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PubMed1997

Reproductive disorders among hairdressers.

To evaluate whether hairdressers have an increased risk of reproductive disorders, we conducted a historical cohort study in the Netherlands. Because exposure to reproduction toxic agents in hair salons may have changed over time, we studied two specific periods: conceptions in 1986-1988 and in 1991-1993. We ascertained 9,000 hairdressers and, as a comparison group, 9,000 clothing salesclerks from their respective trade associations. All were of reproductive age in the defined study periods. Frequency matching on 5-year age groups ensured comparability with regard to age. All women were approached by mail to complete a short, self-administered questionnaire on reproductive history, including questions on time-to-pregnancy, spontaneous abortion, livebirths, and congenital malformations. In the analyses, we used random effect models to account for correlated outcomes (multiple pregnancies per woman). The results show that hairdressers who conceived in 1986-1988 had an increased risk of prolonged time-to-pregnancy of more than 12 months [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 0.8-1.6], spontaneous abortion (OR = 1.6; 95% CI = 1.0-2.4), and a low-birthweight infant (OR = 1.5; 95% CI = 0.7-3.1). In both periods, more major malformations occurred among children of hairdressers, but numbers were small. These results indicate an increase in reproductive risks for hairdressers in earlier years that now seems to be disappearing.

Abnormalities, Drug-Induced↗
PubMed2000

Age at menopause and childbearing patterns in relation to mortality.

Several studies have reported increased mortality risk with early natural menopause. More recently, mortality risk was reported to be reduced among women who gave birth at age > or =40 years. The association between reproductive history and mortality was explored among 826 women in a prospective study involving 18,959 person-years of follow-up (from age 50 to 1990-1991) and 108 deaths. After adjustment for age and other covariates, the risk ratio among parous women was 1.53 (95% confidence interval: 0.58, 4.07) for natural menopause at age < or =45 years compared with > or =51 years. In contrast to a previous report, however, the highest estimated mortality risk was seen among women who gave birth in their forties (adjusted risk ratio = 2.14, 95% confidence interval: 1.05, 4.38) compared with having a last birth at ages 30-34 years.

Adolescent↗
PubMed1994

Pregnancy wastage in two tribal communities (Gujars and Bazigars) of Punjab, India.

The present report is an attempt to secure adequate data about pregnancy wastage in Gujar and Bazigar females of Punjab. Gujars in general are primarily cattle breeders and shepherds but Gujars of Punjab are farmers, too. In Punjab they mostly occupy the submountainous regions and riverline lowlands. Bazigar is a persian word meaning "he who does Bazi" or any sort of game or play but it is applied only to jugglers and acrobats. Bazigars are a gypsy tribe of vagrant habits. Most of them are now settled in the vicinity of large villages or towns. Analysis of reproductive histories of 250 Gujar females and 360 Bazigar females reveals that in the maternal age group 25-29 years, mothers experienced the least number of abortions and stillbirths. However, beyond this, the risk of pregnancy wastage increases with age. An overall rate of pregnancy wastage is 140.55 and 130.09 per 1000 pregnancies among Gujars and Bazigars of Punjab, respectively.

Abortion, Spontaneous↗
PubMed1994

Risk factors for invasive cervical cancer in Kenyan women.

BACKGROUND: Few epidemiological investigations of invasive cervical cancer have been conducted in Sub-Saharan African populations. METHODS: Using information collected as part of the hospital-based World Health Organization (WHO) Collaborative Study of Neoplasia and Steroid Contraceptives, we examined potential risk factors for invasive cervical cancer among Kenyan women. In all 112 women with histologically confirmed invasive cervical cancer diagnosed at the Kenyatta National Hospital, Nairobi, Kenya, between June 1981 and September 1988 and 749 control subjects were included in the present analyses. All women were interviewed regarding their medical and reproductive history, methods of birth control, and history of sexual relationships and sexually transmitted infections. Multiple logistic regression procedures were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: After adjusting for age, several factors were found to be associated with invasive cervical cancer. These include multiple sexual partners, early age at first sexual intercourse (OR = 1.9 and 2.6 for women reporting first intercourse at age 16-17 years and < 15 years, respectively, compared to women with first intercourse > or = 18 years), history of abnormal vaginal discharge (OR = 13.8, 95% CI: 8.3-23.0), and history of gonorrhoeal infection (OR = 3.2, 95% CI: 1.6-6.2). Low educational attainment and multiparity were also associated with the risk of invasive cervical cancer. Although the Papanicolaou smear has been extensively used as a screening method for cervical cancer in many countries, only three cases and four controls reported ever having a Papanicolaou smear (2.6% cases and 0.5% of controls). CONCLUSIONS: As has been observed in other parts of the world, cervical neoplasia in Kenya appears to be a late consequence of venereally transmitted carcinogenic agents.

