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Turkmen, Sahruh
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Publications (10 of 28) Show all publications
Holmberg, E., Sjöstedt, J., Malinina, E., Johansson, M., Turkmen, S., Ragagnin, G., . . . Bäckström, T. (2018). Allopregnanolone involvement in feeding regulation, overeating and obesity. Frontiers in neuroendocrinology (Print), 48, 70-77
Open this publication in new window or tab >>Allopregnanolone involvement in feeding regulation, overeating and obesity
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2018 (English)In: Frontiers in neuroendocrinology (Print), ISSN 0091-3022, E-ISSN 1095-6808, Vol. 48, p. 70-77Article, review/survey (Refereed) Published
Abstract [en]

Obesity is strongly associated with ill health, primarily caused by consumption of excessive calories, and promoted (inter alia) by gamma-amino-butyric-acid (GABA) stimulating food intake by activating GABA(A) receptors (primarily with alpha 3 and alpha 2 subunits) in the hypothalamic arcuate nucleus and paraventricular nucleus. Allopregnanolone is a potent positive GABAA receptor modulating steroid (GAMS). As reviewed here, elevated allopregnanolone levels are associated with increases in food intake, preferences for energy-rich food, and obesity in humans and other mammals. In women with polycystic ovarian disease, high serum allopregnanolone concentrations are linked to uncontrolled eating, and perturbed sensitivity to allopregnanolone. Increases in weight during pregnancy also correlate with increases in allopregnanolone levels. Moreover, Prader-Willis syndrome is associated with massive overeating, absence of a GABA(A) receptor (with compensatory > 12-, > 5- and > 1.5-fold increases in alpha 4, gamma 2, and alpha 1, alpha 3 subunits), and increases in the alpha 4, beta x, delta receptor subtype, which is highly sensitive to allopregnanolone. GABA and positive GABA-A receptor modulating steroids like allopregnanolone stimulates food intake and weight gain.

Place, publisher, year, edition, pages
Academic Press, 2018
Keywords
Allopregnanolone, GABA, GABA(A) receptor, Satiety, Hunger, Obesity, Overeating
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-145173 (URN)10.1016/j.yfrne.2017.07.002 (DOI)000424316800008 ()28694181 (PubMedID)
Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2019-05-06Bibliographically approved
Turkmen, S., Johansson, S. & Dahmoun, M. (2018). Foetal Macrosomia and Foetal-Maternal Outcomes at Birth. Journal of Pregnancy, Article ID 4790136.
Open this publication in new window or tab >>Foetal Macrosomia and Foetal-Maternal Outcomes at Birth
2018 (English)In: Journal of Pregnancy, ISSN 2090-2727, E-ISSN 2090-2735, article id 4790136Article in journal (Refereed) Published
Abstract [en]

To investigate how macrosomia affects foetal-maternal birth outcomes, we conducted a retrospective cohort study of singleton pregnant women who gave birth at gestational age >= 37+0 weeks. The patients were divided into three groups according to birth weight: "macrosomia" group, >= 4500 g, n=285; "upper-normal" group, 3500-4499 g, n=593; and "normal" group, 2500-3499 g, n=495. Foetal-maternal and delivery outcomes were compared among the three groups after adjustment for confounders. Caesarean section was more frequent in the macrosomia group than in upper-normal and normal groups. The duration of labour (p < 0.05) and postpartum care at the hospital (p < 0.001) were the highest in the macrosomia group. Increased birth weight was associated with higher risks of shoulder dystocia (p < 0.001), increased bleeding volume (p < 0.001), and perineal tear (p < 0.05). The Apgar score at 5 minutes (p < 0.05), arterial cord pH (p < 0.001), and partial pressure of O2 (p < 0.05) were lower, while the arterial cord partial pressure of CO2 was higher (p < 0.001), in the macrosomia group. Macrosomia has potentially serious impacts for neonate and mother as a result of a complicated and occasionally traumatic delivery.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-151412 (URN)10.1155/2018/4790136 (DOI)000441978800001 ()
Funder
Swedish Association of Local Authorities and Regions
Available from: 2018-09-03 Created: 2018-09-03 Last updated: 2018-09-04Bibliographically approved
Tawhid Söderholm, N. & Turkmen, S. (2018). Impact of Epidural Analgesia in Labour onNeonatal and Maternal Outcomes. Open Journal of Obstetrics and Gynecology, 8, 767-779
Open this publication in new window or tab >>Impact of Epidural Analgesia in Labour onNeonatal and Maternal Outcomes
2018 (English)In: Open Journal of Obstetrics and Gynecology, ISSN 2160-8792, E-ISSN 2160-8806, Vol. 8, p. 767-779Article in journal (Refereed) Published
Abstract [en]

