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PubMed2003

Birth weight and risk of breast cancer in a cohort of 106,504 women.

The possible association between prenatal factors and breast cancer has been discussed for more than a decade. Birth weight has been used commonly as a proxy measure for intrauterine growth. Whereas some previous studies have found support for an association between birth weight and breast cancer, others have been inconclusive or found no association. We investigated the relationship between birth weight and risk of female breast cancer in a cohort of 106,504 Danish women. Birth weights were obtained from school health records on girls born between 1930-1975. Information on breast cancer came from linking the cohort with the Danish Cancer Registry and the Danish Breast Cancer Cooperative Groups Registry. A total of 2,334 cases of primary breast cancer were diagnosed in the cohort during 3,255,549 person-years of follow-up among women with birth weight between 500-6,000 g. Of these, 922 (40%) were diagnosed with primary breast cancer at the age of 50 years or older. A significant association between birth weight and breast cancer was found equivalent to an increase in risk of 9% per 1,000 g increase in birth weight (95% CI 2-17). The increase was observed for all age groups, representing both pre- and post-menopausal women, and irrespective of tumor characteristics. Adjustment for age at first birth and parity did not influence the results. Birth weight is positively associated with risk of breast cancer, indicating that prenatal factors are important in the etiology of breast cancer.

Adolescent↗
PubMed1999

The association of birth interval, maternal age and season of birth with the fertility of daughters: a retrospective cohort study based on family reconstitutions from nineteenth and early twentieth century Quebec.

In a historical follow-up study, we evaluated the association of the fertility of daughters with five perinatal factors: short (< 15 months) or long (> or = 45 months) preceding birth interval, low (< or = 20 years) or advanced (> or = 40 years) maternal age and season of birth. We used data concerning 2062 women married before the age of 31 and born in the Saguenay region of Quebec, Canada, between 1850 and 1899. Time between the wedding and first birth was used for the estimation of differences in fertility. Using logistic regression and controlling for several potential confounders, we found a slightly increased risk of monthly failure of conception for daughters born after a short but not for those born after a long birth interval (odds ratios [ORs] 1.09 [0.89, 1.33] and 0.87 [0.65, 1.16], respectively, with intervals between 21 and 32 months as the reference category). A slightly increased risk of conceptive failure was also seen for daughters of younger and older mothers (ORs 1.08 [0.89, 1.30] and 1.11 [0.91, 1.35], respectively, compared with maternal age between 24 and 30 years as the reference category). Fertility varied by season of birth (P = 0.02), with summer-born daughters having lowest and winter-born daughters having highest fertility. These results are consistent with the idea that maternal factors before or around birth play a role in the aetiology of reduced fertility. The data, however, do not unequivocally support the hypothesis that gave rise to the present study, namely that ovarian development may be disturbed after conception in conditions with an increased risk of maternal menstrual cycle irregularities.

Adolescent↗
PubMed2004

Reproductive history and mortality after breast cancer diagnosis.

OBJECTIVE: To assess whether reproductive factors are associated with mortality after breast cancer diagnosis. METHODS: We followed up 4,299 U.S. women enrolled between 1980 and 1982 at ages 20-54 years as incident breast cancer cases in a population-based, case-control study, the Cancer and Steroid Hormone Study. Vital status through 1997 for these cases was obtained by linking Cancer and Steroid Hormone Study data to Surveillance, Epidemiology, and End Results files. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for death associated with selected reproductive factors using proportional hazards models. RESULTS: During a median follow-up of 14.5 years, 1,847 deaths occurred. Women aged 20-45 years whose last birth occurred 12 months or less (age-adjusted HR = 1.62, 95% CI 1.10-2.37) and 13-48 months before breast cancer diagnosis (age-adjusted HR = 1.35, 95% CI 1.05-1.75) were at an increased risk for death compared with nulliparous women. After adjusting for additional factors including tumor stage, women whose last birth occurred 12 months or less before diagnosis remained at an increased risk for death (HR = 1.51, 95% CI 1.02-2.23). Fifteen-year survival was 38%, 51%, and 60% among women aged 20-45 years whose last birth was 12 months or less, 13-48 months, and more than 48 months before diagnosis, respectively, compared with 65% among nulliparous women. Mortality risk was not associated with age at first birth, parity, or breastfeeding duration among women aged 20-45 years or among women aged 46-54 years. CONCLUSION: A recent birth may be an adverse prognostic indicator among women diagnosed with breast cancer at ages 20-45 years.

