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.

Fetal growth, diagnostics, and pregnancy dating

Pregnancy and delivery research

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.

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.

Wellbeing of health care staff

Introducing and Evaluating a Reproductive Life Plan

www.reproduktivlivsplan.se is part of a research project on health and lifestyle before, during and after pregnancy. The aim of this sub-project is to increase young people’s knowledge of the impact that age and life style habits have on fertility, through a website with evidence based information. The background of the preventative venture is that many women and men postpone childbearing to age, when especially, a woman’s fertility has started to decline. Preventative information may help to increase young people’s possibilities to make informed choices when it comes to life style and reproductive health, which can have positive impact on fertility, pregnancy, birth and the health of future children.

www.reproduktivlivsplan.se is being translated into several languages and can be used for preconception health and care information by health care providers, and/or by individual women, men or couples.

The inspiration for this project comes from, among others, the American public health authority CDC. Similar projects are going on in several European countries, e.g. in Denmark, Belgium, England and Italy.

Funding

Medical Faculty of Uppsala University, Bayer, Genusmedel, Regionala forskningsmedel, and Vårdforskningsmedel

Responsible researcher/contact person

Maria Ekstrand, maria.ekstrand@kbh.uu.se
Tanja Tydén, tanja.tyden@kbh.uu.se

To Main fields of research

RLP Youth

Preconception care is defined as the provision of biomedical, behavioral and social health interventions prior to conception, to improve health status and reduce risk factors that contribute to poor maternal and child health outcomes. Health behaviors initiated during adolescence may have a great impact on future health and reproductive outcomes. Given the worrying trends among young people of increased sexual risk taking such as high numbers of STI and induced abortions, and scarce knowledge of fertility and factors that might impair fertility and reproductive health, starting preconception health promotion and education in the early reproductive years has the potential to increase fertility awareness and to optimize physical, emotional, and social wellbeing throughout the life course.

‘RLP Youth’ is an interdisciplinary project with special emphasis on promoting adolescent preconception health. The overall aim is to increase awareness, knowledge and beliefs towards fertility and preconception health among adolescents by developing, implementing and evaluating a tool for reproductive life planning called ‘Reproductive Life Plan’ (RLP). The RLP concept has been tested among female Swedish university students and was found to increase the women´s knowledge about fertility and was well adopted by the midwives performing the RLP counselling. It is likely that this concept would be useful also among adolescents and could advantageously be included in contraceptive- or other forms of counselling at arenas such as Youth Clinics.

The RLP Youth-project includes quantitative and qualitative methods, such as individual interviews, focus group discussions, and a randomized controlled study. Gender and diversity aspects will be critically addressed in the project, which is approved by the Regional Ethical Review Board in Uppsala, Sweden, D.nr. 2018/413

Funding

European Society of Human Reproduction and Embryology (ESHRE), the Family Planning Fund of Uppsala, Ebba Danelius foundation, Uppsala Nursing home foundation. The project is a collaboration between Uppsala University, Sophiahemmet University, Mälardalen University and Lund University.

Responsible researcher/contact person

Maria Grandahl, maria.grandahl@kbh.uu.se
Magdalena Mattebo, magdalena.mattebo@kbh.uu.se
Maria Ekstrand, maria.ekstrand@kbh.uu.se
Jenny Stern, jenny.stern@kbh.uu.se
Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se
Karin Cato, karin.cato@kbh.uu.se

To Main fields of research

Life-style factors and reproduction

Health and lifestyle are of great importance when women intend to get pregnant, as well as during pregnancy. It is also crucial that people seeking for infertility are aware of the precise lifestyle changes they can implement in order to enhance the likelihood of treatment success. The overall aim of the project was to investigate the extent to which women comply with the recommendations for lifestyle during the time trying to conceive and early pregnancy and the impact of risk lifestyle factors on treatment result in sub-fertile women. Pregnant women and sub-fertile women answered a questionnaire which included questions on the type of lifestyle factors and mental health at baseline year and number of lifestyle changes made while the women had been trying to conceive with a planned follow-up two years later. Our study assesses furthermore the individual, as well as the cumulative effect of lifestyle risk factors on reproductive outcomes after a first completed IVF cycle. These negative lifestyle factors are easy to detect at an early stage of the assessment process and might allow for optimization of the treatment outcome.

