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Roberta B Ness

Publications and source records attributed to Roberta B Ness.

At least 55 records · Page 3Linked to original sources
PubMed2005

The risk of preeclampsia rises with increasing prepregnancy body mass index.

PURPOSE: To explore the dose-dependent relation between prepregnancy body mass index (BMI) and the risk of preeclampsia after adjusting for measured confounders. METHODS: We studied 1179 primiparous women who enrolled at < 16 weeks' gestation into a prospective cohort study of the pathogenesis of preeclampsia. Multivariable logistic regression was used to quantify the independent effect of prepregnancy BMI on the risk of preeclampsia after adjusting for race and smoking status. BMI was specified as a restricted quadratic spline. RESULTS: Preeclampsia risk rose strikingly from a BMI of 15 to 30 kg/m(2). Compared with women with a BMI of 21, the adjusted risk of preeclampsia doubled at a BMI of 26 (odds ratio 2.1 [95% confidence interval, 1.4, 3.4]), and nearly tripled at a BMI of 30 (2.9 [1.6, 5.3]). Women with a BMI of 17 had a 57% reduction in preeclampsia risk compared with women with a BMI of 21 (0.43 [0.25, 0.76]), and a BMI of 19 was associated with a 33% reduction in risk (0.66 [0.50, 0.87]). CONCLUSIONS: These results indicate that preeclampsia risk rises through most of the BMI distribution. The dramatic elevation in overweight prevalence in the United States may increase preeclampsia incidence in the future.

Adolescent↗
PubMed2005

Risk for coronary artery disease and morbid preeclampsia: a commentary.

PURPOSE: A predisposition to coronary artery disease (CAD) may put women at risk for preeclampsia. Morbid preeclampsia (early, severe, recurrent, and with neonatal morbidity) represents the subset of preeclampsia of greatest public health concern. METHODS: We review here the published links between preeclampsia and CAD. RESULTS: Many risk factors are common to both CAD and preeclampsia. These include obesity; elevated blood pressure; dyslipidemia; insulin resistance; and hyperglycemia, together termed "Syndrome X"; as well as endothelial dysfunction; hyperuricemia; hyperhomocysteinemia; and abnormalities of inflammation, thrombosis, and angiogenesis. After pregnancy, women with preeclampsia are more likely to experience later life CAD. CONCLUSIONS: Both the association between CAD risk factors and preeclampsia and the association between preeclampsia and later CAD appears to be more pronounced among the subset of women with morbid preeclampsia. Thus, women at elevated risk for CAD may be at particularly high risk for morbid preeclampsia and women with morbid preeclampsia may be those at highest risk for later life CAD.

Coronary Artery Disease↗
PubMed2005

Blunt cardiac injury associated with cardiac valve insufficiency: trauma links to chronic disease?

CONTEXT: Cardiac injury has been well recognised as a complication of blunt chest trauma. Its clinical spectrum ranges from blunt cardiac injury (BCI) to complete rupture of cardiac tissues, with cardiac valvular injury often being overlooked. OBJECTIVE: To determine whether hospitalised BCI is associated with increased risk of cardiac valve insufficiency in a large multi-state hospitalised population. METHODS: Cases with BCI and cardiac valve insufficiency were identified based on discharge diagnoses in 1997 statewide hospital discharge data from 19 states. Four valvular outcomes were studied: (1) mitral valve insufficiency, incompetence, regurgitation (MVIIR); (2) aortic valve insufficiency, incompetence, regurgitation, stenosis (AVIIRS); (3) tricuspid valve insufficiency, incompetence, regurgitation, stenosis (TVIIRS); and (4) pulmonary valve insufficiency, incompetence, regurgitation, stenosis (PVIIRS). RESULTS: Among 1,051,081 injury discharges, 2709 (0.26%) people had BCI; 13,087 (1.25%) had MVIIR; 9811 (0.93%) had AVIIRS; 1338 (0.13%) had TVIIRS; 178 (0.02%) had PVIIRS. Independent of potential confounding factors, discharge for BCI was associated with a 12-fold increased risk for TVIIRS and a 3.4-fold increased risk for AVIIRS. CONCLUSION: Cardiac valve insufficiency has been well recognised as an important risk factor for congestive heart failure. With the findings that BCI is associated with an increased risk of specific valvular disorders, it is possible that trauma may play an important and heretofore largely unrecognised role in a portion of the burden of cardiovascular morbidity and mortality.

