Reproductive, Perinatal and Pediatric Epidemiology
“Society has an obligation to fulfil a woman´s right to life and health, when she is risking death to give us life.”
Professor Mahmoud F. Fathalla, FIGO Past President 1994-1997
The reproductive, perinatal and pediatric epidemiology research group: an introduction
The overall objective of the research is to inform evidence-based clinical care of women during pregnancy, childbirth and the postpartum period as well as the care for their infants before and during birth and in the first 28 days of life.
We have long and extensive expertise in conducting large-scale epidemiological studies using high quality population-based health care registers and local registries. We collaborate with other research groups within the Clinical Epidemiology Unit (KEP), other research groups within Karolinska Institutet as well as other universities in Sweden and internationally. The group includes researchers combining clinical work with epidemiological research and is composed of obstetricians and gynecologists, midwives, neonatologists and pediatricians, nutritionists, epidemiologists, biostatisticians and PhD-students. Many of the researchers are also active over a range of different national and local initiatives for safety and improvement of care for women and their infants.
Since 2014, from the inception of the Swedish Pregnancy Register, KEP is also holder of this pregnancy and childbirth quality register.
The group also works in close collaboration with department of Women’s Health at the Karolinska University Hospital and other providers of care in the Stockholm Region. Members of the research group are and involved in several randomized controlled trials (RCTs) and through the Pregnancy Register, also register based RCTs.
Our international collaborations include the following universities and institutions: University of British Columbia, Vancouver, Canada; Oregon Health and Science University, Portland, USA; Stanford University, California, USA; University of Berkeley, California, USA, University of Witwatersrand, Johannesburg, South Africa; London School of Hygiene and Tropical Medicine, London, UK; Bristol University, Bristol, UK; Institute de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso; Oslo University, Oslo, Norway; University of Copenhagen, Denmark; World Health Organization; University of Michigan, USA, Paris Descartes University, France.
The group is well funded and has received research grants from several Swedish and international institutions such as; the Swedish Research Council, the Swedish Research Council for Health, Working Life and Welfare, Belmont Forum, National Institutes of Health (NIH), NordForsk, Karolinska Institutet and the County Council of Stockholm, Sweden.
Not all research questions are possible or even ethical to study in randomized trials why observational studies may cover this gap. The high-quality population-based registers that are kept in Nordic countries allow to answer research questions that are not possible in other parts of the world. An example of this is medication exposure during pregnancy. Our research group covers a broad range of research focusing short- and long-term health outcomes for mother and child, interventions and management during pregnancy and delivery and maternal and infant outcomes. Our research focus is aimed at:
- Weight gain during pregnancy and maternal and perinatal outcomes
- Bariatric surgery before pregnancy and maternal and perinatal outcomes
- Quality of care during childbirth
- Smoking and snuff use during pregnancy and maternal and perinatal outcomes
- Chronic disease including diabetes during pregnancy and maternal, perinatal and infant outcomes
- Pregnancy and associated risks of infant neuropsychiatric and medical disease
- Climate change and the impact on maternal and perinatal health
- Neonatal quality care
Social equity in maternal and infant health outcomes Databases
We use high quality population-based health registers and quality registers for our research. Through the unique identifier of each individual, we are able to link these registers to understand the how broader determinants of health impact maternal and infant health outcomes. Among the registers that we use include:
- The Medical Birth Register
- The Pregnancy Register
- The Patient Register
- The Neonatal Quality Register
- The LISA database
- Multigeneration register
- The Stockholm-Gotland Obstetrix cohort
Olof Stephansson is associate professor in Obstetrics & Gynecology and research group leader for the reproductive epidemiology group at the Clinical Epidemiology Division, Department of Medicine, Solna. Dr Stephansson is clinically active at the Karolinska University Hospital, Department of Women’s Health and is leading projects on duration of labor and adverse pregnancy outcome, risk factors for postpartum hemorrhage (PPH), chronic maternal disease, prescribed drugs and pregnancy outcome. Furthermore, he conducts studies on maternal, social, pregnancy and provider quality of care and the association with maternal and infant morbidity and mortality. Dr Stephansson is funded by the Swedish Research Council, The Swedish Research Council for Health, Working Life and Welfare, Stockholm County Council and Karolinska Institutet. He is director of the board for the Swedish Pregnancy Register for improvement of maternity care and research.
