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Induced abortion and spontaneous abortion: no connection?

The hypothesis that spontaneous abortion is associated with prior induced abortion is tested in an epidemiologic study. The reproductive histories of a consecutive series of women admitted to hospital with spontaneous abortions were compared with those of a control series of women who delivered after 28 weeks gestation. There is no association between spontaneous abortion and prior induced abortion. The power of the analysis to detect a 30% excess in the frequency of induced abortion in cases as compared to controls is 82% at alpha = .05. The design and analysis effectually controlled for all potentially confounding factors.

Abortion, Induced↗

Thiazide use and the risk of cholecystectomy in women.

As part of a case-control study of gallstone disease conducted among the female members of Group Health Cooperative of Puget Sound, the authors investigated the possible etiologic role of prior use of thiazide diuretics. One hundred fifty-three women who underwent gallstone surgery between January 1979 and September 1980, and 156 controls selected from membership files, were interviewed about their past use of certain medications, their reproductive history, and physical and demographic characteristics. The risk of gallstone disease which required surgery among women who had used thiazides relative to those who had not used this drug, after controlling for age, race, pregnancy, and body mass index, was 1.9 (95% confidence interval (CI) = 1.0-3.7). However, this association was present only among women who were not overweight, i.e., those with body mass index less than or equal to 36, for whom the relative risk was 5.0 (95% CI = 1.8-13.5). Among overweight women, the relative risk was 1.0 (95% CI = 0.5-2.2). Among women who were not overweight, there was no further increase in risk with increasing duration or recency of thiazide use. These data fail to agree with data from earlier studies which show a possible thiazide-gallstone disease association. The results of the present study suggest that if thiazide use has any influence on the occurrence of gallstone disease in women, that influence exists primarily in those who are not overweight.

Adult↗

The effect of perinatal screening in Norway on the magnitude of noninherited risk factors for congenital dislocation of the hip.

Several investigators have noted an increase in the rate of congenital dislocation of the hip shortly after the initiation of neonatal screening procedures. This increase has been attributed to the detection of temporarily unstable hips which require no corrective treatment. To test whether neonatal screening had low specificity, the authors obtained data on 17,145 offspring of 7,896 twins from the Norwegian Twin Panel. Information from maternal reproduction history questionnaires was available on the presence or absence of congenital dislocation of the hip, type of obstetric delivery, and parity. The reported prevalence of the disorder did indeed begin to rise sharply during the late 1950s, at which time neonatal screening started in Norway. Infants were then grouped by year of birth (born before or after 1960), and odds ratios were calculated for breech delivery and early (first or second) parity. For the pre-screening group, the odds ratio of congenital dislocation of the hip was 7.7 among children delivered by breech presentation and 2.6 among those of early parity. These values are similar to those found in other studies. In the post-screening group, the odds ratios for breech delivery and early parity were 1.5 and 1.2, respectively. Breech delivery and early parity have been consistent risk factors for congenital dislocation of the hip. Their diminished influence in the post-screening group, as well as sharply increased rates of the disorder, suggests that in Norway neonatal screening programs may have had low specificity in detecting cases that required treatment.

Cross-Sectional Studies↗

The postponement of neonatal deaths into the postneonatal period: evidence from Massachusetts.

Part of the slow decline in the postneonatal mortality rate and the rapid decline in the neonatal mortality rate during the 1970s may have been due to a postponement of some neonatal deaths into the postneonatal period. The authors hypothesized that any such postponement should be accompanied by a lack of decline, or even an increase, in late neonatal and postneonatal mortality rates among low birth weight babies and babies dying of conditions originating in the perinatal period. To examine this theory, the authors used vital records data to compare infant mortality rates in Massachusetts during 1970-1972 with rates during 1978-1980. Log-linear hazard models were used to calculate death rates, while controlling for changes in maternal age, race, education, and prior reproductive history. The authors found that babies of birth weight under 1,500 g had no decline in late neonatal mortality rates and babies of birth weight under 2,500 g had no decline in postneonatal mortality rates. Babies of birth weight 500-999 g had an increased postneonatal mortality rate (rate ratio = 2.4; 95% confidence limits = 1.0-5.4). These unimproved or increased death rates were due in part to conditions originating in the perinatal period. The authors conclude that, although infant mortality rates have declined, this postponement was real, and that efforts to monitor infant mortality will benefit from its routine quantification.

Age Factors↗

Cross-sectional and longitudinal associations between high density lipoprotein cholesterol and women's employment.

