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PubMed2000

Abortion and its effect on risk of preeclampsia and transient hypertension.

We examined the effect of abortion type, number, and gestational age on the risk of preeclampsia and transient hypertension among women who received prenatal care from 13 obstetric practices in southern Connecticut between April 1988 and December 1991 (N = 2,739). Subjects were interviewed before 16 weeks' gestation regarding reproductive history and pregnancy-related risk factors. We estimated the risk of preeclampsia (N = 44) and transient hypertension (N = 172) among nulliparous women who had had one or more abortions, with nulliparous women with no abortion as the referent group. Similar effects were seen for one spontaneous or induced abortion, when analyzed separately. A single prior abortion was associated with a decreased risk of preeclampsia [odds ratio (OR) = 0.35; 95% exact confidence interval (CI) = 0.09-1.01]. One abortion had only a small association with risk of transient hypertension (OR = 1.09, 95% exact CI = 0.68-1.72); however, a history of two or more abortions was associated with a decreased risk (OR = 0.42, 95% exact CI = 0.16-0.94). Among nulliparous women with a history of one abortion, a decreased risk of both hypertensive disorders was observed among women whose aborted pregnancy ended at > or =3 months gestation. These findings suggest that a history of abortion in nulliparous women is a protective factor against the risk of preeclampsia in the subsequent pregnancy.

Abortion, Induced↗
PubMed2000

Beyond ovulation: oral contraceptives and epithelial ovarian cancer.

In a case-control study in three Australian states that included 794 women with epithelial ovarian cancer and 853 community controls for whom we had adequate contraceptive and reproductive histories, we examined the effects of oral contraceptive use after controlling for estimated number of ovulatory cycles. Other covariates included in the multiple logistic regression analysis were parity, smoking, and history of pelvic surgery. The protective effect of duration of oral contraceptive use appeared to be multiplicative, with a 7% decrease in relative risk per year [95% confidence interval (CI) = 4-9%], persisting beyond 15 years of exposure. Use for up to 1 year may have a greater effect than predicted (odds ratio = 0.57; 95% CI = 0.40-0.82), whereas use before the first pregnancy may be additionally beneficial (odds ratio = 0.95; 95% CI = 0.87-1.03, adjusted for overall duration of use). Better control for ovulatory life might attenuate these estimates somewhat. There was little evidence of waning protection with time since last exposure or of extra benefit with early commencement of oral contraceptive use. We found no convincing evidence of effect modification in any factor examined or differences in effect among the three main histologic cancer types or between borderline and malignant tumors. Oral contraceptives may act by both suppressing ovulation and altering the tumor-promoting milieu.

Adult↗
PubMed2003

Risk factors and risk reduction of breast and ovarian cancer.

PURPOSE OF REVIEW: Breast and ovarian cancer remain a significant burden for women living in the Western world. This paper reviews the risk factors and current strategies to prevent these diseases. RECENT FINDINGS: Established factors associated with the risk of breast cancer include family history, reproductive factors and lactation, as well as age at menarche and menopause. Hormone replacement therapy increases the risk, whereas oral contraceptives probably confer no increased risk. Alcohol moderately increases the risk, whereas a diet rich in folate and carotenoids might be protective. The role of other dietary factors, smoking and physical exercise remain unclear. Important risk factors for ovarian cancer are reproductive factors and possibly the long-term use of hormone replacement therapy. The risk is decreased by oral contraceptives. In carriers of a BRCA1 or BRCA2 gene mutation, prophylactic surgery can significantly reduce the risk of breast as well as ovarian cancer. Tamoxifen may be considered as a chemopreventive agent in women with a high risk of breast cancer, including carriers of a BRCA2 mutation, but is probably not effective in BRCA1 carriers. SUMMARY: During the period of this review, the importance of several known risk factors was confirmed, whereas the effects of other factors became more clear. Chemoprevention and prophylactic surgery have emerged as preventative options that can reduce the risk of breast and ovarian cancer.

Alcoholism↗
PubMed1996

Cross-cultural perspectives on menopause.

Numerous physical and psychological symptoms have been attributed to the hormonal changes of menopause. Symptoms have also been attributed to loss of fertility, redefining of roles, empty nest syndrome, loss of femininity, and changes of status. Cross-cultural studies allow researchers to examine the contribution of physiological, psychological, and sociocultural influences to the experience of menopausal symptoms. Such research is complicated by differences between cultures in the definition of menopause, reproductive histories, symptom expression, and beliefs as to what constitutes status. A review of five important cross-cultural studies indicates that there are enormous differences in the experience of menopause among women in the same culture and among cultures. Menopausal symptoms seem to be caused by a combination of physical changes, cultural influences, and individual perceptions and expectations.

