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PubMed2002

Parkinson's disease and reproductive life events.

Onset, progression and duration of Parkinson's disease (PD) seem to be similar in men and women but gender differences have been suggested concerning clinical aspects, such as more severe disease in men and more dyskinesia in women. Taking into account the multiple influences of sex hormones, estrogens in particular, on basal ganglia function, the present work compared the characteristics of reproductive events in PD subjects and in healthy women, with regard to onset and clinical aspects of the disease with respect to the milestones of reproductive life. A total of 150 PD women and 200 healthy women matched for age were interviewed about reproductive life and disease characteristics (if patients). As a group, the women with PD had menarche later than the controls, but in the normal range. Menopause was similar to the controls for time, type (natural) and onset (slow), but with less hormonal therapies. Women with PD had fewer children, while breast feeding and gynecological diseases were comparable to controls. The characteristics of menses were similar as far as dysmenorrhea and premenstrual syndrome (PMS). The women with PD onset before menopause had a longer disease duration, with a more frequent fluctuating stage, and longer treatment with both levodopa and dopamine agonists. They had more dysmenorrhea and PMS when compared with women with PD onset after menopause and controls.

Adult↗
PubMed2005

Estrogen metabolizing polymorphisms and breast cancer risk among older white women.

OBJECTIVE: To investigate breast cancer risk according to metabolizing genes polymorphisms in older women. METHODS: A subset (43.8%) of 4248 older, white women from the Study of Osteoporotic Fractures (SOF) were genotyped for the catechol-O-methyltransferase (COMT) Val108Met polymorphism and the CYP1A1*2C locus. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between genotypes and breast cancer while controlling for potential confounders. RESULTS: During a mean follow up of 12.4 years, 252 women (5.9%) developed breast cancer. The HR (95% CI) for breast cancer was 1.24 (0.87-1.75) for COMT(Val/Met) and 1.35 (0.93-1.97) for COMT(Met/Met). No interactions with lifestyle and reproductive factors were found. The HR associated with the CYP1A1*2C Val allele was 0.80 (0.46, 1.39) with little evidence for interactions with lifestyle or reproductive factors. CONCLUSIONS: Among older white women, neither the COMT Val108/158Met polymorphism nor the CYP1A*2C Val allele plays a major role in breast cancer risk either alone or in combination with lifestyle and reproductive factors.

Aged↗
PubMed2006

Reproductive factors and breast cancer risk among older women.

Reproductive factors have been shown to affect pre- and postmenopausal breast cancer risk differently, but whether there are additional age-specific differences among menopausal women as they age has not been clarified. We analyzed data from a large population-based case-control study that included 1,508 breast cancer cases and 1,556 controls, aged 20-98 years, who completed an in-home interviewer-administered questionnaire. The following subgroups were created to examine if the associations between reproductive factors and breast cancer risk varied by age- and menopausal-status: premenopausal (n=968), postmenopausal <65 years (n=1,045), postmenopausal >or=65 years (n=958). Among postmenopausal women >or=65 years, ever having breastfed decreased risk (odds ratio (OR)=0.67, 95% confidence interval (CI)=0.48, 0.92), and a strong dose-response relationship was observed for longer durations of breastfeeding (P trend=0.02), with the most pronounced protective effect observed for >or=14 months of breastfeeding (OR=0.40, 95% CI=0.21,0.76). Late age at first birth (AFB) and older age at last birth (ALB) were associated with non-statistically significant increases in breast cancer risk in this older group, while late age at menarche and surgical menopause decreased risk. ORs for multiparity were close to the null. Among premenopausal women and postmenopausal women <65 years, multiparity significantly decreased risk, and older AFB nonsignificantly increased risk. Our findings suggest that the well-known protective effect of multiparity attenuates with older age. Moreover, breastfeeding, one of the few potentially modifiable risk factors for breast cancer, was an important factor in decreasing risk among older parous postmenopausal women.

