Women´s health from a life course perspective

The research group's aim is to study factors related to ill health and morbidity at different times in life. The main theme is prevention; i.e. factors that are important for preventing morbidity both in the short and long term for the woman, as well as how the intrauterine environment can affect the future health and morbidity of the unborn child. Contact with healthcare during pregnancy represents an opportunity to identify a variety risk factors that can be intervention targets to improve future health outcomes.

Projects within the research group concern intrauterine imprinting, pregnancy-related complications, identification of risk factors to avoid birth injuries and later morbidity for diabetes and cardiovascular morbidity, as well as studies concerning the prevention of unwanted pregnancies. Intrauterine imprinting is studied by analyzing placental biomarkers (microRNA and protein expression) and their associations with fetal growth. Studies how/if Covid-19 infection affects the fetus via placental changes are ongoing. Gestational diabetes is a strong risk factor for later type 2 diabetes and associated with an increased risk of cardiovascular morbidity. In addition to long-term risks for the woman's health, we know that high blood sugar values during pregnancy affect the fetus (imprinting), create a risk of the fetus becoming large for gestational age and secondarily contribute to birth injuries for mother and child.

Ongoing and planned studies focus on identifying which women have the highest risk of birth injuries, improving management during pregnancy and, through individualized medical assessment, identifying those who later develop type 2 diabetes and risk of cardiovascular morbidity. The aim in the long term is to be able to develop preventive interventions for those who need it most. Pain relief during childbirth and its importance for childbirth experience is studied via a doctoral thesis project. The aim is to identify factors related to pain relief that can be negative or positive for the birth experience. Through a good birth experience, the risk of future caesarean sections is expected to decrease, which in the long run reduces risks for mother and child in future births. Unwanted pregnancies and unmet need for contraception are major global health challenges. Sweden has a high proportion of unwanted pregnancies and the highest number of repeated abortions in the EU. Socio-economically disadvantaged groups tend to prioritize attributes of less effective methods and run a significantly greater risk of discontinuing their contraceptive method use, which in turn increases the risk of unwanted pregnancies and abortions. Studies in areas such as the importance of counseling and long-acting reversible contraceptives (LARC) are ongoing. Studies regarding the duration of pregnancy intervals and the risk of negative outcomes such as low birth weight and maternal depression are ongoing; short pregnancy intervals are more often reported even as unwanted. Premature ovarian insufficiency affects 1-2% of all women, i.e. they reach menopause before the age of 40. Menopausal hormone therapy, MHT, is recommended to reduce future risk of disease and premature death. However, many women never receive treatment, or choose to end treatment prematurely. The magnitude of this undertreatment and the reasons for it are incompletely known.
We now intend to deepen the knowledge of adherence to treatment, causes of undertreatment and consequences thereof in future studies. Cervical cancer prevention with HPV screening is carried out to prevent suffering and disease but also to increase opportunities for equal and effective healthcare. HPV is strongly linked to cervical cancer but also to other genital cancers in the vagina and vulva. In order to further develop HPV screening, various projects are being carried out. Several projects focus on identifying markers that can demonstrate the development of cell changes but also how IUD (intra uterine devise) use can affect this process. The goal is to find methods to be able to more precisely identify in the screening those women who are found not to have an increased risk of developing cancer, and at the same time we are investigating what health economic effects this would have. Screening studies with registry data from the national quality registry for cervical cancer prevention as well as a prospective cohort study are underway to investigate whether it is safe to switch to HPV alone in the follow-up of already established cell changes and after treatment of these, but also whether self-sampling can replace all sampling within screening operations. In addition to screening studies, studies are ongoing for established vaginal and vulvar cancer and where we want to evaluate the presence of HPV and HPV-related characteristics linked to the patients' prognosis.