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PubMed1993

Britain in Europe: international and regional comparisons of fertility levels and trends.

"This chapter compares fertility patterns and trends in Britain with those in other West European countries. Britain shares many features in common with the rest of Western Europe: fertility below the replacement level, late childbearing with births over age 30 becoming more common. Britain stands out, however, by having one of the highest birth rates in Europe and is one of the few European countries not facing population decline in the medium term. Average age at first marriage and first birth are relatively young. Britain also has one of the highest proportions (30 per cent) of births outside marriage...[with] at least a quarter of all children...likely to experience a single parent home or a reconstituted family before age 16." Some data for the rest of the United Kingdom are also discussed.

Age Factors↗

PubMed1998

Fertility problems and breast cancer risk in young women: a case-control study in the United States.

OBJECTIVES: Late age at first birth and nulliparity are established risk factors for breast cancer, yet the extent to which fertility problems contribute to these associations remains largely unexplored. Here, we examine self-reported fertility problems as a risk factor for breast cancer in young women. METHODS: We used a population-based case-control study of 2,173 cases and 1,990 controls aged 20 to 54 years in the United States. Structured in-person interviews were used to elicit detailed information on established and potential breast cancer risk factors. Information was collected on pregnancy details, including difficulties becoming pregnant or maintaining a pregnancy. RESULTS: Self-reported difficulty in becoming pregnant or maintaining a pregnancy was reported by 450 cases and 377 controls. Overall, there was little association between these fertility problems and risk of breast cancer (odds ratio [OR] = 1.05). Parity was associated with a decreased risk of breast cancer in women both with (OR = 0.71) and without (OR = 0.79) fertility problems. There was little evidence of an increased risk of breast cancer with later age at first full-term birth among women without fertility problems (ORage 35+ :age <20 = 1.13, 95 percent confidence interval [CI] = 0.7-1.9), but a relatively strong association among women with fertility problems (ORage 35+ :age <20 = 2.96, CI = 1.3-7.0). Among women with a first full-term birth at age 35 or older, fertility problems were associated with a twofold risk of breast cancer. Analyses of duration of unprotected sexual intercourse prior to first pregnancy as an alternative estimate of infertility produced similar results. CONCLUSIONS: Our study suggests that the association between late age at first birth and breast cancer is stronger among women with self-reported fertility problems than among women with no fertility problems.

Adult↗

PubMed1992

Effects of childhood sexual abuse on childbirth: one woman's story.

Anna Rose is a survivor of childhood emotional, physical, and sexual abuse. Much of the abuse was "submerged" until her mid-thirties, when she was pregnant with her second child, and finally began to remember and deal with the realities of what had happened to her. During her second pregnancy, Anna wrote, "It has taken me more than three years to even begin to deal with the rage I feel about my first birth experience, even though I have been in therapy most of that time. Now that I am pregnant again, the unresolved issues are coming to the surface, and intense fears that this birth will be a repeat of the first." Anna's first child, Elliot, was born in 1987 in a hospital birthing room in the northeastern United States. Her husband Paul, a younger sister, and a close friend were present, and she was attended by an obstetrician named Bernie. She describes that birth as "19 hours of hard labor, absolutely exhausting and unmanageable, which required drugs at some point to let me sleep for a few hours." Labor was induced by Pitocin due to premature rupture of membranes and lack of effective contractions after 12 hours. Continuous electronic fetal monitoring was used throughout labor. Anna breastfed Elliot for three years, and found La Leche League "extremely helpful and supportive" during that time. Tom, Anna's second child, was born at home in 1991. Two midwives attended the birth after she changed caregivers during the pregnancy because she "did not feel safe enough" with the obstetrician and nurse-midwife team she had chosen for this birth. She maintained the team as backup, although they did not know of her plans for a home birth. Her second labor lasted under 6 hours, was noninterventive, and "incredibly intense and painful, partly due to the abuse memories that were coming up and getting in the way and partly due to the baby's position." We thank Anna Rose for sharing her story with Birth. Her reason for doing so is, in her words, because, "I feel strongly that it is important to share this information in an effort to educate health care professionals so that other women may be helped."

Adult↗

PubMed2005

Secondhand smoke exposure in early life and the risk of breast cancer among never smokers (United States).

