Line Jølving - Academia.edu (original) (raw)
Papers by Line Jølving
Alimentary Pharmacology & Therapeutics
British Journal of Clinical Pharmacology
European Journal of Epidemiology
Reproductive BioMedicine Online
Diabetologia
Aims/hypothesis Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women... more Aims/hypothesis Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women in the fertile years and women with diabetes may experience several reproductive issues. We aimed to examine the chance of biochemical pregnancy, clinical pregnancy and live birth after assisted reproductive technology (ART) treatment in women with type 1 and type 2 diabetes and whether obesity per se influenced the results. Methods This nationwide register-based cohort study is based on the Danish ART Registry comprising 594 women with either type 1 diabetes or type 2 diabetes from 2006 to 2017. Results Relative to women without diabetes, the adjusted OR (95% CI) of a live birth per embryo transfer was 0.50 (0.36, 0.71) in women with type 2 diabetes and 1.10 (0.86, 1.41) in women with type 1 diabetes. Conclusions/interpretation Our data on the efficacy of ART treatment in women with type 1 and type 2 diabetes is the first in this field. When compared with women without diabetes, women with type 1 diabetes had an equivalent chance of a live birth per embryo transfer whereas women with type 2 diabetes had a reduced chance. The findings in women with type 2 diabetes did not seem to be driven by obesity per se as the same pattern was seen in both normal-weight and obese women.
Journal of Crohn's and Colitis
Introduction Research on long-term outcomes of children exposed to inflammatory bowel disease (IB... more Introduction Research on long-term outcomes of children exposed to inflammatory bowel disease (IBD) in utero is lacking. Maternal inflammation, IBD medications or other factors may increase the risk of developmental disabilities in the offspring. Methods We used the Danish National Birth Cohort, an ongoing prospective study that includes 100,419 pregnancies of 92,274 women, in conjunction with the Danish National Registries, to evaluate cognitive and motor development of the children of women with and without IBD. We analyzed basic measures of childhood development at 6-month and 18-month interviews with the mother and with validated questionnaires filled out by the parents when the child was 7 years old. We adjusted for multiple confounders, including preterm birth. Results At 6 months, we included 484 children of women with IBD and 69,571 unexposed children; at 18 months, 471 exposed and 66,018 unexposed; at 7 years, 391 exposed and 54,356 unexposed. At 18 months, exposed children...
Clinical Epidemiology
Objective: Maternal thyroid disease (TD) during pregnancy is associated with adverse birth outcom... more Objective: Maternal thyroid disease (TD) during pregnancy is associated with adverse birth outcomes, but little is known on its long-term outcomes. We aimed to examine if children born to mothers with TD have increased disease risk during childhood and adolescence. Patients and methods: A register-based cohort study was conducted on all live born children in Denmark from 1989 to 2013, including the association between maternal TD during pregnancy and somatic and psychiatric diseases in the children. Cox proportional hazards models were used to compute hazard ratios (HRs) according to the type of maternal TD, Graves' disease, and Hashimoto's thyroiditis. Results: A total of 2,618 children were born to women with Graves' disease, 760 to women with Hashimoto's thyroiditis (exposed), and 1,557,577 to women without any TD (unexposed). The median follow-up time for children born to mothers with Graves' disease was 9.3 years (25/75 percentile 5.4/13.9 years) and with Hashimoto's thyroiditis was 4.8 years (25/75 percentile 2.5/8.2 years). In children exposed to maternal Graves' disease in utero, the adjusted HR of TD was 12.83 (95% CI, 9.74-16.90), Graves' disease was 34.3 (95% CI, 20.23-58.35), and type 1 was diabetes 2.47 (95% CI, 1.46-4.18). In children exposed to maternal Hashimoto's thyroiditis, the adjusted HR of Hashimoto's thyroiditis was 24.04 (95% CI, 5.89-97.94). Conclusion: Our data suggest that children born to women with Graves' disease and Hashimoto's thyroiditis have excess long-term morbidities in childhood and adolescence. We particularly found an increased risk of any TD and type 1 diabetes to be diagnosed in children exposed in utero to Graves' disease. These novel findings are relevant for pediatricians, stressing the importance of history of maternal disease when evaluating children with suspected endocrine disorders.
