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PubMed2004

Preimplantation diagnosis in Switzerland--birth of a healthy child after polar body biopsy.

In Switzerland preimplantation genetic diagnosis is limited by law to polar body biopsy (PBB). The indications for PBB include unexplained recurrent miscarriage and improvement of the outcome of in vitro fertilisation (IVF) cycles in women at an advanced reproductive age. In this article we report the first birth of a healthy child after polar body biopsy in Switzerland in a case of unexplained miscarriage after IVF.

Abortion, Habitual↗
PubMed2000

Do parental factors affect male and female fertility?

There is little published evidence on parental characteristics and the fertility of their offspring of either sex. Maternal smoking has been reported to reduce fertility in both sexes and was also suggested to be relevant to the health of the male reproductive system on the basis of descriptive epidemiology. We undertook a cohort study based on a sample representative of the British population born in 1958 who have been followed up since birth. The outcome variable was time to pregnancy measured in months, up to age 33 years. Antecedent variables were the age of both parents; maternal smoking, height, prepregnancy body mass index, and parity; and paternal social class (manual/nonmanual labor). First births to cohort members were analyzed using a Cox logistic model for discrete "survival" times. A total of 1,714 and 2,587 values of time to pregnancy were available, respectively, for male and female cohort members. In the unadjusted analyses, all odds ratios were in the range 0.9-1.1, apart from the father's social class. In the adjusted analyses, this effect also disappeared. We conclude that the observed heterogeneity in biological fertility is unrelated to those characteristics of parents that we were able to analyze.

Adult↗
PubMed1987

Congenital dislocation of the hip in Western Australia. A comparison of neonatally and postneonatally diagnosed cases.

Speculation that neonatally diagnosed congenital dislocation of the hip (CDH) may have a different etiology from cases diagnosed in the postneonatal period has not been examined in Australia because insufficient data have been available. A population-based study of CDH in children up to the age of two years who were born in Western Australia (WA) in 1981, 1982, or 1983 is the subject of this report. Study material comprised cases of CDH from the WA Congenital Malformations Register and denominator data (all births in WA for 1981-1983) from the Health Department of WA. From this material, rates of CDH were calculated for each of the study variables of interest. The rate of CDH was low for babies born to aboriginal mothers, and it is postulated that this may have a cultural basis, possibly in infant carrying postures. Overall, the prevalence of CDH for 1981-1983 was 6.4 cases per 1000 births, with 4.2/1000 diagnosed in the neonatal period and 2.2/1000 in the postneonatal period. Epidemiologic differences were noted between infants diagnosed in the neonatal period and those diagnosed postneonatally; rates of neonatally diagnosed CDH were higher in first births, breech presentation, and postmature infants than were rates of postneonatally diagnosed cases. Bilateral dislocation was more common (45.3%) in neonatally diagnosed cases than in postneonatally diagnosed cases (23.3%). These findings tended to support the idea that the time of diagnosis may define two distinct entities in CDH.

Adult↗
PubMed2006

Association between reproductive factors and breast cancer survival in younger women.

This analysis investigated whether reproductive factors such as age at menarche, parity, and timing and outcomes of pregnancies were associated with survival among women with breast cancer younger than 55 years. Female residents of Atlanta, Georgia, and central New Jersey who were diagnosed with a primary, incident invasive breast cancer between 1990 and 1992 and enrolled in a population-based study (n = 1,264) were followed for 8-10 years. Detailed exposure and covariate information was collected via in-person interviews administered shortly after diagnosis. Vital status as of January 1, 2000 was ascertained through the National Death Index via the state cancer registries (n = 292 deaths). Cox regression methods were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for confounders. Parity of 4 or more births, as compared with nulliparity, was positively associated with all-cause mortality, [HR (95% CI) = 1.71 (1.09-2.67)]. Increased mortality was associated with having given birth within 5 years prior to diagnosis ( 5 years) [1.78 (1.28-2.47)], and was more pronounced among women with a pre-diagnostic body mass index of <25 kg/m2 [2.54 (1.61-4.00)]. Early age at menarche and early age at first birth also modestly increased mortality; history of miscarriage, induced abortion, and ever breastfeeding were not related to survival. These results may help elucidate breast cancer progression mechanisms and enable a better understanding of how reproductive characteristics influence breast cancer survival.

Adult↗
PubMed1995

Mechanisms for maternal age differences in birth weight.

