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Skjeldestad FE, Gissler M, Geirsson RT, Heino A, Sigbjörnsdottir HB, Akerkar R, Gemzell-Danielsson K, Heikinheimo O, Løkeland M. Trends over 50 years with liberal abortion laws in the Nordic countries. PLoS One 2024; 19:e0305701. [PMID: 38985688 PMCID: PMC11236142 DOI: 10.1371/journal.pone.0305701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND During the 1970s the Nordic countries liberalized their abortion laws. OBJECTIVE We assessed epidemiological trends for induced abortion on all Nordic countries, considered legal similarities and diversities, effects of new medical innovations and changes in practical and legal provisions during the subsequent years. METHODS New legislation strengthened surveillance of induced abortion in all countries and mandated hospitals that performed abortions to report to national abortion registers. Published data from the Nordic abortion registers were considered and new comparative analyses done. The data cover complete national populations. RESULTS AND CONCLUSIONS After an increase in abortion rates during the first years following liberalization, the general abortion rates stabilized and even decreased in all Nordic countries, especially for women under 25 years. From the mid-1980s higher awareness about pregnancy termination led women to present at an earlier gestational age, which was accelerated by the introduction of medical abortion some years later. Most terminations (80-86%) are now done before the 9th gestational week in all countries, primarily by medical rather than surgical means. Introduction of routine ultrasound screening in pregnancy during the late 1980s, increased the number of 2nd trimester abortions on fetal anomaly indications without an overall increase in the proportion of 2nd relative to 1st trimester abortions. Further refinement of ultrasound screening and non-invasive prenatal diagnostic methods led to a slight increase in the proportion of early 2nd trimester abortions after the year 2000. Country-specific differences in abortion rates have remained stable over the 50 years of liberalized abortion laws.
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Affiliation(s)
- Finn Egil Skjeldestad
- Department of Community Medicine, Research Group Epidemiology of Chronic Diseases, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mika Gissler
- Department of Knowledge Brokers, THL, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Region Stockholm, Academic Primary Health Care Centre, Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Reynir Tómas Geirsson
- University Department of Obstetrics and Gynecology, Women’s Clinic, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anna Heino
- Department of Knowledge Brokers, THL, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Rupali Akerkar
- Devision of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - Kristina Gemzell-Danielsson
- Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institute, and Karolinska University Hospital, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mette Løkeland
- Devision of Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Palm A, Talaslahti T, Vataja R, Ginters M, Kautiainen H, Elonheimo H, Suvisaari J, Lindberg N, Koponen H. Criminal behavior in alcohol-related dementia and Wernicke-Korsakoff syndrome: a Nationwide Register Study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01804-0. [PMID: 38613687 DOI: 10.1007/s00406-024-01804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Chronic heavy alcohol use may lead to permanent brain damage, cognitive impairment, and dementia. While the link between alcohol use and crime is strong, virtually no research exists on the criminal behavior of patients with the alcohol-related neurocognitive disorders of Wernicke-Korsakoff syndrome (WKS) and alcohol-related dementia (ARD). METHODS The study population included all persons diagnosed with WKS (n = 1149) or ARD (n = 2432) in Finland in 1998-2015. Data on diagnoses, mortality, and crime were obtained from Finnish nationwide registers. Crime incidences were calculated 4 years before and after diagnosis. Crime types, incidences, and mortality were compared between disorders and with the general population. RESULTS Altogether 35.6% of WKS patients and 23.6% of ARD patients had committed crimes in the 4 years preceding diagnosis, most commonly property and traffic crimes, followed by violent crimes. The incidence of criminal behavior decreased significantly after diagnosis; in WKS patients, the standardized criminality ratio (SCR), the ratio of observed to expected number of crimes (95% CI), was 3.91 (3.72-4.10) in 4 years before and 2.80 (2.61-3.00) in 4 years after diagnosis. Likewise, in ARD patients, the SCRs were 2.63 (2.51-2.75) before and 0.84 (0.75-0.92) after diagnosis. No significant difference emerged in mortality between persons with and without a criminal history. CONCLUSIONS Persons with alcohol-related neurocognitive disorders frequently engage in criminal behavior prior to diagnosis, especially multiple offending. In the 4 years before and after diagnosis, crime rates declined in a linear fashion, with a marked reduction after diagnosis.
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Affiliation(s)
- Anniina Palm
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland.
- University of Helsinki, Helsinki, Finland.
| | - Tiina Talaslahti
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Risto Vataja
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Milena Ginters
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | | | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Hannu Koponen
- Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Toivonen E, Taurio K, Kortelainen E, Havulinna AS, Jääskeläinen T, Laivuori H. Validation of the Finnish Care register for Health Care diagnoses for preeclampsia, gestational diabetes and preterm delivery. Pregnancy Hypertens 2024; 35:26-29. [PMID: 38091805 DOI: 10.1016/j.preghy.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Centrally collected Finnish national health register data on adverse pregnancy outcomes are available for research, but the validity of the data is largely unknown. Our aim was to compare the diagnoses of preeclampsia (PE), gestational diabetes (GDM), and preterm delivery from hospital records with the registry based diagnoses from the Finnish Care Register for Health Care (FCR). Data on gestational age at delivery from the Medical Birth Registry (MBR) was also studied. METHODS The Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) Study cohort was used as a data source. Each diagnosis was ascertained from electronic hospital records. The validity of diagnoses obtained by record linkage of FCR and MBR was assessed against the classification previously confirmed independently by a research nurse and a study physician. RESULTS Sensitivity of PE diagnoses in FCR was 80.3 % (95 % CI 78.3 % to 82.2 %) andspecificity 95.3 % (95 % CI 93.9 % to 96.4 %). Sensitivity for GDM was 64.1 % (95 % CI: 58.7 % - 69.3 %) and specificity 98.5 % (95 % CI: 97.9 % - 98.9 %), whereas sensitivity and specificity for preterm delivery were 32.4 % (95 % CI: 29.0 % - 36.0 %) and 99.7 % (95 % CI: 99.3 % - 99.9 %). Sensitivity of preterm delivery in the MBR was 99.1 % and specificity 99.9 %. CONCLUSIONS FCR registry diagnoses for PE have satisfactory sensitivity and high specificity. Diagnoses for GDM and preterm delivery have lower sensitivity limiting their use in studies, and data from MBR should be preferred when studying preterm deliveries.
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Affiliation(s)
- Elli Toivonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland; Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampereen yliopisto, PO Box 100, Tampere 33014, Finland.
| | - Kirsi Taurio
- Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland; Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampereen yliopisto, PO Box 100, Tampere 33014, Finland.
| | - Eija Kortelainen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, PO Box 63, Helsinki 00014, Finland.
| | - Aki S Havulinna
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, University of Helsinki, PO Box 4, Helsinki 00014, Finland; Finnish Institute for Health and Welfare, PO Box 30, Helsinki 00271, Finland.
| | - Tiina Jääskeläinen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, PO Box 63, Helsinki 00014, Finland; Department of Food and Nutrition, University of Helsinki, PO Box 66, Helsinki 00014, Finland.
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, PO Box 2000, Tampere 33521, Finland; Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampereen yliopisto, PO Box 100, Tampere 33014, Finland; Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, PO Box 63, Helsinki 00014, Finland; Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, University of Helsinki, PO Box 4, Helsinki 00014, Finland.
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Pohjoranta E, Suhonen S, Mentula M, Gissler M, Heikinheimo O. Pregnancy outcomes following routine early provision of intrauterine device after first-trimester induced abortion-A secondary analysis of a randomized controlled trial with a 5-year follow up. Acta Obstet Gynecol Scand 2024; 103:342-350. [PMID: 37983839 PMCID: PMC10823387 DOI: 10.1111/aogs.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/17/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Women undergoing an induced abortion are highly fertile and at risk of subsequent unplanned pregnancy. We recently completed a randomized clinical trial showing that routine provision of intrauterine device (IUD) at the time of abortion significantly reduced the risk of subsequent abortion during a 5-year follow up. As the use of highly effective contraception may affect all subsequent pregnancies, we analyzed the rate and distribution of all subsequent pregnancies (deliveries, miscarriages, and abortions), and the risk factors for these various pregnancy outcomes in the above-mentioned randomized clinical trial. MATERIAL AND METHODS We enrolled adult women requesting first-trimester induced abortion and candidates for IUD for post-abortion contraception. Women (n = 751) were randomized to receive an IUD (either levonorgestrel-releasing IUD or copper IUD) by the clinic responsible for abortion care vs. routine care of IUD provision in primary health care with oral contraceptives for interval contraception. In the present secondary analysis, we identified all deliveries, miscarriages, and abortions in the intervention (n = 375) and control (n = 373) cohorts during the 5-year follow up using the Finnish national registries. The trial is registered at Clinical Trials (NTC01223521). RESULTS The overall delivery, miscarriage, and abortion rates were 42.0, 12.0 and 32.1/1000 years of follow up (yFU). Any new pregnancy occurred in 98 women in the intervention and in 129 women in the control cohort (hazard ratio 0.73, 95% confidence interval 0.56-0.95, p = 0.023). The effect of routine IUD provision in reducing pregnancies was limited to the first 2 yFU. The number of subsequent induced abortions and of women undergoing it were significantly reduced, and time to abortion was prolonged by the intervention. However, the overall number, the number of women with subsequent delivery or miscarriage, and the times to these events were not significantly affected. History of previous pregnancy (delivery or abortion) and smoking were risk factors for subsequent induced abortion, but not for delivery or miscarriage. CONCLUSIONS Routine provision of IUD as part of abortion care did not reduce the rates of delivery or miscarriage during the 5-year follow up. The rates of all pregnancies and the need of subsequent induced abortion were reduced by IUD provision during the first 2 yFU.
