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PubMed1997

Parental age in relation to risk of breast cancer.

Data from a population-based case-control study were analyzed to evaluate risk of breast cancer among women according to parental age at the time of subject birth. Between 1988-91, breast cancer cases (n = 1,253) were obtained from the statewide tumor registry in Wisconsin. Concurrently, population controls (n = 1,121) were randomly selected from driver's license lists (if under age 65) and Medicare beneficiary files (if 65-74 years). Information regarding parents' ages and breast cancer risk factors was obtained by telephone interview. Relative risk estimates were very slightly elevated with increasing maternal age, although no consistent trend of increasing risk was observed (P for trend = 0.38). No association between paternal age and breast cancer risk was observed (P for trend = 0.98). Older maternal or paternal age was not associated with risk among any of the subgroups examined, except for daughters who had late age at first birth. These findings are consistent with the majority of studies that have found little or no association between parental age and breast cancer risk.

Adult↗
PubMed1998

Parity, age at first childbirth and the prognosis of primary breast cancer.

Reproductive factors are known to be aetiologically important in breast cancer, but less is known regarding their effect on breast cancer prognosis. We have investigated the prognostic effect of age at first birth and total parity using data from the Danish Breast Cancer Cooperative Group that, since 1977, has collected population-based information on tumour characteristics, treatment regimes and follow-up status on Danish women with breast cancer. Details of pregnancy history were added from the Danish Civil Registration System and the National Birth Registry. Included in the study were 10,703 women with primary breast cancer. After adjusting for age and stage of disease (tumour size, axillary nodal status and histological grading), the number of full-term pregnancies was found without prognostic value. However, women with primary childbirth between 20 and 29 years experienced a significantly reduced risk of death compared with women with primary childbirth below the age of 20 years [20-24 years: relative risk (RR) = 0.88, 95% confidence interval (CI) 0.78-0.99; 25-29 years: RR = 0.80, 95% CI 0.70-0.91]. Further adjustment for oestrogen receptor status did not influence these results. The effect was not modified by age at diagnosis, tumour size or nodal status. In conclusion, low age at first childbirth, but not parity, was associated with a poor prognosis of breast cancer. We speculate whether women who develop breast cancer despite an early first full-term pregnancy might represent a selected group with a more malignant disease.

Adult↗
PubMed1999

Maternal predictors of perinatal mortality: the role of birthweight.

BACKGROUND: Many maternal characteristics increase the risk for perinatal death. To locate potential sites for intervention, it is important to identify these risk factors and examine how much of the excess mortality is explained by infants' low birthweight. METHODS: Data on all newborns in Finland born between 1991 and 1993 (N = 199,291, of which 1461 were perinatal deaths) were obtained from the Medical Birth Register. Logistic regression analysis was used to adjust for background variables, both including and excluding infants' birthweight. The percentage reduction in odds ratios after adjustment for infants' birthweight was used to estimate the contribution of infants' low birthweight to the excess mortality. RESULTS: After adjusting confounding factors, increased risk for perinatal death was found for eight maternal characteristics. In the following the increased risk is given as odds ratios and the proportions of the excess mortality explained by infants' low birthweight are in parentheses: in-vitro fertilization 4.12 (> 100%); earlier stillbirth 3.43 (87%); higher maternal age, from 1.21 to 3.08 (38-99%); maternal diabetes 2.87 (50%); lower socioeconomic status, from 1.30 to 1.70 (27-44%); smoking during pregnancy 1.45 (> 100%); single mother 1.44 (50%); first birth 1.36 (75%). CONCLUSIONS: Excess mortality due to maternal risk factors occurred mainly through their tendency to cause low birthweight. However, the excess mortality associated with low socioeconomic status, single motherhood, and diabetes was mediated by other mechanisms in addition to low birthweight.

Adult↗
PubMed2006

Delivery of the posterior arm reduces shoulder dimensions in shoulder dystocia.

OBJECTIVE: To evaluate a possible reduction in shoulder diameter and circumference by extending the posterior arm during delivery, for an easier birth in cases of shoulder dystocia. METHODS: In this study of 33 neonates the bisacromial diameter and axilloacromial circumference were measured within 72 h of birth, first with the neonate's arms by its chest and then with 1 arm extended above its head. Reductions in diameter and circumference were evaluated. RESULTS: The mean +/- SD differences in bisacromial diameter and axilloacromial circumference were 1.9 +/- 0.69 cm and 2.52 +/- 1.18 cm, respectively. A greater reduction was observed in neonates with a greater shoulder diameter. CONCLUSION: In cases of shoulder dystocia, delivery of the posterior arm should significantly reduce shoulder dimensions, especially in larger fetuses, and prevent a need for excessive traction.

