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PubMed2002

[Relationship between epidural analgesia and type of delivery].

OBJECTIVE: To study the relationship which exists between the administration of an epidural analgesic during labor and an instrument-aided, either with forceps or a suction cup, childbirth in the Teresa Herrera Maternity-Infant Care Hospital in A Coruña for the clinical cases studied during 1999. MATERIALS AND METHODS: 380 cases were selected by lot by going through clinical files; of these 190 had received epidural analgesia while the other 190 had not. RESULTS: Regarding isolated association between epidural analgesic usage and instrument-aided childbirth, we found that the risk of an instrument-aided childbirth is high (OR 2.7) when an epidural analgesic is administered. However, when we analyze our results weighing various factors which may cause confusion, we discover that if it is a woman's first birth, if the newborn's weight is greater than or equal to 3500 g and if an epidural analgesic is administered have an independent effect, in this order, on the presence of an instrument-aided childbirth. At the same time, this study showed a similar occurrence of cases of intra-labor fetal suffering for both groups (5.8% among childbirths in which epidural analgesia was administered and 5.3% among childbirths in which epidural analgesia was not administered); a statistically insignificant relationship (since is less than 0.05%). CONCLUSION: The increase of an instrument-aided childbirth when an epidural analgesic is administered is due more to factors related to the aforementioned analgesia (such as first child birth, fetal weight greater than or equal to 3500 g or a tendency to shorten labor without fetal suffering,...) than to the analgesic itself. The impact of this on the latest developments in childbirth could be affected by a change in obstetrics practices.

Adult↗
PubMed1999

A pooled analysis of case-control studies of thyroid cancer. II. Menstrual and reproductive factors.

OBJECTIVE: It has been suggested that female hormones, and hence menstrual and reproductive factors, play a role in thyroid cancer etiology. Epidemiological data, however, are limited and inconsistent, partly because of the small number of cases included in each study. To clarify the etiology of thyroid cancer, we conducted a pooled analysis of original data from 14 case-control studies, 4 from the United States, 2 from Asia, and 8 from Europe. METHODS: This analysis included a total of 2,247 female cases of thyroid cancer (80% papillary) and 3,699 control women. Pooled odds ratios (OR) were estimated using logistic regression, conditioning on study and (i) matching sets for individually matched studies, or (ii) quinquennia of age for the other studies. Additional terms for age and history of radiation exposure were included in the regression equations. RESULTS: The OR per year of later menarche was 1.04 (95% confidence interval (CI) 1.0-1.1). Compared to premenopausal women, the OR was 1.3 for women with natural menopause, and 1.8 for those with artificial menopause, but the studies were heterogeneous and the association may be due, at least in part, to diagnostic or ascertainment bias. Parity, spontaneous or induced abortions and history of infertility were not associated with thyroid cancer risk. The OR was above unity in women reporting later age at first birth (OR = 1.1, 95% CI 1.0-1.3 for 5-year delay) and higher in the first years after a birth. CONCLUSIONS: The associations of menstrual and reproductive factors with thyroid cancer risk were generally weak, but appeared stronger among women diagnosed with thyroid cancer at younger ages.

Adenocarcinoma, Papillary↗
PubMed1994

Birth order, interpregnancy interval and birth outcomes among Filipino infants.

This study examines the effects of birth order and interpregnancy interval on birthweight, gestational age, weight-for-gestational age, infant length, and weight-for-length in a sample of 2063 births from a longitudinal study in the Philippines. First births are the most disadvantaged of any birth order/spacing group. The risks associated with short intervals (< 6 months) and high birth order (fifth or higher) are confined to infants who have both attributes; there is no excess risk associated with short previous intervals among lower-order infants, nor for high birth order infants conceived after longer intervals. This pattern is observed for all five birth outcomes and neonatal mortality, and persists in models that control for mother's age, education, smoking, family health history and nutritional status. Since fewer than 2% of births are both short interval and high birth order, the potential reduction in the incidence of low birthweight or neonatal mortality from avoiding this category of high-risk births is quite small (1-2%).

Adult↗
PubMed1988

Lactation and cancer risk: is there a relation specific to breast cancer?

