Main fields of research and projects

Preconception health and care

Health conditions and risk factors can affect fertility and pregnancy outcome. Preconception health refers to the health of women and men during their reproductive years. It focuses on taking steps now to protect the health of a baby they might have sometime in the future.

Preconception care describe childbearing-related health care for women and men before pregnancy.​

• Sexual health and reproduction among women and young adults with intellectual disability
• Motherhood by medically assisted reproduction (MAR)
• The effect of endometrial scratch and the role of microbiota and transcriptome in women with unexplained recurrent implantation failure
• Fetal growth and assisted pregnancy
• Dating and fetal growth in IVF-pregnancies

Fetal growth, diagnostics, and pregnancy dating

• ​Magnetic Resonance Tomography (MRT) and 3D-ultrasound for diagnosis of fetal malformations​
• Discrepancy between pregnancy dating methods – correlates and consequences

Affective disorders in the perinatal period and child outcomes

Peripartum depression (PPD) affects approximately 12% of pregnant women and new mothers globally. Apart from obvious consequences, such as the suffering of the woman, infants of mothers suffering from PPD have been reported to have an increased risk of premature birth, and low birth weight. Furthermore, PPD can adversely influence the mother–child attachment, the social behavior of the child, and the child’s cognitive development. Risk factors for developing PPD include previous mental illness, lack of social support, low income, unplanned or unwanted pregnancy, adverse life events, and pregnancy complications.

• UPPSAT
• BASIC
• U-BIRTH
• BASIC child
• PACT
• MOM2B – A perinatal health project using a smartphone application and machine learning algorithms

Vulvodynia

Vulvodynia is defined as vulva pain that lasts at least 3 months without a clear cause. In Sweden, the prevalence is unknown. It is estimated that 2–5 % of women between the ages of 20–30 suffer from vulvodynia. Internet-based interventions for somatic conditions have been shown to be effective both in terms of psychological and disease-related outcomes in patients with chronic somatic conditions and anxiety. Cognitive Behavioural Therapy (CBT) via the internet has also shown good effects on sexual function. Acceptance and Commitment Therapy (ACT) is a branch of CBT and focuses on mindfulness, exposure and acceptance of pain. Internet-based intervention based on ACT-principles has shown good results for a Swedish population with chronic pain, but how an internet-based intervention can affect pain in patients with vulvodynia is, however, less studied.

• Vulvodynia, Cognitive behavioral therapy, Acceptance commitment therapy, pain, sexual health, gynecology

Wellbeing of health care staff

• Midwives’ emotional wellbeing and health

Despite the recent advances in assisted reproductive treatments, the success rate of in-vitro fertilization (IVF) is still low. This depends mainly on the limited implantation rate. Recurrent implantation failure (RIF) occurs in 5-10% of women undergoing IVF cycles. RIF can be defined as the failure to achieve a clinical pregnancy after transfer of at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40. In women with unexplained RIF, suboptimal endometrial receptivity is considered as a key factor in impaired implantation.

Studies have shown that endometrial scratch can improve clinical pregnancy rate and live birth rate in women undergoing IVF treatment, by causing endometrial injury possibly through improved endometrial receptivity.

Molecular studies analyzing endometrial gene expression among these women demonstrate aberrant endometrial regulation. There is, however, a new set of factors – microbial communities (i.e. microbiota) that could influence the gene expression and that seem to have an important role in endometrial function.

The aims of this project are:

• To evaluate the benefits and the side effects of endometrial scratch in women with unexplained RIF.
• To identify microorganisms from endometrium and other mucosal sites of the body (cervix, bladder, gut, mouth) that could be associated with RIF.
• To identify transcription markers in women with unexplained RIF.

Collaborators

University of Granada, Spain.
Stanford University Medical Center, USA
Ludwig-Maximilians University Munich, Germany
University of Tartu Women’s Clinic, Estonia

Funding

Region Uppsalas riktade FoU medel
Gedeon Richter

Responsible researchers

Stavros Iliadis, MD, PhD, stavros.iliadis@kbh.uu.se
Pu Zhang, MD, PhD, pu.zhang@akademiska.se

