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PubMed2000

Successful first vaginal birth after cesarean section: a predictor of reduced risk for uterine rupture in subsequent deliveries.

BACKGROUND: Uterine rupture is a catastrophic obstetric complication, most often associated with a preexisting cesarean section scar. Although a vaginal birth after a cesarean is considered safe in modern obstetrics, it is not known whether repeated VBACs increase the risk of rupture, or whether the first VBAC proves the strength and durability of the scar, predicting further successful and less risky vaginal deliveries. OBJECTIVES: To evaluate the effect of repeated vaginal deliveries on the risk of uterine rupture in women who have previously delivered by cesarean section. METHODS: In this retrospective study, 26 VBAC deliveries complicated by uterine rupture were matched for age, parity, and gravidity with 66 controls who achieved VBAC without rupture. The histories, demography, pregnancy, labor and delivery records, as well as neonatal outcome were compared. RESULTS: We found that the risk of rupture decreases dramatically in subsequent VBACs. Of the 40 cases of uterine rupture recorded during the 18 year study period, 26 occurred during VBAC deliveries. Of these, 21 were complicated first VBACs. We also found that the use of prostaglandin-estradiol, instrumental deliveries, and oxytocin had been used significantly more often during deliveries complicated with rupture than in VBAC controls. CONCLUSIONS: Once a woman has achieved VBAC the risk of rupture falls dramatically. The use of oxytocin, PGE2 and instrumental deliveries are additional risk factors for rupture, therefore caution should be exerted regarding their application in the presence of a uterine scar, particularly in the first vaginal birth after cesarean.

Adult↗
PubMed1996

History of childbearing and colorectal cancer risk in women aged less than 60: an analysis of Swedish routine registry data 1960-1984.

Data from a computerised linkage between the Swedish Cancer Registry and the Fertility Registry were used to study the influence of reproductive history on the risk of colorectal cancer in women aged less than 60, in the period 1960 to 1984. A "nested" case-control design was used with 1,415 colon cancer cases and 733 rectal cancer cases, and 7,073 and 3,665 age-matched controls, respectively. Conditional logistic regression was employed to study the independent effects of parity, age at first birth and years since last birth on the risk of colorectal cancer. High parity was associated with reduced risk in women older then 50 years at diagnosis, both for the colon as a whole and for colon subsites. Women having had 5 children or more had an odds of colon cancer of 0.44 (95% confidence interval 0.24-0.82) relative to that of nulliparous woman. Contrary to the hypothesis advanced by McMichael and Potter (J. Nat. Cancer Inst., 75, 185-191 [1985]), which predicted a strong protective effect of parity in the proximal compared to the distal colon, we found the reverse. Increasing years since last birth seemed to be associated with a reduced risk of rectal cancer. A significant positive trend with increasing age at first birth was suggested with respect to distal colon cancer and rectal cancer risk. The mutually adjusted effects of the reproductive variables under study were similar to the unadjusted effects. Our data suggest that increasing parity is associated with a decline in risk of colon cancer but not rectal cancer, although the association with colon cancer is restricted to women aged 50 or more. The effects of age at first birth and years since last birth are not consistent or pronounced.

Adult↗
PubMed2000

Risk factors for ovarian cancer in central Italy.

