BACKGROUND:New mothers experience childbirth as an existentially transformative event and may need guidance to navigate emotional challenges. However, current pregnancy care is predominantly biomedically and physiologically oriented, whereas aspects related to existential life changes are not equally cared for. Hence, there is a need to explore postnatal existential aspects among new mothers, including paradoxical thoughts about meaning, love, and strength. This study aimed to explore first-time mothers' experience and make sense of existential aspects in the earliest postnatal days, as these are expressed and embodied in their 'narratives of the beginning' during the transition into motherhood. METHODS:Semi-structured interviews with 18 first-time mothers were conducted from a phenomenological perspective, and inductive reflexive thematic analysis was used to identify key themes. Existential psychology and narrative medicine were used as conceptual frameworks. RESULTS:Three themes and two subthemes were identified: (1) A long grand moment - altered perception of time, (2) Moving into higher realms - soft and full of love, and (3) Reflection supports understanding. CONCLUSION:The mothers expressed satisfaction with being interviewed, which prompted reflection in the first days postnatally. Furthermore, the mothers described living with an altered time perception and experiencing a 'next level of happiness'. Engaging in conversations about experiences of happiness, love, and meaning is a fundamental part of salutogenic midwifery care and seems essential in the care of first-time mothers before discharge from the postnatal care unit.

AIM:Nausea and vomiting in pregnancy impact quality of life, yet many pregnant women feel dismissed by healthcare professionals, despite the safety of first-line antiemetic treatments for both mother and fetus. Therefore, this study aims to describe the prevalence of patient-reported antiemetic use in early pregnancy in Copenhagen, Denmark, the changes in use over two time periods, and the maternal characteristics of users and non-users. METHODS:We analysed patient-reported data on antiemetic use during early pregnancy and maternal characteristics from the Copenhagen Pregnancy Cohort (2012-2022). Descriptive statistics were applied to assess the prevalence, changes in use over two time periods and differences between users and non-users. RESULTS:Among 40 856 pregnancies, 1.0% (n = 412) reported using antiemetics in early pregnancy. Metoclopramide was the most used, reported by 0.2% (n = 93). The number of pregnancies with patient-reported antiemetic use doubled from 0.7% in 2012-2017 to 1.4% in 2018-2022. Among users, 83.3% received monotherapy, and 74.1% used antiemetics daily. Compared with non-users, a significantly higher proportion of antiemetic users scored <50 on the World Health Organization Five Well-Being Index (66.6% vs. 20.5%, p < .001) and to a higher extent reported sick leave (68.0% vs. 14.1%, p < .001). CONCLUSION:We found a low but rising prevalence of antiemetic use in early pregnancy, and the treatment often deviated from clinical guidelines. Antiemetic users differed from non-users on several maternal characteristics, with a higher proportion reporting somatic and psychiatric disorders, as well as poorer mental well-being, despite antiemetic treatment.