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Affiliation(s)
- Elina Pohjoranta
- Department of Obstetrics and GynecologyUniversity of HelsinkiHelsinkiFinland
| | - Satu Suhonen
- Department of Obstetrics and GynecologyUniversity of HelsinkiHelsinkiFinland
| | - Maarit Mentula
- Department of Obstetrics and GynecologyUniversity of HelsinkiHelsinkiFinland
- Department of Obstetrics and GynecologyHelsinki University HospitalHelsinkiFinland
| | - Mika Gissler
- Knowledge Brokers, Finnish Institute for Health and WelfareHelsinkiFinland
- Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden
- Region Stockholm, Academic Primary Health Care CenterStockholmSweden
| | - Oskari Heikinheimo
- Department of Obstetrics and GynecologyUniversity of HelsinkiHelsinkiFinland
- Department of Obstetrics and GynecologyHelsinki University HospitalHelsinkiFinland
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Jäntti C, Toffol E, Partonen T, Haukka J, Heikinheimo O. Contraceptive plans and purchase after an induced abortion: A nationwide register study from Finland. Contraception 2024; 129:110299. [PMID: 37804948 DOI: 10.1016/j.contraception.2023.110299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To examine the types of hormonal contraceptive methods chosen at the time of the abortion, and how they correspond to post-abortion hormonal contraceptive purchase. STUDY DESIGN This was a prospective register-based study. We identified the present cohort of 8428 women undergoing induced abortion between July 1, 2017 and December 31, 2018, using the Prescription Centre, Social Insurance Institution database and the Finnish National Register of Induced Abortions. From the Register of Induced Abortions, we gathered information on planned post-abortion contraception. The redeemed prescriptions of hormonal contraception were identified from the Prescription Centre until December 31, 2019. We analyzed the hormonal contraceptive methods planned at the time of the abortion, and how they corresponded to hormonal contraceptive purchase during the 1-year follow-up. We also assessed factors (age, socioeconomic status, education, civil status, and reproductive history) affecting post-abortion contraceptive purchase by using Poisson regression models. RESULTS At the time of the abortion, 83% (n = 7023) of the women were planning to start using hormonal contraception. Planning any hormonal contraception at the time of the abortion was associated with a higher probability to purchase hormonal contraception after the abortion (incidence rate ratio [IRR] 2.30, 95% confidence intervals [CI] 2.07-2.55), especially in cases of the vaginal ring (IRR 42.66, 95% CI 33.89-53.71) and contraceptive patch (IRR 156.33, 95% CI 111.31-219.55). The following variables were associated with lower incidence rates for purchasing hormonal contraception after the abortion: educational level of bachelor at the highest or missing information on education, civil status as married or divorced, and history of delivery or induced abortion. CONCLUSIONS The majority of women undergoing abortion plan to use hormonal contraceptive method for post-abortion contraception. Planning any hormonal contraceptive method at the time of an induced abortion is an important predictor of purchasing the method within the year after the abortion. IMPLICATIONS Hormonal contraceptive purchase after an abortion is associated with pre-abortion contraceptive planning. Many background factors for not purchasing hormonal contraception can be identified, which may guide counseling dedicated to these groups.
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Affiliation(s)
- Camilla Jäntti
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland
| | - Elena Toffol
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Mental Health Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland.
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Azizi A, Norsker FN, Kokla M, Nielsen TT, Holmqvist AS, Øra I, Vettenranta K, Øfstaas H, Hasle H, Rechnitzer C, Winther JF, Kenborg L. Pregnancy outcomes in female survivors of neuroblastoma: a short report from the Adult Life after Childhood Cancer in Scandinavia (ALiCCS) study. Acta Oncol 2023; 62:1635-1641. [PMID: 37837234 DOI: 10.1080/0284186x.2023.2266567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Arezo Azizi
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
| | - Filippa N Norsker
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
| | - Marietta Kokla
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
| | - Thomas T Nielsen
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
| | - Anna S Holmqvist
- Childhood Cancer Center, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ingrid Øra
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kim Vettenranta
- University of Helsinki and Hospital for Children and Adolescents, Helsinki, Finland
| | - Hilde Øfstaas
- Norwegian Cancer Registry and Department of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Catherine Rechnitzer
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeanette F Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
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Kc S, Gissler M, Heino A, Klemetti R. Factors influencing the risk of repeat termination of pregnancy: A register-based study in Finland. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100876. [PMID: 37307625 DOI: 10.1016/j.srhc.2023.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to assess how factors such as sociodemographic characteristics, termination of pregnancy (TOP) related factors and contraception affect the risk of repeat TOP. MATERIALS AND METHOD This is a nationwide register-based study of 193,741 women who had TOP(s) during 1987-2015, using the Finnish Register of Induced Abortions. The risk of various factors, such as age, marital status, residence, parity, TOP related factors and contraception, was assessed separately for each repeat TOP. Cox proportional hazard model was used to estimate risk of different factors for repeat TOPs. RESULTS 21% of the women having TOP had repeat TOPs during the years 1987-2015. Among women with repeat TOPs, more than 70% had one repeat TOP and the rest had two or more. Older, married and rural or semi-urban women had reduced risk of repeat TOPs. Adjusted risk for one repeat TOP was higher among parous women (HR 1.67, 95% CI 1.61-1.72). No significant risk for repeat TOP was observed by method in sub-analysis for the recent period after 2006. Women using less reliable (HR 1.14, 95% CI 1.06-1.23) and unreliable (HR 1.33, 95% CI 1.23-1.43) contraception had increased risk of repeat TOP than women using reliable contraception. CONCLUSION Older age, being married, residing in rural or semi-urban areas and using reliable contraception were found to be protective factors for repeat TOPs whereas, parous women had higher risk for repeat TOPs. Proper counselling regarding contraception and use of reliable contraception immediately after TOP should be encouraged.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland.
| | - Mika Gissler
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden and Region Stockholm, Academic Primary Health Care Centre, S-14183 Stockholm, Sweden
| | - Anna Heino
- Department of Knowledge Brokers, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
| | - Reija Klemetti
- Department of Public Welfare, National Institute for Health and Welfare, FI-00271 Helsinki, Finland
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Tuominen A, Saavalainen L, Niinimäki M, Gissler M, But A, Härkki P, Heikinheimo O. First live birth before surgical verification of endometriosis-a nationwide register study of 18 324 women. Hum Reprod 2023:dead120. [PMID: 37403272 PMCID: PMC10391315 DOI: 10.1093/humrep/dead120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
STUDY QUESTION Do women with endometriosis have lower first live birth rate before surgical diagnosis than women without verified endometriosis? SUMMARY ANSWER Compared to reference women, the incidence of first live birth was lower in women prior to surgical verification of endometriosis irrespective of the type of endometriosis. WHAT IS KNOWN ALREADY Endometriosis is associated with pain and reduced fertility. The mechanism of infertility is partly explained by anatomical, endocrinological, and immunological changes. Over the past decades, the treatment of both endometriosis and infertility has evolved. Knowledge of fertility far before surgical diagnosis of endometriosis in large cohorts and of different types of endometriosis has been lacking. The diagnostic delay of endometriosis is long, 6-7 years. STUDY DESIGN, SIZE, DURATION Retrospective population-based cohort study focused on the time period before the surgical verification of endometriosis. All women with surgical verification of endometriosis in 1998-2012 were identified from the Finnish Hospital Discharge Register and the reference cohort from the Central Population Register. Data on deliveries, gynecological care, and sociodemographic factors before the surgical diagnosis were gathered from Finnish national registers maintained by the Finnish Institute for Health and Welfare, the Digital and Population Data Services Agency, and Statistics Finland. PARTICIPANTS/MATERIALS, SETTING, METHODS All women aged 15-49 years at the time of surgical verification of endometriosis (ICD-10: N80.1-N80.9) in Finland during 1998-2012 were identified (n = 21 620). Of them, we excluded women born in 1980-1999 due to the proximity of the surgical diagnosis (n = 3286) and women left without reference (n = 10) for the final endometriosis cohort of 18 324 women. From the final cohort, we selected sub-cohorts of women with isolated diagnosis of ovarian (n = 6384), peritoneal (n = 5789), and deep (n = 1267) endometriosis. Reference women were matched by age and residence and lacked registered clinical or surgical diagnosis of endometriosis (n = 35 793). The follow-up started at the age of 15 years and ended at the first birth, sterilization, bilateral oophorectomy, hysterectomy, or until the surgical diagnosis of endometriosis or corresponding index day-whichever came first. Incidence rate (IR) and the incidence rate ratio (IRR) of first live birth before the surgical verification of endometriosis with corresponding CIs were calculated. In addition, we reported the fertility rate of parous women (the number of all children divided by the number of parous women in the cohort) until the surgical verification of endometriosis. The trends in first births were analysed according to the women's birth cohort, type of endometriosis, and age. MAIN RESULTS AND THE ROLE OF CHANCE Surgical diagnosis of endometriosis was set at the median age of 35.0 years (IQR 30.0-41.4). Altogether 7363 women (40.2%) with endometriosis and 23 718 (66.3%) women without endometriosis delivered a live born infant before the index day (surgery). The IRs of the first live birth per 100 person-years were 2.64 (95% CI 2.58-2.70) in the endometriosis cohort and 5.21 (95% CI 5.15-5.28) in the reference cohort. Between the endometriosis sub-cohorts, the IRs were similar. The IRR of the first live birth was 0.51 (95% CI 0.49-0.52) between the endometriosis and reference cohorts. Fertility rate per parous woman before the surgical diagnosis was 1.93 (SD 1.00) and 2.16 (SD 1.15) in the endometriosis and reference cohorts (P < 0.01). The median age at the first live birth was 25.5 (IQR 22.3-28.9) and 25.5 (IQR 22.3-28.6) years (P = 0.01), respectively. Between the endometriosis sub-cohorts, women in the ovarian sub-cohort were the oldest at the time of surgical diagnosis with the median age of 37.2 years (IQR 31.4-43.3), (P < 0.001). Altogether 44.1% (2814) of the women with ovarian, 39.4% (2282) with peritoneal, and 40.8% (517) with deep endometriosis delivered a live born infant before the diagnosis. IRRs between the endometriosis sub-cohorts did not differ. Fertility rate per parous woman was lowest, 1.88 (SD 0.95), in the ovarian sub-cohort compared to 1.98 (SD 1.07) in the peritoneal and 2.04 (SD 0.96) in deep endometriosis (P < 0.001). Women with ovarian endometriosis were oldest at first live birth compared to women in other sub-cohorts with a median age of 25.8 years (IQR 22.6-29.1) (P < 0.001). Cumulative distributions of first live birth were presented according to age at first live birth and birth cohorts of the participants. LIMITATIONS, REASONS FOR CAUTION The increasing age at first live birth, increasing practice of clinical diagnostics, conservative treatment of endometriosis, a possible effect of coexisting adenomyosis, and use of artificial reproductive treatments should be considered when assessing the results. In addition, the study is limited due to possible confounding effects of socioeconomic factors, such as level of education. It should be noted that, in this study, we assessed parity only during the years preceding the surgical verification of endometriosis. WIDER IMPLICATIONS OF THE FINDINGS The need for early diagnosis and relevant treatment of endometriosis appears clear given the impairment of fertility prior to its surgical verification. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Hospital District of Helsinki and Uusimaa and by Finska Läkaresällskapet. The authors report no conflicts of interest. All authors have completed the ICMJE Disclosure form. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Tuominen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland
