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The meaning of postponed motherhood for women in the United States and Sweden: aspects of feminism and radical timing strategies.

This exploratory study considered certain psychosocial, medical, and cultural aspects of the phenomenon of postponed motherhood for one cohort of white women born between 1947 and 1953 in Sweden and the United States. A cross-cultural comparison was made of the experience of pregnancy and the early perinatal period in 15 American and 16 Swedish women to find out (a) whether timing decisions reflected the influence of feminist ideology toward a reproductive strategy radically different from the conventional one, and (b) whether the pattern of delayed motherhood was culture specific. Results indicated that the patterns of delayed motherhood were culture specific. Feminist ideology clearly influenced the timing of the American women's first birth but was evident in Sweden. Women in the U.S. exhibited more nonconventional behaviors and attitudes, whereas Swedish women were more conventional. However, the husbands in both groups were remarkably similar in infant caretaking behaviors, regardless of culture and level of education attainment. These findings indicate postponed motherhood has different meanings in the cultural context of these two Western industrialized societies.

Adult↗

Female university students' attitudes to future motherhood and their understanding about fertility.

OBJECTIVES: As highly educated women tend to postpone childbearing, the purpose was to explore female university students' attitudes to future motherhood and their understanding about fertility. METHODS: Female students (n = 300), visiting a Student Health Centre in Sweden, answered a questionnaire with mainly multiple choice questions and verbal rating scales. RESULTS: The women wanted to have two to three children at the age of 29 for the first birth and 35 for the last. Only 2.7% did not plan to have any children. Six out of 10 would consider having an abortion if confronted with an unplanned pregnancy 'right now'. The most important circumstances for women's decision to have children were to be sufficiently mature, have a stable partner to share parenthood with, have completed studies and have a good economy. Having children before they got 'too old' was only ranked as very important by 18% of women. The women had an acceptable understanding about fertility. CONCLUSIONS: It appears that female university students are not very concerned about having children before they get 'too old'. Therefore, it is important that caregivers, working with contraceptive counselling also include information about fertility, especially to women who intend to postpone their motherhood.

Attitude↗

Postnatal depressive symptoms among Pacific mothers in Auckland: prevalence and risk factors.

OBJECTIVE: To assess the prevalence of and risk factors for postnatal depressive symptoms in a cohort of mothers of Pacific Island infants in Auckland, New Zealand. METHOD: The data were gathered as part of the Pacific Island Families Study, in which 1376 mothers were interviewed when their babies were 6 weeks old. The interview included the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 16.4% of mothers were assessed as probably experiencing depression. Prevalence rates varied from 7.6% for Samoans to 30.9% for Tongans. In addition to ethnicity, risk factors identified by stepwise multiple logistic regression included low Pacific Island acculturation, first birth, stress due to insufficient food, household income less than dollar 40,000, difficulty with transport, dissatisfaction with pregnancy, birth experience, baby's sleep patterns, partner relationship and home. A large prevalence difference between Tongans and other groups remained when the effects of other risk factors were controlled statistically. CONCLUSIONS: The prevalence of depressive symptoms among Pacific mothers is at the upper end of the range typically reported. Focus on the overall rate, however, obscures substantial variation between groups. Risk factors are generally similar to those identified in previous research. IMPLICATIONS: The findings have implications for prevention and treatment and caution against assuming homogeneity within ethnic categories. Further research is required to explain differences in prevalence between Tongan and other Pacific Island groups.

Adult↗

Intervention with a low-fat, high-carbohydrate diet does not influence the timing of menopause.

