A systematic review and meta-analysis of family history and risk of ovarian cancer

Objective To estimate the relative risk and lifetime risk of ovarian cancer in women with various categories of family history.
Design A meta-analysis of all published caseecontrol and cohort studies.
Methods Pooled relative risk estimates were calculated for the caseecontrol studies, using the Mantel-Haenzel method. These estimates were combined with the relative risks from the cohort studies. The pooled estimates of relative risk were used to estimate lifetime risks of ovarian cancer from age 15 Up to age 75, for various categories of family history.
Main outcome measures Relative risks and lifetime risks of developing ovarian cancer were calculated for the categories of women with 1. an affected first degree relative; 2. an affected mother; 3. an affected sister; and 4. women with more than one affected relative.
Results The relative risk to first degree relatives is 3.1 (95% CI 2.6–3.7). There is some evidence that this relative risk declines with age. The relative risk to mothers of cases 1.1 (95% CI 0.8–1.6) was lower than the relative risks to sisters: 3.8 (95% CI 2.9–5.1), and daughters: 6.0 (95% CI 3.0–11.9); the explanation of this difference is unclear.
Conclusions Women with a family history of ovarian cancer have a substantially higher risk of developing ovarian cancer compared with women without such a history. However the risk is small for most categories of family history, except for the small number of individuals who have more than one affected relative.     

Does family history of breast cancer improve survival among patients with breast cancer?

Overall cancer mortality to December 1985 among 291 patients whose breast cancer was diagnosed between 1971 and 1974 and who were interviewed shortly after diagnosis was 39.9% (116 deaths). In this study population a positive maternal family history was strongly associated with breast cancer: The odds ratio for patients versus controls of having a mother with breast cancer was 3.32 (95% confidence limits 1.64 and 6.72); the odds ratio of having a mother, sister, or maternal aunt with breast cancer was 1.92 (95% confidence limits 1.27 and 2.91). However, family history was not associated with stage at diagnosis, which is the most important survival factor (53.6% of patients with a family history and 51.7% without were at a local stage at diagnosis). Survival was better, although not significantly so, among women with maternal relatives with breast cancer. The relative risk of dying of cancer, adjusted for confounding factors, was 1.40 for women without versus with a family history; the difference in survival was not statistically significant.     

A possible genetic factor in the pathogenesis of ovarian dermoid cysts

This study was undertaken in order to evaluate a possible genetic influence on the pathogenesis of ovarian dermoid cysts. We have performed a case-control study comparing the prevalence of a history of dermoid cysts in first-degree relatives of women with dermoid cysts and among first-degree relatives of women without dermoid cysts. The study group included 285 women with an established diagnosis of ovarian dermoid cysts. The control group included 378 women with sonographically normal ovaries. To assess the relationship between a first-degree family history of dermoid cysts and the diagnosis of ovarian dermoid cysts, a multivariate stepwise logistic regression model was applied. In 28 families of the study group (9.8%), a dermoid cyst was found in at least 1 first-degree relative as compared with only eight families (2%) among the controls (adjusted odds ratio -5.60; 95% CI 2.24-14.2). The data suggest a genetic predisposition towards dermoid cysts which merits further exploration.     

Does risk of endometrial cancer for women without a germline mutation in a DNA mismatch repair gene depend on family history of endometrial cancer or colorectal cancer?

Objective

To determine whether risk of endometrial cancer for women without a germline mutation in a DNA mismatch repair (MMR) gene depends on family history of endometrial or colorectal cancer.

Methods

We retrospectively followed a cohort of 79,166 women who were recruited to the Colon Cancer Family Registry, after exclusion of women who were relatives of a carrier of a MMR gene mutation. The Kaplan–Meier failure method was used to estimate the cumulative risk of endometrial cancer. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for association between family history of endometrial or colorectal cancer and risk of endometrial cancer.