INTRODUCTION:Migraine is one of the most prevalent conditions worldwide. This systematic review aimed to evaluate the association between migraine, its subtypes, and adverse pregnancy outcomes. MATERIAL AND METHODS:Eligible cohort and retrospective case-control studies were included from PubMed and Embase databases from their inception to May 2024. Adverse pregnancy outcomes of interest were preeclampsia, preterm birth, low birthweight, small for gestational age, and placental abruption. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses of the outcomes with their odds ratios (ORs) and adjusted ORs (aOR), including a 95% confidence interval (CI), were performed using RevMan. Outcomes were pooled using random effects models, with separate analyses for cohort and retrospective case-control studies. The protocol was registered with PROSPERO (no. CRD42023404759). RESULTS:This meta-analysis included 19 studies (11 cohort and 8 retrospective case-control) encompassing 1 420 690 deliveries. Significant associations were observed between migraine and increased risk of preeclampsia (cohort: aOR 1.28 [95% CI: 1.11-1.47], I2 = 0%), (retrospective case-control: aOR 3.4 [95% CI: 1.81-6.4], I2 = 83%) and preterm birth (cohort: aOR 1.30 [95% CI: 1.17-1.44], I2 = 11%). The meta-analyses of adjusted data on low birthweight and small for gestational age were inconsistent with respect to statistical significance (cohort: aOR 1.27 [95% CI: 0.89-1.82], I2 = 36% and cohort: aOR 1.07 [95% CI: 1.03-1.12], I2 = 0%, respectively). In addition, migraine without aura (MO) (cohort: OR 1.62 [95% CI: 1.30-2.01], I2 = 0%; retrospective case-control: aOR 4.91 [95% CI: 2.78-8.67], I2 = 0%) and migraine with aura (MA) (cohort: OR 2.06 [95% CI: 1-4.27], I2 = 29%) were significantly associated with the risk of preeclampsia. Similarly, MO (cohort: OR 1.28 [95% CI: 1.11-1.49], I2 = 0%) and MA (cohort: OR 1.25 [95% CI: 1.07-1.47], I2 = 0%) were associated with preterm birth risk. CONCLUSIONS:Pregnant women with migraines have a higher risk of preeclampsia and preterm birth compared with those without migraines. Migraine could be associated with an increased risk of low birth weight and small for gestational age. Sub-analyses indicate an elevated risk of preeclampsia and preterm birth across migraine subtypes. Notably, no previous meta-analyses have differentiated between migraine subtypes. Additional studies are needed to strengthen these findings.

OBJECTIVE:Migraine is one of the most common pain disorders among women of childbearing age. While medical treatment might be necessary for some during pregnancy, non-pharmacological approaches, such as exercise, are generally recommended. We aimed to assess the association between migraine and exercise behaviours, adherence to the national recommendations for exercise, and the type of exercise undertaken during early pregnancy within a cohort of Danish women. METHODS:We performed a cross-sectional study using patient-reported questionnaire data from The Copenhagen Pregnancy Cohort (2013-2019). Logistic regression analyses were applied to assess associations between migraine and the selected outcomes, with adjustment for relevant confounders. RESULTS:We included 24,017 pregnancies. Women with migraine were more likely to refrain from exercise in early pregnancy compared to those without (46.4% vs 40.8%) (aOR 1.26, 95% CI 1.12-1.41). Additionally, they were more likely not to meet the national recommendations for exercise (62.9% vs 57.8%), (aOR 1.27, 95% CI 1.13-1.42). The differences were consistent among women with migraine with aura (MA) and migraine without aura (MO), respectively. Women with and without migraine participated in similar types of exercise during early pregnancy. CONCLUSIONS:Our findings indicate that women with migraine were less likely to engage in exercise and to adhere to the national recommendations of exercise, compared to those without. Findings were similar for women with MA and MO. The types of exercise performed did not differ between groups.

OBJECTIVE:To estimate risk and to identify risk factors for preterm birth in pregnant women with psoriatic arthritis (PsA) in relation to maternal characteristics, treatment and disease activity, both before and during pregnancy. METHODS:We linked clinical rheumatology registers to medical birth registers in Sweden, Denmark and Norway and identified PsA pregnancies and control pregnancies 2006-2021, matched 1:10 on age, parity, country and birth year. Adjusted ORs (aORs) for preterm birth in PsA pregnancies vs control pregnancies were calculated overall and stratified by maternal characteristics, antirheumatic treatment and disease load (9 months before and during pregnancy). RESULTS:We observed 54 preterm births among 688 PsA pregnancies (7.8%) versus 312 among 6880 control pregnancies (4.5%); aOR, 95% CI: 1.80, 1.29 to 2.51. The risk estimate was largely unaffected by parity, smoking and body mass index. PsA pregnancies exposed to a combination of biologic and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and/or glucocorticoids during pregnancy had a markedly increased risk of preterm birth compared with control pregnancies (4.44, 2.07 to 9.50), whereas exposure to biological DMARD (bDMARD) monotherapy (primarily tumour necrosis factor inhibitors) had not (0.73, 0.22 to 2.42). High disease load before pregnancy was associated with increased risk. The proportion of preterm birth was higher in those stopping bDMARD during the first trimester (21%) opposed to those continuing past the first trimester (10%) based on few events. CONCLUSION:We identified an 80% increased risk of preterm birth in PsA pregnancies compared with control pregnancies. Antirheumatic combination therapy during and high disease load before pregnancy constituted risk factors. Discontinuing bDMARD treatment in early pregnancy further increased the risk. Our findings support that a subgroup of PsA pregnancies should be considered high-risk pregnancies.

