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PubMed1997

The effects of own fetal growth on reported hypertension in parous women aged 33.

BACKGROUND: Data from the study of the British 1958 birth cohort, National Child Development Study (NCDS), has allowed wider investigation of the relationship between retarded fetal growth and risk of adult hypertension. METHODS: A history of self-reported hypertension was related to fetal growth in 3308 parous cohort members. Fetal growth, the measure used, is the difference in actual birthweight from that expected for the gestational age and subsequent adult height. The relationships were investigated both linearly and non-linearly adjusting for potential confounders. RESULTS: After adjustment for confounding factors, including adult weight for height, retarded fetal growth was associated with reported hypertension particularly when not confined to pregnancy. The latter was also associated with accelerated fetal growth, moderate or severe hypertension in the mother when pregnant with the cohort member, being relatively taller than your mother, and lack of educational qualifications. Hypertension confined to pregnancy was more likely among women who were themselves firstborn or older at childbirth. Neither maternal smoking during cohort's gestation nor cohort member's gestational age had a significant effect. The results are consistent with previous reports that fetal growth effects are less marked if gestation is short. CONCLUSIONS: The relationships between fetal growth and subsequent hypertension are extremely complex and variable, and need to be studied allowing for deviations from growth potential. Adult weight for height remains the strongest predictor of hypertension. The results suggest that losing weight is likely to have the same proportional benefit in women with and without a history of retarded fetal growth.

Adult↗
PubMed2002

Social system of the Alaotran gentle lemur (Hapalemur griseus alaotrensis): genetic characterization of group composition and mating system.

Group composition and mating system were investigated in wild Alaotran gentle lemurs (Hapalemur griseus alaotrensis) using genetic markers. These small-bodied herbivorous and cathemeral primates are endemic to the reed and papyrus beds around Lac Alaotra in Madagascar. They live in small groups in small, defended territories. Data were collected during the rainy seasons in 1996, 1997, and 1999, and include 99 individuals from 22 neighboring social groups and an additional 30 animals from other areas representing most of the geographic range. Animals were located by researchers canoeing in the marshes bordering the lake. After a group's size was determined by direct observation, all individuals were captured, marked, and released. During handling each individual was weighed and sexed, and hair samples for DNA extraction were collected. A 342 bp mtDNA control region sequence and 10 nuclear microsatellite loci provided multilocus genotypes that were used to assess pedigree relations and population structure. Alaotran gentle lemurs were found in groups of two to nine individuals (mean: 4.3), comprising one or two breeding females, their offspring, and one reproducing male. Solitary individuals of both sexes were encountered rarely. Breeding females were the permanent core of the social groups, whereas intergroup transfer of reproductive males was relatively frequent. Forty percent of all reproducing groups contained two breeding females, which were related to each other as closely as mother-daughter or full sisters. Parentage assessment revealed a variable mating system ranging from serial monogamy to polygyny within social groups. At least 8% of paternities involved extragroup males. Additional data on life history and reproduction are presented, and the social system of the Alaotran gentle lemur is discussed in the light of the new genetic findings.

Animals↗
PubMed1998

Epidemiology of sociodemographic characteristics, lifestyle, medical history, and colon cancer: a case-control study among French Canadians in Montreal.

Colon cancer is the second most common cancer in both men and women in North America and other developed countries. In a population-based case-control study of colon cancer among French Canadians in greater Montreal, a total of 402 cases and 668 controls were interviewed. The cancer cases were identified through the admission offices of five major Francophone teaching hospitals in Montreal from 1989 to 1993. The controls, matched by age, sex, place of residence, and language, were selected by a modified random digit dialing method. The results show that subjects who had ever been married had a lower risk for colon cancer (odds ratio [OR]: 0.58; 95% confidence interval [95% CI]: 0.48-0.84) than did individuals who had never been married. A significant association (OR: 1.90; p for trend = 0.003) was found between the height of subjects and the risk of colon cancer. The OR for individuals with a family history of colorectal cancer was 2.78 with a p value of 0.01. A direct and significant association (OR: 2.01) was found among constipation, use of laxatives (OR: 1.41), and the risk of colon cancer. Among women, a suggestive inverse association was detected between the number of full-term pregnancies and the risk of colon cancer in female subjects (the OR for five or more pregnancies was 0.58 with a p for trend of 0.08). There was also a suggestive linear trend (increased age-decreased risk) between age at menarche and the risk of colon cancer. No association was apparent between other sociodemographic characteristics and the risk of colon cancer. In conclusion, married individuals had lower risk for colon cancer, perhaps due to food habits or other characteristics of being single. Higher height and weight history 10 years before the diagnosis of cancer are risk factors for breast cancer, while both current weight and body mass index seem to be protective. Positive family history of colon cancer increased the risk of colon cancer significantly.