Arm↗
PubMed1990

Interval between birth of the first and the second twin and its impact on second twin perinatal mortality.

We investigated the impact of a long interval between the birth of the first and the second twin on second twin perinatal mortality (PNM). National data in the Swedish Medical Birth Registry were used on 7533 second twins born in Sweden between 1973 and 1985. PNM as a function of the time interval between the births of the twins was studied in data from two time periods: during 1973-78 (n = 4008) and 1979-85 (n = 3525). During the first period, PNM was significantly higher at intervals of 30 min or more between the births of the twins than at shorter intervals (chi 2 = 11.1, p less than 0.001). When studied within broad birth weight classes, a significant trend was seen for twins weighing 1500-2499 g with an increasing interval (chi 2 = 8.1: p less than 0.01). A non-significant trend was also found for twins weighing less than 1500 g but none for twins weighing greater than or equal to 2500 g. During the second period, abdominal delivery of the second twin after vaginal delivery of the first twin was significantly more common than during the first period (2.0% vs 0.3%, chi 2 = 52.7, p less than 0.001). During the second period, the interdelivery interval had little impact on second twin PNM. The results of this study seem to indicate that with modern management of labor and delivery, as seen in Sweden since 1979, the interdelivery interval has little impact on second twin PNM.

Cesarean Section↗
PubMed1997

Evaluation of reproductive histories constructed by linking vital records.

We used 1.4 million fetal death and birth certificates filed in Georgia between 1980 and 1992 to construct 369,686 chains of two or more reproductive events occurring to the same woman. We evaluated these chains using both information on the certificates and information independently collected in interviews with 1311 women. Overall, 86.6% of the chains had the expected number of events, based on the certificate's information about previous pregnancies. Seventy-nine per cent of the chains had the expected number of events based on the maternal interviews. Consistency between the observed number of events in the chain and the number expected, based either on data from the certificates or from the maternal interviews, was greatest for chains with two or three events. Mothers born in Georgia were more likely to have complete chains than mothers born elsewhere. Among the 551,391 non-linked certificates, 48.7% were the mother's first birth, 40.2% were second or higher-order births to women whose previous pregnancy occurred before 1980, and 11.1% were second or higher-order births to women whose previous pregnancy occurred after 1980. Fetal death and livebirth certificates can be linked to construct pregnancy histories with reasonably low levels of underlinkage and overlinkage.

Adult↗
PubMedDate not supplied

Menarcheal age for Norwegian women born 1830-1960.

Data from birth records from the maternity hospitals in the three main cities in Norway have been used to study the trend in menarcheal age for women born from about 1830 to about 1960. The investigation is based on a sample of 200-300 records around every 10th year from each of the three clinics in partly overlapping time periods relating to a total of 9152 women. The recollected age at menarche fell from just above 16 years for women born around 1830 to just above 13 years for those born around 1960, the decrease being not totally linear. These results correspond closely with a previously published investigation from Oslo from about the same period of time (Brudevoll, Liestøl and Walløe, 1979), but our results, which cover more of Norway, show a more linearily shaped curve than the results covering only Oslo. We have also analysed the relationships of several independent variables to menarcheal age, using multivariate linear regression methods. Besides the woman's year of birth, which was the most important variable throughout the whole period of time, various geographical variables were found to be of moderate importance. Being born in the countryside and in towns other than Oslo and Bergen led to a slightly higher age at menarche. No significant difference between Oslo, Bergen and Trondheim was detected except for the period up to about 1880 where the Bergen women had about 2.6 months earlier menarche than the Oslo women. Married women amongst the sample had experienced menarche a little earlier than the unmarried, and among married women there was an association between occupation and menarcheal age, women from the lowest social classes having the latest ages at menarche. The importance of these socially related parameters declined with time, and for women born after 1945 the difference seemed to have disappeared. The age at menarche was found to be positively related to a woman's age at first birth; the further back in time the stronger the relation. In addition, delayed age at menarche was also found to be associated with irregularities in the menstrual cycles in later life.

Adult↗
PubMedDate not supplied

Assessment of the process and outcomes of the first 1,000 births of a nurse-midwifery service.