Reproductive BioMedicine Online
Clinical Gastroenterology and Hepatology
Clinical Epidemiology
Purpose: Women with thyroid disorders may have increased infertility and poor reproductive outcom... more Purpose: Women with thyroid disorders may have increased infertility and poor reproductive outcomes, but it is unclear if assisted reproductive technology (ART) is effective in this population. The aim of this study was to examine the chance of a pregnancy (biochemical and clinical), and a live birth after ART, in women with thyroid disorders undergoing ART treatment, compared to women without thyroid disorders. Among live-born children, we assessed the risk of congenital malformations. Patients and methods: In a nationwide cohort study of all women undergoing ART treatments in Denmark from 1 January 1994 throughout June 2017, we calculated the chance of a pregnancy and a live birth after embryo transfer. Women with thyroid disorders were stratified into two groups: those diagnosed with hypothyroid or hyperthyroid disorders. The adjusted OR (aOR) of a biochemical and a clinical pregnancy, a live born child and a congenital malformation was computed using multilevel logistic regression models. Results: In total, 199,674 embryo transfers were included in 2,101 women with thyroid disorders and in 65,526 women without thyroid disorders. The chance of a biochemical pregnancy was significantly reduced in women with hyperthyroidism (aOR=0.80, 95% CI 0.69-0.93), and the aOR of a live birth was 0.86, 95% CI 0.76-0.98. The aOR for a live birth in women with hypothyroidism was 1.03 (95% CI 0.94-1.12). Children of women with hypothyroidism, who were conceived after ART treatment, had a significantly increased risk of any congenital malformation (aOR=1.46 [95% CI 1.07-2.00]). Conclusion: Women with hyperthyroidism receiving ART treatment had a decreased chance of a live birth per embryo transfer compared to women without thyroid disorders. Women with hypothyroidism did not have a decreased chance of a live birth but their offspring had an increased risk of congenital malformation.
Inflammatory Bowel Diseases
For decades, the research on reproductive consequences in women with inflammatory bowel disease (... more For decades, the research on reproductive consequences in women with inflammatory bowel disease (IBD) has focused on short-term outcomes, including adverse pregnancy outcomes (eg, abruptio placenta, placenta previa, preeclampsia/eclampsia) and adverse birth outcomes (eg, small for gestational age, preterm birth, and congenital malformations). The long-term health outcomes of the children of parents with IBD have been studied to a much lesser extent, and there is a critical research gap in understanding the influence of parental IBD on long-term outcomes. In this review, we propose the reasons for this lack of evidence and highlight the weakest areas of the research on the impact of parental IBD on offspring health. We will focus on health outcomes in children of parents with IBD from an age of 1 year through childhood, adolescence, and adulthood.
Arthritis care & research, Jan 11, 2017
Fetal exposure to maternal rheumatoid arthritis (RA) might impact the long-term risk of disease i... more Fetal exposure to maternal rheumatoid arthritis (RA) might impact the long-term risk of disease in the offspring. We examined a possible association between maternal RA and 15 selected groups of chronic diseases in the offspring. This nationwide cohort study was based on the Danish health registries and included data on all children born alive in Denmark from January 1 1989 to December 31 2013. The cohort comprised 2106 children born by women with RA (exposed), and 1 378 539 children born by women without RA (unexposed). Cox proportional hazard regression models were used, taking a large range of confounders into consideration, computing the Hazard Ratios (HR) of child- and adolescence diseases. In children being exposed to maternal RA in utero, the HR's of thyroid diseases was 2.19 (95% CI, 1.14 - 4.21), epilepsy 1.61 (95% CI, 1.16 - 2.25), and RA 2.89 (95% CI, 2.06 - 4.05). The HR's for anxiety and personality disorders and chronic lung disease including asthma were in the...
