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PubMed2006

Policy efforts to prevent ART-related preterm birth.

At 12.5%, the preterm birth rate is the highest it has ever been in the US. In tandem with the rise in preterm birth is a dramatic increase in multiple birth rates. The recent trend of delayed maternal age at first birth and the associated use of assisted reproductive technologies (ARTs) have led to the increase in multiple gestation and its attendant increased risk for preterm birth. While ARTs are not responsible for the majority of preterm births, the attributable fraction has increased, is iatrogenic- and preventable. Despite widespread recognition of this problem, the rate of associated twin gestation has not decreased. We offer options for policymakers on several levels--from medical to health systems to societal policy--to decrease ART-related preterm births.

Embryo Transfer↗
PubMed2006

Fertility and abortion rates in the United States, 1960-2002.

This paper provides a general overview of trends in the United States (US) birth, fertility and abortion data from 1960 to 2002. Rates by age, race and Hispanic origin are also discussed. Data presented in this paper are derived primarily from published reports of the US government's Centers for Disease Control and Prevention's National Center for Health Statistics. In 2002, there were 4,021,726 births in the US. The general fertility rate was 64.8 births per 1,000 women aged 15-44 years, the total fertility rate was 2013.0 children per 1,000 women, and the net reproduction rate was 968 daughters per 1000 women. These rates have declined in the US since 1960, down by at least 44% for all rates. While these rates have been declining, there are substantial differences in fertility patterns by age and race and Hispanic origin. Rates for women, 30 years of age and over, increased between 1980 and 2002. In contrast, rates for women under 25 years of age rose considerably during the late 1980s, and then decreased sharply since 1991. Rates for women in their late twenties (25-29 years of age), the principal childbearing ages, have fluctuated within a narrow range throughout this period (1980-2002). As a result of the increase in births to older women, the mean age of mother at first birth increased by nearly 4 years from 1968 to 2002. In 2000, the latest year for which data are available, there were 21.3 induced abortions per 1000 women aged 15-44 years, down from 27.4 in 1990. The total abortion rate, average number of legally induced abortions that would occur to a hypothetical cohort of 1000 women, was 672.0 abortions per 1,000 women in 2000, down from 785.5 in 1980. The abortion rate has declined fairly steadily since 1980. Like the birth and fertility rates, substantial differences in abortion rates exist by age and race and Hispanic origin. The rates of induced abortion increased for women in their thirties between 1980 and 2000, whereas rates for women under 25 years of age and women 40 years of age and over decreased since 1980. The rate for women 25-29 years of age changed little. The rate of induced abortion was considerably higher for non-Hispanic black women (57.4) in 2000 than for non-Hispanic white women (11.7). The rate for Hispanic women (30.6) was intermediate. The total abortion rate was also much higher for non-Hispanic black women than non-Hispanic white and Hispanic women.

Abortion, Induced↗
PubMed1979

Contrasting effects of maternal fertility and birth rank on the occurrence of neural tube defects.

The relationships between the occurrence of anencephalus and spina bifida, sibship size and birth rank were examined, using linked records for births in British Columbia. Comparison of 414 sibships in which at least one infant had a neural tube defect with 1362 randomly chosen unaffected sibships showed that the affected sibships were larger. There were both more births than expected after the affected birth, and shorter intervals between births before the affected birth. Within sibships, the risk of anencephalus or spina bifida decreased strongly with increasing birth rank. No associations were seen with maternal age at first birth.

Anencephaly↗
PubMedDate not supplied

Determinants of couple agreement in U.S. fertility decisions.

An analysis of data from 8,450 women interviewed in 1988 for the National Survey of Family Growth finds that teenagers, never-married women, black women and those with less than a high school education are less likely than other women to have a birth that is jointly desired by both partners; 29%, 35%, 45% and 51% of births, respectively, are wanted by both partners, compared with an overall average of 69%. Third and higher order births are also less likely than earlier births to be jointly planned--58%, compared with 69% of first births and 76% of second births. In situations in which the birth is not jointly planned, black women, unmarried women, teenagers and women having third or higher order births are all significantly more likely than other women in their race, marital status, age and birth-order categories to have a birth when the man's preference is unknown. Never-married women are significantly more likely than married women to have a birth when the woman desires one but the man does not, while black women are significantly more likely than white women to have a birth that the man wanted but that the woman did not.