This article is a retrospective descriptive analysis of the first 1,000 births conducted by the Nurse-Midwifery Group of Fresno County, California, over the period from 1980 to 1985. The multiethnic patient population was of mixed obstetric risk. Nurse-midwifery care was offered within the context of a comprehensive maternity care program in close collaboration with a perinatal health care team. Patient care outcomes were quite favorable when compared with county and state statistics. A perinatal mortality rate of 7.0/1,000 was observed. The incidence of low birth weight infants (5.7%) and the cesarean section rate (7.7%) were also lower than county and state statistics. These data add to the growing body of literature that suggests that nurse-midwifery care, within the structure of collaborative practice, can be effective and advantageous. The nurse-midwifery service made a contribution to access to perinatal care for the residents of this community.

Adolescent↗
PubMed1991

The experience of fathers in dual-earner families following the births of their first infants.

This study explores the experience of fathers in dual-earner families following the births of their first infants. The grounded theory method was used to collect, code, compare and contrast data gathered in interviews with 10 men. The fathers indicated that they viewed their return to a dual-earner lifestyle as a process of redefining roles. Redefining roles was influenced by four basic life resources and two sets of value systems and occurred in the context of needs which were either met or unmet. The basic life resources and value systems not only influenced family members' needs, but also the two basic strategies which the men used in redefining their roles. First, the men monitored role strain and, second, they limited role strain. Each of these strategies evolved from the central concept of redefining roles. The consequences of redefining roles included effects on marital intactness, family members' health and family members' satisfaction. Redefining roles has implications for nurses who work with men in dual-earner families. As first-time fathers assume multiple roles and struggle with redefining their roles, nurses can offer anticipative and concurrent guidance.

Adult↗
PubMed1994

Reproductive history and prognosis in patients with operable breast cancer.

BACKGROUND: Late menarche, early menopause, high parity, and early first birth decrease the risk of development of breast cancer. The influence of these factors on the survival of breast cancer patients has not been explained. METHODS: A group of 1885 patients with operable breast cancer was studied retrospectively. A univariate analysis was used to calculate 10-year overall survival (OS) and disease free survival (DFS) in relation to age, menopausal status, age at menarche and menopause, and number of pregnancies and deliveries. A multivariate analysis (Cox model) was performed in which classic prognostic factors (tumor size and grade, lymph node involvement) were included in addition to reproductive factors. RESULTS: Univariate analysis demonstrated better prognosis in patients who had never been pregnant compared with those who had (OS, 62% vs. 54%, respectively; P = 0.01; DFS, 53% vs. 44%, respectively; P = 0.005) and in nulliparous compared with parous patients (OS, 62% vs. 53%, respectively; P = 0.006; DFS, 52% vs. 44%, respectively; P = 0.004). Survival rates decreased with the number of pregnancies and deliveries. Patients with late menarche had worse survival then those whose first menstruation occurred before the age of 16 years (DFS, 47% vs. 41%, respectively; P = 0.04). By multivariate analysis, parity remained an independent prognostic indicator in addition to classic highly significant prognostic factors (nodal involvement, tumor grade and size). CONCLUSIONS: Results suggest that reproductive factors known to decrease the risk of breast cancer development have an adverse effect on prognosis.

Abortion, Spontaneous↗
PubMed2004

The impact of a reduced fertility rate on women's health.

HEALTH ISSUE: Total fertility rates (TFRs) have decreased worldwide. The Canadian fertility rate has gone from 3.90 per woman in 1960 to 1.49 in 2000. However, not many studies have examined the impact on women's health of reduced fertility rates, delayed fertility and more births to unmarried women. This paper presents information on the relation between family size and specific determinants of health. KEY FINDINGS: The rate of TFR decline varies considerably by geographic location and socio-demographic subgroup. Further, the associations between family size and selected determinants of health are different for women and men. For example a woman with one child is almost four times more likely to be "coupled" than a childless woman, and if she has two children she is significantly more likely to be "coupled" than if she had only one child. However, a man with one or more children is over six times more likely to be "coupled" than his childless counterpart, and this does not vary with family size. DATA GAPS AND RECOMMENDATIONS: There is a paucity of data on the impact of reduced fertility rates on women's health in general and on how women's roles affect their decision to have children. While it would be useful to examine longer-term health outcomes by parity and age of first birth, as well as socio-economic and role-related variables these longitudinal and detailed "role related" data are not available. Given the differing profiles of women and men with children, further health policies research is needed to support vulnerable women with children.

Journal Article↗
PubMed1986

An assessment of the effects of maternal age and parity in different components of perinatal mortality.