Internationell forskning har de senaste åren visat på betydande fördelar för kvinnor och barn när vården ges i form av barnmorskekontinuitet genom vårdkedjan från graviditet, under förlossning och den första tiden efter barnets födelse. Vårdformer med kontinuitet rekommenderas av Världshälsoorganisationen (WHO) för de flesta gravida och födande kvinnor. Olika modeller med barnmorskekontinuitet har utvecklats internationellt. I Sverige är kontinuiteten med samma barnmorska relativt god för kvinnor under graviditeten, men förlossningsvård och eftervård är oftast fragmenterad, med olika vårdgivare, och många olika personalkategorier inblandade.  En stor Cochraneöversiktsartikel visar att vårdformer med kontinuitet innebär bland annat färre ingrepp under förlossningen, fler spontana födslar, hög grad av kontinuitet av en känd barnmorska, nöjdare kvinnor och en billigare vård. 
I Sverige börjar enstaka projekt med kontinuitet att utvecklas. Ett sådant projekt har vi genomfört vid Barnmorskemottagningen Hjärtat i Uppsala i samarbete med förlossningsavdelningen vid Akademiska sjukhuset. Projektet vände sig till förlossningsrädda kvinnor. Ett ytterligare projekt med kontinuitet för förlossningsrädda kvinnor har vi genomfört vid tre sjukhus i landet, där barnmorskan som ansvarat för samtalsstöd till den förlossningsrädda kvinnan även bistod henne i födandet, när så var möjligt. Att ha en känd barnmorska innebar att förlossningsrädslan försvann hos en del av kvinnorna, minskade hos majoriteten och gav överlag en bättre skattning av förlossningsvården och upplevelsen av förlossningen. Projekt om kontinuitet drivs ofta i storstadsregioner, men det är mindre vanligt i glesbygd. I samband med planerad omorganisation av förlossningsvården i Sollefteå gavs tillfälle att prova ett nytt arbetssätt genom att öka kontinuitet och erbjuda en sammanhållen vårdkedja. Projekten kommer att ge ny kunskap om vårdformens betydelse för förlossningens utfall samt kvinnors, partners och barnmorskors upplevelser. 

Forskningshuvudman 
Uppsala universitet

Samarbeten
Region Uppsala
Region Västernorrland
Region Jämtland-Härjedalen
Sofiahemmet Högskola
Mittuniversitetet
Lunds Universitet

Finansiering
Vetenskapsrådet
Sveriges kommuner och regioner (SKR)
Kampradstiftelsen 

Ansvarig forskare/kontaktperson

Ingegerd Hildingsson

Studies have shown differences in birth weight between children born after IVF and spontaneous pregnancies. In general, IVF is associated with an increased rate of low birth weight and premature deliveries. More recent studies have shown a higher incidence of low birthweight and small for gestational age in after fresh embryo transfer, while after frozen embryo transfer there is a higher incidence of large for gestational age. One prospective study will compare fetal growth after fresh and frozen embryo transfer to normal pregnancies using serial biometrical measurements. One registry study will compare the same groups in a larger material by several combined registries. The same database will be used in a third study to get a better understanding in the most proper way to date IVF-pregnancies, a question that is still unclear.

Collaborators

Örebro University

Funding

Uppsala-Örebro, FoU Region Uppsala, Swedish Society of Medicine

Responsible researcher/contact person

Eva Bergman, eva.bergman@kbh.uu.se
Mårten Ageheim, marten.ageheim@kbh.uu.se

Responsible researcher/contact person

Ajlana Mulic Lutvica, ajlana.lutvica@kbh.uu.se
Ove Axelsson, ove.axelsson@kbh.uu.se

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se
Merit Kullinger, merit.kullinger@kbh.uu.se

Responsible researcher/contact person

Ulf Högberg, ulf.hogberg@kbh.uu.se

A follow-up study of the UPPSAT (children at 6 and 11 years of age) and BASIC studies (children at 18 months and 6 years) participants, with focus on maternal mental health and child development.

The aim of the U-BIRTH study is to provide in-depth understanding of how exposure to factors such as maternal depression during fetal and infant life, interact with psychosocial and genetic factors in shaping childrens clinical developmental phenotypes.

Approximately 60% of BASIC and 30% of UPPSAT mothers are included in this follow-up, via web-based questionnaires, and we expect to include 2800 mother-offspring pairs from the BASIC study and 800 pairs in the UPPSAT study. Thus far, about 65% these have already been recruited. An epigenome-wide association study (EWAS) among children with psycho-emotional problems and controls is being conducted. For more information, visit our website https://www.ubirth.se

Collaborators

FinnBrain study

Funding

Göran Gustafsson Foundation, Swedish Brain Foundation, and the Swedish Medical Association

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

An in-depth study initiated by Uppsala Children- and Baby Lab, Department of Psychology, studying child development in relation to maternal mood during and after pregnancy. Patients are recruited from the BASIC study and the children followed up with a series of psychological tests.

Funding

Uppsala Children- and Baby Lab (Marianne and Marcus Wallenberg Foundation)

Responsible researcher/contact person

Gustaf Gredebäck, gustaf.gredeback@psyk.uu.se

In the PACT study, interactions between genetics and environment is investigated in order to increase our understanding of the causes of postpartum depression and postpartum psychosis. An increased understanding is important in order to develop new and better treatments of these conditions, as well as improve prediction of which women are at risk of postpartum depression. PACT is an international study, recruiting women in several countries around the world. So far, more than 11,000 women have been included in the PACT study in Australia, Canada, and the US. Recruitment in Sweden will begin shortly.