BACKGROUND: Later age at menopause is associated with a greater risk of breast cancer. Dietary factors may at least partially influence breast cancer risk through an effect on the age at menopause. OBJECTIVE: We studied the effect of a low-fat, high-carbohydrate (LFHC) dietary intervention on the timing of menopause in women with greater risk of breast cancer. DESIGN: The study population included participants from an LFHC dietary intervention trial for the prevention of breast cancer in women with extensive mammographic density, a strong risk factor for breast cancer. Women who were premenopausal at baseline (n = 2611) were followed for an average of 7 y for menopause. Survival analysis was used to compare the time to menopause between the LFHC and control groups and to assess other factors associated with age at menopause. RESULTS: The LFHC intervention did not affect the time to natural menopause overall (P = 0.72 for log-rank test comparing study groups; n = 699 events). An observed interaction between study group and baseline body mass index (BMI; P = 0.01) indicated that the intervention group experienced earlier menopause than did the control group when BMI was low and that a higher BMI was associated with later menopause in the intervention group only. Greater parity, weight, and education were associated with later menopause, and greater age at first birth and baseline smoking were associated with earlier menopause. CONCLUSIONS: Overall, the LFHC dietary intervention did not influence the timing of menopause. Factors associated with age at menopause in this population were consistent with those reported in other populations.

Body Mass Index↗

Risk factors for invasive epithelial ovarian cancer: results from a Swedish case-control study.

This case-control study evaluated reproductive and other factors in relation to epithelial ovarian cancer (EOC) risk. Between 1993 and 1995, the authors recruited 655 EOC cases and 3,899 population controls aged 50-74 years who were born in and residents of Sweden. Data were collected through mailed questionnaires. Odds ratios were estimated by unconditional logistic regression. Parity reduced EOC risk (odds ratio = 0.61, 95% confidence interval (CI): 0.46, 0.81) for uniparous compared with nulliparous women. The risk of EOC decreased with incomplete pregnancies, early menopausal age, late age at first birth, and unilateral oophorectomy; increased with family history of ovarian cancer; and was not associated with menarcheal age, lactation, irregular menses, and menopausal symptoms. Histology-specific odds ratios of EOC for ever compared with never users of oral contraceptives were: serous, 0.56 (95% CI: 0.42, 0.74); mucinous, 1.96 (95% CI: 1.04, 3.68); endometrioid, 0.71 (95% CI: 0.49, 1.03); clear cell, 0.66 (95% CI: 0.31, 1.43); and all EOCs, 0.73 (95% CI: 0.59, 0.90). Prolonged oral contraceptive use reduced EOC risk, with persistent protection up to 25 years after the last use. Ever use of hormone replacement therapy increased EOC risk (odds ratio = 1.41, 95% CI: 1.15, 1.72). Among etiologic hypotheses, the retrograde transportation hypothesis accommodates most epidemiologic findings concerning EOC risk.

Age Factors↗

Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study.

The authors assessed the risk of uterine leiomyomata in relation to reproductive factors and hormonal contraception in a prospective cohort study of US Black women. From March 1997 through March 2001, the authors followed 22,895 premenopausal women with intact uteri and no prior self-reported diagnosis of uterine leiomyomata. The authors used age- and time-stratified Cox regression models to estimate incidence rate ratios for self-reported uterine leiomyomata, confirmed by ultrasound or hysterectomy, in association with selected reproductive and hormonal factors. During 76,711 person-years of follow-up, 2,279 new cases of ultrasound- or hysterectomy-confirmed uterine leiomyomata were self-reported. After adjustment for age, body mass index, smoking, alcohol intake, and other reproductive covariates, the risk of ultrasound- or hysterectomy-confirmed leiomyomata was inversely associated with age at menarche, parity, and age at first birth and positively associated with years since last birth. Overweight or obesity appeared to attenuate the inverse association between parity and uterine leiomyomata. Current use of progestin-only injectables was inversely associated with risk. No consistent patterns were observed for other forms of hormonal contraception. Reproductive history is an important determinant of leiomyomata risk in premenopausal US Black women. Progestin-only injectables may reduce risk.

Adult↗

Differential distribution of allelic variants in cytokine genes among African Americans and White Americans.

