Background: Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories.

Methods: We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)—a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not).

Results: Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38–1.54) and 1.50 (95% CI 1.43–1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59–3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571).

Conclusions: The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.

Introduction: Severe perineal injuries at childbirth affect women's postnatal health, including future childbirths. First births with vacuum extraction carry an increased risk of obstetric anal sphincter injuries (OASIS). Lateral or mediolateral episiotomy at vacuum extraction may decrease the risk of OASIS. Our aim was to assess whether lateral or mediolateral episiotomy, or OASIS, at vacuum extraction in nulliparous women is associated with prelabor cesarean delivery in the subsequent childbirth.

Material and methods: This is a nationwide observational study using data from the Swedish Medical Birth Register, including women having a first birth with vacuum extraction and a second birth in 2000–2014. Both births were live, single, cephalic, ≥34 gestational weeks without malformations. The association between episiotomy or OASIS in the first birth and prelabor cesarean delivery in the second birth was examined using univariate and multivariate logistic regression with inverse probability of treatment weighting, and interaction analysis. Main outcome measure was prelabor cesarean delivery in the second birth.

Results: In total, 44 656 women with vacuum extraction at their first birth were included. The rate of prelabor cesarean delivery in the second birth was 5.9% (824 of 13 950) in women with episiotomy, compared with 6.0% (1830 of 30 706) in women without episiotomy. Thus, women with episiotomy did not have an increased risk of prelabor cesarean delivery (adjusted odds ratio [aOR] 1.00, 95% confidence interval [95% CI] 0.83–1.20) compared with women without episiotomy. For comparison, the rate of prelabor cesarean delivery in the second birth was 20.6% (1275 of 6176) in women with OASIS, compared with 3.6% (1379 of 38 480) in women without OASIS (aOR 6.57, 95% CI 5.97–7.23). There was no interaction between episiotomy and OASIS.

Conclusions: Lateral or mediolateral episiotomy at vacuum extraction in nulliparous women did not increase the risk of prelabor cesarean delivery in the subsequent childbirth. OASIS increased the odds of prelabor cesarean delivery more than sixfold.

Importance  Bereavement following parental death experienced in adulthood may be associated with suicide over many years, but this risk has received scant attention.

Objective  To investigate whether the risk of suicide increases among adult children around the anniversary of a parent’s death.

Design, Setting, and Participants  This case-crossover study used Swedish register-based longitudinal data from 1990 to 2016, based on the entire national population. Participants included all adults aged 18 to 65 years who experienced parental death and subsequently died by suicide. Conditional logistic regression was used to quantify the association between the anniversary (or preanniversary and postanniversary periods) and suicide, controlling for time-invariant confounding. All analyses were stratified by sex of the offspring. The analyses were also stratified by the sex of the deceased parent, time since parental death, age, and marital status. Data analyses were performed in June 2022.

Exposures  Anniversary of a parent’s death (or preanniversary and postanniversary periods).

Main Outcomes and Measures  Suicide.

Results  Of 7694 individuals who died by suicide (76% intentional self-harm), 2255 (29%) were women, and the median (IQR) age at suicide was 55 (47-62) years. There was evidence of an anniversary reaction among women, with a 67% increase in the odds of suicide when exposed to the period from the anniversary to 2 days after the anniversary, compared with when not being exposed (odds ratio [OR], 1.67; 95% CI, 1.07-2.62). The risk was particularly pronounced among maternally bereaved women (OR, 2.29; 95% CI, 1.20-4.40) and women who were never married (OR, 2.08; 95% CI, 0.99-4.37), although the latter was not statistically significant. An increased risk of suicide from the day before up to the anniversary was observed among women bereaved between the ages of 18 and 34 years (OR, 3.46; 95% CI, 1.14-10.56) and between the ages of 50 and 65 years (OR, 2.53; 95% CI, 1.04-6.15). Men had an attenuated suicide risk for the period from the day before up to the anniversary (OR, 0.57; 95% CI, 0.36-0.92).

