Delayed childbearing in Sweden

Using data from the Swedish Medical Birth Registry, we examined whether reproductive history influenced pregnancy outcomes among women aged 30 to 39 years who gave birth to a first or second child in 1976 through 1980. They were classified group 1, primigravida; group 2, gravida 2, para O; and group 3, gravida 2, para 1. Compared with women aged 20 through 24 years with the same parity and gravidity, the relative risk (RR) of late fetal deaths was significantly greater among those aged 35 through 39 years (RR: group 1 = 1.76, group 2 = 2.22, and group 3 = 2.39). The risk of giving birth to newborns who were low birth weight and preterm, or low birth weight at term, or 2,500 g or greater but preterm was greater among women aged 30 through 39 years in groups 1 and 2--significantly so for group 1 aged 30 through 39 years v group 1 aged 20 through 24 years. Risk increased with maternal age, from 30 through 34 to 35 through 39 years. The increased risk with age and parity-gravidity has ramifications for the increasing rate of delayed childbearing in the United States and elsewhere.     

Reproductive events and family history as risk factors for breast cancer in northern Alberta.

Reproductive events and family history as risk factors for breast cancer in northern Alberta were investigated with the use of data from a computerized population-based registry. Women aged 30 to 79 years attending diagnostic breast clinics at the Cross Cancer Institute from 1971 through 1975 constituted the two study groups; 1232 women had diagnosed breast cancer (malignant disease group) and 602 women were clinically free of all types of breast disease (control group). An increased relative risk of breast cancer was found in women with a family history of breast cancer, those who gave birth to their first term infant at age 30 years or older, those in whom more than 15 years elapsed between menarche and that birth, and those with a late natural menopause. There was a decreased risk, relative to nulliparity, in the postmenopausal women who first gave birth to a term infant 5 years or less after menarche. Artificial menopause (bilateral oophorectomy), parity and age at menarche had no apparent effect on the risk. The pattern of risk factors in northern Alberta differed from that reported for other geographic areas, including other provinces of Canada, thus emphasizing the need for local studies in the planning of screening programs.     

Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease--a case-control study

A case-control study of gall stone disease in women in relation to use of contraceptives, reproductive history, and concentrations of endogenous hormones was undertaken. The study population comprised 200 hospital patients with newly diagnosed gall stone disease, 182 individually matched controls selected from the community, and 234 controls who were patients in hospital. Use of oral contraceptives was associated with an increased risk of developing gall stones among young subjects but a decreased risk among older subjects. The risk of developing gall stone disease increased in association with increasing parity, particularly among younger women. The risk fell with increasing age at first pregnancy, independent of parity. Mean urinary excretion over 24 hours of oestrone, but not of pregnanediol, was significantly (p less than 0.05) greater for postmenopausal patients than controls. The age dependence of the relative risk associated with exposure to oral contraceptives and pregnancy suggests that there are subpopulations of women susceptible to early formation of gall stones after exposure to either oral contraceptives or pregnancy.     

Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer

CONTEXT: Oral contraceptive (OC) use is weakly associated with breast cancer risk in the general population, but the association among women with a familial predisposition to breast cancer is less clear. OBJECTIVE: To determine whether the association between OC use and risk of breast cancer is influenced by family history of the disease. DESIGN AND SETTING: Historical cohort study of 426 families of breast cancer probands diagnosed between 1944 and 1952 at the Tumor Clinic of the University of Minnesota Hospital. Follow-up data on families were collected by telephone interview between 1991 and 1996. PARTICIPANTS: A total of 394 sisters and daughters of the probands, 3002 granddaughters and nieces, and 2754 women who married into the families. MAIN OUTCOME MEASURE: Relative risk (RR) of breast cancer associated with history of OC use by relationship to proband. RESULTS: After accounting for age and birth cohort, ever having used OCs was associated with significantly increased risk of breast cancer among sisters and daughters of the probands (RR, 3.3; 95% confidence interval [CI], 1.6-6.7), but not among granddaughters and nieces of the probands (RR, 1.2; 95% CI, 0.8-2.0) or among marry-ins (RR, 1.2; 95% CI, 0.8-1.9). Results were essentially unchanged after adjustment for parity, age at first birth, age at menarche, age at menopause, oophorectomy, smoking, and education. The elevated risk among women with a first-degree family history of breast cancer was most evident for OC use during or prior to 1975, when formulations were likely to contain higher dosages of estrogen and progestins (RR, 3.3; 95% CI, 1.5-7.2). A small number of breast cancer cases (n = 2) limited the statistical power to detect risk among women with a first-degree relative with breast cancer and OC use after 1975. CONCLUSIONS: These results suggest that women who have ever used earlier formulations of OCs and who also have a first-degree relative with breast cancer may be at particularly high risk for breast cancer. Further studies of women with a strong family history who have used more recent lower-dosage formulations of OCs are needed to determine how women with a familial predisposition to breast cancer should be advised regarding OC use today. JAMA. 2000;284:1791-1798.     