Adult↗
PubMed2006

Do breast cancer risk factors modify the association between hormone therapy and mammographic breast density? (United States).

OBJECTIVE: To evaluate whether the association between hormone therapy (HT) and breast density differs by levels of breast cancer risk factors. METHODS: We evaluated 80,867 screening mammograms from 39,296 postmenopausal women from Washington State. We estimated odds ratios and 95% confidence intervals for dense breasts (Breast Imaging Reporting and Data System categories 3 "heterogeneously dense" and 4 "extremely dense") compared to fatty breasts (categories 1 "almost entirely fat" and 2 "scattered fibroglandular") among HT users compared to never users. We separately examined former HT use and current HT use by type (estrogen plus progestin therapy (EPT) and estrogen-only therapy (ET)). We stratified the associations by age, BMI, race, family history, and reproductive and menopausal factors. RESULTS: Current EPT users had a 98% (1.87-2.09) greater odds of having dense breasts and current ET users had a 71% (1.56-1.87) greater odds compared to never users. Current HT users were more likely to have dense breasts if they were older, had more children, or younger at first birth compared to never users; these associations were stronger among EPT users than ET users. CONCLUSIONS: HT, particularly EPT, may reduce protective effects of older age, parity, and younger age at first birth on mammographic density.

Adult↗
PubMed2006

Reproductive patterns and non-Hodgkin lymphoma risk in Danish women and men.

Reproductive patterns have been inconsistently linked to risk of non-Hodgkin lymphoma (NHL) in women, and fathering patterns in relation to NHL risk have not been studied. The authors conducted a register-based cohort study of 4.1 million Danes to investigate associations of livebirths with subsequent NHL incidence (85 million person-years, 3819 NHL cases). The impact of induced abortions, ectopic pregnancies, spontaneous abortions, missed abortions, stillbirths, and hydatidiform moles on subsequent NHL incidence was studied in a subcohort of 1.2 million women. Ratios of NHL incidence rates, accompanying trend tests and two-sided p-values were calculated by log-linear Poisson regression analyses. Pregnancies, whether ending in livebirths or not, were unrelated to NHL incidence in women. The only statistically significant finding in women was that, among parous women, age at first child-birth was inversely associated with NHL incidence (p-trend = 0.001). In men, there was no overall difference in NHL incidence between fathers and non-fathers. However, in men with children, NHL risk declined with increasing number of children (p-trend = 0.02) and increased with time since birth of the most recent child (p-trend < 0.001). Pregnancies have limited impact, if any, on subsequent NHL risk in women. Our findings in men need replication, but, if verified, they may reflect lymphomagenesis-associated male subfertility prior to NHL diagnosis.

Cohort Studies↗
PubMed2006

Self-reported reproductive outcomes among male and female 1991 Gulf War era US military veterans.

BACKGROUND: Following the 1991 Gulf War, some veterans expressed concerns regarding their reproductive health. Our objective was to assess whether an association exists between deployment to the 1991 Gulf War and self-reported adverse pregnancy outcomes. METHODS: Using a modified Dillman technique with telephone follow-up, we conducted a survey via a postal questionnaire from February 1996-August 1997 to compare selected reproductive outcomes among 10,000 US veterans deployed to the 1991 Gulf War with those of 10,000 nondeployed Gulf War era veterans. RESULTS: A total of 8742 individuals responded to the survey, a response rate of 51 percent. Using multivariable analyses, results showed no differences in number of reported pregnancies between Gulf War veterans and nondeployed veterans. Among 2233 female and 2159 male participants, there were no differences in birth weight of infants born to Gulf War veterans compared with nondeployed Gulf War era veterans. In multivariable models, male and female Gulf War veterans did not significantly differ in risk for ectopic pregnancies, stillbirths, or miscarriages when compared with nondeployed veterans of the same era. CONCLUSIONS: These results do not suggest an association between service in the 1991 Gulf War and adverse reproductive outcomes for both male and female veterans during the 4 years after the war.