Background Young maternal age is associated with lower birthweight and higher rates of preterm birth and childhood hospitalisations. Internationally, teen pregnancy rates vary widely, reflecting differences in social, welfare, and health care factors in different cultural contexts. Objectives To determine whether the increased risk of adverse infant outcomes among teenage mothers varies by country, reflecting different national teenage birth rates and country-specific social/welfare policies, in Scotland (higher teenage pregnancy rates), England, New South Wales (NSW; Australia), Ontario (Canada), and Sweden (lower rates). Methods We used administrative hospital data capturing 3 002 749 singleton births surviving to postnatal discharge between 2010 and 2014 (2008-2012 for Sweden). We compared preterm birth (24-36 weeks' gestation), mortality within 12 months of postnatal discharge, unplanned hospital admissions, and emergency department visits within 12 months of postnatal discharge, for infants born to mothers aged 15-19, 20-24, 25-29, and 30-34 years. Results Compared to births to women aged 30-34 years, risks of adverse outcomes among teenage mothers were higher in all countries, but the magnitude of effects was not related to country-specific rates of teenage births. Teenage mothers had between 1.2% (95% confidence interval [CI] 0.7, 1.7, Sweden) and 2.0% (95% CI 1.4, 2.5, NSW) more preterm births, and between 9.8 (95% CI 7.2, 12.4, England) and 19.7 (95% CI 8.7, 30.6, Scotland) more deaths per 10 000 infants, compared with mothers aged 30-34. Between 6.4% (95% CI 5.5, 7.4, NSW) and 25.4% (95% CI 24.7, 26.1, Ontario), more infants born to teenage mothers had unplanned hospital contacts compared with those born to mothers aged 30-34. Conclusions Regardless of country, infants born to teenage mothers had universally worse outcomes than those born to older mothers. This excess risk did not vary by national rates of livebirths to teenage mothers. Current mechanisms to support teenage mothers have not eliminated maternal age-related disparities in infant outcomes; further strategies to mitigate excess risk in all countries are needed.

This study aims to examine whether disparities in gestational age outcomes between foreign and Swedish-born mothers are contingent on the measure used to estimate gestational age and, if so, to identify which maternal factors are associated with the discrepancy. Using population register data, we studied all singleton live births in Sweden from 1992-2012 (n = 1,317,265). Multinomial logistic regression was performed to compare gestational age outcomes classified into very (<32 weeks) and late preterm (32-36 weeks), term and post-term derived from the last menstrual period (LMP) and ultrasound estimates in foreign- and Swedish-born women. Compared to Swedish-born women, foreign-born women had similar odds of very preterm birth (OR: 0.98 [95% CI: 0.98, 1.01]) and lower odds of moderately preterm birth (OR: 0.95 [95% CI: 0.92, 0.98]) based on ultrasound, while higher risks based on LMP (respectively, OR: 1.10 [95% CI: 1.07, 1.14] and 1.09 [95% CI: 1.06, 1.13]). Conclusions on disparities in gestational age-related outcomes by mother's country of origin depend on the method used to estimate gestational age. Except for very preterm, foreign-born women had a health advantage when gestational age is based on ultrasound, but a health disadvantage when based on LMP. Studies assessing disparities in very preterm birth by migration status are not affected by the estimation method but caution should be taken when interpreting disparities in moderately preterm and preterm birth rates.

There is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender. Drawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-gender combination. We found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorder partially operated via low income of the fathers. Furthermore, grandparents' psychiatric disorders influenced their children's and grandchildren's income. We conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents' mental health problems could cast a long shadow on their children's and grandchildren's socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems.

Background

An increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.

Methods

Using the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.

Results

Compared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).

Conclusion

Refugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.

Background

Postpartum hemorrhage is an important cause of maternal death and morbidity. However, it is unclear whether women who experience postpartum hemorrhage are at an increased risk of postpartum depression.

