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Larsdotter Zweygberg A, Martin FZ, Brynedal B, Storck Lindholm E, Kosidou K, Ahlqvist VH, Magnusson C. Mode of delivery and subsequent self-perceived sexual life satisfaction: a population-based cohort study. Am J Obstet Gynecol 2024:S0002-9378(24)00087-5. [PMID: 38367755 DOI: 10.1016/j.ajog.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The potential association between mode of obstetrical delivery and subsequent sexual outcomes of the birthing parent remains uncertain and has not been well investigated from the perspective of positive sexual life satisfaction. OBJECTIVE This study aimed to investigate if there was any association between mode of delivery and subsequent sexual life satisfaction of the birthing parent. A secondary aim was to assess the extent to which this association changed when stratified by time elapsed since delivery. STUDY DESIGN The study matched participants in the Stockholm Public Health Cohort with deliveries recorded in the Swedish Medical Birth Register. Any deliveries recorded in the registry before the participation in the Stockholm Public Health Cohort were included (n=46,078). The length of time from delivery to outcome assessment varied from 1 month to 41 years (mean, 18 years [±10.8]). Mode of delivery was retrieved from the same registry, whereas self-perceived sexual life satisfaction was retrieved from the Stockholm Public Health Cohort Questionnaires where participants had assessed their sexual life satisfaction as 1 out of 5 mutually exclusive options. Multinomial logistic regression was used to test for any association between mode of delivery (cesarean, instrumental, and spontaneous vaginal delivery) and sexual life satisfaction, both overall and stratified by time elapsed since delivery. RESULTS After adjusting for covariates, no statistically significant (P < .05) difference in subsequent sexual life satisfaction of the birthing parent between modes of delivery was identified. Adjusted odds ratios for assessing sexual life satisfaction as the lowest level ("very unsatisfactory") were 1.11 (95% confidence interval, 0.98-1.25) for cesarean delivery and 1.16 (95% confidence interval, 0.99-1.35) for instrumental delivery, compared with spontaneous vaginal delivery. The difference in covariate-adjusted prevalence of the lowest level of sexual life satisfaction among the different groups categorized by time since delivery was small: 4.0% (95% confidence interval, 2.4%-5.6%) for cesarean delivery as opposed to 2.8% (95% confidence interval, 2.1%-3.6%) for spontaneous vaginal delivery within 2 years since delivery. CONCLUSION These findings do not support any impact of mode of delivery on the subsequent self-perceived sexual life satisfaction among birthing people, either overall or across different time periods since delivery.
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Affiliation(s)
| | - Florence Z Martin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Boel Brynedal
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Kyriaki Kosidou
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Madley-Dowd P, Rast J, Ahlqvist VH, Zhong C, Martin FZ, Davies NM, Lyall K, Newschaffer C, Tomson T, Magnusson C, Rai D, Lee BK, Forbes H. Trends and patterns of antiseizure medication prescribing during pregnancy between 1995 and 2018 in the United Kingdom: A cohort study. BJOG 2024; 131:15-25. [PMID: 37340193 PMCID: PMC10730765 DOI: 10.1111/1471-0528.17573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE To examine antiseizure medication (ASM) prescription during pregnancy. DESIGN Population-based drug utilisation study. SETTING UK primary and secondary care data, 1995-2018, from the Clinical Practice Research Datalink GOLD version. POPULATION OR SAMPLE 752 112 completed pregnancies among women registered for a minimum of 12 months with an 'up to standard' general practice prior to the estimated start of pregnancy and for the duration of their pregnancy. METHODS We described ASM prescription across the study period, overall and by ASM indication, examined patterns of prescription during pregnancy including continuous prescription and discontinuation, and used logistic regression to investigate factors associated with those ASM prescription patterns. MAIN OUTCOME MEASURES Prescription of ASMs during pregnancy and discontinuation of ASMs before and during pregnancy. RESULTS ASM prescription during pregnancy increased from 0.6% of pregnancies in 1995 to 1.6% in 2018, driven largely by an increase in women with indications other than epilepsy. Epilepsy was an indication for 62.5% of pregnancies with an ASM prescription and non-epilepsy indications were present for 66.6%. Continuous prescription of ASMs during pregnancy was more common in women with epilepsy (64.3%) than in women with other indications (25.3%). Switching ASMs was infrequent (0.8% of ASM users). Factors associated with discontinuation included age ≥35, higher social deprivation, more frequent contact with the GP and being prescribed antidepressants or antipsychotics. CONCLUSIONS ASM prescription during pregnancy increased between 1995 and 2018 in the UK. Patterns of prescription around the pregnancy period vary by indication and are associated with several maternal characteristics.