Adult↗
PubMed2006

Analysis of repeated pregnancy outcomes.

Women tend to repeat reproductive outcomes, with past history of an adverse outcome being associated with an approximate two-fold increase in subsequent risk. These observations support the need for statistical designs and analyses that address this clustering. Failure to do so may mask effects, result in inaccurate variance estimators, produce biased or inefficient estimates of exposure effects. We review and evaluate basic analytic approaches for analysing reproductive outcomes, including ignoring reproductive history, treating it as a covariate or avoiding the clustering problem by analysing only one pregnancy per woman, and contrast these to more modern approaches such as generalized estimating equations with robust standard errors and mixed models with various correlation structures. We illustrate the issues by analysing a sample from the Collaborative Perinatal Project dataset, demonstrating how the statistical model impacts summary statistics and inferences when assessing etiologic determinants of birth weight.

Adolescent↗
PubMed2000

Obstetric history and the risk of placenta previa.

OBJECTIVE: To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors. DESIGN: A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors. RESULTS: In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1,000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20-29 years. The recurrence rate was 23 per 1,000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at < or =25 gestational weeks the risk of placenta previa was 6.7 per 1,000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1,000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1,000 (adjusted OR= 1.8). No independent relationship emerged with socio-economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR= 1.3). CONCLUSIONS: We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio-economic factors.

Abruptio Placentae↗
PubMed1994

Do women forget their births? A study of maternity histories in a rural area of Senegal (Niakhar).

5068 maternity histories were recorded among women aged 15-89 years in a rural area of Senegal. The quality of the estimates of fertility, child mortality, and perinatal mortality was analyzed for consistency. There was no evidence of any major underreporting of births, deaths, or still births according to age, even among the oldest women. Estimates were compared with comparable values derived from a longitudinal demographic surveillance system (DSS) in the same area. The age patterns of cumulated fertility and mortality derived from the maternity histories were consistent with those of the DSS. Differences in the levels of fertility and mortality with respect to the longitudinal records could be explained by small differences within the selected villages, by selection biases, and by recent trends in demographic parameters. Values of perinatal mortality were also equivalent to those recorded by the DSS. Women did not seem to forget their births to an extent large enough to produce strong biases, even at older ages. However, an analysis of differences by field workers revealed that some 2% of the births and 4% of the deaths may have been omitted, which gives an idea of the potential accuracy of maternity histories for the estimation of fertility and mortality levels.

Africa↗
PubMed2001

Risk factors for vaginal trichomoniasis among women in Basra, Iraq.

We investigated Trichomonas vaginalis infection among 352 women with vaginal discharge, 46 were found to be infected, an infection rate of 13%. There were no significant differences in the isolation rate of T. vaginalis in women according to occupation, educational level, economic status, age, marital status, parity, menstrual status and contraception use. The difference in the isolation rates of T. vaginalis in women with a history of abortion (7.6%) and in women with no history of abortion (15.7%) was statistically significant.

Adolescent↗
PubMed2003

Sexual behaviour of lesbians and bisexual women.

