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PubMed2006

Parity and breast cancer risk among BRCA1 and BRCA2 mutation carriers.

INTRODUCTION: Increasing parity and age at first full-term pregnancy are established risk factors for breast cancer in the general population. However, their effects among BRCA1 and BRCA2 mutation carriers is still under debate. We used retrospective data on BRCA1 and BRCA2 mutation carriers from the UK to assess the effects of parity-related variables on breast cancer risk. METHODS: The data set included 457 mutation carriers who developed breast cancer (cases) and 332 healthy mutation carriers (controls), ascertained through families seen in genetic clinics. Hazard ratios were estimated by using a weighted cohort approach. RESULTS: Parous BRCA1 and BRCA2 mutation carriers were at a significantly lower risk of developing breast cancer (hazard ratio 0.54, 95% confidence interval 0.37 to 0.81; p = 0.002). The protective effect was observed only among carriers who were older than 40 years. Increasing age at first live birth was associated with an increased breast cancer risk among BRCA2 mutation carriers (p trend = 0.002) but not BRCA1 carriers. However, the analysis by age at first live birth was based on small numbers. CONCLUSION: The results suggest that the relative risks of breast cancer associated with parity among BRCA1 and BRCA2 mutation carriers may be similar to those in the general population and that reproductive history may be used to improve risk prediction in carriers.

Adult↗
PubMed2006

Factors related to genital tract trauma in normal spontaneous vaginal births.

OBJECTIVE: Episiotomy rates are declining in the United States. In settings with very low rates, evidence remains sparse on how best to facilitate birth without lacerations. The purpose of this investigation was to identify maternal and clinical factors related to genital tract trauma in normal, spontaneous vaginal births. METHODS: Data from a randomized clinical trial of perineal management techniques were used to address the study objective. Healthy women had spontaneous births with certified nurse-midwives in a medical center setting. Proportions of maternal characteristics and intrapartum variables were compared in women who did and did not sustain sufficient trauma to warrant suturing, according to parity (first vaginal births versus others). Logistic regression using a backward elimination strategy was used to identify predictors of obstetric trauma. RESULTS: In women who had a first vaginal birth, risk factors for trauma were maternal education of high school or beyond, Valsalva pushing, and infant birthweight. Risk factors in women having a second or higher vaginal birth were prior sutured trauma and infant birthweight. For all mothers, delivery of the infant's head between contractions was associated with reduced trauma to the genital tract. CONCLUSIONS: Delivery technique that is unrushed and controlled may help reduce obstetric trauma in normal, spontaneous vaginal births.

Adult↗
PubMed2002

A vital statistics system for determining births and mortality in the First Nations population of British Columbia, Canada.

We describe a unique method for producing province-wide and selected regional birth and death statistics for the First Nations population, We identified births and deaths of persons with Indian Status in the province of British Columbia, Canada, using three databases: the Vital Statistics Agency's database of births and deaths, the Department of Indian Affairs' Indian Status Verification File and the provincial health insurance plan's Status Indian Entitlement file. A birth or death was considered Status Indian if the person was so identified in any of the three sources. From 1991 through 1998, 24,159 live births were identified as Status Indian: 54% by all three sources, 29% by two sources and 17% by one source. In the same period, 5,680 Status Indian deaths were identified: 28% by all three sources, 38% by two sources and 34% by one source. Deaths were grouped by Underlying Cause and rates in each category were age-standardized for comparison to the general population. This project underscores the importance of using more than one database to ensure complete counting. Otherwise, birth and death rates will be underestimated. This has implications for national reporting if each province does not have a comparable system.

Birth Rate↗
PubMedDate not supplied

Teenage childbearing and welfare: preventive and ameliorative strategies.