Results

A total of 628 endometrial cancer cases were observed, with mean age at diagnosis of 54.4 (standard deviation: 15.7) years. The cumulative risk of endometrial cancer to age 70 years was estimated to be 0.94% (95% CI 0.83–1.05) for women with no family history of endometrial cancer, and 3.80% (95% CI 2.75–4.98) for women with at least one first- or second-degree relative with endometrial cancer. Compared with women without family history, we found an increased risk of endometrial cancer for women with at least one first- or second-degree relative with endometrial cancer (HR 3.66, 95% CI 2.63–5.08), and for women with one first-degree relative with colorectal cancer diagnosed at age < 50 years (HR 1.48, 95% CI 1.15–1.91).

Conclusion

An increased risk of endometrial cancer is associated with a family history of endometrial cancer or early-onset colorectal cancer for women without a MMR gene mutation, indicating for potential underlying genetic and environmental factors shared by colorectal and endometrial cancers other than caused by MMR gene mutations.     

Oral contraceptive use, reproductive history, and risk of epithelial ovarian cancer in women with and without endometriosis

OBJECTIVE: Women with endometriosis may be at an increased risk of ovarian cancer. It is not known whether reproductive factors that reduce the risk of ovarian cancer in general also reduce risk in women with endometriosis. We investigated whether the odds ratios for ovarian cancer that were associated with oral contraceptive use, childbearing, hysterectomy, and tubal ligation differ among women with and without endometriosis. STUDY DESIGN: We pooled information on the self-reported history of endometriosis from 4 population-based case-controlled studies of incident epithelial ovarian cancer, comprising 2098 cases and 2953 control subjects. We obtained data on oral contraceptive use, childbearing, breastfeeding, gynecologic surgical procedures, and other reproductive factors on each woman. Multivariable unconditional logistic regression was used to calculate odds ratios and 95% CI for ovarian cancer among women with endometriosis compared with women without endometriosis. Similar methods were used to assess the frequencies of risk factors among women with and without endometriosis. Adjustments were made for age, parity, oral contraceptive use, tubal ligation, family history of ovarian cancer, and study site. RESULTS: Women with endometriosis were at an increased risk of ovarian cancer (odds ratio, 1.32; 95% CI, 1.06-1.65). Using oral contraceptives, bearing children, and having a tubal ligation or hysterectomy were associated with a similar reduction in the odds ratios for ovarian cancer among women with and without endometriosis. In particular, the use of oral contraceptives for >10 years was associated with a substantial reduction in risk among women with endometriosis (odds ratio, 0.21; 95% CI, 0.08-0.58). CONCLUSION: Women with endometriosis are at an increased risk of epithelial ovarian cancer. Long-term oral contraceptive use may provide substantial protection against the disease in this high-risk population.     

Risk factors for preeclampsia-eclampsia among Zimbabwean women: recurrence risk and familial tendency towards hypertension.

We sought to estimate the risk of recurrence of preeclampsia-eclampsia among Zimbabwean women. Additionally, we sought to assess the extent to which family history of pregnancy-induced or chronic hypertension was predicative of the risk of developing preeclampsia-eclampsia. This hospital based case-control study was conducted at Harare Maternity Hospital, Harare Zimbabwe during the period June 1995 to April 1996. Study participants were 200 women with preeclampsia or eclampsia and 200 normotensive pregnant women serving as controls. Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Among multiparous women, a history of any pregnancy-induced hypertension was associated with a 10.5-fold increase in risk of preeclampsia-eclampsia in a subsequent pregnancy (95% CI 4.7-23.5). Women who reported that their mother or sisters experienced pregnancy-induced hypertension were found to be at an increased risk of preeclampsia-eclampsia (OR = 2.3 and 2.6, respectively). A 2.3-fold excess risk of preeclampsia-eclampsia was associated with paturients' maternal history of chronic hypertension (95% CI 1.3-3.6). The corresponding relative risk of preeclampsia-eclampsia for women reporting to have a sister with chronic hypertension was 2.6 (95% CI 1.2-5.3). Zimbabwean women, like North American and European women, are at increased risk for the recurrence of preeclampsia-eclampsia. Findings from our study and those of others suggest a possible genetic component involved in the multifactorial aetiology of preeclampsia-eclampsia. The information provided here should be useful to clinicians involved in the management of patients with a prior history or family history of hypertension.     

