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PubMed1986

Breast cancer risk factors in Italian women: a multicentric case-control study.

To evaluate the importance of several risk factors for breast cancer in the Italian female population, a large multicentric case-control study was conducted in 10 breast clinics in Italy. The study included 1,556 women affected by breast cancer, histologically and/or cytologically confirmed. Controls were 1,505 women admitted to a hospital in the same town, matched with cases for residence and with the same age distribution of the Italian female population. The risk factors considered in this study were family history of breast cancer, reproductive history, height and weight, use of oral contraceptives, other hormonal therapies and smoking history. The results of this study confirm the significant role of a positive family history of breast cancer (RR = 2.37); the relative risk was even higher when a first-degree relative was affected or the breast cancer was bilateral. The analysis of the reproductive history showed a significant trend of increasing risk with increasing age at first birth and, although less evident, with increasing number of children. Quetelet's index (kg/m-2) was positively correlated with breast cancer risk, mostly in postmenopausal women. Among other studied factors, only late age at menopause confirmed an increased risk for breast cancer, whereas age at menarche, use of oral contraceptives and smoking histories did not show any significant correlation with breast cancer risk. These results are in substantial agreement with other international studies, but represent an interesting contribution to studies about the Italian female population.

Abortion, Spontaneous↗
PubMed2004

Determination of menopausal status in women: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) Study.

PURPOSE: Accurate classification of menopausal status is important to epidemiological research evaluating the role of reproductive hormones in disease processes. Algorithms relying on repeat hormone assays are unfeasible in large epidemiological studies. This paper summarizes the development of the Women's Ischemia Syndrome Evaluation (WISE) Hormonal menopausal status algorithm for determining premenopausal, perimenopausal, and postmenopausal status using menstrual and reproductive history and reproductive hormone levels obtained at a single clinic visit. METHODS: The authors compared the accuracy of this algorithm with two currently used self-report algorithms: Menstrual, based only on months since last menstrual period, and Historical, which adds age and surgical history. RESULTS: The study population consisted of 515 women (329 clearly postmenopausal) enrolled in the WISE study who were undergoing coronary angiography for suspected ischemia. A subgroup of 186, not clearly postmenopausal, was classified by these three algorithms. Results were evaluated against individualized expert consensus classification. The Menstrual and Historical classifications differed significantly (p < 0.0001) from expert consensus, with 32%-26% discordant classifications, respectively. For the WISE Hormonal classification, discordance was 4%. CONCLUSIONS: The authors conclude that inaccurate classifications of menopausal status occur frequently in self-report algorithms. Use of the relatively simple WISE algorithm can improve the accuracy of menopausal status classification for epidemiological research.

Adult↗
PubMedDate not supplied

Postmenopausal estrogen and progestogen therapy and the risk of uterine leiomyomas.

OBJECTIVE: Leiomyomas are common benign neoplasms. Although hormone therapy is the most common and effective treatment for menopausal symptoms, little is known about its effect on leiomyomas. We examined the risk of a first diagnosis of leiomyomas in peri- and postmenopausal women associated with prior use of estrogen and progestogen therapy (EPT). DESIGN: A case-control study was conducted among enrollees from a nonprofit health plan. Cases had a first diagnosis of leiomyomas confirmed by surgery or ultrasound. Controls were women of the same age range without a diagnosis of leiomyomas selected at random from membership and outpatient files. Participants were interviewed regarding prior use of exogenous hormones, medical history, and reproductive history. This analysis was restricted to cases (n = 256) and controls (n = 276) who were peri- or postmenopausal and more than 40 years of age. Adjusted odds ratios (OR) and 95% CIs were estimated using logistic regression models. RESULTS: EPT use for more than 5 years was associated with a 1.7-fold increased risk of leiomyomas (95% CI, 0.9-3.3). Associations with EPT use were only present among women with a body mass index less than 24 kg/m; OR (ever-use), 2.3 (95% CI, 1.2-4.3); and OR (>or= 5 years use), 4.0 (95% CI, 1.6-10.3). CONCLUSION: Among peri- and postmenopausal women, prior EPT use was associated with an increased risk of a subsequent leiomyomas. This association seemed limited to the subset of women with low body mass index. Exogenous sources of estrogen and progestin in the setting of low adiposity may contribute to the development of leiomyomas.