Inflammatory bowel diseases, Aug 1, 2017
Very little is known about the long-term impact of maternal inflammatory bowel disease (IBD) on t... more Very little is known about the long-term impact of maternal inflammatory bowel disease (IBD) on the offspring's future health. We aimed to examine whether children born to mothers with IBD had an increased risk of long-term morbidities. In this nationwide register-based cohort study, including all children born alive in Denmark between 1989 and 2013, we investigated the association between maternal IBD and 15 selected disease categories of physical and mental conditions in the offspring. We used multivariate regression models estimating the hazard ratio (HR) of long-term child morbidities. The cohort comprised 9238 children born to women with IBD (exposed), and 1,371,407 born to women without IBD (unexposed). Median follow-up time among the exposed was 9.7 years (interquartile range [IQR] 4.9-15.7) and 13.8 (interquartile range 7.4-19.9) among the unexposed. In children, who in utero had been exposed to maternal ulcerative colitis, the HR of IBD in the offspring was 4.63 (95% co...
Acta Obstetricia et Gynecologica Scandinavica, 2016
There is substantial evidence of a negative impact of maternal chronic disease during pregnancy o... more There is substantial evidence of a negative impact of maternal chronic disease during pregnancy on reproductive outcomes. Knowledge of the prevalence of chronic diseases during pregnancy is limited, but essential for a focused preventive effort regarding optimal disease control during pregnancy. We aimed to analyse the prevalence of chronic diseases during pregnancy. This register-based cohort study included all women giving birth in Denmark between 1989 and 2013 based on data from Danish health registers. Maternal chronic diseases included 23 disease categories of both physical and mental health conditions recorded within a period of 10 years before childbirth. We included 1,362,200 childbirths during the study period. The overall prevalence of maternal chronic disease increased from 3.71% in 1989 to 15.76% in 2013. The most frequently registered chronic diseases were chronic lung diseases/asthma (1.73%), thyroid disorders (1.50%) and anxiety and personality disorders (1.33%). Taking increasing maternal age at birth into account, the relative risk for women to have a chronic disease from 2009 to 2013 was 4.14 (95% CI 4.05-4.22), compared to mothers giving birth from 1989-1993. We found an increasing prevalence of maternal chronic disease during pregnancy and more than a four-fold increased risk of maternal chronic disease during pregnancy for childbirths in the period 2009 through 2013, compared to 1989 through 1993. The main limitation of our study is related to a potentially greater awareness and hence more careful registration of maternal chronic disease over time and thereby an increased tendency to register diseases. This article is protected by copyright. All rights reserved.
BMJ open, Feb 10, 2018
The aim of this study was to estimate the effects of risk factors on elective and emergency caesa... more The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions. Historical registry-based cohort study. The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included. We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation. The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found t...
Ugeskrift for laeger, Jan 15, 2012
The American Journal of Gastroenterology, 2013
All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered demogra... more All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality. RESULTS: A total of 13,498 PUB patients (median age 74 years) were included, of which one-quarter were in-hospital bleeders. Preadmission use of anticoagulants, multiple coexisting diseases, and the American Society of Anesthesiologists scores increased between 2004 and 2011. Considerable improvements were observed for most QOC indicators over time. Endoscopic treatment was successful with primary hemostasis achieved in more patients (94 % in 2010 -2011 vs. 89 % in 2004 -2006, relative risk (RR) 1.06 (95 % confi dence intervals 1.04 -1.08)), endoscopy delay for hemodynamically unstable patients decreased during this period (43 % vs. 34 % had endoscopy within 6 h, RR 1.33 (1.10 -1.61)), and fewer patients underwent open surgery (4 % vs. 6 % , RR 0.72 (0.59 -0.87)). After controlling for time changes in prognostic factors, rebleeding rates improved (13 % vs. 18 % , adjusted RR 0.77 (0.66 -0.91)). Crude 30-day mortality was unchanged (11 % vs. 11 % ), whereas adjusted mortality decreased nonsignifi cantly over time (adjusted RR 0.89 (0.78 -1.00)).