The results of seven computer simulations suggest that strategies to prevent teenage childbearing may be more effective in reducing the number of young women who require welfare assistance than are strategies to improve the circumstances of teenagers who have already given birth. The first simulation constitutes a baseline projection, in which current levels and patterns of adolescent childbearing are assumed to continue to 1990. Three "preventive" simulations assume that no births or fewer births occur among teenagers during the projection period; and three "ameliorative" simulations assume that changes occur in the completed family size, marriage rate and educational attainment of teenage childbearers. Compared with the baseline projection, the three preventive strategies are estimated to reduce by 22-48 percent the number of adolescent childbearers who, as 20-24-year-olds in 1990, will be receiving welfare payments; the three ameliorative strategies cause only a 6-12 percent drop. The strategy with the least impact is the education scenario, in which adolescent mothers are assumed to be no more likely to drop out of school than are other comparable teenagers. The primary reason for the surprisingly small effect appears to be the relatively low earnings of women--even when they are high school graduates. All of the experimental scenarios tested, however, bring about at least some reduction in projected government spending for the three major public assistance programs considered (Aid to Families with Dependent Children, Medicaid and Food Stamps).

Adolescent↗
PubMed1994

Aspects of neonatal death in St Kilda, 1830-1930.

Neonatal death (mainly due to tetanus) was common in St Kilda until 1891. Two aspects of this phenomenon are studied; factors which predicted death, and the impact of neonatal death on family building. Maternal age appeared to be a predictive factor for death of the first child, but only in children of high birth order were other factors, particularly the number of previous neonatal deaths, important. The first birth interval appeared to be determined mainly by the date of the first birth, independent of neonatal mortality levels. For later intervals, the neonatal death of the previous child appeared to be the main determining factor.

Birth Intervals↗
PubMed2003

[Breast feeding during the first few days after birth: sometimes insufficient].

Two newborn infants that were receiving breast-feeding were admitted to hospital for drowsiness and jaundice on the 6th and 4th day of life, respectively; these were a male infant that had been yellow since the very first day and a female infant that did not grasp the breast properly. Both recovered thanks to phototherapy and the administration of extra fluids. Seven days after discharge, the female infant was readmitted for the same symptoms, after which the breast-feeding was found to be insufficient and the infant was put on bottle-feeding. In infants that are being breast-fed, insufficient intake can result in dehydration with all of its consequences. Such insufficient intake may be difficult to recognise. Weight loss greater than 5% implies that more frequent feeding is necessary and a loss of more than 10% may mean that supplementary feeding is necessary, albeit temporarily.

Birth Weight↗
PubMed2001

Hormonal factors and risk of aneurysmal subarachnoid hemorrhage: an international population-based, case-control study.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) is more common in women than in men, but the role of hormonal factors in its etiology remains uncertain. The aim of this study was to examine the relationship between hormonal factors and risk of SAH in women. METHODS: This was a prospective, multicenter, population-based, case-control study performed in 4 major urban centers in Australia and New Zealand. Two hundred sixty-eight female cases of first-ever aneurysmal SAH occurred during 1995-1998. Controls were 286 frequency-matched women from the general population of each center. Outcome measures included risk of SAH associated with use of oral contraceptive pills (OCPs), hormone replacement therapy (HRT), and various endogenous hormonal factors including menstrual patterns, parity, age at birth of first child, and breast-feeding practices. RESULTS: Cases and controls did not differ with regard to menstrual and reproductive history except in age at birth of first child, where older age was associated with reduced risk of SAH (odds ratio [OR], 0.63; 95% CI, 0.43, 0.91). Relative to never use of HRT, the adjusted OR for ever use of HRT was 0.64 (95% CI, 0.41, 0.98), which did not alter significantly after further adjustment for possible confounding factors. Borderline evidence of an inverse association was detected for past use of HRT (adjusted OR, 0.59; 95% CI, 0.30, 1.13) and current use of HRT (adjusted OR, 0.67; 95% CI, 0.40, 1.13), but there was no evidence of an association for use of OCPs (adjusted OR, 0.97; 95% CI, 0.58, 1.60). CONCLUSIONS: The risks of SAH are lower in women whose first pregnancy is at an older age and women who have ever used HRT but not OCPs. The findings suggest an independent etiologic role for hormonal factors in the pathogenesis of aneurysmal SAH and provide support for a protective role for HRT on risk of SAH in postmenopausal women.