Dipyrone use during pregnancy and adverse perinatal events

Objective  To evaluate the risk of adverse perinatal events among newborns exposed to dipyrone during gestation. Design and Setting  The present study is a secondary analysis of Brazilian study of gestational diabetes (EBDG), a cohort of women attended at healthcare units of the Brazilian national health system (SUS) located in six Brazilian state capitals, between February 1991 and June 1995. Sample  A total number of 5,564 women aged 20 years and over who were between their 21st and 28th week of pregnancy were followed up. Methods  A structured questionnaire was used to obtain data on the pregnant women, their pregnancies, and their use of medications. Other data and the outcomes congenital abnormalities, intrauterine death, preterm birth, or low birth weight were obtained from the medical records. To estimate the odds ratios after adjustment for the potential confounding factors, logistic regression modeling was developed. Main outcome measures  Congenital abnormalities, intrauterine death, preterm birth, and low birth weight. Results  Dipyrone use was reported by 555 pregnant women (11.5%). Their exposure to this medication did not present any association with the outcomes of congenital abnormalities (OR 1.11; 95% CI, 0.58–2.10), intrauterine death (OR 0.69; 95% CI, 0.33–1.43), preterm birth (OR 0.94; 95% CI, 0.73–1.20), or low birth weight (OR 0.88; 95% CI, 0.64–1.22), in the crude analysis. This absence of associations was maintained after performing logistic regression analysis. Conclusions  The data suggest that the exposure to dipyrone during pregnancy does not increase the risk of congenital abnormalities and other adverse events as outcomes from pregnancy.     

Analysis of risk factors related to gestational diabetes mellitus

ObjectiveWith the rapid rising prevalence, gestational diabetes mellitus (GDM) has become one of the leading causes of maternal and child mortality and morbidity worldwide. The present study aimed to analyze GDM-related risk factors for early intervention.Materials and methodsFrom January to June 2018, a total of 250 pregnant women from Chengdu Second People's Hospital were enrolled in the study. According to the diagnostic criteria for GDM, they were assigned into GDM group (n = 48) and non-GDM group (n = 202). The clinical data and biochemical indicators were compared between GDM group and non-GDM group, and Logistic regression analysis was performed to analyze the risk factors of GDM.ResultsGDM group was significantly higher than non-GDM group in the age, pregnancy times, pre-pregnancy body mass index (BMI), low-density lipoprotein cholesterol (LDL-C) level, history of diabetes mellitus in first-degree relatives, incidence of subclinical hypothyroidism (SCH) and the positive rate of thyroid peroxidase antibody (TPOAb) (P < 0.05), whereas was conspicuously lower than non-GDM group in the education level above junior college (P < 0.05). The results of Logistic regression analysis revealed that the age [odds ratios (OR) = 1.125, 95% confidential interval (CI) = 1.019–1.241, P = 0.020], pre-pregnancy BMI (OR = 1.280, 95%CI = 1.118–1.466, P < 0.001), history of diabetes mellitus in first-degree relatives (OR = 4.938, 95%CI = 1.418–17.196, P = 0.012) and TPOAb (+) (OR = 4.849, 95%CI = 1.742–13.501, P = 0.003) were the risk factors of GDM.ConclusionsAdvanced age, pre-pregnancy BMI overweight, history of diabetes mellitus in first-degree relatives and TPOAb (+) are associated with an increased risk of GDM.     

