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PubMed2002

Son preference and fertility in China.

This paper examines the effect of son preference on the hazards of having a second and a third birth. With data from the Two-per-thousand National Sample Survey on Fertility and Contraception conducted in 1988 by the State Family Planning Commission of China, the hazard of having a second birth among 62+ thousand married women who have had a first birth, and the hazard of having a third birth among 43+ thousand married women who have had two births was examined. These two hazards (i.e. the hazard of moving from the first to the second birth, and the hazard of moving from the second to the third birth) were analysed by estimating Cox proportional hazard models. The major covariate in the first analysis is whether or not the first-born was a daughter. In the second analysis the main covariate is whether both of the first two children were girls. In both models seven covariates known to have independent effects on the transition to a second (or third) birth are controlled for, namely, whether the woman is a Han, whether she is a farmer, her age at the birth of the first (or second) child, whether she had her first (or second) birth prior to the initiation in 1979 of the one-child policy, and three dummy variables reflecting her level of education. The results show the important influence of son preference on the hazard of having another birth.

China↗
PubMedDate not supplied

Adolescent sexual attitudes and behavior: are they consistent?

Relationships between sexual attitudes and behavior among adolescents were studied in data collected by self-administered questionnaires from approximately 3,500 junior and senior high school students attending four inner-city schools during 1981-1982. An analysis of the results by sex, race and age found that 83 percent of sexually experienced adolescents cite a best age for first intercourse that is older than the age at which they themselves experienced that event, and 43 percent of them report a best age for first coitus older than their current age. In addition, 88 percent of young women who have had a baby say the best age at which to have a first birth is older than the age at which they first became mothers. Thirty-nine percent of the women and 32 percent of the men say that they believe premarital sex is wrong. Among those who are virgins, the proportions are much higher. However, even among those who have had intercourse, approximately 25 percent of both sexes say they believe sex before marriage is wrong. Women desire stronger relationships before having intercourse than do men, and women claim to have had a stronger relationship with their last sexual partner. Very few teenagers believe neither partner is responsible for pregnancy prevention, which tends to be viewed as a joint responsibility. Those who see it as a shared responsibility are slightly more likely than those who assign the responsibility to one or the other partner to have used a method at last intercourse, and they are considerably more likely to have used a method than are those who believe contraception is neither partner's responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Age at any birth is associated with breast cancer risk.

The period before the first birth is traditionally viewed as particularly critical for a woman's breast cancer risk. Nonetheless, the importance of early timing of a woman's first compared with subsequent births is not well understood. In the present study we examine this question using a population-based cohort of 1.5 million Danish women born between 1935 and 1978. Between 1968 and 1994, 13,049 incident cases of breast cancer were identified in the Danish Cancer Registry. According to our results, a woman's breast cancer risk is related to her age at any of her births. The risk increase per 5 year's increase in maternal age at first, second, third, and fourth birth was 9%, 7%, 5%, and 14%, respectively. For fifth and sixth births it was 5%. We observed a risk reduction after any birth occurring before 30 years of age (in uniparous women before 25 years of age). These effects were strongest more than 10 years after birth. Thus, our study shows that early timing of any additional birth induces an additional long-term reduction in maternal risk of breast cancer; that is, early reproductive years, rather than just the nulliparous years, constitute the critical period.

Adolescent↗
PubMed2006

Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne.