Anne K Örtqvist
Anne K. Örtqvist (https://staff.ki.se/people/annort) is a resident in Obstetrics and Gynecology at Visby Lasarett, Gotland, combining clinical work with research as a postdoc working on a project on health care determinants of pregnancy outcomes, funded by FORTE. The project will focus on structures in health care and potential associations with severe maternal and infant morbidity and mortality. The objective of the research is to increase safety for mother and child during pregnancy and childbirth and to reduce suboptimal delivery care. She defended her PhD in 2015 at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, with a thesis focusing on perinatal risk factors and subsequent childhood health, combining clinical and large register-based data with twin- and family-based epidemiological designs.
Nathalie Roos is a clinically active Gynecologist and Obstetrician and works on a three-year research project - Climate, Heat and Maternal and Neonatal Health in Africa (CHAMNHA) – funded by the Belmont Forum (FORTE). CHAMNHA is led by an interdisciplinary research team (climate, health and social science) that will address key knowledge gaps in terms of the impact of heat on maternal and perinatal health, employing qualitative and quantitative methods. The Swedish component of the project will use nationwide health registers and climate- and air pollution data to understand impact of heat waves and air pollution on maternal and perinatal outcomes.
Nathalie Roos is also leading a project on diabetes mellitus type 1 in pregnant women and the risk of developing preeclampsia and intrauterine growth restriction (funded by Spädbarnsfonden).
Jenny Bolk works as a consultant in neonatology at Sachs´ children and Youth hospital and has a 50% clinical postdoctoral appointment supported by Region Stockholm. Her main clinical area of expertise is neonatal neurology, and her main research interest is how perinatal and neonatal events affects the growing brain. She is currently working on register based studies as well as clinical follow up studies on neurodevelopment in children exposed to perinatal risk events. The main focus is on children who has suffered from perinatal stroke, but she is also active in research on birth asphyxia and neurodevelopment after extreme and moderate prematurity.
Neda Razaz is an Assistant Professor and has completed her PhD in Epidemiology from the School of Population and Public Health, University of British Columbia, Canada. She is currently leading an international collaboration, funded by FORTE, aiming to understand the role of maternal and paternal chronic illness during pregnancy on neurodevelopmental disorders in offspring, using national health databases in Sweden and Canada. She has also been focusing on the impact of obstetrics and neonatal treatment/interventions on the risk of adverse long-term outcomes in childhood and early adulthood.
Linnea Ladfors is MD, graduated from Lund University. She is a PhD student focusing her work on novel approaches for prediction of post-partum hemorrhage. For the PhD project she will be using large datasets from the Pregnancy Register to analyze temporal trends, risk factors and predictors with the aim of better understanding why post-partum hemorrhage is becoming increasingly common.
In 2019, Linnea Ladfors was a visiting research student at the University of British Columbia in Vancouver where she studied risk factors for Caesarean section in low risk nulliparous women. Her bachelor’s thesis, from Lund University on fetal overgrowth in diabetes pregnancies was published in PLOS ONE in 2017.
Xingrong Liu is currently working as a biostatistician in the reproductive epidemiology research group, conducting data analysis and providing statistical support. He had a basic training in computational mathematics and mathematical statistics, defended his PhD in 2017 at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet. He had research experience in development and application of statistical methods for both independent and correlated time-to-event data, with his thesis titled “Generalized Survival Models as a Tool for Medical Research”. During his postdoctoral research period, he further expanded his expertise in genome-wide association studies and meta-analysis.
Louise Lundborg is clinically active working as a midwife and conducting research on labor progression. Her research focuses mainly on the current definitions of normal progress in first stage of spontaneous labor. The research aims to investigate the balance between necessary and unnecessary interventions during first stage of labor in the pursuit of a future clinically and psychologically safe environment for women and infants.