Age Factors↗
PubMed2005

Androgenic progestins in oral contraceptives and the risk of epithelial ovarian cancer.

OBJECTIVE: Oral contraceptives (OCs) have been consistently linked to reduced risk of ovarian cancer. Oral contraceptive formulations display varying degrees of androgenicity. Data linking androgens to ovarian cancer suggest that OC androgenicity may impact efficacy in preventing ovarian cancer. The authors investigated whether OC efficacy might differ according to androgenicity by using data from a large, population-based, case-control study (the Steroid Hormones and Reproductions [SHARE] Study). METHODS: Detailed data on OC formulation was obtained by an in-person interview for 568 cases and 1,026 controls. Multivariable logistic regression was used to assess the association of OC androgenicity with ovarian cancer while controlling for the known potential confounders of age, parity, family history of ovarian cancer, and tubal ligation. RESULTS: Androgenic and nonandrogenic OCs conferred a similar and significant reduction in ovarian cancer risk (odds ratio 0.52, 95% confidence interval 0.35-0.76 and odds ratio 0.59, 95% confidence interval 0.45-0.78, respectively). No differences in duration of use, age at first use, and time since last use were found between androgenic and nonandrogenic formulations. CONCLUSION: In general, the androgenicity of an OC does not alter chemopreventive efficacy. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2005

Early occurrence of metabolic syndrome after hypertension in pregnancy.

OBJECTIVE: The objective of the present study was to evaluate the cardiovascular risk profile and the prevalence of metabolic syndrome among women with a history of pregnancy-induced hypertension (PIH). METHODS: From a cohort of 3,799 nulliparous women prospectively recruited between 1989 and 1997, we performed an observational study on 168 case-control pairs 7.8 years after delivery. Participants were scheduled for a visit with a research nurse to evaluate their cardiovascular risk profile using a questionnaire, anthropometric measurements and blood specimen analysis. RESULTS: One hundred sixty-eight women with prior PIH (105 with gestational hypertension and 63 with preeclampsia) and 168 controls matched for age and year of index delivery were evaluated. The women with PIH (34.6 +/- 4.4 years) were more obese and had higher systolic (115 mm Hg versus 108 mm Hg) and diastolic (75 mm Hg versus 70 mm Hg) blood pressures (P < .001) than the 168 controls (35.1 +/- 4.5 years). They had lower high-density lipoprotein cholesterol level (1.30 mmol/L versus 1.42 mmol/L; P < .001), increased fasting blood glucose concentration (5.2 mmol/L versus 5.0 mmol/L; P = .002), and higher insulin levels (119 versus 91 pmol/L; P < .001). The prevalence of the metabolic syndrome was higher in the PIH group (unadjusted odds ratio = 4.9; 95% confidence interval 2.1-10.9) compared with controls, even after adjustment for confounders (adjusted odds ratio = 3.6; 95% confidence interval 1.4 -9.0). CONCLUSION: In white women in their mid-30s, the prevalence of the metabolic syndrome is 3- to 5-fold increased in those with a history of PIH in their first pregnancy. This emphasizes the importance of long-term follow-up assessment for cardiovascular risk factors in these women.

Adult↗
PubMed2005

Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial.