| | - L Saavalainen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Niinimäki
- Department of Obstetrics and Gynecology, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostobothnia, Oulu, Finland
| | - M Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Center, Stockholm, Sweden
| | - A But
- Department of Biostatistics, University of Helsinki, Helsinki, Finland
| | - P Härkki
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Palm A, Talaslahti T, Vataja R, Ginters M, Kautiainen H, Elonheimo H, Suvisaari J, Lindberg N, Koponen H. Antipsychotic Use and Mortality in Persons with Alcohol-Related Dementia or Wernicke-Korsakoff Syndrome: A Nationwide Register Study in Finland. J Clin Med 2023; 12:4263. [PMID: 37445298 DOI: 10.3390/jcm12134263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Research on the use of psychotropic drugs in people with alcohol-related neurocognitive disorders is virtually nonexistent. We examined the prevalence of antipsychotic drug use and its effect on mortality among patients with Wernicke-Korsakoff syndrome (WKS) or alcohol-related dementia (ARD). METHODS In this nationwide register study, we collected data on the medication use and mortality of all persons aged ≥40 diagnosed with WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the prevalence of antipsychotic use within one year of diagnosis and the adjusted cumulative mortality of antipsychotic users versus non-users in relation to the age-, sex-, and calendar year-matched general population. RESULTS Of the WKS and ARD patients, 35.9% and 38.5%, respectively, purchased one or more antipsychotic drugs in the year following diagnosis. The adjusted cumulative mortality of the antipsychotic users was significantly lower than that of non-users in both the WKS and ARD groups, where the adjusted hazard ratios (95% CI) were 0.85 (0.72-0.99) and 0.73 (0.65-0.81), respectively. WKS and ARD patients using antipsychotics were less likely to die of alcohol-related causes than antipsychotic non-users, but the difference was significant only in the ARD group. CONCLUSIONS This population-based study shows that antipsychotic use is common in patients with WKS or ARD. In contrast to other dementia studies, our results indicate that the mortality of antipsychotic users is significantly lower than that of non-users. The lower mortality could be explained by decreased alcohol use and better healthcare coverage in antipsychotic users.
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Affiliation(s)
- Anniina Palm
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Tiina Talaslahti
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Risto Vataja
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Milena Ginters
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, 70210 Kuopio, Finland
- Folkhälsan Research Center, 00250 Helsinki, Finland
| | - Henrik Elonheimo
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Hannu Koponen
- Department of Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
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10
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Mutru M, Kivelä P, Ollgren J, Liitsola K, Gissler M, Aho I. Induced abortions of women living with HIV in Finland 1987-2019: a national register study. BMC Pregnancy Childbirth 2023; 23:120. [PMID: 36800943 PMCID: PMC9938577 DOI: 10.1186/s12884-023-05430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987-2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented. METHODS A retrospective nationwide register study of all WLWH in Finland 1987-2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland. RESULTS Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987-1997 to 2009-2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998-2019 were being foreign-born (OR 3.09, 95% CI 1.55-6.19), younger age (OR 0.95 per year, 95% CI 0.90-1.00), previous induced abortions (OR 3.36, 95% CI 1.80-6.28), and previous deliveries (OR 2.13, 95% CI 1.08-4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008-0.029%. CONCLUSIONS Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.
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Affiliation(s)
- Mikaela Mutru
- University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland. .,Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland. .,Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Pia Kivelä
- grid.7737.40000 0004 0410 2071University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014 Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Liitsola
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Helsinki, Finland ,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Inka Aho
- grid.7737.40000 0004 0410 2071University of Helsinki, Biomedicum, Haartmaninkatu 8, 00014 Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
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11
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García-Velázquez R, Kieseppä V, Lilja E, Koponen P, Skogberg N, Kuusio H. A multisource approach to health care use: concordance between register and self-reported physician visits in the foreign-born population in Finland. BMC Med Res Methodol 2022; 22:309. [PMID: 36460964 PMCID: PMC9717412 DOI: 10.1186/s12874-022-01780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Reliable information on the use of health services is important for health care planning, monitoring and policy. It is critical to assess the validity of the sources used for this purpose, including register and survey-based data. Studies on foreign-born populations' health care use have usually implemented either survey or register data. The concordance of such data among groups of different cultural background remains largely unknown. In this study, we presented an approach to examine routinely how survey and register-related characteristics may explain disagreement found between the two information sources. METHODS We linked register- and survey-based data pertaining to the Finnish Register of Primary Health Care general physician visits and the Survey on Well-Being among Foreign Born Population (FinMonik, 2018-2019), a nationally representative survey. The sample comprised n = 5,800 informants for whom registered general physician visits were tracked in the 12-month period preceding their participation in the survey. Cohen's kappa was used as measure of multisource concordance, hierarchical loglinear models for the association between single predictors and multisource discrepancy, and a logistic regression model for examining source-related predictors of source discrepancy. Survey weights were used in all sample analyses. RESULTS Source concordance was poor. When dichotomizing general physician visits (zero vs one or more), 35% of informants had reported one or more visits while none were found from register. Both register- and informant-related predictors were associated to this discrepancy (i.e. catchment area, private health care use, inability to work, region of origin and reason for migration). CONCLUSIONS We found high discrepancy between the reported and the registered physician visits among the foreign-born population in Finland, with a particularly high number of reported physician visits when none were found in the register. There was a strong association between the specific catchment area and mismatch, indicating that both register under-coverage and survey over-report are plausible and may coexist behind the discrepancy. However, associations of informant's characteristics and mismatch were less pronounced. Implications on the validity of medical information sources are discussed.
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Affiliation(s)
- Regina García-Velázquez
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Valentina Kieseppä
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Eero Lilja
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Päivikki Koponen
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Natalia Skogberg
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Hannamaria Kuusio
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
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12
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Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up. Arch Gynecol Obstet 2022; 306:2069-2075. [PMID: 36044047 PMCID: PMC9633478 DOI: 10.1007/s00404-022-06737-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022]
Abstract
Purpose Hysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse. Methods We included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9–14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence. Results The re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03). Conclusion Hysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.
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13
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Salonen AH, Castrén S, Latvala TA, Grönroos T, Levola J, Vuori M. Gender- and age-stratified analyses of gambling disorder in Finland between 2011 and 2020 based on administrative registers. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:623-633. [DOI: 10.1177/14550725221108793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Aim: Prevalence studies on gambling have largely relied on survey samples. Little is known about the diagnosed prevalence of gambling disorder (GD) based on register data. This study examines the annual prevalence rate of GD between 2011 and 2020 among Finns by gender and age. Methods: Aggregated data on the diagnosis of GD (corresponding to pathological gambling, code F63.0 in the ICD-10) were retrieved from the following national registers: Register of Primary Health Care Visits, and Care Register for Health Care, including specialised outpatient and inpatient health care, and inpatient Care Register for Social Welfare. Primary and secondary diagnoses of adults were included. Average population during a calendar year (4,282,714–4,460,177 individuals) was utilised to calculate annual prevalence. Results: The annual prevalence of diagnosed GD in the population increased from 0.005% ( n = 196) to 0.018% ( n = 804) within nine years. In 2011, the annual prevalence rate was 0.006% for men and 0.003% for women, compared to rates in 2020 of 0.025% and 0.011%. Gender discrepancy was relatively stable across years: 27.2–33.8% of the diagnoses were for women. The prevalence of GD varied between age groups within genders. GD was most prevalent among 18–44-year-olds. The prevalence rates increased the most among 30–44-year-old women. Conclusion: The extremely low prevalence rate of GD implies that the problem remains under-diagnosed, yet, it has increased among all age groups across genders, except for women aged 60 years or older. Active efforts are needed to increase awareness of GD among both primary and specialised healthcare professionals and the public for better recognition and early detection.