Adult↗
PubMedDate not supplied

Co-risk factors for HPV infection in Northeastern Thai women with cervical carcinoma.

HPV infection is the main cause of cervical cancer; however, factors that promote and maintain HPV infection are still unclear. This study was designed to search for factors responsible for the HPV infection in Northeastern Thai women. A total of 190 volunteers with a normal histopathologic appearance of cervix as controls (n=100) and with squamous cell cervical carcinoma (SCCA) (n=90) were the subjects. Variables of risk factors including sexual behaviors, history of reproduction, history of sexually transmitted diseases and smoking were conducted with self-report and direct interview. Number of sexual partners and smoking history increased the likelihood of high-risk HPV infection. Multiple sexual partners showed significantly higher 3.94-fold risk for HPV infection (95% CI = 1.82-8.82, p-value<0.001). Smoking history of partner increased the risk for HPV infection 3.03-fold (95%CI=1.42-6.58, p-value< 0.002). After OR were adjusted, significant difference was still observed in the number of sexual partners (p-value <0.0001) and smoking history of the partner (p-value<0.005). To decrease the incidence of cervical cancer, we should prevent HPV dissemination and be on the alert for having multiple sexual partners and a partner's smoking habit, which must be included in our public health planning.

Adolescent↗
PubMed2004

Systemic mechanisms of individual reproductive life history in female Medflies.

This paper is the second one in a series of two papers hypothesizing and testing systemic grounds of reproductive life history in the female fruit fly. In the first paper, we analyzed mechanisms of individual fecundity scheduling and have drawn the following conclusions. Individual fecundity in female flies is endowed as a flat pattern with a steady-state period of a constant rate of egg-laying. An individual female reveals three stages in her adult life history: maturation, maturity, and senescence. The first stage is a transient period of achieving a steady state at maturity, which can be maintained until the senescence stage. Thus, an individual fecundity pattern has no maximum. The maximums observed experimentally are averaging-caused artifacts. Two natural causes of deaths exist in flies, senescence-caused ones and premature deaths, probably due to a reproductive overload. In this paper, to confirm these findings, we use individual daily scores of egg-laying in four populations of Mediterranean fruit flies. Based on fecundity scores, we divide each Medfly population into four classes, namely zero-egg, short-, medium- and long-lived egg-layers. We demonstrate that, indeed, the three above findings definitely exist in Medflies. Our procedure allows the efficient storage of individual fecundity in parametric form, with only five numbers for each fly. Finally, this protocol will allow a more precise analysis of fecundity-energy trade-offs in flies carrying appropriate longevity mutations.

Animals↗
PubMed2002

Reproduction life history and hip fractures.

PURPOSE: The present study assesses the association between reproduction and hip fractures. METHODS: We used two surveys on elderly Danish twins of both sexes and the Danish National Register of Patients. In a cross-sectional study of 2045 twins aged 75-98 years in 1995, we studied the association between different aspects of reproduction and hip fractures leading to hospitalization between 1977 and 1994. In a prospective study, 3057 twins aged 66-99 years in 1977 were followed for a total of 29,112 years, and the association between number of children and incidence of hip fractures was investigated. RESULTS: In the cross-sectional study, as well as the prospective study, we found, for both sexes, that having no children was associated with a higher risk of hip fracture compared to having at least one child. When excluding persons without children, we found no effect of number of birth events/children. In the cross-sectional study, we found no effect of birth interval length or age at first birth. For women, we found an effect of age at last birth. CONCLUSIONS: No "cost-of-reproduction" in terms of hip fractures was observed. On the contrary, we found that having one or more children was associated with a lower risk of hip fracture.

Aged↗
PubMed1998

How the magnitude of clinical severity and recurrence risk affects reproductive decisions in adult males with different forms of progressive muscular dystrophy.