Racial disparities in health are largely unexplained. Because many diseases causing premature mortality among African Americans are mediated by the immune system, the authors explored the race-specific distribution of allelic variants in cytokine genes known to stimulate inflammation. The authors studied women seeking prenatal care and delivering singletons in uncomplicated first births at a US hospital in 1997-2001. A total of 179 African-American women and 396 White women were evaluated for functionally relevant allelic variants in cytokine genes. African-American women were significantly more likely to carry allelic variants known to up-regulate proinflammatory cytokines; odds ratios increased with allele dose. Odds ratios for African Americans versus Whites in genotypes up-regulating proinflammatory interleukin (IL) 1 (IL1A-4845G/G, IL1A-889T/T, IL1B-3957C/C, and IL1B-511A/A) ranged from 2.1 to 4.9. The proinflammatory cytokine interleukin-6 IL6-174 G/G genotype was 36.5 times (95% confidence interval (CI): 8.8, 151.9) more common among African Americans. Genotypes known to down-regulate the antiinflammatory interleukin-10 (IL10-819 T/T and IL10-1082 A/A) were elevated 3.5-fold (95% CI: 1.8, 6.6) and 2.8-fold (95% CI: 1.6, 4.9) in African Americans. Cytokine genotypes found to be more common in African-American women were consistently those that up-regulate inflammation.

Adult↗

Hormonal and reproductive factors and the risk of bladder cancer in women.

Gender and cigarette smoking are among the most consistent predictors of bladder cancer risk. After adjustment for known risk factors, an excess risk remains for males, suggesting that other factors may be responsible for the gender differences. Given limited data on hormonal or reproductive factors and bladder cancer risk, the authors examined these factors among women in the US Nurses' Health Study cohort. During 26 years of follow-up (1976-2002), 336 incident cases of bladder cancer were diagnosed. Cox proportional hazards models were used to estimate incidence rate ratios and 95% confidence intervals between hormonal and reproductive factors and bladder cancer risk. Postmenopausal women, compared with premenopausal women, were at increased risk (incidence rate ratio = 1.93, 95% confidence interval: 0.99, 3.78). For postmenopausal women, early age at menopause (</=45 years) compared with late age at menopause (>/=50 years) was associated with a statistically significant increased risk of bladder cancer (incidence rate ratio = 1.63, 95% confidence interval: 1.20, 2.23). The association between age at menopause and bladder cancer risk was modified by cigarette smoking status (p for interaction = 0.01). The authors observed no significant associations of age at menarche, parity, age at first birth, and exogenous hormone use with bladder cancer risk. Findings suggest that menopausal status and age at menopause may play a role in modifying bladder cancer risk among women.

Adult↗

Oral contraceptives, reproductive factors, and risk of colorectal cancer among women in a prospective cohort study.

Previous findings on the associations between oral contraceptive (OC) use and reproductive factors and risk of colorectal cancer have been inconclusive. The authors evaluated associations of OC use and reproductive factors (including parity, age at first birth, age at menarche, and age at menopause) with risk of colorectal cancer among women in a large-scale prospective cohort study. The analysis included 39,680 participants in the Women's Health Study who had usable information on ever use of OCs and potential risk factors for colorectal cancer. Relative risks and 95% confidence intervals were estimated from Cox proportional hazards regression models. All p values were two-sided. During an average of 11 years of follow-up (1992-2004), 267 incident cases of colorectal cancer were documented. Ever use of OCs was associated with a lower risk of colorectal cancer (relative risk = 0.67, 95% confidence interval: 0.50, 0.89). Women who had used OCs for 6 months-<3 years had a relative risk of 0.61 (95% confidence interval: 0.40, 0.94) relative to never users, with little additional decreased risk being seen with longer duration of use (p for multivariate trend = 0.09). No significant association was observed between reproductive factors and colorectal cancer risk. These findings provide some support for a potential role of OCs in reducing risk of colorectal cancer.