Adult↗
PubMed1980

[A study of the weight of the placenta in normal and pathological pregnancies (author's transl)].

The authors have studied 826 placentas in premature births, and in growth retardation and normal births. First of all they describe the technique which should be followed. They establish in this way a correlation between the weight of the placenta and the weight of the infant at birth on the one side and the gestational age on the other. On the other hand, they find that there is no correlation between the weight of the placenta and the mother's weight-gain in pregnancy when this is more than 12 kg. The weight of the placenta is shown to decrease after the 41st week of pregnancy and the placental index is at its highest at 38 weeks of pregnancy according to their study. They suggest that a curve of placental weight growth during pregnancy is useful in studying prematurity and growth retardation.

Female↗
PubMed2002

Normal pregnancies and live births after autograft of frozen-thawed hemi-ovaries into ewes.

OBJECTIVE: To evaluate long-term outcome of autotransplantation of cryopreserved hemi-ovaries into ewes. DESIGN: Animal study. SETTING: University fertility center, Hospices Civils de Lyon; and Ecole Nationale Vétérinaire de Lyon. PATIENT(S): Grivette ewes. INTERVENTION(S): Six hemi-ovaries from 6 ewes aged 6 to 12 months were frozen with a slow cooling protocol using 2 M of dimethyl sulfoxide as cryoprotectant. After dissection of the medulla, the hemi-ovarian cortex was stored at -196 degrees C in liquid nitrogen. Freezing procedure was performed with a programmable freezer. Semiautomatic seeding was performed before crystallization. Four to 6 weeks after the first laparotomy, the left ovary was removed and the frozen-thawed hemi-ovary was sutured. MAIN OUTCOME MEASURE(S): Mean plasma concentrations of FSH, LH, and progesterone after autotransplantation of frozen-thawed hemi-ovary. Ultrasonography was done to confirm pregnancy. Blood samples were collected weekly to measure FSH, LH, and progesterone. After the first birth, the autografted ovary was removed for histologic examination. RESULT(S): Plasma progesterone concentration increased in a regular manner in all ewes except one 4 weeks after the graft. Concentrations of FSH and LH did not reach the menopausal level. Four pregnancies occurred, from which 6 lambs were born. The first delivery of a normal lamb occurred after 135 days of gestation; the lamb died immediately after birth. The second delivery of two normal lambs occurred after 130 days of gestation. A caesarean section was performed on the third pregnant ewe the 110th days of gestation because the ewe had a vaginal prolapsus. The two normal lambs and the ewe died after surgery. The fourth birth of a normal lamb occurred after 132 days of gestation. Histologic examination of the grafted frozen-thawed ovary showed a regressing corpus luteum and few primordial and antral follicles. CONCLUSION(S): These four pregnancies in a ewe model may indicate that women who undergo preservation of their ovaries before chemotherapy or radiotherapy can have successful pregnancy.

Animals↗
PubMed1999

Reproductive history and stage of breast cancer.

A woman's reproductive history influences her risk of breast cancer. The authors hypothesized that reproductive history also influences stage of disease at the time of diagnosis. The authors analyzed a population-based cohort of 1.5 million Danish women born between 1935 and 1978 for whom individual information on births was available. Between 1978 and 1994, 10,790 incident cases of breast cancer in women under 60 years of age were identified. Nulliparous women compared with parous women and women with a late age at first birth compared with an early age were at significantly increased risk of being diagnosed with a large tumor and with cancer that had spread to regional lymph nodes. However, such an association was not seen for women diagnosed with a small tumor and women with cancer that had not spread to regional lymph nodes. Reproductive history did not appear to influence the time interval from first symptoms to first physician visit ("patient delay") or the time interval from first physician visit to surgery ("doctor delay"). The authors conclude that reproductive history is associated both with incidence of breast cancer and with stage of the disease at diagnosis, indicating possible influences on tumor progression and growth rate. Intensified awareness is warranted to achieve earlier diagnosis among nulliparous women and women with a late age at first childbirth, with the hope of improving their prognosis.

