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PubMed1995

History of maternal fetal loss and increased risk of childhood acute leukemia at an early age. A report from the Childrens Cancer Group.

BACKGROUND: Maternal reproductive history of fetal loss previously has been reported to be associated with an increased risk of leukemia in subsequent offspring. Data from a Childrens Cancer Group (CCG) case-control study were analyzed to test the hypothesis that this association was dependent on the number of previous fetal losses and age at leukemia diagnosis. METHODS: A case-control study using a large Childrens Cancer Group database examined maternal history of fetal loss as a risk factor for childhood leukemia in subsequent offspring. One thousand seven hundred fifty-three patients with childhood acute leukemia were compared with 839 community control subjects s and 2081 nonleukemia cancer control subjects. RESULTS: A modest increase in risk was found to be associated with a history of fetal loss. Stratification by age at diagnosis of leukemia showed that this association was significant only for those patients diagnosed before 4 years of age and most significant in those patients diagnosed before 2 years of age. When comparing community controls with patients acute lymphocytic leukemia diagnosed before 2 years of age, one previous fetal loss was associated with a five-fold increased risk (P < 0.001) whereas two or more fetal losses were associated with a relative risk of 24.8 (P < 0.001). Similarly, patients with acute myelocytic leukemia diagnosed before 2 years of age demonstrated 5-fold and 12-fold increased risks associated with the previous fetal loss and 2 or more previous fetal losses, respectively. CONCLUSIONS: Childhood acute leukemia occurring at younger ages may be associated with an underlying genetic abnormality or chronic environmental exposure, which can be either lethal to the developing fetus or mutagenic and result in the development of acute leukemia.

Abortion, Spontaneous↗
PubMed2004

Reproductive effects of occupational DDT exposure among male malaria control workers.

To assess potential effects of human DDT [1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane] exposure, we evaluated the reproductive history of 2,033 workers in the antimalaria campaign of Mexico. Data on occupational exposure to DDT and reproductive outcomes were gathered through a questionnaire, and workers provided information about 9,187 pregnancies. We estimated paternal exposure to DDT before each pregnancy using three approaches: a) a dichotomous indicator for pregnancies before and after exposure began, b) a qualitative index of four exposure categories, and c) an estimation of the DDT metabolite DDE [1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] accumulated in fat. To assess associations, we used logistic regression models that accounted for correlated observations and adjusted for parents' age at each child's birth, exposure to other pesticides, exposure to chemical substances in other employment, smoking, and alcohol consumption. The odds ratio for birth defects comparing pregnancies after and before the first exposure was 3.77 [95% confidence interval (95% CI), 1.19-9.52]. Compared with the lowest quartile of estimated DDE in fat, the ORs were 2.48 (95% CI, 0.75-8.11), 4.15 (95% CI, 1.38-12.46), and 3.76 (95% CI, 1.23-11.44) for quartiles 2, 3, and 4, equivalent to p,p -DDE in fat of 50, 82, and 298 microg/g fat, respectively. No significant association was found for spontaneous abortion or sex ratio. We found an increased risk of birth defects associated with high occupational exposure to DDT in this group of workers. The significance of this association at lower exposure levels found in the general population remains uncertain.

Abortion, Spontaneous↗
PubMed2001

Association of pregnancy history and birth characteristics with neuroblastoma: a report from the Children's Cancer Group and the Pediatric Oncology Group.