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Affiliation(s)
- Anne H. Salonen
- Finnish Institute for Health and Welfare, Helsinki, Finland; and University of Eastern Finland, Kuopio, Finland
| | - Sari Castrén
- Finnish Institute for Health and Welfare, Helsinki, Finland; University of Turku, Turku, Finland; and University of Helsinki, Helsinki, Finland
| | | | - Tanja Grönroos
- Finnish Institute for Health and Welfare, Helsinki, Finland; and University of Helsinki, Helsinki, Finland
| | - Jonna Levola
- University of Helsinki, Helsinki, Finland; and Psychiatry, Hospital District of Helsinki and Uusimaa, HUS, Finland
| | - Miika Vuori
- University of Turku, Research Center for Child Psychiatry, INVEST Research Flagship, Turku, Finland
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14
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Saloranta TH, Gyllenberg FK, But A, Gissler M, Heikinheimo O, Laine MK. Use of reproductive health services among women using long- or short-acting contraceptive methods - a register-based cohort study from Finland. BMC Public Health 2022; 22:1185. [PMID: 35701805 PMCID: PMC9199191 DOI: 10.1186/s12889-022-13581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives (LARCs) have superior contraceptive efficacy compared to short-acting reversible contraceptives (SARCs) and choosing LARCs over SARC methods reduces the need for abortion care. However, little is known how initiating these methods associates with the subsequent overall need of reproductive health services including family planning services, and visits for gynecological reasons in primary and specialized care. METHODS We followed altogether 5839 non-sterilized women aged 15-44 years initiating free-of-charge LARC methods (n = 1689), initiating or switching SARC methods (n = 1524), or continuing with the same SARC method (n = 2626) at primary care family planning clinics in the City of Vantaa, Finland, 2013-2014 for 2 years using Finnish national health registers. We assessed the use of reproductive health services, namely attending public primary or specialized health care for gynecological reasons or attending the family planning clinics by applying unadjusted and adjusted negative binomial regression models on visit counts. RESULTS A total of 11,290 visits accumulated during the two-year follow-up: 7260 (64.3%) at family planning clinics, 3385 (30.0%) for gynecological reasons in primary, and 645 (5.7%) in specialized health care. Altogether 3804 (52.4%) visits at the family planning clinics were for routine checkup, and 3456 (47.6%) for other reasons. Women initiating LARC methods used reproductive health services for reasons other than routine checkups similarly as women initiating or switching SARC methods (adjusted incidence rate ratio 0.93, 95% CI 0.82-1.05), while women continuing with SARC methods used the services less frequently (0.65, 0.59-0.72). Women initiating free-of-charge LARC and those continuing with the same SARC method used services less for abortion care than women initiating or switching SARC (adjusted incidence rate ratios 0.05, 95% CI 0.03-0.08 and 0.16, 95% CI 0.11-0.24, respectively). CONCLUSIONS While women initiating LARC methods have lower need for abortion care compared to women initiating SARC methods, women initiating both LARC and SARC methods have similar overall need for reproductive health services. In contrast, women continuing with their SARC method need reproductive health services less than women initiating LARC or a new SARC method. These service needs should be acknowledged when planning and organizing family planning services, and when promoting long-acting reversible contraception.
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Affiliation(s)
- Tuire Helene Saloranta
- Myyrmäki Health Center, Jönsaksentie 4, 01600, Vantaa, Finland.,Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland
| | - Frida Katrin Gyllenberg
- Myyrmäki Health Center, Jönsaksentie 4, 01600, Vantaa, Finland.,Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3 (Teutori 3. krs), 20014, Turku, Finland.,Region Stockholm, Academic Primary Health Care Centre, Solnavägen 1 E, 113 65, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Solnavägen 1, 17177, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, FI-00029 HUS, Helsinki, Finland.
| | - Merja Kristiina Laine
- Department of General Practice and Primary Care, University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Helsinki, Finland.,Folkhälsan Research Center, Topeliuksenkatu 20, 00250, Helsinki, Finland
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15
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Heikinheimo O, Toffol E, Partonen T, But A, Latvala A, Haukka J. Systemic hormonal contraception and risk of venous thromboembolism. Acta Obstet Gynecol Scand 2022; 101:846-855. [PMID: 35633036 DOI: 10.1111/aogs.14384] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The increased risk of venous thromboembolism associated with the use of hormonal contraception is well recognized, but evidence regarding hormonal contraception containing natural estradiol is limited. This study aimed to assess the associations between the patterns of use of different systemic hormonal contraceptives and the risk of venous thromboembolism during 2017-2019. MATERIAL AND METHODS All fertile-aged women (15-49 years) living in Finland in 2017 and using hormonal contraception in 2017 and their 1:1 age- and residence-matched controls not using hormonal contraception in 2017 (altogether 587 559 women) were selected from the Prescription Centre. All incident venous thromboembolism cases during 2018-2019 and their 4:1 age-matched controls were further analyzed in a prospective nested case-control design to assess the associations between the use (starting, stopping, continuous vs no use) of different hormonal contraception types and venous thromboembolism. RESULTS Altogether, 1334 venous thromboembolism cases occurred during the follow-up period (incidence rate 1.14 per 1000 person-years, 95% confidence interval [CI] 1.08-1.20), with an incidence rate ratio of hormonal contraception vs no hormonal contraception use of 1.42 (95% CI 1.27-1.58). Compared with non-use, starting the use of gestodene and ethinylestradiol (adjusted odds ratio [aOR] 2.85; 95% CI 1.62-5.03), drospirenone and ethinylestradiol (aOR 1.55; 95% CI 0.98-2.44), desogestrel and ethinylestradiol (aOR 1.97; 95% CI 0.99-3.92), and transdermal patch releasing norelgestromin and ethinylestradiol (aOR 5.10; 95% CI 1.12-23.16), as well as continuing the use of gestodene and ethinylestradiol (aOR 2.60; 95% CI 1.61-4.21), drospirenone and ethinylestradiol (aOR 1.55; 95% CI 1.02-2.37), cyproterone-acetate and estrogen/ethinylestradiol (aOR 1.66; 95% CI 1.06-2.61), and vaginal ring releasing etonogestrel and ethinylestradiol (aOR 3.27; 95% CI 1.95-5.48) were associated with venous thromboembolism risk. Regarding the type of estrogen, the highest risk was associated with current use (vs non use in the previous 180 days) of ethinylestradiol-containing preparations (aOR 2.20; 95% CI 1.82-2.65), followed by estradiol-containing preparations (aOR 1.39; 95% CI 1.04-1.87) with no risk for progestin-only hormonal contraception. Current use of estradiol-containing preparations was not associated with venous thromboembolism risk after exclusion of cyproterone-acetate and estrogen/ethinylestradiol (aOR 1.05; 95% CI 0.66-1.66). CONCLUSIONS An increased risk of venous thromboembolism is associated with ethinylestradiol-containing combined preparations. The use of estradiol-containing combined preparations confers only a slightly increased risk, possibly driven by cyproterone-containing combined oral contraceptives, whereas the use of progestin-only contraception is not associated with venous thromboembolism.
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Affiliation(s)
- Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elena Toffol
- Faculty of Medicine, Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Mental Health Team, Equality Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna But
- Faculty of Medicine, Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Jari Haukka
- Faculty of Medicine, Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
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Kvist T, Sammallahti S, Lahti-Pulkkinen M, Cruceanu C, Czamara D, Dieckmann L, Tontsch A, Röh S, Rex-Haffner M, Wolford E, Reynolds R, Eriksson J, Suomalainen-König S, Laivuori H, Kajantie E, Lahdensuo E, Binder E, Räikkönen K. Cohort profile: InTraUterine sampling in early pregnancy (ITU), a prospective pregnancy cohort study in Finland: study design and baseline characteristics. BMJ Open 2022; 12:e049231. [PMID: 35105615 PMCID: PMC8804635 DOI: 10.1136/bmjopen-2021-049231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The InTraUterine sampling in early pregnancy (ITU) is a prospective pregnancy cohort study. The overarching aim of ITU is to unravel genomic, epigenomic, transcriptomic, endocrine, inflammatory and metabolic maternal-placental-fetal mechanisms involved in the programming of health and disease after exposure to prenatal environmental adversity, such as maternal malnutrition, cardiometabolic disorders, infections, medical interventions, mental disorders and psychosocial stress. This paper describes the study protocol, design and baseline characteristics of the cohort. PARTICIPANTS We included 944 pregnant Finnish women, their partners and children born alive between April 2012 and December 2017. The women were recruited through the national, voluntary trisomy 21 screening between 9+0 and 21+6 gestational weeks. Of the participating women, 543 were screen positive and underwent fetal chromosomal testing. Test result of these women suggested no fetal chromosomal abnormality. Further, we recruited 401 women who were screen negative and who did not undergo fetal chromosomal testing. FINDINGS TO DATE We have collected chorionic villi and amniotic fluid from the screen-positive women; blood, urine, buccal swabs and diurnal salivary samples from all women; blood and buccal swabs from all partners; and placenta, cord blood and buccal swabs from all newborns for analyses of the genome, epigenome, transcriptome, and endocrine, inflammatory and metabolic markers. These data are coupled with comprehensive phenotypes, including questions on demographic characteristics, health and well-being of the women and their partners during pregnancy and of the women and their children at the child's age of 1.7 and 3 years. Data also come from patient records and nationwide registers covering health, lifestyle and medication data. FUTURE PLANS Multiple layers of ITU data allow integrative data analyses, which translate to biomarker identification and allow risk stratification and understanding of the biological mechanisms involved in prenatal programming of health and disease.