Adolescent↗
PubMed1999

Childbearing at older age and endometrial cancer risk (Sweden).

OBJECTIVES: Several studies have found an inverse association between older age at last birth and endometrial cancer risk. A nested case-control study was undertaken to examine the influence of this and other aspects of reproductive patterns on the risk of developing endometrial cancer. METHODS: Among women born in 1925 and later, 4,839 eligible patients were identified in the Swedish Cancer Register. For each case, five individually age-matched controls were randomly selected from a population-based Fertility Register. Relative risks were estimated from odds ratios obtained from conditional logistic regression analyses. RESULTS: Compared to uniparous women, childless women were at a higher risk of endometrial cancer (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.25-1.52). This association was stronger in younger (< 50 years) than in older (50+ years) women. At all ages of first birth, a delivery was associated with a reduced risk of endometrial cancer that slowly diminished with time. Among parous women, the risk decreased by almost 20% for each additional live birth (OR = 0.81, CI = 0.78-0.84). In an analysis limited to women with two or more births that compared the independent effects of age at first and at last birth, only older age at last birth was associated with a lowered risk of endometrial cancer. The risk decreased at a rate of about 15% per five-year delay of last birth. CONCLUSIONS: Endometrial cancer is often referred to as the prototype hormonally-determined disease in women. However, our findings give further support to the hypothesis that a birth may not only affect risk through hormonal influences, but possibly also through mechanical shedding of cells that have undergone malignant transformation.

Adult↗
PubMed2000

Population growth of Gyrodactylus salaris (Monogenea) on Norwegian and Baltic Atlantic salmon (Salmo salar) stocks.

Reproductive success of Gvrodactylus salaris from River Lierelva was compared experimentally on 3 stocks of salmon (12.5 degrees C +/- 0.2). Isolated fish from 2 susceptible Norwegian stocks (Rivers Lier and Alta) and 1 resistant Baltic stock of salmon (River Neva) were infected with a single gravid worm in order to record the temporal sequence of births and age at death of individual parasites. Establishment success (proportion of worms surviving to give birth) was generally low and mortality high, but significantly fewer worms survived on Neva (45% with mean survival of 3.5 days) compared to Alta and Lier fish (60 % mean survival 7.9 and 5.2 days, respectively). There was a dramatic difference in parasite fecundity between the host stocks: only 2 births occurred on Neva fish compared to third and fourth births on both Alta and Lier hosts. The timing of the first birth was more variable on Neva hosts and was significantly extended (mean 2.3 days) relative to that on Alta and Neva fish (1.8 days). However, timing of the second birth did not vary on any of the 3 salmon stocks. Age-specific mortality and fecundity data are consistent with exponential population growth of G. salaris on Alta and Lier fish but eventual extinction on Neva hosts. This is the first demonstration that gyrodactylids maintained on different host stocks exhibit variations in fecundity, development and mortality, which may in turn account for the variable virulence noted when G. salaris infects different salmonid hosts.

Age Factors↗
PubMedDate not supplied

Achieving and maintaining pregnancy after age 40.

Demographic data from the United States show the need for testing ovarian reserve in a population that is increasingly delaying reproduction. The childless rate for U.S. women over the age of 35 has nearly doubled to 25% since 1925. Yet, in 1994 approximately one-third of all first births were by women over the age of 35. The first-line treatment for the aging effect on the ovarian reservoir of oocytes is ovulation induction. Study results reveal that a delivery rate of only 2.4% was achieved at age 42, and in 119 cycles of therapy in women above that age there were no live births. The clomiphene citrate challenge test is one method of dynamic testing of ovarian reserve. It has the advantages of simplicity and reduced cost when compared with the gonadotropic stimulatory test. In one test group utilizing the clomiphene citrate challenge test only 4.8% conceived at any age following an abnormal test. As a prognostic test with an approximate 95% accuracy rate for negative predictive value it has much to offer. With oocyte donation becoming more widespread as an acceptable method of achieving pregnancy, clomiphene citrate challenge testing should be performed more frequently, in order to spare couples the emotional and financial sequelae of multiple attempts at ovulation induction and IVF when expected pregnancy rates fall below a level acceptable to both patient and physician.