Evidence is increasing that some early life exposures affect breast cancer risk. Exposure to secondhand smoke (SHS) during childhood may be one such exposure. As part of the WEB Study (Western New York Exposures and Breast Cancer Study), we conducted a population-based, case-control study with 1166 women aged 35 to 79 diagnosed with histologically confirmed, primary, incident breast cancer. Controls (n = 2105) were randomly selected from the Department of Motor Vehicles driver's license list (< or =age 65) and the Center for Medicare & Medicaid Services rolls (> age 65). Participants were queried regarding household and workplace SHS exposure. Person-years of lifetime cumulative SHS exposure were computed as well as cumulative exposure up to 21 years of age. Unconditional logistic regression adjusting for potential confounders was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Lifetime cumulative exposure to household SHS was not associated with an increase in breast cancer risk for premenopausal (OR = 1.17, 95% CI = 0.54-2.56) or postmenopausal (OR = 1.29; 95% CI = 0.82-2.01) women. Neither was risk increased among women exposed to SHS before the age of 21 or at the time of birth, menarche, or a women's first birth. In this study, exposure to SHS either in adult or early life does not appear to be associated with the risk of breast cancer.

Adult↗

PubMed1997

Variation in the incidence of uterine leiomyoma among premenopausal women by age and race.

OBJECTIVE: To quantify the incidence of uterine leiomyoma confirmed by hysterectomy, ultrasound, or pelvic examination according to age and race among premenopausal women. METHODS: From September 1989 through May 1993, 95,061 premenopausal nurses age 25-44 with intact uteri and no history of uterine leiomyoma were followed to determine incidence rates of uterine leiomyoma. The self-reported diagnosis was confirmed in 93% of the medical records obtained for a sample of cases. Using pooled logistic regression, we estimated relative risks (RRs) of uterine leiomyoma according to race and examined whether adjustment for other potential risk factors could explain the variation in the race-specific rates. RESULTS: During 327,065 woman-years, 4181 new cases of uterine leiomyoma were reported. The incidence rates increased with age, and the age-standardized rates of ultrasound- or hysterectomy-confirmed diagnoses per 1000 woman-years were 8.9 among white women and 30.6 among black women. After further adjustment for marital status, body mass index, age at first birth, years since last birth, history of infertility, age at first oral contraceptive use, and current alcohol consumption, the rates among black women were significantly greater for diagnoses confirmed by ultrasound or hysterectomy (RR 3.25; 95% confidence interval [CI] 2.71, 3.88) and by hysterectomy (RR 1.82; 95% CI 1.17, 2.82) compared with rates among white women. We observed similar RRs when the cohort was restricted to participants who reported undergoing a screening physical examination within the 2 years before baseline. CONCLUSION: A higher prevalence of known risk factors did not explain the excess rate of uterine leiomyoma among premenopausal black women.

Adult↗

PubMed2002

Reproduction life history and hip fractures.

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

Aged↗

PubMed2001

Factors associated with unfavourable birth outcomes in Kenya.

Studies addressing factors associated with adverse birth outcomes have almost exclusively been based on hospital statistics. This is a serious limitation in developing countries where the majority of births do not occur within health facilities. This paper examines factors associated with premature deliveries, small baby's size at birth and Caesarean section deliveries in Kenya based on the 1993 Kenya Demographic and Health Survey data. Due to the hierarchical nature of the data, the analysis uses multilevel logistic regression models to take into account the family and community effects. The results show that the odds of unfavourable birth outcomes are significantly higher for first births than for higher order births. Furthermore, antenatal care (measured by frequency of antenatal care visits and tetanus toxoid injection) is observed to have a negative association with the incidence of premature births. For the baby's size at birth, maternal nutritional status is observed to be a predominant factor. Short maternal stature is confirmed as a significant risk factor for Caesarean section deliveries. The observed higher odds of Caesarean section deliveries among women from households of high socioeconomic status are attributed to the expected association between socioeconomic status and the use of appropriate maternal health care services. The odds of unfavourable birth outcomes vary significantly between women. In addition, the odds of Caesarean section deliveries vary between districts, after taking into account the individual-level characteristics of the woman.

Adolescent↗

PubMed1975

Frequency of marriage and live birth among survivors prenatally exposed to the atomic bomb.