Ayoub Mitha is a French neonatologist from Lille University Hospital, doing his postdoc at KEP led by Prof. Sven Cnattingius and Prof. Olof Stephansson.
He defended his PhD in 2019 at INSERM U1153, Paris, with the Obstetrical, Perinatal and Paediatric Epidemiology Research Team, on breast milk feeding at discharge among preterm infants and unit policies from the EPIPAGE-2 cohort study. He is interested in neurodevelopmental care, breastfeeding, and preterm outcomes.
He is currently working on moderate and late preterm outcomes.
Mia Ahlberg is a clinically active midwife and works on 4-year project, Safe labor - a reappraisal of labor duration- funded by Forte and Stockholm County Council. The aim of the project is to reevaluate normal and prolonged labor duration and to identify maternal, neonatal and management factors that influence progress of labor and labor duration.
Mia Ahlberg is also leading the implementation of a new continuity model of care during pregnancy-childbirth and postpartum care called “Min Barnmorska” (case load midwifery) at Karolinska University Hospital. The project is funded by Stockholm County Council and The Swedish Research Foundation and aims to evaluate the effect of caseload midwifery on maternal and neonatal outcomes among vulnerable women in Sweden.
Sophia Brismar Wendel is a senior consultant, lead obstetrician, and post doc at Karolinska Institutet Danderyd Hospital and affiliated to REP KEP. She leads a national multicenter randomized controlled trial, the EVA trial, funded by the Swedish Research Council running in nine hospitals. It is a PROBE trial of lateral episiotomy or not in vacuum assisted delivery in nulliparous women to assess if episiotomy can reduce obstetric anal sphincter injury, including short, medium, and long-term outcomes in the mother and child. Partner experience and health economics are also assessed. In parallel, she studies aspects of episiotomy and other obstetric interventions and outcomes using epidemiological registers.
She is a postdoc at Lund University and affiliated to Reproductive Epidemiology at KEP and to the MIFam Network of Professor Dahlen, Western Sydney University, Australia. Malin Edqvist is the project leader of a multicentre randomized controlled trial which evaluates a clinical practice among midwives to prevent severe perineal trauma (One plus one trial). Follow up studies involve Swedish Women’s After Birth Experiences (SWABE). Another project currently in progress, is exploring midwife’s supervision during the second stage of labour. The projects are funded by Forte and ALF Pedagogik, SLL.
Huiling Xu is a PhD student in the Reproductive Epidemiology group. She is working with the association between weight gain during pregnancy and pregnancy outcomes, and further underlying mechanisms of bariatric surgery on a subsequent pregnancy.
With a background at the intersection of clinical and social research, I am specialized in perinatal epidemiology using national registers. I look for ways to improve maternal health by building scientific evidence that can inform clinical and social policy.
Martina Persson is a senior consultant in pediatric Diabetes/Endocrinology and associate professor in Pediatrics at Karolinska Institutet. M.P is active in both clinical studies and register-based epidemiological projects with focus on diabetes and obesity. Register based studies include maternal and perinatal outcomes in pregnancies with diabetes and/or obesity, assessment of long-term prognosis and risks in young individuals with diabetes or obesity as well as studies aiming at dissecting the heterogeneity of childhood type 1 diabetes (T1D).
Current projects include several clinical trials investigating the impact of insulin sensitivity, visceral fat mass and fat cell metabolism on cardiovascular function in individuals with T1D. An RCT study, testing the effect of a new cognitive method for improvement of glycemic control in young females with T1D. M.P is also actively involved in the planning of a national, clinical project “SESAM”, aiming at a detailed characterization of beta cell function over time in individuals diagnosed with T1D.
M.P is a steer group member of the BDD study – Better Diabetes Diagnosis, and the CDC4-gtrial evaluating the medical and socioeconomic consequences of the new criteria for diagnosis of gestational diabetes. Her work is mainly funded by SLL and ALF medicine but also by the National Diabetes Foundation and the Swedish Pediatric Diabetes Foundation.