Age Factors↗

DNA damage and breast cancer risk.

To evaluate whether deficient DNA repair contributes to elevated DNA damage and breast carcinogenesis, we used the comet assay (single-cell alkaline gel electrophoresis) to measure the levels of DNA damage in peripheral lymphocytes from 70 breast cancer cases and 70 controls. DNA damage, measured as the comet tail moment, was not influenced by age, family history (FH), age at menarche, age at first birth or parity. The results showed that cancer cases had significantly higher DNA damage compared with controls; the comet tail moments (mean +/- SD) for cases and controls were: 10.78 +/- 3.63 and 6.86 +/- 2.76 (P < 0.001) for DNA damage at baseline (DB), 21.24 +/- 4.88 and 14.97 +/- 4.18 (P < 0.001) for DNA damage after exposure to 6 Gy of ionizing radiation (DIR), and 14.76 +/- 5.35 and 9.75 +/- 3.35 (P < 0.001) for DNA damage remaining after 10 min repair following exposure to 6 Gy of IR (DRP), respectively. Body mass index (BMI) affected DNA damage differently for cases and controls. Damage decreased with increasing BMI for controls, while damage increased with increasing BMI for cases. Above-median DNA damage was significantly associated with breast cancer risk; the age-adjusted odds ratio (OR) = 13.44 [95% confidence interval (CI) = 5.97-30.24] for DB, 13.65 (6.07-30.71) for DIR and 6.54 (3.11-13.79) for DRP, respectively. This association was stronger in women with above-median BMI. Our results, although based on a relatively small group of subjects, indicate that elevated DNA damage is significantly associated with breast cancer risk and warrant larger studies to further define the molecular mechanisms of DNA damage/repair in breast cancer susceptibility.

Age Distribution↗

Regional differences in the prevalence of pre-eclampsia in relation to the risk factors for coronary artery disease in women in Finland.

AIMS: The aim of this study was to examine the prevalence of pre-eclampsia in Southern, Eastern, and Northern Finland, and the relationship between history of pre-eclampsia and maternal coronary artery disease (CAD) risk factors. METHODS AND RESULTS: Women aged 25-64 years, who participated in a cross-sectional population survey and had been pregnant (n=3650), were studied. The proportion of women who had ever had pre-eclampsia was lower in Southern (7.9%) compared with Northern Finland (13.9%) (P=0.001), but did not differ from Eastern Finland (11.1%). In the logistic regression model, the age-adjusted prevalence of pre-eclampsia was 1.92-fold in Northern (95% CI: 1.46-2.53, P<0.001) and 1.47-fold in Eastern Finland (95% CI: 1.11-1.96, P=0.008) compared with Southern Finland. The odds ratios (ORs) were 1.70 (95% CI: 1.21-2.38, P=0.002) and 1.16 (95% CI: 0.82-1.64, P=0.40), respectively, when adjusted for age at first birth, current age, parity, body mass index (BMI), increased blood cholesterol, hypertension, diabetes/impaired glucose tolerance, CAD, and mother's myocardial infarction. History of pre-eclampsia was associated with increased blood cholesterol, higher current BMI and blood pressure, and higher current prevalence of hypertension, diabetes/impaired glucose tolerance. CONCLUSIONS: Pre-eclampsia is most prevalent in the Northern part of Finland and could only be partly explained by higher prevalence of CAD risk factors.

Adult↗

Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of ovarian hyperstimulation syndrome: preliminary report: short communication.