Adult↗
PubMed1982

Direct and indirect associations of five factors with infant mortality.

The relationship between several factors including maternal age, race, education and prior obstetric experience to infant mortality was investigated using vital statistics data from four regionalized networks in 1974 and 1975 and applying the log-linear model. By making a causal assumption, these relationships can be decomposed into a direct component and an indirect component acting through the association of the variables with birth weight. Detailed examination of the interactions between these factors revealed that all of the factors except education could demonstrate a direct component at the 5% significance level in their relationship to neonatal death, while all but birth order had a direct component relating to postneonatal deaths. The strength of the direct components was expressed in the form of odds ratios, leading to a conclusion confirming some earlier reports from these data, but suggesting that births to mothers over 35 years of age have smaller increased neonatal risk relative to those aged 18-34 years than had been reported previously. In addition, the direct component associated with first births does not show a higher risk than those of birth order 2 and 3. Added risk in this group is traceable to the indirect component. The disadvantage associated with having a prior fetal death is only found among low birth orders, with a possible reversal of the pattern in the high parity group. Analysis of postneonatal risks shows an interaction between maternal age and race, in which births to mothers under age 18 had increased risks only for whites.

Adolescent↗
PubMed1996

Fertility patterns according to occupational grouping in Norway, 1989.

In the early 1990s, most pregnant women in Norway were in gainful employment. This led to increased interest in the possible consequences for reproductive health, and a growing concern for the need to accommodate the pregnancy. We have therefore investigated how accurately general fertility rates predict the number of pregnancies in the workforce. Fertility rates (FR) among employed women and standardized fertility ratios (SFR) in occupational groups were estimated on the basis of information from the Labour Market Statistics and the national survey "Pregnancy and Work", Norway, 1989. The fertility rate among employed women was 17% higher than the general fertility rate. Two occupational groups had significantly different SFRs: technical/professional workers (SFR 118) and transport/communication workers (SFR 82). In addition, differences were found for parity-specific SFRs in administrative/executive work (SFR nullipara 80, SFR para 125) and service work (SFR nullipara 114, SFR para 80). We suggest that work status and occupation should be included among the variables registered in the Medical Birth Registry of Norway, in order to facilitate routine presentations of fertility rates and pregnancy outcomes for women in paid work. The results further indicate that work-specific conditions influence first-birth fertility. This should be explored in demographic studies of the relation between women's fertility and participation in paid work.

Adolescent↗
PubMed2005

Do higher status and more autonomous women have longer birth intervals? Results from Cebu, Philippines.

We look at whether women's status and autonomy affect birth-to-conception intervals using data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in the Philippines. We followed 1123 married, fecund women, aged 25-49, for up to 5 years. In a 1994-1995 survey, women were asked about the timing of their last birth. In 1998-2000, women were asked about any pregnancies since the 1994-1995 survey. Using these two surveys, we calculated birth to conception intervals. Women were censored if they reached their 50th birthday during follow-up. We measure autonomy based on whether the wife has the final say in 10 household decisions as measured in the 1994-1995 survey. Using Cox proportional hazards models we find that women with more decision-making autonomy have significantly longer birth-to-conception intervals in unadjusted models. After adjustment for age, wealth, education, other socio-economic variables, and women's status, decision-making autonomy remained a significant predictor in all models. This effect remains even after adjusting for contraceptive use, implying that autonomy influences birth-to-conception intervals through other mechanisms above and beyond increased contraceptive use. Additionally, few of the women's status variables were significantly associated with time to next conception. Women who had their first birth later in life were more likely to conceive during the observation period suggesting that they may be having shorter birth intervals in order to "catch up" with their peers. Maternal and child health-care efforts can help women achieve their desired spacing goals by supporting women's autonomy-in addition to ensuring they have accurate information and a range of contraceptive options.

Adult↗
PubMed1995

Long term prognosis of patients with cystic fibrosis in relation to early detection by neonatal screening and treatment in a cystic fibrosis centre.