Association Between Bowel Obstruction or Intussusception and Endometriosis

ObjectiveTo evaluate the association between endometriosis and bowel obstruction or intussusception using a large population database.MethodsThis was a population-based study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP‐NIS) from 2005 to 2014. We studied women aged 18 to 55 years without inflammatory bowel disease or cancer. Multivariate logistic regression was used to examine the association between endometriosis and bowel obstruction.ResultsOf the 18 427 520 women who met the criteria for inclusion, 96 539 had experienced bowel obstruction, for an overall prevalence of 52 per 10 000, and 3825 had experienced intussusception, for an overall prevalence of 2 per 10 000. When adjusted for sociodemographic characteristics, women with pelvic endometriosis had a consistently higher likelihood of bowel obstruction (odds ratio [OR] 2.6; 95% confidendence interval [CI] 2.3–3.00, P <0.01). In particular, intestinal endometriosis was associated with a 14.6-fold increased risk of bowel obstruction (95% CI 11.4–18.8, P <0.01), while rectovaginal endometriosis was associated with a 2.00-fold increased risk (95% CI 1.5–2.6, P <0.01). Pelvic endometriosis was significantly associated with adhesive bowel obstruction (adjusted OR: 3.2; 95% CI 2.6–3.9) and non-adhesive bowel obstruction (adjusted OR 2.4; 95% CI 2.0–2.8). The rates of endometriosis among women with or without intussusception were comparable.ConclusionsPelvic endometriosis, in particular rectovaginal and intestinal endometriosis is strongly associated with bowel obstruction, independent of the presence of intra-abdominal adhesions. We did not find any association between pelvic endometriosis and intussusception.     

Family trait analysis: a case-control study of 43 women with endometriosis and their best friends

Analyses of lineage patterns show that for 43 women with endometriosis who reported that other family members have the disease, the vast majority of these familial cases involve the maternal lineage (79% to 93%). Of these women 34.9% of their mothers and 21.2% of their sisters were affected. With use of these rates, expected rates for first-degree relatives in a general population of women with endometriosis were determined. These rates were 6.2% and 3.8%, respectively; in combination, these rates yield an overall risk of 4.9% for first-degree relatives. Prior studies estimated this overall risk to be 6.9%; however, z scores determined that these rates do not differ statistically. Rates for second-degree maternal relatives are reported for grandmothers and aunts (0.4% compared to 3.1%, respectively), thus expanding results of former studies. In combination, an overall risk of 1.9% is estimated for second-degree relatives, as measured.     

Identificación de factores que se asocian a alto riesgo de desarrollar diabetes gestacional

ObjectivesThe main objective is to determine the current prevalence of recognised risk factors for gestational diabetes mellitus (GDM) in our region, and to define the profile of patients at higher risk of developing this condition. We also investigate patient acceptability of the screening tests.Material and methodsThis is an ambispective study with 1,448 pregnant women recruited between December 2017 and July 2019 from a single centre. Inclusion criteria were no diabetes mellitus prior to the pregnancy, no history of GDM in any previous pregnancy, no history of bariatric surgery before the pregnancy, and GDM screening tests performed.ResultsThe prevalence of GDM was 6.7%. Risk factors associated with development of GDM were: age ≥ 27.5 years (OR: 3.8; 95% CI: 2.01-9.16); BMI ≥ 28.5 kg/m² (OR: 2.3; 95% CI: 1.47-3.59); history of diabetes mellitus in first-degree relatives (OR: 2.3; 95% CI: 1.5-3.66); and multiple pregnancy (OR: 2.8; 95% CI: 0.86-6.36); Prevalence of GDM increased with the number of risk factors presented by patients: from 1.4% with no risk factor, to 25.2% with 3. The O'Sullivan test (50 g glucose) and oral glucose tolerance test (100 g glucose) were perceived as “unpleasant” by 26.8% and 65.4% of patients, respectively.ConclusionsAge ≥ 27.5 years, BMI ≥ 28.5 kg/m², history of diabetes mellitus in first-degree relatives, and multiple pregnancy are factors related to an increased risk of GDM; these factors would be enough to identify most pregnant women developing GDM. Our findings may be used to improve programmes aimed at early diagnosis of gestational diabetes and supporting high-risk mothers in antenatal care.     