OBJECTIVE: We conducted a case-control study to analyze risk factors for ovarian cancer. METHODS: Cases included 440 women (age range 13-80 years, median 54) with a histologically confirmed diagnosis of epithelial ovarian cancer who were admitted to the Gynecological Oncological Department of Gynecologic Oncology at the Catholic University Hospital in Rome, Italy. Controls were women admitted to the same hospital where cases were identified for acute nongynecological, nonhormonal, and nonneoplastic conditions. A total of 868 control women (age range 19-80 years, median 55) were interviewed. RESULTS: In comparison with ever married women, the multivariate odds ratios (OR) of ovarian cancers was 2.0 (95% confidence interval, CI 1.3-3.2) for never married women. Cases and controls were similar as regards educational status and body mass index. No clear relation emerged between ovarian cancer and age at menarche, menopausal status, and age at menopause. In comparison with nulliparae, the estimated ORs were 0.8, 0.9, and 0.7, respectively, in women reporting one, two, or three births. Women reporting two or more induced abortions were at decreased risk of ovarian cancer (OR 0.5, 95% CI 0.3-1.0). In comparison with women reporting their first birth before 20 years of age, the multivariate ORs were 1.8, 2.0, and 2.8, respectively, for women reporting their first birth at age 20-24, 25-30, and >/=31 (chi(2) trend = 10.1). Breast-feeding for more than 1 year was associated with an OR of 0.5 (95% CI, 0.4-0.8). Forty-two (9.5%) cases and 164 (18.9%) controls reported ever oral contraceptive use: in comparison with never users, the multivariate OR was 0.4 (95% CI 0.3-0.6) for ever users, and the risk decreased with duration of use. The OR for ovarian cancer was 2.9 (95% CI, 1.5-5.8) for women with a family history of the disease. CONCLUSION: This study, conducted on a relatively low-risk population, confirms the role of oral contraceptive on ovarian cancer risk and the direct association with family history of ovarian cancer. It also indicates that a later age at first birth is directly, and induced abortion and breast-feeding are inversely, related to the risk of the disease.

Adolescent↗
PubMed1989

Reproductive patterns and cancer incidence in women: a population-based correlation study in the USSR.

Many of the known or suspected risk factors of sex hormone-dependent cancers in women (low parity, delay in childbearing, etc) are typical features of modern reproductive behaviour. Within the USSR regional variations in principal reproductive characteristics and the incidence of breast and cervical cancers have been studied using standard correlation and regression analysis. The associations identified in previous analytical studies are generally present in the overall USSR population. However, the demographic peculiarities of this country (low mean ages at marriage and first birth, high rate of induced abortions, etc) introduce specificity into these relationships. The principal findings are: prevailing influence of parity versus age at first birth on regional variation of breast cancer incidence; consistent association between abortion rates (total, out-of-hospital and in primigravidas) and incidence of both breast and cervical cancers; suggested positive associations of early marriage and first birth with cervical cancer risk. Most of the reproductive variables studied affect the incidence of breast and cervical cancers in opposite ways.

Adult↗
PubMed1997

The association of change in maternal marital status between births and adverse pregnancy outcomes in the second birth.

The relationships between change in marital status between two consecutive births and adverse pregnancy outcomes at the second birth were investigated using linked Washington State 1980-93 white singleton birth certificates. Women who were married at the first birth had lower low birthweight (LBW) and small-size-for-gestational-age (SGA) rates at that birth than single women, and women married at the second birth had lower LBW, SGA and preterm delivery rates at that birth regardless of marital status at the first birth. Adjusted relative risks (RR) of LBW and SGA were significantly increased for initially married women who were single at the second birth compared with those who remained married (RR = 1.4 and 1.3, respectively). Risks of LBW and SGA were significantly decreased among initially single women who married by the second birth, compared with those remaining single (RR = 0.7 for LBW and 0.8 for SGA). We conclude that the largely unstudied subgroup of previously married women is at increased risk for adverse pregnancy outcomes. Public health policy and programmes directed at high-risk mothers and infants should be aware of the specific physical and emotional needs of this group of child-bearing women.

Adult↗
PubMed1984

Risk factors for pathologically confirmed benign breast disease.