Objectives

To examine whether postpartum hemorrhage is associated with postpartum depression.

Methods

We conducted a national register-based cohort study of 486,476 Swedish-born women who had a singleton livebirth between 2007 and 2014. We excluded women with pre-existing depression or who filled a prescription for an antidepressant before childbirth. We classified postpartum depression up to 12 months after giving birth by the presence of an International Classification of Diseases, version 10 (ICD-10) diagnosis code for depression or a filled outpatient prescription for an antidepressant. We used Cox proportional hazard models, adjusting for maternal sociodemographic and obstetric factors.

Results

Postpartum depression was identified in 2.0% (630/31,663) of women with postpartum hemorrhage and 1.9% (8601/455,059) of women without postpartum hemorrhage. In our unadjusted analysis, postpartum hemorrhage was not associated with postpartum depression (unadjusted hazard ratio (HR) = 1.06, 95% confidence interval (CI) 0.97-1.15). After adjusting for maternal age, parity, education, cohabitation status, maternal smoking status, and early pregnancy maternal BMI, gestational age, and birthweight, the association did not appreciably change, with confidence intervals overlapping the null (adjusted HR = 1.08, 95% CI 0.99, 1.17).

Conclusions

Within a population-based cohort of singleton women in Sweden with no prior history of depression, postpartum hemorrhage was not associated with postpartum depression.

Objective

To investigate the effects of maternal and paternal depression on the risk for preterm birth.

Design

National cohort study.

Setting

Medical Birth Register of Sweden, 2007–2012.

Population

A total of 366 499 singleton births with linked information for parents’ filled drug prescriptions and hospital care.

Methods

Prenatal depression was defined as having filled a prescription for an antidepressant drug or having been in outpatient or inpatient hospital care with a diagnosis of depression from 12 months before conception until 24 weeks after conception. An indication of depression after 12 months with no depression was defined as ‘new depression’, whereas all other cases were defined as ‘recurrent depression’.

Main outcome measures

Odds ratios (ORs) for very preterm (22–31 weeks of gestation) and moderately preterm (32–36 weeks of gestation) births were estimated using multinomial logistic regression models.

Results

After adjustment for maternal depression and sociodemographic covariates, new paternal prenatal depression was associated with very preterm birth [adjusted OR (aOR) 1.38, 95% confidence interval (95% CI) 1.04–1.83], whereas recurrent paternal depression was not associated with an increased risk of preterm birth. Both new and recurrent maternal prenatal depression were associated with an increased risk of moderately preterm birth (aOR 1.34, 95% CI 1.22–1.46, and aOR 1.42, 95% CI 1.32–1.53, respectively).

Conclusions

New paternal and maternal prenatal depression are potential risk factors for preterm birth. Mental health problems in both parents should be addressed for the prevention of preterm birth.

Importance  To better support children with the experience of parental death, it is crucial to understand whether parental death increases the risk of adverse school outcomes.

Objectives  To examine whether parental death is associated with poorer school outcomes independent of factors unique to the family, and whether children of certain ages are particularly vulnerable to parental death.

Design, Setting, and Participants  This population-based sibling cohort study used Swedish national register-based longitudinal data with linkage between family members. Register data were collected from January 1, 1990, to December 31, 2016. Data analyses were performed on July 14, 2021. The participants were all children born between 1991 and 2000 who lived in Sweden before turning age 17 years (N = 908 064).

Exposure  Parental death before finishing compulsory school.

Main Outcomes and Measures  Mean school grades (year-specific z scores) and ineligibility for upper secondary education on finishing compulsory school at age 15 to 16 years. Population-based cohort analyses were conducted to examine the association between parental death and school outcomes using conventional linear and Poisson regression models, after adjustment for demographic and parental socioeconomic and health indicators measured before childbirth. Second, using fixed-effect linear and Poisson regression models, children who experienced parental death before finishing compulsory school were compared with their siblings who experienced the death after. Third, the study explored the age-specific associations between parental death and school outcomes.