Adult↗
PubMed1991

Positive correlation between parity and incidence of thyroid cancer: new evidence based on complete Norwegian birth cohorts.

We have examined the effect of parity on the incidence of thyroid cancer within a hazard model framework, using individual data on all (1.1 million) Norwegian women born 1935-1969. This unique data source was established by linking information from the Cancer Registry with maternity histories derived from the Central Population Register of Norway. The relative effects on the total incidence of thyroid cancer, net of age, place of residence and birth cohort, are 1.00 for the childless (arbitrarily chosen baseline group), 1.13 for parity 1, 1.30 for parity 2, 1.39 for parity 3 and 1.46 for parity 4+. The latter 3 figures are significantly higher than 1.00. The effects are larger for follicular carcinoma, and for this type of thyroid cancer there are also indications of a recent-pregnancy effect. Among women with 2 or more children, those who became pregnant less than 45 months previously have a higher cancer incidence than others at the same parity. Moreover, we have found that parity has virtually the same effect at all ages, in all birth cohorts and in both parts of the country. Age at first birth as well as the length of the interbirth interval appear to be unrelated to the thyroid-cancer risk. Our findings are consistent with previous case-control studies from other countries.

Adolescent↗
PubMed1996

Black/white differences in the relationship of maternal age to birthweight: a population-based test of the weathering hypothesis.

This study seeks to explore if early health deterioration ('weathering') among young adult African American women contributes to observed increases with maternal age in the black/white disparity in birth outcome. Theoretically, 'weathering' is constructed as being a physical consequence of social inequality. Thus, we also examine whether African American mothers vary in their age trajectories of poor birth outcome with respect to social class. Black or white singleton first births to Michigan residents aged 15-34 in 1989 (N = 54,888 births) are analyzed, using data drawn from linked birth and infant death certificates augmented with census-based economic information. We find among blacks, but not whites, advancing maternal age above 15 years is associated with increased odds of LBW and VLBW. Among blacks in low-income areas, the odds of LBW increase 3-fold, and of VLBW 4-fold, between maternal ages 15 and 34. The findings suggest that African American women, on average, and those residing in low-income areas, in particular, experience worsening health profiles between their teens and young adulthood, contributing to their increasing risk of LBW or VLBW with advancing maternal age and to the black-white gap in this risk. The findings suggest the importance of comprehensive prevention strategies to improve the health of socioeconomically disadvantaged African American women prior to pregnancy and the reduction of social inequalities that impact health.

Adolescent↗
PubMed2006

The influence of childbirth expectations on Western Australian women's perceptions of their birth experience.

OBJECTIVES: to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. DESIGN: a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. SETTING: Perth, Western Australia. PARTICIPANTS: 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. FINDINGS: the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. IMPLICATIONS FOR PRACTICE: the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.

Adult↗
PubMed1999

[Reproductive risk factors associated with breast cancer in Colombian women].

INTRODUCTION: As of 1992, breast cancer has been the second cause of death in Columbian women, with a rising trend in mortality due to this type of neoplasm (average annual rate 4.5*/100.000 inhabitants). Information about potential risk factors for breast cancer in Latin American countries is scarce. The objectives of the project were to test the breastfeeding protection against breast cancer and to establish the reproductive factors associated with breast cancer in Columbia. METHODS: A hospital case-control study was carried out from July 1995 to March 1996 in Bogotá, Columbia, using paring by age groups. The study population consisted of 171 histopathologically confirmed cases and 171 controls. Reproductive history and sociodemographic data were collected through a questionnaire, and logistic regression models were used for statistical analysis of the data. RESULTS: The following associated factors were found as principal results: nuli-parousness as compared with women with over 3 children (OR=3.35 CI 1.40-8.0), age at first birth (OR=1.83 CI 0.70- 4.80), breast cancer history, breastfeeding the first child (OR=0.09 CI 0.01-0.64 for 1-11 months) and with a highly significant trend for accumulated breastfeeding above 24 months (p=0.001). CONCLUSIONS: This study indicates the importance of focusing on the promotion of prolonged breastfeeding by women identified as being at higher risk, and confirms that socio-economic level can determine life styles and reproductive events among women (such as breastfeeding time); this could explain the increase in breast cancer mortality in Latin American countries, similar to that in developed countries in terms of fertility and risk factors for breast cancer. The epidemiological information produced by this study will be useful for planning and carrying out early diagnosis and treatment of breast cancer in women identified as being at high risk of this disease.