BACKGROUND: A study was undertaken to evaluate whether an early diagnosis by neonatal screening may improve the long term prognosis of patients with cystic fibrosis and to assess the influence of expert management started immediately after the diagnosis. METHODS: Comparative clinical follow up in three birth cohorts of patients with cystic fibrosis was performed at the Cystic Fibrosis centre in Groningen in close collaboration with paediatricians in general hospitals in the north-eastern part of the Netherlands. The first birth cohort (n = 19) was detected by screening and the two other cohorts were detected clinically, one (n = 30) consisting of patients born during the screening programme and the other (n = 32) of patients born during the six years immediately after the screening programme ended. The total number of patients in the three birth cohorts included all patients with cystic fibrosis born in this area during a 12 year period. Cumulative survival rates and the variation with time of lung function, the levels of immunoglobulins, and growth patterns were used as main outcome measures. RESULTS: Patients born during the screening programme but detected clinically appeared to have a reduced life expectancy compared with patients detected by screening. The patients detected by screening showed less deterioration in lung function (annual decrease 1.2% of FEV1 % pred), a smaller increase in immunoglobulin levels, and minimal catch-up growth compared with an annual decrease of 3.25% of FEV1 % pred in the non-screened birth cohort of the same age, a higher rise in immunoglobulins leading to increased levels at the end of the observation period, and catch-up growth for weight as well as height. Differences between patients treated in a cystic fibrosis centre and those not referred to a specialist centre were smaller but similar, in favour of treatment at a cystic fibrosis clinic. CONCLUSIONS: Expert management started immediately after an early diagnosis of cystic fibrosis by neonatal screening results in important beneficial effects on the outcome and clinical course of the condition. The institution of very early treatment may be critical for the outcome and long term prognosis for most patients with cystic fibrosis. Neonatal screening programmes for cystic fibrosis should be introduced more widely.

Age Factors↗
PubMed1995

Timing of prenatal starvation in women and birth weight in their first and second born offspring: the Dutch Famine Birth Cohort study.

OBJECTIVES: To examine the long-term effects of severe in utero maternal undernutrition on offspring birth weight. STUDY DESIGN: Birth weights were analyzed of 575 first born and 454 second born offspring of 683 women born in Amsterdam, the Netherlands, at the time of a severe famine at the end of World War II. In utero maternal undernutrition was defined separately for each pregnancy trimester by an average daily nutrition ration (supplied to the grandmother) of less than 1000 calories in that trimester of pregnancy. RESULTS: Compared to controls, birth weights of first born infants of women prenatally exposed in the first trimester of pregnancy were 73 g heavier (95% CI: -64, 210), and birth weights of second born infants were 96 g lighter (95% CI: -249, 58). Birth weights of infants of women exposed in the second or third trimester were much closer to controls. CONCLUSIONS: A substantial (200 g or more) impact of severe in utero maternal undernutrition on OBW can be ruled out. There may, however, be parity specific, moderate (50-100 g) effects of maternal undernutrition early in pregnancy on OBW. This suggestion requires confirmation in other populations.

Adult↗
PubMed2005

Quantitative electroencephalographic patterns in normal preterm infants over the first week after birth.

BACKGROUND: Currently available tools to assist clinicians with prediction of neurodevelopmental outcome of preterm infants are inadequate. Modified cotside electroencephalography (EEG) has the ability to produce quantitative electrophysiologic measures. These measures may be useful in future prediction of outcome. AIM: To determine patterns of change in quantitative EEG measures in preterm infants during their first week after birth. DESIGN: Observational. SUBJECTS: Preterm infants born at less than 32 weeks completed gestation surviving to discharge with unremarkable serial ultrasound scans. OUTCOME MEASURES: Changes in continuity, amplitude and spectral edge frequency measures of EEGs obtained over the first week after birth. RESULTS: Results of EEGs performed using a novel EEG device on 63 infants are reported here. Their median (range) gestation was 29 (24-31) weeks and birthweight was 1,235 (540-1,980) g. Quantitative measures of EEG continuity increased over the first week after birth from 72 (25-99)% to 92 (54-100)% at the 25 microV threshold, and from 39 (10-87)% to 64 (34-75)% at the 50 microV threshold, both p<0.0001. There was a related 32% increase in median amplitude from 5.8 (2.6-10.6) microV on day 1 to 7.6 (4.3-9.4) microV on day 4, p=0.005. There was a trend for average spectral edge frequency to fall from 10.7 (9.3-12.9) Hz on day 1 to 9.9 (8.1-12.3) Hz on day 3, p=0.06. Each gestational tertile showed similar patterns. CONCLUSIONS: There are consistent changes in quantitative neurophysiologic measures over the first week after birth, and particularly measures of continuity over the first 4 days, in normal preterm infants.

