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

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

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

Illustration: Carin Bådagård

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 in 2016, giving single mothers by choice access to medically assisted reproduction (MAR), a new study was conducted. The objective was to assess characteristics and motivations of single women as well as to explore the decision making to choose motherhood by assisted reproduction. Designs were both quantitative and qualitative and the studies are published.

Collaborators

Schmidt L. MD, PhD, Professor, Dept. of Public Health, University of Copenhagen, Denmark

Responsible researcher/contact person

Helena Volgsten helena.volgsten@kbh.uu.se

Publications

Helena Volgsten & Lone Schmidt (2021) Motherhood through medically assisted reproduction – characteristics and motivations of Swedish single mothers by choice, Human Fertility, 24:3, 219-225, https://DOI: 10.1080/14647273.2019.1606457

Helena Volgsten & Lone Schmidt (2021) Exploring Swedish single women’s decision to choose motherhood through medically assisted reproduction – a qualitative study, Human Fertility,DOI: 10.1080/14647273.2021.2017026

Design: Anna D Volgsten

The effect of endometrial scratch and the role of microbiota and transcriptome in women with unexplained recurrent implantation failure

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

Barnmorskekontinuitet (Känd barnmorska, Barnmorska Hela Vägen)

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

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

Perinatal exposure and infant disease

Responsible researcher/contact person

Ulf Högberg, ulf.hogberg@kbh.uu.se

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

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

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. 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

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

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): 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

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. 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

3PAD: Physiological Predictors of Postpartum Anxiety and Depression

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

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

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

Last modified: 2022-05-11