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Reproductive history and breast cancer in a population of high fertility, Costa Rica, 1984-85.

The relationship between breast cancer and women's reproductive history in Costa Rica was analyzed using logistic regression methods on data from 171 breast cancer cases and 826 population-based controls aged 25-58 years. The risk of breast cancer in nulliparous women under age 45 was 3 times that for parous women in the same age group. Women over 44 years of age with a parity greater than 4 had a risk of breast cancer of 0.3 compared to women of the same age but with a parity of 1-4. Neither breast-feeding nor birth interval showed an overall association with breast cancer independent of parity. Women with early age at first birth had a lower relative risk of breast cancer than women aged 20-24 at first birth, but only in two subgroups--women aged 45 and over and women with parity 1-4. Women without a completed pregnancy in the last 20 years had an elevated relative risk. However, results are not conclusive because some information is probably distorted by recall errors. Declines in fertility rates in the 1960s and 1970s may result in an increase of 30% in breast cancer incidence in Costa Rica between 1980 and the year 2000, according to the relative risks found in this study. In contrast, the effect of childlessness will probably not produce significant changes in national breast cancer trends.

Adult↗

Modification of BRCA1- and BRCA2-associated breast cancer risk by AIB1 genotype and reproductive history.

Women who have inherited a germ-line mutation in the BRCA1 or BRCA2 (BRCA1/2) genes have a greatly increased risk of developing breast cancer compared with the general population. However, there is also substantial interindividual variability in the occurrence of breast cancer among BRCA1/2 mutation carriers. We hypothesize that genes involved in endocrine signaling may modify the BRCA1/2-associated age-specific breast cancer penetrance. We studied the effect of alleles at the AIB1 gene using a matched case-control sample of 448 women with germ-line BRCA1/2 mutations. We found that these women were at significantly higher breast cancer risk if they carried alleles with at least 28 or 29 polyglutamine repeats at AIB1, compared with women who carried alleles with fewer polyglutamine repeats [odds ratio (OR), 1.59; 95% confidence interval (CI), 1.03-2.47 and OR, 2.85; 95% CI, 1.64-4.96, respectively]. Late age at first live birth and nulliparity have been associated with increased breast cancer risk. We observed increases in BRCA1/2-associated breast cancer risk in women who were either nulliparous or had their first live birth after age 30 (OR, 3.06; 95% CI, 1.52-6.16). Women were at significantly increased risk if they were nulliparous or had a late age at first live birth and had AIB1 alleles no shorter than 28 or 29 or more AIB1 polyglutamine repeats (OR, 4.62; 95% CI, 2.02-10.56 and OR, 6.97; 95% CI, 1.71-28.43, respectively) than women with none of these risk factors. Our results support the hypothesis that pathways involving endocrine signaling, as measured through AIB1 genotype and reproductive history, may have a substantial effect on BRCA1/2-associated breast cancer risk.

Adult↗

Superiority of reproductive histories to sperm counts in detecting infertility at a dibromochloropropane manufacturing plant.

Sperm count distributions among exposed and control groups at a dibromochloropropane (DBCP) manufacturing plant were remarkably similar. Yet reproductive histories from 60 exposed men obtained in conjunction with the semen analyses indicated that fertility had been reduced during exposure. Ratios of observed to expected births or standardized fertility ratios (SFRs) were computed for reproductive experience at parities of 1 or greater. The SFR for the period at risk from DBCP exposure (SFR = 0.63) was significantly lower than those derived from the entire not-at-risk period (SFR = 1.21) or the portion related to nonexposed employment at the plant preceding exposure (SFR = 1.33). Significant reductions would have been evident at least 18 years prior to the year in which the histories were obtained. The effect on fertility seems to have been greatest during the initial period of DBCP production. Most fertility reduction occurred after 3.5 years of exposure. Fertility returned to normal following cessation of exposure (SFR = 1.18), although it appeared to remain subnormal for about two years. Wherever there is concern about the potential for adverse reproductive effects in the workplace, data suitable for fertility analyses should be collected during annual medical examinations.

Adolescent↗

Reproductive history and involvement in pregnancy and childbirth of fathers of babies born to teenage mothers in Stockholm, Sweden.