BACKGROUND: In the 1980s there was substantial interest in early pregnancy and pre-pregnancy interventions to increase birth weight and reduce preterm birth. We developed an inter-pregnancy intervention, implemented in a randomised controlled trial, to be provided by midwives at home soon after women's first birth. METHODS: MCH nurses invited women to take part during their home visit to new mothers. Women's contact details, with their permission, were passed to the study midwife. She had a randomisation schedule to which women's names were added before she met the women or their partners. All women recruited had a home visit from the study midwife with a discussion of their first pregnancy, labour and birth and the postpartum experience. Women in the intervention arm received in addition a pre-pregnancy intervention with discussion of social, health or lifestyle problems, preparation and timing for pregnancy, family history, rubella immunisation, referrals for health problems, and a reminder card. The primary outcome was defined as a birth weight difference in the second birth of 100 g (one-sided) in favour of the intervention. Additional data collected were gestational age, perinatal deaths and birth defects. Analyses used EPI-INFO and STATA. RESULTS: Intervention and comparison groups were comparable on socioeconomic factors, prior reproductive history and first birth outcomes. Infant birth weight in the second birth was lower (-97.4 g,)) among infants in the intervention arm. There were no significant differences between intervention and comparison arms in the proportion of women having a preterm birth, an infant with low birthweight, or an infant with a birth weight <10th percentile. There were more adverse outcomes in the intervention arm: ten births <32 weeks), compared with one in standard care, and more infants with a birth weight <2000 g, 16 compared with two in standard care CONCLUSION: As the primary outcome was envisaged to be either improved birth weight or no effect, the study was not designed to identify the alternative outcome with confidence. Despite widespread support for pre-pregnancy interventions to improve maternal and perinatal health, this first randomised controlled trial of a multi-component intervention provided at home, did not have a beneficial outcome.

Adult↗
PubMed2004

Can the Gail model be useful in American Indian and Alaska Native populations?

BACKGROUND: Very little is known about breast carcinoma risk factors for American Indian/Alaska Native (AI/AN) women undergoing screening. The Gail model has been a useful tool for predicting the risk of breast carcinoma in several populations. It has not been applied systematically to AI/AN women. METHODS: The current study was a retrospective review of 1458 screening mammograms performed for AI/AN women. The authors applied the Gail model to estimate both absolute risk and relative risk for breast carcinoma for AI/AN women screened in South Dakota, Arizona, and Alaska. RESULTS: The mean age of the women was 52.4 years. The onset of menses was not significantly different than expected. The average age at first birth was 20 years, very few women were nulliparous, and few women were age > 30 years at first live birth. The proportion of women reporting a first- or second-degree relative with breast carcinoma was similar to the proportion in the general population. The results of the model indicated an overall average relative risk that ranged from 1.42 to 2.69 compared with white American women, depending on the model assumptions used. Using a modified Gail model and calculating an imputed absolute risk, the expected incidence of breast carcinoma in this population increased to rates of 170-180 per 100,000 in the next 10 years, a significant increase over the Surveillance, Epidemiology and End Results-derived incidence rates from 1988 to 1992 of 31.6 per 100,000 for AI women in New Mexico and 78.9 per 100,000 for AN women. CONCLUSIONS: The model indicated a likelihood of increasing rates of breast carcinoma in the study population. The data obtained were useful in generating preliminary estimates of breast carcinoma risk in the study population, for which no prospective population survey has been completed. The inherent weaknesses in the current retrospective study indicated the need for a large-scale prospective data collection to confirm these exploratory findings.

Adult↗
PubMed1993

Delayed birth intervals of immature fraternal triplets in preterm labor. A case report.

The preterm birth of immature triplets before 28 weeks is associated with excess morbidity and mortality risks attributable to extreme immaturity. We report a case of fraternal triplets in preterm labor in which the second and third triplet births were delayed 11 days after the first birth, at 26 4/7 weeks' gestation. The later-born sibs were heavier at birth and throughout their neonatal course in the hospital and suffered less severe complications as compared to the first-born triplet. Delayed birth intervals of triplets in preterm labor should be considered to improve perinatal salvage of immature triplets, although a successful outcome is rare and unexpected.

Adult↗
PubMed1991

Late expectations: childbearing patterns of American women for the 1990's.

"This paper will examine the changes in the timing of entry into motherhood among post World War II birth cohorts of women and the childbearing patterns of women after age 30 [in the United States]. The principal data source used in this paper will be the Census Bureau's fertility and birth expectations survey from the Current Population Survey (CPS)....A brief summary of the origins and evolving problems associated with using birth expectations data as a method to predict future fertility swings will first be examined. Next, the usefulness of expectations data as a predictor of the future will be discussed in the context of historical patterns of childbearing....Finally, this paper will examine which socioeconomic groups of women are most likely to be characterized by delays in childbearing and their current prospects for having their first birth at later ages."