Mother-infant separation during postpartum care is common when either the infant or the mother requires specialized treatment, often disrupting skin-to-skin contact (SSC) and closeness for parents and infants. SSC promotes parent-infant bonding and has numerous short- and long-term benefits. However, challenges in implementation remain, especially in the highly specialized setting. We aimed to describe the frequency of obstetric and neonatal conditions in mother-infant pairs requiring postnatal care and to examine potential associations between these conditions and early SSC within six hours after birth with mother or co-parent. This cross-sectional study included mother-infant pairs admitted to the Departments of Obstetrics and Neonatology. We collected data from medical records and questionnaires. We used descriptive statistics to analyze the frequency of conditions, and binomial generalized linear models were applied to analyze associations between selected conditions and early SSC. We included 186 mothers with a median age of 32, of which 22.6

Context: Female minipuberty is characterized by complex dynamics of circulating reproductive hormones, while the relationship between ovarian and uterine morphology and reproductive hormones remains to be elucidated. Objective: This work aimed to investigate the association between reproductive hormones and ovarian as well as uterine morphology by transabdominal ultrasound scan (TAUS) at minipuberty. Methods: A secondary analysis was conducted from The Copenhagen Analgesic Study (COPANA) (ClinicalTrials.gov NCT04369222) of healthy infant girls (n = 302, aged 3.4 months [0.4] mean [+/- SD]: mamma tissue diameter [mm], n = 300). TAUS: uterine volume (n = 230), endometrial thickness (n = 255), ovarian volume, antral follicle count (total/2-4 mm/>= 5 mm) (n = 203). Blood samples (n = 269/302 = 89%): antim & uuml;llerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), inhibin B (immunoassays), progesterone (PROG), androstenedione (Adione), testosterone (T), estrone (E1), estradiol (E2) (liquid chromatography-tandem mass spectrometry). Statistics: Pearson/Spearman correlation coefficient (parametric/nonparametric data). Results: Total follicle count correlated positively with ovarian volume (r = 0.606; P < .001), AMH (r = 0.378; P < .001), inhibin B (r = 0.251; P < .001), and negatively with FSH concentrations (r = -0.327; P < .001). Larger follicles (>= 5 mm) correlated positively with AMH (r = 0.264; P < .001), inhibin B (r = 0.230; P = .002), E1 (r = 0.209; P = .004), E2 (r = 0.269; P < .001), PROG (r = 0.160; P = .031), and T (r = 0.210; P = .004) and negatively with FSH (r = -0.183; P = .015). Circulating E1 and E2 levels correlated with the size of estrogen-responsive tissue sizes: E2 vs uterine volume (r = 0.134; P = .054), E2 vs endometrial thickness (r = 0.155; P = .020), E1 and E2 vs mammary tissue diameter (r = 0.213 and r = 0.198, respectively; both P < .001). Conclusion: Correlations between reproductive hormones and the number of antral follicles suggest that negative feedback in the female hypothalamic-pituitary-gonadal axis is established during minipuberty, with ovarian activity promoting uterine and glandular breast tissue growth. We provide normative data of infant ovarian and uterine morphology directly implementable to a clinical setting.