Adult↗
PubMed1999

Predictors of cesarean section delivery among college-educated black and white women, Davidson County, Tennessee, 1990-1994.

Cesarean section delivery increases the cost, morbidity, and mortality of childbirth. Cesarean section rates vary nationwide with the highest rates occurring in the southern United States. The Department of Health and Human Services has published year 2000 objectives that include a 15% reduction in the cesarean section rate. This study identified factors contributing to cesarean section delivery among a cohort of college-educated black and white women in Davidson County, TN. Logistic regression models were applied to Linked Infant Birth and Death certificate data from 1990-1994. Data on singleton first births for 606 black women and 3661 white women completing 16 years of education were analyzed. College-educated African Americans were at a significantly higher risk of cesarean section delivery than whites. This difference could not be accounted for by controlling for all other variables. The geographic differences in cesarean section rates in this country may be the result of varying in provider practice styles, perceptions, or attitudes. Improving the health of women and children will require establishing a system of maternity care that is comprehensive, case-managed, culturally appropriate, and available to all women.

Adult↗
PubMed2005

Prepregnancy exposure to cigarette smoking and subsequent risk of postmenopausal breast cancer.

OBJECTIVE: To examine the association of cigarette smoking before first pregnancy with risk of postmenopausal breast cancer in a large population-based cohort. PATIENTS AND METHODS: The Iowa Women's Health Study is a prospective cohort study of 55- to 69-year-old women at baseline in 1986. In January 1986, a questionnaire was mailed to 99,826 postmenopausal women to Identify risk factors for cancer and other chronic diseases; 41,836 women responded (42.7% response rate). The primary analyses examined the associations among smoking, parity, age at first birth, and postmenopausal breast cancer. RESULTS: Of the 37,105 women in the cohort at risk, 7095 (19%) and 4186 (11%) initiated smoking before and after first pregnancy, respectively, and 2017 breast cancers were identified before December 31, 1999. Compared with parous women who never smoked, women who began smoking after their first full-term pregnancy were not at increased risk of postmenopausal breast cancer (multivariate-adjusted risk ratio, 1.03; 95% confidence interval, 0.88-1.21). However, women who began smoking before their first pregnancy had a slightly elevated risk of breast cancer (risk ratio, 1.21; 95% confidence Interval, 1.07-1.37). Results were not attenuated by adjustment for age at first pregnancy or number of live births. CONCLUSION: These data suggest that cigarette smoking is associated with a slightly greater risk of postmenopausal breast cancer for women who started smoking before their first full-term pregnancy.

Age Factors↗
PubMed2005

Existing demand for birth spacing in developing countries: perspectives from household survey data.

OBJECTIVE: To identify the extent of demand for birth spacing, according to age and parity among married women of reproductive age (MWRA) in developing countries. METHODS: Secondary analysis of data from the Demographic and Health Surveys (DHS) using cross-tabulations. Data collected from nationally representative samples of MWRA in selected developing countries between 1990 and 2004. RESULTS: Demand for birth spacing is the most prevalent reason for an interest in family planning among married women aged 15-29 years in the majority of developing countries examined. In the 15-19-year age cohort, the demand for spacing is proportionally the most prevalent reason for a demand for family planning. A demand for spacing even exists among young, zero-parity married women in each country examined. Findings on the demand for spacing among zero-parity married women quantifies the expressed desire of some married women in developing countries to postpone a first birth or the timing of a first pregnancy. CONCLUSION: The substantial demand for birth spacing among young, low- and zero-parity women suggests that family planning programs in developing countries may need to reevaluate how accessible services are for this cohort of potential contraception users. Currently, many service-delivery protocols, counseling practices and service provider training may not fully address the needs of younger, low- or zero-parity clients.