OBJECTIVES: To provide data about the sexual histories of a large sample of lesbians and bisexual women, to inform those who provide health care or carry out research with women who may be sexually active with other women. DESIGN: Cross sectional survey. SETTING/SUBJECTS: 803 lesbians and bisexual women attending, as new patients, lesbian sexual health clinics, and 415 lesbians and bisexual women from a community sample. MAIN OUTCOME MEASURES: Self reported sexual history and sexual practice with both male and female partners. RESULTS: 98% of the whole sample gave a history of sexual activity with women, 83% within the past year, with a median of one female partner in that year. 85% of the sample reported sexual activity with men; for most (70%) this was 4 or more years ago. First sexual experience tended to be with a man (median 18 years old), with first sexual experience with a woman a few years later (median 21 years). Oral sex, vaginal penetration with fingers, and mutual masturbation were the most commonly reported sexual practices between women. Vaginal penetration with penis or fingers and mutual masturbation were the most commonly reported sexual activities with men. CONCLUSIONS: These data from the largest UK survey of sexual behaviour between women to date demonstrate that lesbians and bisexual women may have varied sexual histories with both male and female partners. A non-judgmental manner and careful sexual history taking without making assumptions should help clinicians to avoid misunderstandings, and to offer appropriate sexual health advice to lesbians and bisexual women.

Adolescent↗
PubMedDate not supplied

Cervical inflammation and preterm delivery in pregnant women with a history of preterm delivery.

BACKGROUND: A previous preterm delivery is a risk factor for preterm delivery in a subsequent pregnancy. We tested the hypothesis that evidence of inflammation on a Papanicolaou smear obtained during pregnancy is a risk factor for preterm delivery for women with a history of preterm delivery. METHODS: We studied women who had two singleton deliveries at a university hospital during an 8-year period. Women eligible for our study were those whose first delivery was preterm (< 37 weeks of gestation) and for whom a Papanicolaou smear was obtained during the second pregnancy. These smears were examined for evidence of inflammation by a cytopathologist. Information about the second pregnancy was obtained by chart review. RESULTS: The cytopathologist reviewed Papanicolaou smears from 92 study pregnancies and found evidence of cervical inflammation on 34 smears (37 percent). Preterm delivery ended 24 (26.1 percent) of the second pregnancies. The incidence of preterm delivery in women with inflammation on Papanicolaou smear was 41.2 percent compared with an incidence of 17.2 percent in women without inflammation (relative risk of 2.40 with a 95 percent confidence interval of 1.19 to 4.83). This association remained significant after controlling for potential confounding variables. A stratified analysis found that the association of cervical inflammation with preterm delivery was limited to women who had systemic exposure to an antibiotic during pregnancy. CONCLUSION: Among pregnant women with a history of preterm delivery, evidence of inflammation on Papanicolaou smear was associated with an increased risk of preterm delivery. If replicated in other studies, this finding might have implications for the management of pregnancies in women with a history of preterm delivery.

Adult↗
PubMed1993

Describing time-trends in fertility using maternity history information.

"The problems that can arise in documenting trends in mean family size, parity progression ratios, mean age at birth and interbirth intervals are examined by means of the maternity histories collected in the [U.K.] General Household Survey of 1989. Methods of removing the various biases are discussed. The advantages and disadvantages of adopting each approach are discussed. The period parity progression approach to fertility measurement is the most efficient way of using maternity history information to document trends, but it is a little more complex to apply than other methods."

Age Factors↗
PubMed1999

Childbearing history associated with improved survival in choroidal melanoma.

BACKGROUND: Research in cutaneous melanoma suggests that women may experience better tumor-dependent survival than men, and some studies have shown that the advantage is specific to childbearing. OBJECTIVE: To examine whether childbearing may be a favorable prognostic factor in melanoma of the uveal tract. DESIGN: Prospective follow-up study. SETTING: Hospital. MAIN OUTCOME MEASURE: Death from metastatic choroidal melanoma. METHODS: We evaluated a consecutive series of 1818 patients with choroidal melanoma, 748 parous and 165 nulliparous women and 905 men, after treatment with proton irradiation. Three hundred fifty-two deaths from metastasis were documented in follow-up. RESULTS: Overall multivariate-adjusted death rates from metastasis were approximately 25% higher in nulliparous women (relative risk [RR], 1.23; 95% confidence interval [CI], 0.83-1.82) and men (RR, 1.25; 95% CI, 1.00-1.56) than in women who had given birth. The protective influence of parity was strongest in the early period following diagnosis and treatment (RR, 1.58; 95% CI, 0.88-2.86, and RR, 1.51; 95% CI, 1.04-2.19, in nulliparous women and men, respectively, during the first 36 months of follow-up). The level of protection increased with the number of live births (P for trend, .04). CONCLUSION: These data provide support for the hypothesis that a history of childbearing confers protection from death in choroidal melanoma.