When should we perform prophylactic antibiotics in elective cesarean cases?

Objective  The aim of this study was to determine whether the timing of prophylactic antibiotics at cesarean delivery influences maternal and neonatal infectious morbidity. Study design  This was a prospective, randomized trial. Four hundred patients that underwent elective cesarean section between June and December 2007 formed the study population. Eleven patients were excluded from the study because they needed transfusion during the cesarean section. The population was divided into two groups: Group A, antibiotic prophylaxis was applied to 194 women before skin incision and Group B, antibiotic prophylaxis was applied to 195 women after umbilical cord clamping. The occurrence of endomyometritis/endometritis, wound infection, febrile morbidity, total infectious morbidity, and neonatal complications were compared. Results  There were 389 patients enrolled. No demographic differences were observed between groups. No significant difference was found between the groups for total infectious morbidity [relative risk (RR) 1.39, 95% confidence interval (CI) 0.71–2.69] and endometritis (RR 1.40, 95% CI 0.43–4.51). There was no increase in neonatal sepsis (RR 1.47, 95% CI 0.61–3.53), sepsis workup (RR 1.35, 95% CI 0.75–2.42), need for neonatal intensive care (RR 1.77, 95% CI 0.51–6.16), and intensive care stay period (P = 0.16). Conclusions  Time of antibiotic prophylaxis application does not change maternal infectious morbidity in cesarean section deliveries. Preoperative prophylaxis application does not affect neonate morbidity rates as stated in literature.     

Increased rate of endometriosis and spontaneous abortion in an in vitro fertilization program: no correlation with epidemiological factors.

BACKGROUND: There are conflicting data concerning endometriosis and spontaneous abortion (SAB). The aim of the present study was to evaluate if there was any association between endometriosis and SAB. Moreover, we investigated risk factors in women with endometriosis and SAB. METHODS: The medical files of 457 married women with endometriosis and 200 infertile women without endometriosis were studied retrospectively. All cases were diagnosed by laparoscopy. Data concerning demographic variables and menstrual characteristics were recorded from 226 women with endometriosis, which were divided into two groups. Group 1 included 126 cases with endometriosis and SAB, and Group 2 comprised 100 parous women with endometriosis and without SAB. Statistical comparisons between groups were made using the chi(2) test and odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The proportion of SAB was significantly higher in women with endometriosis than in infertile women without endometriosis (126/457 (27.6%) vs. 36/200 (18.0% ); OR = 1.7, 95% CI 1.1 = 2.6; p = 0.01). The frequency of nulligravid women was significantly higher in women with endometriosis than in the control group (OR = 1.9, 95% CI 1.4 - 2.81; p = 0.001). Mean age, age at onset of endometriosis, race, height, weight, body mass index, medical history of allergies, and family histories of endometriosis and cancer were similar in women with endometriosis and SAB and in parous women with endometriosis but without SAB. Moreover, the two groups were similar in age at menarche, length of cycle, duration and amount of flow, and the severity of disease. The incidence of infertility was significantly higher in women with SAB (p < 0.001). CONCLUSION: These data suggest but do not prove that the risk of SAB is increased in women with endometriosis. The epidemiological risk factors of endometriosis are not associated with an increase in the abortion rate.     

Increased rate of endometriosis and spontaneous abortion in an in vitro fertilization program: No correlation with epidemiological factors

Background. There are conflicting data concerning endometriosis and spontaneous abortion (SAB). The aim of the present study was to evaluate if there was any association between endometriosis and SAB. Moreover, we investigated risk factors in women with endometriosis and SAB.

