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Objective: To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth. Design: Nationwide population‐based cohort study. Setting: Sweden. Population: Women (n = 411 317) with first and second singleton vaginal births in Sweden, 2001–2019. Methods: Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth. Main outcome measures: Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). Results: In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11–3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53–15.24) of recurrent OASI. Conclusions: Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth. [ABSTRACT FROM AUTHOR]

Objective: To explore whether the association between polycystic ovary syndrome (PCOS) and pre‐eclampsia depends on treated clinical hyperandrogenism and whether PCOS is associated with different subtypes of pre‐eclampsia. Design: Nationwide register‐based cohort study. Setting: Sweden. Population: Nulliparous women with PCOS (n = 22 947) and non‐PCOS controls (n = 115 272) giving singleton birth at ≥22 gestational weeks during 1997–2015. Treated clinical hyperandrogenism was defined as filled prescriptions of anti‐androgenic drugs during 2005–2017 (n = 2301 among PCOS women). Methods: The risk of pre‐eclampsia was estimated with conditional logistic regression, expressed as adjusted odds ratio (OR) with 95% confidence interval (CI). Adjustments were performed individually for confounders and predictors. Main outcome measures: Overall pre‐eclampsia. Early/late (delivery <34/≥34 weeks) pre‐eclampsia. Pre‐eclampsia with or without a small‐for‐gestational‐age (SGA) infant. Results: Compared with controls, women with PCOS had a 29% increased risk of pre‐eclampsia (predictor adjusted OR 1.29, 95% CI 1.20–1.39), with similar risk estimates for PCOS women with and without treated clinical hyperandrogenism. The association between PCOS and early pre‐eclampsia seemed stronger than its association with late pre‐eclampsia (predictor adjusted OR 1.64 (95% CI 1.33–2.02) and 1.26 (95% CI 1.17–1.37). Additionally, the association seemed slightly stronger between PCOS and pre‐eclampsia in women with an SGA infant than without. Conclusions: Women with PCOS face an increased risk for pre‐eclampsia, especially early pre‐eclampsia and pre‐eclampsia with an SGA infant. We were unable to determine on the basis of available data, whether hyperandrogenism is associated with pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether mild neonatal hypoxic ischaemic encephalopathy (HIE) in term born infants is associated with cerebral palsy, epilepsy, mental retardation and death up to 6 years of age. Design: Population‐based cohort study. Setting: Sweden, 2009–2015. Population: Live term born infants without congenital malformations or chromosomal abnormalities (n = 505 075). Methods: Birth and health data were retrieved from Swedish national health and quality registers. Mild HIE was identified by diagnosis in either the Swedish Medical Birth Register or the Swedish Neonatal Quality Register. Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Main outcome measures: A composite of the outcomes cerebral palsy, epilepsy, mental retardation and death up to 6 years of age. Results: Median follow‐up time was 3.3 years after birth. Of 414 infants diagnosed with mild HIE, 17 were classified according to the composite outcome and incidence rates were 12.6 and 2.9 per 1000 child‐years in infants with and without HIE respectively. Infants with mild HIE was four times as likely to be diagnosed with the composite outcome (HR 4.42, 95% CI 2.75–7.12) compared with infants without HIE. When analysed separately, associations were found with cerebral palsy (HR 21.50, 95% CI 9.59–48.19) and death (HR 19.10, 95% CI 7.90–46.21). HRs remained essentially unchanged after adjustment for covariates. Conclusions: Mild neonatal HIE was associated with neurological morbidity and mortality in childhood. Challenges include identifying infants who may develop morbidity and how to prevent adverse outcomes. Linked article: This article is commented on by William M. Curtin, pp. 1610 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17596. [ABSTRACT FROM AUTHOR]

Objective: Investigate associations between pre‐pregnancy participation and performance in a demanding cross‐country ski race (proxy for exercise volume and fitness) and perinatal outcomes. Pre‐registered protocol: osf.io/aywg2. Design: Prospective cohort study. Setting: Based on entire overlap between the Vasaloppet registry and the population‐based Swedish Pregnancy Register. Sample All female Vasaloppet participants 1991–2017 with subsequent singleton delivery (skiers), and age‐ and county‐matched non‐skiers. Methods: We calculated odds ratios (ORs) for non‐skiers versus skiers (model 1) and, among skiers, by performance (model 2), in Bayesian logistic regressions adjusted for socio‐demographics, lifestyle factors, and comorbidities. We repeated calculations adjusting for early pregnancy body mass index (potential mediator) and explored robustness (selection/exposure settings; multiple comparisons correction). Main outcome measures: Twenty‐nine important perinatal outcomes, predefined based on existing expert consensus. Results: Non‐skiers (n = 194 384) versus skiers (n = 15 377) (and slower versus faster performance, not shown) consistently had higher odds of gestational diabetes mellitus (GDM) (OR 1.70, 95% highest density interval: 1.40–2.09), excessive gestational weight gain (GWG) (1.28, 1.22–1.38), psychiatric morbidity (1.60, 1.49–1.72), any caesarean section (CS) (1.34, 1.28–1.40), elective CS (1.39, 1.29–1.49), and large‐for‐gestational‐age babies (>90th percentile, 1.11, 1.04–1.18); lower odds of inadequate GWG (0.83, 0.79–0.88); and no associations with fetal/neonatal complications (e.g. preterm birth [1.09, 0.98–1.20], small for gestational age [SGA] [1.23, 1.05–1.45]). Adjustment for body mass index attenuated associations with excessive (1.20, 1.14–1.30) and inadequate GWG (0.87, 0.83–0.92) and large for gestational age (1.07, 1.00–1.13). Conclusion: Non‐skiers compared with skiers, and slower versus faster performance, consistently displayed higher odds of GDM, excessive GWG, psychiatric morbidity, CS and large‐for‐gestational‐age babies; and lower odds of inadequate GWG, after adjustment for socio‐demographic and lifestyle factors and comorbidities. There were no associations with fetal/neonatal complications. [ABSTRACT FROM AUTHOR]

The clear dose-dependent weight loss effect that we found in our study2 strongly supports the importance of gastric-bypass-induced weight loss on pre-eclampsia risk. I Sir, i We find it unlikely that the effect of calcium and vitamin D supplementation would be large enough to be equal to/compete with the metabolic and weight loss effects of gastric bypass in severely obese women and thereby, as van Gelder et al.1 put it, make it 'challenging to distinguish between the effect of gastric bypass itself and the effect of vitamin D and calcium supplementation'. Although calcium and vitamin D supplementation could have contributed to the substantial risk reduction of pre-eclampsia in the gastric bypass group, we do not agree with van Gelder et al. SP 1 sp that stating 'gastric bypass in itself is effective in the prevention of pre-eclampsia may still be considered premature'. [Extracted from the article]