Child Development↗
PubMed1993

Effect of oxygen and neostigmine on stillbirth and pig viability.

In this experiment, 98 multiparous Yorkshire sows blocked on farrowing date were randomly assigned to four treatments in a 2 x 2 factorial arrangement. Oxygen inhalation (6 L/min) by the sow was tested in an effort to reduce stillbirth rate and improve pig viability. This study also tested the effect of increasing uterine contractions using neostigmine (5 mg) to determine whether simultaneous administration of oxygen to the sow could improve the inconsistent response of stillbirth rate to neostigmine. Pig viability was assessed using viability scoring and blood gas analysis of samples obtained from the suborbital sinus immediately after birth. The farrowings averaged 12.2 pigs/litter, 7.8% stillbirths, and 3.5% low viability (viability score < or = 6) pigs. Treatment had no effect on stillbirth rate or pig viability. Oxygen treatment increased pO2 (P = .0002), increased pCO2 (P = .02), and decreased pH (P = .02) in sow venous blood sampled after the birth of the last pig, but it had no effect on pig venous blood gases. Neostigmine treatment had no effect on either sow or pig venous blood gases. Oxygen treatment doubled the length of the first birth interval after the start of treatment (P = .003) but had no effect on remaining birth intervals. Neostigmine had no effect on birth interval. It is suggested that the effect of oxygen on birth interval is the reason for the lack of improvement in stillbirth rate.

Animals↗
PubMed1989

[Regional living conditions, migration, and family composition].

"On the basis of life history data of German birth cohorts born 1929-31, 1939-41, and 1949-51 hypotheses about the relation between regional context, migration and family formation are tested. Results of proportional hazard models do not show significant regional effects on first birth rates for stayers when sociostructural variables are controlled for. However, social background and employment status of [women], which are proved to be important factors concerning family formation, reflect differential regional opportunities on the labor market. For men including the indicator of marriage in the model makes the regional effect insignificant." The impact on fertility of rural or urban residence and of rural-urban migration is analyzed. (SUMMARY IN ENG)

Cohort Studies↗
PubMed2000

Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer.

CONTEXT: Oral contraceptive (OC) use is weakly associated with breast cancer risk in the general population, but the association among women with a familial predisposition to breast cancer is less clear. OBJECTIVE: To determine whether the association between OC use and risk of breast cancer is influenced by family history of the disease. DESIGN AND SETTING: Historical cohort study of 426 families of breast cancer probands diagnosed between 1944 and 1952 at the Tumor Clinic of the University of Minnesota Hospital. Follow-up data on families were collected by telephone interview between 1991 and 1996. PARTICIPANTS: A total of 394 sisters and daughters of the probands, 3002 granddaughters and nieces, and 2754 women who married into the families. MAIN OUTCOME MEASURE: Relative risk (RR) of breast cancer associated with history of OC use by relationship to proband. RESULTS: After accounting for age and birth cohort, ever having used OCs was associated with significantly increased risk of breast cancer among sisters and daughters of the probands (RR, 3.3; 95% confidence interval [CI], 1.6-6.7), but not among granddaughters and nieces of the probands (RR, 1.2; 95% CI, 0.8-2.0) or among marry-ins (RR, 1.2; 95% CI, 0.8-1.9). Results were essentially unchanged after adjustment for parity, age at first birth, age at menarche, age at menopause, oophorectomy, smoking, and education. The elevated risk among women with a first-degree family history of breast cancer was most evident for OC use during or prior to 1975, when formulations were likely to contain higher dosages of estrogen and progestins (RR, 3.3; 95% CI, 1.5-7.2). A small number of breast cancer cases (n = 2) limited the statistical power to detect risk among women with a first-degree relative with breast cancer and OC use after 1975. CONCLUSIONS: These results suggest that women who have ever used earlier formulations of OCs and who also have a first-degree relative with breast cancer may be at particularly high risk for breast cancer. Further studies of women with a strong family history who have used more recent lower-dosage formulations of OCs are needed to determine how women with a familial predisposition to breast cancer should be advised regarding OC use today. JAMA. 2000;284:1791-1798.