Adolescent↗
PubMed1998

Epidemiologic differences between women with extraovarian primary peritoneal carcinoma and women with epithelial ovarian cancer.

OBJECTIVE: To describe the epidemiologic features of women with extraovarian primary peritoneal carcinoma and compare them with those of women with primary epithelial ovarian cancer. METHODS: The epidemiologic features of 50 women with extraovarian primary peritoneal carcinoma were compared with those of 503 women with primary epithelial ovarian cancer. We included all women with the respective diagnoses admitted to the Roswell Park Cancer Institute between October 1982 and October 1996 who returned an epidemiologic questionnaire. Epidemiologic features of the study and control groups were extracted from a database compiled from a self-administered questionnaire that has been given to patients as part of the admission process since 1982. Individual variables between the study and control groups were compared using Student t test, chi2 analysis, and Wilcoxon nonparametric test. Two-tailed P < .05 was considered significant. RESULTS: We found few significantly different epidemiologic features between women with extraovarian primary peritoneal carcinoma and those with primary epithelial ovarian cancer. Women with extraovarian primary peritoneal carcinoma were significantly older (mean age 63.8 versus 55.0 years, P < .001), had later menarche (13.3 versus 12.8 years, P = .024), and were less likely to have used perineal talc powder (26.0% versus 48.1%, P = .003). There were no significant differences with respect to reproductive history, contraceptive use, or use of hormone replacement therapy. A larger proportion of ovarian cancer patients reported a family history of breast cancer, but the numbers were too small to reach statistical significance. CONCLUSION: The epidemiologic features of women with extraovarian primary peritoneal carcinoma compared with women with primary epithelial ovarian cancer show few differences. The observed areas of difference warrant further research to determine whether they suggest the occurrence of distinct disease entities.

Epidemiologic Factors↗
PubMedDate not supplied

Prevalence of illicit drugs detected in the urine of women of childbearing age in Alabama public health clinics.

Each year, it is estimated that from 350,000 to 739,000 U.S. infants are exposed in utero to one or more illicit drugs. To estimate the prevalence of and risk factors for illicit drug use by women of childbearing age in Alabama, during 2 months in 1991 the authors collected patient-reported histories, clinical histories, and urine specimens from 6,195 women statewide attending public health maternity clinics, family planning clinics, and a high-risk referral obstetrical clinic. Blind drug screening of urine specimens for marijuana, cocaine, opiates, barbiturates, and amphetamines was performed with the use of a fluorescent polarization immunoassay. The overall prevalence of positive results for drugs tested was 10.1 percent, including 8.4 percent of the 3,554 pregnant and 12.3 percent of the 2,571 nonpregnant women screened. The drugs most frequently detected were marijuana and cocaine. Characteristics of the subjects associated with a higher prevalence of positive results for any drug tested or for marijuana included white race, older age, being divorced, non student occupation, having 12 or less years of education, attending a clinic located in a suburban county, self-reported substance use, increased risk for human immunodeficiency virus infection, and reproductive history. Characteristics of women with positive screening for cocaine results were similar to those who tested positive for any drug, except that the prevalence of cocaine was higher among black women and those attending urban county clinics and did not vary by years of education. Patient-reported histories of drug use were insensitive in identifying women who had positive drug screening results (sensitivity, 6.3 percent; specificity, 98.2 percent). Thus, in this study,the use of illicit drugs among women of childbearing age attending public clinics in Alabama was common and emphasizes the need for targeted drug education and interventions to reduce the impact of drug use on this high-risk population.

Adolescent↗
PubMed2006

Characteristics of women at low risk of STI presenting with pelvic inflammatory disease.

OBJECTIVE: To investigate the background and reproductive history of women who are considered at low risk of sexually transmitted infection (STI) presenting with acute pelvic inflammatory disease (PID). METHODS: Case-control study, investigating 51 women admitted to hospital with a diagnosis of acute PID and 50 healthy women attending for routine gynecological checkup. RESULTS: Women with PID were older (p = 0.003) and more often unemployed (p = 0.008), and had a lower educational level (p = 0.000003). Healthy women reported more regular routine attendance to gynecologists (p = 0.0008) and were less often smokers (p = 0.0009). There was no difference between groups regarding age at first sexual intercourse, number of sex partners during life, duration of current sexual partnership, and frequency of sexual intercourse, total number of deliveries, spontaneous abortions, ectopic pregnancies and outcome of last pregnancy. The number of induced abortions was significantly higher in the PID group (p = 0.0004). There were no differences between the groups with regard to previous episodes of PID. Healthy controls more often reported a history of STI (p = 0.00007). IUD was the most commonly reported current contraceptive method in both groups, and there was no difference in contraceptive practices between groups. CONCLUSION: Women with PID differed from healthy controls only with regard to socio-demographic characteristics and not with regard to common risk factors for PID.