OBJECTIVE: Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by outpatient treatment and inpatient treatment. We assessed whether outpatient is as effective as inpatient treatment in relevant age, race, and clinical subgroups of women with PID. METHODS: Women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease (n = 831) were randomized into a multicenter trial of inpatient treatment, initially employing intravenous cefoxitin and doxycycline compared with outpatient treatment consisting of a single intramuscular injection of cefoxitin and oral doxycycline. Comparisons between treatment groups during a mean of 84 months of follow-up were made for pregnancies, live births, time to pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy. RESULTS: Outpatient treatment assignment did not adversely impact the proportion of women having one or more pregnancies, live births, or ectopic pregnancies during follow-up; time to pregnancy; infertility; PID recurrence; or chronic pelvic pain among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without high temperature/white blood cell count/pelvic tenderness score. This was true even in teenagers and women without a previous live birth. Ectopic pregnancies were more common in the outpatient than the inpatient treatment group, but because these were so rare, the difference did not reach statistical significance (5 versus 1, odds ratio 4.91, 95% confidence interval 0.57-42.25). CONCLUSION: Among all women and subgroups of women with mild-to-moderate PID, there were no differences in reproductive outcomes after randomization to inpatient or outpatient treatment. LEVEL OF EVIDENCE: I.

Adult↗
PubMed2005

Bacterial vaginosis (BV) and the risk of incident gonococcal or chlamydial genital infection in a predominantly black population.

OBJECTIVE: The objective of this study was to assess in prospective data whether bacterial vaginosis (BV) is associated with gonococcal/chlamydial cervicitis. STUDY: A total of 1179 women at high risk for sexually transmitted infections was followed for a median of 3 years. Every 6 to 12 months, vaginal swabs were obtained for Gram stain, culture of microflora, and Neisseria gonorrhoeae and Chlamydia trachomatis. A Gram stain score of 7 to 10 based on the Nugent criteria categorized BV. RESULTS: Baseline BV was associated with concurrent gonococcal/chlamydial infection (adjusted odds ratio, 2.83; 95% confidence interval [CI], 1.81-4.42). However, the association between BV and subsequent, incident gonococcal/chlamydial genital infection was not significant (adjusted relative risk [RR], 1.52; 95% CI, 0.74-3.13). Dense growth of pigmented, anaerobic Gram-negative rods (adjusted RR, 1.93; 95% CI, 0.97-3.83) appeared to elevate the risk for newly acquired gonococcal/chlamydial genital infection. CONCLUSIONS: BV was common among a predominantly black group of women with concurrent gonococcal/chlamydial infection but did not elevate the risk for incident infection.

Adolescent↗
PubMed2005

Comparison of acute and subclinical pelvic inflammatory disease.

OBJECTIVE: The objective of this study was to compare the demographic, clinical, and microbiologic findings in women with subclinical pelvic inflammatory disease (PID) and women with acute PID. STUDY: A cross-sectional study was performed using cohorts from 2 separate studies of 1293 women at risk for PID. Most participants were recruited from emergency departments, sexually transmitted disease clinics, and family planning clinics in metropolitan centers. We compared demographic, clinical, and microbiologic findings among women with acute PID, women with subclinical PID, and women without endometritis (controls). Statistical analyses included chi-square for categorical variables, calculation of odds ratio and 95% confidence intervals, and polychotomous logistic regression when appropriate. RESULTS: Similar proportions of women with acute and subclinical PID tested positive for cervical Chlamydia trachomatis (odds ratio [OR], 1.1; 95% confidence interval, 0.6-2.0) and had bacterial vaginosis (OR, 0.7; 95% CI, 0.2-1.8). The rate of cervical Neisseria gonorrhoeae infection in women with subclinical PID was intermediate between the rates in women with acute PID and controls (21% vs. 49% vs. 7%, respectively, P <0.001, test for trend). Endometrial recovery of N. gonorrhoeae and C. trachomatis in women with subclinical PID was also seen at intermediate levels. Similar distributions of teenagers, women who smoked or used illicit drugs, and women engaging in sexual intercourse during menses were found in each group. Proportions of women with subclinical PID who were black and with lower education levels were intermediate between the proportions of these characteristics in women with acute PID and controls. CONCLUSION: Demographic and microbiologic characteristics of women with subclinical and acute PID are comparable. These findings suggest that the pathophysiological mechanisms of acute and subclinical PID are similar.

Adolescent↗
PubMed2005

Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease.