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Affiliation(s)
- Tuomas Kvist
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Sara Sammallahti
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Cristiana Cruceanu
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda Dieckmann
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Alina Tontsch
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Simone Röh
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Monika Rex-Haffner
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Eiina Wolford
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Rebecca Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Johan Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Obstetrics and Gynaecology, National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Sanna Suomalainen-König
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Helsinki Institute of Life Science, Institute of Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
| | - Eija Lahdensuo
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Elisabeth Binder
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Kong L, Chen X, Liang Y, Forsell Y, Gissler M, Lavebratt C. Association of Preeclampsia and Perinatal Complications With Offspring Neurodevelopmental and Psychiatric Disorders. JAMA Netw Open 2022; 5:e2145719. [PMID: 35089349 PMCID: PMC8800079 DOI: 10.1001/jamanetworkopen.2021.45719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Maternal preeclampsia has been reported to increase the risk of autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability in offspring. However, the association between maternal preeclampsia combined with perinatal complications and neurodevelopmental and psychiatric disorders in offspring is less well documented. OBJECTIVE To examine the association of maternal preeclampsia, separately and together with perinatal complications, with neurodevelopmental and psychiatric disorders in offspring. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from nationwide registries in Finland to assess all singleton live births (N = 1 012 723) between January 1, 1996, and December 31, 2014. Offspring were followed up until December 31, 2018 (when the oldest reached age 22 years). Exclusion criteria were maternal inpatient psychiatric diagnoses and pregestational diabetes. The study and data analysis were conducted from May 1, 2020, to June 1, 2021. EXPOSURES Preeclampsia and perinatal complications (delivery earlier than 34 weeks' gestation and/or small for gestational age). MAIN OUTCOMES AND MEASURES The primary outcomes were neurodevelopmental and psychiatric diagnoses and dispensation of psychotropic drugs among offspring until December 31, 2018. Cox proportional hazards regression analyses were performed to assess the associations. RESULTS Of 1 012 723 singleton live births (51.1% boys; mean [SD] maternal age at birth, 30.0 [5.4] years; specific data on race and ethnicity were not available in the data set), 21 010 children (2.1%) were exposed to preeclampsia alone, 33 625 children (3.3%) were exposed to perinatal complications alone, and 4891 children (0.5%) were exposed to both preeclampsia and perinatal complications. A total of 93 281 children (9.2%) were diagnosed with a neurodevelopmental or psychiatric disorder. Offspring exposed to both preeclampsia and perinatal complications had an increased risk of any neurodevelopmental or psychiatric disorder after adjusting for potential confounding (adjusted hazard ratio [aHR], 2.11; 95% CI, 1.96-2.26) compared with those not exposed to either preeclampsia or perinatal complications; this risk was higher than exposure to either preeclampsia alone (aHR, 1.18; 95% CI, 1.12-1.23) or perinatal complications alone (aHR, 1.77; 95% CI, 1.72-1.82). Sibling pair analyses did not detect any increase in the risk of neurodevelopmental or psychiatric disorders after exposure to preeclampsia alone, but offspring exposed to both preeclampsia and perinatal complications had increased risks of intellectual disabilities (aHR, 3.24; 95% CI, 1.05-10.06), specific developmental disorders (aHR, 3.56; 95% CI, 2.35-5.41), ADHD and conduct disorders (aHR, 2.42; 95% CI, 1.09-5.39), and other behavioral and emotional disorders (aHR, 2.45; 95% CI, 1.17-5.13). The risk estimates for specific developmental disorders (aHR, 2.82; 95% CI, 2.60-3.05) and ADHD and conduct disorders (aHR, 1.88; 95% CI, 1.65-2.14) were higher among offspring exposed to both preeclampsia and perinatal complications compared with those exposed to perinatal complications alone (aHR, 2.26 [95% CI, 2.18-2.33] and 1.60 [95% CI, 1.52-1.68], respectively). CONCLUSIONS AND RELEVANCE In this study, exposure to both maternal preeclampsia and perinatal complications was associated with intellectual disabilities, specific developmental disorders, ADHD and conduct disorders, and other behavioral and emotional disorders in offspring. For specific developmental disorders and ADHD and conduct disorders, the risk estimates were higher among offspring exposed to both preeclampsia and perinatal complications compared with those exposed to perinatal complications only.
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Affiliation(s)
- Linghua Kong
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Xinxia Chen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Translational Psychiatry Unit, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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18
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Männistö J, Sammalkorpi H, Niinimäki M, Mentula M, Mentula P. Association of complicated appendicitis on the risk of later in vitro fertilization treatment requirement and ectopic pregnancy: a nationwide cohort study. Acta Obstet Gynecol Scand 2021; 100:1490-1496. [PMID: 33896004 DOI: 10.1111/aogs.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A population-based register study utilizing three Finnish National Registers was carried out to determine whether uncomplicated appendicitis, complicated appendicitis and appendectomy without appendicitis are associated with a subsequent risk of requiring in vitro fertilization (IVF) treatment or a risk of ectopic pregnancy among reproductive-age women. MATERIAL AND METHODS A total of 23 997 women who underwent appendectomy for uncomplicated or complicated appendicitis or for nonspecific abdominal pain or who had nonspecific abdominal pain without surgical procedures between 2000 and 2012 were included in the study. The later risks of IVF treatment requirement and ectopic pregnancy were assessed after uncomplicated appendicitis, complicated appendicitis and appendectomy without appendicitis. Women with nonspecific abdominal pain without surgical procedures served as the reference group. RESULTS The rates of later IVF treatment after uncomplicated appendicitis, complicated appendicitis and appendectomy without appendicitis were low (2.1%, 2.5% and 2.3%, respectively; p = 0.681). Neither appendicitis nor appendectomy was associated with the risk of requiring IVF treatment. The rate of ectopic pregnancy after uncomplicated and complicated appendicitis was very low (0.8%). Women with uncomplicated appendicitis had a significantly lower risk of ectopic pregnancy compared with patients with nonspecific abdominal pain. CONCLUSIONS Appendicitis, whether complicated or uncomplicated, and appendectomy without appendicitis does not increase the risk of requiring later IVF treatment or the risk of ectopic pregnancy.
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Affiliation(s)
- Jaana Männistö
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Henna Sammalkorpi
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Clinic, Helsinki, Finland
| | - Panu Mentula
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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19
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Pohjoranta E, Suhonen S, Gissler M, Ikonen P, Mentula M, Heikinheimo O. Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial. Hum Reprod 2021; 35:796-804. [PMID: 32266392 DOI: 10.1093/humrep/deaa031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can the incidence of subsequent termination of pregnancy (TOP) be reduced by providing intrauterine contraception as part of the abortion service? SUMMARY ANSWER Provision of an intrauterine device (IUD) as part of TOP services reduced the need for subsequent TOP but the effect was limited to the first 3 years of the 5-year follow-up. WHAT IS KNOWN ALREADY An IUD is highly effective in preventing subsequent TOP. Prompt initiation of IUD use leads to a higher usage rate during follow-up, as compliance with post-TOP IUD insertion visits is low. STUDY DESIGN, SIZE, DURATION The objective of this randomised controlled trial was to assess the effect of early comprehensive provision of intrauterine contraception after TOP, with primary outcome being the incidence of subsequent TOP during the 5 years of follow-up after the index abortion. This study was conducted at a tertiary care centre between 18 October 2010 and 21 January 2013. Altogether, 748 women undergoing a first trimester TOP were recruited and randomised into two groups. The intervention group (n = 375) was provided with an IUD during surgical TOP or 1-4 weeks following medical TOP at the hospital providing the abortion care. Women in the control group (n = 373) were advised to contact primary health care for follow-up and IUD insertion. Subsequent TOPs during the 5-year follow-up were identified from the Finnish Register on induced abortions. PARTICIPANTS/MATERIALS, SETTING, METHODS The inclusion criteria were age ≥18 years, duration of gestation ≤12 weeks, residence in Helsinki and accepting intrauterine contraception. Women with contraindications to IUD were excluded. MAIN RESULTS AND THE ROLE OF CHANCE The overall numbers of subsequent TOPs were 50 in the intervention and 72 in the control group (26.7 versus 38.6/1000 years of follow-up, P = 0.027), and those of requested TOPs, including TOPs and early pregnancy failures, were 58 and 76, respectively (30.9 versus 40.8/1000, P = 0.080). Altogether 40 (10.7%) women in the intervention and 63 (16.9%) in the control group underwent one or several subsequent TOPs (hazard ratio 1.67 [95% CI 1.13 to 2.49], P = 0.011). The number of TOPs was reduced by the intervention during years 0-3 (22.2 versus 46.5/1000, P = 0.035), but not during years 4-5 (33.3 versus 26.8/1000, P = 0.631). LIMITATIONS, REASONS FOR CAUTION Both medical and surgical TOP were used. This may be seen as a limitation, but it also reflects the contemporary practice of abortion care. The immediate post-TOP care was provided by two different organizations, allowing us to compare two different ways of contraceptive service provision following TOP. WIDER IMPLICATIONS OF THE FINDINGS Providing TOP and IUD insertion comprehensively in the same heath care unit leads to significantly higher rates of attendance, IUD use and a significantly lower risk of subsequent TOP. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Helsinki University Central Hospital Research funds and by research grants provided by the Jenny and Antti Wihuri Foundation, the Yrjö Jahnsson Foundation and Finska Läkaresällskapet. E.P. has received a personal research grant from the Finnish Medical Society. The City of Helsinki supported the study by providing the IUDs. The funding organisations had no role in planning or execution of the study, or in analysing the study results. TRIAL REGISTRATION NUMBER The trial was registered at clinicaltrials.gov (NCT01223521). TRIAL REGISTRATION DATE 18 October 2010. DATE OF FIRST PATIENT’S ENROLMENT 18 October 2010.
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Affiliation(s)
- Elina Pohjoranta
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Suhonen
- Centralized Family Planning, Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Finnish Institute for Health and Wellfare, Helsinki, Finland
| | - Pirjo Ikonen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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20
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Saloranta T, Gyllenberg F, But A, Gissler M, Laine MK, Heikinheimo O. Use of universally offered family planning services - a cohort study in the city of Vantaa, Helsinki metropolitan area, Finland. Scand J Public Health 2021; 50:454-462. [PMID: 33818219 DOI: 10.1177/14034948211002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Knowledge about the women reached by public family planning services is scarce. The means for provision of these services that are pivotal for women's health and empowerment varies globally. In Finland, family planning services are offered free of charge, but often separately for different age groups. City of Vantaa offers these services for all female residents without age limit. The aim of this study was to describe the characteristics of the women using public family planning services. Methods: We assessed the sociodemographic and reproductive characteristics of women aged 15-44 using (n = 11,790) and not using (n = 42,931) these services in 2013-2014. We obtained adjusted odds ratios (AORs) and 95% confidence intervals (95%CIs) for service use by multivariate logistic regression. Results: Women under 35 years of age had higher odds of service use compared with those over 35 (AORs ranging from 2.79 [95%CI 2.54-3.07] for 15-19 year-olds to 1.81 [95%CI 1.69-1.95] for 30-34 year-olds). Women speaking a foreign native language used services less when aged under 30 and more when aged 35-44 compared with women speaking the national languages. Women with a history of delivery, induced abortion or sexually transmitted infections, or with a lower socioeconomic or educational status were more likely to use the services. Conclusions: Young women in general were more likely to use free-of-charge family planning services. In contrast, young women speaking a foreign native language were underrepresented among service users. It is important to recognise and actively reach underrepresented groups, such as young women with a foreign background, to optimise equal access to family planning services.