Acute Disease↗
PubMed1995

The effect of gynecological risk factors on lumbar and femoral bone mineral density in peri- and postmenopausal women.

The relationship between gynecological history and bone mineral density (BMD) of the lumbar spine and femoral neck was studied in 3126 perimenopausal women. The study population was a random, stratified sample of participants, selected from the Kuopio Osteoporosis Study, which consisted primarily of all 14,220 women aged 47-56 years in Kuopio Province in 1989. After exclusion of 1521 women reporting past or present hormonal replacement therapy (HRT), 1605 women formed the final study population. Present HRT users had significantly higher lumbar BMD but not femoral BMD, than non-hormone users. Postmenopausal status, late menarche, and bilateral oophorectomy were risk factors for low BMD. Protective factors against low BMD were increased body weight, increased number of pregnancies, as well as hysterectomy without bilateral oophorectomy. The majority (43.8%) of these operations had been performed due to the presence of leiomyomas. No significant correlation was found between nulliparity, breast-feeding or amenorrhea before the age of 30 and BMD. In the multiple regression analysis, gynecological variables could account for only 18.4-26.8% of the variance in BMD, while time since last periods, age, age at menarche, weight and hysterectomy were the most significant variables. We conclude that reproductive history gives rise to some special risk groups, to whom BMD measurements and osteoporosis prevention efforts should be directed. However, it is impossible to predict BMD by gynecological characteristics.

Bone Density↗
PubMed2002

Inherited predisposition and breast cancer: modifiers of BRCA1/2-associated breast cancer risk.

Germline mutations in the BRCA1 and BRCA2 (BRCA1/2) genes explain a substantial proportion of hereditary breast and ovarian cancer. Women who have inherited a mutation in one of these genes are at increased risk to develop breast and/or ovarian cancer, although there is variability in the manifestation of tumors by age and site. This variability may be explained, in part, by the BRCA1/2 mutation type or location. However, it is also possible that risk-modifying factors exist that explain interindividual variability in cancer risk. These factors include genes at other loci and endogenous or exogenous exposures. A more complete understanding of factors that modify cancer risk in BRCA1 and BRCA2 mutation carriers may help to refine estimates of cancer risk. A number of exposures, including reproductive history and exogenous hormone use, have been implicated as BRCA1/2-associated cancer risk modifiers. Similarly, genes involved in hormone metabolism, including the AIB1 and AR genes, have been linked with altered breast cancer risk. Therefore, although germline BRCA1/2 mutations raise a woman's breast and ovarian cancer risk, other factors may interact with BRCA1/2 mutations to modulate this risk.

Breast Neoplasms↗
PubMed1998

International variability in ages at menarche, first livebirth, and menopause. World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives.

The occurrences and timing of reproduction-related events, such as menarche, first birth, and menopause, play major roles in a woman's life. There is a lack of comparative information on the overall patterns of the ages at and the timing between these events among different populations of the world. This study describes the variability in reproductive factors across populations in Europe, the Americas, Asia, Australia, and Africa. The study sample consisted of 18,997 women from 13 centers in 11 countries interviewed between 1979 and 1988 who comprised the control group in a World Health Organization international, multicenter case-control study of female cancers. All were surveyed with the same questionnaire and methodology. Overall, a typical woman in this study reached menarche at age 14 years and delivered her first live child 8 years later, at age 22. She was 50 years old at natural menopause and had had 36 years of reproductive life. The median ages at menarche varied across centers from 13 to 16 years. For all centers, the median age at first livebirth was 20 or more years, with the largest observed median (25 years) occurring in China. The median delay from menarche to first livebirth ranged from 5 to 11 years. Among the centers, the median age at natural menopause ranged between 49 and 52 years. In most populations, younger women had a first birth at a later age than did older women. This tendency was more accentuated in some populations. These results reveal, perhaps for the first time, the variability of reproductive histories across different populations in a large variety of geographic and cultural settings. Except for menopause, international variability is substantial for both biologically related variables (age at menarche) and culturally related variables (age at first birth). There is a generational effect, characterized by more variability of age at first birth and delay to first birth in the younger than in the older generations.

Adolescent↗
PubMed2004

Advanced paternal age and risk of fetal death: a cohort study.