The authors studied three hypothesized explanations for reduced birth weights of infants born to US adolescent mothers--social disadvantage, biologic immaturity, and unhealthy behaviors during pregnancy. A hierarchical regression analysis was pursued to evaluate these explanations using data from the National Longitudinal Study of Youth on 1,754 first births between 1979 and 1983 to women aged 14-25 years at the time of birth. The birth weights of infants of mothers aged 14-17, 18-19, and 20-23 years were 133, 54, and 88 g less than for infants of mothers aged 23-25. The regression results indicate that the reduced birth weights of infants born to young mothers, particularly women aged 14-17, were related to their disadvantaged social environment. When adjustment was made for poverty and minority status, there were no maternal age differences in birth weight. The reduced birth weights were not related to the young woman's health behaviors during pregnancy or her biologic characteristics. Ethnicity, poverty status, age at menarche, maternal height, net maternal weight gain, and smoking during pregnancy had an independent effect on birth weight in this sample of young women.

Adolescent↗
PubMed2001

Risk factors for infant mortality in a rural community in Nigeria.

In this prospective community based study, information on births and deaths was collected for five consecutive years (1993-1997) by trained village health workers (VHW) and traditional birth attendants (TBA). The main objective was to identify factors which are associated with infant deaths in a typical rural community in southwestern Nigeria with a current mid-year population of 3,308. Infant mortality rate was found to be 68.2 per 1,000 live births and is lower than the national rate but higher than the regional rate. Neonatal deaths, with a rate of 37.6 per 1,000 live births, accounted for 55.1% of all infant deaths while postneonatal deaths accounted for 44.9% of the deaths. Twelve (44.4%) of all neonatal deaths (27) occurred within 24 h of delivery while 20 (74.1%) of all neonatal deaths occurred in the first week of life and were perinatal deaths. These high perinatal rates indicate that more efficient obstetric and public health services are needed in the community. First birth order and older mothers (> 34 years) at time of death of infant were associated with significantly higher risk for mortality in this village (p = 0.004). Females were twice as likely as males to die in infancy (p = 0.011), a finding which is contrary to what is generally found; there is a need for further studies to exclude gender discrimination in this village. Significantly more neonatal deaths occurred during the rainy season than in the dry season (p = 0.018) suggesting that environmental factors play a role in neonatal deaths. In the neonatal period, the commonest cause of death was due to complications of low birth weight while in the postneonatal period it was due to infection. VHWs and TBAs are good resource persons for obtaining accurate numerical data at the grass-roots level, and the potential of using their services to collect vital but non-existent statistics should be explored. These workers also need to be trained to recognise factors that put infants at risk. Reassessment of preventive strategies already implemented for reducing infant mortality may be required in order to further reduce the infant mortality rate in this community.

Adolescent↗
PubMed2005

Late parenthood among subfertile and fertile couples: motivations and educational goals.

OBJECTIVES: The percentage of first birth among women and men in their early thirties is growing rapidly. Personal development is considered as an important factor for postponement of having children. Also, subfertility may lead to late parenthood. METHODS: In this study 72 younger and 154 older first time parents in the Netherlands answered a questionnaire regarding parenthood. Subfertile parents and fertile parents were separately analysed. RESULTS: Both fertile and subfertile mothers expressed a lesser desire to have a child than younger ones. Older fertile mothers valued the personal development of their children as more important than younger fertile mothers. Also, older fertile mothers had less traditional reasons for motherhood and reported less feminine characteristics. Younger fertile fathers assessed the future material success of their child as less important than older ones. Also, they reported less feminine characteristics. CONCLUSION: There is more common ground than differences between younger and older first-time mothers. PRACTICE IMPLICATIONS: Counselors should be aware that there appears to be no ground to fear that having children in the age of 30 and 40, has negative effects regarding parenting.

Adult↗
PubMed2001

Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births.

BACKGROUND: Individuals who are small at birth are at increased risk of ischaemic heart disease (IHD) in later life. One hypothesis to explain this association is fetal adaptation to a suboptimum intrauterine environment. We investigated whether pregnancy complications associated with low birthweight are related to risk of subsequent IHD in the mother. METHODS: Routine discharge data were used to identify all singleton first births in Scotland between 1981 and 1985. Linkage to the mothers' subsequent admissions and deaths provided 15--19 years of follow-up. The mothers' risks of death from any cause or from IHD and admission for or death from IHD were related to adverse obstetric outcomes in the first pregnancy. Hazard ratios were adjusted for socioeconomic deprivation, maternal height and age, and essential hypertension. FINDINGS: Complete data were available on 129,920 (95.6%) eligible deliveries. Maternal risk of IHD admission or death was associated with delivering a baby in the lowest birthweight quintile for gestational age (adjusted hazard ratio 1.9 [95% CI 1.5--2.4]), preterm delivery (1.8 [1.3--2.5]), and pre-eclampsia (2.0 [1.5--2.5]). The associations were additive; women with all three characteristics had a risk of IHD admission or death seven times (95% CI 3.3--14.5) greater than the reference category. INTERPRETATION: Complications of pregnancy linked to low birthweight are associated with an increased risk of subsequent IHD in the mother. Common genetic risk factors might explain the link between birthweight and risk of IHD in both the individual and the mother.