Relations between previous lactation experience and risks of cancer of the breast and other sites were investigated after follow-up of 50,274 parous women from 1961 through 1980. Among women with complete information on lactation, 5102 developed cancer and, of these, 1136 were diagnosed with breast cancer. Analyses of associations with mean duration of lactation per birth and duration for each of the three first births suggested a nonlinear relation to breast cancer. The highest risk was observed for those with intermediate duration of breast feeding, whereas lower risks were found among those with very short or very long duration. For all nongenital cancers combined, decreased risks were observed among those with the longest duration of breast feeding. However, among cancers of specific sites, a significant inverse association was found for pancreatic cancer only. The overall impression given by our data is that breast feeding is not strongly related to risks of breast cancer or any other common cancer.

Breast Feeding↗
PubMedDate not supplied

Recent trends in teen births in the United States.

Teenage births and birth rates have dropped steadily during the 1990s. Overall, the teen birth rate declined 15 percent between 1991 and 1997. The trend in the 1990s reverses a period of steep increases from 1986 to 1991. Despite the recent declines, the teen birth rate in 1997 is still higher than rates in the mid 1980s when they were at an all-time low (50-51 per 1,000). In general, teen birth rates have declined more for younger teenagers (15-17 years) than for older teens (18-19 years). Among all race and ethnic groups, black teenagers have experienced the greatest declines in childbearing during the 1990s. From 1991 to 1997, the rate for black teens 15-19 years dropped 23 percent to the lowest level on record. A particularly noteworthy finding is that the birth rate for second births to all teenagers who have had a first birth (repeat childbearing) declined by 21 percent between 1991 and 1996. Despite the recent decline in teen births and birth rates, a growing number and proportion are to unmarried teens. Most teenagers giving birth in the 1990s are not married--78 percent overall in 1997. Teenage childbearing has important social and health consequences for the teenage mother herself and for her baby. Most teen births are unintended, the educational attainment of teen mothers is limited, teen mothers are less likely to receive timely prenatal care, and teens are more likely to smoke during pregnancy than are older women. As a consequence of these and other factors, babies born to teen mothers are at greater risk of preterm delivery and low birthweight. Teen pregnancy prevention has become a major focus of attention over the past several years, contributing to a wide variety of initiatives and strategies at the national, state and community level.

Adolescent↗
PubMed1996

The "epidemic" of breast cancer in the U.S.--determining the factors.

Breast cancer incidence rates in the United States rose by 24% between 1973 and 1991. Mortality during this period, however, remained stable. Both the 5-year relative survival rate and the rates of in situ and stage I breast cancers have been increasing, while the incidence of later-stage cancers has been decreasing. Increased mammography screening may explain the documented jump in breast cancer incidence rates during the mid-1980s. Differences in the distribution of breast cancer risk factors may account, in part, for the temporal trends in breast cancer incidence. In particular, breast cancer risk factors may vary by birth cohort, including age at menarche, age at first birth, physical activity, obesity, diet, alcohol intake, estrogen therapy, and exposure to environmental organochlorines. After decades of epidemiologic research, a preventive approach to breast cancer that focuses on the physiologic effects of the sex steroid hormones, and their potential interactions with family history, is being carefully formulated.

Adult↗
PubMedDate not supplied

Main results of recent Hungarian family planning studies.

The Hungarian Central Statistical Office has carried out five different sample surveys in the last fifteen years for investigating more closely questions of fertility, family planning and birth control. The study summarizes the main findings. Some of these surveys applied retrospective methods to investigate fertility, family planning and birth control bahaviour of females in the past. Surveys of another type tried to reveal in perspective manner, with longitudinal observation of the couples, changes which took place in family planning and birth control ideas and practice. The main purpose of recent population policy measures was to ensure simple reproduction of the population. As a result of the measures taken in 1974 to increase the number of births the birth-rate went up significantly. This increase (30% as compared to 1973) appeared primarily for the second birth which constitutes 62% of the increment in births in 1974, 31% is accounted for by an 11% increase in the first births. The number of third births rose by 13% and their relative share remained 10%. The number of fourthand further births did not increase and their relative share decreased by 1%. Fertility data of 1974 show that the birth-rate increase was not in line with the intended aim, i.e. it was not the number of third births that increased. The net reproduction coefficient showing long-range growth of the population calculated with birth-rate of 1974, has developed favourably, it was over unity for the first time since 1958 (it was about 1.05). The birth-rate increased in 1974 in every age-group of females. The largest increase (19%) occurred for females 25-34 years old. Though it was 16% also for females under 24. According to a sample survey investigating the number of intended children by married females under 35 it did not increase as compared to data of previous surveys of similiar character. The differences is that the proportion of those who wished to have two children increased, while of those who wished to have one or three and more children decreased. The study deals also with changes in the relative shares of intended children by females under 35 who are now to be married. In the concluding part of the study the femeles' attitude to birth control and changes in this field are discussed.