Please read more on http://uu.diva-portal.org/smash/get/diva2:1175795/FULLTEXT01.pdf

Collaborators

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet; https://ki.se/meb/uppstart

Funding

Uppsala University Hospital, the Family Planning Fund in Uppsala, the Uppsala-Örebro Regional Research Council, the Swedish Research Council, and Västmanland County Council

Responsible researcher/contact person

Alkistis Skalkidou, alkistis.skalkidou@kbh.uu.se
Lana Salih Joelsson, lana.salih@kbh.uu.se

To Main fields of research

The midwife’s dialogue about alcohol in a life cycle perspective with parents-to-be

The aim of the project is to develop and to evaluate a method and a theory about social and psychosocial support for an alcohol-free pregnancy and for responsible alcohol consumption during parenthood, involving both parents-to-be.  It will also evaluate the feasibility of the implementation of such a method.

The intervention consists of a dialogue about alcohol with both parents-to-be in the beginning of a pregnancy.  The dialogue is based on a semi-structured guide and the aim is to prevent and to detect alcohol disorders and to refer for treatment. The intervention is evaluated by questionnaires to both parents. The questionnaires will also be evaluated through different techniques.

Funding

Public Health Agency in Sweden

Responsible researcher/contact person

Hjördis Högberg, hjordis.hogberg@kbu.uu.se
Margareta Larsson, margareta.larsson@kbh.uu.se
Michael Wells (Karolinska Institute), michael.wells@ki.se

To Main fields of research

Illustration: Carin Bådagård

Sexual health and reproduction among women and young adults with intellectual disability

The aim of Berit Höglund’s thesis was to investigate pregnancy and childbirth in women with intellectual disability (ID), in Sweden, the health of their newborns and midwifery care. Mothers with ID had more complicated births and their newborns had a higher proportion of preterm births, were small for gestational age, stillborn or died in the perinatal period. The women with ID struggled to attain motherhood and feared to lose custody of the child. Midwives stated it was different to care for women with ID and requested additional knowledge. Women with ID and their children should be considered as risk groups and professionals need to elucidate their knowledge and skills for counselling and supporting this group of women. The project has continued with an investigation of health and health risks among children born to mothers with intellectual disability. The children have an increased risk for mental health problems as well as injuries, violence and child abuse early in childhood. Further work was focused by interview studies regarding sexual health and reproduction among staff’s experience and perceptions regarding sexual and reproductive health about young adults with ID. Interview studies regarding sexual health and reproduction among young adults with ID and their parents are also planned.

Collaborations

Berit Höglund
Margareta Larsson
Maria Wickström
Maria Lundgren

Funding

Sävstaholm Foundation and Uppsala University
European Society of Contraception and Reproductive Health

Responsible researcher/contact person

Berit Höglund, berit.hoglund@kbh.uu.se

To Main fields of research

Illustration: Carin Bådagård

Midwives work with contraceptive counselling and contraception among women with intellectual disability (ID) in Sweden

The aims of the project was to gain a deeper understanding of midwives’ perceptions of sexual health and contraceptive use of women with ID, and of midwives’ practices in providing contraceptive counselling to women with ID by focus groups. The midwives experienced ambivalence, uncertainty and ethical dilemmas when counselling women with ID. They stated that few women with ID requested contraceptive counselling, which limited midwives’ knowledge, experience and competence. The midwives therefore planned the visits carefully and strived to enabale informed choices about contraceptives for these women. They wanted to ensure the best-adapted contraceptive method balanced aginst any risk of long-term use and possible side effects for individual women.

Collaborations

Berit Höglund
Margareta Larsson

Funding

ALF

Responsible researcher/contact person

Berit Höglund

To Main fields of research

Evaluating a new model about insights in reproductive health and parenting in adulthood among students with intellectual disability (ID) – a randomized controlled intervention study

The aim of the project is to develop and evaluate an intervention method using the Parenting Toolkit “Children – what does it involve? and the Real Care Baby (RCB) simulator among students with ID. This project follows the outline from our pilot study “An intervention using the Parent Toolkit “Children-What does it involve and the Real Care Baby simulator among students with intellectual disability – A feasibility study, (2018)”.

The intervention has involved seven high schools in Sweden, which consists of educational sessions twelve weeks (1,5 hours/week) and taking care of the RCB simulator during 3 days and nights at home. Other high schools are during recruitment. Data collection is ongoing and is based on structured questionnaires to the students as well as in depth interviews with 15 students.

Collaborations

Berit Höglund
Margareta Larsson
Gunnel Janeslätt

Funding

ALF
Regionala Forskningsmedel Uppsala-Örebro regionen (RFR)

Responsible researcher/contact person

Berit Höglund, berit.hoglund@kbh.uu.se
Margareta Larsson, margareta.larsson@kbh.uu.se

To Main fields of research

Foster care and prevention among children to mothers with intellectual disability (ID)

The aim of the study is to explore if foster care protect physical injuries, child abuse and violence among children to mothers with ID in Sweden. This project is a national register study (National Board of Health and Welfare and Statistics Sweden) during 1999-2012 comparing data with other children born to mothers without ID. The statistical analyses are ongoing.