Perinatal mortality has several components which may have distinct epidemiologic features. In an investigation of the total singleton birth population of New York City in 1976-1978 (n = 320,726), the authors divided perinatal mortality into four components: late fetal deaths that occurred before labor (late antepartum fetal deaths), fetal deaths during labor (intrapartum fetal deaths), neonatal deaths, and perinatal deaths attributed to congenital anomalies, and they assessed the relation of each of these to maternal age and parity, controlling for relevant confounding factors. In analyses which controlled for prior fetal loss, type of service (public vs. private), race, marital status, and mother's educational attainment in a multiple logistic regression model, the authors found that: 1) increasing maternal age was strongly associated with antepartum fetal deaths but not with intrapartum fetal deaths, while older maternal age was also associated with perinatal deaths attributed to congenital anomalies; 2) high parity bore a strong relationship to intrapartum fetal deaths, but none to antepartum fetal deaths, neonatal deaths, or congenital anomaly deaths; and 3) for neonatal death, there was a statistically significant (p less than 0.001) interaction between parity and age such that mothers over 34 years old having their first birth were at especially high risk.

Adult↗
PubMed1995

The ideas and experiences of pregnancy and childbirth of Asian and non-Asian women in east London.

This study examined differences between the ideas and experiences of pregnancy and childbirth of Asian and non-Asian women giving birth in East London, and sources of variability in Asian women's accounts. In line with the findings of previous research, Asian women's ideas about diet in pregnancy, the gender of their children and postnatal care (e.g. the need for rest and recovery, and restrictions on their activities) were influenced by cultural beliefs and practices. However, in other ways Asian women demonstrated a strong commitment to Western maternity care. In contrast to some other studies Asian women wanted their husbands or partners present at delivery, indicating the extent to which traditional ideas are being modified. Qualitative analysis of Asian women's fuller accounts indicated that women subscribed to traditional practice as well as Western maternity care. Acculturation or familiarity with Western ideas about maternity care was associated with variability in Asian women's ideas and experiences, in line with previous research. However, in spite of frequent assumptions about its significance, religion was not associated with variability in Asian women's ideas and experiences. Parity, however, was a major variable, for Asian and for non-Asian women, suggesting that the first birth has different significance for parents than subsequent births. The implications for the provision of maternity care are discussed, especially the need to go beyond stereotypical views based on women's ethnicity or religion to consider the beliefs and preferences of women as individuals and their personal circumstances.

Adolescent↗
PubMed1998

Obstacles to reducing cesarean rates in a low-cesarean setting: the effect of maternal age, height, and weight.

OBJECTIVE: To examine risk factors for elective and nonelective cesarean delivery in a population with a low cesarean rate. METHODS: Nulliparous women delivering singleton births in Sweden during 1992-93 were included (n=92,623). Logistic regression analyses were performed to calculate adjusted odds ratios (ORs) and rates of cesarean delivery. RESULTS: The overall cesarean rate was 11.9%. Risks for cesarean increased consistently with increasing maternal age, decreasing maternal height, and increasing prepregnancy body mass index (BMI). Compared with teenagers, the OR of cesarean was 2.6 among women 30-34 years and 4.4 among women 35 years of age or older. Compared with tall women (greater than 174 cm), the OR of cesarean for women 155-164 cm was 2.0, and 4.5 for short women (less than 155 cm). Compared with lean women (BMI less than 20.0), the ORs of cesarean for overweight (BMI 25.0-29.9) and obese women (BMI of at least 30.0) were 1.8 and 2.4, respectively. Similar risks also were obtained when the analyses were restricted to elective or nonelective cesarean deliveries. The effect of prepregnancy BMI on cesarean rate was influenced by maternal height: among tall women, rates of cesarean increased from 5% among lean women to 11% among obese women, whereas corresponding rates among short women were 19% and 36%, respectively. The influence of mother's education, type of hospital, and other factors was considerably less. CONCLUSION: The increase in maternal age at first birth and the weight among young women present obstacles to the reduction of cesarean rates in developed countries.

Adult↗
PubMed2006

The impact of parity on course of labor in a contemporary population.