Acta Obstetricia et Gynecologica Scandinavica, 2011
From September 2010, all births in Denmark will be monitored from a quality perspective with the ... more From September 2010, all births in Denmark will be monitored from a quality perspective with the Danish National Indicator Project in order to document and develop the quality of the care provided during delivery. We describe the process of selecting the indicators based on relevance, scientific evidence, usefulness and applicability, acceptability and patient safety. Eight indicators were selected covering different aspects of delivery: anesthesia/pain relief; continuous support for women in the delivery room; lacerations, 3rd or 4th degree; acute cesarean section; post-partum hemorrhage; establishment of skin-to-skin contact between mother and newborn infant; severe fetal hypoxia; delivery of a healthy child after uncomplicated delivery. Registration will be mandatory for all delivery units in Denmark. Subsequently, the clinical units will receive feedback in the form of real-time monthly and quarterly standard reports including unadjusted results that may be used for the unit's own internal monitoring and development of quality.
Ugeskrift for laeger, Jan 7, 2008
In 2004 the Danish National Board of Health issued new guidelines for prenatal diagnostics in Den... more In 2004 the Danish National Board of Health issued new guidelines for prenatal diagnostics in Denmark. The guidelines include a general offer to all pregnant women in Denmark of first trimester risk assessment of combined non-invasive tests integrating measurement of nuchal translucency and maternal biochemistry for detection of fetal chromosomal abnormalities like trisomy 21, and replacing the screening criteria of > or =35 of age. The study is based on registered data covering 5,504 pregnancies during the period 1 July 2005 to 31 December 2005 in Aarhus and Viborg Counties. 77% of the pregnant women had a complete combined test and only 2% declined the program. At a cut off at 1:400 at term the detection rate for trisomy 21 was 85% (CI: 62.1-96.8%) with a false positive rate of 3.4%. There was a significant reduction in the number of prenatal karyotypes from 2002 to 2005 in both counties, with a 58% reduction in Viborg County and 33% in Aarhus County. The percentage of abnormal...
Alimentary Pharmacology & Therapeutics
British Journal of Clinical Pharmacology
European Journal of Epidemiology
Reproductive BioMedicine Online
Diabetologia
Aims/hypothesis Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women... more Aims/hypothesis Type 1 and type 2 diabetes are among the most prevalent chronic diseases in women in the fertile years and women with diabetes may experience several reproductive issues. We aimed to examine the chance of biochemical pregnancy, clinical pregnancy and live birth after assisted reproductive technology (ART) treatment in women with type 1 and type 2 diabetes and whether obesity per se influenced the results. Methods This nationwide register-based cohort study is based on the Danish ART Registry comprising 594 women with either type 1 diabetes or type 2 diabetes from 2006 to 2017. Results Relative to women without diabetes, the adjusted OR (95% CI) of a live birth per embryo transfer was 0.50 (0.36, 0.71) in women with type 2 diabetes and 1.10 (0.86, 1.41) in women with type 1 diabetes. Conclusions/interpretation Our data on the efficacy of ART treatment in women with type 1 and type 2 diabetes is the first in this field. When compared with women without diabetes, women with type 1 diabetes had an equivalent chance of a live birth per embryo transfer whereas women with type 2 diabetes had a reduced chance. The findings in women with type 2 diabetes did not seem to be driven by obesity per se as the same pattern was seen in both normal-weight and obese women.
Journal of Crohn's and Colitis
Introduction Research on long-term outcomes of children exposed to inflammatory bowel disease (IB... more Introduction Research on long-term outcomes of children exposed to inflammatory bowel disease (IBD) in utero is lacking. Maternal inflammation, IBD medications or other factors may increase the risk of developmental disabilities in the offspring. Methods We used the Danish National Birth Cohort, an ongoing prospective study that includes 100,419 pregnancies of 92,274 women, in conjunction with the Danish National Registries, to evaluate cognitive and motor development of the children of women with and without IBD. We analyzed basic measures of childhood development at 6-month and 18-month interviews with the mother and with validated questionnaires filled out by the parents when the child was 7 years old. We adjusted for multiple confounders, including preterm birth. Results At 6 months, we included 484 children of women with IBD and 69,571 unexposed children; at 18 months, 471 exposed and 66,018 unexposed; at 7 years, 391 exposed and 54,356 unexposed. At 18 months, exposed children...