Previous studies have suggested a relationship between reproductive history, pregnancy and birth factors, and the risk of neuroblastoma. We conducted a case-control telephone interview study that included a total of 504 children under the age of 19 years with newly diagnosed neuroblastoma identified by two national collaborative clinical trials groups, the Children's Cancer Group and the Pediatric Oncology Group. A total of 504 controls, matched to cases on age, were identified by random digit dialing. Conditional logistic regression was used to estimate the matched odds ratio (OR) and 95% confidence interval (CI) with adjustment for household income, and maternal race and education. In addition, case subgroups defined by age at diagnosis, tumour MYCN oncogene amplification status, and stage were evaluated. A suggestive pattern of increased risk was seen for a greater number of prior pregnancies, history of previous miscarriages and induced abortions, with nearly a twofold increase in risk for two or more prior induced abortions (OR = 1.9, 95% CI [1.0,3.7]). No association was found for the following diseases or conditions during pregnancy: hepatitis, rubella, measles, mumps, chickenpox, mononucleosis, vaccinations, morning sickness, pre-eclampsia, bleeding, proteinuria, anaemia, urinary tract infections, heart disease, kidney disease, liver disease and diabetes. A weak association was found for hypertension during pregnancy. Several labour and delivery factors were related to an increased risk, including threatened miscarriage, anaesthetic during labour (specifically epidural) and caesarean delivery. We found associations between premature delivery (<33 weeks: OR = 1.9, 95% CI [0.7,4.8]), very low birthweight (<1500 g: OR = 2.6, 95% CI [0.7,10.3]) and risk of neuroblastoma. There was no consistent pattern of increased risk found for most factors within subgroups defined by age at diagnosis, stage or MYCN status.

Adolescent↗
PubMed1979

Müllerian anomalies: a proposed classification. (An analysis of 144 cases).

Hospital and clinic charts for 100 patients with diagnosed Müllerian anomalies were reviewed. Reproductive history, type of therapy, and treatment results for those patients and for another 44 with a history of exposure to diethylstilbestrol and abnormal hysterosalpingographic findings were recorded and evaluated. The anomaly most frequently associated with reproductive failure was the septate uterus. A new classification, based on degree of failure of normal development, was used in separating the anomalies into groups with similar clinical manifestations, treatment, and prognosis for fetal salvage.

Female↗
PubMedDate not supplied

Retrospective study of couples with a history of recurrent spontaneous abortion.

Clinical treatment of recurrent spontaneous abortion (RSA) is still a matter of debate due to the absence of an univocal definition of the term. As a consequence of the reproductive history of the couple, there is still uncertainty regarding the moment when the problem of recurrent abortion arises and this prevents the start of diagnostic evaluation and therapy. In addition to a critical review of the literature, the aim of this study was to evaluate whether two successive abortions with the same partner are sufficient to suggest that the couple should undergo diagnostic test, or if it would be more sensible to wait for other reproductive failures. The study was performed in 50 couples suffering from recurrent abortion who attended the Laboratory of Cytogenetics in the Department of Animal Biology at Turin University for caryotyping in order to exclude the presence of chromosomal aberrations. Interviewed by telephone, out of 50 couples 41 presented the necessary requisites for being included in the study. Follow-up ranged between a maximum of 8.5 years and a minimum of 1 year (mean of 4.7 years). From the data collected it emerged that the probable cause of RSA was identified in 21 out of 41 couples enrolled in the study group (51.2 per cent). In the remaining 20 couples tests were within normal ranges. In all diagnosed cases the reproductive problem was identified with one or more alterations present in women. Among the hypothesized cause of RSA, uterine abnormalities were the most frequent (19.5 per cent), followed by immunological problems (17.1 per cent), etiologic factors of hormonal origin (12.2 per cent), one single case of genital infection (2.4 per cent), one balanced chromosomal translocation (2.4 per cent) and at last only one case of cervical incompetence of (2.4 per cent). The diagnosis was determined effectively in 85.7 per cent of couples. Of 20 couples who had not shown any abnormalities, 80 per cent had had a healthy child without any abortions and with the same partner. In conclusion, diagnostic tests performed finally identified the cause of RSA in 43.9 per cent of the couples who completed the procedure; vice versa, 39.0 per cent of couples solved the problem without the need for diagnostic tests; finally, the remaining 18.1 per cent were unable to carry pregnancy to term. By comparing our results to those reported by other authors, we believe that the probability of identifying the cause of RSA and curing it is sufficiently high to justify the start of the diagnostic evaluation of the problem as early as the second abortion in view of the stress on the couple produced by repeated reproductive failures.

Abortion, Habitual↗
PubMed1983

Spontaneous abortion and subsequent Down syndrome livebirth.

