Malin Edqvist

Most adverse events within maternity care stem from communication and teamwork failures. Despite national and international recommendations, few interventions include person-centered care as means for safe care. The aim of this project is to evaluate the effectiveness and implementation of TeamBirth (TB)

designed to enhance teamwork and person-centered intrapartum care.TB will be evaluated at nine labor wards, covering 26% of all births in Sweden. During this four year project outcomes, processes, and implementation will be addressed in four work packages (WPs). The research group is multidisciplinary with extensive knowledge in epidemiology, implementation science, and biostatistics.WP1. Patient safety and person-centered care: Interrupted time series design using data from the Swedish Pregnancy Register & Questionnaire.WP2. Patient reported experiences: TBs contribution to person-centered care will be explored by validated questionnaires to women.WP3. Process measures: Patient safety climate and interprofessional teamwork will be investigated using a longitudinal cross-sectional design with validated scales to staff.WP4. Process evaluation: A mixed method design using data from questionnaires and interviews.  Adverse events are devastating for those involved and highly costly for society, highlighting the urgent need for interventions. This project will advance the field of patient safety and contribute to new knowledge benefiting women, their infants, and society.

Trots stora insatser för att förbättra förlossningsvården drabbas fortfarande kvinnor och barn av komplikationer. Detta medför lidande inte bara individen och familjen, utan också stora kostnader för samhället. Av rapporterade patientsäkerhetsfall beräknas 60-70% vara undvikbara och majoriteten kan härledas till brister i kommunikation och teamarbete. Den personcentrerade vården anses vara en förutsättning för säker vård. Trots detta visar data från den nationella graviditetsenkäten att endast 50% av kvinnorna upplevt sig vara delaktiga i sin vård och beslut i den utsträckning de önskat under förlossningen. Idag saknas interventioner för att förbättra patientsäkerhet under förlossning och som innefattar personcentrerad vård. TeamFödsel (TF) är en intervention som utvecklats i USA för att förbättra teamets kommunikation och samarbete. TF består av strukturerade avstämningar tillsammans med den födande och hens partner. Processen dokumenteras på en strukturerad Whiteboardtavla där rubrikerna önskemål, plan, och förlossningsprogress ingår. Projektet kommer att utvärdera TF i fyra delstudier, vid nio förlossningsavdelningar, avseende patientsäkerhetsutfall, patientsäkerhetskultur, interprofessionellt samarbete samt kvinnors upplevelse av interventionen. Metoder innefattar registerdata och tidsserieanalys för att utvärdera patientsäkerhet. Enkätdata används för att undersöka om TF bidrar till personcentrerad vård under förlossning samt personalens skattning av patientsäkerhetskultur och teamarbete över tid. En processevaluering kommer att genomförs där kvalitativa data och enkäter används för att utvärdera implementering samt kontextuella faktorer påverkar användningen av TF. Projektet kommer att bidra med viktig kunskap om patientsäkerhet och personcentrerad vård under förlossning samt om faktorer som påverkar implementering och användning av TF. I förlängningen kommer projektet att bidra till förbättrad vård och hälsa för kvinnor och nyfödda barn.

Research problem and specific questionsInfants are at risk of contracting severe respiratory infections such as whooping cough and infection with respiratory syncytial virus (RSV). Vaccination of pregnant women induces a vaccine-specific immune response with the formation of antibodies that pass across the placenta to the fetus, thus protecting the child from potentially life-threatening infections. We plan to investigate factors related to the uptake of pertussis and RSV vaccination in pregnancy, as well as the safety and effectiveness of the vaccines.Data and methodBy studying data from population-based national registers of all women who have given birth in Sweden since 2014 (&gt