Giulia Muraca is a postdoctoral fellow in the Reproductive Epidemiology Unit at KI and in the Dept of Ob/Gyn at the University of British Columbia. She received her MPH and PhD degrees from the School of Population and Public Health at the University of British Columbia. Dr. Muraca was awarded a Vanier Canada Graduate Scholarship to support her doctoral work in perinatal epidemiology. Her PhD focused on the evaluation of perinatal and maternal safety resulting from various strategies aimed at reducing the rate of caesarean delivery. Her postdoctoral research is funded by a Canadian Institutes of Health Research Fellowship and builds on her previous work to identify optimal rates of interventions during labour among women living in industrialized settings.
Sven Cnattingius is Senior Professor in Reproductive Epidemiology at the Clinical Epidemiology Division, Department of Medicine Solna. He is MD, with a clinical background in obstetrics and gynecology. Dr Cnattingius has a long experience in reproductive epidemiology, and have published studies on outcomes of maternal pregnancy, postpartal and long-term outcomes; neonatal and long-term risks in offspring, including neurodevelopmental and psychiatric disorders, cardio-vascular and cancer diseases. Sven Cnattingius research includes environmental risk factors for pregnancy complications, including maternal smoking and snuff use and maternal overweight/obesity. Sven Cnattingius present research is predominantly focused on pregnancy and neonatal complications with respect to infant and childhood risks.
Kari Johansson is a Nutritionist and Assistant Professor. Her main research is focused on different aspects of prevention and treatment of obesity before and during pregnancy. In an international collaboration she is studying the effect of weight gain during pregnancy on adverse maternal and child outcomes. Further, by using Swedish National Health Care and Quality Register, she is studying risks and benefits of bariatric surgery before pregnancy on maternal and child outcomes. She is supported by Karolinska Institutet with a faculty funded care position as Assistant Professor and her projects are further funded by FORTE.
Michaela Granfors is a senior consultant in Fetal Medicine and Obstetrics at Karolinska University Hospital, Stockholm, and she is committed as a course leader for various regional and national clinical education programs. She is the register holder of the Swedish Pregnancy Register, a national quality register with certification level 1, a fantastic source for improvement of maternity care and research. Since her dissertation at Uppsala University about Hypothyroidism and Pregnancy in 2015, she is affiliated as a post doc to the reproductive epidemiology group at the Clinical Epidemiology Division, Department of Medicine, Solna. Her current main interest in research are register-based studies with focus on fetal ultrasound, pregnancy dating and fetal growth estimation.
She works as a specialised paediatrician and she has a residency in neuropediatrics at the Sachs' Children and Youth Hospital. I am a PhD student since April 2020 and my area of interest is neonatal neurology and brain development, especially when the conditions are far from optimal. My research is about paediatric stroke; risk factors and life-long consequences.
Eleonor Tiblad is MD PhD and senior consultant in Obstetrics and Gynecology. She is clinically active at The Centre for Fetal Medicine at Karolinska University Hospital and the Director of the National Program of Fetal Therapy. Her research area includes alloimmunization in pregnancy, immunology of pregnancy, fetal medicine and therapy as well as complicated multiple pregnancies. She is the Swedish PI for the international multicenter phase 2 and 3 Unity studies, investigating new pharmaceutical treatment possibilities for severe hemolytic disease of the fetus and newborn, funded by Janssen Pharmaceuticals.