Analyses of two data sets are presented, one based on nationwide hospital discharges for the USA for 1970-1971, the other for Upstate New York vital record data for 1976-1981. Summary relative risks of a Down syndrome livebirth were calculated within the three maternal age categories below 20, 20-29, and 30 years and above for those with a history of one spontaneous abortion and for those with a history of two or more, compared to those with no reported previous abortions. There was significant heterogeneity by age and reproductive history in the relative risk of an affected child. In general the trends revealed that the younger the mother and the more the number of abortions, the higher the relative risk of a Down syndrome livebirth compared to the rates for women of the same age for those with no previous abortions. Extrapolation from average maternal age specific rates on Down syndrome imply a rate per 1000 livebirths somewhere in the range of 1.1 to 11.4 for women under 20 years with a history of one spontaneous abortion, of 5.2 to 13.4 for women under 20 years with a history of two or more spontaneous abortions, and of 1.0 to 2.4 for women 20 to 29 years with a history of two or more spontaneous abortions. (Average "background" livebirth rates in women under 30 years are, in contrast, in the range of about 0.5 to 1.0 per 1000 and for the average woman aged 35 years, at which prenatal diagnosis is usually felt to be indicated, 2.7 per 1000.) For those in the other categories these data did not reveal clinically significant effects upon average maternal age specific rates. It is emphasized that because of limitations in the data it is not possible to refine these risks by adjusting for karyotype, the age at which the abortions occurred, or other biologic and social factors associated with embryonic and fetal death. The implications of the analyses here for genetic counseling should be regarded as preliminary and tentative.

Abortion, Spontaneous↗
PubMed2003

An evaluation of PGD in clinical genetic services through 3 years application for prevention of beta-thalassaemia major and sickle cell thalassaemia.

PGD represents an alternative within prenatal diagnosis services, which avoids terminating affected on-going pregnancies. In Greece, prevention programmes for haemoglobinopathies, including the option of prenatal diagnosis, are well established. Following optimization of a single-cell genotyping strategy (designed to be applicable for the majority of beta-thalassaemia major or sickle thalassaemia genotype interactions) along with close collaboration with an IVF unit, we integrated the option of PGD for at-risk couples with a problematic reproductive history. A total of 59 couples requesting PGD were counselled, of whom 41 initiated 63 PGD cycles. Following standard assisted reproduction treatment for oocyte retrieval, 20 cycles were cancelled (too few oocytes and/or poor quality embryos), but in 43 cycles single blastomeres were biopsied from 3 day embryos and genotyped (total 302). Diagnosis was achieved for 236 embryos, and 100 of 125 unaffected embryos were transferred. Sixteen pregnancies were established, although six were lost within the first trimester. Ten pregnancies underwent second trimester prenatal diagnosis, with nine pregnancies (13 babies: six singletons, two twins and one triplet) confirmed unaffected, although one singleton was a PGD misdiagnosis and terminated. The triplet pregnancy was selectively reduced to twins, and nine pregnancies went to term, with 12 healthy babies born. This report highlights advantages, limitations and approaches towards improvement when incorporating PGD within genetic services for a common recessive disease.

Anemia, Sickle Cell↗
PubMed2000

The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil.

OBJECTIVE: A cohort study has been designed to identify predictors of adverse health events in the elderly. The methodology of the study and preliminary descriptive results are presented. METHODS: The study population comprises all residents of Bambuí (Minas Gerais, Brazil), aged 60 or more years (n=1.742). From these, 92.2% were interviewed and 85.9% underwent clinical examination, consisting of haematological and biochemical tests, serology for Trypanosoma cruzi, anthropometric and blood pressure measures and electrocardiogram. Aliquots of serum, plasma and DNA were stored for future investigations. The baseline interview included sociodemographic characteristics, self-referred health condition and history of selected diseases, medication use, health service use, source of medical care, physical activities, smoking, drinking and eating habits, reproductive history, physical functioning, life events, social support and mental health. Individuals are being followed up annually. RESULTS: The following characteristics predominated among participants: women (60,0%), married (48.9%) or widowed (35.4%), people living in households with up to 2 residents (73.8%), heads of family (76.7%), people with monthly income between 1.00 and 2.99 Brazilian minimum wages (62.0%) and people with up to 4 years of schooling (89.1%). The median age was 68 years. Among the cohort members, only 1.7% were lost in the first follow-up. CONCLUSIONS: In general, the characteristics of the study population were very similar to those from other epidemiological studies of the elderly based on large Brazilian cities. The small number of losses to follow-up indicates that the choice of Bambuí was adequate, assuring the feasibility of a long term cohort study.