Adolescent↗
PubMed2002

Lung cancer risk among Czech women: a case-control study.

BACKGROUND: Few data are available to explain the ongoing increase in lung cancer mortality among Czech women. The study is aimed at examining the role of smoking and known or suspected cofactors. METHODS: Data collected by in-person interviews from 269 female lung cancer cases and 1079 controls were analyzed using unconditional logistic regression and other methods. RESULTS: Cigarette smoking was the most important factor associated with excess risk of lung cancer among women. Risk was increased both among current smokers (OR = 10.30), long-term ex-smokers (> or =10 years ago; OR = 3.79), and short-term ex-smokers (<10 years ago; OR = 14.63), all compared against never-smokers. In addition, significant associations with risk were found for chronic cough, chronic phlegm of less than 2-year duration, and shortness of breath. Inverse associations emerged for physical exercise and body mass index. Excess risk associated with consumption of red meat and poultry, and protective effects associated with intake of vegetables were restricted to squamous-, small-, and large-cell cancers combined, but were not apparent for adenocarcinoma. CONCLUSIONS: While smoking has been verified to be the main determinant of lung cancer risk among Czech women, cofactors such as diet, history of lung disease, and lifestyle factors may have a contributory role.

Adult↗
PubMed1985

Female reproductive health in two lamp factories: effects of exposure to inorganic mercury vapour and stress factors.

To evaluate the possible influence of mercury vapour on female reproduction, 153 women working in a mercury vapour lamp factory have been compared with 193 women employed in another factory of the same company, where mercury was not used. Both groups of subjects were exposed to stress factors (noise, rhythms of production, and shift work). The production process has been analysed by inspection of the plants and by collective discussions with "homogeneous groups" of workers; a retrospective inquiry into work history and reproductive health events has been subsequently performed by an individual interview. Women exposed to mercury vapour currently not exceeding the time weighted average air concentration of 0.01 mg/m3 declared higher prevalence and incidence rates of menstrual disorders, primary subfecundity, and adverse pregnancy outcome; however, the progression of these problems with the level of exposure to mercury inside the same factory was not always clear. The results of this study neither prove nor exclude the possibility that occupational exposure to this concentration of mercury has a negative effect on female reproduction.

Adult↗
PubMed2005

Fertility history and health in later life: a record linkage study in England and Wales.

Women born at different periods within the 20th century in England and Wales have followed varying fertility pathways with large changes in, for example, proportions having no children or only one child. Among the consequences of these changes may be effects on women's health later in life. Links between fertility histories and later health and mortality have been investigated in several studies, but in many of these socio-economic characteristics have not been allowed for, even though there are socio-economic differences in both fertility and mortality patterns and results are conflicting. Here we analyse associations between the fertility histories of women born 1911-1940 in England and Wales and their mortality and health status after age 50. We used data from the Office for National Statistics Longitudinal Study; a record linkage study of approximately 1% of the population initially based on those enumerated in the 1971 Census of England and Wales. We used survival analysis to investigate the effects of parity, short birth intervals, and timing of fertility on mortality from age 50 to the end of 2000, controlling for a range of relevant socio-demographic characteristics. For survivors to 1991, we additionally used logistic regression to model probability of having a limiting long-term illness in 1991. We found that nulliparous women and women with five or more children had significantly higher mortality than other women, and that in the oldest groups women with just one child also had raised mortality. Women who had been teenage mothers had higher mortality and higher odds of poor health than other parous women. Mothers with short birth intervals, including mothers of twins, also had elevated risks in some cohorts. Late childbearing (after age 39) was associated with lower mortality. Personal demographic history is an important factor to consider in analyses of health and mortality variations in later life. More research is needed to further elucidate causal pathways.