Adult↗
PubMed2006

Severe obstetric complications and birth characteristics in preterm or term delivery were accurately recalled by mothers.

OBJECTIVE: This study examined the accuracy of maternal recall of obstetric complications and birth characteristics and its determinants for both preterm and term deliveries 3-9 years ago. METHODS: In 101 preterm and 107 term deliveries at the National Taiwan University Hospital during 1995-2000, recall data were obtained by telephone interview with the mothers and were matched with medical records. RESULTS: Among 10 obstetric complications assessed, the accuracy of maternal recall could either have high sensitivity and high specificity (Cesarean section, gestational hypertension, and induced labor), low to moderate sensitivity and high specificity (pre-eclampsia, breech, and cord loops), or low sensitivity and low specificity (ante partum vaginal bleeding, edema, and proteinuria). The correlations between maternal recall and medical records for birth weight (r = .95) and gestational age (r =.93) in the preterm group were slightly higher than those in the term group (r = .89 and .83, respectively). Factors associated with higher recall accuracy included preterm delivery, first birth order, and lower total parity, but no factor consistently related to maternal accuracy for all obstetric complications and birth characteristics. CONCLUSION: The accuracy of maternal recall on obstetric complications varied depending on the nature of complications examined, whereas that on birth characteristics was high.

Birth Weight↗
PubMed2005

Urinary estrogen metabolites and their ratio among Asian American women.

Controversy persists regarding the role of a low ratio of 2-hydroxyestone (2-OHE(1))/16alpha-hydroxyestrone (16alpha-OHE(1)) as a potential estrogen metabolism marker of increased risk for breast cancer. Most of the evidence has been provided by case-control studies, where tumor effects on hormone metabolism are not known. Studies in populations at various risk of breast cancer are not consistent, with some suggesting that levels of the ratio may be altered by changes in diet and exercise. We studied Asian American women participating as controls in a case-control study of breast cancer in which migration history--a composite of the subject's place of birth, type of residence in Asia (urban or rural), length of time living in the West, and grandparents' place of birth--was associated with a 6-fold risk gradient that paralleled the historical differences in incidence rates between the United States and Asian countries. This population offered the possibility to address whether the ratio of 2-OHE(1):16alpha-OHE(1) differs according to recognized breast cancer risk factors, including migration history. Overnight 12-hour urines were obtained from 368 premenopausal and 143 naturally postmenopausal women of Chinese, Japanese, or Filipino descent who donated urines between 1985 and 1988. The estrogen metabolites 2-OHE(1) and 16alpha-OHE(1) were measured with an ELISA kit and adjusted for creatinine levels. In each ethnic group, the ratio of 2-OHE(1):16alpha-OHE(1) was consistently lower in women born in the West than in those who had migrated from Asia. For premenopausal women, the ratio declined 20% due to lower levels of 2-OHE(1). Among postmenopausal women, the ratio was 23% lower in those born in the West, but no consistent patterns based on place of birth were observed for either 2-OHE(1) or 16alpha-OHE(1). The ratio did not vary with most recognized breast cancer risk factors, except for lower metabolite ratios in women with a younger age at first birth and more children, which runs contrary to the hypothesis, because both characteristics reduce breast cancer risk. Our study suggests that the ratio of 2-OHE(1):16alpha-OHE(1) may be a marker for lifestyle influences on estrogen metabolism associated with westernization.

Adult↗
PubMed2004

Prevalence of low birth weight and its determinants in an urban resettlement area of Delhi.

Birth weight remains an important factor affecting infant and child mortality. Many factors influence the occurrence of low birth weight (LBW). The present study was conducted to study the prevalence and determinants of LBW in an urban resettlement area of Delhi. A baseline survey was done to enroll all pregnant women in the area. These women were followed up every month till outcome. The prevalence of LBW was 39.1%. Occurrence of LBW was related to age, parity, weight and height of the mother. In multiple logistic regression analysis, mother's weight and parity alone emerged as significant variables. On further analysis, on adjusting for age, parity and birth weight were associated for the 20-35-year age group only. Thus, prevalence of LBW remains high in the urban under privileged of Delhi; maternal age, parity and weight and height are important determinants. Increasing age of first birth to more than 20 years can minimize effect of primi parity.

Adult↗