Aging↗
PubMed1975

Listeria monocytogenes septicemia in pregnancy.

A case of Listeria monocyto-enes septicemia in a patient with a poor reproductive history is presented. The clinical aspects and implications of this infectious disease during pregnancy are discussed, and the role of Listeria as a cause of recurrent pregnancy wastage is summarized.

Adult↗
PubMed1994

The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain.

OBJECTIVE: To assess the effect of nonsurgical management of leiomyomas, abnormal uterine bleeding, and chronic pelvic pain on symptoms and quality of life. METHODS: We performed a prospective cohort study of women receiving nonsurgical management (n = 380) or hysterectomy (n = 311) for leiomyomas, abnormal uterine bleeding, or chronic pelvic pain. Patients recruited from the practices of 63 physicians throughout Maine were interviewed at the outset of treatment and 3, 6, and 12 months later. The principal outcome measures were frequency and severity of physical and psychological symptoms, and quality of life as measured by validated indices of mental and general health and physical activity. RESULTS: Medical therapy for abnormal bleeding and chronic pelvic pain produced significant improvements in symptoms and quality of life. However, almost one-quarter of patients initially treated nonsurgically subsequently underwent hysterectomy; of patients continuing nonsurgical therapy, 25% with abnormal bleeding and 50% with chronic pelvic pain reported substantial levels of symptoms after 1 year. There were no significant changes in symptoms and quality of life in patients treated nonsurgically for leiomyomas. New problems including tiredness, hot flashes, weight gain, and depression developed in 10% or less of women who did not report these symptoms preoperatively. A logistic regression analysis controlling for age, reproductive history, and severity of symptoms showed that hysterectomy was the factor most highly correlated with a positive outcome at 1 year for all three conditions. CONCLUSIONS: Many women with leiomyomas, abnormal bleeding, and chronic pelvic pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treatment fails.

Adult↗
PubMed1980

Reproductive failure and cervical incompetence in women exposed to diethylstilbestrol.

Exposure to diethylstilbestrol in utero is recognized to be associated with a wide range of developmental abnormalities in the female genital tract, the most prominent being adenocarcinoma of the vagina. Recently anatomic anomalies have been discovered with increasing frequency. This case illustrates the association of exposure to diethylstilbestrol, cervical incompetence, and poor reproductive history, and stresses the importance of early evaluation.

Adult↗
PubMed1996

A comparative study of risk factors for hyperplasia and cancer of the endometrium.

A cohort study has been carried out to investigate risk factors for cancer as well as hyperplasia of the endometrium. Over the 13 years for which we followed 25,000 women aged 40-65 (who took part in a population-based screening programme for breast cancer), 111 cases of endometrial cancer and 109 cases of endometrial hyperplasia were diagnosed. A comparison of the outcome between the two disease entities revealed that large body weight among postmenopausal women and the use of oestrogenic drugs at all ages were risk factors for both cancer and hyperplasia of the endometrium. However, reproductive histories and premenopausal steroid profiles differed. Steroid excretion determinations in urine samples collected years before diagnosis provided further evidence in favour of the hypothesis of unopposed action of oestrogens in the aetiology of endometrial cancer. In women who were to develop endometrial hyperplasia or cancer the obesity-oestrogen relationship was stronger than in those who remained free of endometrial disease during the period of follow-up. The possible significance of differences in aromatase activity among the obese is considered.

Adult↗
PubMedDate not supplied

Age at menopause and prevalence of its different types in contemporary Greek women.

OBJECTIVE: This study attempted to estimate the mean age at menopause and also characterize and quantify its types and frequencies in Greek women who have recently become postmenopausal. DESIGN: A retrospective analysis of hospital records was used to record the frequency of natural, spontaneous or induced premature, and delayed natural menopause; the mean age at menopause of each group; and their possible interrelationships with major events of reproductive history in 1,747 women visiting an endocrine clinic 1 to 5 years after menopause. A group of 438 postmenopausal women drawn from 4,000 cases from the nongynecological clinics of this hospital comprised the control group. RESULTS: Natural menopause was found in 1,333 (76.3%) women with a median age of 51 (95% CI, 50.8-51.2) and mean +/- SD of 48.7 +/- 3.8 years. Medically induced menopause after the age of 40 was recorded in 204 women (11.7%), spontaneous premature in 127 (7.1%), medically induced premature in 60 (3.7%), and delayed menopause in 26 (1.5%), with mean ages of 43.6 +/- 1.7, 35.1 +/- 3.3, 37.2 +/- 1.6, and 59.6 +/- 2.1 years, respectively. No significant differences in mean age at menopause or its types were noted between the two groups. Furthermore, no significant correlations among the parameters examined could be demonstrated except between smoking and age at menopause in the spontaneous premature menopause subgroup (P < 0.05). Finally, ovarian autoantibodies were found in 6.7% of the tested women with premature menopause. CONCLUSIONS: Natural menopause occurred at a mean age of 48.7 years in Greek women, who displayed an unexpectedly high prevalence of spontaneous or induced premature cessation of menstruation.