OBJECTIVE: to describe and compare sexual and reproductive history as well as reactions to the pregnancy and attendance in antenatal care, family classes and childbirth of fathers of babies born to teenage mothers and fathers of babies born to average aged mothers. DESIGN: a descriptive comparative study using a structured questionnaire for data collection. SETTING: eleven postnatal wards at the five obstetric and gynaecological departments in the Stockholm area. PARTICIPANTS: 132 fathers of babies born to primiparous teenage mothers (Group A) and the same number of fathers of babies born to primiparous women aged between 25-29 years (Group B) who were present in the postnatal wards. FINDINGS: 43 of Group A compared to 17% of the Group B fathers had their first intercourse before 15 years of age. This early sexual debut was related to other health hazard, such as use of illicit drugs and cigarette smoking. The majority of the pregnancies in Group A were unplanned but most fathers reacted positively to the pregnancy and participated in the antenatal care. In contrast, only half of these fathers attended family classes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: fathers of babies born to teenage mothers differed from fathers of babies to older mothers regarding reproductive background as well as involvement during pregnancy. The findings of this study challenge midwives to organise clinical practice in order to meet the specific needs of this group.

Adolescent↗

Maternal smoking and low birthweight in the reproductive history of women in Puerto Rico, 1982.

In 1982, a representative sample of 3,175 women ages 15 to 49 years living in Puerto Rico were interviewed and complete reproductive histories obtained. Births to mothers who started smoking regularly at some time before delivery and who were still smoking at the time of the interview (the exposure definition) were compared with unexposed births. Our analysis of 4,444 single, live births delivered in public and private hospitals from 1946 through 1982 demonstrates that births to smoking women aged 20 and older delivering in public hospitals were 2.5 times more likely to weigh less than 2,500 grams (95% confidence interval (CI) = 1.9, 2.3), and on the average weighed 207 grams less (95% CI = 130, 284) than births to a comparable group of nonsmoking mothers. However, we found no other difference in birthweight between newborns of smoking and nonsmoking women when comparing their births within the same hospital category and age group. The data in this study suggest that the effect of smoking on birthweight among births to Puerto Rican women may be modified by maternal age and by whether the infant was born in a private or public hospital.

Adolescent↗

Reproductive history, socioeconomic status, and self-reported health status of women aged 50 years or older.

OBJECTIVES: This paper describes the relationship between self-reported general health status and several facets of reproductive history. METHODS: We analyzed survey data on a national probability sample of 1341 women aged 50 and older from the Panel Study of Income Dynamics. We used multivariate regression techniques to control for differences in health indices that assessed health status and functioning. RESULTS: Women with a history of six or more completed pregnancies were found to be disadvantaged in educational attainment, financial resources, and health status compared with women with no or fewer pregnancies. When current sociodemographic factors were controlled, six or more pregnancies were associated with worse general health and worse physical role functioning. When sociodemographic factors and number of births were controlled, among women with at least one delivery, women who had experienced an infant's death reported worse health as measured by all three indices. Women with a first delivery before the age of 18 were more likely to report a functional limitation. CONCLUSIONS: Women with high parity status, a history of an infant's death, and an early first pregnancy may be at greater risk of poor health in later life.

Activities of Daily Living↗

Age at menopause in relation to reproductive history in Japanese, Caucasian, Chinese and Hawaiian women living in Hawaii.

A multiple regression analysis was undertaken to examine the relationship between age at menopause and selected biological and sociological variables in the reproductive history of Caucasian, Japanese, Chinese and part-Hawaiian post-menopausal women living in Hawaii. The analysis was conducted using the medical history records of 196 Caucasian, 181 Japanese, 72 Chinese and 60 Hawaiian women. Age at menarche, parity and months spent breast-feeding were found to have no significant effect on age at menopause. Regression models were not found to be heterogeneous among ethnic groups and no substantial interaction of ethnic group was found with age at menarche, parity or months spent breast-feeding.

Asian People↗

Marital and reproductive histories of women with cancer of the breast and their sisters.

In a study of 45 pairs of sisters-each pair including one sister with cancer of the breast and one without the disease-differences in marital and reproductive histories were observed. These differences included less frequent marriage, later marriage, fewer children, and a longer delay between date of marriage and the first pregnancy in the sisters with the disease. These findings appear to confirm presently known reproductive risk factors for cancer of the breast, but they also raise the possibility that unknown behavioral factors influencing the endocrine system may be delaying marriage and pregnancy.

Adult↗

In vitro replication potential of serially passaged mammary parenchyma from mice with different reproductive histories.