BACKGROUND:Development of the gonads during fetal life is complex and vital for adult reproductive health. Cell and animal studies have shown an alarming effect of mild analgesics on germ cells in both males and females. More than 50% of pregnant women use mild analgesics during pregnancy, which potentially could compromise the reproductive health of the next generation. OBJECTIVES:We present a research protocol designed to evaluate the effect of prenatal exposure to mild analgesics and endocrine-disrupting chemicals on gonadal function in the offspring. POPULATION:Healthy, singleton pregnant women and their partners. DESIGN:The COPANA cohort is a prospective, observational pregnancy and birth cohort. METHODS:Participants were enrolled during the first trimester of pregnancy. Information on the use of mild analgesics was collected retrospectively 3 months prior to pregnancy and prospectively every 2 weeks throughout the study. We collected extensive data on lifestyle and reproductive health. Biospecimens were collected in the first trimester (maternal and paternal urine- and blood samples), in the third trimester in conjunction with a study-specific ultrasound scan (maternal urine sample), and approximately 3 months post-partum during the infant minipuberty period (maternal and infant urine- and blood samples). A comprehensive evaluation of reproductive function in the infants during the minipuberty phase was performed, including an ultrasound scan of the testis or ovaries and uterus. PRELIMINARY RESULTS:In total, 685 pregnant women and their partners were included between March 2020 and January 2022. A total of 589 infants (287 males) and their parents completed the follow-up during the minipuberty phase (December 2020-November 2022). CONCLUSIONS:The Copenhagen Analgesic Study holds the potential to provide novel and comprehensive insights into the impact of early and late prenatal exposure to mild analgesics and other endocrine-disrupting chemicals on future reproductive function in the offspring.

Background:Conditions in utero influence intrauterine and postnatal infant growth and a few studies indicate that maternal inflammation and insulin resistance might affect birth and breastfeeding outcomes. Furthermore, hormones in human milk (HM) may influence infant appetite-regulation and thereby milk intake, but the associations are less understood.Objective:(1) To investigate associations between maternal inflammatory, lipid and metabolic markers and birth and breastfeeding outcomes, and (2) to assess predictors of maternal inflammatory, lipid and metabolic markers in pregnancy.Methods:Seventy-one mother-infant dyads participating in the Mothers, Infants and Lactation Quality (MILQ) study were included in the present study. Fasting blood samples were collected around 28th gestational week, and HM samples at three time points from 1.0 to 8.5 months, where milk intake was assessed using 24-h test weighing. Maternal plasma inflammatory, lipid and metabolic markers included high-sensitive C-reactive protein (hs-CRP), tumor-necrosis factor-α (TNFα), interferon-γ (IFNγ), Interleukin (IL)-6, IL-8, high-, low-, and very-low-density lipoprotein (HDL, LDL, VLDL), total-cholesterol, triglycerides, leptin, adiponectin, insulin, C-peptide, the homeostasis model assessment of insulin resistance (HOMA-IR) and glucose concentration at t = 120 min following an oral glucose tolerance test. Of these, TNFα, IFNγ, IL-6, IL-8, leptin, adiponectin and insulin were also measured in HM samples.Results:HDL in pregnancy was inversely associated with gestational age (GA) at birth and GA-adjusted birthweight z-score, whereas triglycerides and glucose (t = 120) were positively associated with GA-adjusted birthweight z-score. Higher hs-CRP, VLDL and triglycerides were associated with a higher placental weight. Furthermore, higher HDL, insulin, leptin and HOMA-IR were associated with longer duration of exclusive breastfeeding (EBF). Higher pre-pregnancy BMI was the main predictor of higher levels of hs-CRP, log-TNFα, leptin, insulin, C-peptide, and HOMA-IR.Conclusion:Maternal lipid and metabolic markers influenced birthweight z-score and placental weight as well as duration of EBF. Furthermore, pre-pregnancy BMI and maternal age predicted levels of several inflammatory and metabolic markers during pregnancy. Our findings indicate that maternal lipid and metabolic profiles in pregnancy may influence fetal growth and breastfeeding, possibly explained by overweight and/or higher placental weight.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03254329.