Birth Weight↗
PubMed1996

Oral contraceptives and cervical cancer--further findings from the Oxford Family Planning Association contraceptive study.

In 1983, we reported results from the Oxford Family Planning Association contraceptive study regarding the association between oral contraceptives (OCs) and cervical neoplasia, after a 10 year follow-up of a cohort of 17,000 women. Further findings from this study are reported here after an additional 12 years of follow-up. A nested case--control design was used in which cases were all women diagnosed under 45 years of age with invasive carcinoma (n = 33), carcinoma in situ (n = 121) or dysplasia (n = 159). Controls were randomly selected from among cohort members and matched to cases on exact year of birth and clinic attended at recruitment to study. Conditional logistic regression analysis was used to determine odds ratios (ORs) and 95% confidence intervals (CIs) associated with various aspects of OC use relative to never users adjusted for social class, smoking, age at first birth and ever use of diaphragm or condom. Ever users of OCs had a slightly elevated OR for all types of cervical neoplasia combined (OR = 1.40, 95% CI 1.00-1.96). Odds ratios were highest for invasive carcinoma (OR = 4.44, 95% CI 1.04-31.6), intermediate for carcinoma in situ (OR = 1.73, 95% CI 1.00-3.00) and lowest for dysplasia (OR = 1.07, 95% CI 0.69-1.66). The elevated risk associated with OC use appeared to be largely confined to current or recent (last use in the past 2 years) long-term users of OCs. Among current or recent users, ORs for all types of cervical neoplasia combined were 3.34 (95% CI 1.96-5.67) for 49-72 months of use, 1.69 (95% CI 0.97-2.95) for 73-96 months and 2.04 (95% CI 1.34-3.11) for 97 or more months. These results suggest a possible effect of OC use on later stages of cervical carcinogenesis, although residual confounding due to sexual factors or human papillomavirus (HPV) infection cannot be ruled out.

Adult↗
PubMed1997

Breast cancer risk in mothers of twins.

The risk of breast cancer associated with delivering a twin birth was examined in a population-based nested case-control study of nearly 4800 Swedish women with breast cancer and 47000 age-matched control subjects. All were aged less than 50 years and parous. After adjustment for age at first birth and parity, a 29% reduction in breast cancer risk was observed in mothers of twins relative to those who were not (odds ratio = 0.71, 95% confidence interval 0.55-0.91). These results provide evidence that women who bear twins are at reduced risk of breast cancer, one explanation for which may be their unusual levels of hormonal exposure.

Breast Neoplasms↗
PubMed1996

Oral contraception, parity, breast feeding, and severity of rheumatoid arthritis.

OBJECTIVE: To investigate the influence of breast feeding, use of the oral contraceptive pill (OCP), and parity on rheumatoid arthritis (RA). METHODS: One hundred and seventy six women with RA were compared with 145 control subjects; all had at least one child. RA patients were classified as having severe (n = 82) or mild disease (n = 89) according to clinical joint evaluation, radiological score, biological inflammation, and the presence of HLA-DR1 or -DR4 alleles. RESULTS: The mean age of RA patients was 58 years, and the mean age at the time of diagnosis of RA was 46 years. The mean time between onset of RA and the first birth was 23.6 (SD 3.8) years. The OCP user rates were 33% in the RA group and 47.6% in the control group (p < 0.02). OCP use was related to the mother's year of birth. The relative risk for developing RA was 0.598 (95% confidence interval (CI) 0.33 to 1.1) in women who had used OCP for more than five years compared with those who had never used OCPs. In contrast, the age at which the first pregnancy occurred, the number of children breast fed, and the duration of breast feeding were comparable in RA patients and healthy subjects. Among the RA patients, parity, duration of breast feeding, and the number of breast fed children were significantly increased in those with severe disease. Having more than three children increased the risk of developing severe disease 4.8-fold when adjusted for age and OCP use. Forty six percent of women with severe RA had a history of breast feeding duration greater than six months before disease onset, compared with 26% of patients with mild disease (p < 0.008). Having more than three breast fed children increased the risk of poor disease prognosis 3.7-fold. In contrast, OCP use had a protective role in the course of RA (44% of RA patients with mild disease were OCP users, compared with 21.7% of those with severe RA; p < 0.001). Among those using OCP for more than five years, the relative risk of developing severe disease was 0.1 (95% CI 0.01 to 0.6), after adjustment for age, parity, and breast feeding. CONCLUSION: Our results suggest that parity, and to a lesser extent breast feeding, before RA onset worsened RA prognosis, whereas OCP use had a protective role. Prolactin and oestrogen may have a role in these effects.