Aged↗
PubMed2001

Reproductive investment in pre-industrial humans: the consequences of offspring number, gender and survival.

The number and gender of offspring produced in a current reproductive event can affect a mother's future reproductive investment and success. I studied the subsequent reproductive outcome of pre-industrial (1752-1850) Finnish mothers producing twins versus singletons of differing gender. I predicted that giving birth to and raising twins instead of singletons, and males instead of females, would incur a greater reproductive effort and, hence, lead to larger future reproductive costs for mothers. I compared the mothers' likelihood of reproducing again in the future, their time to next reproduction and the gender and survival of their next offspring. I found that mothers who produced twins were more likely to stop breeding or breed unsuccessfully in the future as compared with women of a similar age and reproductive history who produced a same-gender singleton child. As predicted, the survival and gender of the offspring produced modified the costs of reproduction for the mothers. Giving birth to and raising males generally appeared to be the most expensive strategy, but this effect was only detected in mothers who produced twins and, thus, suffering from higher overall costs of reproduction.

Birth Intervals↗
PubMedDate not supplied

Assessment of reproductive disorders and birth defects in communities near hazardous chemical sites. III. Guidelines for field studies of male reproductive disorders.

Exposures to environmental toxicants can have detrimental effects on several aspects of human male reproduction: fertility, sexual function, hormone status, and pregnancy/birth outcomes. However, no simple prescreening methods are available for reliably identifying potential hazards; questionnaires alone are relatively imprecise and inefficient in the absence of field data. Multidisciplinary field studies are required that include detailed exposure information, health and reproductive histories, physical examinations, semen analyses, and possibly, hormone analyses. Semen analysis is a critical component of field studies for evaluating two aspects of male reproduction: 1) changes in sperm or seminal content, which may be indicative of adverse effects on the male reproductive system with possible implications for fertility potential; and 2) defects in sperm DNA or chromosomes, which may be associated with subsequent changes in viability during embryonic development and health risks to the offspring. Semen analyses may be tiered: 1) initially, each semen study may include conventional semen assays (concentration, motility, and morphology) as well as specific biomarkers indicated by the health effect of concern in the study cohort: and 2) archived samples (i.e., frozen, videotaped, or smeared) may be utilized in later second-tier analyses to further characterize specific findings. Before initiating any field study, it is cost effective to critically evaluate the suitability of the cohort by confirming exposure and determining that there are adequate numbers of male participants in each exposure category. Such evaluations must be based on the statistical sensitivities of the specific tissue biomarkers and health endpoints for detecting changes. This article summarizes the components of the ideal field study and identifies research needs for improving field studies of male effects and for understanding the mechanisms of male reproductive toxicity. Several promising semen methods currently under development are also discussed.

Adult↗
PubMed2001

Case-control study on risk factors for premature ovarian failure.

Objective of this case-control study was to investigate the potential risk factors for premature ovarian failure (POF). Seventy-three patients with secondary hypergonadotropic amenorrhea and, as control group, 144 women with acute, non-gynecological, non-neoplastic, non-hormone-related diseases were included in the study. Information was obtained on sociodemographic characteristics, gynecological and obstetric data, general lifestile habits, smoking habits and history of selected gynecological and other clinical conditions. A statistically significant association between high education level and POF was found (p = 0.03). Parity was related to a reduced risk of POF and this reduction increased with the number of live births (p = 0.02). No association emerged between POF risk and age at menarche, cycle length and oral contraceptive use. Women with POF could not be distinguished from control women by behavioral and reproductive history, except for lower fertility. The minor influence that reproductive and lifestyle factors have on the occurrence of POF suggests that genetic inheritance plays a more important role.

Adult↗
PubMed1986

Bias resulting from using the card-back system to contact patients in an epidemiologic study.