Methods. The medical files of 457 married women with endometriosis and 200 infertile women without endometriosis were studied retrospectively. All cases were diagnosed by laparoscopy. Data concerning demographic variables and menstrual characteristics were recorded from 226 women with endometriosis, which were divided into two groups. Group 1 included 126 cases with endometriosis and SAB, and Group 2 comprised 100 parous women with endometriosis and without SAB. Statistical comparisons between groups were made using the χ² test and odds ratios (OR) and 95% confidence intervals (CI).

Results. The proportion of SAB was significantly higher in women with endometriosis than in infertile women without endometriosis (126/457 (27.6%) vs. 36/200 (18.0% ); OR = 1.7, 95% CI 1.1 = 2.6; p = 0.01). The frequency of nulligravid women was significantly higher in women with endometriosis than in the control group (OR = 1.9, 95% CI 1.4 – 2.81; p = 0.001). Mean age, age at onset of endometriosis, race, height, weight, body mass index, medical history of allergies, and family histories of endometriosis and cancer were similar in women with endometriosis and SAB and in parous women with endometriosis but without SAB. Moreover, the two groups were similar in age at menarche, length of cycle, duration and amount of flow, and the severity of disease. The incidence of infertility was significantly higher in women with SAB (p < 0.001).

Conclusion. These data suggest but do not prove that the risk of SAB is increased in women with endometriosis. The epidemiological risk factors of endometriosis are not associated with an increase in the abortion rate.     

A randomised controlled trial of amniotomy and immediate oxytocin infusion versus amniotomy and delayed oxytocin infusion for induction of labour at term

Background  There is uncertainty as to the optimal time interval between amniotomy and oxytocin administration when inducing labour. The aim of this study was to compare the efficacy of amniotomy and immediate oxytocin infusion with amniotomy and delayed oxytocin infusion for induction of labour at term. Method  A total of 123 women were randomly chosen to receive either amniotomy and immediate oxytocin infusion (referred to as the ‘immediate group’) or amniotomy and delayed oxytocin infusion (referred to as the ‘delayed group’). The main outcome measure was the proportion of women in established labour at 4 h as well as the proportion that delivered within 12 h of amniotomy. Data were analysed using standard statistical methods. Results  Women in the immediate group were more likely to be in established labour 4 h post-amniotomy [relative risk (RR) 12.8; 95% CI 55.1–111.7], have a shorter amniotomy to delivery interval (P < 0.001) and achieve vaginal delivery within 12 h (RR 1.5; 95% CI 1.2–12.6). There was no difference between the groups with regards to the mode of delivery, incidence of uterine hyperstimulation and abnormal foetal heart rate recording. Compared to the delayed group, women in the immediate group were more likely to be satisfied with the induction process (RR 4.1, 95% CI 1.1–16.1) and the duration of labour (RR 1.8 95% CI 1.0–3.3). Conclusion  In induction of labour at term, amniotomy and immediate oxytocin infusion is associated with the establishment of active labour at 4 h, a shorter amniotomy-delivery interval and greater maternal satisfaction.     

A genetic epidemiological study of carcinoma of the fallopian tube

OBJECTIVE: The goal of this work was to evaluate the importance of genetic factors in the etiology of fallopian tube cancer. METHODS: All pathologically confirmed cases of fallopian tube cancer diagnosed in Ontario from 1990 to 1998 were identified from the records of the Ontario Cancer Registry. Living patients were approached to provide information about their family history and to provide a blood sample for testing for mutations in BRCA1 and BRCA2. RESULTS: A modest increase in the risk of ovarian cancer (relative risk (RR) = 2.2; 95% confidence interval (CI) = 0.4, 6.3) and of early-onset breast cancer (RR = 2.4; 95% CI = 0.6, 6.1) was observed in the first-degree relatives of the fallopian cancer cases. Five of the forty-four cases were positive for a mutation in BRCA1 (11%) and two were positive for a BRCA2 mutation (5%). Five of eighteen women diagnosed at or before age 55 were positive (28%). Two of the seven mutation carriers had a strong family history of breast and ovarian cancer, and three carriers had a modest family history. Three of the forty-four cases were Jewish, and of these, two carried a founder mutation characteristic of this population. CONCLUSIONS: Fallopian tube carcinoma should be considered to be a clinical component of the hereditary breast-ovarian cancer syndrome, and may be associated with BRCA1 and BRCA2 mutations. Genetic evaluation should be offered to women who present with fallopian tube carcinoma. It is important to consider the risk of fallopian tube carcinoma when prophylactic oophorectomy is performed in high-risk women.     