1 million mother-child pairs) with information on socio-economics, origin, vaccinations, diagnoses, medications, congenital malformations and deaths, we will study rare but serious side effects of the vaccines, their effectiveness and factors influencing vaccination uptake among pregnant women. In order to increase knowledge and understanding of pregnant women´s reluctance and motivation for vaccination, individual interviews with vaccinated and unvaccinated pregnant women, as well as focus group discussions with healthcare professionals, who encounter these women, will be conducted.Societal relevance and utilizationVaccination during pregnancy can reduce and prevent severe illness and death in children. At the same time, we know that vaccination uptake is influenced by socio-economic, cultural and regional factors, which can lead to unequal social conditions when it comes to the burden of disease. Further, pregnant women need to know that the vaccines are safe and effective. In this project, we have a unique opportunity to use family- and population-based, as well as qualitative data to answer these questions and thus contribute to the maintenance of society´s trust in vaccinations, customize interventions to increase vaccination uptake and reduce the burden of disease in an equal way in society.Plan for project realizationThe epidemiological analyses regarding whooping cough, as well as the qualitative study will begin in 2025. Data extraction for RSV studies will be initiated in 2025 and analyses will begin in 2026. The costs for the project consist of data extraction from national registers, implementation of the qualitative study, salaries for the applicant, co-applicants, biostatistician, as well as for a doctoral student and a post-doc, who will be recruited in 2025.

Preeclampsia (PE), a severe hypertensive disorder of pregnancy, is strongly associated with complications in subsequent pregnancy and early-onset cardiovascular diseases (CVD). Women with PE also have an increased risk of CVD risk factors after pregnancy, with weight retention and overweight being key modifiable factors. Thus, the postpartum phase provides a window of opportunity for implementation of screening and preventive strategies.The overall aim of this multi-centre two-armed single-blind parallel RCT is to assess the efficacy of a bundle intervention 3-12 months postpartum tailored for primiparous women with prior PE. This includes information, targeted screening and promotion of a healthy lifestyle through support by healthcare personnel and a Smartphone-App.Population: Primiparous with PE (n=724)Intervention: A bundle intervention divided into: Light intervention 3-6 months postpartum and Intensive intervention 6-12 months postpartumControl: Standard careOutcomes: Primary: weight change over 9 months. Secondary: 1) weight change over 9 months, stratified by early pregnancy BMI&lt

25/≥25

2) systolic & diastolic blood pressure 12 months postpartumThis study seeks to fill the knowledge gap of a clinically implementable postpartum intervention in women with prior PE, with specific focus on patient perspectives. Results will be used to update clinical guidelines, thereby improving short term and possibly long-term outcomes, and ultimately lower overall health costs.

Research problem and specific questionsType-2 diabetes (T2DM) and gestational diabetes (GDM) prevalence are increasing in Sweden. Effective disease management and interventions during pregnancy could improve pregnancy outcomes and long-term health of the mother and child.This project consists of two parts

one epidemiological, and the other implementation. The epidemiological part will use contemporary cohorts to understand pregnancy outcomes in women with T2DM/GDM, in relation to disease management. Specifically, we will:Investigate the modifying effect of intensified medical surveillance and treatment – glucose control and medication.Quantify whether these associations are socially (region of birth, socioeconomic position) and BMI patterned.For the implementation part, we will explore:Barriers/facilitators for providing optimal care and self-managing diabetes during pregnancy and postnatally.Whether a co-creational process - involving health care professionals and women with T2DM/GDM - can lead to improved strategies to support person-centred care, shared decision making, and self-management of T2DM/GDM during pregnancy.Data and methodsSingleton births in the Medical Birth Register from 2003-2020 (N=2,070,000) and the Pregnancy Register from 2016-2022 (N=380,000) will be linked to quality (diabetes and neonatal) and national health registers. Regression analysis will be used to estimate the association between T2DM and GDM and maternal/infant outcomes, modified by glucose levels, treatment, BMI and social factors.The implementation part uses a multiple methods approach

focus group discussions (FGD) and individual interviews with women with T2DM/GDM and health care professionals - to explore barriers/facilitators for optimal care

and participatory action research (PAR) to co-create strategies for improved self-care.Societal relevance and utilizationEven though pregnancy is a unique opportunity for interventions targeted towards lifestyle modifications, the barriers and obstacles need to be explored. This would positively influence maternal and infant health in the short-term, reducing the likelihood of diabetes in subsequent pregnancies and later life.Plan for project realisationThe project will be conducted at the Clinical Epidemiology Division (Department of Medicine, Solna, Karolinska Institutet) and Karolinska University Hospital. Project costs include salaries (PhD student, researchers, biostatistician, data manager) and acquiring register data.