Growth properties of multicellular units (organoids) of mouse mammary parenchyma have been analyzed. These intact units grew differently in collagen-matrix cultures than did dispersed cells prepared from them. The latter actively migrated in the collagen matrix and reorganized themselves into multicellular structures before producing three-dimensional protuberances in gel. Terminal unit (end-bud/alveoli)-enriched fractions grew more extensively than did ducts, as predicted from growth patterns in vivo. To assess the growth potential and the relationships between replication history in vivo and replication potential in vitro in mammary parenchyma, intact terminal units from mammary glands of mice of different ages and with different reproductive histories were isolated and their growth characteristics compared. Terminal-unit organoids were cultured in collagen gel matrix and passaged weekly for up to 5 weeks. Morphology, growth rates, and growth fractions were compared among organoids from young virgin, old virgin, monoparous, and multiparous mice. Morphologies observed in various passages of organoids from the groups of mice were similar. Organoids from old virgin and multiparous mice declined in growth rate for four passages and then growth rate increased again during the fifth passage. (However, fifth-passage organoids failed to form tumors if implanted in syngeneic mice in vivo.) Growth of organoids from either old or young virgin mice was less at any given passage than tissue from multiparous mice of similar age. Growth fractions of organoids from old parous mice were the same as those from old virgin mice but reached the same maximum fraction faster. Later passage organoids from the different mouse groups responded morphologically to the hormone combination of estrogen, progesterone, prolactin, and cortisone but not respond to cholera toxin. These results suggest that an animal's hormonal history (altered profoundly by pregnancy and lactation) may be as important as chronological age in determining subsequent growth potentials of mammary epithelium.

Aging↗

Reproductive history and gastric cancer among post-menopausal women.

A total of 339 post-menopausal women with gastric cancer (GC) and 515 population controls were interviewed in a multicenter study in Italy for information on reproductive history, dietary habits and other socio-demographic variables. After adjusting for these factors, GC risk was significantly higher among women reporting menopause below age 45, while no effect was shown for age at menarche, parity, age at first livebirth, and number of abortions. When age at menopause was considered together with age at menarche for an index of fertility years, GC risk showed a significant inverse relation to duration of fertility. These results suggest a protective role for endocrine or other factors related to late age at menopause or to length of fertility. These findings may be relevant to explain the fact that rates of GC reported among females are lower than among males around the world, and suggest the need for further research into hormonal and other related risk factors.

Age Distribution↗

Maternal reproductive history and birth characteristics in childhood acute lymphoblastic leukemia.

Using birth-registration data, a case-control study was done to investigate the possible associations of childhood acute lymphoblastic leukemia (ALL) with birth characteristics and maternal reproductive history. The data included cases born and diagnosed in Minnesota since 1969. Matched analyses were conducted using 337 cases and 1336 birth year-matched controls. There was a statistically significant increased odds of ALL for birth to older (greater than 35 years) mothers (odds ratio (OR) = 2.14, 95% confidence interval (CI) = 1.28, 3.58), older fathers (OR = 1.62, 95% CI = 1.14, 2.30), mothers with at least a high school education (OR = 1.61, 95% CI = 1.05, 2.48), and larger intervals (greater than 5 years) between the birth of the proband and the preceding sibling (OR = 1.86, 95% CI = 1.12, 3.09). The increased odds of ALL for birth by Caesarean section approached significance (OR = 1.42, P = 0.06). No overall association was found for: gender, race, paternal education, fetal-loss history, birth order, prenatal care history, pregnancy complications, inducement of labor, multiple birth, gestational age, or birth weight. Age at diagnosis was an important effect modifier of some analyses. For cases diagnosed before age 2 years, there was a 2.7-fold increased odds of ALL if the last pregnancy had resulted in a fetal loss (P = 0.03). For cases diagnosed before age 4 years, birth weight greater than 3800 g was associated with a significant 2.05-fold increased odds of ALL. These data strengthen the hypothesis that prenatal events may play a causative role in childhood ALL, particularly in those cases diagnosed at a younger age.

Abortion, Spontaneous↗

[Reproductive histories of coastal and inland women with and without exposure to methylmercury in Kumamoto].

To examine the difference in abnormal conception by region and generation and its possible causes in the town of Tsunagi, which experienced intensive methylmercury-pollution during the 1950s and 1960s, reproductive histories of 109 women in 3 coastal villages and 64 controls in 5 inland villages were obtained by visit- and interview-study in 1991. There were about 290 married women in respective regions. The subjects were divided into 4 age groups to form 10-year-birth cohorts from 1915 to 1954. The rate of sterility and those who had never become pregnant after marriage, did not differ between coastal (7.3%) and inland women (6.3%). The younger the birth cohort, the smaller the total number of conceptions. The rate of abnormal conception, i.e., abnormal conception (abortion+stillbirth) per normal conceptions (total number of conceptions--number of artificial abortions), in the coastal women tended to increase after the 1960s with its peak (19%) in 1965-70. The rate in the inland women was already as high as 15% in 1945-50, and was constantly above 10% afterwards. However, it did not differ between the two groups during 1950-1970, when severe methylmercury-pollution occurred in the area. Breakdown of the abnormal conceptions in the inland women showed 4 stillbirths and 19 abortions, among the latter of which 16 were related to climbing up and down the hills to fetch water, hard agricultural work and agitation. The abnormal conceptions in the coastal women showed 3 stillbirths and 19 abortions. Sixteen of the latter were not related to any specific physical causes.