Oral contraceptives and risk of breast cancer

Use of oral contraceptives (OCs) by women before age 25 or first full-term pregnancy has been theorized to increase the risk of breast cancer. While multiple studies have reported a positive relationship between early use and subsequent breast cancer development, numerous researchers have concluded there is no effect. One reason for the varied results may be the case control methodology utilized by the majority of studies and its associated biases including selection, information, and recall bias. Other theories include an undetected latent effect, changing dosages and formulations, earlier breast cancer diagnosis and follow-up among OC users, and chance. While more research is needed, the weight of evidence supports no increased risk of breast cancer among OC users, including women less than 25 years of age and before first full-term pregnancy. Hence, it seems unnecessary to change the current approach toward OC use.     

女性癌症发病率和病死率与体重指数的关系：百万妇女队列研究

目的 检测体重指数（BMI）与癌症发病率和病死率的关系。设计前瞻性队列研究。研究对象1996年至2001年间,年龄50～64岁的120万英国女性;对其随访,对发病率平均随访5．4年,对病死率平均随访7．0年。主要检测结果发病率和病死率的相对危险度（RR）;对于17种类型的肿瘤,分析其BMI、校正年龄、地理区域、社会阶层、初产年龄、孕产次、吸烟情况、饮酒情况、活动能力,绝经期及激素替代治疗情况。结果 随访期间45037例患癌,17203例死亡。发病率随BMI增大而增高的有：子宫内膜癌（RR=2．89,95％可信区间2．62～3．18）,食管腺癌（2．38,1．59～3．56）,肾癌（1．52,1．27～1．84）,白血病（1．50,1．23～1．83）,多发性骨髓瘤（1．31,1．04～1．65）,胰腺癌（1．24,1．03～1．48）,非霍奇金淋巴瘤（1．17,1．03～1．34）,卵巢癌（1．14,1．03～1．27）,所有癌症合并（1．12,1．09～1．14）,绝经后女性乳腺癌（1．40,1．31～1．49）,绝经前女性结直肠癌（1．61,1．05～2．48）;简言之。病死率与BMI的关系与发病率类似。而结肠癌、恶性黑色素瘤、乳腺癌和子宫内膜癌的发病风险,根据是否绝经有明显不同。结论 在检测的17种癌症中,10种癌症随着BMI增大发病风险明显增加。对于英国绝经后妇女,5％（每年约6000例）的癌症与超重或肥胖相关。对于子宫内膜癌和食管腺癌,BMI是独立风险因素,绝经后妇女约有半数病例与超重和肥胖有关。     

Sexual, reproductive and contraceptive risk factors for carcinoma-in-situ of the uterine cervix in Sydney

Sexual, reproductive and contraceptive risk factors were investigated in a matched community-based case-control study of carcinoma-in-situ of the uterine cervix in Sydney. The risk was related strongly to the number of sexual partners: women who had had seven or more sexual partners in a lifetime had a six-fold increased risk compared with those with one or no partner. Early age at first sexual intercourse was also a risk factor, but this effect was reduced substantially after adjustment for the number of partners, with only a two-fold excess risk persisting for those with first intercourse before the age of 16 years as compared with those whose first sexual intercourse was at the age of 25 years or later. The long-term use of oral contraceptive agents was associated with an elevated risk (relative risk, 2.3 for more than six years of use); this effect was maintained for both oestrogen and progestogen doses. The risk increased with the number of induced abortions that had been undergone (relative risk, 2.2 for two or more abortions), but this effect was not statistically significant. A protective effect was found for women who had had a tubal ligation, for those who practised the rhythm method of birth control, and for women who breastfed. It is possible that these reduced risks may relate to unmeasured variables of life-style.     