OBJECTIVE: The objective of this study was to assess the risk profile for chronic pelvic pain (CPP) after pelvic inflammatory disease (PID). STUDY: Multivariate logistic regression was used to assess risk factors for CPP in a longitudinal study of 780 predominately black, urban women with clinically suspected PID: complaints of acute pain (<30 days); a clinical finding of pelvic tenderness; and leukorrhea, mucopurulent cervicitis, or untreated gonococcal or chlamydial cervicitis. CPP was defined as pain reported at >or=2 consecutive interviews conducted every 3 to 4 months for 2 to 5 years. RESULTS: Nonblack race (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.31-3.58), being married (OR, 2.06; 95% CI, 1.02-4.18), a low SF-36 mental health composite score (OR, 2.71; 95% CI, 1.69-4.34), >or=2 prior PID episodes (OR, 2.84; 95% CI, 1.07-7.54), and smoking (OR, 1.65; 95% CI, 1.01-2.71) independently predicted CPP. Histologic endometritis or evidence of endometrial Neisseria gonorrhoeae or Chlamydia trachomatis infection was negatively associated with CPP (OR, 0.69; 95% CI, 0.44-1.10). CONCLUSIONS: A range of demographic, clinical, historical, and behavioral factors predict CPP after PID.

Adolescent↗
PubMed2005

Inflammation and endometrial cancer: a hypothesis.

Endometrial cancer is the most common gynecologic malignancy in the United States. Substantial epidemiologic data implicate an imbalance of estrogens and progestogens in the etiology of this disease. We propose that inflammation also plays a role in endometrial cancer development. Emerging laboratory data suggest that elevated levels of prostaglandin E(2) may underlie the transformation of normal endometrium to neoplastic tissue and that in vitro nonsteroidal anti-inflammatory drugs may inhibit endometrial cancer cell growth. In this review, we suggest that the risk factors for endometrial cancer--unopposed estrogens, anovulation, polycystic ovary syndrome, excessive menstruation, early menarche, and late menopause--may be viewed as factors increasing the exposure of the endometrium to inflammation, whereas pregnancy and smoking, two likely protective factors, have the opposite effect. Chronic inflammation can induce rapid cell division, increasing the possibility for replication error, ineffective DNA repair, and subsequent mutations. A proinflammatory milieu can also directly increase estrogen production. Hence, inflammation may work in conjunction with or in addition to estrogen exposure in the development of endometrial cancer.

Anovulation↗
PubMed2004

Differential distribution of allelic variants in cytokine genes among African Americans and White Americans.

Racial disparities in health are largely unexplained. Because many diseases causing premature mortality among African Americans are mediated by the immune system, the authors explored the race-specific distribution of allelic variants in cytokine genes known to stimulate inflammation. The authors studied women seeking prenatal care and delivering singletons in uncomplicated first births at a US hospital in 1997-2001. A total of 179 African-American women and 396 White women were evaluated for functionally relevant allelic variants in cytokine genes. African-American women were significantly more likely to carry allelic variants known to up-regulate proinflammatory cytokines; odds ratios increased with allele dose. Odds ratios for African Americans versus Whites in genotypes up-regulating proinflammatory interleukin (IL) 1 (IL1A-4845G/G, IL1A-889T/T, IL1B-3957C/C, and IL1B-511A/A) ranged from 2.1 to 4.9. The proinflammatory cytokine interleukin-6 IL6-174 G/G genotype was 36.5 times (95% confidence interval (CI): 8.8, 151.9) more common among African Americans. Genotypes known to down-regulate the antiinflammatory interleukin-10 (IL10-819 T/T and IL10-1082 A/A) were elevated 3.5-fold (95% CI: 1.8, 6.6) and 2.8-fold (95% CI: 1.6, 4.9) in African Americans. Cytokine genotypes found to be more common in African-American women were consistently those that up-regulate inflammation.

Adult↗
PubMed2004

Bacterial vaginosis and anaerobic bacteria are associated with endometritis.