Results  In the conventional population-based analyses, bereaved children (N = 22 634; 11 553 boys [51.0%]; 11 081 girls [49.0%]; mean [SD] age, 21.0 [2.8] years) had lower mean school grade z scores (adjusted β coefficient, −0.19; 95% CI, −0.21 to −0.18; P < .001) and a higher risk of ineligibility for upper secondary education than the nonbereaved children (adjusted risk ratio, 1.36; 95% CI, 1.32-1.41; P < .001). Within-sibling comparisons using fixed-effects models showed that experiencing parental death before finishing compulsory school was associated with lower mean school grade z scores (−0.06; 95% CI, −0.10 to −0.01; P = .02) but not with ineligibility for upper secondary education (adjusted risk ratio, 1.07; 95% CI, 0.93-1.23; P = .34). Independent of birth order, losing a parent at a younger age was associated with lower grades within a family.

Conclusions and Relevance  In this cohort study, childhood parental death was associated with lower school grades after adjustment for familial confounders shared between siblings. Children who lost a parent may benefit from additional educational support that could reduce the risk of adverse socioeconomic trajectories later in life.

Background Population-based longitudinal studies on bereaved children and youth’s mental health care use are scarce and few have assessed the role of surviving parents’ mental health status.

Methods Using register data of individuals born in Sweden in 1992–1999, we performed a matched cohort study(n = 117,518) on the association between parental death and subsequent initiation of antidepressant treatment among individuals bereaved at ages 7–24 years. We used flexible parametric survival models to estimate the hazard ratios (HRs) over time after bereavement, adjusting for individual and parental factors. We further examined if the association varied by age at loss, sex, parental sociodemographic factors, cause of death, and the surviving parents’psychiatric care.

Findings The bereaved were more likely to initiate antidepressants treatment than the nonbereaved matched individuals during follow-up (incidence rate per 1000 person years 27.5 [26.5–28.5] vs. 18.2 [17.9–18.6]). The HRs peaked in the first year after bereavement and remained higher than the nonbereaved individuals until the end of the follow-up. The average HR over the 12 years of follow-up was 1.48 (95% confidence interval [1.39–1.58]) for father’s death and 1.33 [1.22–1.46] for mother’s death. The HRs were particularly high when the surviving parents received psychiatric care before bereavement (2.11 [1.89–2.56] for father’s death; 2.14 [1.79–2.56] for mother’s death) or treated for anxiety or depression after bereavement (1.80 [1.67–1.94]; 1.82 [1.59–2.07]).

Interpretation The risk of initiating antidepressant treatment was the highest in the first year after parental death and remained elevated over the next decade. The risk was particularly high among individuals with surviving parentsaffected by psychiatric morbidity.

Background: Fathers may affect expectant mothers’ daily living situations, which in turn might influence pregnancy outcomes. We investigated the association between paternal violent criminality and risk of preterm birth (≤36 weeks). Methods: We conducted a register-based study with all live singleton births in the Swedish Medical Birth Register from 1992 to 2012, linked with records of paternal violent crime convictions from the National Crime Register from 1973 to 2012. Results: Paternal violent criminality was associated with increased risk of preterm birth and lower gestational age. The association was especially pronounced among infants of reoffenders: men convicted of three or more violent crimes (adjusted odds ratio [aOR] 1.23 [95% CI 1.17, 1.29]). Maternal half sibling-comparisons, an analytic approach controlling for maternal factors stable across pregnancies, also suggested increased risk of preterm birth and lower gestational age when exposed to a violently reoffending father compared to a father without violent criminal convictions (aOR 1.30 [0.99, 1.72], adjusted mean difference − 1.07 [− 1.78, − 0.36]). Conclusions: Persistent paternal violent criminality was associated with increased risk of preterm birth, even after controlling for maternal characteristics that did not change between pregnancies.

