The study aims to investigate several pregnancy and childbirth complications among women of minority ethnic background in Denmark. Women of minority ethnic background have been shown to have adverse outcome during pregnancy and childbirth. The study acts as a starting point to further research into inequality in our healthcare, with specific focus on prevention and intervention.

Research Year student Hawa-Idil Harakow. Main supervisor: Lars Henning Pedersen

hawhar@biomed.au.dk

Post.Doc. Period: xx.xx.2023 - 

The association between diabetes, social inequality and low health literacy presents a paradox in the care of pregnant women with diabetes in socially vulnerable positions. Due to risks of complications associated with diabetes and social inequality, these women are followed closely by professionals across sectors. However, the tasks involved in participating in the recommended care trajectories, constitute a treatment burden, risking to overwhelm the women that are supposed to benefit from them. This makes the women less likely to participate in antenatal care, thus challenging their ability to access and benefit from health care. In this project, we examine the consequences of this paradox, by looking at how the possibilities and challenges of practicing good care is influenced by organizational and moral dynamics. We do so based on ethnographic fieldwork among professionals across sectors involved in care for pregnant women with diabetes in socially vulnerable positions and the women themselves. We thereby shift the focus from patients’ abilities to the care practices in which professionals and patients are actively involved. In doing so, we aim to articulate the specificities of practices of care which can provide us with insights into how organizational dynamics and structures might contribute to or hinder health equity.

Mette Schlütter: 

PhD period: October 2020 to October 2025 

Obesity in pregnancy is a common condition and it is associated with a number of complications during pregnancy and in labor including gestational diabetes, preeclampsia, fetal macrosomia, stillbirth, postpartum haemorrhage, neonatal death, and caesarean delivery. In this PhD project we aim to investigate if the risk of caesarean delivery is lower when labor is induced in 39 gestational week compared to expectant management of pregnancy in women with obesity. This objective is investigated in a multicentre, randomised clinical trial in collaboration with several Danish delivery departments. The trial is named the WINDOW trial. Learn more about the project at our webpage (in Danish): Windowstudiet

PhD student: Lise Qvirin Krogh: lise.qvirin.krogh@clin.au.dk

Main Supervisor: Jens Fuglsang 
Co-supervisors: Julie Glavind, Sidsel Boie, Tine Brink Henriksen, Jim Thornton

PhD period: December 2019 to December 2023.

The overall aim of this PhD project is to describe the development and evaluate both short- and long-term effects of (severe) insulin resistance in pregnancy among women with type 2 diabetes. Diabetes during pregnancy is a condition with important implications for pregnancy outcomes and long-term morbidity in mother and offspring. However, it is sparsely described for women with type 2 diabetes. Furthermore, obtaining knowledge about the mechanisms behind the development of severe insulin resistance during pregnancy, as well as the effects and consequences of insulin treatment, could benefit the women and the future generation.

PhD Student: Anna Sofie Koefoed, MD, annask@clin.au.dk

Department of Gynaecology and Obstetrics, Steno Diabetes Center Aarhus, Aarhus University Hospital

Main supervisor: Ulla Kampmann Opstrup, Clinical Associate Professor, MD, Steno Diabetes Center Aarhus, Aarhus University Hospital, co-supervisor: Per Ovesen, Professor, Department of Gynaecology and Obstetrics, Aarhus University Hospital

Aim: To assess the effect of ultrasound scanning outreach in pregnancy on the incidens and outcome
of high-risk births at Masanga Hospital in rural Sierra Leone. Background: 17% of women in the
rural areas of Sierra Leone give birth outside the hospital, which might have severe or fatal
consequences for especially pregnant women with a high-risk diagnosis and their unborn child. Our
hypothesis is that some of these complications can be prevented by antenatal ultrasound, which can
identify women at high-risk and advise them to give birth at Masanga Hospital. Method: We
investigate the incidence of high-risk births, maternal and perinatal death and severe complications
related to birth at Masanga Hospital before and after the implementation of maternal scanning
outreach at 4 community health centres in October 2020. Perspective: This study will yield novel
insights into the value of antenatal ultrasound offered in an outreach programme in rural Sierra Leone.

Research Year Student: Matilde Have Kallesøe, 201809934@post.au.dk

Supervisors:

• Susanne Haas, MD, PhD, associate professor, Department of Clinical Medicine at Aarhus University and Department of surgery at Randers Regional Hospital.

• Monica Lauridsen Kujabi, MD, PhD student, Department of Global Health at University of Copenhagen and resident at department of Obstetrics and Gynecology, Aarhus University Hospital Skejby

• Emmeli Mikkelsen, MD, PhD student, Department of Clinical Medicine at Aarhus University and Department of Obstetrics and Gynaecology at AUH.

• Niels Uldbjerg, Professor, DMSc, Department of Clinical Medicine at Aarhus University and Department of Obstetrics and Gynaecology at AUH.

PhD project period: October 2020 – June 2024.

We aim to find specific biomarkers for threatening preterm rupture of the fetal membranes in blood samples from pregnant women to improve its diagnosis and treatment. Globally, more than 1 out of 10 babies are born preterm, which is the leading cause of mortality and morbidity among children under the age of 5. Although Preterm Prelabor Rupture of Membranes (PPROM) is responsible for 1/3 of these cases, there is currently no generally accepted diagnostic tool for early diagnosis of the pregnancies at risk. We have isolated a new cell type from maternal blood, which probably origins from the fetal membranes. When the membrane is degraded near term or at threatening PPROM, fetal membrane cells are shed into the maternal blood. By measuring the concentration of this cell type at different times of gestation, we want to investigate if it can be used as a biomarker for threatening PPROM.