AimTo evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. 

Methods: A retrospective cohort study of nulliparous parturients who gave birth in Vasternorrland County, Sweden, over a 2-year period between 2015 and 2016. Neonatal outcomes (Apgar score at 5 min and umbilical cord arterial blood gases), maternal outcomes (perineal injury, total bleeding volume and maternal satisfaction with birth) and labour parameters (mode of delivery and the durations of labour and postpartum hospital stay) were evaluated. 

Results: The study cohort consisted of 1449 women with singleton pregnancies. Patients were divided into two groups according to whether during labour they were administered epidural analgesia using bupivacaine and sufentanil (EDA group, n = 615) or not (non-EDA group, n = 834). The rate of assisted vaginal delivery was significantly higher in the EDA group than in the non-EDA group (15.6% and 11.3%, respectively, p < 0.05), whereas the rates of caesarean section were similar. The duration of the active phase of labour was significantly longer in the EDA group than in the non-EDA group (489 ± 217 min versus 371 ± 210 min, respectively, p < 0.001). The Apgar score at 5 min and umbilical cord blood pH were lower and the base deficit greater in the EDA group (p < 0.001, p < 0.001 and p < 0.01, respectively). Bleeding volume was similar between the groups after adjusting for gestational age. Women in the EDA group were more satisfied with their labour experience, as measured by the visual analogue scale (p < 0.05). 

Conclusion: The results of this study suggest that EDA affects delivery and neonatal-maternal outcomes negatively, but increases the mother’s satisfaction with labour.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2018
Keywords
Obstetric, Visual Analogue Scale, Maternal Satisfaction, Apgar Score, Perineal Injury, Mode of Delivery, Foetal Blood Gases
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-158015 (URN)10.4236/ojog.2018.89080 (DOI)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-16Bibliographically approved
Danielsson, C., Dahmoun, M., Bolin, M., Agrell, J. & Turkmen, S. (2018). Management and outcomes of preterm premature rupture of the membranes. CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY, 45(3), 419-424
Open this publication in new window or tab >>Management and outcomes of preterm premature rupture of the membranes
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2018 (English)In: CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY, ISSN 0390-6663, Vol. 45, no 3, p. 419-424Article in journal (Refereed) Published
Abstract [en]

Purpose of investigation: To compare the maternal and neonatal outcomes of preterm premature rupture of the membranes (PPROM) between two management strategies. Materials and Methods: This retrospective cohort study involved 153 pregnant women who presented with PPROM at a gestational age of 28+0 to 36+6 weeks to evaluate the effects of expectant management (EM; labor > 36 hours) and active management (AM; labor < 36 hours) on maternal and neonatal outcomes. The EM and AM groups were also compared independently of gestational age and after being divided into two subgroups: early PPROM (gestational age 28+0 to 33+6 weeks) and late PPROM (34+0 to 36+6 weeks). Results: There were no differences between the AM and EM groups in the rates of maternal infection or placental abruption, or in neonatal outcomes, including low Apgar scores, respiratory distress syndrome, or the need for continuous positive airway pressure (CPAP). In the early PPROM subgroup, arterial umbilical blood base excess levels were more negative in the AM group (p = 0.007). In the late PPROM subgroup, the change in systolic blood pressure between admission to the maternity care center and membrane rupture was greater in the AM group (p = 0.049). Conclusions: There were no clinically significant differences in the maternal and neonatal outcomes of PPROM between AM and EM.