Aged↗

Reproductive history and semen analysis in prevasectomy fertile men with and without varicocele.

A group of 598 allegedly fertile men requesting vasectomy were investigated; varicocele was found in 97 (16.2%) of these men. The mean ages and age distributions of men with and without varicocele were not significantly different. Reproductive histories (number of pregnancies, living children and spontaneous abortions, as well as incidence of present pregnancy) were similar in both groups. The average seminal characteristics (semen volume, sperm count, total sperm count, percentage of motile spermatozoa, quality of motility, morphology) were not different for men with and without varicocele, except for a slight, but significantly higher incidence of oval-headed sperm in men without varicocele. However, the incidence of varicocele was significantly higher in men with sperm counts below 40 million/ml. Three important observations may be made from this study: 1) the incidence of varicocele in this prevasectomy population was similar to that reported for the general population, but lower than the incidence reported for male partners of infertile couples; 2) in this population of allegedly fertile men, the presence of a varicocele did not significantly affect reproductive performance; 3) even though the incidence of varicocele was higher in men with sperm counts below 40 million/ml, the average seminal characteristics were not different in men with and without varicocele.

Adult↗

Effects of different artificial insemination techniques and sperm doses on fertility of normal mares and mares with abnormal reproductive history.

The effects of different artificial insemination (AI) techniques and sperm doses on pregnancy rates of normal Hanoverian breed mares and mares with a history of barrenness or pregnancy failure using fresh or frozen-thawed sperm were investigated. The material included 187 normal mares (148 foaling and 39 young maiden mares) and 85 problem mares with abnormal reproductive history. Mares were randomly allotted into groups with respect to AI technique (routine AI into the uterine body, transrectally controlled deep intracornual AI ipsilateral to the preovulatory follicle, or hysteroscopic AI onto the uterotubal junction ipsilateral to the preovulatory follicle), storage method of semen (fresh, frozen-thawed), AI volume (0.5, 2, 12 ml), and sperm dose (50 x 10(6) or 300 x 10(6) progressively motile sperm (pms) for fresh semen and 100 or 800 x 10(6) frozen-thawed sperm with >35% post-thaw motility). The mares were inseminated once per cycle, 24 h after hCG administration when fresh semen was used, or 30 h for frozen-thawed semen. Differences in pregnancy rates between treatment groups were analyzed by Chi-squared test, and for most relevant factors (insemination technique, mare, semen, and stallion) expectation values and confidence intervals were calculated using multivariate logistic models. Neither insemination technique, volume, sperm dose, nor mare or stallion had significant effects (P > 0.05) on fertility. Type of semen, breeding mares during foal heat, and an interaction between insemination technique, semen parameters, and mares did have significant effects (P < 0.05). In problem mares, frozen semen AI yielded significantly lower pregnancy rates than fresh semen AI (16/43, 37.2% versus 25/42, 59.5%), but this was not the case in normal mares. In normal mares, hysteroscopic AI with fresh semen gave significantly (P < 0.05) better pregnancy rates than uterine body AI (27/38, 71% versus 18/38, 47.3%), whereas in problem mares this resulted in significantly lower pregnancy rates than uterine body AI (5/15, 33.3% versus 16/19, 84.2%). Our results demonstrate that for problem mares, conventional insemination into the uterine body appears to be superior to hysteroscopic insemination and in normal mares, the highest pregnancy rates can be expected by hysteroscopic insemination.

Animals↗

Rat embryo culture to detect nutritional deficiency in women with poor reproductive histories.