Adult↗
PubMed1994

International Variations and Trends in the Incidence of Breast Cancer in Older Women.

This article explores age-related variations in breast cancer mortality in the western world and analyzes potential risk factors for older women. The highest breast cancer mortality rates are observed in England, Wales, and Denmark; the United States, Canada, Sweden, central and southern Europe have intermediate mortality rates; and Latin America and Russia have the lowest rates. Three case-control studies involving over 4000 Italian women demonstrate that age at menarche is a risk factor only for premenopausal women; multiparity (>5 births) increases the risk of breast cancer for women under age 35 years but reduces the risk of breast cancer for older women. Obesity is a risk factor only for postmenopausal women, and the influence of other risk factors, such as age at first birth, family history and late menopause, does not show age-related variations. The influence of diet and steroidal contraceptives on the breast cancer rate in older women is not established.

Journal Article↗
PubMed1992

Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study.

OBJECTIVE: Our objective was to evaluate the risk for endometrial cancer in relation to reproductive, menstrual, and medical factors. STUDY DESIGN: A case-control study of 405 endometrial cancer cases and 297 population controls in five areas of the United States enabled risk to be evaluated. RESULTS: A major risk factor was the absence of a prior pregnancy (relative risk 2.8, 95% confidence interval 1.7 to 4.6). The protective effect of pregnancy appeared to reflect the influence of term births, because spontaneous and induced abortions were unrelated to risk. Among nulliparous women infertility was a significant risk factor, with women having sought medical advice having nearly eight times the risk of those without difficulty conceiving. After adjustment for other reproductive characteristics, age at first birth and duration of breast-feeding were not related to risk. CONCLUSIONS: Elevated risks were found for subjects reporting early ages at menarche (relative risk 2.4 for ages < 12 vs > or = 15) and longer days of flow (relative risk 1.9 for > or = 7 vs < 4 days), but there was no relationship with late ages at natural menopause. Height was not associated with risk, but there was a significant relation to weight, with the risk for 200 versus < 125 pounds being 7.2 (95% confidence interval 3.9 to 13.3). After adjustment for weight and other factors, histories of hypertension and gallbladder disease were not significantly related to risk, but an effect of diabetes persisted (relative risk 2.0, 95% confidence interval 1.1 to 3.6). Hirsutism developing at older ages was also significantly related (relative risk 2.0, 95% confidence interval 1.2 to 3.4).

Adult↗
PubMed1975

Obstetrics and perinatal medicine in Iceland 1881-1971, with a detailed report on deliveries in Iceland 1972-1974.

Chapter I describes the adoption of a new certificate of the outcome of pregnancy in Iceland and Iceland's participation in a feasibility study of the registration of pregnancies and their outcome in cooperation with WHO. New maternity and infant forms adopted in 1972 are described and their effect on antenatal control and the coordination of the registration of deliveries and their outcome explained. Chapter II offers a survey of population growth in Iceland since 1881. Data concerning birth-rate and death-rate from 1881-1971 are given, together with data on perinatal mortality. The perinatal mortality rate is shown year by year from 1951 to 1971 and maternal death from 1881-1970. There follows a description of the development of birth institutions in Iceland and the chapter is concluded by data on maternal age since the turn of the century. Chapter III shows processing of data for the years 1972-1974. Tables and diagrams demonstrate the distribution of deliveries in Iceland, the distribution of first births according to mothers age, the marital status of Icelandic mothers, the relation between marital status and the number of deliveries, years of mothers education, parity in Iceland, gestational length, the relation between the number of antenatal visits and perinatal mortality. Tables further demonstrate registered complications of pregnancy and delivery. The sex, weight and bodylength of newborns are discussed. Also tabulations of registered infant diagnoses. At the conclusion of the report, the advantages and disadvantages brought to light by the data processing and expected improvements and future processing are discussed.