Abortion, Spontaneous↗
PubMed2006

Gynecological characteristics related to breast cancer in pre and postmenopausal women.

BACKGROUND: The objective of this study was two fold: to identify gynecological characteristics that distinguish women diagnosed with early-stage breast cancer from those at more advanced stages; to identify distinguishing characteristics between premenopausal and postmenopausal women diagnosed with the same stage. POPULATION AND METHOD: 186 incident cases diagnosed with breast cancer were identified out of the 685 patients who were seen to in 2000-2001. The variables to be studied were obtained by means of a specific questionnaire which collected data concerning reproductive characteristics and contraceptive types. RESULTS: Significant differences in the mean age were found, since the early-stage group was younger (57.01+/-12.82 vs. 65.06+/-15.11). Characteristic factors found in pre-menopausal women were: early menopause, they either had no children or a single child, no breastfeeding practice and a more extensive use of contraceptives. Postmenopausal women presented more advanced stages, more pregnancies and less abortions. CONCLUSIONS: By taking the obtained results into consideration, it would be recommendable to bring forward the age at which women are to be included in early detection programmes, and to conduct a follow-up of those women who present such factors to favour an earlier diagnosis of the disease.

Abortion, Induced↗
PubMed1975

The current status of prostaglandins as abortifacients.

The present use and potential uses of prostaglandins as abortifacients are summarized. Pertinent history, chemistry, prostaglandins' possible role in physiologic and pathologic processes and pharmacologic actions are discussed. The results of natural prostaglandins and their analogues by systemic and intrauterine administration for the purposes of postcoital contraception, menstrual regulation, first- and second-trimester abortion, preoperative dilation of the cervix, and delivery of patients with death in utero are presented. The only approved method of induction of abortion with prostaglandins, prostaglandin F2alpha by the intra-amniotic route for the induction of midtrimester abortion, is evaluated and compared to other methods of midtrimester abortion. It was concluded that: (1) the present use of prostaglandins is an important addition to the obstetrician's armamentarium, (2) more effective and/or convenient methods that are useful in patients over a wider gestational age appear to have been defined, and (3) the routine use of prostaglandins for postcoital contraception, menstrual regulation, and first-trimester abortion will require the development of analogues that are more specific as to their abortifacient actions than the natural prostaglandins and/or the development of improved delivery systems.

Abortifacient Agents↗
PubMed1983

Clinical chemistry in women treated with levonorgestrel implants (Norplant) or a TCu 200 IUD.

Two groups of implant users and two groups of IUD users participated in the study at different times. In the first groups, fractionation of lipoproteins was performed on serum samples from 28 subjects who had used the implants for 37 months and from 26 subjects who had used the Copper TCu 200 for 30 months. Users of the implants had significantly lower levels of total cholesterol, triglycerides and LDL-cholesterol than users of the IUDs. HDL-cholesterol levels were not different between the groups. In the other groups of women, general chemistries and selected hormone assays were carried out on samples from 30 subjects who had used implants for 51 months and from 24 subjects who had used the TCu 200 IUDs for 43 months. The parameters studied were the SM-12 chemistry group profile, estradiol, cortisol, testosterone, triiodothyronine, thyroxine and thyroid stimulating hormone. In the implant group, mean serum glucose levels were statistically significantly elevated and inorganic phosphorus levels were significantly reduced as compared to the IUD group. In both cases all individual measurements were within the normal range for the population. Testosterone and triiodothyronine levels in the implant group were significantly lower than in the IUD group, but no individual values were outside the normal range for the population. Mean values for all other parameters were not significantly different between the groups.

Adult↗
PubMed1994

The use of contraceptive methods among women seeking a legal abortion.