Between November 1981 and March 1983, data were collected to evaluate risk factors for benign breast lesions in a case-control study based on 288 women with histologically proven benign breast disease, admitted for biopsy to the Tumor Institute of Milan, and 285 age-matched controls. Questions were asked about menstrual and reproductive characteristics, marital status, education, history of various diseases, and lifetime use of oral contraceptives and other hormonal treatments. Nulliparity or low parity, late age at first birth, and late menopause were associated with an increased risk of benign breast disease. The elevated risk associated with late age at first birth was not accounted for by parity. Early age at menarche was associated with an increased risk, but the estimate was not statistically significant. The data do not suggest that the use of oral contraceptives or other female hormones (such as estrogen replacement therapy) is related to the risk of benign breast disease. Risk was apparently lower, however, among current and long-term oral contraceptive users. There was no evidence of a trend with reference to body mass index. The present data indicate a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease, not only directly, by showing a relationship with parity, age at first birth, and age at menopause, but also indirectly, by failing to produce evidence that greater weight or the use of oral contraceptives has a protective effect.

Adolescent↗
PubMedDate not supplied

An evolutionary ecological perspective on demographic transitions: modeling multiple currencies.

Life history theory postulates tradeoffs of current versus future reproduction; today women face evolutionarily novel versions of these tradeoffs. Optimal age at first birth is the result of tradeoffs in fertility and mortality; ceteris paribus, early reproduction is advantageous. Yet modern women in developed nations experience relatively late first births; they appear to be trading off socioeconomic status and the paths to raised SES, education and work, against early fertility. Here, [1] using delineating parameter values drawn from data in the literature, we model these tradeoffs to determine how much socioeconomic advantage will compensate for delayed first births and lower lifetime fertility; and [2] we examine the effects of work and education on women's lifetime and age-specific fertility using data from seven cohorts in the Panel Study of Income Dynamics (PSID).

Adolescent↗
PubMedDate not supplied

Birth spacing patterns and correlates in Shaanxi, China.

This study shows that most women in Shaanxi Province, China try to have their first birth as soon as possible after their first marriage, and that the length of the interval between marriage and first birth is strongly correlated with the woman's age at first marriage. The length of the second and third birth intervals and the likelihood of going on to have a second or third birth are strongly influenced by the sex composition of children already born, the survival time of the child initiating the interval, the duration of breastfeeding, and the woman's occupation. There is significant regional variation in the length of birth intervals and in the prevalence of second and third births in Shaanxi. The findings indicate that China's one-child policy is far from being universally accepted in Shaanxi, including its urban areas. The persistence of many social, economic, institutional, and cultural factors promoting high fertility poses many obstacles to further fertility decline.

Adult↗
PubMed2006

Statistical methods for analysis of repeated measures on maternal morbidity.

OBJECTIVES: This paper applies statistical methods to identify factors associated with pregnancy-related complications in rural Bangladesh. The results are examined in order to identify the factors that can help formulate policy for reducing pregnancy-related morbidity. METHODS: Two statistical methods are used in this study to analyse the repeated-measures data on pregnancy-related complications in rural Bangladesh. One method is based on the application of linear logistic regression at each follow up, and the results are compared to identify the potential risk factors. Then the generalised estimating equation (GEE) approach is used, and the results based on each follow up are compared with those obtained from the application of the GEE approach. The maternal morbidity data collected by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies are used in this paper. RESULTS: Economic status, visit for antenatal care, and histories of sexually transmitted disease, hypertension, heart disease and breathing problem are positively associated with the complications during pregnancy, while wanted pregnancy, household type, primary and secondary schooling, and five or more pregnancies are associated negatively with the response variable. Involvement with gainful employment shows a negative association by the first technique. The GEE approach failed to identify some important factors such as history of anaemia, previous pregnancy and gainful employment. However, duration of pregnancy appears to have an association with pregnancy complications, which was not found from the conditional model based on each follow up. CONCLUSION: It appears that unwanted pregnancies need to be reduced through a well-organised and targeted family planning campaign for potential mothers of all ages in rural Bangladesh. Nutritional anaemia may cause various complications, and suggestions are given for reducing anaemia among pregnant women. In the rural areas of Bangladesh, first births usually occur at teenage. The first-birth pregnancy among teenagers can be a source of severe complications. There can be special programs to address the need for delay in the first pregnancy of those who marry at an early age.

