Umeå University's logo

umu.sePublikasjoner
Endre søk
Link to record
Permanent link

Direct link
Wihlbäck, Anna-CarinORCID iD iconorcid.org/0009-0007-5476-1525
Alternativa namn
Publikasjoner (10 av 21) Visa alla publikasjoner
Bäcklund, N., Lundstedt, S., Tornevi, A., Wihlbäck, A.-C., Olsson, T., Dahlqvist, P. & Brattsand, G. (2024). Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test. Journal of Clinical Endocrinology and Metabolism
Åpne denne publikasjonen i ny fane eller vindu >>Salivary cortisol and cortisone can circumvent confounding effects of oral contraceptives in the short synacthen test
Vise andre…
2024 (engelsk)Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197Artikkel i tidsskrift (Fagfellevurdert) Epub ahead of print
Abstract [en]

Context: Adrenal insufficiency (AI) is usually diagnosed by low plasma cortisol levels following a short Synacthen test (SST). Most plasma cortisol is bound to corticosteroid-binding globulin, which is increased by estrogen in combined estrogen-progestin oral contraceptives (COCs). Women with AI using COCs are therefore at risk of having an apparently normal plasma cortisol level during SST, which would not adequately reflect AI.

Objective: To test whether salivary cortisol or cortisone during SST is more robust against the COC effect and to calculate the lower reference limits (LRLs) for these to be used as tentative diagnostic cutoffs to exclude AI.

Methods: Forty-one healthy women on COCs and 46 healthy women without exogenous estrogens performed an SST with collection of plasma and salivary samples at 0, 30, and 60 min after Synacthen injection. The groups were compared using regression analysis with age as covariate and the LRLs were calculated parametrically.

Results: SST-stimulated plasma cortisol levels were significantly higher in the COC group versus controls, while mean salivary cortisol and cortisone levels were slightly lower in the COC group. Importantly, COC use did not significantly alter LRLs for salivary cortisol or cortisone. The smallest LRL difference between groups was seen for salivary cortisone.

Conclusion: Salivary cortisol and especially salivary cortisone are considerably less affected by COC use than plasma cortisol during SST. Due to similar LRLs, a common cutoff for salivary cortisol and cortisone during SST can be used to exclude AI in premenopausal women irrespective of COC use.

sted, utgiver, år, opplag, sider
Oxford University Press, 2024
Emneord
short Synacthen test, salivary cortisol, salivary cortisone, oral contraceptives, adrenal insufficiency, reference limits
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-222629 (URN)10.1210/clinem/dgad763 (DOI)001140071500001 ()38173358 (PubMedID)
Forskningsfinansiär
Region VästerbottenUmeå University
Tilgjengelig fra: 2024-03-22 Laget: 2024-03-22 Sist oppdatert: 2024-03-25
Wihlbäck, A.-C. (2022). Kroppsklåda och hudförändringar (2ed.). In: Marie Bixo; Inger Sundström Poromaa (Ed.), Problemorienterad gynekologi och obstetrik: (pp. 330-339). Stockholm: Liber
Åpne denne publikasjonen i ny fane eller vindu >>Kroppsklåda och hudförändringar
2022 (svensk)Inngår i: Problemorienterad gynekologi och obstetrik / [ed] Marie Bixo; Inger Sundström Poromaa, Stockholm: Liber, 2022, 2, s. 330-339Kapittel i bok, del av antologi (Annet vitenskapelig)
sted, utgiver, år, opplag, sider
Stockholm: Liber, 2022 Opplag: 2
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-207848 (URN)9789147141906 (ISBN)
Tilgjengelig fra: 2023-05-03 Laget: 2023-05-03 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Bendix, M., Bixo, M., Wihlbäck, A.-C., Ahokas, A. & Jokinen, J. (2019). Allopregnanolone and progesterone in estradiol treated severe postpartum affective disorder. Paper presented at 49th Annual Conference of the International-Society-of-Psychoneuroendocrinology - 50 Years of Psychoneuroendocrinology - Returning to Where It All Began, AUG 29-31, 2019, Milan, ITALY. Psychoneuroendocrinology, 107, 68-68
Åpne denne publikasjonen i ny fane eller vindu >>Allopregnanolone and progesterone in estradiol treated severe postpartum affective disorder
Vise andre…
2019 (engelsk)Inngår i: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 107, s. 68-68Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
sted, utgiver, år, opplag, sider
PERGAMON-ELSEVIER SCIENCE LTD, 2019
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-164512 (URN)10.1016/j.psyneuen.2019.07.195 (DOI)000483655400194 ()
Konferanse
49th Annual Conference of the International-Society-of-Psychoneuroendocrinology - 50 Years of Psychoneuroendocrinology - Returning to Where It All Began, AUG 29-31, 2019, Milan, ITALY
Tilgjengelig fra: 2019-11-20 Laget: 2019-11-20 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Bendix, M., Bixo, M., Wihlbäck, A.-C., Ahokas, A. & Jokinen, J. (2019). Allopregnanolone and progesterone in estradiol treated severe postpartum depression and psychosis: Preliminary findings. Neurology, psychiatry and brain research, 34, 50-57
Åpne denne publikasjonen i ny fane eller vindu >>Allopregnanolone and progesterone in estradiol treated severe postpartum depression and psychosis: Preliminary findings
Vise andre…
2019 (engelsk)Inngår i: Neurology, psychiatry and brain research, ISSN 0941-9500, Vol. 34, s. 50-57Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Postpartum affective disorders may be associated with dysregulation of gonadal steroids. We investigated peripheral levels of allopregnanolone and progesterone in a combined group of women with postpartum onset of severe depression and/or psychosis who, as previously reported, responded with rapid symptom remission during sublingual estradiol treatment. The aim was to assess differences in allopregnanolone and progesterone between patients and healthy controls at baseline, and hormonal changes during estradiol treatment and symptom remission in patients.