Age Factors↗
PubMed1998

Intergenerational influences affecting birth outcome. I. Birthweight for gestational age in the children of the 1958 British birth cohort.

There is considerable literature on intergenerational influences on birthweight. Few studies have been able to investigate such influences on the more basic measures of birthweight for gestational age and gestational age itself. This paper considers fetal growth. The investigations are derived from the 1958 British birth cohort followed from birth to age 33 years. Included were questions on physical and social characteristics of each parent and the grandparents, and birth details of parent and first child. In the present study, fetal growth in non-preterm babies, after adjustment for the known effects of smoking and sex of the child, is explained best by factors relating to the parent's own growth, primarily in utero, but also to adulthood. There are small additional effects of education or social class but not of parent's gestational age. Only 15% of the variability in the child's fetal growth can be explained by the mother's characteristics and approximately 7% by the father's. Parent's own fetal growth accounts for nearly half of the variability if unadjusted for other factors and nearly a third after adjustment for sex of child, smoking, parental height and weight, maternal age at menarche and paternal age at first birth. Parental fetal growth makes the greatest anthropometric contribution.

Adolescent↗
PubMed1999

Relationship Between Relative Risk of Developing Breast Cancer and Absolute Risk in a Population of Rural, Older African American Women.

Relative risks computed from known breast cancer risk factors can be used to quantitate a woman's individual risk of developing breast cancer. However, among older women the absolute risk of developing breast cancer over a specified time interval may be more useful in risk-benefit counseling. The objective of this investigation is to characterize the relationships between relative risks and absolute risks of breast cancer among a population of rural, older African American women. Among 224 African American women aged 50-91 years, relative risks were computed from historical information on age at menarche, number of previous biopsies, age at first birth, and number of first-degree relatives with breast cancer. These estimates, combined with the woman's current age, average remaining life expectancy, age-specific mortality, and breast cancer incidence rates, were used to estimate lifetime probabilities of developing breast cancer. Most women in the cohort (72.8%) had weak relative risks of 1.01-1.5 and only 3.5% of the women had relative risks of greater than 3.0. The majority of the women (87.5%) had lifetime probabilities of developing breast cancer that were less than 5%. Although there is a marked increase in age-specific breast cancer incidence with age, the probability of developing breast cancer in this population is low, primarily due to the low relative risks and the effects of competing mortality at older ages. Screening mammography should be directed toward women with high risks who are not receiving regular screening mammograms.

Journal Article↗
PubMed2002

Defining early adolescent childbearing.

OBJECTIVES: This study determined the age group for the case definition of early adolescent childbearing based on rates of adverse clinical outcomes. METHODS: We examined rates of infant mortality, very low birthweight (<1500 g), and very preterm delivery (<32 weeks) per 1000 live births for all US singleton first births (n = 768 029) to women aged 12 to 23 years in the 1995 US birth cohort. RESULTS: Rates of infant mortality, very low birthweight, and very preterm delivery were graphed by maternal age. In all 3 cases, the inflection point below which the rate of poor birth outcome is lower and begins to stabilize is at 16 years; therefore, mothers 15 years and younger were grouped together to determine the case definition of early adolescent childbearing. The inflection points were similar when outcomes were stratified by the 3 largest US racial/ethnic groups (non-Hispanic White, non-Hispanic Black, and Mexican American). CONCLUSIONS: From this population-based analysis of birth outcomes, we conclude that early adolescent childbearing is best defined as giving birth at 15 years or younger.

Adolescent↗
PubMed1990

[Epidemiology of breast cancer].