Medical Doctor and PhD Student: Emmeli Mikkelsen 
emmeli.mikkelsen@clin.au.dk
+45 29652328

Main Supervisor:  Niels Uldbjerg

Study protocol

In Denmark since 2004, all pregnant women are offered prenatal diagnostics as part of their first and second trimester ultrasound scan, and 97% of the women welcome this test. In case of severe malformations or chromosomal abnormalities, the parents may apply for termination of pregnancy via their MD, who contacts a regional council for late termination of pregnancy for the permission. In Denmark in 2020, 618 terminations of pregnancy due to fetal anomaly was performed after gestational week 12.

This PhD-project is based on data from the national cohort Life after the Loss and on interviews with midwives working in the field. The cohort holds information on more than 1.200 bereaved parents who answered questionnaires at one, seven and thirteen months after the loss. In this project we focus on their mental and emotional health, feelings of guilt and post traumatic stress after a termination of pregnancy due to fetal anomaly. Furthermore, we explore the midwives’ experiences and existential thoughts concerning late terminations of pregnancy, by using data from qualitative interviews with seven midwives from a recently established Unit for Loss at Gødstrup Hospital.

PhD student Mette Eklund, midwife, cand. Scient. in midwifery

Main supervisor: Dorte Hvidtjørn, midwife (RM), associate professor at Department of Clinical Medicine, AU. Other supervisors: Christina Prinds, midwife (RM) associate professor at Department of Clinical Research, University of Southern Denmark, Maja O’Connor, psychologist, associate professor at Department of Psychology and Behavioral Sciences, AU and Anne Hammer Lauridsen, MD, associate professor at Department of Clinical Medicine, AU.

Study period: March 2023 to February 2028

Every year 15 million babies are born prematurely, which can lead to death or life-long disabilities. It is often caused by a dysfunction of the uterine cervix, which constitutes the narrow channel between the vagina and womb. During pregnancy, this channel must remain closed until the beginning of term labor. A weak cervix may not withstand the weight of the fetus, the amniotic fluid and the placenta and the cervical canal will open up and cause late miscarriage or preterm delivery. In order to prevent this, a band (cerclage) can be applied around the cervix either vaginally or laparoscopically prior to a new pregnancy.

To evaluate which treatment is best for most women, we will randomize (allocate by chance) women at risk for preterm birth, to either vaginal cerclage or laparoscopic cerclage in the nordic countries and England.

Ph.d-student: Lea Kirstine Hansen: lea.hansen@clin.au.dk

Main supervisor: Julie Glavind

Co-supervisors: Niels Uldbjerg, Pernille Tine Jensen, Andrew Shennan

Study period: 01.01.2022 – 10.02.2025. 

Gestational diabetes mellitus (GDM) is one of the most common pregnancy disorders. Women diagnosed with GDM in one pregnancy have increased risk of developing GDM in following pregnancies. The most common neonatal complication to GDM is fetal macrosomia. The aim of this study is to describe the incidence of recurrent GDM, to characterize the insulin sensitivity in cases with recurrent GDM and to evaluate predicting factors for development of recurrent GDM. Furthermore, I aim to examine the role of continuous glucose monitoring (CGM) in GDM pregnancies, and to evaluate the glycemic variability monitored by CGM in GDM pregnancies as a predictor for large for gestation fetuses. The knowledge obtained from the studies will help clinicians to tailor the best possible treatment and hopefully contribute to alter the course of GDM with beneficial consequences both for the pregnant women and the future generation.

Ph.d-student: Ninna Lund Larsen: nll@clin.au.dk

Main supervisor: Associate professor Jens Fuglsang, MD, PhD
Institution: Department of Clinical Medicine – Department of Obstetrics and Gynecology, Aarhus University Hospital
Email: Jens.fuglsang@skejby.rm.dk
 

Co-supervisor: Associate professor Ulla Kampmann Opstrup, MD, PhD
Institution: Department of Clinical Medicine - SDCA-Steno Diabetes Center Aarhus
Email: ullaopst@rm.dk
 
Co-supervisor: Professor Per Glud Ovesen, MD, DMSc
Institution: Department of Clinical Medicine – Department of Obstetrics and Gynecology, Aarhus University Hospital
Email: perovese@rm.dk
 
Co-supervisor: Lene Ring Madsen, MD, PhD
Institution: Department of Clinical Medicine - SDCA-Steno Diabetes Center Aarhus - Department of Medicine, Regionshospital Gødstrup
Email: lenemase@rm.dk
 
Co-supervisor: Harold David McIntyre, MD, Professor, Director of Obstetric Medicine, Head of University of Queensland Mater Clinical Unit
Institution: University of Queensland Mater Clinical Unit, Mater Health, Brisbane, Australia
Email: David.McIntyre@mater.org.au

PhD period: 01.12.24 – 30/11-27

A systematic Cochrane review published in 2020 including 40 studies and 6548 women demonstrates that membrane sweeping is a safe method, that may be associated with a higher incidence of spontaneous onset of labor and reduced need for medical and mechanical induction. However, the existing evidence is of low certainty due to risk of bias according to study design and imprecision due to small sample sizes. To qualify the findings and to identify rather membrane sweepings at term promotes spontaneous onset of labor we will randomize low-risk pregnant women at term to no membrane sweeping or serial membrane sweepings in Danish public antenatal outpatient clinics.

PhD student: Sofie Gyrup, sofiegyrup@clin.au.dk

Main supervisor: Julie Glavind

Co supervisors: Mie de Wolff, Malou Barbosa, Lise Brogaard, Sidsel Boie.

Webpage: sweeptrial.dk