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Affiliation(s)
- Paul Madley-Dowd
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
| | - Jessica Rast
- - A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- - Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Viktor H. Ahlqvist
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
- - Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Caichen Zhong
- - A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Florence Z. Martin
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
| | - Neil M. Davies
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
- - K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Norway
- - Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, London W1T 7NF
- - Department of Statistical Sciences, University College London, London WC1E 6BT, UK
| | - Kristen Lyall
- - Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Craig Newschaffer
- - College of Health and Human Development, The Pennsylvania State University, USA
| | - Torbjörn Tomson
- - Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Cecilia Magnusson
- - Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- - Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Dheeraj Rai
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, BS8 2BN, United Kingdom
- - NIHR Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- - Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, United Kingdom
| | - Brian K. Lee
- - A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- - Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
- - Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Harriet Forbes
- - Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- - Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Martin FZ, Madley‐Dowd P, Ahlqvist VH, Jónsson‐Bachmann E, Fraser A, Forbes H. Mode of delivery and maternal sexual wellbeing: A longitudinal study. BJOG 2022; 129:2010-2018. [PMID: 35856885 PMCID: PMC9804306 DOI: 10.1111/1471-0528.17262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/02/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the association between mode of delivery and subsequent maternal sexual wellbeing. DESIGN Prospective birth cohort study. SETTING Avon (in Bristol area), UK. POPULATION Participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). METHODS Mode of delivery was abstracted from obstetric records and sexual wellbeing measures were collected via a self-report questionnaire. Missing data were imputed using multiple imputation, and ordinal logistic regression models for ordered categorical outcomes were adjusted for the covariates maternal age at delivery, pre-pregnancy body mass index, diabetes during pregnancy, socio-economic position, parity, depression and anxiety. MAIN OUTCOME MEASURES Sexual enjoyment and frequency at four time points postpartum (between 33 months and 18 years) and two types of sex-related pain (pain in the vagina during sex and elsewhere after sex) at 11 years postpartum. RESULTS We found no association between mode of delivery and sexual enjoyment (e.g. adjusted odds ratio [OR] 1.11, 95% confidence interval [95% CI] 0.97-1.27 at 33 months) or sexual frequency (OR 0.99, 95% CI 0.88-1.12 at 33 months). Caesarean section was associated with an increased odds of pain in the vagina during sex at 11 years postpartum as compared with vaginal delivery in the adjusted model (OR 1.74, 95% CI 1.46-2.08). CONCLUSIONS These findings provide no evidence supporting associations between caesarean section and sexual enjoyment or frequency. However, mode of delivery was shown to be associated with dyspareunia, which may not be limited to abdominal scarring.
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Affiliation(s)
- Florence Z. Martin
- MRC Integrative Epidemiology UnitPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Paul Madley‐Dowd
- Centre for Academic Mental HealthPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | | | | | - Abigail Fraser
- MRC Integrative Epidemiology UnitPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Harriet Forbes
- Centre for Academic Mental HealthPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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Martin FZ, Fraser A, Zuccolo L. Alcohol Intake and Hypertensive Disorders of Pregnancy: A Negative Control Analysis in the ALSPAC Cohort. J Am Heart Assoc 2022; 11:e025102. [PMID: 36172928 DOI: 10.1161/jaha.121.025102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Alcohol intake increases blood pressure yet estimates of associations between maternal intake and hypertensive disorders of pregnancy (HDP) are sparse and range from null to a protective effect. Here we estimated the association of maternal drinking during pregnancy with preeclampsia and gestational hypertension (separately and jointly, as HDP). We used partner's alcohol intake as a negative control exposure, beverage type-specific models, and a range of sensitivity analyses to strengthen causal inference and reduce the influence of bias. Methods and Results We performed a longitudinal analysis of prospectively collected data on self-reported alcohol intake and presence of HDP from the UK ALSPAC (Avon Longitudinal Study of Parents and Children) cohort. Multivariable multinomial regression models were adjusted for confounders and mutually adjusted for partner's or maternal alcohol intake in the negative control analysis. We also performed a beverage type analysis of the effect of beer and wine separately on HDP risk, owing to different social patterning associated with different drinks. Sensitivity analyses assessed the robustness of results to assumptions of no recall bias, no residual confounding, and no selection bias. Of the 8999 women eligible for inclusion, 1490 fulfilled the criteria for HDP (17%). Both maternal and partner's drinking were associated with decreased HDP odds (mutually adjusted odds ratio [OR], 0.86; [95% CI, 0.77-0.96], P=0.008 and OR, 0.82; [95% CI, 0.70-0.97], P=0.018, respectively). We demonstrate the validity of the negative control analyses using the same approach for smoking as the exposure. This confirmed an inverse association for maternal but not partner's smoking, as expected. Estimates were more extreme for increasing levels of wine intake compared with increasing levels of beer. Multiple sensitivity analyses did not alter our conclusions. Conclusions We observed an inverse relationship between alcohol intake during pregnancy and risk of HDP for both maternal and, more surprisingly, partner's drinking. We speculate that this is more likely to be due to common environmental exposures shared between pregnant women and their partners rather than a true causal effect. This warrants further investigation using different study designs, including Mendelian randomization.
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Affiliation(s)
- Florence Z Martin
- MRC Integrative Epidemiology Unit (IEU) University of Bristol United Kingdom
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit (IEU) University of Bristol United Kingdom.,Department of Population Health Sciences, Bristol Medical School University of Bristol United Kingdom.,NIHR Biomedical Research Centre, Bristol Medical School University of Bristol United Kingdom
| | - Luisa Zuccolo
- MRC Integrative Epidemiology Unit (IEU) University of Bristol United Kingdom.,Department of Population Health Sciences, Bristol Medical School University of Bristol United Kingdom
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