Adult↗
PubMed2003

Does pregnancy induce the shedding of premalignant ovarian cells?

BACKGROUND: High parity is associated with reduced risk of ovarian cancer. One hypothesis is that pregnancy is associated with clearance of a fraction of the genetically modified (premalignant) cells from the ovaries. METHODS: We evaluated this hypothesis using a model that estimates the cell clearance fraction at first and second pregnancy according to age at pregnancy. The model was fitted using reproductive history data from a cohort of 1.5 million Danish women born between 1935 and 1978 and followed for 28.7 million person-years. During this follow-up period, 2,035 developed invasive ovarian cancer. RESULTS: We found the model to have a satisfactory fit despite the very few parameters involved. The model estimated similar cell clearance fractions for the first and second pregnancy and decreasing clearance with later age at pregnancy. CONCLUSION: The relation of pregnancy history to risk of ovarian cancer can be well described by a cell clearance model that allows the cell clearance fraction to decrease with age at pregnancy.

Adult↗
PubMedDate not supplied

Staging reproductive aging: a comparison of proposed bleeding criteria for the menopausal transition.

OBJECTIVE: A staging system for female reproductive aging has recently been proposed. Bleeding criteria are an important component of a staging system, as bleeding patterns are readily observable. Several different bleeding criteria have been proposed, but their concordance and validity have not been evaluated. Five proposed bleeding criteria or markers for the onset of early menopausal transition and four criteria for the onset of the late transition were evaluated using data from the Menstruation and Reproductive History Study, or Tremin Trust. DESIGN: Correlations between time from age 35 to each marker event were assessed using Kendall's tau correlation coefficients. Kaplan-Meier survival analysis was used to examine associations between the marker events and age at final menstrual period (FMP). RESULTS: The first occurrence of marker events for the late menopausal transition demonstrated low to high correlation (r = 0.23 to 0.77), whereas the first occurrence of marker events for the early transition stage demonstrated no correlation to moderate correlation (r = 0.0 to 0.65). After age 40, the occurrence of the marker events distinguished a subgroup of women who were more proximate to their FMP. Differences in years to FMP between women with and without the marker events were greatest in the early to mid-40s and declined with age. CONCLUSIONS: A 60-day cycle may be a desirable marker for entry into the late transition stage because of its reliability, proximity to the FMP, and ease of calculation. More work is needed to conceptually define the onset of the early menopausal transition before appropriate bleeding criteria can be established.

Adult↗
PubMed2002

Femininity and fertility in sisters with twin brothers: prenatal androgenization? Cross-sex socialization?

Are sisters of twin brothers behaviorally or physiologically masculinized? Prenatal exposure to their brothers' androgens and postnatal socialization experiences unique to girls growing up with twin brothers might influence their attitudes, pubertal development, and reproductive histories. To investigate, we studied age- and cohort-matched samples of Finnish sisters from same-sex and opposite-sex twin pairs. Using data from two ongoing longitudinal studies of consecutive birth cohorts of Finnish twins, we assessed pubertal development at ages 11 and 14 and endorsement of attitudes associated with femininity at age 16. We also studied fertility in Finnish women from same- and opposite-sex twin pairs born from 1958 through 1971, obtaining information on their child-bearing histories when they were ages 15 to 28. Results of each comparison were unambiguously negative: There was no evidence of differences between sisters from same- and opposite-sex twin pairs, and thus, no evidence of either androgenization or cross-sex socialization.

Adolescent↗
PubMed2004

Reproductive factors and extreme levels of maternal serum alpha-fetoprotein: a population-based study.