Collaborations

Berit Höglund
Maria Lundgren
Jan Gustafsson

Funding

Sävstaholm Foundation
Gillbergska Foundation

Responsible researcher/contact person

Berit Höglund, berit.hoglund@kbh.uu.se

To Main fields of research

Motherhood by medically assisted reproduction (MAR)

Reproductive health includes the individual's capability to reproduce and the ability to give birth to a child is fundamental to most women. Infertility is a reproductive failure affecting 10-15% of all couples. The main objective of the research was to determine the prevalence of mood and anxiety disorders and related risk factors in infertile women and men undergoing assisted reproductive technology (ART). Further research was to follow the same cohort five years after undergoing ART, results indicating that psychiatric disorders were less common than at baseline assessment. The majority of women and men were at five-year follow-up living with children, as a result from live birth after ART, spontaneous pregnancy and/or adoption. However, almost one out of five women had no live birth at follow-up.

After a new legislation, introduced in 2016, giving single mothers by choice access to medically assisted reproduction (insemination and/or ART), an ongoing study is conducted. The objective is to assess characteristics and reasons of single women to choose motherhood by the use of assisted reproduction. Designs are both quantitative (questionnaire) and qualitative (individual interviews).

Collaborators

Dept. of Public Health, University of Copenhagen, Denmark

Responsible researcher/contact person

Helena Volgsten helena.volgsten@kbh.uu.se

To Main fields of research

Design: Anna D Volgsten

Fetal growth and assisted pregnancy

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

To Main fields of research

Dating and fetal growth in IVF-pregnancies

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

To Main fields of research

Pornography, Youth and Health

The overall aim of Magdalena Mattebo’s PhD project was to investigate pornography use among young people in Sweden in relation to health indicators and attitudes to gender equality. The core category emerging from focus group discussions, among personnel working with adolescents, was “Conflicting messages about sexuality”. The participants’ stated that the message conveyed by pornography was contradictory to the message conveyed by national public health goals and laws. A professional approach was emphasized, and adequate methods and knowledge to improve sexuality and relationship education were requested.

A prospective longitudinal questionnaire study among 800 high school students showed that pornography has become a part of everyday life for many adolescents. Frequent users of pornography were mainly boys, and there were minor differences in sexual experiences between the male consumption groups. Frequent use was associated with lifestyle problems, such as the use of alcohol and a sedentary lifestyle to a higher extent than with sexual experiences and physical symptoms. In the longitudinal analyses frequent use of pornography was more associated to psychosomatic symptoms compared with depressive symptoms.

Funding

Uppsala University, European Society of Contraception and Reproductive Health, Regional Research Council, Uppsala-Örebro

Responsible researcher/contact person

Magdalena Mattebo, magdalena.mattebo@kbh.uu.se
Tanja Tydén, tanja.tyden@kbh.uu.se
Margareta Larsson, margareta.larsson@kbh.uu.se

To Main fields of research

Information before prenatal tests for chromosomal aberrations

We elucidate what pregnant women coming for prenatal tests of Downs syndrome know about Down syndrome, what they think about the received information and what kind of information they had wished to get.

Funding

The Regional Research Fund, ALF

Responsible researcher/contact person

Ove Axelsson, ove.axelsson@kbh.uu.se

To Main fields of research

Childbirth related fear

Childbirth related fear (CBRF) is a well-known complication during pregnancy. CBRF affects the well-being of the woman and baby, requests for cesarean section and the number of children women give birth to. Population studies from the Nordic countries have reported a prevalence of CBRF in 17-20 % of all pregnant women. In earlier studies foreign born women have not been included although foreign born women have been pointed out as a risk population.

We have conducted a population based study and for this purpose translated the FOBS-scale into eight different languages. Measurement of CBRF has been studied before but the focus has not been implemented in clinical settings. Fear of birth scale (FOBS) is an instrument that identifies women with CBRF. FOBS have been used in research and it has the benefit of being short and user friendly. More knowledge is needed to find out if FOBS also can be used in clinical practice. Women with CBRF need evidence-based treatment. In Sweden there is no evidence-based standard care of CBRF. As a consequence, a randomized controlled trial is ongoing comparing two different treatments of CBRF; standard care and internet-based cognitive behavioral treatment. We recruit women from three hospital areas in Sweden. Counseling with specially trained midwives is offered in all hospitals in Sweden, but the effect is rarely investigated. We have identified background factors and outcome in women undergoing such counseling and currently we are investigating the organization of counseling in Swedish hospital.