Leading position and further increase in breast cancer incidence in many countries are the most important facts of the descriptive epidemiology of breast cancer. In the GDR breast cancer incidence amounts to 60 per 100,000 per year. There are large differences in the incidence between populations, which support hypotheses about the life style, especially of diet, as a risk factor for breast cancer. Early age at menarche and late menopause, nulliparity and late age at first birth, breast cancer in first-degree relatives, benign breast disease and radiation increase breast cancer risk. Intake of oral contraceptives does not alter the overall risk for breast cancer. However, there are different results concerning the use in young age and before first full term pregnancy. Case-control studies concerning diet are not yet convincing. The results are discussed with respect to beneficial activities in controlling breast cancer.

Breast Neoplasms↗
PubMed1988

[Epidemiology of breast cancer].

Important facts and hypotheses of descriptive and analytic epidemiology of breast cancer are presented and discussed in connection with results of studies carried out by the authors. Leading position and further increase in breast cancer incidence in many countries are the most important point of descriptive epidemiology. In the GDR breast cancer incidence amounts to 60 per 100,000 per year. On the other hand, there are large differences in the incidence between populations, which support hypotheses about the life style, especially of diet, as a risk factor for breast cancer. The most important groups of risk factors which have been investigated are menstrual and reproductive factors, genetics, hormonal status, diet, benign breast disease, radiation and oral contraceptives. Early age at menarche and late age at menopause, nulliparity and late age at first birth, breast cancer in first-degree relatives, benign breast disease and radiation increase breast cancer risk. The results of case-control studies concerning diet are not yet convincing. A number of studies shows no overall increase of breast cancer risk. Finally, possibilities of breast cancer control are discussed.

Age Factors↗
PubMed1986

Female sterilization: can the woman who will seek reversal be identified prospectively?

Demographic socio-economic and decision-making aspects of sterilization and reversal of sterilization were compared in a group of 103 women requesting reversal (RR) and 117 women about to undergo sterilization (S), to determine the practicality of identifying in advance the woman likely to request reversal. The willingness of patients to pay for these procedures and the ethical implications of these decisions were also examined. RR were younger at the first relationship, birth of first child and birth of last child. There were no differences (RR vs S) between the number of full-term pregnancies, living children and therapeutic abortions. The timing of sterilization (puerperal versus interval) did not influence the decision to be reversed. The level of education, partner's level of education and mean family income were lower in the group requesting reversal. Multiple regression analysis revealed three characteristics which were most discriminatory: youth at first birth; lack of spousal support; and failure to choose 'family complete' as a reason for sterilization. The predictability was not strong enough to provide an accurate assessment of the individual woman. RR were of significantly lower socio-economic standing but were more likely to be prepared to pay a large sum of money for the reversal. The ethical implications of this finding are discussed.

Adult↗
PubMed1997

Effect of parity and age at delivery on breast cancer risk in Slovenian women aged 25-54 years.

In 1988, a case-control study on breast cancer and oral contraceptives with 624 cases and 624 matched controls in the age range 25-54 years was undertaken in Slovenia. This analysis assesses the relationship between parity and breast cancer risk: the relative importance of age at first birth, age at subsequent births and total parity. We also evaluate whether a dual effect of an increased risk immediately after childbirth followed by a long-term benefit exists. Three logistic regression models were used. Age at first delivery is an important breast cancer risk factor: among parous women it was associated with a 5.3% increase/year in the odds of breast cancer. Multiparity was not shown to be an independent risk factor. Age at subsequent deliveries was associated with a 1% increase in risk for every 1 year increase of age at any birth, but this contribution to the risk was not significant. In the analysis stratified by parity the most important influence is with the age at first birth. We find no evidence of an effect on the odds of breast cancer associated with the age at the second, or later, births. We do find that there is an increased risk associated with the birth of the first child followed by a longer term protective effect. A post-menopausal woman has a reduced breast cancer risk compared with a pre-menopausal woman of the same age, adjusting for the same number of deliveries and ages at these deliveries.

Adult↗
PubMed1983

On a modification of life table technique for analysis of birth interval data and its application.