The reproductive history of 177 male patients affected with Becker (BMD) (n=69), limb-girdle (LGMD) (n=54), and facioscapulohumeral (FSHMD) (n=54) muscular dystrophy (MD) was analysed according to severity of the disease (BMD>LGMD>FSHMD) and magnitude of recurrence risk (RR) (high for FSHMD, intermediate for BMD, and low for LGMD). Additionally, 62 male patients were interviewed on psychosocial issues, in order to disentangle the factors influencing reproductive decisions among patients affected with MD. Among male adults, significantly more FSHMD than LGMD or BMD patients were married and had children. Age specific reproductive outcome was 0.31-0.32 for BMD, 0.51-0.62 for LGMD, and 0.58-1.02 for FSHMD, reflecting the influence of the disease's severity. High RRs did not significantly diminish reproduction after genetic counselling or correlate with less prospective desire for children. Instead, early onset, severity of the disease, and past reproductive history were found to diminish reproductive outcome after genetic counselling, and prospective family planning was also found to be influenced by past reproductive history as well as by emotional/sexual dysfunction with the opposite sex.

Adult↗
PubMed2003

History of fetal loss and other adverse pregnancy outcomes in relation to subsequent risk of preterm delivery.

OBJECTIVE: To evaluate the association between maternal reproductive history and preterm delivery. METHODS: The 312 preterm delivery cases, studied in aggregate, and in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34-36 weeks], and very preterm delivery [gestational age at delivery <34 weeks]), were compared with 424 randomly selected women who delivered at term. Maternal medical records provided information on maternal reproductive history, pregnancy outcome, as well as sociodemographic characteristics. Using multivariate logistic regression, we derived maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A history of 2+ miscarriages was (OR = 2.2; 95% CI 1.2-3.9), but a history of 2+ prior induced abortions (OR = 1.2; 95% CI 0.7-2.0) was not, associated with preterm delivery in the index pregnancy. Analyses of preterm delivery subgroups indicated that a history of 2+ miscarriages was associated with an increased risk of spontaneous preterm labor (OR = 2.6; 95% CI 1.2-2.8), preterm premature rupture of membrane (OR = 1.8; 95% 0.7-4.4), and medically induced preterm delivery (OR = 1.9; 95% CI 0.8-4.2), though only the former approached statistical significance. Excess risk of preterm delivery was associated with maternal prior history of delivering a stillborn infant (OR = 10.7), a prior history of delivering a newborn that later died during the neonatal period (OR = 3.2), and a prior history of having a pregnancy complicated by spontaneous preterm delivery (OR = 6.0). Generally these associations were evident for each subgroup of preterm delivery, though inferences were often hindered by our relatively small sample size. CONCLUSIONS: These results support the hypothesis that maternal adverse reproductive history is associated with an increased risk of preterm labor and delivery.

Abortion, Induced↗
PubMed1998

Validity of an estimator of reproductive success.

Lifetime reproductive success is a major component of individual fitness and a central dependent variable for the study of natural selection. For long-lived animals, such as apes or baboons, assessment of lifetime reproductive success requires observations of identified individuals in continuous, long-term studies from which it is difficult and often impossible to obtain an adequate sample of necessary reproductive and survival data. This situation can be alleviated by the availability of a valid measure that uses incomplete reproductive histories to estimate the lifetime reproductive success of individuals. The validity of one such estimator was tested by determining if, after 10.5 years of studying free-ranging female baboons, it predicted lifetime reproductive success obtained from full reproductive histories after 21.5 years. Validity was evaluated for seven criteria of success, ranging from the number of a female's live births to the number of her offspring that reached the age of 72 months. Moderate to good prediction of lifetime reproductive success by the estimator was found for criteria of offspring living to 36 months or more. After 10.5 years, complete reproductive life spans were available for only eight females. Using the estimator, analytic potential, via sample representativeness and size, was improved at 10.5 years by an increase from a sample of eight to between 34 and 62, depending upon the criterion used, and at 21.5 years from 39 to 70. With a valid estimator, the opportunity to study lifetime reproductive success of a long-lived species is substantially improved without having to depend upon rarely available, uninterrupted data collection for 20-60 years.