Birth Rate↗
PubMed2005

Birth centre care over a 10-year period: infant morbidity during the first month after birth.

AIM: To study morbidity during the first month of life affecting infants of mothers booked for birth centre care during pregnancy. METHODS: 3238 live single-born infants whose mothers were admitted to an in-hospital birth centre, located at South Hospital in Stockholm, between 1989 and 2000 were compared with 179,502 infants whose mothers received standard maternity care in the Stockholm region during the same period, and who fulfilled the same medical inclusion criteria as those of the birth centre group. Information on other exposures and outcomes was collected from the Swedish Medical Birth and Hospital Discharge Registers. Logistic regression analyses were performed to calculate the odds ratio (OR), using 95% confidence intervals (95% CI). RESULTS: Compared with infants born in standard care, infants in the birth centre group had a higher risk of respiratory problems (OR 1.39; 95% CI 1.14-1.69), a difference correlated to less serious respiratory diagnoses. However, the difference was not statistically significant if the birth centre group was compared only with infants born in standard care at South Hospital (OR 1.18; 95% CI 0.94-1.47). Birth centre care was associated with a lower risk of fractures (OR 0.40; 95% CI 0.25-0.63). CONCLUSION: Birth centre care was not associated with severe infant morbidity and even appeared to reduce the risk of birth trauma, such as clavicle and other fractures.

Birthing Centers↗
PubMed1999

Postmenopausal weight status, body composition and body fat distribution in relation to parameters of menstrual and reproductive history.

OBJECTIVES: In the present study the association between menstrual and reproductive history patterns and weight status, fat distribution and body composition during postmenopause was tested. METHODS: In 106 healthy postmenopausal women ranging in age from 48 to 58 years (x = 53.7 year) the weight status was classified according to the recommendations of the WHO. Additionally body composition was estimated by dual energy X-ray absorptiometry and fat distribution was calculated using the fat distribution index. Weight status, body composition and fat distribution were correlated with self-reported parameters of menstrual and reproductive history (age at menarche, average cycle length, number of births, age at first and last birth, average pregnancy weight gain, age at menopause). RESULTS: It was shown that number of births, age at first birth and pregnancy weight gain were related significantly to the postmenopausal weight status, body composition and fat distribution. CONCLUSION: An early first birth a low number of births and a high weight gain during pregnancies can be assumed as risk factors for overweight, a higher amount of adipose tissue, android fat patterning and therefore for the development of the metabolic syndrome during postmenopause. In contrast no adverse effect of menstrual and reproductive parameters on postmenopausal bone mass was found.

Adipose Tissue↗
PubMed1982

Birth weight and birth defects in relation to maternal spermicide use.

The possible effects of maternal spermicide use on birth characteristics of offspring were examined in two studies. First, birth weight of offspring was examined in a cohort study of 302 women who reported using spermicides and 716 women who used no contraceptive methods in the year prior to pregnancy resulting in a 1974 live birth (without a malformation) in Upstate New York. There was no evidence that spermicide use prior to the last menstrual period (LMP) had an effect on mean birth weight or on the proportion of lower weights. Mean birth weight of female births was significantly lower in post-LMP spermicide users than in pre-LMP-only spermicide users and no-contraceptive users. In multiple linear regression analyses of birth weight among births to spermicide users, including maternal smoking during pregnancy and other variables, time of discontinuation of spermicide use was an important predictor of female (but not male) birth weight. In the second (case-control) study of 715 Upstate New York births with selected birth defects and 715 control births (matched on maternal age and race), no significantly increased relative risks were associated with maternal spermicide use prior to LMP or after LMP. Based on small numbers, relative risks for post-LMP spermicide use were greater than 1.00 for hypospadias (8/2 or 4.00, not significant) and for limb reduction defects (6/3 or 2.00, not significant).

Abnormalities, Drug-Induced↗
PubMed2004

Geographic clustering of residence in early life and subsequent risk of breast cancer (United States).