Background Threatened preterm delivery is a serious obstetrical complication and has for decades been prescribed physical activity restrictions (AR). Adherence to the recommended level of physical AR is however unknown. This study aimed to assess the objectively measured different physical positions and activities of pregnant women recommended AR due to threatened preterm delivery complications, compared to a reference group of uncomplicated pregnant women without restrictions, and to explore if admission status influenced adherence to AR. Methods A Danish descriptive, clinical multi-center study included singleton pregnancies between 22–33 gestational weeks admitted to an antenatal ward or during midwife consultations either prescribed AR due to threatened preterm delivery or uncomplicated controls without restrictions. For seven days participants wore two tri-axial accelerometric SENS® monitors. Accelerometric data included time spent in five different positions, activities, and step counts. At inclusion demographic and obstetric information was collected. Results Seventy-two pregnant women participated; 31% were prescribed strict AR, 15% moderate, 3% light, 8% unspecified, and 43% had no AR. Strict AR participants rested in the supine/lateral position for 17.7 median hours/day (range:9.6–24.0); sat upright 4.9 h/day (0.11–11.7); took 1,520steps/day (20–5,482), and 64% were inpatients. Moderate AR participants rested in the supine/lateral position for 15.1 h/day (11.5–21.6); sat upright 5.6 h/day (2.0–9.3); took 3,310steps/day (467–6,968), and 64% were outpatients. Participants with no AR rested 10.5 h/day (6.3–15.4) in supine/lateral position; sat upright 7.6 h/day (0.1–11.4) and took 9,235steps/day (3,225–20,818). Compared to no restrictions, participants with strict or moderate AR spent significant more time in physical resting positions and took significant fewer mean steps. Among strict AR admission status did not alter time spent in the physical positions, nor the step count. Conclusions Overall, participants adhered highly to the recommended AR. However, discriminating between strict and moderate AR recommendations did not alter how physical resting positions and activities were carried out. The admission status did not influence how participants adhered to strict AR.

AIMS:Paracetamol is commonly consumed by pregnant women, even though recent data have questioned its safety. Having chronic medical diseases (CMDs) may influence the prevalence of use during pregnancy. We aimed to assess the prevalence and patterns of use 3 months prior to pregnancy and in the first trimester among women with and without CMDs and the potential influence of CMDs on frequent use in the first trimester.METHODS:We used patient-reported data from the Copenhagen Pregnancy Cohort from 1 October 2013 to 23 May 2019 with information on CMDs and paracetamol use. Prevalence and patterns of use were assessed descriptively and by multivariable logistic regression models.RESULTS:We included 24 019 pregnancies. Use of paracetamol prior to and in early pregnancy was significantly higher among women with CMDs compared to women without (40.7% vs. 35.8% and 9.1% vs. 5.1%, respectively). Women with CMDs were 2.7 times more likely to have a frequent intake compared to women without [aOR 2.69 (95% CI 2.05-3.32)]. Migraine, rheumatoid arthritis and mental disease were associated with a higher use of paracetamol [aOR 4.39 (3.20-6.02), aOR 4.32 (2.41-7.72) and aOR 2.74 (1.67-4.49), respectively].CONCLUSIONS:Women with CMDs had a higher paracetamol use before and during pregnancy than women without CMDs. Women with migraine, rheumatoid arthritis and mental disease showed the highest risk of frequent use. This study highlights the importance of discussing pain relief in pregnancy and evaluating the influence of maternal CMDs when assessing adverse effects of paracetamol use during pregnancy.

Aims: Paracetamol is commonly consumed by pregnant women, even though recent data have questioned its safety. Having chronic medical diseases (CMDs) may influence the prevalence of use during pregnancy. We aimed to assess the prevalence and patterns of use 3 months prior to pregnancy and in the first trimester among women with and without CMDs and the potential influence of CMDs on frequent use in the first trimester.Methods: We used patient-reported data from the Copenhagen Pregnancy Cohort from 1 October 2013 to 23 May 2019 with information on CMDs and paracetamol use. Prevalence and patterns of use were assessed descriptively and by multivariable logistic regression models.Results: We included 24 019 pregnancies. Use of paracetamol prior to and in early pregnancy was significantly higher among women with CMDs compared to women without (40.7% vs. 35.8% and 9.1% vs. 5.1%, respectively). Women with CMDs were 2.7 times more likely to have a frequent intake compared to women without [aOR 2.69 (95% CI 2.05-3.32)]. Migraine, rheumatoid arthritis and mental disease were associated with a higher use of paracetamol [aOR 4.39 (3.20-6.02), aOR 4.32 (2.41-7.72) and aOR 2.74 (1.67-4.49), respectively].Conclusions: Women with CMDs had a higher paracetamol use before and during pregnancy than women without CMDs. Women with migraine, rheumatoid arthritis and mental disease showed the highest risk of frequent use. This study highlights the importance of discussing pain relief in pregnancy and evaluating the influence of maternal CMDs when assessing adverse effects of paracetamol use during pregnancy.