Perinatal mortality: a sporadic event or a recurrent catastrophe?

Objective  The purpose of this study was to determine whether women who experienced perinatal mortality in their first delivery had, in their subsequent birth, a higher risk for adverse perinatal outcome. Methods  A population-based study was undertaken to compare all second deliveries of women with previous perinatal mortality in their first delivery to those with no such history. Deliveries occurred from 1988 to 2004 in a tertiary medical center. Patients lacking prenatal care, multiple gestations, and congenital malformations were excluded from the analysis. A multivariable logistic regression model and the Mantel–Haenszel procedure were carried out to control for confounders. Results  During the study period, out of 25,876 singleton second deliveries, 230 (0.9%) cases were of patients with previous perinatal mortality. Multivariable analysis with backward elimination showed a significant association between previous perinatal mortality and the following conditions: hypertensive disorders (OR = 2.6, 95% CI 1.7–3.9, P < 0.001), diabetes mellitus (OR = 2.4, 95% CI 1.5–3.7, P < 0.001), fertility treatment (OR = 2.7, 95% CI 1.6–4.7, P = 0.001), and younger maternal age (OR = 0.9, 95% CI 0.92–0.98, P < 0.001). Controlling for preterm delivery, using the Mantel–Haenszel procedure, the association between previous and subsequent perinatal mortality remained significant (weighted OR = 2.2, 95% CI 1.2–3.9, P = 0.010). Conclusion  Previous perinatal loss poses an independent risk for subsequent perinatal mortality. Prospective studies are warranted in order to establish the appropriate means of surveillance and/or interventions needed to decrease future adverse perinatal outcomes. Presented in part in the 27th annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, CA. Dedicated with love to our dear friend and colleague Amit Rozen M.D. who tragically passed away prematurely on his 34th birthday.     

Severe preeclampsia is associated with a positive family history of hypertension and hypercholesterolemia.

OBJECTIVE:To investigate an association between a family history of cardiovascular disease and severe preeclampsia and/or HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets). METHODS: One hundred twenty-eight women with a history of severe preeclampsia and/or HELLP syndrome and 123 women with previous uncomplicated pregnancies only were included in the study. All participants completed questionnaires about diagnoses of cardiovascular diseases, hypertension, and hypercholesterolemia among their first-degree relatives, which were subsequently confirmed by the relatives' general practitioners. The main outcome measures were the prevalence of cardiovascular diseases, hypertension, and hypercholesterolemia among first-degree relatives of both groups. Statistical analysis was done using chi(2)-analysis. RESULTS:The prevalence of familial cardiovascular disease among women with a history of severe preeclampsia and/or HELLP syndrome (23%) compared to controls (19%) was not significantly different (OR 1.3, 95%CI 0.7-2.5). However, women with a history of severe preeclampsia and/or HELLP syndrome more often had one or more first-degree relatives with hypertension and/or hypercholesterolemia before the age of 60 years compared to controls (54% vs. 32%, respectively; OR 2.6, 95%CI 1.5-4.3). The prevalence of hypertension and hypercholesterolemia among first-degree relatives, irrespective of age, also was significantly higher among women with a history of severe preeclampsia and/or HELLP syndrome as compared to controls (60% vs. 42%, respectively; OR 2.0, 95%CI 1.2-3.4). CONCLUSION:Severe preeclampsia is associated with a positive family history of hypertension and/or hypercholesterolemia.     

