined from 19.3 to 8.2/1000, being 12.6/1000 in the whole diabetic population and 5.5/1000 in the general population (95% CI 3.4-8.8/1000). The risk was especially increased in insulin-treated gestational diabetic (GDM) pregnancies (14.3/1000). The proportion of macrosomic newborns (31.7%) in diabetic women was significantly higher than among the general population (3.2%) (95% CI 27.0-33.9%). CONCLUSIONS: The decentralization and change-over to a mainly out-patient basis of management does not appear to have increased the number of cases of adverse outcome of diabetic pregnancy when patients have been selected to the appropriate level of care. The risks in insulin-treated GDM pregnancies were almost similar to Type 1 diabetes. To succeed, there must be a standardized care programme, continuous education and motivated personnel.

Birth Weight↗

PubMed2001

Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: a register study.

BACKGROUND: Asthma is generally regarded as a disease with strong T(H)2-type cytokine expression, whereas in autoimmune disorders, such as coeliac disease (CD), insulin-dependent diabetes mellitus (IDDM), and rheumatoid arthritis (RA), T(H)1-type expression is seen. According to the cross-regulatory properties of T(H)1 and T(H)2 cells, one would assume that these diseases exist in different patient populations. OBJECTIVE: We sought to test the hypothesis that asthma could exist in children with T(H)1-type diseases, such as CD, IDDM, and RA. METHODS: Comparison was made of the cumulative incidence of asthma in children with CD, IDDM, or RA by linking Finnish Medical Birth Register data on the whole 1987 birth cohort (n = 60,254 births) with the data of several national health registers to obtain information on the incidences of these diseases during the first 7 years of life. RESULTS: The cumulative incidence of asthma in children with CD (24.6%) or RA (10.0%) was significantly higher than in children without CD (3.4%) or RA (3.4%; P < .001 and P = .016, respectively). Asthma tended to be more common in children with IDDM than in children without IDDM. CONCLUSION: These data indicate that the T(H)1 and T(H)2 diseases can coexist, indicating a common environmental denominator behind the disease processes.

Arthritis, Rheumatoid↗

PubMed2001

Smoking during pregnancy in Finland: determinants and trends, 1987-1997.

OBJECTIVES: This study examined determinants of and trends in smoking during pregnancy in Finland from 1987 through 1997. METHODS: A repeated cross-sectional investigation of 694,926 women was conducted. RESULTS: The prevalence of smoking during pregnancy remained similar from 1987 through 1997 (at 15%). In 1997, prevalences of smoking were alarmingly high among young (37%), single (30%), and less educated (25%) women and among women living in northern (20%) and eastern (19%) Finland. These determinants were persistent over time, with the exception of an increase in regional differences. CONCLUSIONS: Despite increasing knowledge of adverse effects, smoking during pregnancy has not declined in Finland over the past decade.

Adult↗

PubMed2000

Birth dimensions of offspring, premature birth, and the mortality of mothers.

A person's birthweight is inversely related to their cardiovascular disease (CVD) mortality risk, and preliminary data suggest that the birthweights of offspring are also inversely related to parental CVD mortality risk. In a cohort of pregnant Finnish women, we assessed the relation between birth dimensions of the offspring and maternal characteristics, and subsequent mortality. Maternal CVD mortality was inversely related to the birthweight of offspring and women having premature deliveries were also at increased CVD risk. Breast-cancer mortality was positively associated with ponderal index of offspring.

Birth Weight↗

PubMed2000

Regional equity in childhood health--register-based follow-up of the Finnish 1987 birth cohort.

Our objective was to investigate regional health differences among Finnish children using a population-based longitudinal register data. All live births born in 1987 were included in the study (N=59,546) and followed-up until the age of seven years. Statistically significant regional variation was found for all health indicators but diabetes. Background variables, such as maternal age and social class, explained only the difference in mortality. Various indicators gave different geographical patterns. Regional equity in childhood health has not been achieved in Finland. Existing health registers were feasible in studying regional variation in health, but a set of comprehensive morbidity indicators - preferably derived from different data sources - should be developed to monitor equity in health.

