Publications by authors named "Christina Anne Vinter"

10 Publications

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Barriers to a healthy postpartum lifestyle and the possibilities of an information technology-based intervention: A qualitative study.

Midwifery 2021 Apr 3;98:102994. Epub 2021 Apr 3.

Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark; Department of Endocrinology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. Electronic address:

Background: Being overweight or obese is associated with higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Many women exceed the gestational weight gain recommendations. Thus, it is important to focus on the women's lifestyle between their pregnancies to lower the risk of weight retention before the next pregnancy as well as in a life course perspective.

Objective: The objective of this study was to explore barriers postpartum women experience with respect to a healthy lifestyle during the postpartum period, and to assess whether an IT-based intervention might be a supportive tool to assist and motivate postpartum women to healthy lifestyle.

Method: A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. The results were analysed within the frame of the capability, opportunity, motivation and behaviour model (COM-B).

Results: From the women's perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritize own health related risks, and to motivate them to plan and take care of their own health. There is room for engaging the partner more in the communication related to the baby and family's lifestyle. Lastly, the women already use audiobooks and podcasts to obtain information.

Conclusion: Postpartum women need tools that inform and motivate for a healthy lifestyle postpartum. The tools should allow access to high quality information from health care professionals when the information is needed and also allow engagement from the partner. An IT-based intervention could be a way to support and motivate postpartum women for a healthy lifestyle.
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April 2021

Recent advances in cultivation-independent molecular-based techniques for the characterization of vaginal eubiosis and dysbiosis.

Fac Rev 2020 9;9:21. Epub 2020 Dec 9.

Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Kløvervænget 10, 10th floor, 5000 Odense C, Denmark.

"The bacterial vaginosis syndrome" has significant adverse effects for women and babies, including preterm birth and increased risk of acquisition of sexually transmitted infections and HIV. Currently, the gold standard for diagnosis is Gram stain microscopy of vaginal secretions, which is not readily available, is somewhat subjective, and does not differentiate between the likely different subtypes of vaginal dysbioses that may have different etiologies, microbiology, responses to antibiotics, and phenotypic outcomes. With new information from molecular-based, cultivation-independent studies, there is increasing interest in the use of molecular techniques for the diagnosis of bacterial vaginosis. We reviewed the current evidence on and the rationale behind the use of molecular techniques for the diagnosis of bacterial vaginosis. We found a number of commercially available molecular diagnostic tests, a few of which have US Food and Drug Administration (FDA) and/or Conformité Européenne diagnostic (CE-IVD) approval, and we have compared their performance with respect to sensitivities and specificities. Molecular-based tests have the advantage of objectivity, quantification, detection of fastidious organisms, and validity for self-obtained vaginal swabs. The performance of the molecular tests against standard microscopy is impressive, but further education of users on interpretation is needed. Bacterial vaginosis is the major cause of vaginal dysbiosis and should be recognized for the threat it is to women's genital tract health. Quantitative assessment of microbial abundance, the diversity of other organisms present, specific primers for gene sequence regions, and clades and biovars of target microbes should be recognized and incorporated into future molecular diagnostic tests to better differentiate between vaginal eubiosis and dysbiosis.
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December 2020

Effectiveness of fetal scalp stimulation test in assessing fetal wellbeing during labor, a retrospective cohort study.

BMC Pregnancy Childbirth 2020 Jun 5;20(1):347. Epub 2020 Jun 5.

Department of Clinical Sciences Lund, Gynecology and Obstetrics, Lund University, Faculty of Medicine, Lund, Sweden.

Background: It is discussed whether fetal scalp stimulation (FSS) test is a reliable complimentary tool to cardiotocography (CTG) to assess fetal wellbeing during labor. The test is based on the assumption that a well-oxygenated fetus, in contrast to the depressed fetus, will respond to a certain stimulus. The aim of this study was to investigate the effectiveness of the FSS-test.

Methods: A retrospective observational study carried out Copenhagen University Hospital, Herlev, Denmark. Laboring women with singleton pregnancies in cephalic presentation after gestation week 33 and indication for fetal blood sampling (FBS) were eligible for inclusion. The FSS-test was classified as positive when an acceleration was absent at the time of FBS and negative when an acceleration was present. Lactate in scalp blood was measured by the point-of-care device LactatePro™ and pH in artery umbilical cord blood by the stationary blood gas analyzer ABL800. Lactate level < 4.2 mmol/L in scalp blood and arterial cord pH > 7.1 were cut-offs for normality.