The cause of habitual early pregnancy loss is not known for most affected couples. It has been proposed that a deficiency of amino acids or other nutrients may contribute to early embryo loss, and an assay based on culture of rat embryos in human serum has been proposed to evaluate women with poor reproductive histories. We tested this assay in women with unexplained infertility (n = 27), habitual abortion (n = 15), and normal midtrimester pregnancies (n = 10) by examining the ability of subject's serum to support the normal development of rat embryos in culture with and without supplemental vitamins and amino acids. Nonpregnant women with nutrient deficiencies identified in this manner were given oral supplements or placebo and were retested. A similar proportion of women in each group had serum that was unable to support the normal development of rat embryos without supplemental vitamins and amino acids. When oral supplements were used, most sera were able to support normal embryo growth. There were no seroconversions on placebo. In spite of the apparent success in producing seroconversions on oral supplementation, only two women conceived, one on the placebo treatment and one on nutritional supplements. Because serum nutrient deficiencies identified by rat embryo culture could not distinguish normal pregnant women from women with unexplained infertility or habitual abortion, and because of the low pregnancy rates, we could not confirm the utility of this assay for the general population of women with habitual abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Habitual↗

Influence of reproductive history on age at diagnosis of breast cancer and prognosis.

The effect on age at breast cancer diagnosis of age at menarche, age at first baby, parity and age at menopause has been determined for 739 unselected patients diagnosed between 1975 and 1980 as having operable breast cancer. Age at diagnosis was significantly and positively associated with ages at menarche, first baby and menopause. The average number of children significantly declined with increasing age at diagnosis. This was largely due to a change in the proportion of patients who were nulliparous (15% in women aged 41-50 years compared to about 30% in those over 60 years). A group of 1,989 normal women whose reproductive history was also collected between 1975 and 1980 showed similar trends between age and age at menarche, age at first baby and parity as the patients. Thus it appears that these reproductive parameters do not alter the time of onset of breast cancer but could be explained by temporal changes in reproductive patterns. There was no significant correlation between age at menopause and age at diagnosis for patients whose age at menopause was no more than 54 years and age at diagnosis no less than 55 years, respectively. It is therefore unlikely that age at menopause affects age at diagnosis. Postmenopausal patients with 3 or more children had a significantly shorter disease-free interval and lower survival rate than those with less children. None of the other parameters was associated with prognosis.

Adult↗

The association of reproductive history, demographic factors, and alcohol and tobacco consumption with the risk of developing nausea and vomiting in early pregnancy.

The role of maternal risk factors in the development of nausea and vomiting in pregnancy was studied in a historical cohort of 825 women who gave birth at the University of California (Los Angeles) Medical Center during a one-year period (April 1983-March 1984). The roles of demographic factors, reproductive history, and consumption of alcohol and tobacco in affecting the risk of developing nausea and vomiting were studied using both bivariate and multivariate statistical methods. Interpretations of the statistical analyses identify three risk factor associations correlated with decreased risk of nausea and vomiting and one factor associated with increased risk. The most apparent pattern was that women who were ethnically white, of white collar or professional occupation, and who consumed alcohol prior to conception, were at decreased risk for nausea and vomiting. The second pattern of decreased risk consisted of women over 35 years old with a history of infertility for one or more years prior to the current conception. The third low-risk pattern consisted of women without a history of nausea during prior pregnancies. The only factor associated with an increased risk was housewife occupational status. The results of this study are consistent with an endocrinologic model for the etiology of pregnancy-induced nausea and vomiting.

Adolescent↗

Relation of contraceptive and reproductive history to ovarian cancer risk in carriers and noncarriers of BRCA1 gene mutations.

In the general population, ovarian cancer risk is inversely associated with oral contraceptive use, tubal ligation, and childbearing. Among carriers of BRCA1 gene mutations, the data are conflicting. The authors identified women diagnosed with incident invasive epithelial ovarian cancer in the San Francisco Bay Area of California from March 1997 through July 2001. They compared the contraceptive and reproductive histories of 36 carrier cases and 381 noncarrier cases with those of 568 controls identified by random digit dialing who were frequency matched to cases on age and race/ethnicity. In both carriers and noncarriers, reduced risk was associated with ever use of oral contraceptives (odds ratio = 0.54 (95% confidence interval (CI): 0.26, 1.13) for carriers and 0.55 (95% CI: 0.41, 0.73) for noncarriers), duration of oral contraceptive use (risk reduction per year = 13% (p = 0.01) for carriers and 6% (p < 0.001) for noncarriers), history of tubal ligation (odds ratio = 0.68 (95% CI: 0.25, 1.90) for carriers and 0.65 (95% CI: 0.45, 0.95) for noncarriers), and increasing parity (risk reduction per childbirth = 16% (p = 0.26) for carriers and 24% (p < 0.001) for noncarriers). These data suggest that BRCA1 mutation carriers and noncarriers have similar risk reductions associated with oral contraceptive use, tubal ligation, and parity.

Adult↗