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  1. Article ; Online: Urinary Incontinence in Midlife According to Weight Changes Across and After Childbearing Years.

    Taastrøm, Katja / Kjeldsen, Anne Cathrine / Hjorth, Sarah / Gommesen, Ditte / Axelsen, Susanne M / Nohr, Ellen A

    International urogynecology journal

    2024  Volume 35, Issue 3, Page(s) 579–588

    Abstract: Introduction and hypothesis: The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife.: Methods: Data were obtained from 35,645 women responding to the ... ...

    Abstract Introduction and hypothesis: The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife.
    Methods: Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression.
    Results: At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight.
    Conclusions: Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.
    MeSH term(s) Female ; Humans ; Adult ; Urinary Incontinence/etiology ; Urinary Incontinence/complications ; Urinary Incontinence, Urge ; Urinary Incontinence, Stress/complications ; Surveys and Questionnaires ; Weight Gain ; Weight Loss ; Risk Factors
    Language English
    Publishing date 2024-01-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1050631-7
    ISSN 1433-3023 ; 0937-3462
    ISSN (online) 1433-3023
    ISSN 0937-3462
    DOI 10.1007/s00192-023-05713-z
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  2. Article ; Online: Invited Commentary: Maternal Obesity and Impaired Fetal and Infant Survival-One More Piece Added to the Puzzle.

    Nohr, Ellen A

    American journal of epidemiology

    2016  Volume 184, Issue 2, Page(s) 106–109

    Abstract: The association between maternal obesity and increased risks of stillbirth and infant mortality is well documented, but it has often been questioned whether the association is driven by obesity per se or by unmeasured factors such as insulin resistance ... ...

    Abstract The association between maternal obesity and increased risks of stillbirth and infant mortality is well documented, but it has often been questioned whether the association is driven by obesity per se or by unmeasured factors such as insulin resistance or genes. In this issue of the Journal, Lindam et al. (Am J Epidemiol. 2016;184(2):98-105) present results from a sibling case-control study which strongly support that these tragic outcomes are independent of genetic and early environmental risk factors shared within families. By sampling sisters from the Swedish Medical Birth Register, Lindam et al. compared the body mass indices (weight (kg)/height (m)(2)) of women who had stillbirths and infant deaths with those of their sisters or of population controls. Significant excess risks of both outcomes were observed in obese women (body mass index ≥30), and associations were strongest when sister controls were used. Although this careful analysis adds to the existing evidence of a causal relationship between maternal obesity and impaired fetal and infant survival, a biological pathway has not yet been established. Additionally, we are in urgent need of effective tools to reduce obesity in childbearing women and to identify and treat high-risk pregnancies.
    MeSH term(s) Case-Control Studies ; Female ; Humans ; Infant ; Obesity/epidemiology ; Pregnancy ; Pregnancy Complications/epidemiology ; Stillbirth/epidemiology ; Sweden/epidemiology
    Language English
    Publishing date 2016--15
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2937-3
    ISSN 1476-6256 ; 0002-9262
    ISSN (online) 1476-6256
    ISSN 0002-9262
    DOI 10.1093/aje/kww047
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  3. Article ; Online: Use of pudendal nerve block among midwives in Norway: A national cross-sectional study.

    Lukasse, Mirjam / Bratsberg, Alette B / Thomassen, Katrine / Nøhr, Ellen A

    European journal of midwifery

    2022  Volume 6, Page(s) 34

    Abstract: Introduction: Pudendal nerve block (PNB) is an effective analgesic during the second stage of labor and for suturing. With the introduction of epidural and spinal analgesia, PNB use decreased considerably. Most midwives receive some teaching on PNB ... ...

    Abstract Introduction: Pudendal nerve block (PNB) is an effective analgesic during the second stage of labor and for suturing. With the introduction of epidural and spinal analgesia, PNB use decreased considerably. Most midwives receive some teaching on PNB during their midwifery education. The aim of this study was to examine the use of PNB by midwives in Norway.
    Methods: This was a cross-sectional study, in January 2020, using an electronic questionnaire which was distributed to approximately 1500 midwives.
    Results: A total of 527 midwives responded to the questionnaire (35%). Less than half (44.6%) of the midwives used PNB, of whom only half (123/235) used it frequently (at least once a month). The use of PNB was most common at specialized obstetric units with ≥1500 births per year. Midwives who reported good theoretical knowledge and practical skills of PNB used it significantly more often than midwives not reporting these (p<0.001). Reasons for not using PNB were: the lack of practice and experience (72.6%), and never having been taught (42.8%). Midwives reported needing training (83%) and clinical support to start using PNB (43%).
    Conclusions: Few midwives use PNB regularly. To increase the use of PNB, midwifery education needs to include both theoretical and practical skills teaching. Midwives with insufficient knowledge and skills require the same teaching and training. In the clinical area, midwives require clinical support and supervision to practice and gain experience. Women are not offered PNB as long as midwives are not confident in providing this method of pain relief.
    Language English
    Publishing date 2022-06-07
    Publishing country Greece
    Document type Journal Article
    ISSN 2585-2906
    ISSN (online) 2585-2906
    DOI 10.18332/ejm/146690
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  4. Article ; Online: Parity and mode of birth and their relationships with quality of life: A longitudinal study.