In a case-control study of thyroid cancer in women in western Washington, the card-back system was used to contact patients. Demographic characteristics and reproductive history of 124 cases who returned a card and 35 who did not were compared, and were found to differ with respect to various reproductive and demographic factors. Relative risk estimates for various thyroid cancer risk factors were calculated two ways: including as cases only those who returned a card, and including all cases; these estimates differed for some risk factors. The results suggest that the use of the card-back system may result in a low level of response which can lead to biased study results.

Adolescent↗
PubMed1997

Bone mass and risk factors for bone loss in perimenopausal Danish women.

OBJECTIVES: To determine risk factors for low bone mass at menopause and risk factors for subsequent bone loss in the following period. DESIGN: A cross-sectional study and a 2-year prospective follow-up. SETTING: The catchment area of Sundby Hospital in Copenhagen. SUBJECTS: Four hundred and thirty-three women aged 45-58 years, with amenorrhea for 3-24 months, of whom 87 were followed for a 2-year period. MEASUREMENTS: Registration of life-style and anthropometric variables, reproductive history, and family history of fractures. Total body bone mineral content (BMC) was measured with dual energy X-ray absorptiometry. RESULTS: By means of multiple regression analysis height, body weight, and length of reproductive period were found to be positively related to whole body BMC (P < 0.001), whilst a negative relationship was found to age (P < 0.001), smoking (P < 0.001), and family history of fractures (P < 0.005). In the longitudinal study, only body weight at the inclusion (P = 0.005) and subsequent changes in body weight and fat mass (P < 0.001) were related to the changes in bone mass. CONCLUSION: The most significant predictors for bone loss were changes in body weight and fat mass. Hence, weight loss is a risk factor for bone loss in the early postmenopausal period, whereas weight gain seems to preserve bone.

Body Weight↗
PubMed1989

Validity of questionnaire information on frequency of coitus.

A total of 91 women provided reproductive histories, including usual frequency of coitus, at their enrollment into prospective studies conducted by the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina, in 1984-1986. Those data were compared with coital data recorded during study participation. Overall, women reported a significantly higher frequency of coitus on the interviewer-administered questionnaire than they recorded daily, by an average of 0.8 episodes per week. The size of this difference did not vary significantly for subgroups of women defined by demographic and other covariates. Excluding days of menses from the prospective records reduced the difference by 25%. The authors attribute the overestimate on the questionnaire to a tendency to report a coital frequency that might exist in the absence of travel, illness, and other transient factors that are likely to decrease frequency. This nondifferential information bias is unlikely to produce misleading comparisons or erroneous associations in epidemiologic studies of reproduction.

Adult↗
PubMed1996

Menstrual and reproductive factors and risk of breast cancer in Asian-Americans.

We conducted a population-based case-control study of breast cancer among Chinese-, Japanese- and Filipino-American women in Los Angeles County Metropolitan Statistical Area (MSA), San Francisco-Oakland MSA and Oahu, Hawaii. One objective of the study was to quantify breast cancer risks in relation to menstrual and reproductive histories in migrant and US-born Asian-Americans and to establish whether the gradient of risk in Asian-Americans can be explained by these factors. Using a common study design and questionnaire in the three study areas, we successfully conducted in-person interviews with 597 Asian-American women diagnosed with incident, primary breast cancer during the period 1983-87 (70% of those eligible) and 966 population-based controls (75% of those eligible). Controls were matched to cases on age, ethnicity and area of residence. In the present analysis, which included 492 cases and 768 controls, we observed a statistically non-significant 4% reduction in risk of breast cancer with each year delay in onset of menstruation. Independent of age at menarche risk of breast cancer was lower (odds ratio; OR=0.77) among women with menstrual cycles greater than 29 days. Parous Asian-American women showed a significantly lower risk of breast cancer then nulliparous women (OR=0.54). An increasing number of livebirths and a decreasing age at first livebirth were both associated with a lower risk of breast cancer, although the effect of number of livebirths was no longer significant after adjustment for age at first livebirth. Women with a pregnancy (spontaneous or induced abortions) but no livebirth had a statistically non-significant increased risk (OR=1.84), but there was no evidence that one type of abortion was particularly harmful. A positive history of breastfeeding was associated with non-significantly lower risk of breast cancer (OR=.78). There are several notable differences in the menstrual and reproductive factors between Asian-Americans in this study and published data on US whites. US-born Asian Americans had an average age at menarche of 12.12 years-no older than has been found in comparable studies of US whites, but 1.4 years earlier than Asian women who migrated to the US. Asian-American women, particularly those born in the US and those who migrated before age 36, also had a later age at first birth and fewer livebirths than US whites. A slightly higher proportion of Asian-American women breastfed, compared with US whites. The duration of breastfeeding was similar in US-born Asians and US whites, but was longer in Asian migrants, especially those who migrated at a later age. Menstrual and reproductive factors in Asian-American women are consistent with their breast cancer rates being at least as high as in US whites, and they are. However, the effects of these menstrual and reproductive factors were small and the ORs for migration variables changed only slightly after adjustment for these menstrual and reproductive factors. These results suggest that the lower rates of breast cancer in Asians must be largely as a result of other environmental/lifestyle factors.