Frequency of marriage and birth as of January 1973 was determined for persons exposed in utero to the atomic bombs in 1945 and for controls. The marriage rate was lower in persons heavily exposed in utero than in the non-exposed or lightly exposed. This difference is attributed partly to the lesser marriageability of persons with mental retardation who are significantly more numerous among the heavily exposed, and partly to unmeasured variables, possibly including social discrimination against survivors of the atomic bomb. No consistent relation was observed between radiation exposure and three reproductive indices: childless marriages, number of births, and interval between marriage and first birth.

Adult↗

PubMed2004

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

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

Abortion, Spontaneous↗

PubMed2006

Birth outcome in women with previously treated breast cancer--a population-based cohort study from Sweden.

BACKGROUND: Data on birth outcome and offspring health after the appearance of breast cancer are limited. The aim of this study was to assess the risk of adverse birth outcomes in women previously treated for invasive breast cancer compared with the general population of mothers. METHODS AND FINDINGS: Of all 2,870,932 singleton births registered in the Swedish Medical Birth Registry during 1973-2002, 331 first births following breast cancer surgery--with a mean time to pregnancy of 37 mo (range 7-163)--were identified using linkage with the Swedish Cancer Registry. Logistic regression analysis was used. The estimates were adjusted for maternal age, parity, and year of delivery. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate infant health and mortality, delivery complications, the risk of preterm birth, and the rates of instrumental delivery and cesarean section. The large majority of births from women previously treated for breast cancer had no adverse events. However, births by women exposed to breast cancer were associated with an increased risk of delivery complications (OR 1.5, 95% CI 1.2-1.9), cesarean section (OR 1.3, 95% CI 1.0-1.7), very preterm birth (<32 wk) (OR 3.2, 95% CI 1.7-6.0), and low birth weight (<1500 g) (OR 2.9, 95% CI 1.4-5.8). A tendency towards an increased risk of malformations among the infants was seen especially in the later time period (1988-2002) (OR 2.1, 95% CI 1.2-3.7). CONCLUSIONS: It is reassuring that births overall were without adverse events, but our findings indicate that pregnancies in previously treated breast cancer patients should possibly be regarded as higher risk pregnancies, with consequences for their surveillance and management.

Adolescent↗

PubMed2003

Contribution of excess weight gain during pregnancy and macrosomia to the cesarean delivery rate, 1990-2000.

OBJECTIVE: After declining for many years, cesarean delivery rates recently increased. To explore whether this increase is associated with excess weight gain during pregnancy, resulting in macrosomic infants who require cesarean delivery, we examined trends in excess weight gain, macrosomia, and cesarean delivery. METHODS: Analysis of 1990-2000 US Natality Files of birth certificate data were restricted to first birth, singleton infants of 37 to 42 weeks' gestation to avoid confounding by repeat cesarean delivery, complications of multigestational pregnancy, and preterm and postterm birth. Excess weight gain was defined according to current guidelines (41+ lb) and macrosomia as birth weight >4000 g. RESULTS: From 1990-2000, excess weight gain rose steadily from 18.6% to 24.2%. There was a 19.3% decline in macrosomic infants among women who gained excess weight compared with an 11.9% decline among women who gained 15-40 lb, although the absolute risk remained substantially greater among women who gained excess weight (eg, 14.2% vs 7.2%, in 2000). From 1990-1997, cesarean delivery declined by 20.2% among women who gained excess weight compared with 15.7% among women who gained 15 to 40 lb. After 1997, cesarean delivery increased in all weight gain categories, and absolute risks in 2000 were 25.8% for women who gained excess weight compared with 21.6% for women who gained 15-40 lb. Overall, women who gained excess weight accounted for 24.1% of cesarean deliveries in 1990 and 28.1% in 2000. CONCLUSIONS: Excess weight gain and macrosomia do not seem to be the primary factors that contribute to the recent increase in cesarean delivery because cesarean delivery rates have increased in all weight gain categories and macrosomia rates have decreased steadily from 1990-2000. Nonetheless, women who gain excess weight account for a growing proportion of cesarean deliveries because their relative numbers have grown.

Birth Certificates↗

PubMed2003

[Risk factors for cervical cancer].