Age Distribution↗
PubMed1987

Factors involved in the decline of the developmental quotient in the very low birth weight infant during the first two years.

The developmental status of 62 infants with birth weights less than 1,501 g was evaluated at nine or 12 months and at two years of age corrected for prematurity. The mean developmental scores were 99.8 at the first examination and 84.4 at the second, a significant drop (P less than 0.0001). Half of the infants (Group 1) dropped less than 16 points (mean score from 97.1 to 91.3) and half of the infants (Group 2) dropped less than 15 points (mean score from 102.8 to 76.9). The incidence of small for gestational age infants was overrepresented in Group 2. A multivariate analysis revealed that a group of factors including maternal hypertension and diabetes, gestational age, birth weight, and resuscitation at birth correctly classified 87 per cent of the infants into the two groups. The influence of this cluster of medical factors on developmental decline of the very low birth weight infant deserves further consideration.

Birth Weight↗
PubMed1981

Rh hemolytic disease of the newborn: using incidence observations to evaluate the use of RH immune globulin.

During the 1970s, the crude incidence of Rh hemolytic disease of the newborn (RhHDN) in the United States dropped 65 per cent---from 40.5/10,000 total births in 1970 to 14.3/10,000 total births in 1979. Since the risk of RhHDN is directly associated with birth order, changes both in birth order-specific RhHDN incidence rates and in the birth order distribution would be expected to influence crude RhHDN incidence. Review of birth order-specific incidences ascertained in Connecticut, 1972-1977, shows that incidence was stable for first and second births, whereas it dropped significantly for third and fourth births. Due to the nearly complete use of Rh immune globulin (RhIG) in Connecticut during these years, the drop in these specific rates is best attributed to this prevention strategy. Nationwide, during the 1970s, the annual percentages of fourth and higher order births decreased from 18 per cent to 10 per cent. We estimate that some 30 per cent to 40 per cent of the 1970-1979 drop in the crude rate is attributed to changes in the birth order distribution, whereas 60 per cent to 70 per cent of the drop is attributed to RhIG. However, comparison of pooled incidences for 1972-1974 and 1975-1977 observed in Connecticut for first births and births to 15-19 year olds showed significant increases for both groups in 1975-1977. Further study of specific trends from other areas is needed to confirm these observations. Also needed is investigation of likely causes of sensitization among these teenaged, primiparous women.

Birth Order↗
PubMedDate not supplied

Menarche, pregnancy, birth spacing and menopause among the Agta women foragers of Cagayan province, Luzon, the Philippines.

The reproductive histories of 74 post-menarcheal Agta Negrito women, tropical foragers of Cagayan province, north-eastern Luzon, the Philippines are described and analysed in comparison with data collected by Howell on Dobe !Kung hunter-gatherers. Among the Agta, mean age at menarche is 17, mean age at first live birth is 20.14 years, mean completed parity is 6.53 and mean age at menopause is 44. Average height is 141.24 cm and average weight 36.72 kg. No time trends were detected in age at menarche and age at first live birth among the Agta. Average spacing between live births where an infant survives until the birth of the next sibling was 2.85 years. Compared to the Dobe !Kung, Agta women have later menarche, but shorter birth spacing and a longer active childbearing span.

Adolescent↗
PubMed1996

[Thyroid hormones in dairy calves after birth and in the first days of life. Amplitude of variation, maternal-fetal relationships and reaction patterns specific to the individual].

Dairy calves and their dams from the dairy herd of the institute were used for this investigation. Calvings were watch carefully and jugular venous blood samples taken immediately after delivery from the cow and the calf and in the calf at 24 hours and at 48 hours of postnatal age as well were analyzed for T4, FT4, T3 and FT3 by luminescence enzyme immunoassay (LEIA). Higher thyroid values in calves than in their dams could be found increasing short after birth and reaching their highest level within 24 hours of postnatal life. The individual thyroid hormone values at birth and at 24 hours and at 48 hours of age are well correlated meaning the changes during the first days are specific for each calf. Strong correlation between the thyroid hormone values of the cows and those of the calves could be found. Mean values of thyroid hormones were significantly higher in female than in male calves all time but not different in the dams of these calves.