OBJECTIVE: This study focused on geographic clustering of breast cancer based on residence in early life and identified spatio-temporal clustering of cases and controls. METHODS: Data were drawn from the WEB study (Western New York Exposures and Breast Cancer Study), a population-based case-control study of incident, pathologically confirmed breast cancer (1996-2001) in Erie and Niagara counties. Controls were frequency-matched to cases on age, race, and county of residence. All cases and controls used in the study provided lifetime residential histories. The k-function difference between cases and controls was used to identify spatial clustering patterns of residence in early life. RESULTS: We found that the evidence for clustered residences at birth and at menarche was stronger than that for first birth or other time periods in adult life. Residences for pre-menopausal cases were more clustered than for controls at the time of birth and menarche. We also identified the size and geographic location of birth and menarche clusters in the study area, and found increased breast cancer risk for pre-menopausal women whose residence was within the cluster compared to those living elsewhere at the time of birth. CONCLUSION: This study provides evidence that early environmental exposures may be related to breast cancer risk, especially for pre-menopausal women.

Adult↗
PubMed2006

Association of reproductive factors, oral contraceptive use and selected lifestyle factors with the risk of ovarian borderline tumors: a Danish case-control study.

OBJECTIVE: The aim was to examine risk factors for ovarian borderline tumors overall, and according to histological subtype (serous vs. mucinous), in a large Danish population-based case-control study. METHODS: Ovarian borderline cases and controls were recruited from 1995 to 1999, and personal interviews were conducted. In all, 202 cases and 1,564 randomly selected controls were included. The analysis was performed using multiple logistic regression models. RESULTS: The risk of ovarian borderline disease decreased with increasing parity (OR=0.79 per birth, 95% CI: 0.63-0.98) and older age at first birth (OR=0.67 per 5 years, 95% CI: 0.53-0.84). Both a history of breastfeeding and use of oral contraceptives reduced the risk of borderline tumor, the effect being most pronounced for serous tumors. Increasing body mass index (BMI) was associated with elevated risk of serous borderline tumor (OR=1.05 per BMI unit; 95% CI: 1.00-1.10), whereas current smoking was a strong risk factor only for mucinous tumors (OR=2.10; 95% CI: 1.22-3.60). Finally, increasing consumption of milk (all types) was found to increase the risk of borderline disease (OR=1.04 per glass milk per week; 95% CI: 1.02-1.06), and increasing intake of total lactose also increased the risk significantly (OR=1.16 per 50 gram lactose per week; 95% CI: 1.06-1.26). CONCLUSION: The risk profile of ovarian borderline tumors is similar to that of ovarian carcinomas, and we observed significant etiological differences between serous and mucinous borderline tumors.

Adenocarcinoma, Mucinous↗
PubMed1987

Influences on the timing of first childbearing.

The author develops the hypothesis that women from different population subgroups respond differently to economic and background influences when timing initial childbearing. Data are taken from the National Longitudinal Survey of Labor Market Experience and concern some 5,000 U.S. women followed from 1968 to 1978. "Among all groups examined, age at first birth tends to increase as education levels increase, and married women with spouses present tend to be older than other women at first childbirth. Among whites, all economic influences considered--hourly pay rate, nonmarket income, and work during the year prior to childbearing--have a significant influence in deferring first childbirth, but family background does not. Among blacks, family background plays a significant role in determining age at first childbirth, but only one economic influence--the hourly pay rate--is significant."

Black or African American↗
PubMed1987

Is birth weight determined genetically?

Birthweight correlations were analysed among 505 intergenerational pairs of first births to women aged 18-25 identified from a large obstetric data bank. After standardisation for fetal sex, maternal height, gestational age, and proteinuric pre-eclampsia residual correlations of between 0.1402 and 0.1725 were found, suggesting only a small genetic effect. It is concluded that genetic factors play only a small part in determining birth weight.

Adolescent↗
PubMed1999

Why do cohabiting couples marry? An example of a causal event history approach to interdependent systems.