Responsible researcher/contact person

Christine Rubertsson, christine.rubertsson@kbh.uu.se
Ingegerd Hildingsson, ingegerd.hildingsson@kbh.uu.se
Elin Ternström, elin.terstrom@kbh.uu.se
Birgitta Larsson, birgitta.larsson@kbh.uu.se
Liisa Svensson, liisa.svensson@kbh.uu.se

To Main fields of research

UPPSAT

The UPPSAT study was a population-based cohort conducted between 2006 and 2007, at Uppsala University Hospital. The primary aim of the study was to examine maternal, paternal, and infant well-being after childbirth, and it can be considered the foundation for the BASIC study. All women giving birth at the hospital were contacted by their midwife or midwife’s assistant after childbirth and were asked about participation. Information on the participants was retrieved through paper surveys administered at five days, six weeks, and six months postpartum. The surveys included data on socio-demographic characteristics, lifestyle, breastfeeding, partner support, stressful life events, as well as depression.

Responsible researcher/contact person

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

To Main fields of research

BASIC

The aim of the BASIC study is to enrich and expand our knowledge on the pathophysiological processes underlying perinatal depression and to pinpoint both epidemiological and biological predictors of the disease in order to improve early detection. BASIC is a mental health population-based cohort of women followed from mid-pregnancy up to one year after childbirth and has so far included more than 6500 pregnancies. All women in Uppsala called for routine ultrasound examination in pregnancy week 16–17 are invited to participate in this study since 2009. During pregnancy and after delivery, women are followed by web-based questionnaires (depression, anxiety and personality assessment tools, early life stress, sleep disorders, socioeconomic factors). Relevant biological material (blood samples, umbilical cord blood samples, umbilical cord samples, placenta samples, amniotic and spinal fluid samples, and microbiota samples) is stored in a biobank. The children of the BASIC participants are followed up in the U-BIRTH study.

The BASIC study data is used in several projects:

  • to study the association between the HPA axis and immune system with peripartum depression (PPD)
  • to investigate genetic correlates of PPD
  • to unravel the complex interplay between breastfeeding and PPD
  • to assess the association between personality and attachment and PPD
  • to assess the association between delivery complications and PPD
  • to investigate if there is seasonality of PPD in Sweden, and examine how the metabolome and inflammatory systems are affected by seasons
  • to assess if there are differences in bio-impedance and heart rate variability measurements between depressed and non-depressed women postpartum
  • o assess differences in placental gene expression among SSRI-users, depressed and non-depressed pregnant women
  • to assess differences in microbiome composition among depressed and non-depressed women during and after pregnancy, and the assess the possible predictive role of the microbiome composition in mid-pregnancy for preterm delivery and postpartum depression
  • to identify the best predictive algorithm based on machine learning methods, with data collected up to delivery for the risk for developing postpartum depression, for future application in clinical use.

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

Collaborators

Uppsala Biobank of Pregnant Women

Funding

Swedish Research Council, Uppsala University Hospital, Göran Gustafsson Foundation, Swedish Brain Foundation, Marianne and Marcus Wallenberg Foundation, Söderström Königska Foundation, Swedish Society of Medicine, Crime Victim Compensation and Support Authority, P.O. Zetterling Foundation, Swedish Council for Working Life and Social Research, Family Planning Foundation, Fredrik and Ingrid Thuring Foundation, Födelsefonden, General Maternity Hospital Foundation, Gillbergska Foundation, Märta and Nicke Nasvell Foundation, Professor Bror Gadelius Memorial Fund, and Naeslund Scholarship.

Responsible researcher/contact person

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

To Main fields of research

U-BIRTH

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.

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

To Main fields of research

BASIC child

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

To Main fields of research

PACT

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, coming soon): 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

To Main fields of research

MOM2B – A perinatal health project using a smartphone application and machine learning algorithms

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.

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.

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

To Main fields of research

Midwives’ emotional wellbeing and health

A high proportion of midwives leave the profession due to stress and heavy workload or dissatisfaction with salary or working conditions. A random sample of midwives from Sweden, Australia and New Zealand were recruited to a study where burnout and work related aspects are compared.

Responsible researcher/contact person

Ingegerd Hildingsson, ingegerd.hildingsson@kbh.uu.se

To Main fields of research