In a simple random sample study of 404 women 20 to 29 years of age, 201 applying for abortion and 203 continuing their pregnancies, all were interviewed personally and requested to complete a questionnaire. The aim of the study was to analyse the use and experience of contraceptives among the abortion applicants in this age group, and to compare their experience with that of women in a matched control group. The most important reasons given for desisting in the use of contraceptives were the experience of side effects, worry about the side effects, and the "human failure" factor involved even with methods of contraception such as pills, which generally are regarded as safe. This study demonstrates that women living alone without any permanent relationship, having a strained economy or having previously had an abortion, need particular and detailed contraceptive advice plus continued close follow-up. To improve the continuation rate, precise contraception counselling focusing on both positive and adverse effects to reduce worry seems essential.

Abortion Applicants↗
PubMed1994

Oral contraceptive use and benign gallbladder disease; revisited.

An analysis is described of 482 women with benign gallbladder disease (surgically confirmed in 407) identified in the Oxford Family Planning Association contraceptive study. There was no significant overall association between oral contraceptive use and gallbladder disease (relative risk ever use to never use 1.1, 95% confidence interval 0.9 to 1.3). Likewise, duration of oral contraceptive use had no significant effect (relative risk 97 or more months use to never use 1.1, 95% confidence interval 0.8 to 1.5). There was no indication of any interaction between oral contraceptive use and body mass index or oral contraceptive use and age in the production of disease. It is concluded that it is unlikely that oral contraceptives are of either clinical or public health significance in relation to the occurrence of gallbladder disease.

Adult↗
PubMedDate not supplied

Home birth in the United States, 1989-1992. A longitudinal descriptive report of national birth certificate data.

This study was conducted to profile home birth in the United States from 1989 to 1992 using two birth certificate data sources from the Natality Branch of the National Center for Health Statistics (NCHS). Analysis included published and unpublished descriptive tables about all U.S. home births from 1989 to 1992, and a subset of the 82,210 U.S. home births from 1989 to 1991 that were drawn from NCHS national birth certificate data tapes. Results indicated that less than one-third of reported home births were attended by nurse-midwives or physicians. Distinct regional patterns in the frequency of home births were observed, with higher concentrations in the southwestern and western states. When compared with the average childbearing woman in the United States, mothers who gave birth at home were more likely to be older, have fewer years of education, be married, and be white; they were also more likely to be of higher parity and to receive less prenatal care. Home birth mothers were less likely than average to smoke or drink alcohol prenatally, to have a prenatal medical risk condition or an obstetric complication, or to receive certain prenatal tests. The outcomes of newborns born at home compared favorably to the national average during the same period. Several findings varied considerably by race or ethnicity of the mother.

Birth Certificates↗
PubMed1994

Risk factors for placenta praevia.

Risk factors for placenta praevia have been analysed in a case control study conducted in Milan, Italy. A total of 140 cases of placenta praevia and the two women who delivered healthy babies consecutively after each index case (280 controls) were identified reviewing clinical records of 49,765 registered deliveries at the Clinica Mangiagalli in Milan from 1979 to 1991. An increased relative risk (RR) of per cent confidence interval, CI, 2.3-6.7) and among those with previous abortions (RR = 1.8, 95 per cent CI, 1.2-2.8) or with more than one previous pregnancy (RR = 1.9, 95 per cent CI, 1.1-3.3). A non-significant trend in risk was observed with parity (RR = 1.2 for one and 1.5 for two previous deliveries versus nulliparas) and for caesarean section (RR = 1.2 for one and 2.1 for two previous caesarean deliveries versus no previous caesarean section). No relation emerged with sex of the newborn and multiple pregnancy and risk of placenta praevia. Our study shows that older age and previous abortions are associated with an increased frequency of placenta praevia.

Adult↗
PubMed1994

The influence of reproductive status on rural Kenyan women's time use.