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Affiliation(s)
- Tuire Saloranta
- Health Center, City of Vantaa, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Frida Gyllenberg
- Health Center, City of Vantaa, Finland.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Biostatistics consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute of Health and Welfare (THL), Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University and Helsinki University Hospital, Helsinki, Finland
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21
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Toffol E, Heikinheimo O, But A, Latvala A, Partonen T, Haukka J. Population-level indicators associated with hormonal contraception use: a register-based matched case-control study. BMC Public Health 2021; 21:465. [PMID: 33678190 PMCID: PMC7938490 DOI: 10.1186/s12889-021-10512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Monitoring factors related to hormonal contraception (HC) use is essential to evaluating public health strategies and promoting access to contraception. We aimed to examine municipal social and health indicators of HC use at the population level, and to identify patterns of inequality across Finnish municipalities. Methods We identified all women (15–49 years) with a redeemed HC prescription in Finland in 2017 (n = 294,445), and a control group of non-users. Municipal social and health indicators at the population level were retrieved from the nationwide Statistics and Indicator Bank. Differences between the groups across 309 municipalities were calculated, and associations of municipal-specific proportions of HC users with municipal-specific indicators were studied using LASSO (Least Absolute Shrinkage and Selection Operator) models. Results Sociodemographic differences between HC users and non-users were non-homogenous across municipalities. Indicators positively associated with HC use included: larger population and higher proportions of population aged 16–24 years, of household-dwelling units with one person, of persons with higher education, and of divorces among those aged 25–64. Lower HC use was associated with higher proportions of Swedish-speaking population, of those aged 7–15 years, of young people not in education/training, and of household-dwelling units in overcrowded conditions. Lower HC use was also associated with indicators of outpatient and inpatient healthcare, and of municipal finances in welfare and healthcare. Conclusions Sociodemographic differences in relation to HC use exist across Finnish municipalities. Municipal indicators of social structure, health and welfare, and investment in and use of healthcare services are related to HC use. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10512-6.
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Affiliation(s)
- Elena Toffol
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Mental Health Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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22
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Jalanko E, Gyllenberg F, Krstic N, Gissler M, Heikinheimo O. Municipal contraceptive services, socioeconomic status and teenage pregnancy in Finland: a longitudinal study. BMJ Open 2021; 11:e043092. [PMID: 33597141 PMCID: PMC7893665 DOI: 10.1136/bmjopen-2020-043092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Declining teenage pregnancy rates have been linked to improved access to youth-friendly contraceptive services, but information on the combined association of these services and socioeconomic factors with teenage pregnancy is lacking. DESIGN AND SETTING This retrospective longitudinal register-based study covers the annual teenage childbirth and induced abortion rates in the 100 largest municipalities in Finland in 2000-2018. We investigated the combined association of regional, socioeconomic (ie, education level and need for social assistance) and adolescent contraceptive service variables (ie, free-of-charge contraception, an adolescent-only clinic and availability of over-the-counter emergency contraception (OTC EC)) with teenage childbirth and induced abortion rates at the municipality level by using Poisson mixed-effects model. PRIMARY OUTCOME MEASURES Annual teenage childbirth and induced abortion rates as numbers per 1000 teenage girls aged 15-19 years old in the 100 largest municipalities in Finland from 2000 to 2018. RESULTS The following variables were significantly associated with both lower teenage childbirth and induced abortion rates when adjusted for all the other variables used in the model: providing free-of-charge contraception (rate ratio (RR) 0.82 (95% CI 0.73 to 0.92) and RR 0.87 (95% CI 0.79 to 0.96), respectively), availability of OTC EC without age limit (RR 0.70 (95% CI 0.67 to 0.75) and RR 0.74 (95% CI 0.71 to 0.78), respectively), and high education level of the municipality (RR 0.94 (95% CI 0.94 to 0.95) and RR 0.94 (95% CI 0.93 to 0.94), respectively). CONCLUSION Providing free-of-charge contraception and availability of OTC EC without age limit are associated with lower teenage pregnancy rates. These services combined with proper counselling are thus important contents of youth-friendly contraceptive services that should be provided equally for all teenagers in order to further reduce teenage pregnancy rates.
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Affiliation(s)
- Eerika Jalanko
- Obstetrics and Gynecology, Naistenklinikka, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Frida Gyllenberg
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- City of Vantaa, Division of Health Care and Social Services, Vantaa, Finland
| | - Nikolas Krstic
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mika Gissler
- Information, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Oskari Heikinheimo
- Obstetrics and Gynecology, Naistenklinikka, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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23
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Melin JM, Seppänen VI, Ylöstalo TM, Malila NK, Pitkäniemi JM, Gissler M, Madanat-Harjuoja LMS. Risk of induced abortions in childhood cancer survivors. Cancer 2021; 127:1439-1447. [PMID: 33491215 DOI: 10.1002/cncr.33384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The relative probability of pregnancy and parenthood in cancer survivors is reduced. Studies have shown that cancer survivors are concerned about the health of their offspring and the recurrence of their own cancer. This could lead to an increased risk of induced abortion. The aim of this study was to examine whether pregnancies of childhood cancer survivors (CCSs) who were 0 to 14 years old at diagnosis in 1971-2012 were more likely to result in induced abortions in comparison with population controls. METHODS Data from Finnish registries for cancer, births, and induced abortions were merged to identify 420 first pregnancies of CCSs and 2508 first pregnancies of age-matched population controls in 1987-2013. Poisson regression and logistic regression modeling were used to estimate incidence rates and relative risks (RRs) with 95% confidence intervals (CIs) of first pregnancies and induced abortions in CCSs in comparison with population controls. RESULTS The risk of first pregnancy was reduced in CCSs in comparison with population controls (RR, 0.72; 95% CI, 0.64-0.80), whereas the risk of a first pregnancy resulting in an induced abortion was similar in CCSs and population controls (RR, 1.01; 95% CI, 0.77-1.33). In subanalyses stratifying by decade of diagnosis and cancer treatment, the risk of induced abortion was similar in CCSs and population controls. CONCLUSIONS Female CCSs do not have an overall increased risk of induced abortions. The reduced probability of pregnancy among CCSs highlights the continued need for interventions to preserve fertility at the time of a cancer diagnosis.
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Affiliation(s)
- Johanna M Melin
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Viivi I Seppänen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Tiina M Ylöstalo
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nea K Malila
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Janne M Pitkäniemi
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurology, Care Science, and Society, Karolinska Institute, Stockholm, Sweden
| | - Laura-Maria S Madanat-Harjuoja
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland.,Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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24
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Kemppainen V, Niinimäki M, Bloigu A, Saisto T, Rouhe H, Gissler M, Heikinheimo O, Mentula M. Fear of childbirth after medical vs surgical abortion. Population-based register study from Finland. Acta Obstet Gynecol Scand 2021; 100:743-750. [PMID: 33393097 DOI: 10.1111/aogs.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy. MATERIAL AND METHODS This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85-168 days of gestation). Primary outcome measures were the incidence of registry-identified fear of childbirth and cesarean delivery related to it. RESULTS The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. CONCLUSIONS One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.
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Affiliation(s)
- Venla Kemppainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Aini Bloigu
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute of Health and Welfare (THL), Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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25
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Free-of-charge long-acting reversible contraception: two-year discontinuation, its risk factors, and reasons. Am J Obstet Gynecol 2020; 223:886.e1-886.e17. [PMID: 32562657 DOI: 10.1016/j.ajog.2020.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/07/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Since 2013, the residents of the city of Vantaa, Finland, have been offered their first long-acting reversible contraceptive method (levonorgestrel-releasing intrauterine system, implant, and copper intrauterine device) free of charge. OBJECTIVE The primary aim of this study was to assess the 2-year cumulative discontinuation rates of long-acting reversible contraceptive methods when provided free of charge for first-time users in a real-world setting. Additional aims were to describe factors associated with discontinuation and to evaluate the reasons for discontinuation. STUDY DESIGN This is a retrospective register-based cohort study of 2026 nonsterilized women aged 15 to 44 years, who initiated a free-of-charge long-acting contraceptive method in 2013-2014 in the city of Vantaa. Removals within 2 years after method initiation and reasons for discontinuation were obtained from electronic health records and from national registers. We calculated the 2-year cumulative incidence rates of discontinuation with 95% confidence intervals for each method. Furthermore, we assessed crude and adjusted incidence rate ratios of discontinuation with 95% confidence interval by Poisson regression models comparing implants and copper intrauterine device with levonorgestrel-releasing intrauterine systems. RESULTS During the 2 -year follow-up, 514 women discontinued, yielding a cumulative discontinuation rate of 28.3 per 100 women-years (95% confidence interval, 26.2-30.4). Among the 1199 women who initiated the levonorgestrel-releasing intrauterine system, the cumulative discontinuation rate was 24.2 per 100 women-years (95% confidence interval, 21.7-26.9); among the 642 implant users, 33.3 per 100 women-years (95% confidence interval, 29.5-37.4); and among the 185 copper intrauterine device users, 37.8 per 100 women-years (95% confidence interval, 31.0-45.7). Compared with women aged 30 to 44 years, women aged 15 to 19 years (adjusted incidence rate ratio, 1.58; 95% confidence interval, 1.17-2.14) and 20 to 29 years (adjusted incidence rate ratio, 1.35; 95% confidence interval, 1.11-1.63) were more likely to discontinue. We observed a higher discontinuation rate in women who had given birth within the previous year (adjusted incidence rate ratio, 1.36; 95% confidence interval, 1.13-1.65), spoke a native language other than Finnish or Swedish (adjusted incidence rate ratio, 1.31; 95% confidence interval, 1.06-1.63), and had a history of a sexually transmitted infection (adjusted incidence rate ratio, 1.62; 95% confidence interval, 1.07-2.46). No association was found in marital status, overall parity, history of induced abortion, socioeconomic status, education level, or smoking status. The most common reason for discontinuation was bleeding disturbances, reported by 21% of women who discontinued the levonorgestrel-releasing intrauterine system, by 71% who discontinued the implant, and by 41% who discontinued the copper intrauterine device. One in 4 women who discontinued the copper intrauterine device reported heavy menstrual bleeding, whereas only 1% who discontinued the levonorgestrel-releasing intrauterine system and none who discontinued implants reported this reason. Abdominal pain was the reported reason for discontinuation in 20% of both intrauterine device users and in only 2% who discontinued implants. CONCLUSION At 2 years, the use of implants and copper intrauterine devices was more likely to be discontinued than that of the levonorgestrel-releasing intrauterine system. Women younger than 30 years and those who gave birth in the preceding year, spoke a native language other than Finnish or Swedish, or had a history of sexually transmitted infections were more likely to discontinue. The levonorgestrel-releasing intrauterine system was least likely to be removed owing to bleeding disturbances.