A new treatment option for patients undergoing ovarian stimulation is the gonadotrophin-releasing hormone (GnRH) antagonist protocol, with the possibility to trigger a mid-cycle LH surge using a single bolus of GnRH agonist, reducing the risk of developing ovarian hyperstimulation syndrome (OHSS) in high responders and the chance of cycle cancellation. This report describes the use of 0.2 mg triptorelin (Decapeptyl) to trigger ovulation in eight patients who underwent controlled ovarian hyperstimulation with recombinant FSH (rFSH, Puregon) and concomitant treatment with the GnRH antagonist ganirelix (Orgalutran) for the prevention of premature LH surges. All patients were considered to have an increased risk for developing OHSS (at least 20 follicles > or =11 mm and/or serum oestradiol at least 3000 pg/ml). On the day of triggering the LH surge, the mean number of follicles > or =11 mm was 25.1 +/- 4.5 and the median serum oestradiol concentration was 3675 (range 2980-7670) pg/ml. After GnRH agonist injection, endogenous serum LH and FSH surges were observed with median peak values of 219 and 19 IU/l respectively, measured 4 h after injection. The mean number of oocytes obtained was 23.4 +/- 15.4, of which 83% were mature (metaphase II). None of the patients developed any signs or symptoms of OHSS. So far, four clinical pregnancies have been achieved from the embryos obtained during these cycles, including the first birth following this approach. It is concluded that GnRH agonist effectively triggers an endogenous LH surge for final oocyte maturation after ganirelix treatment in stimulated cycles. Our preliminary results suggest that this regimen may prove effective in triggering ovulation and could be said to prevent OHSS in high responders. The efficacy and safety of such new treatment regimen needs to be established in comparative randomized studies.

Adult↗

Perinatal outcome and developmental studies on children born after IVF.

Since the first birth after IVF, many scientific papers have been published on the technical aspects of the IVF procedure, but few studies have addressed the issue of the perinatal outcome of IVF pregnancies and of the children's development and well-being. A high rate of adverse outcome has been demonstrated in a large group of IVF pregnancies. Prematurity, low birth weight and perinatal mortality are higher than in the general population. The majority of these complications are related to multiple births, but they are also found in singleton pregnancies. An analysis of the multiple risk factors involved in these complications is needed. The infertile status of IVF patients clearly plays a role in the risk of adverse outcome. Age and parity may be important factors. The role of IVF itself has not been demonstrated convincingly. The effect of ovarian stimulation deserves further study. Most of the studies published on the follow-up of IVF children are reassuring, but it is clear that these studies are not sufficient to eliminate without doubt any adverse effects on the well-being of IVF children. All IVF pregnancies should be followed with great care, not because they are more precious than spontaneous pregnancies, but because they are exposed to an increased risk of complications. The main problem of IVF remains the high rate of multiple pregnancies, including twins.

Age Factors↗

An epidemiological study of Hirschsprung's disease.

All newly diagnosed cases of Hirschsprung's Disease among children born in Baltimore City and County, Maryland and diagnosed within the Baltimore Standard Metropolitan Area during 1969 through 1977 were identified. Using hospital records and death certificates, 33 cases were ascertained. An overall incidence rate of 18.6 per 100 000 livebirths was found, similar to that reported by others. A high male to female ratio (4.32:1) was found; the ratio for non-whites to whites was 1.67:1. Non-white males had the highest rate, 37.6 per 100 000 livebirths. These findings plus the fact that 9% of these children were also diagnosed as having Down's Syndrome, were evidence that the aetiology of Hirschsprung's Disease may be partially genetic. Among environmental factors studied, there was no time trend and no relationship with socioeconomic status found. Among whites, there was a larger percentage of children who were the first births of mothers aged 30 and above, a result previously reported for children with neural tube defects. Very little is known about micro-environmental factors in relation to Hirschsprung's Disease and this would seem to be the area for future emphasis in research.

Adolescent↗

Cutaneous malignant melanoma in females: the role of hormonal and reproductive factors.