This study examined the association between women's employment and high density lipoprotein (HDL) cholesterol. Subjects were 1.998 women aged 25-64 years who were sampled by the first MONICA Augsburg Survey (Monitoring of Trends and Determinants in Cardiovascular Disease). The women were sampled from the population of Augsburg, Federal Republic of Germany, in 1984-1985, were followed up for 3 years, and were reexamined in 1987-1988. In cross-sectional analysis (1984-1985), the mean HDL cholesterol level of employed women was 3.4 mg/dl higher than that of full-time homemakers (p less than 0.001). After adjustment for age, body mass, cigarette smoking, consumption of coffee and alcohol, use of sex hormones, leisure-time physical activity, and reproductive history, this difference decreased to 2.1 mg/dl and remained statistically significant (p less than 0.01). As was predicted from the cross-sectional findings, the mean HDL cholesterol levels of women who gave up employment and became full-time homemakers during the follow-up period decreased by 3.04 mg/dl (p less than 0.01), whereas homemakers who became employed showed no significant change in HDL cholesterol levels. The change in mean HDL cholesterol of employed women who had become homemakers could be explained in part by changes in alcohol consumption and in number of pregnancies. The authors conclude that giving up employment is related to life-style changes that are associated with a decrease in HDL cholesterol levels. Furthermore, the findings suggest that employment may exert a beneficial influence on coronary risk in women that is consistent with a positive association between employment and HDL cholesterol.

Adult↗

Risk factors predicting the incidence of second primary breast cancer among women diagnosed with a first primary breast cancer.

This study examined risk factors for development of a contralateral breast cancer among 4,660 US women diagnosed with a first primary breast cancer between 1980 and 1982. The authors believe it to be the first prospective cohort study on this topic that has employed direct patient interviews. All subjects were interviewed within 6 months of the diagnosis of their initial tumor as part of the multi-center, population-based, case-control Cancer and Steroid Hormone Study, and they were followed until the end of 1986 through the Surveillance, Epidemiology, and End Results program. Exclusive of those diagnosed during the initial 6 months after diagnosis of a first primary, 136 second primary breast cancers were identified. Proportional hazards models were used to assess the independent effects of multiple predictors. Specific risk factors evaluated included: age at diagnosis of first primary, exposure to exogenous hormones, menstrual and reproductive histories, tumor characteristics, demographic variables, and treatment modalities. The age-specific incidence rates of second primary breast cancer were higher in all age categories than are the incidence rates of breast cancer in the general population, yet the age at diagnosis of first primary breast cancer was not an important predictor of contralateral breast cancer. The risk of contralateral breast cancer was increased among cohort members who reported a personal history of benign breast biopsy (multivariable-adjusted rate ratio (RR) = 1.69, 95% confidence interval (CI) 1.13-2.53) and in those with an initial tumor that was classified as lobular carcinoma (multivariable-adjusted RR = 1.96, 95% CI 1.17-3.27). Treatment with chemotherapy for the first primary was associated with a lower risk of development of a second breast cancer (multivariable-adjusted RR = 0.56, 95% CI 0.33-0.96), while radiation therapy had little effect on the risk (multivariable-adjusted RR = 1.19, 95% CI 0.78-1.80).

Adult↗

Pregnancy and lactation as determinants of bone mineral density in postmenopausal women.

The relation of pregnancy and breast feeding to bone mineral density of the wrist, radius, hip, and spine was examined in a white, upper middle-class, homogeneous sample of 741 postmenopausal women ranging in age from 60 to 89 years. Number of pregnancies ranged from 0 to 14, with a mean of 2.0 pregnancies and 1.5 live births. Almost two thirds of the women who had had a live birth reported breast feeding. Unadjusted comparisons indicated that bone mineral density of the wrist, radius, and hip increased with increasing numbers of pregnancies, and women who had breast-fed had higher bone mineral densities at these sites. However, after adjustment for age or age and body mass index, these associations were no longer significant. Multiple regression analyses adjusted for age, age at menopause, obesity, cigarette smoking, and estrogen and thiazide use also indicated that number of pregnancies and breast feeding were not significantly associated with bone mineral density at any of the four sites measured. Results of the present study suggest that reproductive history and breast feeding are not long-term determinants of bone mineral density.

Age Factors↗

Miscarriages among female physical therapists who report using radio- and microwave-frequency electromagnetic radiation.