Adolescent↗
PubMed1994

Cesarean delivery in the United States, 1990.

Information now available on method of delivery from birth certificates confirms past findings on the groups at highest risk of cesarean delivery and greatly expands our knowledge of the demographic and health characteristics associated with cesarean delivery. Mothers who live in the South, who are in the oldest years of childbearing, having their first birth, married, or who have high educational attainment are all at increased risk of a cesarean delivery. Very short gestations, low or high birthweights, multiple delivery, the presence of certain complications of pregnancy, labor and/or delivery, abnormal conditions of the newborn, and the use of some obstetric procedures are also associated with elevated cesarean rates. Several recent studies (28,29) have concluded that advanced maternal age in and of itself may be an independent risk factor for cesarean delivery, due to physician and patient concern over pregnancy outcome for older women. Many of the characteristics examined in this study are highly related to maternal age (for example, marital status and educational attainment). Therefore, for these variables, mother's age is also taken into account to determine if age itself is the underlying reason for differences in rates of cesarean delivery. The importance of the role of maternal age in the risk of cesarean delivery is clearly demonstrated throughout this report: Older mothers are more likely to deliver by cesarean regardless of race, Hispanic origin, parity, marital status, or educational attainment. The overall rate of cesarean delivery is only slightly lower for black than for white mothers (22.1 percent compared with 23.0 percent), despite the generally lower educational attainment of black mothers and the higher percentage who are unmarried or in their teen years, all factors that tend to substantially lower the risk of cesarean delivery. However, there are many offsetting factors that tend to raise the cesarean rate for black mothers. A relatively high proportion of black births occur in the South, which has the highest cesarean rate of all regions; the incidence of low and very low birthweight is far higher for black births; and premature delivery is twice as frequent for black babies. Also, although rates of cesarean delivery for most medical risk factors, complications of labor and or delivery, and abnormal conditions of the infant are about the same for both races, the incidence of a number of these conditions is substantially higher for black mothers and babies, and that has the effect of increasing the overall cesarean rate for black mothers.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

Projected changes in breast cancer incidence due to the trend toward delayed childbearing.

Because there has been a recent trend toward delay of childbearing in the United States, women in the birth cohort of 1945-49 will have an estimated 5 per cent greater incidence of breast cancer, and those in the cohort of 1950-54 an estimated 9 per cent greater incidence compared with the cohort of 1935-39, which had the distribution of age at first birth most favorable for breast cancer risk.

Adult↗
PubMed2004

Birth seasonality in the Old Order Amish.

The Old Order Amish are a healthy and well-nourished natural fertility population, so that the timing of births is not influenced by behaviours to limit family size, undernutrition or disease. The present study examines the monthly distribution of 8160 births occurring between 1920 and 1991 in the Geauga Settlement in north-east Ohio, USA. The monthly distribution of births in the Geauga Settlement is bimodal, with a major peak extending from August to October, a minor peak in February, and a major trough from April to June. This pattern is almost identical to the pattern found in the US in 1943. The monthly distribution of first births appears to be influenced to some extent by a highly significant seasonal pattern of weddings. The pattern of births in the Old Order Amish is consistent with the hypothesis that the spring trough in US births is at least partially caused by a decrease in coital frequency and/or a decrease in fecundability as a result of hot summer temperatures but is not consistent with the hypothesis that the fall peak in US births is primarily due to an increase in coital frequency during the Thanksgiving and Christmas holiday seasons.

Adult↗
PubMed2001

Long-term impact of reproductive factors on the risk of cervical, endometrial, ovarian and breast cancer.

The influence of maternal age, parity, low or high birthweight, multiple births, and pre-eclampsia on the risk of cervical, endometrial, ovarian and breast cancers was studied. Data on 40951 women and the outcomes of their deliveries between 1955 and 1995 were obtained from birth registers. For the mothers, data from the Swedish Cancer Registry and the Cause of Death Register were added. The sample was evaluated using Cox's regression in univariate and bivariate analyses where the relative risk and its 95% confidence interval were calculated. Increasing maternal age at first birth was associated with an increasing relative risk of endometrial, ovarian, and breast cancers, and with a decreased risk of cervical cancer. Multiparity was a protective factor for all gynaecological cancers, including cervical and breast cancers. Multiple births were associated with an increased risk of endometrial cancer.

Adolescent↗