The purpose of this paper is to demonstrate a causal approach to interdependent systems based on two empirical investigations. These examples demonstrate 1) the study of two highly interdependent processes: entry into first marriage as the dependent process and the process of first birth/first pregnancy as the explaining one; 2) an interdependence occurring mainly in a very specific phase of individuals' lives (i.e., during the period of first family formation); 3) the involvement of time lags between cause and its effect (e.g., time until detection of conception); and 4) the highly dynamic character of an unfolding effect over time (i.e., the effect of first pregnancy/first birth on first marriage strongly depends on the progress of pregnancy and the time since the birth has taken place).

Birth Intervals↗
PubMed2005

Risk factors for pre-eclampsia in nulliparous and parous women: the Jerusalem perinatal study.

Pre-eclampsia has been described as a 'disease of first pregnancies' and many believe that its occurrence in a later pregnancy signals a fundamentally different entity. We sought to compare risk factors in first and subsequent pregnancies. We studied 1319 cases of pre-eclampsia recorded in a historical cohort of 82,436 deliveries in Jerusalem in 1964-76. Logistic regression was used to control for covariates. The adjusted odds ratio (OR) for pre-eclampsia in first births was 2.58 (95% confidence interval[CI] 2.23, 2.97), compared with all later birth order groups, between which there were no detectable differences in risk. Other risk factors included increasing maternal age, diabetes (OR 5.64, 95% CI 4.33, 7.35), multiple gestations (OR 3.38, 95% CI 2.54, 4.49), fetal haemolytic disease (OR 2.24, 95% CI 1.43, 3.50) and lower maternal education. The risk of pre-eclampsia was not associated with the mother's employment outside the home and did not differ between immigrants vs. Israeli-born mothers or between groups of women whose fathers had been born in Western Asia, North Africa or Europe. Effects of each risk factor were similar within first and subsequent births. These results lend no support to the hypothesis that there is a fundamental difference between pre-eclampsia in a first pregnancy compared with that occurring in a later pregnancy; conclusions may be moderated, however, by the knowledge that the incidence of pre-eclampsia was low in this historical cohort.

Adolescent↗
PubMed1996

Child spacing and two child policy in practice in rural Vietnam: cross sectional survey.

OBJECTIVE: To explore the reproductive pattern of women in rural Vietnam in relation to the existing family planning policies and laws. DESIGN: Cross sectional survey with question-naires on reproductive history. SETTING: Tien Hai, a district in Red River Delta area, where the population density is one of the highest in Vietnam. SUBJECTS: 1132 women who had at least one child under 5 years of age in April 1992. MAIN OUTCOME MEASURES: Birth spacing and probability of having a third child. RESULTS: The mean age at first birth was 22.2 years. The average spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers, and women belonging to the Catholic religion had shorter spacing between the first and second child and also a higher probability of having a third child. In addition, women who had no sons or who had lost a previous child were more likely to have a third child. CONCLUSION: Most families do not adhere to the official family planning policy, which was introduced in 1988, stipulating that each couple should have a maximum of two children with 3-5 years' spacing in between. More consideration should be given to family planning needs and perceptions of the population, supporting the woman to be in control of her fertility. This may imply improved contraceptive services and better consideration of sex issues and cultural differences as well as improved social support for elderly people.

Age Factors↗
PubMed1995

International renal-cell cancer study. V. Reproductive factors, gynecologic operations and exogenous hormones.

The relationships between reproductive factors, exogenous hormones and renal-cell cancer were examined in an international, multicenter, population-based, case-control study undertaken in 1989-1991. Data from 5 centers situated in Australia, Denmark, Germany, Sweden and the United States included for analysis 608 women with renal-cell cancer and 766 female controls. A significant trend in risk (p = 0.002) was associated with number of births, with an 80% excess risk for 6 or more births [RR = 1.8, 95% confidence interval (CI) = 1.1 to 2.9] compared with one birth. A decreasing risk was seen for increasing age at first birth, although this was confounded by body-mass index and number of births. A suggestive reduction of risk was also seen for increasing age at menarche. Age at menopause was unrelated to risk of renal-cell cancer. An increased risk was observed for women having had both a hysterectomy and an oophorectomy. Use of oral contraceptives in non-smoking women reduced the risk of renal-cell cancer (RR = 0.5, 95% CI = 0.4 to 0.8); this reduction increased with longer duration of use. No association was observed for estrogen replacement therapy. Our results indicate that certain hormonal and reproductive variables may be related to risk of renal-cell cancer and deserve further investigation, both epidemiologically and experimentally.

Adult↗