Place, publisher, year, edition, pages
I R O G CANADA, INC, 2018
Keywords
Preterm, Premature, Rupture of membrane, Delivery, Expectant management, Active management, Neonatal and maternal outcomes
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-151202 (URN)10.12891/ceog4278.2018 (DOI)000435158800021 ()2-s2.0-85049743484 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-09-05Bibliographically approved
Turkmen, S., Tjernström, M., Dahmoun, M. & Bolin, M. (2018). Post-partum duration of satisfaction with childbirth. Journal of obstetrics and gynaecology research, 44(12), 2166-2173
Open this publication in new window or tab >>Post-partum duration of satisfaction with childbirth
2018 (English)In: Journal of obstetrics and gynaecology research, ISSN 1341-8076, E-ISSN 1447-0756, Vol. 44, no 12, p. 2166-2173Article in journal (Refereed) Published
Abstract [en]

AIM: Satisfaction with childbirth has become increasingly important among healthcare providers. We evaluated whether satisfaction levels change with time (up to 3 months after delivery).

METHODS: A prospective study of nulliparous women was designed to evaluate their levels of satisfaction with childbirth and care during birth in the maternity unit of a county hospital in Sundsvall, Sweden. Patient satisfaction with birth and health care was measured twice, during the first week after birth and 3 months later, with the Childbirth Experience Questionnaire (CEQ). Maternal and labor information were collected with a form filled in by the patients and completed with information from the patients' records.

RESULTS: A total of 78 primiparous women participated in the study and answered the questionnaire in the first week after labor, and 63 of them completed the study by answering the same questionnaire 3 months after delivery. The total CEQ score did not change after 3 months, but the scores for the subscales 'professional support' and 'participation' decreased 3 months after labor (P = 0.008 and P = 0.001, respectively). A visual analogue scale predicted the total CEQ scores at both 1 week (P < 0.001) and 3 months (P = 0.003).

CONCLUSION: Our results indicate that satisfaction with labor and birth among primiparous women was unchanged 3 months after labor.

Place, publisher, year, edition, pages
Blackwell Publishing, 2018
Keywords
memory, primiparous, professional support, questionnaire, satisfaction, visual analogue scale score
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-153626 (URN)10.1111/jog.13775 (DOI)000451854100005 ()30058272 (PubMedID)2-s2.0-85051220437 (Scopus ID)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2018-11-26 Created: 2018-11-26 Last updated: 2019-02-01Bibliographically approved
Klevedal, C. & Turkmen, S. (2017). Fetal-maternal outcomes and complications in pregnant women with polycystic ovary syndrome. Minerva Ginecologica, 69(2), 141-149
Open this publication in new window or tab >>Fetal-maternal outcomes and complications in pregnant women with polycystic ovary syndrome
2017 (English)In: Minerva Ginecologica, ISSN 0026-4784, E-ISSN 1827-1650, Vol. 69, no 2, p. 141-149Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Earlier studies have shown that polycystic ovary syndrome (PCOS) is associated with cardiovascular disease as well as pregnancy complications. We examined whether women with PCOS have an increased risk of complications in pregnancy compared with healthy women, and if there are any correlations between complications and clinical/demographic variables before and/or in early pregnancy.

METHODS: This retrospective cohort study comprised 37 women with PCOS and 126 healthy women whose birth was recorded at Sundsvall County Hospital, Sweden, from 2009 to 2014. Medical records were searched to identify pregnancy complications, maternal outcomes, and neonatal outcomes.

RESULTS: Compared with healthy women, the women with PCOS were more likely to have a history of miscarriage (42.9% vs. 19.8% P=0.005) and undergo caesarean section (41.2% vs. 21.4%, P=0.019). They were also at increased risk of developing a complication (odds ratio 2.38, 95% CI: 1.05-5.38) or having multiple concurrent complications (odds ratio 8.27, 95% CI: 1.45-47.3). The rates of premature birth, birth weight and Apgar score at 5 min were similar between the two groups. The preconception serum testosterone concentration was positively correlated with the complication rate and negatively correlated with gestational age.

CONCLUSIONS: We found that women with PCOS are at greater risk of complications during pregnancy than healthy women, consistent with the results of earlier studies. High testosterone concentrations could be an aggravating factor in the risk of complications. Therefore, women with PCOS may require more careful monitoring during pregnancy than healthy women.