Interpregnancy interval (IPI) is associated with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California during 1997-2012. Adjusting for confounders measured in the index pregnancy (i.e., the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios for SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared with an IPI of 18-23 months, an IPI of <6 months had the same risk for SMM in between-mother comparisons (adjusted risk ratio (aRR) = 0.96, 95% confidence interval (CD: 0.91, 1.02) but lower risk in within-mother comparisons (aRR = 0.76, 95 degrees/0 CI: 0.67, 0.86). IPIs of 24-59 months and >= 60 months were associated with increased risk of SMM in both between-mother (aRR = 1.18 (95% CI: 1.13, 1.23) and aRR = 1.76 (95% CI: 1.68, 1.85), respectively) and within-mother (aRR = 1.22 (95% CI: 1.11, 1.34) and aRR = 1.88 (95% CI: 1.66, 2.13), respectively) comparisons. The association between IPI and SMM did not vary substantially by maternal age or parity. In this study, longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.

OBJECTIVES: Adverse early-life experience may affect preterm delivery later in life through priming of stress response. We aim to investigate the links between out-of-home care (OHC) experience in childhood, as a proxy of severe adversities, on subsequent risk of preterm delivery. METHODS: A register-based national cohort of all women born in Sweden between 1973 and 1977 (N = 175 821) was crosslinked with information on these women's subsequent deliveries as recorded in the Swedish medical birth register. During 1986-2012, 343 828 livebirths of these women were identified. The associations between women's OHC experience and her risk of preterm delivery were analyzed through logistic regression models, adjusting for women's own preterm birth, intrauterine growth, and childhood socioeconomic situation. RESULTS: Compared with women that never entered OHC, women with OHC experience up to and after age 10 were both associated with increased risks of preterm delivery (adjusted odds ratio [aOR] = 1.23 [95% confidence interval 1.08-1.40] and aOR = 1.29 [1.13-1.48], respectively). Women who experienced OHC before or at 10 years of age had increased risk of both spontaneous and medically indicated preterm delivery (aOR = 1.19 [1.03-1.38] and aOR = 1.27 [1.02-1.59], respectively). Women who experienced OHC after age 10 had a more pronounced risk of medically indicated preterm delivery (aOR = 1.76 [1.44-2.16]) than for spontaneous preterm delivery (aOR = 1.08 [0.92-1.27]). CONCLUSIONS: Women who were placed in OHC in childhood had increased risk of preterm delivery independent from their own perinatal history. Stress response, as 1 consequence of early life adversities, may take its toll on women's reproductive health and their offspring, calling for integrative efforts in preventing early life adversity.

Families involved with child welfare services (CWS) often diverge systematically from the general population. They are more likely to live in challenging circumstances characterised by adverse socioeconomic conditions (e.g. poverty) and psychosocial adversities (e.g. mental health problems and substance misuse). Past research has primarily focused on the development and lifelong health and social outcomes of children who have experienced out-of-home care (OHC). However, the separation could also trigger negative emotions and other changes in parents, but much less attention has been paid to the associations between children’s placement and parents’ lives.

This scoping review synthesises results from quantitative studies investigating the socioeconomic and psychosocial outcomes of parents who have experienced the removal of a child into OHC. Six databases were comprehensively searched, with 15 studies selected for inclusion in the review. Studies were conducted among countries of the Organization for Economic Cooperation and Development (OECD) with substantial heterogeneity in the methods and designs, as grouped into three categories: “cross-sectional assessments” (4 studies), “longitudinal assessments” (7 studies) and “pre-post assessment” (4 studies).

To a large extent, studies focus on psychosocial outcomes among mothers. The majority indicate that having a child placed in OHC is associated with the deterioration of psychosocial or socioeconomic outcomes among parents. We may conclude that parents who have experienced the removal of a child are a group that deserves tailored support and counselling. However, further quantitative research into aspects of parents’ lives after children’s OHC placement is needed, particularly with longitudinal designs and more rigorous methods to enable a better understanding of the causes and effects of these associations. This might support the development of targeted and effective interventions for these families.