BACKGROUND: Chlamydia trachomatis and/or Neisseria gonorrhoeae account for approximately one-third to one-half of pelvic inflammatory disease (PID) cases. Thus, up to 70% of cases have an unknown, nongonococcal/nonchlamydial microbial etiology. METHODS: We investigated the associations of N. gonorrhoeae, C. trachomatis, bacterial vaginosis, anaerobic bacteria, facultative bacteria, and lactobacilli with endometritis among 278 women with complete endometrial histology and culture from the PID Evaluation and Clinical Health Study. RESULTS: Women with acute endometritis were less likely to have H(2)O(2)-producing Lactobacillus species (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.01-0.8) and more likely to be infected with C. trachomatis (OR, 16.2; 95% CI, 4.6-56.6), N. gonorrhoeae (OR, 11.6; 95% CI, 4.5-29.9), diphtheroids (OR, 5.0; 95% CI, 2.1-12.2), black-pigmented gram-negative rods (OR, 3.1; 95% CI, 1.4-7.0), and anaerobic gram-positive cocci (OR, 2.1; 95% CI, 1.0-4.3) and to have bacterial vaginosis (OR, 2.4; 95% CI, 1.3-4.3). CONCLUSIONS: We conclude that bacterial vaginosis-associated organisms are frequent among women with PID. Because these organisms were strongly associated with endometritis, we recommend that all women with PID be treated with regimens that include metronidazole.

Adolescent↗
PubMed2004

Homocysteine and folic acid are inversely related in black women with preeclampsia.

Black women have an increased risk of preeclampsia compared with white women. Plasma homocysteine is increased in preeclampsia. Homocysteine concentrations are affected by nutritional deficiencies, particularly decreased folic acid and B12, leading to increased homocysteine. Previous studies have reported racial differences in nutritional intake including folic acid. Therefore, we investigated whether there were racial differences in plasma homocysteine, folic acid, and vitamin B12 among women with preeclampsia. We tested for an association between homocysteine and folic acid and B12, and we hypothesized an inverse relationship of homocysteine and folic acid in preeclampsia, more so in black women in whom preeclampsia developed. Black women with preeclampsia (n=26) had elevated homocysteine concentrations (8.7+/-1.4 micromol/L) compared with black women with normal pregnancy (n=52, 7.6+/-0.5 micromol/L), white women with preeclampsia (n=34, 7.5+/-0.6 micromol/L), and white women with normal pregnancy (n=48, 5.5+/-0.3 micromol/L). Folic acid concentrations were lower in black women (14.1+/-0.8 ng/mL) compared with white women (18.5+/-0.9 ng/mL, P<0.01). However, plasma homocysteine was inversely related to folic acid only among black women with preeclampsia (r=-0.23, P=0.01). These racial differences may have implications for the higher rates of preeclampsia in this group and may have long-term implications for future cardiovascular risk. Racial differences in diet, adherence to folic acid supplementation, or interactions of nutritional and maternal factors warrant further study by race and pregnancy status.

Adolescent↗
PubMed2004

Oral contraceptive use, reproductive history, and risk of epithelial ovarian cancer in women with and without endometriosis.

OBJECTIVE: Women with endometriosis may be at an increased risk of ovarian cancer. It is not known whether reproductive factors that reduce the risk of ovarian cancer in general also reduce risk in women with endometriosis. We investigated whether the odds ratios for ovarian cancer that were associated with oral contraceptive use, childbearing, hysterectomy, and tubal ligation differ among women with and without endometriosis. STUDY DESIGN: We pooled information on the self-reported history of endometriosis from 4 population-based case-controlled studies of incident epithelial ovarian cancer, comprising 2098 cases and 2953 control subjects. We obtained data on oral contraceptive use, childbearing, breastfeeding, gynecologic surgical procedures, and other reproductive factors on each woman. Multivariable unconditional logistic regression was used to calculate odds ratios and 95% CI for ovarian cancer among women with endometriosis compared with women without endometriosis. Similar methods were used to assess the frequencies of risk factors among women with and without endometriosis. Adjustments were made for age, parity, oral contraceptive use, tubal ligation, family history of ovarian cancer, and study site. RESULTS: Women with endometriosis were at an increased risk of ovarian cancer (odds ratio, 1.32; 95% CI, 1.06-1.65). Using oral contraceptives, bearing children, and having a tubal ligation or hysterectomy were associated with a similar reduction in the odds ratios for ovarian cancer among women with and without endometriosis. In particular, the use of oral contraceptives for >10 years was associated with a substantial reduction in risk among women with endometriosis (odds ratio, 0.21; 95% CI, 0.08-0.58). CONCLUSION: Women with endometriosis are at an increased risk of epithelial ovarian cancer. Long-term oral contraceptive use may provide substantial protection against the disease in this high-risk population.