Introduction A pandemic may negatively influence psychological well-being in the individual. We aimed to assess the potential influence of the first national lockdown in Denmark (March to June 2020) due to the COVID-19 pandemic on psychological well-being and the content and degree of worries among pregnant women in early pregnancy. Material and methods In this hospital-based cross-sectional study based on self-reported data we compared psychological well-being and worries among women who were pregnant during the first phase of the pandemic (COVID-19 group) (n = 685), with women who were pregnant the year before (Historical group) (n = 787). Psychological well-being was measured by the five-item World Health Organization Well-being Index (WHO-5), using a score <= 50 as indicator of reduced psychological well-being. Differences in WHO-5 mean scores and in the prevalence of women with score <= 50 were assessed using general linear and log-binomial regression analyses. The Cambridge Worry Scale was used to measure the content and degree of major worries. To detect differences between groups, Pearson's Chi-square test was used. Results We found no differences in mean WHO-5 score between groups (mean difference) 0.1 (95% CI -1.5 to 1.6) or in the prevalence of women with WHO-5 score <= 50 (prevalence ratio 1.04, 95% CI 0.83-1.29) in adjusted analyses. A larger proportion of women in the COVID-19 group reported major worries about Relationship with husband/partner compared with the Historical group (3% [n = 19] vs 1% [n = 6], p = 0.04), and 9.2% in the COVID-19 group worried about the possible negative influence of the COVID-19 restrictions. Conclusions Our findings indicate that national restrictions due to the COVID-19 pandemic did not influence the psychological well-being or the content and degree of major worries among pregnant women. However, a larger proportion of women in the COVID-19 group reported major worries concerning Relationship with husband/partner compared with the Historical group and 9.2% in the COVID-19 group worried about the possible negative influence of the COVID-19 restrictions.

Objective To estimate how often midwives, specialty trainees and doctors specialised in obstetrics and gynaecology are attending to specific obstetric emergencies or high-risk deliveries (obstetric events). Design A national cross-sectional study. Setting All hospital labour wards in Denmark. Participants Midwives (n=1303), specialty trainees (n=179) and doctors specialised in obstetrics and gynaecology (n=343) working in hospital labour wards (n=21) in Denmark in 2018. Methods Categories of obstetric events comprised of Apgar score <7/5 min, eclampsia, emergency caesarean sections, severe postpartum haemorrhage, shoulder dystocia, umbilical cord prolapse, vaginal breech deliveries, vaginal twin deliveries and vacuum extraction. Data on number of healthcare professionals were obtained through the Danish maternity wards, the Danish Health Authority and the Danish Society of Obstetricians and Gynaecologists. We calculated the time interval between attending each obstetric event by dividing the number of events occurred with the number of healthcare professionals. Outcome measures The time interval between attending a specific obstetric event. Results The average time between experiencing obstetric events ranged from days to years. Emergency caesarean sections, which occur relatively frequent, were attended on average every other month by midwives, every 9 days for specialty trainees and every 17 days by specialist doctors. On average, rare events like eclampsia were experienced by midwives only every 42 years, every 6 years by specialty trainees and every 11 years by specialist doctors. Conclusions Some obstetric events occur extremely rarely, hindering the ability to obtain and maintain the clinical skills to manage them through clinical practice alone. By assessing the frequency of a healthcare professionals attending an obstetric emergency, our study contributes to assessing the need for supplementary educational initiatives and interventions to learn and maintain clinical skills.