Malin Bergström is an associate professor and a clinical child psychologist at Sachsska children's hospital. Her research involves clinical studies on interventions for young children's wellbeing and mental health as well as epidemiological studies on children with separated parents. In the Elvis project she conducts studies on children in joint physical custody, who share their time between their parents' respective homes after a divorce. Malin Bergström has a particular interest in fathers' parenting and in interventions to support fathers.
works as a consultant in obstetrics at Karolinska university hospital and maternal care clinics in Stockholm. Her main research area is prediction of pregnancy complications and adverse outcomes at birth. She is interested in how maternal characteristics, such as obesity, affect fetal growth during pregnancy, and how important early fetal growth is on birth weight and pregnancy outcome. Her research focuses on risk for excessive fetal growth and high birth weight.
is a biostatistician and has been providing statistical support to the reproductive, perinatal and pediatric epidemiology research group since June 2020. He is trained in mathematics, mathematical statistics and epidemiology and has been working as a statistician since 2011. Johan completed his PhD at Karolinska Institutet 2017, focusing on statistical methods for twin and sibling studies. Main areas of competence are causal inference and methods for clustered (e.g. sibling) data. Johan has mainly been involved in observational studies using Swedish national registers as well Swedish Quality registers.
Fatine Khammari Nyström
works a consultant in pediatrics at Astrid Lindgren Childrens´ Hospital, Karolinska, Solna. She is a PhD student in Postnatal Epidemiology at the Clinical Epidemiology Division, Department of Medicine Solna. Her PhD project is about the diagnostic values of the routine examination of the newborn. Her research is specially focused on hip dysplasia, congenital heart disease and congenital cataract in the newborns.
Charlotte Lindblad Wollmann
Charlotte is a senior consultant in Obstetrics and Gynecology at Karolinska University Hospital. She did her thesis on women with previous cesarean delivery, “Trial of labour after caesarean”, and dissertated in 2019. She is now focusing on uterine rupture, a feared risk for women with a previous cesarean delivery. She is also a course leader for a national clinical education about fetal monitoring during delivery. Another great interest of her is invasive placenta, another risk after previous cesarean delivery. She is head of a national group working with invasive placenta.
Olof Stephansson firstname.lastname@example.org , MD, PhD, Group leader
Anders Hjern email@example.com , MD, Professor
Anna Sandström Anna.Sandstrom@ki.se . MD, PhD
Anna-Karin Elisabeth Edstedt Bonamy firstname.lastname@example.org , MD, PhD
Anna-Karin Wikström Anna-Karin.Wikstrom@ki.se , MD, Professor
Anne Örtqvist email@example.com , MD, PhD
Ayoub Mitha firstname.lastname@example.org , MD, PhD
Can Liu email@example.com , PhD
Charlotte Elvander firstname.lastname@example.org , RM, PhD
Charlotte Lindblad Wollmann email@example.com , MD, PhD
Fatine Khammari Nyström firstname.lastname@example.org , PhD Student
Gunnar Petersson email@example.com Data manager
Hanna Carr firstname.lastname@example.org
Huiling Xu email@example.com , PhD student
Jenny Bolk firstname.lastname@example.org ,PhD
Kari Johansson email@example.com , PhD
Katarina Åberg firstname.lastname@example.org
Katarina Remaeus email@example.com , MD, PhD student
Louise Lundborg firstname.lastname@example.org , PhD student
Malin Bergström email@example.com, MD, PhD
Malin Holzmann Malin.Holzmann@ki.se , MD, PhD
Maria (Mia) Ahlberg firstname.lastname@example.org , RM, PhD
Maria Altman email@example.com , MD, PhD
Marija Simic firstname.lastname@example.org , MD, PhD
Martina Persson Martina.Persson@ki.se , MD, PhD
Michaela Granfors email@example.com , MD, PhD
Nathalie Roos firstname.lastname@example.org , MD, PhD
Neda Razaz email@example.com
Ruoqing Chen firstname.lastname@example.org
Sven Cnattingius email@example.com , MD, Senior Professor
Malin Edqvist firstname.lastname@example.org
Xingrong Liu email@example.com
Giulia Muraca firstname.lastname@example.org
Eleonor Tiblad email@example.com
Sophia Brismar-Wendell firstname.lastname@example.org
Ängla Mantel email@example.com
Stefan Johansson firstname.lastname@example.orgMD, PhD
Eleni Simatou email@example.com
Linnea Ladfors firstname.lastname@example.org , PhD Student