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Toffol E, But A, Heikinheimo O, Latvala A, Partonen T, Haukka J. Associations between hormonal contraception use, sociodemographic factors and mental health: a nationwide, register-based, matched case-control study. BMJ Open 2020; 10:e040072. [PMID: 33060091 PMCID: PMC7566729 DOI: 10.1136/bmjopen-2020-040072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Sociodemographic and mental health characteristics are associated with contraceptive choices. We aimed to describe the sociodemographic, reproductive and mental health characteristics of all fertile-aged women in Finland who used hormonal contraception (HC) in 2017. DESIGN A nationwide, register-based study. SETTING All women living in Finland in 2017; data from the Care Register of Health Care, Medical Birth Register, Population Register Centre, Prescription Centre, Register of Induced Abortions. PARTICIPANTS All women aged 15-49 with one redeemed HC prescription in 2017 (n=294 356), and a same-sized, age-matched and residence-matched, control group of non-users. OUTCOMES Rates of HC use; associations between HC use and mental disorders, sociodemographic and reproductive characteristics. RESULTS 25.8% of women aged 15-49 years used HC. Women with the lowest socioeconomic levels had lower odds of using HC than women with upper-level statuses (OR, 95% CI students: 0.97, 0.94 to 0.99; entitled to pension: 0.66, 0.63 to 0.69; other: 0.87, 0.85 to 0.89; unknown: 0.90, 0.85 to 0.90). Women with the highest education (secondary: 1.46, 1.43 to 1.48; tertiary: 1.64, 1.58 to 1.70; academic: 1.60, 1.56 to 1.63) and income (second quarter: 1.57, 1.54 to 1.60; third quarter: 1.85, 1.82 to 1.89; fourth quarter: 2.01, 1.97 to 2.06), and unmarried women had higher odds of using HC than women with the lowest education and income levels, and married (0.61, 0.60 to 0.62), divorced (0.86, 0.84 to 0.88), widowed (0.73, 0.65 to 0.83) or other marital status women (0.26, 0.22 to 0.30).Parous women (0.70, 0.69 to 0.71), those with previous induced abortion(s) (0.91, 0.89 to 0.92) or recent eating (0.68, 0.62 to 0.75) or personality (0.89, 0.79 to 0.97) disorders had lower odds of HC use. Absolute risk differences between women with and without mental disorders ranged from 3.1% (anxiety disorders) to 10.1% (eating disorders). CONCLUSIONS A quarter of the fertile-aged women use HC in Finland. Sociodemographic disparities persist in relation to HC use, although of small effect size. HC use is less common among women suffering from severe to moderate psychiatric disorders, especially eating disorders.
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Affiliation(s)
- Elena Toffol
- Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Kc S, Gissler M, Klemetti R. The duration of gestation at previous induced abortion and its impacts on subsequent births: A nationwide registry-based study. Acta Obstet Gynecol Scand 2020; 99:651-659. [PMID: 32128786 DOI: 10.1111/aogs.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous induced abortions have been associated with adverse birth outcomes. However, only a few studies have considered the possible influence of gestational age at induced abortion. Therefore, this study aimed to identify the impacts of gestational age during prior induced abortion(s) on subsequent births among first-time mothers in Finland. MATERIAL AND METHODS First-time mothers (n = 418 690) with singleton births between 1996 and 2013 were identified from the Finnish Medical Birth Register and linked to the Abortion Register. Logistic regression analysis was used to estimate the risk (odds ratio [OR] and 95% confidence interval [CI]) of birth outcomes such as prematurity, low birthweight, perinatal death and small for gestational age (SGA). RESULTS Higher risk was determined for extremely preterm birth (OR 2.28; 95% CI 1.53-3.39) and very low birthweight (OR 1.62; 95% CI 1.22-2.16) in women having had late-induced abortion(s) (≥12 gestational weeks) compared with women having had early-induced abortion(s) (<12 gestational weeks); after adjusting for women's background characteristics, abortion method and interval between the pregnancies. When the analysis was limited to a single abortion, an increased risk was found for extremely preterm birth (OR 1.71; 95% CI 1.02-2.81). Higher risks were found for extremely preterm (OR 4.09; 95% CI 2.05-8.18) and very low birthweight (OR 2.65; 95% CI 1.61-4.35) among women with two or more late-induced abortions compared with those with two or more early-induced abortions. Worse outcomes were seen after a late-induced abortion compared to an early-induced abortion for both medically and surgically induced abortion. CONCLUSIONS The risk of subsequent adverse birth outcomes is very small if any, but the risk is higher with increasing gestational age at the time of induced abortion. Our study supports reduction of unintended pregnancy and offering abortion services without delay and as early in gestation as possible.
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Affiliation(s)
- Situ Kc
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Reija Klemetti
- Department of Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Männistö J, Mentula M, Bloigu A, Gissler M, Heikinheimo O, Niinimäki M. Induced abortion and future use of IVF treatment; A nationwide register study. PLoS One 2019; 14:e0225162. [PMID: 31725766 PMCID: PMC6855489 DOI: 10.1371/journal.pone.0225162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/30/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this nationwide study we assessed the use and factors associated with future in vitro fertilization (IVF) treatment after induced abortion. MATERIALS AND METHODS The study population was collected by means of record linkage between Finnish national registers. All women who underwent induced abortion between 2000 and 2009 in Finland were identified through the Register of Induced Abortions (n = 88 522). The study group consisted of women who underwent induced abortion and subsequently had an IVF treatment (n = 379); the comparison group were all women who had a spontaneous pregnancy and delivery 12-24 months after the index abortion (n = 7434). Demographic characteristics at the time of index abortion, and factors associated with the abortion (gestational age at abortion, indication and method of abortion, complications after abortion) were compared between the study groups. Logistic regression was used to assess whether some of the demographic characteristics or abortion associated factors increased the use of IVF treatment in the future. RESULTS The proportion of women with IVF treatment after induced abortion in the whole cohort was 0.4%. Women needing IVF treatment were older, of a higher socioeconomic status, and had fewer previous induced abortions and deliveries compared to women in the comparison group. No statistically significant differences were observed in the gestational age (≤ 12 weeks or >12 weeks of gestation) at abortion, method or complications of abortion. In multivariable analysis higher age increased, and history of previous deliveries or one or two abortions decreased the use of IVF. CONCLUSIONS Infertility necessitating the use of IVF treatment after induced abortion is uncommon. The factors associated with use of IVF after abortion are those generally recognized as risk factors of infertility. Abortion-related outcomes are not associated with an increased need of future IVF-treatment.
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Affiliation(s)
- Jaana Männistö
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Aini Bloigu
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University Hospital of Oulu and University of Oulu, Oulu, Finland
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Gyllenberg FK, Saloranta TH, But A, Gissler M, Heikinheimo O. Induced Abortion in a Population Entitled to Free-of-Charge Long-Acting Reversible Contraception. Obstet Gynecol 2018; 132:1453-1460. [DOI: 10.1097/aog.0000000000002966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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30
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Jokela S, Lilja E, Kinnunen TI, Gissler M, Castaneda AE, Koponen P. Births and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland -comparison of self-reported and register data. BMC Pregnancy Childbirth 2018; 18:296. [PMID: 29991354 PMCID: PMC6038285 DOI: 10.1186/s12884-018-1931-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 07/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Since reproductive health is often considered a highly sensitive topic, underreporting in surveys and under coverage of register data occurs frequently. This may lead to inaccurate information about the reproductive health. This study compares the proportion of women having births and induced abortions among migrant women of Russian, Somali and Kurdish origin in Finland to women in the general Finnish population and examines the agreement between survey- and register-based data. Methods The survey data from the Migrant Health and Wellbeing Study conducted in 2010–2012 and data from the Health 2011 Survey with corresponding information on women in the general population were used in this study. The respondents were women aged 18–64: 341 Russian, 176 Somali and 228 Kurdish origin women and 630 women in the general population. The survey data were linked to the Finnish Medical Birth Register and the Register of Induced Abortions. Results In the combined (survey and register) data, migrant groups aged 30–64 had a higher proportion (89–96%) compared to the general population (69%) of women with at least one birth. Under-coverage of registered births was observed in all study groups. Among women aged 18–64, 36% of the Russian group and 24% of the Kurdish group reported more births in the survey than in the register data. In the combined data, the proportions of Russian origin (69%) and Kurdish origin (38%) women who have had at least one induced abortion in their lifetime are higher than in the general population (21%). Under-reporting of induced abortions in survey was observed among Somali origin women aged 18–29 (1% vs. 18%). The level of agreement between survey and register data was the lowest for induced abortions among the Somali and Russian groups (− 0.01 and 0.27). Conclusion Both survey- and register-based information are needed in studies on reproductive health, especially when comparing women with foreign origin with women in the general population. Culturally sensitive survey protocols need to be developed to reduce reporting bias.