Place, publisher, year, edition, pages
Turin: Edizioni Minerva Medica, 2017
Keywords
Body Mass Index, Polycystic ovary syndrome, Pregnancy outcome, Pregnancy complications, Retrospective studies, Testosterone
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-134184 (URN)10.23736/S0026-4784.16.03946-0 (DOI)27310674 (PubMedID)
Available from: 2017-04-28 Created: 2017-04-28 Last updated: 2018-06-09Bibliographically approved
Turkmen, S., Ahangari, A. & Bäckström, T. (2016). Roux-en-Y Gastric Bypass Surgery in Patients with Polycystic Ovary Syndrome and Metabolic Syndrome. Obesity Surgery, 26(1), 111-118
Open this publication in new window or tab >>Roux-en-Y Gastric Bypass Surgery in Patients with Polycystic Ovary Syndrome and Metabolic Syndrome
2016 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, no 1, p. 111-118Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We aimed to evaluate the impact of Roux-en-Y gastric bypass (RYGB) surgery on metabolic syndrome-related variables in obese women with polycystic ovarian syndrome (PCOS).

METHODS: Thirteen obese women with PCOS (Rotterdam criteria) who met the International Diabetes Federation criteria for metabolic syndrome and who qualified for RYGB were enrolled. Clinical examinations included ovarian ultrasonography and measurement of waist, hip, body mass index and blood pressure. Venous blood samples were taken at the visit before surgery to measure triglyceride, high-density lipoprotein, low-density lipoprotein, fasting glucose, glycated haemoglobin (HbA1c), serum progesterone, allopregnanolone, total testosterone and sex hormone-binding globulin (SHBG) levels. Six months after surgery, patients underwent the same examinations and provided blood samples to analyse the same variables.

RESULTS: At 6 months after surgery, the metabolic syndrome-related variables improved in all patients, except in six patients with anovulatory menstrual cycles who still satisfied the criteria for metabolic syndrome. The metabolic variables normalised and serum progesterone and allopregnanolone levels increased in seven patients with ovulatory cycles. Testosterone and SHBG normalised in all patients at 6 months after surgery. Serum HDL and diastolic blood pressure did not change after surgery. Correlations were found among testosterone, progesterone, allopregnanolone, lipoproteins, triglyceride, fasting glucose and HbA1c levels, which was interpreted as progesterone and its metabolite allopregnanolone may contribute to metabolic abnormalities.

CONCLUSIONS: In PCOS patients, normalisation of metabolic dysfunction may be incomplete by 6 months after RYGB surgery, and the start of ovulatory menstrual cycles may indicate normalisation of metabolic dysfunction.

Keywords
Polycystic ovarian syndrome, Metabolic syndrome, Roux-en-Y gastric bypass, Progesterone, Allopregnanolone
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-114902 (URN)10.1007/s11695-015-1729-0 (DOI)000367542800019 ()25975201 (PubMedID)
Available from: 2016-05-02 Created: 2016-01-29 Last updated: 2018-06-07Bibliographically approved
Turkmen, S., Bixo, M., Hedström, H., Gideonsson, I., Nyberg, S., Wang, M. & Bäckström, T. (2016). The author's reply: Blood allopregnanolone levels in women with polycystic ovary syndrome [Letter to the editor]. Clinical Endocrinology, 85(1), 152-154
Open this publication in new window or tab >>The author's reply: Blood allopregnanolone levels in women with polycystic ovary syndrome
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2016 (English)In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 85, no 1, p. 152-154Article in journal, Letter (Refereed) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-124215 (URN)10.1111/cen.13079 (DOI)000378512100023 ()27061597 (PubMedID)
Available from: 2016-08-01 Created: 2016-07-28 Last updated: 2018-06-07Bibliographically approved
Ahangari, A., Bäckström, T., Innala, E., Andersson, C. & Turkmen, S. (2015). Acute intermittent porphyria symptoms during the menstrual cycle. Internal medicine journal (Print), 45(7), 725-731
Open this publication in new window or tab >>Acute intermittent porphyria symptoms during the menstrual cycle
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2015 (English)In: Internal medicine journal (Print), ISSN 1444-0903, E-ISSN 1445-5994, Vol. 45, no 7, p. 725-731Article in journal (Refereed) Published
Abstract [en]

Background: Acute intermittent porphyria (AIP), a life-threatening form of the disease, is accompanied by several pain, mental and physical symptoms.