Adult↗
PubMed2004

Preferences for fertility in women with pelvic inflammatory disease.

OBJECTIVE: To identify the value that women with pelvic inflammatory disease (PID) assign to the health impact of future infertility. DESIGN: Cross-sectional observations on patient preferences. SETTING: Participants in an existing multicenter clinical trial of PID treatment options. PATIENT(S): Five hundred thirty-two women with signs and symptoms of PID who were identified from emergency departments and sexually transmitted disease clinics. INTERVENTION(S): Women were asked to rate whether life with future infertility was more or less meaningful than life with each of seven chronic health conditions: sinus congestion, insomnia, chronic headache, asthma, incontinence, dialysis, and paralysis. MAIN OUTCOME MEASURE(S): Preferences regarding future infertility. RESULT(S): Most respondents rated future infertility as being worse than sinus congestion and asthma but better than the health impact of incontinence, dialysis, and paralysis. There was a wide range of opinion, with 18% viewing future infertility as minor (better than all conditions) and 5% viewing it as extremely important (worse than all conditions). Future infertility ratings were influenced by race, parity, difficulty in conceiving, and views on the importance of future pregnancy. CONCLUSION(S): The majority of women with PID rate future infertility as a significant issue. Optimizing access to infertility treatment may affect the quality of life for such women.

Adult↗
PubMed2004

Polymorphisms of interleukin (IL)-1alpha, IL-1beta, IL-6, IL-10, and IL-18 and the risk of ovarian cancer.

OBJECTIVE: Recent studies of ovarian cancer have suggested a role for inflammation in carcinogenesis. Data from a population-based case-control study in Hawaii were examined to assess the relation between polymorphisms in cytokines involved with the inflammatory response, specifically members of the interleukin (IL) family and the incidence of ovarian cancer. PATIENTS AND METHODS: The analysis of 182 epithelial ovarian cancer cases and 219 controls focused on the polymorphisms in the following genes: IL-1alpha, IL-1beta, IL-6, IL-10, and IL-18. Genotype data were obtained from blood samples collected in participants' homes, and reproductive, demographic, and lifestyle histories were collected during interview. RESULTS: There were no significant odds ratios (ORs) for ovarian cancer by allelic variants in any of the IL genes after adjusting for age, ethnicity, education, oral contraceptive pill use, pregnancy, and history of tubal ligation. Although there was a significantly reduced risk of ovarian cancer risk among women with an IL-1alpha (-4845) T allele compared to women with two G alleles (OR: 0.59; 95% confidence interval: 0.37-0.97) after adjustment for age and ethnicity, the trend was not significant (p = 0.10). Further examination of the data suggested that women with at least one IL-18 variant allele (a G to C transition at position -137) were at significantly decreased risk of advanced ovarian cancer (OR: 0.51; 95% confidence interval: 0.28-0.90) compared to women with the IL-18 GG genotype. There was a significant difference in the risk of ovarian cancer associated with the IL-18 C allele by stage at diagnosis (p = 0.04 for homogeneity in the ORs): cases with IL-18 GC or CC genotypes were less likely to be diagnosed at regional/distant stages. Analysis of the data within ethnic subgroups revealed a significant positive association of the heterozygous IL-18 GC genotype with ovarian cancer risk among Native Hawaiian women (OR: 9.96; 95% CI: 1.88-52.90). The OR for ovarian cancer was not significant for Native Hawaiian women homozygous for the IL-18 C allele, but only one case and control had the IL-18 CC genotype. CONCLUSIONS: Overall, this study does not support an association of selected IL-1alpha, IL-1beta, IL-6, IL-10, or IL-18 polymorphisms with the risk for ovarian cancer. However, the IL-18 G137C variant may be a marker for ovarian cancer progression or metastasis.

Adult↗