Adolescent↗
PubMed1997

Birth of a healthy female after intracytoplasmic sperm injection of cryopreserved human oocytes.

OBJECTIVE: To describe the first birth achieved after intracytoplasmic sperm injection (ICSI) of cryopreserved human oocytes. DESIGN: Case report. SETTING: University of Bologna Hospital, Department of Obstetrics and Gynecology, Reproductive Endocrinology Unit, IVF and Infertility Center. PATIENT(S): One patient undergoing IVF. INTERVENTION(S): Transvaginal ultrasound-guided oocyte retrieval followed by oocyte freezing. Artificial preparation of the endometrium with E2 and P, oocyte thawing, and ICSI. RESULT(S): Four of 12 cryopreserved oocytes survived; using ICSI, 2 underwent normal fertilization but only 1 cleaved. One good-quality 4-cell embryo was transferred. A single gestation was confirmed by ultrasound at the 7th week. Amniocentesis was performed at the 16th week and demonstrated a normal female karyotype of 46,XX. After a normal pregnancy, a healthy female infant was born at the 38th week of gestation. CONCLUSION(S): The combination of ICSI and oocyte cryopreservation is a new tool in assisted reproductive technology.

Adult↗
PubMed2005

A population-based case-control study of isolated anophthalmia and microphthalmia.

The purpose of the study was to reveal the etiological factors in the origin of isolated an/microphthalmia. The dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-2002 containing 56 cases with isolated an/microphthalmia and 22,744 malformed controls with other non-ocular defects from the Hungarian Congenital Abnormality Registry, in addition of 56 matched control pairs and 37,837 population controls without defects from the National Birth Registry, was evaluated. Exposure data and family history were collected (i) prospectively by prenatal logbook and other medical records, (ii) retrospectively through a structured questionnaire filled-in by mothers, and (iii) information obtained by regional nurses at home visit of non-respondent mothers. The autosomal recessive origin of isolated an/microphthalmia was indicated in about 10% of cases on the basis of sib recurrence. Cases with isolated an/microphthalmia had a much shorter mean gestational age and smaller mean birth weight, a much larger proportion of preterm birth and low birthweight. Their mothers were younger with a predominance of first birth order, frequently unmarried with low socioeconomic status. These findings are in agreement with a much higher prevalence at birth of cases with isolated an/microphthalmia in the gypsy population probably due to the interaction of inbreeding effect and low socioeconomic status. Further molecular genetic studies are needed to identify gene mutations of isolated an/microphthalmia in the Hungarian gypsy population.

Anophthalmos↗
PubMed2006

Multifocal atrial tachycardia in 2 children.

The incidence of multifocal atrial tachycardia (MAT) is very low and accounts for less than 1% of supraventricular tachycardia in infants and children. In this report, the clinical characteristics, medical treatment and outcome of MAT in 2 children are described. The first patient presented with tachycardia and respiratory failure since the day after birth. First, he received amiodarone, propranolol, and digoxin and then amiodarone alone. The heart rhythm converted to sinus rhythm 2 weeks after hospitalization. Although nonsustained MAT was occasionally observed when the infant suffered from pulmonary infection, the frequency of recurrent MAT decreased as the infant grew up. The second patient was a 5-year-old girl. She had congenital heart disease with double outlets of right ventricle (DORV), patent ductus arteriosus, coarctation of aorta, and ventricular and atrial septal defects. She underwent total correction at the age of 4 years. MAT was noted 3 months after the operation with the presentation of congestive heart failure. The heart rate slowed down and returned to normal sinus rhythm within several hours after amiodarone use. The symptoms and signs of congestive heart failure also disappeared. The patient took amiodarone regularly, and no tachycardia was detected during the follow-up period. MAT is considered to be a relatively benign arrhythmia with likely good outcome if there is no severe underlying illness. It can be well controlled under appropriate drugs, and a long period of follow-up is suggested. If pharmacologic intervention is required, we suggest that amiodarone may be an excellent choice.

Amiodarone↗