    Davis, Deborah L / Wu, Chunsen / Brown, Wendy J / Nohr, Ellen A

    PloS one

    2022  Volume 17, Issue 9, Page(s) e0273366

    Abstract: Objective: To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.: Design: Prospective cohort study.: Setting: Australia.: R sample: A total of ...

    Abstract Objective: To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.
    Design: Prospective cohort study.
    Setting: Australia.
    R sample: A total of 7770 women participating in the 1973-1978 cohort of the Longitudinal Study of Women's Health.
    Methods: Linear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories.
    Main outcome measure: Quality of Life as measured by the SF36.
    Results: Women experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05).
    Conclusions: Parity and mode of birth may have long-term implications for women's physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.
    MeSH term(s) Cesarean Section/psychology ; Child ; Delivery, Obstetric/psychology ; Female ; Humans ; Longitudinal Studies ; Parity ; Pregnancy ; Prospective Studies ; Quality of Life ; Young Adult
    Language English
    Publishing date 2022-09-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0273366
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  5. Article ; Online: How to investigate and adjust for selection bias in cohort studies.

    Nohr, Ellen A / Liew, Zeyan

    Acta obstetricia et gynecologica Scandinavica

    2018  Volume 97, Issue 4, Page(s) 407–416

    Abstract: Longitudinal cohort studies can provide important evidence about preventable causes of disease, but the success relies heavily on the commitment of their participants, both at recruitment and during follow up. Initial participation rates have decreased ... ...

    Abstract Longitudinal cohort studies can provide important evidence about preventable causes of disease, but the success relies heavily on the commitment of their participants, both at recruitment and during follow up. Initial participation rates have decreased in recent decades as have willingness to participate in subsequent follow ups. It is important to examine how such selection affects the validity of the results. In this article, we describe the conceptual framework for selection bias due to nonparticipation and loss to follow up in cohort studies, using both a traditional epidemiological approach and directed acyclic graphs. Methods to quantify selection bias are introduced together with analytical strategies to adjust for the bias including controlling for covariates associated with selection, inverse probability weighting and bias analysis. We use several studies conducted in the Danish National Birth Cohort as examples of how to quantify selection bias and also understand the underlying selection mechanisms. Although women who chose to participate in this cohort were typically of higher social status, healthier and with less disease than all those eligible for study, differential selection was modest and the influence of selection bias on several selected exposure-outcome associations was limited. These findings are reassuring and support enrolling a subset of motivated participants who would engage in long-term follow up rather than prioritize representativeness. Some of the presented methods are applicable even with limited data on nonparticipants and those lost to follow up, and can also be applied to other study designs such as case-control studies and surveys.
    MeSH term(s) Cohort Studies ; Data Interpretation, Statistical ; Gynecology ; Humans ; Obstetrics ; Research Design ; Selection Bias
    Language English
    Publishing date 2018-03-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80019-3
    ISSN 1600-0412 ; 0001-6349
    ISSN (online) 1600-0412
    ISSN 0001-6349
    DOI 10.1111/aogs.13319
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  6. Article ; Online: Sexual health in parous women with a history of polycystic ovary syndrome: A national cross-sectional study in Denmark.

    Nohr, Ellen A / Hansen, Anne-Sofie Bang / Andersen, Marianne Skovsager / Hjorth, Sarah

    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

    2021  Volume 157, Issue 3, Page(s) 702–709

    Abstract: Objective: To examine associations between polycystic ovary syndrome (PCOS) and sexual health in midlife.: Methods: We included 31 645 mothers from the Danish National Birth Cohort who participated in a Maternal Follow up in 2013-14. A lifetime PCOS ... ...