Clinical Epidemiology
Objective: Maternal thyroid disease (TD) during pregnancy is associated with adverse birth outcom... more Objective: Maternal thyroid disease (TD) during pregnancy is associated with adverse birth outcomes, but little is known on its long-term outcomes. We aimed to examine if children born to mothers with TD have increased disease risk during childhood and adolescence. Patients and methods: A register-based cohort study was conducted on all live born children in Denmark from 1989 to 2013, including the association between maternal TD during pregnancy and somatic and psychiatric diseases in the children. Cox proportional hazards models were used to compute hazard ratios (HRs) according to the type of maternal TD, Graves' disease, and Hashimoto's thyroiditis. Results: A total of 2,618 children were born to women with Graves' disease, 760 to women with Hashimoto's thyroiditis (exposed), and 1,557,577 to women without any TD (unexposed). The median follow-up time for children born to mothers with Graves' disease was 9.3 years (25/75 percentile 5.4/13.9 years) and with Hashimoto's thyroiditis was 4.8 years (25/75 percentile 2.5/8.2 years). In children exposed to maternal Graves' disease in utero, the adjusted HR of TD was 12.83 (95% CI, 9.74-16.90), Graves' disease was 34.3 (95% CI, 20.23-58.35), and type 1 was diabetes 2.47 (95% CI, 1.46-4.18). In children exposed to maternal Hashimoto's thyroiditis, the adjusted HR of Hashimoto's thyroiditis was 24.04 (95% CI, 5.89-97.94). Conclusion: Our data suggest that children born to women with Graves' disease and Hashimoto's thyroiditis have excess long-term morbidities in childhood and adolescence. We particularly found an increased risk of any TD and type 1 diabetes to be diagnosed in children exposed in utero to Graves' disease. These novel findings are relevant for pediatricians, stressing the importance of history of maternal disease when evaluating children with suspected endocrine disorders.
Reproductive BioMedicine Online
Clinical Gastroenterology and Hepatology
Clinical Epidemiology
Purpose: Women with thyroid disorders may have increased infertility and poor reproductive outcom... more Purpose: Women with thyroid disorders may have increased infertility and poor reproductive outcomes, but it is unclear if assisted reproductive technology (ART) is effective in this population. The aim of this study was to examine the chance of a pregnancy (biochemical and clinical), and a live birth after ART, in women with thyroid disorders undergoing ART treatment, compared to women without thyroid disorders. Among live-born children, we assessed the risk of congenital malformations. Patients and methods: In a nationwide cohort study of all women undergoing ART treatments in Denmark from 1 January 1994 throughout June 2017, we calculated the chance of a pregnancy and a live birth after embryo transfer. Women with thyroid disorders were stratified into two groups: those diagnosed with hypothyroid or hyperthyroid disorders. The adjusted OR (aOR) of a biochemical and a clinical pregnancy, a live born child and a congenital malformation was computed using multilevel logistic regression models. Results: In total, 199,674 embryo transfers were included in 2,101 women with thyroid disorders and in 65,526 women without thyroid disorders. The chance of a biochemical pregnancy was significantly reduced in women with hyperthyroidism (aOR=0.80, 95% CI 0.69-0.93), and the aOR of a live birth was 0.86, 95% CI 0.76-0.98. The aOR for a live birth in women with hypothyroidism was 1.03 (95% CI 0.94-1.12). Children of women with hypothyroidism, who were conceived after ART treatment, had a significantly increased risk of any congenital malformation (aOR=1.46 [95% CI 1.07-2.00]). Conclusion: Women with hyperthyroidism receiving ART treatment had a decreased chance of a live birth per embryo transfer compared to women without thyroid disorders. Women with hypothyroidism did not have a decreased chance of a live birth but their offspring had an increased risk of congenital malformation.