Aging↗
PubMed1993

Association of the common cold in the first trimester of pregnancy with birth defects.

OBJECTIVE: To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring. DESIGN: A case-control study. SETTING: Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987. SUBJECTS: A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls. RESULTS: Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95% CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95% CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95% CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias. CONCLUSION: Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously.

Adult↗
PubMedDate not supplied

Developmental progress in very low birth weight infants during the first year of life.

A multivariate study investigated developmental progress in very low birth weight infants (VLBW less than or equal to 1,500 grams) during the first year of life. The subjects were 41 VLBW infants (M birth weight = 1,203 grams) who were free from congenital anomalies and appropriate for gestational age. Eighteen infants were male, 23 were female. Data were gathered from the infants' charts and during home visits when the subjects were 6 and 12 months corrected gestational age. Birth weight, intraventricular hemorrhage status, number of days supported by mechanical ventilation, number of days in the intensive care nursery, socioeconomic status, and characteristics of the childrearing environment were examined in relation to developmental progress. Data were analyzed using multiple regression analysis and cross-lagged panel analysis. Environmental factors were powerful influences accounting for 67% of the variance in development at 1 year. Cross-lagged panel analysis suggested a causal relationship between the quality of the home environment and developmental achievement at 1 year.

Child Development↗
PubMed1988

Reproductive factors and risk of cancer of the uterine corpus: a prospective study.

Relationships between reproductive factors and risk of cancer of the uterine corpus were investigated in a prospective study of 62,079 women in Norway. A total of 420 cases were diagnosed during follow-up, from 1961 through 1980. The risk of endometrial carcinoma decreased significantly with increasing parity as well as with increasing age at first and last birth. The estimated odds ratio for women with 5 or more births versus uniparous was 0.60 in analyses with adjustment for age and residence characteristics. For first birth at age greater than or equal to 35 versus less than or equal to 19 the odds ratio was 0.48, and for last birth at age greater than or equal to 40 versus less than or equal to 24 we found an odds ratio of 0.45, in analyses with additional adjustment for parity. Significant associations were also found with age at menarche and menopause, the highest risks being observed for women with early menarche or late menopause. The different reproductive variables seemed to affect the risk of sarcomas of the uterine corpus and the risk of endometrial carcinomas in a similar way.

Adult↗
PubMed1997

Potassium metabolism in extremely low birth weight infants in the first week of life.

OBJECTIVE: Nonoliguric hyperkalemia has been reported to occur in the first week of life in as many as 50% of extremely low birth weight (ELBW) infants. We studied potassium balance and renal function in the first 5 days of life to characterize potassium metabolism during the three phases of fluid and electrolyte homeostasis that we have described in ELBW infants and to elucidate the factors that contribute to the development of nonoliguric hyperkalemia. STUDY DESIGN: Plasma potassium concentration (PK), potassium intake and output, and renal clearances were obtained for the first 6 days of life in 31 infants with a birth weight of 1000 gm or less. Collection periods in which urine flow rate was greater than or equal to 3 ml/kg per hour and weight loss was greater than or equal to 0.8 gm/kg per hour were denoted to be diuretic. Prediuresis includes all collection periods before the first diuretic period; diuresis includes all collection periods between the first and last diuretic periods; postdiuresis includes all collection periods after the last diuretic period. Infants with a PK greater than 6.7 mmol/L on at least one measurement were denoted to have hyperkalemia. RESULTS: PK increased initially after birth--despite the absence of potassium intake- and then decreased and stabilized by the fourth day of life. Diuresis occurred in 27 of 31 infants. The age at which PK peaked was closely related to the onset of diuresis. PK decreased significantly during diuresis as the result of a more negative potassium balance, despite a significant increase in potassium intake. In fact, PK fell to less than 4 mmol/L in 13 of 27 infants during diuresis. After the cessation of diuresis, potassium excretion decreased even though there was a significant increase in potassium intake, potassium balance was zero, and PK stabilized. Hyperkalemia developed in 11 of 31 infants. The pattern of change in PK with age was similar in infants with normokalemia and hyperkalemia: PK initially increased (essentially in the absence of potassium intake) and then decreased and stabilized by the fourth day of life. However, the rise in PK after birth was greater in infants with hyperkalemia than in those with normokalemia: 0.7 +/- 0.2 versus 1.8 +/- 0.2 mmol/L (p < 0.001). No differences in fluid and electrolyte homeostasis or renal function were identified as associated with hyperkalemia. CONCLUSIONS: PK increases in most ELBW infants in the first few days after birth as a result of a shift of potassium from the intracellular to the extracellular compartment. The increase in the glomerular filtration rate and in the fractional excretion of sodium, with the onset of diuresis, facilitates potassium excretion, and PK almost invariably decreases. Hyperkalemia seems to be principally the result of a greater intracellular to extracellular potassium shift immediately after birth in some ELBW infants.