Results: Three hundred eighty-five women were included. The cohort was divided by the FBS-to-delivery time: Group 1 (n = 128) ≤ 20 min, Group 2 (n = 117) 21-59 min and Group 3 (n = 140) ≥ 60 min. The proportion of FSS-positive tests differed significantly between the groups (p < 0.000). In Group 1 the sensitivity, specificity and likelihoods for scalp lactate ≥4.2 mmol/L were 81.5 (95% CI 67-90.1), 13.3 18.5 (95% CI 5.9-24.6), LHR+ 0.94 (95% CI 0.8-1.1) and LHR - 1.4 (95% CI 0.6-3.2) and for umbilical artery pH ≤ 7.10 the values were 82.6% (95% CI 61.2-95.1), 16% (95% CI 9.4-24.7), 1.0 (95% CI 0.8-1.2) and 1.1 (95% CI 0.4-3) respectively. Regardless of the FBS-to-delivery time the LHR+ for lactate ≥4.2 mmol/L increased to 1.38 (95% CI 1.2-1.6).

Conclusion: The effectiveness of scalp stimulation test was poor for both ruling in and out fetal hypoxia during labor. Absence of a provoked acceleration seems to be a normal phenomenon in the second stage of labor.
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June 2020

Protocol for a randomised controlled trial of a co-produced, complex, health promotion intervention for women with prior gestational diabetes and their families: the Face-it study.

Trials 2020 Feb 7;21(1):146. Epub 2020 Feb 7.

Health Promotion, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.

Background: Gestational diabetes mellitus (GDM) is associated with an increased risk of future diabetes in both mother, father and offspring. More knowledge is needed about how to effectively reduce the risk of diabetes through sustained behavioural interventions in these families. The Face-it intervention is a complex health promotion intervention embedded in multi-level supportive environments. The aim of the intervention is to reduce type 2 diabetes risk and increase quality of life among families in the first year following a GDM-affected pregnancy by promoting physical activity, healthy dietary behaviours and breastfeeding through a focus on social support, motivation, self-efficacy, risk perception and health literacy.

Methods: This national multicentre study is a two-arm randomised controlled trial including 460 women with GDM in a ratio of 2 (intervention):1 (usual care). The Face-it intervention consists of three main components: 1) additional visits from municipal health visitors, 2) digital health coaching tailored to family needs and 3) a structured cross-sectoral communication system in the health care system. The intervention runs from 3 to 12 months after delivery. The primary outcome is maternal body mass index at 12 months after delivery as a proxy for diabetes risk. The women will be examined at baseline and at follow-up, and this examination will include blood tests, oral glucose tolerance test (OGTT), anthropometrics, blood pressure, self-reported diet and physical activity, breastfeeding, quality of life, health literacy, physical and mental health status, risk perception and social support. Aside from those data collected for OGTT and breastfeeding and offspring parameters, the same data will be collected for partners. Data on offspring anthropometry will also be collected. Information on pregnancy- and birth-related outcomes will be derived from the medical records of the woman and child.

Discussion: This randomised controlled trial seeks to demonstrate whether the Face-it intervention, addressing the individual, family and health care system levels, is superior to usual care in reducing diabetes risk for mothers and their families. Coupled with a process evaluation and an economic analysis, the study will provide evidence for policymakers and health services about health promotion among families affected by GDM and the potential for reducing risk of type 2 diabetes and associated conditions.

Trial Registration: NCT03997773. Registered June 25, 2019 - Retrospectively registered.
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February 2020

Lifestyle interventions to maternal weight loss after birth: a systematic review.

Syst Rev 2019 12 16;8(1):327. Epub 2019 Dec 16.

Department of Public Health, University of Southern Denmark, Odense, Denmark.

Background: Over the past decades, there has been an increase in overweight and obesity in women of childbearing age, as well as the general population. Overweight and obesity are related to a later, increased risk of type 2 diabetes and cardiovascular diseases. Increasing weight between pregnancies has a negative impact on the development of the fetus in a subsequent pregnancy. It is also related to long-term obesity and overweight for the woman. Accordingly, weight control in women of the childbearing age is important for both women and their offspring. Information and communication technology (ICT) has become an integrated part of many peoples' lives, and it has the potential to prevent disease. In this systematic review, we summarize the evidence from randomized controlled trials to compare effects of different ICT-based interventions to support postpartum women to achieve weight loss.

Methods: A systematic search was performed in PubMed, Embase, PsycInfo, CINAHL, Web of Science, Scopus, and Cochrane, searching on terms, such as postpartum, weight loss, telemedicine, and randomized controlled trials. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials.

Results: Eight studies were included in the systematic review. All of them were characterized by applying one or more ICT components to assist postpartum women in weight control, and had weight loss as an outcome measure. A significant difference was found in weight loss between control group and intervention group in the majority of the studies. However, five of the studies had a relatively short follow-up period (40 days to 16 weeks), six of the studies had a relatively small sample size (18 to 66 women), and half of the studies indicated challenges with adherence to the interventions over time.