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Affiliation(s)
- Satu Jokela
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland.
| | - Eero Lilja
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland
| | - Tarja I Kinnunen
- Faculty of Social Sciences, University of Tampere, PL 100, Arvo Ylpön katu 34, Tampere, 33520, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, PL 30, Mannerheimintie 166, Helsinki, 00271, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anu E Castaneda
- Department of Welfare, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, PL 30, Finland
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Väisänen H, Koponen P, Gissler M, Kontula O. Contraceptive use among migrant women with a history of induced abortion in Finland. EUR J CONTRACEP REPR 2018; 23:274-281. [PMID: 29939819 DOI: 10.1080/13625187.2018.1483019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Women's contraceptive choices may change after an induced abortion, due to contraceptive counselling or a behavioural change prompted by the experience. The effect may vary between women; sociocultural background, for example, may affect their subsequent reproductive choices. OBJECTIVE We examined whether women's current contraceptive use was differently associated with a history of induced abortion among immigrant groups in Finland (Russian, Kurdish and Somali) and the general Finnish population. METHODS We analysed data from two surveys, the Migrant Health and Wellbeing study and the Health 2011 study, linked to the Finnish register of induced abortions. Propensity score weighted logistic regression was used to analyse the data. RESULTS The likelihood of using contraceptives after an abortion varied depending on women's sociocultural background. A history of induced abortion increased contraceptive use among all groups, except Russian women, in whom there was no effect. The effect was particularly strong for Kurdish women. CONCLUSION Sociocultural background was an important determinant of post-abortion contraceptive use. Some immigrants may struggle to navigate the Finnish health care system due to language or literacy issues. Attention should be paid to improving access to family planning among these groups.
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Affiliation(s)
- Heini Väisänen
- a Department of Social Statistics and Demography , University of Southampton , Southampton , UK
| | - Päivikki Koponen
- b Department of Public Health Solutions , National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Mika Gissler
- c Information Services Department , National Institute for Health and Welfare (THL) , Helsinki , Finland.,d Research Centre for Child Psychiatry , University of Turku , Turku , Finland.,e Department of Neurobiology , Care Services and Society, Karolinska Institute , Stockholm , Sweden
| | - Osmo Kontula
- f Population Research Institute , Family Federation of Finland (Väestöliitto) , Helsinki , Finland
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Korjamo R, Heikinheimo O, Mentula M. Risk factors and the choice of long-acting reversible contraception following medical abortion: effect on subsequent induced abortion and unwanted pregnancy. EUR J CONTRACEP REPR 2018. [DOI: 10.1080/13625187.2018.1440385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Riina Korjamo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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33
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Gyllenberg F, Juselius M, Gissler M, Heikinheimo O. Long-Acting Reversible Contraception Free of Charge, Method Initiation, and Abortion Rates in Finland. Am J Public Health 2018; 108:538-543. [PMID: 29470111 DOI: 10.2105/ajph.2017.304280] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate whether a public program providing long-acting reversible contraceptive (LARC) methods free of charge increases the LARC initiation rate and reduces the unintended pregnancy rate in the general population. METHODS Since 2013, all women in Vantaa, Finland, have been entitled to 1 LARC method free of charge. With time-series analysis between 2000 and 2015, we assessed whether this public program was associated with changes in steady-state mean rates of LARC initiation and abortions. RESULTS The initiation rate of LARCs (1/1000 women) increased 2.2-fold from 1.9 to 4.2 after the intervention (P < .001). Concomitantly, the abortion rate (1/1000 women) declined by 16% from 1.1 to 0.9 in the total sample (P < .001), by 36% from 1.3 to 0.8 among those aged 15 to 19 years (P < .001), and by 14% from 2.0 to 1.7 among those aged 20 to 24 years (P = .01). CONCLUSIONS The LARC program was associated with increased uptake of LARC methods and fewer abortions in the population. Public Health Implications. Entitling the population to LARC methods free of charge is an effective means to reduce the unmet need of contraception and the need for abortion, especially among women younger than 25 years.
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Affiliation(s)
- Frida Gyllenberg
- Frida Gyllenberg and Oskari Heikinheimo are with the Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland. Frida Gyllenberg is also with the City of Vantaa, Vantaa, Finland. Mikael Juselius is with the Bank of Finland, Helsinki. Mika Gissler is with the Information Services Department, National Institute for Health and Welfare, Helsinki, and with Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Mikael Juselius
- Frida Gyllenberg and Oskari Heikinheimo are with the Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland. Frida Gyllenberg is also with the City of Vantaa, Vantaa, Finland. Mikael Juselius is with the Bank of Finland, Helsinki. Mika Gissler is with the Information Services Department, National Institute for Health and Welfare, Helsinki, and with Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Mika Gissler
- Frida Gyllenberg and Oskari Heikinheimo are with the Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland. Frida Gyllenberg is also with the City of Vantaa, Vantaa, Finland. Mikael Juselius is with the Bank of Finland, Helsinki. Mika Gissler is with the Information Services Department, National Institute for Health and Welfare, Helsinki, and with Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Oskari Heikinheimo
- Frida Gyllenberg and Oskari Heikinheimo are with the Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland. Frida Gyllenberg is also with the City of Vantaa, Vantaa, Finland. Mikael Juselius is with the Bank of Finland, Helsinki. Mika Gissler is with the Information Services Department, National Institute for Health and Welfare, Helsinki, and with Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
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Kc S, Gissler M, Virtanen SM, Klemetti R. Risks of Adverse Perinatal Outcomes after Repeat Terminations of Pregnancy by their Methods: a Nationwide Register-based Cohort Study in Finland 1996-2013. Paediatr Perinat Epidemiol 2017; 31:485-492. [PMID: 28815662 DOI: 10.1111/ppe.12389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Repeat terminations of pregnancy (TOPs) are associated with an increased risk of adverse outcomes in the subsequent birth. The perinatal outcomes after repeat TOPs by their methods have not yet been properly studied. This study aimed to examine perinatal outcomes in subsequent pregnancy among the women with a singleton birth and a history of TOPs. METHODS All the first-time mothers (n = 419 879) with a singleton birth during 1996-2013 in Finland were identified from the Medical Birth Register and linked to the Abortion Register. Adjusted multivariable logistic regression analysis was used to estimate risks of adverse perinatal outcomes. RESULTS The increased incidence of adverse perinatal outcomes was found with increasing number of surgical TOPs. After adjusting for confounders, the women with one surgical TOP had slightly increased but significant odds of 1.07 (95% CI 1.02, 1.13) for being small for gestational age compared with the women having no TOP. A significantly high risk for extremely preterm birth (OR 1.51, 95% CI 1.03, 2.23) was found among the women having had repeat surgical TOPs when compared to the women with no TOP. Non-significant risks were found for adverse perinatal outcomes after women's repeat surgical TOPs than repeat medical TOPs. CONCLUSION Information regarding the consequences of repeat induced TOPs will be significant in sexual health education as well as counselling women after first termination.
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Affiliation(s)
- S Kc
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - M Gissler
- Department of Information Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - S M Virtanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - R Klemetti
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
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KC S, Hemminki E, Gissler M, Virtanen SM, Klemetti R. Perinatal outcomes after induced termination of pregnancy by methods: A nationwide register-based study of first births in Finland 1996-2013. PLoS One 2017; 12:e0184078. [PMID: 28863151 PMCID: PMC5593514 DOI: 10.1371/journal.pone.0184078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 08/17/2017] [Indexed: 11/28/2022] Open
Abstract
Background Women with previous terminations of pregnancy (TOPs) before their first birth have been associated with poorer perinatal outcomes. However, previous studies on the perinatal outcomes by the method in previous TOPs are inconsistent. Objective To examine the perinatal outcomes of the first-time mothers with singleton births, by the method of previous TOP (medical and surgical vs no TOP, and surgical vs medical). Method This is a nationwide register-based study including 419,879 first-time Finnish mothers with singleton birth during the time period 1996–2013. Mothers having their first birth were identified from the Medical Birth Register and linked to the Abortion Register by their identification numbers. Multinomial logistic regression analysis was performed to examine the risk for preterm birth, low birth weight, small for gestational age and perinatal death by the method in previous TOPs. Results Among the first-time mothers, 87.0% had no history of TOPs, 3.2% had a history of medical TOP(s), 9.2% had a history of surgical TOP(s) and 0.6% had a history of both (medical and surgical) TOP(s). No significant differences in perinatal outcomes were found among the women with surgical TOPs, compared to the women with no TOPs. In unadjusted analysis, increased odds for preterm birth and low birth weight were found when comparing women having previous surgical TOPs with medical TOPs. Even after the adjustment of potential confounders, odds for preterm birth < 37 weeks (OR = 1.19, 95% CI = 1.04–1.36) and low birth weight < 2500 g (OR = 1.16, 95% CI = 1.00–1.35) remained significant. After restricting data to the single TOP, the results were similar; OR for both preterm birth and low birth weight was 1.18 (95% CIs = 1.02–1.36 and 1.01–1.38). Conclusion Perinatal outcomes did not differ among the mothers with surgical TOPs compared to the mothers with no TOPs, while the outcomes were poorer after surgical TOP(s) than after medical TOP(s).
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Affiliation(s)
- Situ KC
- School of Social Sciences, University of Tampere, Tampere, Finland
- * E-mail:
| | - Elina Hemminki
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Suvi M. Virtanen
- School of Social Sciences, University of Tampere, Tampere, Finland
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Reija Klemetti
- Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
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