Methods: Allopregnanolone and progesterone in serum were analyzed with radioimmunoassay before and four weeks after initiation of sublingual estradiol treatment in ten women with postpartum depression and four women with postpartum psychosis (ICD-10). Twenty-eight healthy postpartum controls were included for baseline comparison.

Results: Allopregnanolone declined significantly during estradiol treatment while there was a trend for lower baseline allopregnanolone levels in patients compared with healthy postpartum controls. The ratio between allopregnanolone and progesterone was significantly lower in patients compared with controls and it remained unchanged after clinical recovery.

Limitations: This study is a secondary analysis of two estradiol treatment studies based on availability of samples for the analysis of allopregnanolone. Healthy controls were assessed earlier after delivery. Data on potential confounders (somatic health, breastfeeding, other medication) were not available.

Conclusions: These preliminary findings suggest that clinical recovery of severe postpartum depression and psychosis during estradiol treatment does not seem to depend on increasing levels of allopregnanolone. Differences in progesterone metabolism may constitute a risk factor for severe postnatal affective dysregulation.

sted, utgiver, år, opplag, sider
Elsevier, 2019
Emneord
Postpartum depression, Postpartum psychosis, Allopregnanolone, Progesterone, Estradiol, Estradiol treatment
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-156823 (URN)10.1016/j.npbr.2019.10.003 (DOI)2-s2.0-85074335144 (Scopus ID)
Merknad

Originally included in thesis in manuscript form with title: "Allopregnanolone and progesterone in estradiol treated severe postpartum depression and psychosis".

Tilgjengelig fra: 2019-02-28 Laget: 2019-02-28 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Wiberg-Itzel, E., Pembe, A. B., Järnbert-Pettersson, H., Norman, M., Wihlbäck, A.-C., Hoesli, I., . . . Darj, E. (2016). Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries. PLOS ONE, 11(10), Article ID e0161546.
Åpne denne publikasjonen i ny fane eller vindu >>Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries
Vise andre…
2016 (engelsk)Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 10, artikkel-id e0161546Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL). Objectives: To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries. Methods: A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal/fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation >= 3 cm were required before the women were invited to take part in the study. Results: AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (>= 10.1 mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27-50), specificity 90.3% (95% CI; 87-93) PPV 37.3% (95% CI; 27-48) and NPV was 91.0% (95% CI; 88-93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time > 12h (p = 0.04), post-partum fever (> 38 degrees C, p = 0.01) and post-partum haemorrhage > 1.5L (p = 0.04). Conclusion: The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.

sted, utgiver, år, opplag, sider
Public library science, 2016
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-129746 (URN)10.1371/journal.pone.0161546 (DOI)000389602800009 ()2-s2.0-84992560124 (Scopus ID)
Tilgjengelig fra: 2017-01-09 Laget: 2017-01-09 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Timby, E., Bäckström, T., Nyberg, S., Stenlund, H., Wihlbäck, A.-C. N. & Bixo, M. (2016). Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls — a pilot study. Psychopharmacology, 233(11), 2109-2117
Åpne denne publikasjonen i ny fane eller vindu >>Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls — a pilot study
Vise andre…
2016 (engelsk)Inngår i: Psychopharmacology, ISSN 0033-3158, E-ISSN 1432-2072, Vol. 233, nr 11, s. 2109-2117Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