Child↗

PubMed2000

Comparison between research data and routinely collected register data for studying childhood health.

Cohort studies are usually based on detailed information gathered on a limited number of individuals. Increasing collection of administrative registers offers an alternative method to gather health data. In the first study health information from birth until the age of seven years on 8708 children born in the two most northern provinces of Finland in 1985-86 was gathered through questionnaires, medical record reviews, medical examinations and some register data. In the second study, similar information on 8222 children born in the same provinces in 1987 was gathered using administrative registers. Both data collection methods gave equal results for mortality, long-term medication. and cumulative incidence of diabetes and intellectual disabilities. The register data identified more children with delayed development, but less children with long-term illness (77% of the level identified by the research data), with asthma (74%), and with epilepsy (40%). The register data was unsuitable for investigating hearing and vision disorders. The administrative data gave a gender ratio similar to that of the research data for two of the variables with poor coverage (asthma and epilepsy), but identified more boys with long-term illness in general than the research data. Administrative registers are useful for studying many long-term health problems, e.g. those resulting in hospital care or social benefits or those registered in vital statistics. Specific cohort studies with separate data collection is still needed to study for example outpatient care, self-assessed health, growth and development.

Age Factors↗

PubMed2000

[Small intestinal transit with radio-opaque markers to localize intermittent small bowel obstruction] .

AIM: In difficult diagnostic cases of partial small bowel obstruction, radiopaque, non-digestible markers were used to challenge and localize the site of obstruction. MATERIAL AND METHOD: 32 patients (19 female, 13 male, 3-80 years) were examined. Each patient received 20 4-mm radiopaque markers orally. Abdominal radiographs were obtained at 4-8 h intervals. Mechanical obstruction was defined as the clustering of at least 3 markers for 4 hours or longer. The transit of radiopaque markers was compared to plain radiography, ultrasound, barium meal, computed tomography, enteroclysis and operative findings. RESULTS: 18 of 32 patients showed small bowel clustering suggestive of obstruction. Diagnostic agreement was found in 12 of 14 cases with ultrasound, in 7 of 13 cases with plain radiography and in 3 of 6 cases with enteroclysis. 13 of the 18 patients with clustering had surgery. All of them (13/13) had adhesions with the need of resection. CONCLUSION: This investigation is an alternative diagnostic method for the decision between conservative and surgical treatment in cases of intermittent partial small bowel obstruction.

Adolescent↗

PubMed2000

Births in Finland and Estonia from 1992 to 1996: convergent differences?

OBJECTIVE: To describe the differences in childbearing, in prenatal and obstetrical practices, and in perinatal health outcome in Finland and Estonia. DESIGN: Registry study using the data from the Finnish and Estonian medical birth registries for years 1992 to 1996 (in total 324,021 and 74,297 newborns, respectively). RESULTS: In 1992 the birth rates were 51 per 1,000 women aged 15 to 49 in Finland and 48 per 1,000 in Estonia. The birth rate declined in the study period in both countries, but the decline was more rapid in Estonia (-26%) than in Finland (-6%). In the same period the rates of induced abortion declined in both countries (-34% and -6%, respectively), but the rate in 1996 was still much higher in Estonia (46/1,000) than in Finland (8/1,000). Compared with Finnish mothers, Estonian mothers were younger, had fewer multiple births, less prenatal care and fewer interventions during pregnancy and delivery. The intervention rates increased in both countries during the study period, but this increase was more rapid in Estonia. The infant outcomes were poorer in Estonia, but the differences between Estonia and Finland decreased during the 1990's. CONCLUSIONS: The differences in prenatal and maternal care and in induced abortion rates have decreased between Estonia and Finland. Changes in maternal backgrounds, improved referral system for complicated pregnancies, improvements in prenatal care and in availability of appropriate equipment and technology may have caused improved maternal and infant health in Estonia, but this should be further investigated.

Abortion, Spontaneous↗