Inflammatory Bowel Diseases
For decades, the research on reproductive consequences in women with inflammatory bowel disease (... more For decades, the research on reproductive consequences in women with inflammatory bowel disease (IBD) has focused on short-term outcomes, including adverse pregnancy outcomes (eg, abruptio placenta, placenta previa, preeclampsia/eclampsia) and adverse birth outcomes (eg, small for gestational age, preterm birth, and congenital malformations). The long-term health outcomes of the children of parents with IBD have been studied to a much lesser extent, and there is a critical research gap in understanding the influence of parental IBD on long-term outcomes. In this review, we propose the reasons for this lack of evidence and highlight the weakest areas of the research on the impact of parental IBD on offspring health. We will focus on health outcomes in children of parents with IBD from an age of 1 year through childhood, adolescence, and adulthood.
Arthritis care & research, Jan 11, 2017
Fetal exposure to maternal rheumatoid arthritis (RA) might impact the long-term risk of disease i... more Fetal exposure to maternal rheumatoid arthritis (RA) might impact the long-term risk of disease in the offspring. We examined a possible association between maternal RA and 15 selected groups of chronic diseases in the offspring. This nationwide cohort study was based on the Danish health registries and included data on all children born alive in Denmark from January 1 1989 to December 31 2013. The cohort comprised 2106 children born by women with RA (exposed), and 1 378 539 children born by women without RA (unexposed). Cox proportional hazard regression models were used, taking a large range of confounders into consideration, computing the Hazard Ratios (HR) of child- and adolescence diseases. In children being exposed to maternal RA in utero, the HR's of thyroid diseases was 2.19 (95% CI, 1.14 - 4.21), epilepsy 1.61 (95% CI, 1.16 - 2.25), and RA 2.89 (95% CI, 2.06 - 4.05). The HR's for anxiety and personality disorders and chronic lung disease including asthma were in the...
Inflammatory bowel diseases, Aug 1, 2017
Very little is known about the long-term impact of maternal inflammatory bowel disease (IBD) on t... more Very little is known about the long-term impact of maternal inflammatory bowel disease (IBD) on the offspring's future health. We aimed to examine whether children born to mothers with IBD had an increased risk of long-term morbidities. In this nationwide register-based cohort study, including all children born alive in Denmark between 1989 and 2013, we investigated the association between maternal IBD and 15 selected disease categories of physical and mental conditions in the offspring. We used multivariate regression models estimating the hazard ratio (HR) of long-term child morbidities. The cohort comprised 9238 children born to women with IBD (exposed), and 1,371,407 born to women without IBD (unexposed). Median follow-up time among the exposed was 9.7 years (interquartile range [IQR] 4.9-15.7) and 13.8 (interquartile range 7.4-19.9) among the unexposed. In children, who in utero had been exposed to maternal ulcerative colitis, the HR of IBD in the offspring was 4.63 (95% co...
Acta Obstetricia et Gynecologica Scandinavica, 2016
There is substantial evidence of a negative impact of maternal chronic disease during pregnancy o... more There is substantial evidence of a negative impact of maternal chronic disease during pregnancy on reproductive outcomes. Knowledge of the prevalence of chronic diseases during pregnancy is limited, but essential for a focused preventive effort regarding optimal disease control during pregnancy. We aimed to analyse the prevalence of chronic diseases during pregnancy. This register-based cohort study included all women giving birth in Denmark between 1989 and 2013 based on data from Danish health registers. Maternal chronic diseases included 23 disease categories of both physical and mental health conditions recorded within a period of 10 years before childbirth. We included 1,362,200 childbirths during the study period. The overall prevalence of maternal chronic disease increased from 3.71% in 1989 to 15.76% in 2013. The most frequently registered chronic diseases were chronic lung diseases/asthma (1.73%), thyroid disorders (1.50%) and anxiety and personality disorders (1.33%). Taking increasing maternal age at birth into account, the relative risk for women to have a chronic disease from 2009 to 2013 was 4.14 (95% CI 4.05-4.22), compared to mothers giving birth from 1989-1993. We found an increasing prevalence of maternal chronic disease during pregnancy and more than a four-fold increased risk of maternal chronic disease during pregnancy for childbirths in the period 2009 through 2013, compared to 1989 through 1993. The main limitation of our study is related to a potentially greater awareness and hence more careful registration of maternal chronic disease over time and thereby an increased tendency to register diseases. This article is protected by copyright. All rights reserved.