To determine the effects that pregnancy and infant care have on Embu women's commercial, agricultural and household activities, time use patterns were studied for women at different stages of pregnancy and lactation. Time allocation data were collected from 169 households, visited at random intervals over a year, by use of the spot observations technique. Detailed reproductive data were collected monthly, and household socioeconomic data quarterly. Analyses of Embu women's time use by reproductive status reveal that the demands of pregnancy and lactation require women to decrease the amount of time spent on subsistence agriculture, commercial activities, housework, and tending animals; and to devote more time to resting, breastfeeding, and child care. Agricultural and economic activities are curtailed especially in the 3rd trimester of pregnancy and the 1st period of lactation. This data provide insight into how pregnancy and lactation require women to adjust their time allocation between reproductive and farm labor activities. This decrease in time spent on subsistence agriculture, commercial activities, and household work increases the risk of household economic insecurity during the woman's reproductive years.

Activities of Daily Living↗
PubMed1996

Urbanisation, household composition and the reproductive health of women in a South African city.

Post-apartheid South Africa is faced with the effects of a distorted urbanisation process. A coherent response to urbanisation includes the mitigation of the adverse health effects of urbanisation. Women, by virtue of the stringent control of their movements to urban areas under apartheid, have migrated to the urban areas at an increasing rate recently. One consequence has been the transformation of traditional household structures consonant with changing patterns of fertility and infertility in the urban areas. This paper describes the composition of households in Khayelitsha, South Africa, a suburb that has seen an explosive increase in population over a 5-year period, from 5000 to an estimated 250,000 people. A survey of 659 households revealed the woman-headed households increased from 11% in those women who had been in the urban areas for fewer than 5 years, to 35% in those who had been in the urban areas for more than 20 years. This was not a function of widowhood or divorce, but appears to be an adaptive strategy adopted by women in the face of gender oppression in a harsh urban environment. The study also revealed the phenomenon of "alliance" household formation, in which atypical households made up of a variety of non-descript combinations of people provide support for women from remote rural areas, another adaptive strategy. Fertility was related to age, income, education and urbanisation. Women who had been in the urban areas for longer than 10 years had a total fertility rate (TFR) of 2.5, while those who had been in the urban areas for less than 10 years had a TFR of 5.8. Reported infertility was related to marital status, education, gynaecological illness and urbanisation, with recently urbanised women reporting more infertility. This probably reflects the different expectations of rural women and changes the mix of attitudes to fertility in the urban areas substantially. These findings have major implications for population policies in South Africa and an eclectic mix of approaches, including small area-specific approaches, to family spacing is recommended.

Adolescent↗
PubMed1996

The role of reproductive and menstrual factors in cancer of the breast before and after menopause.

The aim of the study was to elucidate the role of reproductive and menstrual factors in the aetiology of breast cancer, overall and by menopausal status. A cooperative case-control study was conducted between 1991 and 1994 in six different Italian areas (including three from the centre and the south). The study included 2569 histologically confirmed incident cases of breast cancer (median age 55 years, range 23-78 years) and 2588 control women (median age 56 years, range 20-79 years) admitted to the same hospitals for a variety of acute conditions unrelated to the hypotheses in study. A trend of increasing risk with increasing age at menopause (odds ratio (OR) for age at menopause > or = 53 versus < 45 years = 1.8; 95% confidence interval (CI) = 1.4-2.2). High parity reduced cancer risk (OR for > or = 4 versus 1 birth = 0.7; 95% CI = 0.5-0.9). Overall, nulliparous women showed a 20% lower risk than uniparous ones (OR = 0.8; 95% CI = 0.7-1.0). Late age at first birth (or pregnancy) had an independent adverse effect (OR for first birth at > or = 32 versus < 20 years = 1.7; 95% CI = 1.3-2.1) both before and after menopause. An approximately 2-fold elevation of breast cancer risk was evident up to 10 years after the last birth. No trend in risk was evident for induced abortions (OR = 1.2 for 1 and 1.1 for > or = 2 induced abortions versus 0). Other examined menstrual and reproductive characteristics did not seem important. Multiparity, early age at first birth and early age at menopause were therefore the most important determinants of breast cancer risk. The effects of the timing of births was significantly heterogeneous in pre- and postmenopausal women because of the transient adverse effect of such events, evident only in premenopausal women.

Adult↗