Adult↗
PubMed1984

Incidence of thyroid cancer in women in relation to previous exposure to radiation therapy and history of thyroid disease.

Female residents of 13 counties of Western Washington, in whom papillary, follicular, or mixed papillary-follicular thyroid carcinomas had been diagnosed between 1974 and 1979 were interviewed regarding their medical and reproductive histories and past exposure to radiation treatments. For comparison, a random sample of women from the same population was interviewed. Women who had received radiation treatments to the head or neck prior to 5 years before interview were 16.5 times (95% confidence interval = 8.1-33.5) more likely than unexposed women to develop cancer. The relative risk (RR) was highest for papillary cancer (19.4) but also was elevated substantially for follicular and mixed papillary-follicular tumors. Women first irradiated at age 19 years or younger had a much higher RR than did women irradiated at age 20 or older. Regardless of prior radiation exposure, women who ever had had a goiter were at increased risk of developing thyroid cancer. Women who had ever developed a goiter had 17 times the risk of developing follicular cancer and almost 7 times the risk of developing papillary cancer as compared with women who never had had a goiter. Risk of thyroid cancer was elevated even among women who had had a history of goiter many years prior to diagnosis. A history of thyroid nodules was also a risk factor for papillary and mixed thyroid cancer. Neither a history of hypothyroidism nor hyperthyroidism was found to increase the risk of thyroid cancer.

Adolescent↗
PubMed2000

Daily fecundability: first results from a new data base.

This multicenter study has produced a database of 7017 menstrual cycles contributed by 881 women. It provides improved knowledge on length and location of the "fertile window" (identified as of up to 12 days duration) and the patterns and level of daily conception probability. The day of ovulation was identified in each cycle from records of basal body temperature and mucus symptoms. By referencing days of intercourse to the surrogate ovulation markers, estimates of daily fecundability were computed either directly or by the Scwartz model, both for single and multiple acts of intercourse in the fertile window. The relationship between coital pattern and fecundability has been explored. Univariate analysis underlines the significant link with fecundability only of the woman's reproductive history.

Developed Countries↗
PubMed1997

[Ectopic pregnancy recurrence: role of gynecologic, obstetric, contraceptive and smoking history].

The purpose of this study, based on data from the register of ectopic pregnancy in Auvergne (centre of France), is to identify risk factors of recurrence of ectopic pregnancy (EP). The social characteristics, gynaecological, surgical and reproductive history and conditions of the conception of 96 women with a previous EP were compared to those for 566 women without previous EP. Risk factors associated with the management of the first EP could not be analysed with the data available. Several factors increased the risk of recurrence: previous proved or suspected salpingitis (OR = 3.6), maternal smoking (OR = 1.7 to 2.0 according to the consumption level), maternal age greater than 30 (OR = 2.0), and previous recurrent spontaneous abortions (SA) among childless women (OR = 3.4 to 11.9 according to the number of SA). The last of these factors may reflect another unknown risk factors common to recurrent SA and recurrent EP (for example hormonal or karyotype factors). Previous use of intra uterine device is associated with a decrease in the risk of recurrence of EP (OR = 0.27), but this contraceptive method should be considered as an indicator of good fertility rather than as a protective factor for EP recurrence.

Abortion, Spontaneous↗