Animals↗
PubMed2002

Quality of data on subsequent events in a routine Medical Birth Register.

BACKGROUND: The maintenance of health registers has become routine. The main prerequisite for their use is that registers be complete and that their contents correspond to reality. METHODS: Data on all primiparous women who gave birth between 1987 and 1989 (N=73009) and on their second (N=55388) and third births (N=22904) in the 1987-1998 period were retrieved from the Finnish Medical Birth Register (MBR). The consistency of the MBR data on reproductive history and on previous Caesarean section was investigated by comparing the records on subsequent births. MAIN RESULTS: In total 98.5% of the information on reproductive history corresponded with the previous data in the MBR. Data quality decreased over time and with increasing parity. There were problems with the registration of rare cases, e.g. several extrauterine pregnancies or stillbirths. The quality deteriorated in the late 1990s, because no data on previous induced abortions and extrauterine pregnancies were collected between 1991 and 1995. The quality of data on previous Caesarean section was poor in 1987-1990, a period when the data were collected by using ICD-9 codes, but the quality improved after the introduction of a check-box format in 1991. CONCLUSIONS: Changes in question formats may change the quality of register data significantly. Check-boxes seem to improve quality compared to open-ended questions. The data on reproductive history and previous Caesarean sections could be combined routinely to improve the quality of the MBR.

Birth Rate↗
PubMed2005

Integrating life-history and reproductive success data to examine potential relationships with organochlorine compounds for bottlenose dolphins (Tursiops truncatus) in Sarasota Bay, Florida.

Research initiated in 1970 has identified a long-term, year-round resident community of about 140 bottlenose dolphins (Tursiops truncatus) in Sarasota Bay, Florida, providing unparalleled opportunities to investigate relationships between organochlorine contaminant residues and life-history and reproductive parameters. Many individual dolphins are identifiable and of known age, sex, and maternal lineage (< or =4 generations). Observational monitoring provides data on dolphin spatial and temporal occurrence, births and fates of calves, and birth-order. Capture-release operations conducted for veterinary examinations provide biological data and samples for life-history and contaminant residue measurement. Organochlorine concentrations in blubber and blood (plasma) can be examined relative to age, sex, lipid content, and birth-order. Reproductive success is evaluated through tracking of individual female lifetime calving success. For the current study, 47 blubber samples collected during June 2000 and 2001 were analyzed for PCB concentrations of 22 congeners relative to life-history factors and reproductive success. Prior to sexual maturity, males and females exhibited similar concentrations of about 15-50 ppm. Classical patterns of accumulation with age were identified in males, but not in females. Subsequently, males accumulated higher concentrations of PCBs through their lives (>100 ppm), whereas females begin to depurate with their first calf, reaching a balance between contaminant intake and lactational loss (<15 ppm). In primiparous females, PCB concentrations in blubber and plasma and the rates of first-born calf mortality were both high. First-born calves had higher concentrations than subsequent calves of similar age (>25 vs.<25 ppm). Maternal burdens were lower early in lactation and increased as calves approached nutritional independence. Empirical data were generally consistent with a published theoretical risk assessment and supported the need for incorporation of threats from indirect anthropogenic impacts such as environmental pollutants into species management plans. Long-term observational monitoring and periodic biological sampling provide a powerful, non-lethal approach to understanding relationships between organochlorine residue concentrations in tissues and reproductive parameters for coastal dolphins.

Adipose Tissue↗
PubMed1984

Investigation of area differences in the prevalence at birth of anencephalus in Belfast.