In premenstrual dysphoric disorder (PMDD), a condition that afflicts 3-8 % of women in fertile ages, the cyclic recurrence of debilitating mood symptoms is restricted to the luteal phase of the menstrual cycle. The progesterone metabolite allopregnanolone is produced by the corpus luteum, and circulating levels are reflected in the brain. Allopregnanolone is a modulator of the GABA(A) receptor, enhancing the effect of gamma-aminobutyric acid (GABA). Previous studies have demonstrated different sensitivity to other GABA(A) receptor agonists, i.e., benzodiazepines, alcohol, and pregnanolone, in PMDD patients compared to controls.

This study aimed to investigate the sensitivity to intravenous allopregnanolone over the menstrual cycle in PMDD patients.

Allopregnanolone, 0.05 mg/kg, was administered intravenously once in the mid-follicular and once in the luteal phase of the menstrual cycle to 10 PMDD patients and 10 control subjects. The saccadic eye velocity (SEV) was recorded by electrooculography as a measurement of functional GABA(A) receptor activity, at baseline and repeatedly after the injection. A mixed model was used to analyze data.

There was a highly significant group x phase interaction in the SEV response to allopregnanolone (F(1,327.489) = 12.747, p < 0.001). In the PMDD group, the SEV response was decreased in the follicular phase compared to the luteal phase (F(1,168) = 7.776, p = 0.006), whereas in the control group, the difference was opposite during the menstrual cycle (F(1,158.45) = 5.70, p = 0.018).

The effect of exogenous allopregnanolone is associated with menstrual cycle phase in PMDD patients and in controls. The results suggest an altered sensitivity to allopregnanolone in PMDD patients.

Emneord
Neurosteroid, GABA, Premenstrual dysphoric disorder, Saccadic eye velocity, Menstrual cycle
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-50057 (URN)10.1007/s00213-016-4258-1 (DOI)000376102100009 ()2-s2.0-84960465338 (Scopus ID)
Merknad

Originally included in thesis in manuscript form

Tilgjengelig fra: 2011-11-24 Laget: 2011-11-24 Sist oppdatert: 2024-04-08bibliografisk kontrollert
Wiberg-Itzel, E., Pembe, A. B., Wray, S., Wihlbäck, A.-C., Darj, E., Hoesli, I. & Åkerud, H. (2014). Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome. Acta Obstetricia et Gynecologica Scandinavica, 93(1), 80-85
Åpne denne publikasjonen i ny fane eller vindu >>Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome
Vise andre…
2014 (engelsk)Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, nr 1, s. 80-85Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

ObjectiveTo assess whether the frequency of adverse neonatal outcome at delivery is related to the level of lactate in amniotic fluid and to the use of oxytocin. DesignProspective observational study. SettingSoder Hospital, Stockholm, Sweden. PopulationSeventy-four women in active labor with a gestational age 36weeks and mixed parity. MethodsLevels of lactate in amniotic fluid were analyzed bedside from an intrauterine catheter every 30min during labor. Deliveries were divided into groups with and without oxytocin. Main outcome measuresThe frequency of adverse neonatal outcome at delivery. ResultOf the deliveries 13.5% (10/74) concluded with an adverse neonatal outcome. The levels of lactate in amniotic fluid increased during labor, more so in deliveries where oxytocin was used. In the group with an adverse neonatal outcome, the level of lactate in amniotic fluid was significantly higher in the final sample before delivery (p=0.04). In 18 deliveries, stimulation with oxytocin was temporarily halted for at least 30min due to overly stimulated labor contractions. A decreasing level of lactate in amniotic fluid was shown within a median 5%/30min. In the group where the administration of oxytocin was halted, there was no adverse neonatal outcome. ConclusionThe frequency of adverse neonatal outcome was associated with the level of lactate in amniotic fluid and with the use of oxytocin. The level of lactate in amniotic fluid may be an additional valuable tool when oxytocin is administered during labor.