Incidence and risk factors for severe perineal laceration after vaginal delivery in Japanese patients

Objective: The aim of this study was to assess the frequency of severe perineal lacerations defined as either third- or fourth-degree lacerations during normal spontaneous vaginal delivery and to evaluate potential risk factors in Japanese patients. Materials and methods: An electronic audit of the perinatal database at the Tama-Nagayama Hospital of Nippon Medical School and Yamaguchi Hospital from 1997 through 2004 was completed. Singleton vaginal vertex deliveries were analyzed for potential risk factors using univariate and multivariate logistic regression analysis. Results: From the database, 7,946 deliveries were identified, with 135 deliveries resulting in severe lacerations (1.7%). In the multivariate logistic regression analysis, severe lacerations were associated significantly with primiparous (odds ratio, 4.36; 95% CI, 2.17–9.57), oxytocin use (odds ratio, 2.19; 95% CI, 1.27–3.73), midline episiotomy (odds ratio, 4.68; 95% CI, 2.09–11.55), forceps-assisted delivery (odds ratio, 7.11; 95% CI, 1.95–20.59), vacuum-assisted delivery (odds ratio, 5.93; 95% CI, 3.38–10.36), and shorter attendant experience (odds ratio, 2.88; 95% CI, 1.12–9.81). Conclusions: The present study demonstrated that operator factors, such as midline episiotomy, oxytocin use, assisted delivery and attendant experience, are independent risk for severe perineal lacerations after vaginal delivery in Japanese patients. The results suggest that midline episiotomy and assisted vaginal delivery, especially forceps-assisted delivery should be avoided in patients who are being delivered of a first child whenever possible.     

Pregnancy spacing among women delaying initiation of childbearing

Introduction  An increasing proportion of women in the US and other countries delay initiation of childbearing until their thirties. Little is known about their subsequent pregnancies, particularly with regard to pregnancy spacing. Objectives  To determine interpregnancy interval (IPI) patterns, factors associated with IPI among women delaying initiation of childbearing until their thirties, and ascertain if delay in initiation of childbearing is associated with increased likelihood for short interpregnancy interval of less than 6 months. Methods  A retrospective cohort study was performed using the Missouri maternal linked file for 1978–1997, inclusive. Analysis was limited to mothers aged 20–50 years at first pregnancy, having a first and second pregnancy during the study period; the sample size included 242,559 mother–infant pairs. Analysis strategies included stratified analysis, and multivariable logistic regression. Interpregnancy interval was main outcome variable, and was grouped in seven categories: 0–5, 6–11, 12–17, 18–23, 24–59, 60–119, ≥120 months. Results  The mean interpregnancy interval was significantly shorter for women delaying start of childbearing (≥30 years) compared to 20–29 year olds. Observed intervals are 31 (±24) months for mothers aged 20–29 years, 25 (±17) months for mothers aged 30–34 years, 21 (± 14) for 35–39 year olds, and 19 (±16) for 40–50 year olds (P < 0.0001). A significant trend for shorter intervals was noted as maternal age at first pregnancy increased (P < 0.0001). Factors associated with interpregnancy interval for women delaying initiation of childbearing included adverse outcome in preceding pregnancy, and low educational status. Mothers aged 35 and above at first pregnancy had increased odds for a second pregnancy following short IPI <6 months; (35–39 years OR = 1.26 95% CI 1.11–1.44; 40–50 OR = 1.91 95% CI 1.13–3.24). Mothers aged 30–34 years have lower odds for short IPI (OR = 0.93 95% CI 0.87–0.99). Conclusion  First time mothers aged 35 and above have higher odds of having a second pregnancy shortly after their first pregnancy. Given the increasing number of first time mothers aged 35 and above, these findings are of relevance for preconception counseling for this unique population of women. Greg R. Alexander was deceased.