Birth Intervals↗
PubMed2000

Primary and secondary infertility in sub-Saharan Africa.

BACKGROUND: No previous study has provided national estimates of the prevalence of primary and secondary infertility in sizeable areas of sub-Saharan Africa. METHODS: Primary infertility is measured by the proportion childless among women who entered their first marriage at least 7 years before date of censoring. Secondary infertility is measured by the 'subsequently infertile estimator' from parous ever-married women. Exposure begins at the age of the woman at the birth of her first child, and exposure ends when the woman is of an age, which is 5 years lower than her age at censoring. These last 5 years are used to determine her status as infertile or fertile at the last observation 5 years before censoring. A woman is considered infertile at last observation if she has had no livebirths during the last 5 years before censoring, otherwise she is considered fertile. A woman who has not given birth at age a or later is defined as being 'infertile subsequent to age a'. The index of the proportion subsequently infertile at age a is estimated as the number of women infertile subsequent to age a, divided by the total number of women observed at that age. Infertility is estimated for women age 20-44. RESULTS: Primary infertility is relatively low and it exceeds 3% in less than a third of the 28 African countries analysed. In contrast, elevated levels of secondary infertility prevail in most countries. Secondary infertility for women age 20-44 ranges from 5% in Togo to 23% in Central African Republic. CONCLUSIONS: It is feasible to gauge national levels of primary and secondary infertility from population based surveys including a birth history. The prevalence of infertility of pathological origin is so high in sub-Saharan Africa that infertility is not merely an individual concern, it is a public health problem.

Adolescent↗
PubMed2003

Modification of family size in families reporting history of haemophilia from Maharashtra, India.

BACKGROUND: In India, genetic counselling services are largely unavailable. The question of whether awareness of the hereditary nature of the disorder leads to modified family size in affected families remains unanswered. The objective of this study was to determine whether family history of haemophilia resulted in modification of family size in families reporting haemophilia in the State of Maharashtra, India. METHODS: The study was a retrospective cohort analysis from pedigrees collected from an earlier survey on haemophilia in Maharashtra. Pedigree data were manually defined into families with or without experience of haemophilia. Family size was defined as the number of live births per woman as documented in the pedigree. The data were analysed using Microsoft Excel package (version 2000) and SPSS package (version 10). RESULTS: Family size of obligate carriers who were daughters of patients was significantly less than the family size of obligate carriers who reported haemophilia in a brother or maternal relative (z = 7.14, P < 0.001). As compared with parents from an older generation, a significant reduction in the number of children born to younger families with haemophilia was observed, irrespective of family history of the condition. In families with history of haemophilia, there was no significant reduction in the number of families with more than one affected son in between two generations of parents (chi(2) = 1.43). CONCLUSIONS: The results revealed a reduction in size of families with haemophilia over a generation, which possibly reflected the reducing fertility trends observed in the Indian population. Reduction in the number of children born to women with a haemophilic father suggested a comprehension of father to daughter transmission of haemophilia. This was not true when relatives other than the father were affected. The lack of significant reduction in the number of families with history of haemophilia of having more than one affected son may suggest a compensatory response to the high mortality associated with the disorder in India.

Cohort Studies↗
PubMed1995

Distribution and determinants of low birthweight in central Sudan.

Two studies were conducted during 1989-90 in Central Sudan to determine the incidence of low birthweight and to ascertain the major risk factors which influence birthweight. In a hospital-based investigation, surveillance of all births was accompanied by a nested case-control study, and in a community based investigation, all midwife-assisted births were studied. There were 4868 and 1523 livebirths among the hospital and community populations, respectively. The incidence of low birthweight was 18.1% in the community and 8.2% in the hospitals. The ratio of term to pre-term low birthweight was 2.9 in the community but only 1.3 in the hospitals. Several risk factors showed consistent and significant associations with low birthweight in the hospital and community studies. Two important and modifiable predictors of term and preterm low birthweight were low maternal weight and malaria infection during pregnancy. Other risk factors included low socio-economic status and, among the hospital population, lack of antenatal care, short birth intervals, poor obstetric history and complications of pregnancy.

Case-Control Studies↗