sted, utgiver, år, opplag, sider
Wiley-Blackwell, 2014
Emneord
Adverse fetal outcome, amniotic fluid, anaerobe metabolism, lactate, overstimulation, oxytocin
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-84752 (URN)10.1111/aogs.12261 (DOI)000328435300012 ()
Tilgjengelig fra: 2014-02-10 Laget: 2014-01-20 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Wiberg-Itzel, E., Pembe, A., Norman, M., Wihlbäck, A.-C., Hoesli, I., Azria, E. & Akerud, H. (2014). The dysfunctional labor study. Paper presented at 34th Annual Scientific Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine, FEB 03-08, 2014, New Orleans, LA. American Journal of Obstetrics and Gynecology, 210(1), S328-S329
Åpne denne publikasjonen i ny fane eller vindu >>The dysfunctional labor study
Vise andre…
2014 (engelsk)Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 210, nr 1, s. S328-S329Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-86618 (URN)000330322600672 ()
Konferanse
34th Annual Scientific Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine, FEB 03-08, 2014, New Orleans, LA
Tilgjengelig fra: 2014-04-30 Laget: 2014-03-03 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Wiberg-Itzel, E., Pembe, A., Wihlbäck, A.-c., Darj, E. & Åkerud, H. (2013). The association between dystocic labors and circadian signals. Paper presented at 33rd Annual Meeting/Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine (SMFM), FEB 11-16, 2013, San Francisco, CA. American Journal of Obstetrics and Gynecology, 208(1), S139-S140
Åpne denne publikasjonen i ny fane eller vindu >>The association between dystocic labors and circadian signals
Vise andre…
2013 (engelsk)Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 208, nr 1, s. S139-S140Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
Abstract [en]

Objective: Human deliveries commonly occur during the dark period of the day. Melatonin hormone is released as a circadian signal from the human brain, and has been shown to have a synergistic effect together with oxytocin in facilitating the uterine contractions during labor. Melatonin is inhibited by light and energized by dark. During winter the numbers of light hours per day in Sweden are few, but during the summer they are numerous. In Tanzania there is no season difference.

Study Design: In 2011,452 Tanzanian and 919 Swedish healthy primiparas with a normal pregnancy and a spontaneous onset of labor were included in the study. Time and date together with the length and outcome of delivery were studied, and a statistical comparison was made.

Results: 47% of the Swedish deliveries started in early morning, and 48% ended at midnight. The median time of active labor was significantly longer during the summer season (May to August vs. November to February, p=0.05). The frequency of labor dystocia was increased during summer season, and significantly more in the region on Sweden with midnight sun (29 vs. 40%, p=0.03).

48% of Tanzania labors started at midnight, and 41% ended at lunch time. Among Tanzanian women, no difference in median time of active delivery (p=0.5) or the frequency of dystocic labors was shown, according to season of the year (13.7 vs. 14.1 %, p=0.8).

Oxytocin was used in 68% of the Swedish deliveries, and the use was higher during the summer season. Oxytocin was used in 31% of the Tanzanian deliveries. No difference in use of oxytocin was shown according to season.

Conclusion: In this project a variation of labor dystocia according to season of the year has been studied. A significant overrepresentation of prolonged and dystocic deliveries were shown during the summer season in Sweden. This new knowledge may be of a great importance, when handling a dysfunctional labor.

sted, utgiver, år, opplag, sider
Elsevier, 2013
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-66411 (URN)000313393500310 ()
Konferanse
33rd Annual Meeting/Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine (SMFM), FEB 11-16, 2013, San Francisco, CA
Tilgjengelig fra: 2013-02-22 Laget: 2013-02-19 Sist oppdatert: 2024-03-25bibliografisk kontrollert
Wihlbäck, A.-C., Nyberg, S., Andersson, A., Bixo, M., Bäckström, T. & Sundström-Poromaa, I. (2007). Allopregnanolone serum concentrations and neurosteroid sensitivity during withdrawal from postmenopausal hormone therapy.. Gynecological Endocrinology, 23(10), 590-596
Åpne denne publikasjonen i ny fane eller vindu >>Allopregnanolone serum concentrations and neurosteroid sensitivity during withdrawal from postmenopausal hormone therapy.
Vise andre…
2007 (engelsk)Inngår i: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Gynecol Endocrinol, Vol. 23, nr 10, s. 590-596Artikkel i tidsskrift (Fagfellevurdert) Published
Identifikatorer
urn:nbn:se:umu:diva-16445 (URN)10.1080/09513590701550015 (DOI)17852417 (PubMedID)
Tilgjengelig fra: 2007-09-28 Laget: 2007-09-28 Sist oppdatert: 2024-04-08bibliografisk kontrollert
Organisasjoner
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0009-0007-5476-1525