BACKGROUND: Few studies have examined in depth the labor progression of multiparas to determine if there is any additional impact of being parous beyond the first birth. The objective of this study was to determine the effect of parity on labor progression in contemporary obstetric practice. METHODS: Our sample consisted of all low-risk women who delivered a term, live-born infant from January 2002 to March 2004 at a single institution in Delaware, United States (n = 5,589). The median duration of labor by each centimeter of cervical dilation was computed for parity = 0 (n = 2,645); parity = 1 (n = 1,839); parity = 2 (n = 750); and parity = 3 + (n = 355). RESULTS: Multiparas had a significantly faster labor progression from 4 to 10 cm (293, 300, and 313 min, respectively, for parity = 1, parity = 2, and parity = 3 +), compared with nulliparas (383 min for parity = 0), as well as a shorter second stage of labor. However, no significant differences were found in duration of the active phase or the second stage of labor among multiparas. CONCLUSIONS: Additional childbearing appears to have no effect of on the progression of labor among multiparous subgroups. The difference in duration of the active phase between nulliparas and multiparas is substantially smaller in a contemporary population.

Adult↗
PubMed1995

Respiratory water loss in relation to gestational age in infants on their first day after birth.

Respiratory water loss, oxygen consumption and carbon dioxide production were measured in 32 infants on their first day after birth. Gestational age was between 27 and 41 weeks. All infants were studied in incubators with 50% ambient relative humidity and an ambient temperature that allowed the infant to maintain a normal and stable body temperature. During the measurements the infants were usually asleep. Respiratory water loss was found to be highest in the most preterm infants and lower in more mature infants. Respiratory water loss per breath (mg/kg) was almost the same at all gestational ages and the higher respiratory water loss found in the most preterm as compared with the more mature infants is thus and increased with increasing gestational age. Thus, in full-term infants respiratory water loss and transepidermal water loss are of approximately equal magnitude at an ambient humidity of 50%, while respiratory water loss constitutes a smaller proportion than transepidermal water loss in very preterm infants. Respiratory water loss increases with the rate of breathing.

Gestational Age↗
PubMed2004

Caloric restriction and incidence of breast cancer.

CONTEXT: Restricting caloric intake is one of the most effective ways to extend lifespan and to reduce spontaneous tumor occurrence in experimental animals, but whether similar associations hold in humans has not been appropriately studied. OBJECTIVE: To determine whether caloric restriction in early life reduces the risk of invasive breast cancer. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using data from the Swedish Inpatient Registry, the Swedish Cancer Registry, the Swedish Death Registry, and the Swedish Fertility Registry. Participants were 7303 Swedish women hospitalized for anorexia nervosa prior to age 40 years between 1965 and 1998. Women were excluded (n = 31) if they were diagnosed with cancer prior to their first discharge from hospitalization for anorexia nervosa. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer. RESULTS: Compared with the Swedish general population, women hospitalized for anorexia nervosa prior to age 40 years had a 53% (95% confidence interval [CI], 3%-81%) lower incidence of breast cancer; nulliparous women with anorexia nervosa had a 23% (95% CI, 79% higher to 75% lower) lower incidence, and parous women with anorexia nervosa had a 76% (95% CI, 13%-97%) lower incidence. CONCLUSIONS: Severe caloric restriction in humans may confer protection from invasive breast cancer. Low caloric intake prior to first birth followed by a subsequent pregnancy appears to be associated with an even more pronounced reduction in risk.

Adult↗
PubMed1996

Lactation and the risk of breast cancer in an Italian population.

The relation between breast feeding and breast cancer was investigated in a multicentric case-control study conducted in Italy on 2,167 parous women with histologically confirmed breast cancer, diagnosed within 1 year, and 2,208 parous control women admitted to hospitals in the same catchment areas of cases for acute, non-neoplastic, non-gynecological non-hormone-related diseases. Compared with women who had never tried to lactate, those who had always failed had a multivariate odds ratio (OR; adjusted for parity, education and several other potential confounding factors) of 0.94, and those who had lactated had an OR of 1.17. The multivariate ORs of women who had breast fed 1, 2 and 3 or more children were, respectively, 1.14, 1.18 and 1.32, compared with women who had never lactated. None of these ORs was statistically significant. Compared with women who had never breast fed, the multivariate ORs were 1.19 for women reporting less than 6 months of breast feeding, 1.15 for 6-11 months, 1.34 for 12-17 months, 1.10 for 18-23 months and 0.86 for 24 months or more. No appreciable difference was evident across strata of age, menopausal status, parity and age at first birth, while there was a hint of interaction with education. Our study therefore excluded any appreciable protective role for lactation in breast cancer risk, with the patterns of lactation in this European population, aside from the protective role of parity on breast carcinogenesis.

Adult↗