    Abstract Objective: To examine associations between polycystic ovary syndrome (PCOS) and sexual health in midlife.
    Methods: We included 31 645 mothers from the Danish National Birth Cohort who participated in a Maternal Follow up in 2013-14. A lifetime PCOS diagnosis was self-reported. Sexual health was assessed by specific sexual problems including reduced sexual desire, insufficient lubrication, difficulty in obtaining orgasm, vaginismus and pain during intercourse within the past year. We also generated a combined outcome which was positive if the women reported one or more sexual problems. Logistic regression was used to estimate adjusted odds ratios (aOR) for sexual problems with 95% confidence intervals (CI).
    Results: Participants were on average 44 years old, and 920 women (2.9%) had ever had PCOS. One or more sexual problems were more often reported in women with PCOS compared with other women (42.6% versus 36.3%, aOR 1.29, 95% CI 1.13-1.48). Especially reduced sexual desire (25.6% versus 21.0%, aOR 1.29, 95% CI 1.10-1.50) and dyspareunia (11.4% versus 8.7%, aOR 1.34, 95% CI 1.09-1.66) were more frequent in women with PCOS. These associations were slightly weakened when further adjusting for mental and somatic health problems.
    Conclusion: Our data suggest that PCOS is linked to long-term impaired sexual health, especially reduced sexual desire and dyspareunia.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Denmark/epidemiology ; Dyspareunia/epidemiology ; Dyspareunia/etiology ; Female ; Humans ; Male ; Polycystic Ovary Syndrome/complications ; Polycystic Ovary Syndrome/epidemiology ; Sexual Health
    Language English
    Publishing date 2021-09-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80149-5
    ISSN 1879-3479 ; 0020-7292
    ISSN (online) 1879-3479
    ISSN 0020-7292
    DOI 10.1002/ijgo.13911
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  7. Article ; Online: Body mass index, waist circumference, and urinary incontinence in midlife: A follow-up of mothers in the Danish National Birth Cohort.

    Hjorth, Sarah / Axelsen, Susanne M / Gommesen, Ditte / Kjeldsen, Anne C M / Taastrøm, Katja A / Nohr, Ellen A

    Neurourology and urodynamics

    2023  Volume 42, Issue 5, Page(s) 1111–1121

    Abstract: Background: Obesity is a modifiable risk factor for urinary incontinence, yet few studies have investigated how waist circumference as compared to body mass index (BMI) influences the risk of urinary incontinence.: Objective: To estimate how BMI and ... ...

    Abstract Background: Obesity is a modifiable risk factor for urinary incontinence, yet few studies have investigated how waist circumference as compared to body mass index (BMI) influences the risk of urinary incontinence.
    Objective: To estimate how BMI and waist circumference associates with risk of urinary incontinence in midlife and determine which of the two is the strongest predictor of urinary incontinence.
    Methods: Cohort study among mothers in the Danish National Birth Cohort. Weight and waist circumference were self-reported 7 years after cohort entry. Symptoms of urinary incontinence in midlife were self-reported using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and analyzed continuously and as presence or absence of any, stress (SUI), urgency (UUI), and mixed (MUI) urinary incontinence. Linear and log binomial regressions were used to calculate mean differences and risk ratios (RR) with 95% confidence intervals (CI). Restricted cubic splines were generated to explore nonlinear relationships.
    Results: Among 27 254 women at a mean age of 44.2 years, any urinary incontinence was reported by 32.1%, SUI by 20.9%, UUI by 2.4%, and MUI by 8.6%. For all outcomes, increases in risk were similar with higher BMI and waist circumference. The estimates of association were strongest for MUI (RR 1.10, 95% CI 1.08;1.12 and RR 1.12, 95% CI 1.10;1.14 for half a standard deviation increase in BMI and waist circumference, respectively). While increases in risk of the other outcomes were seen across the entire range of BMI and waist circumference, the risk of SUI rose until BMI 28 kg/m
    Conclusions: Symptoms of urinary incontinence and prevalence of any urinary incontinence, SUI, UUI, and MUI increased with higher BMI and waist circumference. Self-reported BMI and waist circumference were equally predictive of urinary incontinence.
    MeSH term(s) Humans ; Female ; Adult ; Body Mass Index ; Urinary Incontinence, Urge/complications ; Mothers ; Cohort Studies ; Follow-Up Studies ; Waist Circumference ; Birth Cohort ; Urinary Incontinence, Stress/etiology ; Urinary Incontinence/epidemiology ; Urinary Incontinence/complications ; Denmark/epidemiology
    Language English
    Publishing date 2023-03-21
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 604904-7
    ISSN 1520-6777 ; 0733-2467
    ISSN (online) 1520-6777
    ISSN 0733-2467
    DOI 10.1002/nau.25175
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  8. Article ; Online: Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort.