Reflections on having children in the future—interviews with highly educated women and men without children

Background

There is a trend to delay birth of the first child until the age at which female reproductive capacity has started to decrease. The aim of the present study was to explore how highly educated women and men reflected on future parenthood.

Methods

Twenty-two women and 18 men, who had started their professional career, were subjected to individual qualitative semi-structured interviews with qualitative content analysis guiding the analysis.

Results

All informants, except for three women, planned to have children when some important prerequisites were fulfilled. Women and men reflected in much the same way, and prerequisites for parenthood were being of reasonable age and having a partner in the same phase of life. A reasonable age was considered in relation to reproductive capacity, and both women and men expressed awareness of the natural decline in fertility at higher ages. Good living conditions with stable finances were also important. Parenthood was perceived as a challenge and a sacrifice but also as enriching life. Reasons for having children included being part of the future and settling down to build their own family. Many concluded that there would never be a perfect time for having children.

Conclusion

Highly educated women and men reflect on various factors when considering family planning. Being of reasonable age and having good living conditions, in particular a sound personal economy, were important. Given their goals, it is not surprising that many postpone parenthood until ages when female reproductive capacity is decreased.     

Analysis of Antenatal Care and its Related Factors among Married Chinese Women

Objective To explore the related factors of antenatal care Methods The data derived from National Demography and Reproductive Health Survey in 1997 conducted by National Population and Family Planning Commission. 11 892 women who had given birth to at least one survival child were involved in this study. SAS software was used in multivariate analysis. Results The average rate of general antenatal care is 57.3% and has increased dramatically in the recent 30 years. The major reason why most subjects didn‘t have antenatal care was lacking the recognition of the importance of antenatal care. The antenatal care was associated with residence in rural area or urban area, age, educational level, parity of the last birth, local average income, distance between home and township in rural area and so on. Conclusion Women of childbearing age need to improve their health knowledge; the government should increase the availability of antenatal care.     

生育模式与女性乳腺癌

目的探讨生育模式对女性乳腺癌的影响。方法以唐山市住院的乳腺病患者为对象,采用1：1配比的病例对照研究。结果发现初婚年龄晚、初产年龄推迟、生育次数少、哺乳期短是乳腺癌的危险因素．但经调整后,除初产年龄外,其他因素对乳腺癌的作用无显著意义。本文较为有意义的发现是初产年龄在21～24岁间的危险性显著低于其他初产年龄组。经生育次数及总哺乳期调整,初产年龄在21～24岁间的保护作用只有在生育次数1～2次,或哺乳时间至少18个月时有显著意义。结论这种生育模式有利于乳腺癌的预防,与我国目前实行的计划生育政策保持一致。     

浙江省兰溪市2000-2010年围产儿出生缺陷及相关因素分析

目的：分析浙江省兰溪市围产儿出生缺陷的基本情况及动态变化,探索影响该市围产儿出生缺陷的主要原因和预防策略。方法：对2000-2010年兰溪市妇幼保健院产科出生缺陷资料进行统计分析。结果：9458例围产儿中发生出生缺陷216例,总出生缺陷发生率28.86‰;出生缺陷儿死亡率3.62‰。出生缺陷前五位的是唇腭裂、神经管发育畸形、无脑儿、先天性心脏病、脐疝;出生缺陷发生率与孕产妇年龄成正比,36岁以上孕妇是发生出生缺陷的高危因素;农村出生缺陷的发生率高于城市。结论：加强育龄孕妇产前筛查、农村育龄妇女孕期护理和相关知识的普及,降低围产儿的出生缺陷发生率。     

Oral contraceptives and breast cancer. A prospective cohort study

In 1976, information on oral contraceptive (OC) use as well as numerous risk factors for breast cancer was provided by 121,964 married female registered nurses aged 30 to 55 years. Ninety-two percent of women in the cohort completed follow-up questionnaires, and vital records were systematically searched to ascertain deaths among nonrespondents. After four years of follow-up, 592 incident cases of breast cancer were identified. Compared with never users, the age-adjusted relative risk (RR) of breast cancer, regardless of menopausal status, among all women who had ever used OCs was 1.0. Among premenopausal women compared with those who had never used OCs, the RR of breast cancer was 1.5 for current use of OCs in 1976 and 1.0 for past use. Among postmenopausal women, the RR for past use of OCs was 1.0. These estimates were essentially unaltered after controlling for other known risk factors for breast cancer in multiple logistic regression analysis. Furthermore, there was no modification of these effects by family history of breast cancer, age at first use, timing of the first birth, or other breast cancer risk factors. Data on past use of OCs provide substantial reassuring evidence that there is no large excess risk of breast cancer within a few years of cessation of pill use. The observed moderate elevation of breast cancer risk with current use was of borderline statistical significance. However, the observation was based on 29 cases and may reflect the effect of sampling variability, as most other studies have not observed a relationship between current use of OCs and breast cancer in women of this age.     