Physical therapists are exposed to radio- and microwave-frequency electromagnetic radiation by operating shortwave and microwave diathermy units. Recent studies suggest that use of shortwave diathermy is associated with an excess risk of birth defects, perinatal deaths, and late spontaneous abortions among the offspring of exposed female therapists. To assess the impact of occupational use of microwave and shortwave diathermy at the time of conception, the authors mailed questionnaires to 42,403 physical therapists in 1989. Both occupational and reproductive histories were obtained. Exposures to shortwave and microwave diathermy were both assessed in the same fashion and were examined in relation to early recognized fetal loss in a nested case-control design. A total of 1,753 case pregnancies (miscarriages) were matched to 1,753 incidence density control pregnancies (other pregnancies except ectopic pregnancies). A pregnancy was considered "exposed" if the mother reported using microwave or shortwave diathermy anytime during the 6 months prior to the first trimester or during the first trimester. Pregnancies of mothers reporting microwave use 6 months prior to the pregnancy or during the first trimester were more likely to result in miscarriage (odds ratio (OR) = 1.28, 95% confidence interval (CI) 1.02-1.59). The odds ratio increased with increasing level of exposure (chi 2 = 7.25, p < 0.005). The odds ratio in the highest exposure group (20 or more exposures/month) was 1.59. The overall odds ratio was slightly lower after it was controlled for prior fetal loss (OR = 1.26, 95% CI 1.00-1.59), but the exposure-response effect remained (chi 2 = 5.17, p < 0.01). The risk of miscarriage was not associated with reported use of shortwave diathermy equipment (OR = 1.07, 95% CI 0.91-1.24). The odds ratio in the highest exposure group was 0.87.

Abortion, Spontaneous↗

Physical activity and risk of breast cancer in the Framingham Heart Study.

The authors analyzed data from the Framingham Heart Study to evaluate the association between physical activity and breast cancer risk. Physical activity was ascertained by a physician-administered questionnaire from 2,321 women at the fourth biennial examination conducted in 1954-1956. Breast cancers were identified by self-report, surveillance of admissions to Framingham Union Hospital, and review of death records; all but one were histologically confirmed. During 28 years of follow-up, 117 breast cancer cases were diagnosed among the 2,307 women with data on physical activity and reproductive history (a potential confounder). Analysis was performed using Cox proportional hazards models with age as the underlying time variable. Models were adjusted for age at physical activity assessment, menopausal status, age at first pregnancy, parity, education, occupation, and alcohol ingestion. We observed a gradient of increasing risk of breast cancer with increasing physical activity (trend p = 0.06). The relative risk for women in the highest versus lowest activity quartile was 1.6 (95% confidence interval 0.9-3.0; p = 0.13). Although both moderate-to-heavy leisure and occupational activities were associated with an increased risk, the association was marginally significant only for leisure activity (p = 0.06). Our findings do not support a protective effect of physical activity during adulthood for breast cancer, but suggest an increased risk among more active women.

Adult↗

In-vivo blastocyst production and ovum yield among fertile women.

We evaluated ova recovered from 13 fertile women undergoing uterine lavage for purposes of embryo donation, and assessed differences in blastocyst production and ovum yield among subjects. Six women produced 10 blastocysts during 31 insemination cycles (32%). Yet, despite undergoing at least four insemination cycles apiece, seven women produced no blastocysts in 52 lavage attempts. Comparing the ovum recovery rates between the blastocyst-producing and non-blastocyst-producing groups, we found the former more likely to yield ova (P less than or equal to 0.05), and more importantly 10 to 20 recovered ova were blastocysts. We conclude that donor fecundity is highly variable among fertile women, and that reproductive history alone does not predict ovum donor efficiency.

Adult↗

Risk factors for spontaneous abortion: a case-control study in France.

A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in spontaneous abortion. A total of 279 cases and 279 controls were compared for socio-demographic characteristics, reproductive history and for conditions of conception. Prior fetal losses [odds ratio (OR) = 2.30 for n greater than or equal to 2; 95% confidence interval (CI) = 1.17-4.61] and maternal age at pregnancy (greater than 30 years) appeared to be major and independent risk factors of spontaneous abortion. Other factors associated with an increased risk of fetal loss were: geographical or ethnic origin (OR = 2.85 for North African women; 95% CI = 1.58-5.10); psychological problems at the time of conception, either related to the outcome of the pregnancy (OR = 3.08; 95% CI = 0.92-10.25) or unrelated to this outcome (OR = 3.35; 95% CI = 1.41-8.00). The following factors were not associated with spontaneous abortion: gravidity, parity, prior induced abortion, prior sexually transmitted diseases and Chlamydia trachomatis serology, menstrual cycle abnormalities, induced conception cycle and in-vitro fertilization, cigarette smoking, current or past use of combined oestrogen/progestagen pill or intrauterine device. These findings confirm the importance of two risk factors for fetal loss: maternal age and number of prior spontaneous abortions. Two risk factors, ethnic origin and psychological problems at the time of conception are also identified, which require further study.