In the following document a case and control study carried out in the Hospital General de Mexico is presented. The research obtained and analyzed facts related to social and cultural issues, as well as the obstetrics and gynecologist background, stating for each one of them, the relative risk and its statistical meaning with a trust degree of 95%. All of these aspects are considered critical causes for the development of cervix and uterine cancer. The results demonstrated that the scholar degree, the age in which the patients started sexual activity, the number of sexual partners, the number of births, the age in which the first birth occurred, and the smoking habits are facts that influence the natural evolution of this disease and should be considered as important background.

Adult↗

PubMed1993

[Cryopreservation of embryos in the in vitro fertilization/embryo transfer program].

An ultra-rapid method for cryopreservation of human embryos, using 1,2-propane-diol, was developed. 280 spare embryos obtained in the IVF program were frozen by this method. 91 embryos were thawed and 68 of them (74.7%) survived the procedure with more than half the blastomeres intact. 65 embryos were transferred in 28 cycles. Two pregnancies developed (7.1%), one of which ended by the birth of a healthy girl (the first birth after transfer of a frozen/thawed embryo in the Czech Republic). The other pregnancy is ongoing.

Cryopreservation↗

PubMed2003

Sociodemographic, behavioral, and reproductive factors associated with weight gain in Chinese women.

OBJECTIVE: To examine whether certain sociodemographic, behavioral, and reproductive factors are associated with an increased weight gain in Chinese women. DESIGN: Baseline survey data, including recalled past weight and measured current weight, from an ongoing prospective cohort study conducted in Shanghai, China. SUBJECTS: The analytical sample included 75 039 nonpregnant women aged 40-70 y. MEASUREMENTS: Statistical associations between certain sociodemographic, behavioral, and reproductive factors and weight gain were evaluated using multiple linear and logistic regression models. RESULTS: Weight gain and waist-to-hip ratio (WHR) increased with age among pre- and postmenopausal women before age 55 y. Weight gain declined but WHR continued rising as aging among postmenopausal women over age 55 y. Lower education levels, more parity and earlier age at the first birth, and earlier menarcheal age were associated with a higher long-term weight gain and current body weight. CONCLUSION: Age, education levels, parity, age at the first live birth, and menarcheal age were associated with long-term weight gain in Chinese women. However, these results concerning weight gain are based on recalled past weight and should be interpreted with caution. Further studies are needed to clarify the association of weight gain with lifestyle factors suggested by this study.

Adult↗

PubMed2004

Excess gains in weight and waist circumference associated with childbearing: The Coronary Artery Risk Development in Young Adults Study (CARDIA).

OBJECTIVE: To examine the association of childbearing with weight and waist circumference (WC) changes, we compared women with and without pregnancies or births during follow-up. STUDY DESIGN: A multicenter, longitudinal observational study over 10 years. Comparison groups defined by the number of pregnancies and births during follow-up: P0 (0 pregnancies; nongravid), P1 (1+ miscarriages or abortions; 'short' pregnancies), B1 (1 birth), and B2 (2+ births). Mean changes in weight and WC for P1, B1 and B2 groups vs P0 were examined separately by race (black and white), baseline parity (nulliparous and parous) and baseline weight status (normal weight; BMI <25 kg/m(2) and overweight; BMI >/=25 kg/m(2)). SUBJECTS: A population-based sample of 2070 women aged 18-30 y at baseline (1053 black subjects and 1017 white subjects) from Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California were examined five times between 1985-1986 and 1995-1996. MEASUREMENTS: Weight and WC measurements were obtained using standardized protocol at baseline and examinations at years 2, 5, 7 and 10. Sociodemographic, reproductive, and behavioral attributes were assessed at baseline and follow-up examinations. RESULTS: Gains in weight and WC associated with pregnancy and childbearing varied by race (P<0.001), baseline parity (P<0.05) and overweight status (P<0.001). Among overweight nulliparas, excess gains in weight (black subjects: 3-5 kg, white subjects: 5-6 kg) and WC (black subjects: 3-4 cm, white subjects: 5-6 cm) were associated with 'short' pregnancies and one or more birth(s) during follow-up compared to no pregnancies (P<0.01 and 0.001). Among normal weight nulliparas, excess gains in weight (about 1 kg) and WC (2-3 cm) were associated with follow-up birth(s) (P<0.05). Among women parous at baseline, no excess weight gains were found, but excess WC gains (2-4 cm) were associated with follow-up births. CONCLUSION: Substantial excess weight gain is associated with both short pregnancies and a first birth in women overweight prior to initiation of childbearing. Excess weight gain was not associated with higher order births. Increases in waist girth were cumulative with both first and higher order births among overweight as well as normal weight women. Interventions to prevent obesity should be targeted at women who are overweight prior to initiation of childbearing. The impact of excess WC gains associated with childbearing on women's future health risk should be evaluated further.