Conclusion: ICT-based interventions can support postpartum women to achieve a healthy lifestyle and weight control. Future studies should focus on larger sample sizes, longer follow-up periods, and adherence to the interventions.

Systematic Review Registration: PROSPERO CRD42018080731.
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December 2019

Re: Effects of oral probiotic supplements on vaginal microbiota during pregnancy: a randomised, double-blind, placebo-controlled trial with microbiome analysis.

BJOG 2020 01 20;127(2):303. Epub 2019 Oct 20.

Research Unit of Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.

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January 2020

[Acquired clitoral phimosis causing a periclitoral pseudocyst].

Ugeskr Laeger 2018 Mar;180(10)

Clitoral phimosis or preputial fusion may occur as a result of atrophic vaginitis among other conditions. A 72-year-old woman presented with atrophic vaginitis, preputial fusion, and a painful periclitorial pseudocyst. We suggest that a minimal surgery approach in a manual retraction of the synarchies without making an incision is a gentle and effective surgical management of preputial fusion. Suturing the ends from each other combined with continuous topical prophylaxis will minimise the risk of recurrence of pseudo-cyst and prevent worsening scar tissue formation.
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March 2018

Targeting pregnancy as a time to treat obesity.

Expert Rev Endocrinol Metab 2015 Sep;10(5):491-497

a Department of Gynecology and Obstetrics, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.

Maternal obesity is recognized as one of the largest contributors to compromised health during pregnancy. Lifestyle interventions in obese pregnant women may be able to reduce gestational weight gain (GWG) but have shown limited success in improving pregnancy and neonatal outcomes. Lack of statistical power, poor compliance and inconsistency in inclusion BMI and setting across studies may be some of the reasons. Since pregestational BMI is the single most important predictor of obesity-related complications, the metabolic profile in the first trimester of pregnancy may play a very important role. Observational studies have shown that interpregnancy weight loss reduces the risk of macrosomia in a subsequent pregnancy. Future lifestyle randomized controlled trials should target the prepregnant state and examine the effect on maternal and neonatal outcomes.
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September 2015

Postpartum weight retention and breastfeeding among obese women from the randomized controlled Lifestyle in Pregnancy (LiP) trial.

Acta Obstet Gynecol Scand 2014 Aug 13;93(8):794-801. Epub 2014 Jun 13.

Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark.

Objectives: To study the effects of lifestyle intervention in pregnancy on weight retention 6 months postpartum among obese women from the "Lifestyle in Pregnancy" (LiP) study, and to determine associations between breastfeeding with postpartum maternal weight.

Design: Six months postpartum follow up after a randomized controlled intervention trial.

Setting: Two university hospitals in Denmark.

Population: A total of 360 women with pregestational body mass index ≥30 kg/m(2) .

Methods: The intervention involved lifestyle changes (diet and exercise) during pregnancy. The control group received routine pregnancy care. Both groups received standard postnatal care.

Main Outcome Measures: Gestational weight gain, postpartum weight retention and breastfeeding.

Results: Follow up was completed in 238 women of whom 46% in the intervention group and 57% in the control group had retained weight 6 months postpartum (p = 0.088). Women with gestational weight gain ≤9 kg, (recommended by the Institute of Medicine), retained less postpartum weight compared with those who exceeded 9 kg (median -0.7 vs. 1.5, p < 0.001). Ninety-two percent in both weight gain groups initiated breastfeeding. The number of breastfeeding mothers was higher among women with postpartum weight retention ≤5 kg compared with those with weight retention > 5 kg (94% vs. 85%, p = 0.034).

Conclusions: We could not detect sustained weight control at 6 months postpartum despite a lower gestational weight gain for obese women during pregnancy who received a lifestyle intervention rather than standard care. Women who adhered to gestational weight gain recommendations had significantly lower postpartum weight retention. Breastfeeding for 6 months was negatively associated with postpartum weight retention.
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August 2014

[Obese pregnant women and complications in relation to pregnancy and birth].

Ugeskr Laeger 2012 Apr;174(16):1079-82

Gynækologisk Obstetrisk Afdeling, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.

One third of the pregnant Danish women are overweight or obese. Maternal obesity is an independent risk factor for adverse maternal and foetal outcomes including infertility, miscarriage, congenital malformations, preeclampsia, gestational diabetes, complicated deliveries, caesarean section, macrosomia and childhood obesity. This article reviews the effect of maternal obesity on obstetric and neonatal outcomes and provides recommendations for management of obesity in pregnancy.
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April 2012