BACKGROUND: Levels of maternal alpha-fetoprotein (AFP) are increased during multiple gestations and preeclampsia but little is known regarding AFP levels in relation to other reproductive factors. Consequently, the objective of this work was to describe the possible relationship between AFP levels during pregnancy and maternal age at birth, maternal age at first birth, parity, time since previous birth and gender of the offspring. METHODS: Based on national registries we obtained the reproductive history on a population-based cohort of 44 227 women who had serum AFP levels determined in gestational weeks 14-21 and whose present and previous pregnancies resulted in live-born singletons. RESULTS: Many previous births and an interval of less than 2 years since last birth were significantly associated with extremely low levels of AFP in the mother. However, age at first birth and age at present pregnancy did not influence the AFP level. Women who gave birth to a girl had AFP levels that were 5%[95% confidence interval (CI) 4-6%] lower than those of women who had a boy. Adjustment for birthweight did not significantly affect the estimate. CONCLUSIONS: Low serum AFP levels in pregnancy are significantly correlated with high parity and with a short interval between births. The significantly lower levels of AFP in women who gave birth to girls could indicate a possible gender-specific regulatory mechanism.

Adolescent↗
PubMed2005

Histologic placental lesions in women with recurrent preterm delivery.

BACKGROUND: The aim of this study was to evaluate whether particular placental histopathology lesions are associated with recurrent preterm birth. METHODS: We analyzed a database of 413 consecutive singleton pregnancies delivered at <32 weeks with past reproductive history available. After the exclusion of nulliparous women, the pregnancies were divided according to the obstetrical history into group 1 (n = 328), women without prior preterm delivery (PTD); group 2 (n = 49), women with one prior preterm childbirth; and group 3 (n = 36), women with > or =2 prior preterm deliveries. Demographic and clinical variables were compared among the three groups by using Kruskal-Wallis test and chi-square test for trend. Finally, the individual placental lesions (i.e. 42 lesions of acute or chronic inflammation, uteroplacental vascular pathology, and intraplacental villous lesions) were correlated with the number of prior preterm deliveries by using regression analysis. A two-tailed P < 0.05 was considered significant. RESULTS: No differences were found among the three groups in demographic or clinical variables. Regression analysis of scored placental lesions corrected for gestational age at delivery showed that the number of prior preterm deliveries was correlated only with chronic marginating choriodeciduitis (correlation coefficient = 0.13; P = 0.01) and acute choriodeciduitis (correlation coefficient = 0.14; P = 0.008). CONCLUSIONS: Among women delivered at <32 weeks, those with prior preterm birth have histologic findings compatible with acute or chronic inflammatory involvement of the uterine cavity, suggesting that a prepregnancy endometrial infection rather than an ascending intrapregnancy pathway may be responsible for some recurrences of PTD.

Adult↗
PubMedDate not supplied

A case-control study evaluating the association of purposeful physical activity, body fat distribution, and steroid hormones on premenopausal breast cancer risk.

The objective of this case-control study was to investigate the relationship between purposeful physical activity, body fat distribution, body mass index, and steroid hormones. These factors are known to be implicated in modulating breast cancer risk in premenopausal women. A total of 112 newly diagnosed, premenopausal breast cancer patients and 106 age-matched premenopausal disease-free controls were admitted to the study. Information regarding personal, medical, hormonal, and reproductive history, smoking and alcohol use, physical activity history, and anthropometric measurements was obtained. Serum samples for steroid hormone assays were collected and analyzed. Disease-free premenopausal controls had a significantly higher physical activity index (PAI) (p</=0.05), however, significantly higher weight (p</=0.05), body mass index (BMI) (p=0.01), waist (p</=0.005) and hip (p</=0.05) circumferences, waist:hip ratios (p</=0.05), and serum total estradiol levels (p<0.0005) were observed in cancer cases. The final model using stepwise logistic regression analysis indicates that the variables that significantly predicted breast cancer risk were waist:hip ratio (odds ratio [OR]=1.11, p</=0.005) and serum total estradiol levels (OR=1.03, p</=0.0001). Our study provides some evidence that purposeful physical activity may reduce upper body fat distribution associated with adult weight gain. This may be a result of alterations in the steroid hormone pathway, such as reduced estradiol levels. This demonstrates the potential mechanism through which increased physical activity can reduce the risk for breast cancer in premenopausal women.

Adult↗
PubMed2007

Risk factors differ for non-small-cell lung cancers with and without EGFR mutation: assessment of smoking and sex by a case-control study in Japanese.