For more information, visit our website (in Swedish): https://www.pactstudie.se/

Collaborators

Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium (http://www.pactforthecure.com/)

Funding

Swedish federal government under the ALF agreement

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

The collection of human behavioral data from real life situations collected from smartphones and other digital devices is called digital phenotyping. This kind of data holds potential for detecting and understanding psychiatric conditions. General smartphone app usage patterns, regardless of the particular task at hand, may contain clinically relevant predictive information. To date, 6449 women have registered.

The project will use self-report surveys and smartphone usage patterns together with state of the art machine learning techniques to improve the identification of mothers at high risk of (1) developing perinatal mental morbidity (e.g., peripartum depression) or (2) suffering perinatal somatic complications (e.g., preterm birth).  By linking data to the Swedish national health registers, we also aim to identify perinatal data that is associated with long-term wellbeing. For more information, visit our website https://mom2b.se

Collaborators

Dept. of Information Technology, Uppsala University

Funding

Swedish Association of Local Authorities and Regions

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

Syftet med 3PAD är att försöka förutsäga vilka kvinnor som har högre risk för förlossningsdepression, eller postpartumdepression (PPD), genom två så kallade neurofysiologiska mätningar. Genom att mäta hur ögats pupill rör sig (pupil dilation, PD) och hur fort hjärtat slår (heart rate variability, HRV) i vila och under koncentration beräknar vi hur kroppen reagerar på stress och avslappning, något som är viktigt för risken att utveckla symptom på ångest och depression. Första studien baseras på ett urval kvinnor från BASIC-studien som gjorde HRV-mätningar vid graviditetsvecka 38 samt besvarade enkäter 6 veckor efter förlossning. 
Under hösten 2021 planerar vi också att starta en ny datainsamling där gravida kvinnor bjuds in till två besök under graviditeten där vi mäter PD och HRV, och deltagaren svarar på några enkäter. Första besöket planeras ungefär graviditetsvecka 14 - 19 och andra besöket planeras ungefär vecka 38. Dessutom planeras en telefonintervju  ungefär 6 veckor efter förlossningen. Vi hoppas att resultaten från dessa studier kan bidra till en prediktionsmodell som kan hjälpa till att identifiera kvinnor med hög risk för förlossningsdepression och ångest. 

Forskningshuvudman 

Uppsala universitet

Samarbeten

Psykologiska Institutionen och Institutionen för neurovetenskap, Uppsala universitet
University of Zurich, Schweiz

Finansiering

Projektmedel från Women’s Mental Health during the Reproductive Lifespan
https://uu.se/forskning/womher/

Ansvarig forskare/kontaktperson

Emma Fransson,
emma.fransson@kbh.uu.se

Allison Eriksson
allison.eriksson@kbh.uu.se

Delta i forskningsprojektet

The EMBLA study is a randomized controlled trial and aims to evaluate the effect of an internet-based intervention for women with vulvodynia during the waiting period for clinical treatment. The project has been mainly funded by Regional Research Council Mid Sweden and Centre for Clinical Research Västerås.

Patients diagnosed with vulvodynia were recruited from the waiting lists at Gynecology clinics in Uppsala, Örebro, Falun and Gävle and announces in social media Representatives from all involved hospitals and different professions are included in the project (doctor, physiotherapist, midwife, psychologist and health economist). Recruitment started in 2015 and was completed in 2020. Patients have been randomized to either a six-week self-treatment via the internet or treatment as usual. To investigate the effects and cost-effectivity of the intervention, demographic data,information on pain, pain acceptance, depression, anxiety, quality of life and health care consumption were collected. Further, some participants were invited to participate in an interview study with the aim of describing women’s experiences of internet-based treatment.

Vulvodynia can mean a great deal of suffering for patients and the treatment is often long. Treatment accessibility may vary depending on available local resources. After internet-based treatment, participants reported less pain during intercourse and increased pain acceptance. Further, the internet-based treatment was appreciated by the participants regarding content, support from eCoach and accessibility. Technical difficulties and length of treatment were barriers to treatment. Results of these studies suggests that internet-based treatment may be used as a complement to clinical treatment. A study investigating cost-effectiveness of the treatment is now under way and will provide a deeper understanding of internet-treatment for vulvodynia.  

Collaborators

Region Örebro län, Landstinget Dalarna, Region Gävleborg, Centrum för Klinisk ForskningVästerås

Funding

Regional Research Council Mid Sweden and Centre for Clinical Research Västerås

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se

Andrea Hess Engström, andrea.hess.engström@kbh.uu.se