The role of hormonal and reproductive factors as risks for cutaneous malignant melanoma (CMM) was explored by means of a population-based case-control study conducted in Turin, north-western Italy, on 186 female CMM cases and 205 controls. Past use of oral contraceptives (OC) did not seem to exert any effect on CMM risk odds ratio (OR) = 1.12, 95% confidence interval (CI): 0.56-2.24). No association was found even for the longest duration of use, for superficial spreading melanoma cases and for CMM of lower limbs only. While age at first birth did not affect CMM risk, women who had had three or more children seemed to be significantly protected as compared to nulliparous ones. The association was, however, substantially diminished by adjustment for education and other CMM risk correlates (OR for at least three children versus none = 0.62; 95% Cl: 0.29-1.31).

Adolescent↗

Relationship of blood prolactin levels and the risk of subsequent breast cancer.

Between 1968 and 1976 a total of 5162 women volunteers were enrolled into a prospective study conducted on the Island of Guernsey. Up to February 1990 145 women subsequently developed breast cancer. Blood samples were taken at the time of enrollment and prolactin levels were known for 85% of the volunteers. In calculating the relationship between blood prolactin levels and subsequent breast cancer risk, women were excluded if they had a hysterectomy or an oophorectomy or had cancer at any site before enrollment. The final analysis was based on 2596 premenopausal and 1180 naturally postmenopausal women and, of these respectively, there were 71 and 40 volunteers who subsequently developed breast cancer. The total follow-up for these two groups was 49,941 and 22,360 woman-years, respectively. In assessing the relationship between blood prolactin levels and risk of subsequent breast cancer the cohort was divided into quintiles according to prolactin concentration and relative risks (RR) were estimated. In calculating these values possible confounding by age at entry, age at menarche, parity, age at first birth, years since menopause, body build, history of benign breast disease and family history of breast cancer were taken into consideration. There was no significant relation between risk of breast cancer and prolactin in either pre- or postmenopausal women. Hence prolactin appears not to be an important determinant of breast cancer risk.

Adolescent↗

Mortality from ovarian cancer among women with many children.

The exposure range for number of children as a risk factor for ovarian cancer has been severely restricted in most studies. This study is the first to describe the effect of many children, i.e. six or more, on the risk for death from ovarian cancer. The association between number of children in the current marriage given at the Norwegian Census in 1970 and mortality from ovarian cancer was investigated in a prospective study of 800,814 women followed over 15 years. Among postmenopausal women a strong negative trend between number of children and mortality from ovarian cancer was found; women with 8-11 children had a relative risk (RR) of 0.30 (95% confidence interval (CI): 0.17-0.54). For postmenopausal women the rate differences according to parity were constant across age strata indicating an additive model. No significant effect was found for age at first birth or social class. The study indicates that low parity could be the major risk factor for death from postmenopausal ovarian cancer.

Adult↗

Lifetime alcohol consumption and postmenopausal breast cancer rate in Denmark: a prospective cohort study.

Alcohol intake may be one of the few modifiable risk factors for breast cancer. In a prospective cohort of 29,875 women with 423 cases of breast cancer during 1993-2000, we examined the relationship between postmenopausal breast cancer incidence rate and alcohol consumption in different life periods. When alcohol intake during four age ranges, twenties, thirties, forties and fifties was evaluated, only the intake in the fifties increased the risk of breast cancer [rate ratio (RR)=1.12 (95% CI: 1.05-1.19)] per 10 g/d increase in alcohol intake. After adjustment for intake at study entry, this association was no longer present [RR=1.01 (95% CI: 0.91-1.13)]. The cumulative lifetime alcohol intake, adjusted for recent intake, showed no association with postmenopausal breast cancer risk. Recent alcohol intake, adjusted for the alcohol intake in the other life time periods, showed a significant association of RR=1.09 (95% CI: 1.00-1.18) per 10 g/d. There was no indication of a higher risk among women with early drinking start, nor did women who started to drink before their first birth have a higher risk than women who started to drink later in life. Our results suggest that baseline intake of alcohol is a more important determinant of postmenopausal breast cancer risk than earlier lifetime exposure.

Adult↗