A possible detrimental paternal age effect on offspring health due to mutations of paternal origin should be reflected in an association between paternal age and fetal loss. The authors used data from a prospective study of 23,821 pregnant women recruited consecutively to the Danish National Birth Cohort from 1997 to 1999 to assess the association between paternal age and fetal death. Fathers of the pregnancies were identified by record linkage to population registers. The paternal age-related risks of fetal death and its components, early and late fetal loss, were estimated using survival analysis. Pregnancies fathered by a man aged 50 or more years (n = 124) had almost twice the risk of ending in a fetal loss compared with pregnancies with younger fathers (hazard ratio = 1.88, 95% confidence interval: 0.93, 3.82), after adjustment for maternal age, reproductive history, and maternal lifestyle during pregnancy. Various approaches to adjustment for potential residual confounding of the relation by maternal age did not affect the relative risk estimates. The paternal age-related risk of late fetal death was higher than the risk of early fetal death and started to increase from the age of 45 years. It should, however, be interpreted cautiously because of the restricted number of fetal deaths.

Abortion, Spontaneous↗
PubMed1999

An assessment of fertility in male workers exposed to molinate.

Molinate is a thiocarbamate herbicide used for weed control in rice fields. Since the late 1970s, findings from reproductive toxicology studies of rats have led to concern that molinate might affect human male fertility. Semen samples were collected from 272 formulation and production workers at three US plants. The samples were collected at the end of four alternate monitoring periods of either high or low exposure to molinate. In addition, 222 married workers provided reproductive-history information. Workers' mean exposures to molinate during the monitoring periods ranged from 12.7 micrograms/m3 to 210.9 micrograms/m3. There was no evidence that sperm and serum hormone levels were related to exposure to molinate before the study or exposure during the four monitoring periods. There was also no evidence of a molinate exposure-related effect on the ratio of observed to expected births.

Alabama↗
PubMedDate not supplied

Genital manifestations and reproductive health in female residents of a Wuchereria bancrofti-endemic area in Tanzania.

To assess the significance of lymphatic filariasis for the development of chronic genital manifestations and for reproductive health in women, we conducted a cross-sectional study of 2 villages in north-eastern Tanzania including interview and gynaecological examination of adult women, focusing primarily on reproductive history and genital health. In a population of 2165 residents, prevalence of Wuchereria bancrofti microfilaraemia was 28%, and geometric mean intensity of microfilariae (mf) was 722 mf/mL. Leg lymphoedema (elephantiasis) was present in 4.2% of adults aged > or = 15 years, and hydrocoele in 26.5% of adult males. Five hundred and thirty women completed an interview, and 404 of these completed a gynaecological examination. Most women were Muslims (72%), polygamy was common (29%), and 49% of women had undergone circumcision (clitoridectomy). Presence of microfilaraemia did not influence fertility or fertility-related variables including age at menarche, parity, spontaneous abortion, stillbirth, Caesarean section and premature labour, nor presence of primary or secondary infertility. Mf status was strongly correlated with abnormal menstruation pattern in the 30+ years age-group (P = 0.001), but not in the < 30 years age-group. Cervical, vaginal and vulval pathology was unrelated to mf status. Two women, aged 46 and 77 years, had vulval oedema of probable filarial origin, both were mf negative. Overall, microfilaraemia appeared to have no influence on genital disease or reproductive health, and chronic manifestations of lymphatic filariasis of the genitals does not appear to be a substantial problem in women.

Adolescent↗
PubMedDate not supplied

Crossing the border for abortion services: the Tijuana-San Diego connection.

In this study we created a profile of women living on both sides of the US-Mexico border who terminated pregnancies in San Diego at the largest clinic providing abortion services in California. Sociodemographic and reproductive history data were collected on all 1558 women terminating pregnancies in 1996. Using country of residence, language use, and surname, the sample was stratified into four comparison groups: Tijuana residents, U.S. Non-Latinas, U.S. English-speaking Latinas, and U.S. Spanish-speaking Latinas. These data were supplemented by interviews with field experts. Compared to U.S. residents, crossborder abortion seekers were older, had healthier habits, were less likely to terminate in the second trimester, and more likely to pay cash for their procedure. While crossborder abortion seekers in San Diego face multiple barriers to access abortions, they posed no increased risk for complications, nor did they represent a financial burden on California.

Abortion Applicants↗
PubMed2002

Socio-demographic and reproductive characteristics of mothers delivered at the Korle-Bu Teaching Hospital, Ghana.