A retrospective case-control study comparing social and biological factors relating to all stillbirths and liveborn infants with anencephalus (n = 433) and a 10% random sample of all livebirths (n = 107 346) born to women resident in Belfast between 1957 and 1969 was carried out. The aim was to determine whether the large difference in the prevalence rate at birth of anencephalus within this city could be explained by any previously identified risk factors. For the 15 electoral wards the average rate over the study period was lowest in Windsor ward and highest in Court ward--rates 2.7 and 8.0 per 1000 livebirths respectively. Also, for one particular group of women who lived in certain areas of Belfast and who had an abnormal reproductive history the anencephalic rate was between 7.1 and 10.1 per 1000 livebirths depending on their parity. Although reproductive history was significantly associated with the risk of anencephalus this did not explain the area differences in rates within the city. These findings together with other work suggest that there are at least two separate sets of factors influencing the occurrence of anencephalus. One set relates to area of residence and may reflect adverse social circumstances and diet; the second set relates to maternal reproductive history, acts largely independently of the first and may have a genetic basis. Although this hypothesis accounts for a number of observations relating to anencephalus the excess of affected females cannot be adequately explained.

Adult↗
PubMed1997

Attributable risks for breast cancer in Italy: education, family history and reproductive and hormonal factors.

The percent population attributable risk (AR) for breast cancer was estimated in relation to education, family history of the disease and some reproductive and hormonal factors, using data from a case-control study conducted between June 1991 and February 1994 in 6 Italian centres on 2,569 histologically confirmed incident breast cancer cases and 2,588 controls, admitted to hospital for a wide range of acute, non-neoplastic, non-hormone-related diseases. On the basis of multivariate odds ratios, a high level of education accounted for 20% of cases, elevated age at first birth and nulliparity for 38% and a family history of breast cancer in first-degree relatives for 7%. Education and nulliparity and age at first birth together explained 47% of all breast cancer cases, and the combination of these 2 factors plus a family history of the disease explained 50% of cases. In pre-menopausal women a high level of education accounted for 31% of all breast cancer cases, older age at first birth for 44% and the combination of the 2 factors for 49%. In post-menopausal women the corresponding values were 13%, 31% and 42%; further addition of risk associated with family history of the disease explained 52% of pre-menopausal cases. In post-menopausal women older age at menopause and the use of hormone replacement therapy accounted for 15% and 2% of breast cancer cases, respectively. The combination of risks associated with a high level of education, old age at first birth and nulliparity and older age at menopause accounted for 51% of cases; further inclusion of risk associated with use of hormone replacement therapy explained 52%, and the AR resulting from these 4 risk factors combined plus a family history of breast cancer was 56%. Thus, a few selected and well-identified risk factors explain about one-half the breast cancer cases in this Italian population.

Age Factors↗
PubMed1995

Do reproductive factors influence colorectal cancer survival?

During 29 years follow up of 63,090 Norwegian women, 1347 women had a diagnosed cancer of the colon or rectum. Seven hundred and fifty-five of these women (56%) subsequently died of colorectal cancer. We investigated possible relationships between reproductive history and cancer survival and found little evidence that reproductive history is of prognostic value for colorectal cancer survival.

Adult↗
PubMed2003

Ovarian cysts in guinea pigs: influence of age and reproductive status on prevalence and size.

Forty-three guinea pigs presented as part of a screening programme were divided into six categories on the basis of age and reproductive history. Three age groupings were used: less than one year, one to two years, and over two years. Each age group was further divided into two categories: animals which had had single or multiple pregnancies, and animals which had never bred. Each animal received a clinical examination and was scanned using B-mode ultrasound for the presence of ovarian cysts. Possible relationships between reproductive history and the prevalence of cysts were investigated using Mantel-Haenzel analysis, and between prevalence, cyst size and age using linear regression analysis. Two out of the 43 animals (4.7 per cent) showed symmetrical alopecia. No statistically significant correlation between reproductive history and the prevalence of cysts was detected at the 95 per cent confidence level. A statistically significant relationship was found, however, between cyst size and age (P<0.01) and between cyst prevalence and age (P<0.02).

Age Factors↗
PubMed1990

Maternal employment and reproductive risk factors.