福建省武平县10年妇科普查资料分析

目的 为了解育龄妇女生殖健康状况及影响因素。方法 对我县近10年妇科普查资料进行分析。结果 妇女病平均患病率为52．2l％,宫颈糜烂占首位,宫颈疾病在妇女病构成中占65．42％;妇女病患病率受年份、年龄、职业影响,35岁以下妇女和农民患病率较高。结论 必须采取有效的妇女保健干预措施,以提高妇女生殖健康水平。     

Reflections on having children in the future—interviews with highly educated women and men without children

Abstract

Background. There is a trend to delay birth of the first child until the age at which female reproductive capacity has started to decrease. The aim of the present study was to explore how highly educated women and men reflected on future parenthood.

Methods. Twenty-two women and 18 men, who had started their professional career, were subjected to individual qualitative semi-structured interviews with qualitative content analysis guiding the analysis.

Results. All informants, except for three women, planned to have children when some important prerequisites were fulfilled. Women and men reflected in much the same way, and prerequisites for parenthood were being of reasonable age and having a partner in the same phase of life. A reasonable age was considered in relation to reproductive capacity, and both women and men expressed awareness of the natural decline in fertility at higher ages. Good living conditions with stable finances were also important. Parenthood was perceived as a challenge and a sacrifice but also as enriching life. Reasons for having children included being part of the future and settling down to build their own family. Many concluded that there would never be a perfect time for having children.

Conclusion. Highly educated women and men reflect on various factors when considering family planning. Being of reasonable age and having good living conditions, in particular a sound personal economy, were important. Given their goals, it is not surprising that many postpone parenthood until ages when female reproductive capacity is decreased.     

浙江省农村育龄妇女乳腺、生殖系统疾病现状调查

目的调查我省农村育龄妇女乳腺、生殖系统疾病的现状。方法采用调查问卷及现场体检的方式,对我省农村育龄妇女的生殖健康状况进行调查,并分析影响生殖健康状况的危险因素。结果我省已婚育龄妇女的生殖系统及乳腺疾病发病率较高。妇女年龄30～44岁、职业农民、文化程度初中以下、家庭年均收入5000～10000元、痛经、初产年龄〉25周岁、生育次数〉2次、有引流产史是妇女生殖系统疾病及乳腺疾病的危险因素。结论本文的调查结果为我省初步制定农村妇女生殖健康宣传计划提供了比较科学的依据,有利于各级政府开展计划生育指导工作。     

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic.

CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, S?o Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mothers age < 18 years, congenital infections, malformations and low mothers education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinics professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mothers age 18 years and older. Low birth weight, history of perinatal asphyxia and mothers age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.     

Cancer risks and the contraceptive pill. What is the evidence after nearly 25 years of use?