Aims: In this study, we evaluated the cyclicity of AIP and premenstrual syndrome (PMS) symptoms in 32 women with DNA-diagnosed AIP during their menstrual cycles, in northern Sweden.

Methods: The cyclicity of AIP symptoms and differences in them between the follicularand luteal phases, and the cyclicity of each symptom in each individual woman indifferent phases of her menstrual cycle were analysed with a prospective daily ratingquestionnaire. PMS symptoms were also evaluated in the patients on a daily rating scale.

Results: Of the 32 women, 30 showed significant cyclicity in at least one AIP or PMS symptom (P < 0.05–0.001). Back pain (10/32) was the most frequent AIP pain symptomand sweet craving (10/15) was the most frequent PMS symptom. Pelvic pain (F = 4.823,P = 0.036), irritability (F = 7.399, P = 0.011), cheerfulness (F = 5.563, P = 0.025), sexualdesire (F = 8.298, P = 0.007), friendliness (F = 6.157, P = 0.019), breast tenderness (F =21.888, P = 0.000) and abdominal swelling (F = 16.982, P = 0.000) showed significantcyclicity. Pelvic pain and abdominal swelling (rs= 0.337, P < 0.001) showed the strongest correlation. The age of women with latent AIP was strongly correlated with abdominal swelling during the luteal phase (rs= 0.493, P < 0.01).

Conclusion: Our results suggest that the symptoms of AIP patients change during their menstrual cycles.

Keywords
acute intermittent porphyria, PMS/PMDD, progesterone, pain, hormone, symptomcyclicity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-107080 (URN)10.1111/imj.12784 (DOI)000357432200007 ()25871503 (PubMedID)
Available from: 2015-11-04 Created: 2015-08-18 Last updated: 2018-06-07Bibliographically approved
Turkmen, S., Andreen, L. & Cengiz, Y. (2015). Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome. Gynecological Endocrinology, 31(4), 301-305
Open this publication in new window or tab >>Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome
2015 (English)In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 31, no 4, p. 301-305Article in journal (Refereed) Published
Abstract [en]

Polycystic ovary syndrome (PCOS) is associated with abnormal eating habits. We examined whether surgical treatment affected allopregnanolone levels and eating behaviour in nine women with PCOS who qualified for Rou-en-Y gastric bypass surgery. Blood samples were obtained to measure sex-hormone-binding globulin, total testosterone, progesterone, and allopregnanolone, and eating behaviour was evaluated using the Three-Factor Eating Questionnaire before surgery and at 6 and 12 months after surgery. Body mass index and total testosterone levels decreased, and progesterone and sex-hormone-binding globulin levels increased after bariatric surgery compared with pre-surgical values. In patients with anovulatory menstrual cycles, both the serum allopregnanolone level and the allopregnanolone/progesterone ratio were unchanged after surgery. The patients had high uncontrolled and emotional eating scores, and low cognitive restraint scores before surgery, and these scores had improved significantly at 6 and 12 months after surgery. The presurgical allopregnanolone levels were significantly correlated with uncontrolled eating. In conclusion, these results suggest that allopregnanolone appear to be part of the mechanism underlying the abnormal eating behaviour of obese PCOS patients by causing the loss of control over food intake. Roux-en-Y gastric bypass surgery can improve eating behaviour and clinical symptoms, and may facilitate weight loss in obese women with PCOS.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
Keywords
Bariatric surgery, eating behaviour, GABA(A), neurosteroid, obesity, PCOS
National Category
Endocrinology and Diabetes Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-107314 (URN)10.3109/09513590.2014.994600 (DOI)000358466600012 ()25537661 (PubMedID)
Available from: 2015-08-21 Created: 2015-08-21 Last updated: 2018-06-07Bibliographically approved
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