The present study aimed to assess the impact of smoking and sex for the risk of non-small-cell lung cancer (NSCLC) with or without epidermal growth factor receptor (EGFR) mutation. We conducted a case-control study using 152 patients with EGFR-mutated (EGFRmut) NSCLC, 283 with EGFR-wild-type (EGFRwt) NSCLC and 2175 age- and sex-frequency-matched controls. Smoking was a significant risk factor for EGFRwt NSCLC (odds ratio [OR] for ever-smokers, 4.05; 95% confidence interval [CI], 2.79-5.88) but not for EGFRmut NSCLC (OR, 0.73; CI, 0.46-1.14). Sex did not affect this association. The association was observed consistently with other smoking-related parameters including pack-years. Sex was the sole risk factor for EGFRmut NSCLC (OR for women relative to men, 2.19; CI, 1.41-3.39) and there was no significant interaction between women and smoking. In contrast, sex, smoking and their interaction were significant in EGFRwt NSCLC. The impact of sex on EGFR mutation status was assessed by several indicators of reproductive history among women. Total fertile years showed a significant positive association with EGFRmut NSCLC but not with EGFRwt NSCLC. Other indicators showed similar trends and this result may partly explain the sexual difference in the acquisition of EGFR mutation. In conclusion, our case-control study clearly demonstrated that the impacts of smoking and sex on the risk of EGFRmut NSCLC are different from those for EGFRwt NSCLC. Further epidemiological evaluation is warranted.

Aged↗
PubMed2004

New pregnancies and loss of allergy.

BACKGROUND: Inverse associations between allergic disease and sibship have been consistently described and are frequently explained by purported lower rates of early infection among children from small families. Alternative explanations include the possibility that pregnancy itself determines maternal atopic status. OBJECTIVE: To test the hypothesis that atopy defined by skin prick test (SPT) declines with increasing numbers of pregnancies. METHODS: At enrollment to a birth cohort, mothers were skin prick tested to three common allergens. Seven years later these women underwent a second SPT and provided information on their reproductive histories. At both visits, information on allergic disease was also sought. RESULTS: Twenty five (15%) women who were initially atopic were no longer so at the second visit; loss of hayfever symptoms was reported by 33 (29%) women. Women with higher numbers of intervening pregnancies were more likely to 'lose' their atopy (P=0.05) and symptoms of hayfever (P=0.02); this was not true for asthma. The findings could not be accounted for by maternal age. CONCLUSION: Successive pregnancies may in part determine a mother's atopic state. Since maternal atopy is a risk factor for childhood atopic disease, this process may affect the atopic state of successive children. These findings suggest an alternative explanation for the sibship effect in allergic disease.

Adult↗
PubMed1992

How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?

OBJECTIVE: We wished to determine the prevalence of polycystic ovaries (PCO) and relate morphological appearance to fertility. DESIGN: We sent postal invitations to a random sample of women born in the years 1952-1969 from a list of a single Group Practice to attend for reproductive history questionnaire, examination, ultrasound scan of the ovaries and hormone measurements within 5 days of the onset of menstruation. SUBJECTS: Of 1065 women potentially available for study, 571 (54%) replied of whom 353 (62%) agreed to participate. One hundred and ninety (18%) completed the study, 163 were deferred (57 because of current or very recent pregnancy, 106 because of inconvenience at time approached), and 18 additional women volunteered. MEASUREMENTS: Prevalence of polycystic ovaries, ovarian size and morphology, menstrual history, features of androgen excess, fertility status, serum hormone levels. RESULTS: The prevalence of PCO was 22% (41/190). PCO and non-PCO women were similar with respect to age, body mass index, oral contraceptive pill (OCP) usage, acne, and menstrual pattern but hirsutism (Ferriman and Gallwey score > 7) was significantly (P = 0.006) more frequent among PCO women. Proven prior fertility was the same in PCO (56%) and non-PCO (64%) women and an equal proportion in each group had not yet tested their fertility. Of those women with previously proven fertility, self-perceived difficulty in conception occurred in similar proportions of women with and without PCO. Unresolved primary or secondary infertility (2.5-4%) was similar in both groups. Ovarian volume (each ovary separately) was larger in women with PCO irrespective of current OCP usage. Serum levels of oestradiol and FSH were similar in PCO and non-PCO women, but LH was distributed around a higher median in PCO women. Median testosterone and androstenedione levels were the same in PCO and non-PCO women. CONCLUSIONS: The prevalence of polycystic ovarian morphology is high but, in this sample of women, was accompanied by minimal clinical manifestations and apparently no deleterious effects on earlier fertility. An isolated finding of polycystic ovaries may be a normal variation and should not necessarily imply altered fertility potential.

Adult↗