    Nohr, Ellen A / Taastrøm, Katja A / Kjeldsen, Anne Cathrine M / Wu, Chunsen / Pedersen, Frank Henning / Brown, Wendy J / Davis, Deborah L

    Birth (Berkeley, Calif.)

    2023  Volume 51, Issue 1, Page(s) 198–208

    Abstract: Background: Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and ... ...

    Abstract Background: Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis.
    Methods: We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals.
    Results: UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode.
    Conclusion: While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.
    MeSH term(s) Child ; Pregnancy ; Female ; Humans ; Cesarean Section ; Follow-Up Studies ; Longitudinal Studies ; Endometriosis/epidemiology ; Endometriosis/complications ; Menorrhagia/complications ; Australia/epidemiology ; Parity ; Women's Health ; Urinary Incontinence/epidemiology ; Urinary Incontinence/etiology ; Pain ; Surveys and Questionnaires
    Language English
    Publishing date 2023-10-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604869-9
    ISSN 1523-536X ; 0730-7659
    ISSN (online) 1523-536X
    ISSN 0730-7659
    DOI 10.1111/birt.12781
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  9. Article ; Online: Maternal obesity and neonatal mortality in an African setting.

    Nohr, Ellen A

    Lancet (London, England)

    2012  Volume 380, Issue 9850, Page(s) 1292–1293

    MeSH term(s) Female ; Humans ; Infant Mortality ; Obesity/complications ; Pregnancy ; Pregnancy Complications
    Language English
    Publishing date 2012-10-13
    Publishing country England
    Document type Comment ; Journal Article
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(12)61181-7
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  10. Article ; Online: Sexual Health in Women with Inflammatory Bowel Disease in the Danish National Birth Cohort.

    Nøhr, Ellen A / Nielsen, Jan / Nørgård, Bente M / Friedman, Sonia

    Journal of Crohn's & colitis

    2020  Volume 14, Issue 8, Page(s) 1082–1089

    Abstract: Background and aims: Previous studies indicate an increased risk of sexual dysfunction in women with inflammatory bowel disease [IBD] but none have examined sexual function in a large population-based cohort.: Methods: To investigate the risk of ... ...

    Abstract Background and aims: Previous studies indicate an increased risk of sexual dysfunction in women with inflammatory bowel disease [IBD] but none have examined sexual function in a large population-based cohort.
    Methods: To investigate the risk of sexual dysfunction in women with IBD, we used data from the Danish National Birth Cohort, a nationwide study of 92 274 pregnant women recruited during 1996-2002. We performed a cross-sectional study based on mothers who participated in the Maternal Follow-up in 2013-14. The outcome was self-reported sexual health. Information regarding demographics and IBD characteristics was retrieved from the Danish National Patient Register. Using regression models and adjusting for important confounders, we compared sexual function in women with and without IBD.
    Results: The study population consisted of 38 011 women including 196 [0.5%] with Crohn's disease [CD] and 409 [1.1%] with ulcerative colitis [UC]. Median age was 44 years. Compared to women without IBD, women with UC did not have significantly decreased sexual function, while women with CD had more difficulty achieving orgasm (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI] 1.02-2.30], increased dyspareunia [aOR 1.71; 95% CI 1.11-2.63] and deep dyspareunia [aOR 2.00; 95% CI 1.24-3.22]. The risk for difficulty achieving orgasm and deep dyspareunia was further increased within 2 years of an IBD-related contact/visit [aOR 1.81; 95% CI 1.11-2.95; and aOR 2.37; 95% CI 1.34-4.19].
    Conclusions: Women with CD have significantly increased difficulty achieving orgasm and increased dyspareunia. Physicians should be cognizant of and screen for sexual dysfunction in this group of patients.
    MeSH term(s) Adult ; Cohort Studies ; Colitis, Ulcerative/diagnosis ; Colitis, Ulcerative/epidemiology ; Crohn Disease/diagnosis ; Crohn Disease/epidemiology ; Denmark/epidemiology ; Dyspareunia/diagnosis ; Dyspareunia/etiology ; Female ; Humans ; Reproductive History ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Risk Factors ; Self Report/statistics & numerical data ; Sexual Dysfunction, Physiological/diagnosis ; Sexual Dysfunction, Physiological/epidemiology ; Sexual Health/statistics & numerical data
    Language English
    Publishing date 2020-02-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2390120-2
    ISSN 1876-4479 ; 1873-9946
    ISSN (online) 1876-4479
    ISSN 1873-9946
    DOI 10.1093/ecco-jcc/jjaa038
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