BMJ open, Feb 10, 2018
The aim of this study was to estimate the effects of risk factors on elective and emergency caesa... more The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions. Historical registry-based cohort study. The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included. We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation. The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found t...
Ugeskrift for laeger, Jan 15, 2012
The American Journal of Gastroenterology, 2013
All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered demogra... more All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality. RESULTS: A total of 13,498 PUB patients (median age 74 years) were included, of which one-quarter were in-hospital bleeders. Preadmission use of anticoagulants, multiple coexisting diseases, and the American Society of Anesthesiologists scores increased between 2004 and 2011. Considerable improvements were observed for most QOC indicators over time. Endoscopic treatment was successful with primary hemostasis achieved in more patients (94 % in 2010 -2011 vs. 89 % in 2004 -2006, relative risk (RR) 1.06 (95 % confi dence intervals 1.04 -1.08)), endoscopy delay for hemodynamically unstable patients decreased during this period (43 % vs. 34 % had endoscopy within 6 h, RR 1.33 (1.10 -1.61)), and fewer patients underwent open surgery (4 % vs. 6 % , RR 0.72 (0.59 -0.87)). After controlling for time changes in prognostic factors, rebleeding rates improved (13 % vs. 18 % , adjusted RR 0.77 (0.66 -0.91)). Crude 30-day mortality was unchanged (11 % vs. 11 % ), whereas adjusted mortality decreased nonsignifi cantly over time (adjusted RR 0.89 (0.78 -1.00)).
Acta Obstetricia et Gynecologica Scandinavica, 2011
From September 2010, all births in Denmark will be monitored from a quality perspective with the ... more From September 2010, all births in Denmark will be monitored from a quality perspective with the Danish National Indicator Project in order to document and develop the quality of the care provided during delivery. We describe the process of selecting the indicators based on relevance, scientific evidence, usefulness and applicability, acceptability and patient safety. Eight indicators were selected covering different aspects of delivery: anesthesia/pain relief; continuous support for women in the delivery room; lacerations, 3rd or 4th degree; acute cesarean section; post-partum hemorrhage; establishment of skin-to-skin contact between mother and newborn infant; severe fetal hypoxia; delivery of a healthy child after uncomplicated delivery. Registration will be mandatory for all delivery units in Denmark. Subsequently, the clinical units will receive feedback in the form of real-time monthly and quarterly standard reports including unadjusted results that may be used for the unit's own internal monitoring and development of quality.
Ugeskrift for laeger, Jan 7, 2008
In 2004 the Danish National Board of Health issued new guidelines for prenatal diagnostics in Den... more In 2004 the Danish National Board of Health issued new guidelines for prenatal diagnostics in Denmark. The guidelines include a general offer to all pregnant women in Denmark of first trimester risk assessment of combined non-invasive tests integrating measurement of nuchal translucency and maternal biochemistry for detection of fetal chromosomal abnormalities like trisomy 21, and replacing the screening criteria of > or =35 of age. The study is based on registered data covering 5,504 pregnancies during the period 1 July 2005 to 31 December 2005 in Aarhus and Viborg Counties. 77% of the pregnant women had a complete combined test and only 2% declined the program. At a cut off at 1:400 at term the detection rate for trisomy 21 was 85% (CI: 62.1-96.8%) with a false positive rate of 3.4%. There was a significant reduction in the number of prenatal karyotypes from 2002 to 2005 in both counties, with a 58% reduction in Viborg County and 33% in Aarhus County. The percentage of abnormal...