"This paper presents some modifications [of] the usual life table technique to analyse the data on the time of first birth and inter live birth intervals which are compiled from the birth histories of females, of varying marital durations, enumerated in a retrospective survey." The fact that a female may not be exposed to the risk of conception following childbirth or marriage, because of postpartum amenorrhea or of customs involving visits to parents, is taken into account. A method to obtain maximum likelihood estimates of the conditional risk of conception is given, and an analysis of birth intervals is presented using this technique and data for India from the Rural Development and Population Growth--A Sample Survey 1978.

Amenorrhea↗
PubMed2006

The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial.

BACKGROUND: The Term Breech Trial compared the safety of planned cesarean and planned vaginal birth for breech presentations at term. The combined outcome of perinatal or neonatal death and serious neonatal morbidity was found to be significantly lower among babies delivered by planned cesarean section. In this study we conducted a cost analysis of the 2 approaches to breech presentations at delivery. METHODS: We used a third-party-payer (i.e., Ministry of Health) perspective. We included all costs for physician services and all hospital-related costs incurred by both the mother and the infant. We collected health care utilization and outcomes for all study participants during the trial. We used only the utilization data from countries with low national rates of perinatal death (< or = 20/1000). Seven hospitals across Canada (4 teaching and 3 community centres) were selected for unit cost calculations. RESULTS: The estimated mean cost of a planned cesarean was significantly lower than that of a planned vaginal birth (7165 dollars v. 8042 dollars per mother and infant; mean difference -877 dollars, 95% credible interval -1286 dollars to -473 dollars). The estimated mean cost of a planned cesarean was lower than that of a planned vaginal birth for both women having a first birth (7255 dollars v. 8440 dollars) and women having had at least one prior birth (7071 dollars v. 7559 dollars). Although the treatment effect was largest in the subgroup of women having their first child, there was no statistically significant interaction between treatment and parity since the 95% credible intervals for difference in treatment effects between parity equalling zero and parity of one or greater all include zero. INTERPRETATION: Planned cesarean section was found to be less costly than planned vaginal birth for the singleton fetus in a breech presentation at term in the Term Breech Trial.

Adult↗
PubMed1996

Parity, age at first and last birth, and risk of breast cancer: a population-based study in Sweden.

Associations between parity and the risk of breast cancer, and the relative importance of age at first and age at last birth on breast cancer risk, were estimated in a case-control study nested in a nation-wide cohort of Swedish women born between 1925 and 1960. A total of 12,782 women with breast cancer and five times as many individually age-matched controls, aged less than 60 years with concomitant fertility information, were included in the analysis. Increasing parity was associated with a pronounced decrease in the risk of breast cancer with each additional birth conferring a 10 percent risk reduction (odds ratio 0.90 [95% CI 0.88-0.91]). In an analysis limited to women with two or more parities, and after adjustment for the effects of ages at interim births, the risk of breast cancer increased by about 13 percent for each five-year increment in age at first birth (odds ratio 1.13 [1.08-1.19]). For every five year-increase in age at last birth there was a small risk increase of marginal statistical significance (odds ratio 1.05 [1.01-1.09]). The present findings contradict recent claims that age at last birth has a stronger effect than age at first birth on breast cancer risk. The dominance of age at first birth as risk modulator is likely to reflect the protection afforded by the terminal differentiation of breast cells induced by a first pregnancy.

Age Factors↗
PubMed1987

[Some aspects of the first and second birth interval].

"This article presents an analysis of the influence of demographic, socio-cultural and socioeconomic variables on the birth spacing pattern of women [in the Netherlands] with the aid of data from the Netherlands Fertility Survey 1982 and the follow-up study in 1985 (NFS'82/'85). Only the first and second intervals of women married for the first time and born between 1945-1964 are taken into account." The results indicate that 18 percent of the variance in the length of the first birth interval is due to such factors, suggesting that the influence of personal factors on fertility behavior is substantial. However, such variables account for only 8 percent of variance in the length of second birth intervals. (SUMMARY IN ENG)

Birth Intervals↗