Adolescent↗
PubMed1991

Reproductive factors and risk of endometrial cancer.

The role of reproductive factors in endometrial cancer risk has been analyzed in a case-control study conducted since 1983 in the greater Milan area on 568 women (cases) with histologically confirmed endometrial cancer and 1925 women (controls) who were admitted for acute, nonmalignant, hormonal, gynecologic conditions to hospitals that cover a comparable catchment area. Compared with nulliparous women, parous women had a 30% lower risk of endometrial cancer, but there was no evidence of a decline in risk with increasing number of births. The risk of the disease decreased with number of spontaneous or induced abortions; the multivariate relative risk estimates were, compared respectively with no spontaneous or induced abortions, 0.5 for women with two or more spontaneous abortions and 0.3 for women with two or more induced abortions; both trends in risk were statistically significant. When parous women only were considered, no association emerged between endometrial cancer and age at first birth, but the risk decreased with increasing age at last birth: compared with women whose last birth occurred before age 25, the relative risk was 0.5 for women who were greater than or equal to 35 years old at last birth, and the multivariate trend in risk was statistically significant. For most of the reproductive factors that were considered, the risk estimates tended to be greater at younger age or among premenopausal women and to flatten off in subsequent strata of age. An association between endometrial cancer and age at first birth was observed in women who were less than or equal to 49 years old, but not in older groups. The observation that later age at last birth as well as later first birth in younger women decreases the risk of endometrial cancer suggests a short-term protective effect of pregnancy. This finding is consistent with a late-stage (promotional) effect of reproductive factors on endometrial carcinogenesis.

Adult↗
PubMed1997

Modifying effect of reproductive risk factors on the age at onset of breast cancer for German BRCA1 mutation carriers.

Female carriers of mutations in the BRCA1 gene on chromosome 17q have a very high risk of developing breast and/or ovarian cancer during their lifetime. There is, however, little knowledge of to what extent non-genetic risk factors, such as age at menarche, age at first birth, and body mass index, alter the age at onset of disease. We identified individuals showing a high probability of linkage to BRCA1 and examined the effect of other known risk factors on disease risk. A total of 43 families with at least three breast or ovarian cancer cases, including two affected before 60 years of age, were studied for linkage to the susceptibility locus BRCA1. Blood samples from relevant family members were used to genotype for at least three chromosome 17q polymorphic markers. Information on reproductive history, hormone use and lifestyle factors was collected from female members using a self-administered questionnaire. Diagnoses of breast and ovarian cancer were verified through pathology reports and paraffin blocks were obtained when available. Multipoint LOD (logarithm of the odds) scores were calculated and individuals from 10 families with a posteriori probability for linkage greater than 0.90 were used for further analysis. Forty-six BRCA1 carriers were identified by the disease haplotype; 30 were affected with breast cancer and 5 with ovarian cancer. Proportional- hazards analysis of age at onset of breast cancer yielded increased relative risks of 1.74 for early age at menarche (< 14 years), 1.58 for late age at first birth (> or = 25 years) or nulliparity, and 2.78 for recent year of birth (> or = 1940); however, none of the risk estimates was statistically significant. When both breast and ovarian cancer were considered as disease endpoints, the birth cohort effect was stronger and age at first birth showed no effect. Our data provide some evidence that reproductive risk factors for breast cancer have an effect on age at onset for BRCA1 carriers. However, considering that our analyses were based on limited numbers, these results warrant further clarification.

Adult↗
PubMed1977

Labor force participation of working mothers and family formation: some further evidence.

This paper offers additional insight and evidence on the well-documented inverse relationship between female employment and fertility. Interviews with 388 working mothers from a probability sample in Robeson County, North Carolina, provide the data for testing the hypothesized relationships. Generally, the results indicate that lower fertility, lower desires and expectations, and earlier use of birth control are associated with work before the first birth and with employment of the longest duration. The timing of the first birth was not differentiated by variations in work experience. The results are conditional in that the relationships hold more for whites than for blacks or Indians.