Background: Previous Swedish studies have shown a social gradient on paediatric care for viral gastroenteritis. Aim: To study the effect of a free rotavirus vaccine programme on hospital care for viral gastroenteritis. Method: A register-based national cohort study of paediatric in- and outpatient care for viral gastroenteritis in children <2 years old in two Swedish counties in 2014-2017, with the rest of the country as comparison. Adjusted hazard ratios were estimated by the differences-in-differences (DiD) estimator in Cox regression in the entire cohort and by social indicators. Results: Reductions of 37% and 24% for inpatient care, and 11 % and 21% for outpatient care for viral gastroenteritis were found in the Stockholm and Jonkoping counties, respectively, after adjusting for time trends and social indicators. For inpatient care, the change was similar over social groups in both counties. In the larger county of Stockholm, smaller reductions in outpatient care were detected for children in socially disadvantaged families. Conclusions: A free rotavirus vaccination programme moderately reduced paediatric care for viral gastroenteritis. There were indications of an increase in socioeconomic differences in paediatric outpatient care for viral gastroenteritis, but further studies are needed to confirm this result in a broader health care perspective.

Background: Many births in industrialised countries are to immigrant parents, or to one immigrant and one domestically born parent. Their newborn outcomes have not been well studied. 

Methods: We conducted a study of 1690423 singleton infants born in Sweden between 1987 and 2008, including those of immigrants from East Asia, South Asia, Sub-Saharan Africa, and East Africa. Preterm delivery and small for gestational age (SGA) were assessed among infants of (i) immigrant parents from the same world region, (ii) an immigrant mother and a Swedish-born father, and (iii) a Swedish-born mother and an immigrant father; each compared to (iv) two Swedish-born parents. Log binomial regression analysis generated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) for preterm delivery and SGA.

Results: Compared with infants of two Swedish-born parents, infants born to immigrant mothers from East Asia, South Asia, and Sub-Saharan African were at higher risk of preterm delivery (ARR ranging from 1.2 to 1.9), irrespective of whether the father was from the same world region or Swedish-born, with the only exception of East African women, who had lower risk. Infants born to two foreign-born parents had the highest risks of SGA, particularly South Asians (ARR 4.69; 95% CI 4.29, 5.12). Mixed couples exhibited intermediate risks of SGA. 

Conclusions: Adverse birth outcomes differ according to a couple's ethnic composition. Having a Swedish-born partner is associated with lower risk of SGA among immigrant mothers and fathers, and with lower risk of preterm delivery among immigrant fathers but not mothers.

The objective of this study is to examine the intergenerational transmission of out-of-home care. This population-based study used data from the Swedish National Registers and included all children born in Sweden between 1990 and 2012 (followed for up to 13 years), whose parents were both born in Sweden between 1973 and 1980 (278 327 children; 145 935 mothers; 146 896 fathers). Cox regression models are used to obtain crude and adjusted hazard ratios (HR) of OHC placement among children based on parents’ history of OHC. Compared with children whose parents both did not have a history of OHC, the risk of being placed in OHC was greater when both parents spent time in OHC (crude HR = 48.70, 95% CI 41.46–57.21; adjusted HR = 3.04, 95% CI = 2.54–3.64), however, children who had only one parent who spent time in care were also at higher risk (mothers only adjusted HR = 2.37, 95% CI = 2.08–2.70; fathers only adjusted HR = 1.33, 95% CI = 1.13–1.55). The crude rate of placement in OHC was highest for children whose parents were placed in care during adolescence, but after adjusting for social and behavioral covariates, children whose parents were in care in early childhood were at greater risk of OHC than children whose parents were in care in adolescence. To reduce this intergenerational transmission of OHC, more supports should be provided to parents who spent time in OHC to ensure a successful transition to parenthood.