Abortion, Spontaneous↗

Seminal white blood cells and recurrent abortion.

The incidence of leukocytospermia (> 1 million white blood cells/ml semen) and concentrations of white blood cell populations in semen from men whose partners experience unexplained recurrent spontaneous abortion by conventional testing criteria are described and compared to those of men whose partners have normal reproductive histories. Comparable seminal granulocyte and total white blood cell concentrations between groups suggest that couples with unexplained recurrent abortion do not have an abnormally high incidence of subclinical genital tract infections for which leukocytospermia could serve as a marker. However, a significantly higher prevalence of elevated CD4+ and CD8+ T lymphocyte concentrations in semen from men whose partners have cellular immunity to sperm antigens (i.e. produce embryotoxic factors in response to sperm antigen stimulation) warrants further investigation.

Abortion, Habitual↗

Factors associated with abnormal Pap results in systemic lupus erythematosus.

OBJECTIVE: Previous studies have suggested that women with systemic lupus erythematosus (SLE) are at greater risk for cervical dysplasia than are women in the general population. However, the factors associated with abnormal Pap test results in SLE have not been well studied. We therefore aimed to determine the factors associated with lifetime occurrence of an abnormal Pap test in women with SLE, and the influence of immunosuppressive exposure on the odds of abnormal Pap test results occurring after diagnosis of SLE. METHODS: Data were pooled from SLE cohorts from three centres. Self-report data were available on smoking, reproductive history, use of oral contraceptives (OC), history of sexually transmitted diseases (STDs) and whether the subjects had had cervical dysplasia on Pap testing. Logistic regression was used to examine the effect of these variables on the lifetime odds of cervical dysplasia. We then generated the adjusted odds ratio (OR) for the effect of immunosuppressive exposure on cervical dysplasia occurring after diagnosis of SLE. RESULTS: History of STDs and use of OCs were positively associated with reports of cervical dysplasia in adjusted analyses. The ORs for the effect of immunosuppressives on abnormal Pap test occurrence (adjusted for race, age, smoking, nulliparity, OC use and history of STDs) after diagnosis of SLE was 1.6 (95% CI 1.0, 2.7). CONCLUSIONS: A history of STDs and use of OCs were associated with abnormal Pap reports in this SLE sample. Immunosuppressive exposure may confer further risk to women with SLE.

Adult↗

Are there social inequities in child morbidity and mortality in rural Vietnam.

This study was conducted to investigate the relationship between various socio-economic factors, and child morbidity and mortality during a period of rapid social change in Vietnam. One-thousand-one-hundred-and-thirty-two rural mothers with children under 5 years of age were interviewed regarding their reproductive history, survival of their children, and morbidity of their children under 5 years of age. Causes of child death were established by a verbal autopsy technique. Fifty-seven per cent of the children were reported to have suffered from some illness during the preceding 2 weeks. Acute respiratory infection (ARI) (46 per cent of all children) was most common. Two-thirds of the sick children had been treated with antibiotics. Eighty-one children under 5 years of age had died during the 10-year period 1982-1992. Two-thirds of these deaths occurred in infancy, most of them were related to prematurity, asphyxia or tetanus. ARI was more common in poor families while neither education nor occupation were associated with ARI occurrence. No significant relationship between education or occupation of the mother and mortality was found. The low under-5 mortality (U5MR) in spite of the high morbidity may be related to good child health care both by families and by the health care system.

Analysis of Variance↗

Gonadotropin-releasing hormone treatment induces follicular growth and ovulation in seasonally anestrous mares.