Adolescent↗
PubMedDate not supplied

Marriage among unwed mothers: whites, blacks and Hispanics compared.

CONTEXT: Much of the debate over welfare reauthorization centers on whether marriage promotion should play a key role. Few studies, however, have tracked the marriage and divorce histories of unwed mothers, including minority women, who are often the main targets of welfare reform. METHODS: Data from the 1995 National Survey of Family Growth were used to estimate the hazards of the transition to marriage for women who delayed childbearing until marriage and for teenagers and older women who had a nonmarital first birth, and of the transition to divorce among the ever-married. Life-table estimates calculated with these estimated transition hazards show the cumulative proportions married and divorced, by race and ethnicity, for women who had a nonmarital first birth and for those who did not. RESULTS Nonmarital childbearing reduces the likelihood of marriage. Some 82% of white women, 62% of Hispanics and 59% of blacks who had a nonmarital first birth had married by age 40; the corresponding proportions among those who avoided nonmarital childbearing were 89%, 93% and 76%, respectively. There is no evidence to suggest that the negative effect of nonmarital childbearing on marriage is caused by other observed or unobserved differences between unwed mothers and women who remain childless until marriage. Nonmarital childbearing raises the likelihood of divorce among unwed mothers who eventually marry, a finding that also varies by race and ethnicity. CONCLUSIONS: Marriage promotion policies should focus on lowering rates of nonmarital childbearing. Reductions in nonmarital childbearing, however, may not eliminate long-standing discrepancies in marriage rates between black and white women.

Adolescent↗
PubMed1979

Breast cancer in black American women.

A case-control study of breast cancer among Black American women was conducted in seven hospitals in New York City from 1969 to 1975. Results are reported for 127 cases and 317 controls. Compared to women with a first birth before age 19, those with a first birth after 25 had a relative incidence rate for breast cancer of 3.8 and 2.2 for the pre- and postmenopausal age-groups, respectively. Compared to nulliparous women, parous women had a relative incidence rate of 0.6 for premenopausal and 0.7 for postmenopausal women. The incidence rate of breast cancer for women with a menopause after age 49 was estimated to be 3.1 times that of women with a menopause before age 45. Thus, the known risk factors for breast cancer among Whites are also related to the etiology of the disease among Blacks. The incidence rate of breast cancer has increased among younger Blacks since 1947 and is now similar to that among younger Whites. However, among older women, the incidence rate is still appreciably higher for Whites. The most likely explanation of this pattern is that Black women born since about 1925 are being exposed at the same frequency as White women to the causes of breast cancer.

Adolescent↗
PubMed1991

The epidemiology of ovarian cancer.

The descriptive and analytical epidemiology of ovarian cancer is reviewed, starting from the substantial geographical differences, with high rates in North America and Europe and low rates in developing countries and Japan, although, on a worldwide scale, almost 50% of 140,000 total cases occur in developing countries. Over the past decades, incidence and mortality rates have remained approximately stable in high-risk areas, but have generally tended to rise in low-risk areas. In the past, ovarian cancer was more common in higher social classes, but sociocultural differences seem to have flattened off over recent decades. In etiological terms, the protection afforded by multiparity and oral contraceptive (OC) use is well established, with relative risks (RRs) of the order of 0.5 for multiparae and OC users. There is also consistent evidence that risk increases with late age at menopause. Less consistent and weak, if any, are the effects of age at menarche and first birth, although there is hint that a first birth over age 35 is not protective. It is conceivable that diet can play an important role in ovarian carcinogenesis, but only scattered data are available to suggest that high fat consumption may represent an indicator of risk. Available knowledge on ovarian cancer epidemiology is also discussed in relation to models of carcinogenesis and implications for prevention and public health.

Female↗
PubMed1995

Proportion of breast cancer cases in the United States explained by well-established risk factors.