The question of whether the steroidal components in oral contraceptives (OCs) may have an initiating or promotional influence on the development of cancer continues to be raised as a public health issue. It is estimated that since the introduction of OCs nearly 25 years ago, more than 150 million women have used 1 or more types of the formulation and nearly 1 billion woman-years of exposure to the steroids have accumulated. Contraceptive practice in Australia would indicate that about 25% of women of reproductive age are using OCs. The debate about the OC's carcinogenic potential has recently been reopened with 2 reports in "The Lancet" of an association between the incidence of breast and cervical cancer and OC usage. Biologically the relationship between the contraceptive steroids and cancer must continue to be regarded as the most important concern with the longterm use of OCs. The demonstration of receptors to these steriods in these organs, in both normal and malignant tissues, further increases the speculation that the steroid hormones have a biological role in carcinogenesis in these target organs. Theoretical reasons exist for the concern about carcinogenesis and contraceptive steroids. This paper reviews the available evicence. Data can be derived only from large-scale epidemiological research, by means of case-control or cohort studies. No clear evidence exists that OCs cause or increase the chance of developing any cancer in the female genital tract and the breast. In fact, OC offers a significant protection against the development of endometrial and ovarian cancer, especially to those women who have taken OCs for a long time. The association between the risk of breast cancer and OC use is less certain, but factors such as the history of benign breast disease, a close relationship with breast cancer, or nulliparity -- previously considered to be important -- do not appear to contribute significantly to the risk. The weight of evidence indicates that no increased risk of breast cancer exists, even in those younger women aged less than 25 years who decide to use OCs before their 1st full-term pregnancy. There is some evidence that suggests that the risk of cervical neoplasia -- dysplasia, carcinoma-in-situ and invasive carcinoma -- may increase slightly in OC users but the actual part played by the patient's sexual history under these circumstances remains to be defined. There is now strong evidence to implicate multiplicity of sexual partners and wart virus infection in carcinogenesis of the uterine cervix. There does not appear to be an overall relationship between OCs and malignant melanoma. Overall, the evidence is reassuring. The low-dose combined OC can be considered safe, not only in terms of cardiovascular and thromboembolic risks, but also in relation to carcinogenesis.     

Oral contraceptive use and the occurrence of pituitary prolactinoma

To determine whether prior oral contraceptive (OC) use is a risk factor for pituitary prolactinoma, we attempted to identify all women (n = 72) with a prolactinoma diagnosed between 1976 and 1980 in three counties in western Washington. A control group of 303 women was selected by dialing random telephone numbers from the same counties. Prior OC use, according to OC indication, was ascertained during a standardized telephone interview. Relative to the risk for women who had never used an OC, the risk of prolactinoma for women who had used OCs for birth control was 1.3 (95% confidence interval, 0.7 to 2.6). This risk was 7.7 for women who used OCs for menstrual regulation (95% confidence interval, 3.7 to 17.0). Previous findings of an association between OC use and prolactinoma may have resulted from OC treatment of menstrual irregularity in women with an undiagnosed prolactinoma.     

北京部分郊区279例孕产妇早产相关因素分析

目的 通过对早产孕妇不同的病理因素、生理因素和社会因素的分析,了解北京市部分郊区流动人口孕产妇保健状况,并能够有效的预防早产发生.方法 回顾性分析279例自2004年1月至2008年12月在解放军三○六医院住院分娩的早产孕妇.包括年龄、产次、职业、户口所在地、受教育程度、产检情况、阴道炎病史、是否胎膜早破、是否患绒毛膜羊膜炎等因素与早产的关系.结果 本组病例早产总发生率为5.34%(279/5228).早产有统计学意义(P＜0.05)指标为:绒毛膜羊膜炎、胎膜早破、以细菌性阴道病(BV)为主的阴道炎、未规范产检者、未受过高等教育者及流动人口、经产妇及低于法定婚者.而孕产妇职业因素与早产发生率差异无统计学意义(P＞0.05).结论 无规范产检、受教育程度低、阴道炎、绒毛膜羊膜炎及胎膜早破是早产的危险因素,应针对特殊人群加强孕期教育,并在孕期积极治疗生殖道炎症.

Abstract：

Objective To study the health conditions of pregnant migrant women in some suburban areas of Beijing by comparing a variety of pathological, physiological and social factors and exploring the relevant factors associated with preterm birth so as to prevent effectively preterm birth. Methods A total of 279 cases of pregnancy in preterm birth at out hospital from January 2004 to December 2008 were reviewed.The date of maternal age, parity, prenatal examinations, history of vaginitis, history of chorioamnionitis,premature rupture of membranes, occupation, residing location and education status were recorded. And the relationship between them and preterm birth were analyzed by X2 test. Results The overall incidence of preterm birth was 5.34%. And the following factors had statistically significant differences with premature birth: chorioamnionitis, vaginitis, premature rupture of membranes, a lack of prenatal examinations, low education status, migrant population or maternal parity. However there was no statistical significance ( P ＞0.05) between preterm birth and other factors, such as occupation. Conclusion The incidence of preterm birth is associated with a lack of prenatal examinations, low education status, chorioamnionitis, bacterial vaginitis and premature rupture of membranes. Therefore the migrant women in Beijing should receive targeted education programs during pregnancy. And reproductive tract inflammation should be properly treated.