A study was conducted to evaluate the effectiveness of gonadotropin-releasing hormone (GnRH) pulse infusion to stimulate follicular development and induce ovulation in seasonally anestrous standardbred mares. Seventeen mares were selected for use in this experiment, on the basis of a previous normal reproductive history, and were housed under a photoperiod of 8L:16D beginning one week prior to the start of the experiment (second week in January). Mares were infused with 20 micrograms (n = 7) or 2 micrograms (n = 6) GnRH/h, or were subjected to photoperiod treatment only (controls, n = 4). Serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and progesterone did not vary, and neither significant follicular development nor ovulation was observed in any control mare throughout the experimental period (greater than 60 days). By contrast, both groups of GnRH-treated mares showed elevated serum concentrations of LH and FSH within one day after the start of infusion. Mares infused with 20 micrograms GnRH/h had at least one follicle greater than or equal to 25 mm in 7.4 +/- 1.3 (mean +/- SEM) days following the start of infusion, and ovulated in 12.0 +/- 0.7 days. In the 2-microgram-GnRH/h treatment group, a 25-mm follicle was detected in 5.7 +/- 0.7 days, and ovulation occurred after 10.0 +/- 0.3 days of infusion. Ovulation in every instance was followed by a functional luteal phase, as indicated by the profiles of progesterone secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anestrus↗

Maternal age at birth and risk of breast cancer in daughters.

Data from a large case-control study of breast cancer were examined to test the hypothesis that maternal age at the birth of female offspring is related to the incidence of breast cancer in daughters. Participants were between the ages of 20 and 54 at the time of the study. Based on results for 2,492 parous women who were newly diagnosed with breast cancer and 2,687 parous controls from the general population, a 15-year increase in maternal age was found to be associated with a 29% increase in the risk of breast cancer in daughters. Adjustment for the daughter's age, her own reproductive history, and other potential confounding factors yielded an estimate of 25% for this increase in risk (95% CI, 8% to 46%). The corresponding increase among 499 nulliparous cases and 457 nulliparous controls was 7%, which was not statistically significantly different in magnitude from the increase among parous women. These findings provide evidence for perinatal influences on the subsequent incidence of breast cancer during adulthood. Although specific mechanisms cannot be inferred directly, the results are consistent with the hypothesis that mutations in the genes of the human egg or sperm play a role in the etiology of breast cancer in female offspring.

Adult↗

Association of physical and behavioral characteristics with menstrual cycle patterns in women age 29-31 years.

We examined the association between menstrual cycle characteristics (cycle length, variability, and bleeding length) and physical and behavioral attributes in 766 women age 29-31 years. Menstrual cycle data were prospectively recorded as part of the Menstruation and Reproductive History Study of college women in Minnesota, begun by Alan Treloar in 1934. Data on lifetime height, weight, physical activity, alcohol and caffeine consumption, and smoking history were collected in 1990 using a self-administered questionnaire. Cycle variability, as measured by the standard deviation of the cycle length, was increased, and menstrual cycles > or = 42 days in length were more common among women in the lowest quartile of Quetelet index [odds ratio (OR) for long cycle = 1.6;95% confidence interval (CI) = 0.82-3.0] and among the most physically active (OR = 1.7;95% CI = 0.93-3.1). Long menstrual cycles were less common (OR = 0.40;95% CI = 0.22-0.73) among women who drank alcohol than among nondrinkers. Variable or long menstrual cycles may reflect anovulation and relatively low levels of estrogen exposure. We would expect, based on our data, reduced estrogen exposure among lean women, physically active women, and those who do not consume alcohol. These findings suggest an explanation for the reported associations between these factors and breast cancer risk.

Adult↗

Conditions at conception and risk of menstrual disorders.

In a case-control study, we evaluated the association of the risk of menstrual disorders with four periconceptional factors: short preceding interpregnancy interval (< 6 months), low (< or = 19 years) or high (> or = 40 years) maternal age at conception, and month of conception. We divided 919 women who had visited a fertility clinic between 1991 and 1995 into three categories: cases (with mean menstrual cycle length > or = 42 or < or = 21 days, or a variation of > or = 14 days between cycles, or amenorrhea, N = 294), controls (with cycles within a range of 25-35 days and variation < or = 7 days, N = 520), and intermediates (N = 105). A self-administrable questionnaire was mailed, asking for information about maternal reproductive history and age, and potential confounders such as smoking, exercise, and level of education. Response (77%) differed little among cases, intermediates, and controls. We found elevated risks for short pregnancy intervals [adjusted odds ratio (OR) = 2.04; 95% confidence interval (CI) = 1.04-4.02] and advanced maternal age (OR = 3.24; 95% CI = 1.27-8.30) but not for low maternal age (OR = 0.58; 95% CI = 0.11-3.14) (cases vs controls). We found similar effects for intermediates vs controls. The distribution of month of conception did not differ much from controls for both cases and intermediates. The results indicate that conception after short pregnancy intervals or at advanced maternal age increases the risk of menstrual disorders in daughters. The precise etiology is unclear, but it may lie in the quality of the oocyte at conception.

Adolescent↗