BACKGROUND: Few estimates of the fraction of cases of breast cancer attributable to recognized risk factors have been published. All estimates are based on selected groups, making their generalizability to the U.S. population uncertain. PURPOSE: Our goal was to estimate the fraction of breast cancer cases in the United States attributable to well-established risk factors (i.e., later age at first birth, nulliparity, higher family income, and first-degree family history of breast cancer), using data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS), the survey and follow-up of a probability sample of the U.S. population. METHODS: From a cohort of 7508 female participants surveyed in the early 1970s, and followed up between 1982 and 1984 and again in 1987, 193 breast cancer cases were accrued for study. We calculated incidence rates, relative risks (RRs), and population attributable risks (PARs) for breast cancer risk factors and extended our results to the U.S. female population by using sample weights from the NHANES I survey. RESULTS: Our PAR estimates suggest that later age at first birth and nulliparity accounted for a large fraction of U.S. breast cancer cases, 29.5% (95% confidence interval [CI] = 5.6%-53.3%); higher income contributed 18.9% (95% CI = -4.3% to 42.1%), and family history of breast cancer accounted for 9.1% (95% CI = 3.0%-15.2%). Taken together, these well-established risk factors accounted for approximately 47% (95% CI = 17%-77%) of breast cancer cases in the NHEFS cohort and about 41% (95% CI = 2%-80%) in the U.S. population. CONCLUSIONS: The RRs for most of these risk factors were modest, but their prevalence as a group was high, leading to estimates that suggest that a substantial proportion of breast cancer cases in the United States are explained by well-established risk factors. IMPLICATIONS: Elucidation of the determinants underlying recognized factors and study of other factors that may confer risk or protection are needed in efforts to advance understanding of breast cancer etiology and to aid in devising strategies for prevention.

Adult↗
PubMedDate not supplied

The socioeconomic consequences of teenage childbearing: findings from a natural experiment.

A study based on census data from 1970 and 1980 examines the socioeconomic effects of unplanned teenage childbearing by comparing teenage mothers whose first birth was to twins with those whose first birth was to a single infant. Among black women, an unplanned teenage birth--represented by the secondborn twin--results in significantly lower rates of high school graduation and labor-force participation and significantly higher rates of poverty and welfare recipiency. Ten years after giving birth, black women who have an unplanned child are also significantly less likely than women who have not to be currently married, but are not less likely to have ever been married. Like black women, white women who have an unplanned teenage birth have significantly higher rates of poverty and welfare recipiency; they also have significantly lower family earnings and household income.

Adolescent↗
PubMed2003

First live birth after ovarian stimulation using a chimeric long-acting human recombinant follicle-stimulating hormone (FSH) agonist (recFSH-CTP) for in vitro fertilization.

OBJECTIVE: To report the first pregnancy and live birth after ovarian stimulation using a chimeric long-acting human recombinant FSH agonist (recFSH-CTP) for IVF. DESIGN: Case report. SETTING: Tertiary fertility center. PATIENT(S): A 32-year-old woman with a 7-year history of primary infertility. INTERVENTION(S): Ovarian stimulation with a single SC injection of 180 microg recFSH-CTP on cycle day 3, followed by daily injections of 150 IU recFSH from cycle day 10 onward, combined with daily GnRH antagonist 0.25 mg SC to prevent a premature LH rise. Final oocyte maturation was induced by 10,000 IU hCG. MAIN OUTCOME MEASURE(S): First ongoing pregnancy obtained with recFSH-CTP. RESULT(S): Twelve oocytes were retrieved. Ten oocytes were fertilized in vitro by intracytoplasmic sperm injection, and from these 10 oocytes, two embryos were subsequently transferred after 3 days of culture. A pregnancy test 2 weeks after ET was positive, and ultrasound investigation revealed an intact, intrauterine, singleton pregnancy after 12 weeks. CONCLUSION(S): The first pregnancy and live birth was achieved after ovarian stimulation using recFSH-CTP for IVF.

Adult↗