Adolescent↗

PubMed2005

Current understanding of genetic factors in preterm birth.

Several lines of evidence support a genetic predisposition to spontaneous preterm labour and preterm birth. Firstly, a leading risk factor for spontaneous preterm labour and preterm birth is a personal or family history. If a woman previously delivered preterm, her subsequent babies are also more likely to be born preterm. Women who experienced an early preterm birth (<32 completed weeks) in their first pregnancy have the highest rate of recurrent preterm birth in subsequent pregnancies. Spontaneous preterm labour and preterm birth in subsequent pregnancies tend to recur at equivalent gestational ages. If a woman herself was born preterm, she is also at an increased risk of spontaneous preterm labour and preterm birth, with the risks being highest for those women who themselves were born most preterm. This predisposition does not apply to men who were born preterm. Racial predispositions to preterm birth have also been observed. Black women suffer twice the rate of preterm birth compared with Caucasians, even when confounding social and economic variables are controlled. It is well established that upper genital tract infection and/or inflammation is seen in association with spontaneous preterm labour and preterm birth. Previous investigations have focussed primarily on an infectious aetiology for this finding. However, an alternative hypothesis has emerged, which suggests that this finding may represent an abnormal inflammatory response. The frequent association of spontaneous preterm labour and preterm birth with histological infection/inflammation and elevated body fluid concentrations of inflammatory cytokines has focussed investigations on single gene polymorphisms of these cytokines in both mother and fetus. The polymorphisms tumour necrosis factor-alpha-308 (TNF-alpha-308), interleukin-1beta (IL-1beta) + 3953/3954 and IL-6-174 have been most consistently associated with spontaneous preterm labour and preterm birth. Toll-like receptors (TLRs) are important components of the innate immune systems, which have also been linked to spontaneous preterm labour and preterm birth. Both maternal and fetal polymorphisms of the TLR-4 gene have been associated with spontaneous preterm labour and preterm birth in certain populations, but in others no apparent link has been observed. These findings confirm a clear genetic predisposition to spontaneous preterm labour and preterm birth and raise hopes that patient-specific therapies may be developed in the future.

Cytokines↗

PubMed1990

Development of a record linkage protocol for use in the Dutch Cancer Registry for Epidemiological Research.

A method has been developed to determine the optimal linkage key for record linkage between the cancer registry and a large-scale prospective cohort study in the Netherlands. The proposed linkage procedure is a two-stage process in which the initial computerized linkage using a particular linkage key is followed by visual inspection with additional information to separate the computer matches into true and false positives. In the determination of the optimal key, both informativeness and susceptibility to error of personal identifiers were taken into account. The performance of the various keys in the linkage was expressed in terms of sensitivity and predictive value of a reported computer match. The key, consisting of date of birth, first four characters of the family name and gender was the optimal choice, with a sensitivity of 98% and an initial predictive value of a computer match of 98%. When additional information on migration, place of birth and first initial was collected in the second stage, it was possible to eliminate the false positives from the reported computer matches without loss of true positives. Thus, the sensitivity remained constant whereas the secondary predictive value of accepted matches was maximized.

Databases, Factual↗

PubMed2004

Birth month, school graduation, and the timing of births and marriages.

We investigated the timing of fertility and marriage in Sweden using exogenous variation in the age at school graduation that results from differences in birth month. Our analysis found that the difference of 11 months in the age at leaving school between women who were born in two consecutive months, December and January, implies a delay in the age at first birth of 4.9 months. This effect of delayed graduation also persists for the timing of second births and first marriages, but it does not affect completed fertility or the overall probability of marriage before age 45. These results suggest the existence of a relatively rigid sequencing of demographic events in early adulthood, and the age at graduation from school emerges as an important factor in determining the timing--but not the quantum--of familyformation. In addition, these effects point to a potentially important influence of social age, defined by an individual's school cohort, instead of biological age. The relevance of social age is likely due to social interactions and peer-group influences exerted by individuals who are in the same school cohort but are not necessarily of the same age.

Adult↗