Studies of reproductive hazards in the workplace must address potential biases related to selection for employment. The National Natality Survey, a probability sample of live births to married women in 1980, was used to examine the relation between female employment during pregnancy and factors that might affect reproductive outcome by analyzing the 5,927 women with complete occupational data. Demographic and behavioral attributes as well as reproductive history were compared for the 3,712 women employed and the 2,215 women not employed during pregnancy. Employed mothers were of more optimal reproductive age, were more highly educated, had higher incomes, began prenatal care earlier, had greater weight gain during pregnancy, and were slightly less likely to be heavy smokers. Employed women had markedly fewer previous births and less favorable reproductive histories (more stillbirths, miscarriages, and induced abortions) than unemployed women, controlling for gravidity. Full- and part-time workers were similar with regard to demographic and behavioral characteristics, but part-time workers had higher parity. Differences were noted by employment sector: professional women had especially favorable demographic and behavioral traits, and women employed as operatives and service workers were less advantaged. These results indicate that substantial differences in pregnancy-related risk factors exist in relation to employment, with working women generally having more favorable demographic and behavioral characteristics and less favorable reproductive histories. This pattern could produce selection bias in studies of work and reproductive health, and it encourages the restriction of comparison groups to other employed women, with a need to consider heterogeneity among working women as well.

Adult↗
PubMed1976

Tetracycline-resistant T-mycoplasmas (Ureaplasma urealyticum) from patients with a history of reproductive failure.

The susceptibilities of T-mycoplasmas (Ureaplasma urealyticum) to minocycline, demeclocycline, doxycycline, tetracycline, and erythromycin were determined by a direct tube dilution test. T-mycoplasma-positive urine sediments of 105 patients with a history of reproductive failure were used as inocula. Minocycline was found to be the most active of the group of antibiotics commonly used to eradicate T-mycoplasma infection. Based on the median initial minimum inhibitory concentration, minocycline was the lowest with 0.03 mug/ml, followed by demeclocycline and doxycycline with 0.125 mug/ml, tetracycline with 0.25 mug/ml, and erythromycin with 2.0 mug/ml. Six T-mycoplasma isolates which had been cloned three times were also tested for susceptibility to the same five antibiotics. The same susceptibility pattern was found. Strains resistant to high concentrations of all antibiotics occurred. Strong positive correlation was seen in 21 patients between in vitro highly resistant strains and positive posttreatment cultures. These results indicate that empirical treatment of genital mycoplasma infections is not justified. Cultures should be taken pretreatment, susceptibility testing performed prior to treatment, and follow-up cultures done posttreatment.

Drug Resistance, Microbial↗
PubMed2004

The National Women's Health Study: assembly and description of a population-based reproductive cohort.

BACKGROUND: Miscarriage is a common event but is remarkably difficult to measure in epidemiological studies. Few large-scale population-based studies have been conducted in the UK. METHODS: This was a population-based two-stage postal survey of reproductive histories of adult women living in the United Kingdom in 2001, sampled from the electronic electoral roll. In Stage 1 a short "screening" questionnaire was sent to over 60,000 randomly selected women in order to identify those aged 55 and under who had ever been pregnant or ever attempted to achieve a pregnancy, from whom a brief reproductive history was requested. Stage 2 involved a more lengthy questionnaire requesting detailed information on every pregnancy (and fertility problems), and questions relating to socio-demographic, behavioural and other factors for the most recent pregnancy in order to examine risk factors for miscarriage. Data on stillbirth, multiple birth and maternal age are compared to national data in order to assess response bias. RESULTS: The response rate was 49% for Stage 1 and 73% for the more targeted Stage 2. A total of 26,050 questionnaires were returned in Stage 1. Of the 17,748 women who were eligible on the grounds of age, 27% reported that they had never been pregnant and had never attempted to conceive a child. The remaining 13,035 women reported a total of 30,661 pregnancies. Comparison of key reproductive indicators (stillbirth and multiple birth rates and maternal age at first birth) with national statistics showed that the data look remarkably similar to the general population. CONCLUSIONS: This study has enabled the assembly of a large population-based dataset of women's reproductive histories which appears unbiased compared to the general UK population and which will enable investigation of hard-to-measure outcomes such as miscarriage and infertility.

Abortion, Spontaneous↗