OBJECTIVES: To measure selected socio-demographic and reproductive history characteristics of parturients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, and to compute the risk load. DESIGN: A non-randomised cross-sectional survey. SETTING: Korle-Bu Teaching Hospital, Accra, Ghana. SUBJECTS: Korle-Bu Teaching Hospital, a tertiary institution delivers about 11,000 women annually. From 1st November to 12th December 1994, 961 parturients were studied out of 978 delivered during the study period. Seventeen questionnaires were excluded from analysis because of errors and omissions that could not be corrected before the parturients' discharge from hospital. METHODS: The data sources were the patients' antenatal and delivery records, and a structured interviewer-administered questionnaire. RESULTS: More than three percent of the subjects were less than 18 years, and 10.8% were over 35 years of age. Before the index delivery, 5.8% were grand multiparae. Eighteen per cent had never been to school. Seventeen per cent of parous subjects had experienced a perinatal death. The non-educated had significantly more births. The mean birth interval was less than two years in 26.4%. Fifty percent of those who had been previously pregnant had a history of at least one induced-abortion. Only 21.0% of the 961 subjects had ever used a family planning method. The risk load was 53.0%. CONCLUSION: Analysis of the historical factors of parturients surveyed at the KBTH showed a high risk load related mainly to lack of education. Formal education of the female child and family health education of our women are recommended to reduce the high past abortion rate and risk load. Additionally, postpartum tubal ligation for those who have completed their families will further reduce the risk load.

Adolescent↗
PubMedDate not supplied

[Risk factors for breast cancer among rural Teréna Indian women in the State of Mato Grosso do Sul, Brazil].

In order to evaluate the distribution of selected risk factors for breast cancer among Teréna Indian women in the State of Mato Grosso do Sul, Brazil, two samples were interviewed, respectively, in 1995 (330 women from ten Indian villages) and 1997 (40 women from the Limão Verde village). Reproductive history, diet characteristics, and family and personal medical history were investigated and body mass index was measured. In the larger sample, mean age at menarche was 12.3 years (30% at 13 years old or later), 86% of women reported one or more pregnancies (42% reporting 5 or more), 71% reported three or more pregnancies, mean age at first pregnancy was 18.9 years (3.8% after 28 years), mean duration of breastfeeding was 84 months, and 70% reported menopause before age 50. Dietary pattern in the smaller sample revealed a high intake of fruits, vegetables, pasta, and tubers and scarce intake of red meat and chicken; 50 of the women (95% CI: 34.1-65.9) presented overweight (BMI 25-29) and 27% (95% CI: 15.1-44.1) obesity (BMI > 29).

Adult↗
PubMed2001

Cumulative duration of breast-feeding influences cortisol levels in postmenopausal women.

Cortisol levels dramatically increase during pregnancy, peak at birth, and subsequently decline. However, all previous studies examined women during pregnancy and early postpartum. None examined the long-term association of parity and lactation with cortisol levels. We examined the relation of reproductive history to cortisol levels in postmenopausal women. Subjects were 749 women, aged 50-89, who were not using estrogen in 1984-1987 when morning cortisol was measured. Parity was not significantly associated with cortisol. However, women who breast-fed for >12 months had significantly higher cortisol levels than women who breast-fed for shorter durations or not at all (p = 0.003). This association was stronger among women with three or more births. Duration of breast-feeding is a determinant of cortisol levels in postmenopausal women. Because both increased cortisol and increased duration of breast-feeding may play protective roles in certain autoimmune diseases, such as rheumatoid arthritis, we suggest that the beneficial effect of lactation on the course of these diseases may be mediated by cortisol.

Aged↗
PubMed2005

Reproductive and dietary determinants of the age at menopause in EPIC-Heidelberg.

OBJECTIVES: The aim of the study was to explore the influence of reproductive and dietary factors on the age at menopause. METHODS: During follow-up of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort in Heidelberg (median duration 5.8 years), 1009 women experienced natural menopause. They were compared to 3798 women who did not experience menopause. Baseline dietary intake was obtained by means of validated food frequency questionnaires. Data on reproductive history and medication was collected by means of questionnaires. Cox' proportional hazard models were applied in order to identify determinants of the age at natural menopause. RESULTS: Increasing age at first full term pregnancy and a longer time interval until occurrences of regular menses are associated with later onset of natural menopause. Compared to never smokers, current smokers have the risk of younger age at menopause. High carbohydrate consumption and high intake of vegetable, fibre and cereal products are inversely related to the age at natural menopause. Women with higher intake of total fat, protein and meat experienced a delayed onset of natural menopause. CONCLUSION: Age at natural menopause is influenced by lifestyle and dietary factors. Further studies including biological markers are needed to clarify these associations.

Adult↗