Background: Individuals involved in out-of-home care are at higher risk of death by suicide. We aimed to determine whether parents with two generations of involvement in out-of-home care (themselves as children, and their own children) are at increased risk of death by suicide than parents with no involvement or parents with one generation of involvement in out-of-home care. Method: This population-based cohort study included all individuals born in Sweden between 1973 and 1980 who had at least one child between 1990 and 2012 (n=487,948). Women (n=259,275) and men (n=228,673) were examined separately. Results: When compared with mothers with no involvement in out-of-home care, mothers with two generations of involvement were at more than five times greater risk of death by suicide (aHR=5.52; 95% CI 2.91-10.46); mothers with one generation of involvement were also at significantly higher risk of death by suicide (mothers were in care as children: aHR=2.35; 95% CI 1.27-4.35; child was placed in care: aHR=3.23; 95% CI 1.79-5.83). Involvement in out-of-home care (in either generation) did not affect risk of death by suicide for fathers. Limitations: Reason for placement in out-of-home care is not known; these reasons could also be associated with risk of death by suicide Conclusion: Mothers with involvement in out- of-home care, either as children or when their child was placed in care, are at significantly higher risk of death by suicide. Mental health services should be provided to individuals involved in out-of-home care.

We examined whether women experiencing severe maternal morbidity (SMM) are more likely to be treated for a psychiatric illness or be prescribed psychotropic medications in the postpartum year than mothers who did not experience SMM. We also examine the relationship between SMM and specific mental health-related outcomes, and the relationship between specific SMM diagnoses/procedures and postpartum mental-health-related outcomes. The national registers in Sweden were used to create a population-based matched cohort. Every delivery with SMM between July 1, 2006, and December 31, 2012 (n = 8558), was matched with two deliveries without SMM (n = 17,116). Conditional logistic regression models assessed the relationship between SMM and postpartum mental health-related outcomes. Women who experienced SMM had significantly greater odds of being treated for a psychiatric disorder (aOR 1.22; 95% CI 1.03-1.45) and being prescribed psychotropic medications (aOR 1.40; 95% CI 1.24-1.58) in the postpartum year. Specifically, they had significantly greater odds of being treated for neuroses (aOR 1.35; 95% CI 1.09-1.69) and having a prescription for anxiolytics/hypnotics (aOR 1.36; 95% CI 1.18-1.58) or antidepressants (aOR 1.35; 95% CI 1.17-1.55). Women who were diagnosed with shock or uterine rupture/obstetric laparotomy during delivery had the greatest odds of postpartum mental health-related outcomes. This study identified mothers with SMM as a group at high risk for postpartum mental illness. Postpartum mental health services should be provided to ensure the well-being of these high-risk mothers.

BACKGROUND: Separation from one's child can have significant consequences for parental health and well-being. We aimed to investigate whether parents whose children were placed in care had higher rates of avoidable mortality.

METHODS: Data were obtained from the Swedish national registers. Mortality rates among parents whose children were placed in care between 1990 and 2012 (17 503 mothers, 18 298 fathers) were compared with a 1:5 matched cohort of parents whose children were not placed. We computed rate differences and HRs of all-cause and avoidable mortality.

RESULTS: Among mothers, deaths due to preventable causes were 3.09 times greater (95% CI 2.24 to 4.26) and deaths due to amenable causes were 3.04 times greater (95% CI 2.03 to 4.57) for those whose children were placed in care. Among fathers, death due to preventable causes were 1.64 times greater (95% CI 1.32 to 2.02) and deaths due to amenable causes were 1.84 times greater (95% CI 1.33 to 2.55) for those whose children were placed in care. Avoidable mortality rates were higher among mothers whose children were young when placed in care and among parents whose children were all placed in care.

CONCLUSIONS: Parents who had a child placed in out-of-home care are at higher risk of avoidable mortality. Interventions targeting mothers who had a child aged less than 13 placed in care, and parents whose children were all placed in care could have the greatest impact in reducing avoidable mortality in this population.