Age Factors↗
PubMed1993

Changes in cerebral hemodynamics and oxygenation in the first 24 hours after birth asphyxia.

OBJECTIVE: To investigate whether or not postasphyctic cerebral hypoperfusion and decreased cerebral metabolism occur in the perinatally asphyxiated neonate, as has been reported in adults and newborn animals. METHODS: Using near-infrared spectroscopy, we monitored changes in oxyhemoglobin (HbO2), deoxyhemoglobin (HbR), total hemoglobin (HbO2 + HbR, which represents changes in cerebral blood volume [CBV]), and cytochrome oxidase (Cytaa3, which indicates changes in oxidation level of this intracerebral mitochondrial enzyme). Thirty-one neonates (gestational age > 34 weeks), divided into three groups, were monitored between 2 and 12 hours or between 12 and 24 hours of life. Group I consisted of healthy newborns: N = 8 (2 to 12 hours) and N = 5 (12 to 24 hours). Patients in group II were moderately asphyxiated newborns but neurologically normal in the first 24 hours of life: N = 6 (2 to 12 hours) and N = 3 (12 to 24 hours). Group III consisted of severely asphyxiated newborns with an abnormal neurologic behavior within 24 hours after birth: N = 5 (2 to 12 hours) and N = 4 (12 to 24 hours). RESULTS: From 2 to 12 h, CBV levels in groups I and II were stable. In group III CBV decreased in all infants. This decrease in CBV was associated with a drop in both HbO2 and HbR. Cytaa3 was stable in groups I and II, but showed a marked decrease in two of the five infants of group III. There was a positive relationship between CBV and mean arterial blood pressure in groups II and III. Between 12 and 24 hours, all groups showed stable CBV and Cytaa3 patterns. A positive relation existed now between transcutaneous PCO2 and CBV in groups II and III. CONCLUSIONS: CBV, HbO2, HbR, and Cytaa3 decreased in the first 12 hours of life in severely asphyxiated neonates who subsequently developed neurologic abnormalities. We therefore suggest that posthypoxic-ischemic reperfusion injury of the brain during early neonatal life occurs in neonates with severe birth asphyxia.

Asphyxia Neonatorum↗
PubMed1992

[Human papillomavirus type 16 and human cytomegalovirus in cervical carcinoma].

Using techniques of DNA-DNA dot blot hybridization, we examined 98 cervical specimens for the presence of human papillomavirus type 16 HPV-16 and human cytomegalovirus (HCMV) sequence and analysed the relationship between virus infection and various cervical diseases, age of patients, age at first coitus, age of first child birth, the number of pregnancy, use of oral contraceptives. The results showed that the rate of HPV DNA and HCMV DNA positivity in cervical carcinoma is significantly higher than that of non-carcinomatous tissue. In addition, the positivity correlates with age, at first intercourse, but not with age of first child birth, the number of pregnancy and use of oral contraceptives. These data suggested that HPV-16 and HCMV infection is associated with cervical carcinoma. Some cases of cervical erosion with HPV infection may lead to cervical. The high incidence of cervical carcinoma in women married early in life may be related to virus infection in adolescence. HPV acting with other synergistic factors, such as HCMV is considered to lead to the occurrence of cervical carcinoma.

Adult↗