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PubMed2003

Attitudes toward prenatal diagnosis, termination of pregnancy, and reproduction by parents of children with nonsyndromic oral clefts in Argentina.

OBJECTIVE: To investigate the attitudes of Argentine parents of children with nonsyndromic oral clefts with respect to prenatal diagnosis, termination of pregnancy, and reproduction and to assess the variables that might influence their responses. DESIGN: One hundred and sixty-five parents of children with oral clefts, ascertained from a craniofacial clinic in the suburbs of Buenos Aires, answered a 151-item semistructured questionnaire. The questionnaire included sections covering sociodemographic information, level of religiousness, characteristics of the child's cleft, parental perception of their child's cleft, pregnancy history, recurrence risk, access to health care, attitudes in regard to abortion, and family environment. RESULTS: Most parents (60%) believe their child's cleft is not a serious condition. None of the respondents would terminate a pregnancy because the ultrasound reveals an oral cleft. Similarly, very few (6.1%) would terminate the pregnancy if there were an early diagnosis of Down syndrome. Half of the respondents believe that abortion should not be an option for any couple expecting a child. CONCLUSIONS: Most respondents do not perceive oral clefts as a severe condition. Parents would not choose to terminate the pregnancy over delivery of such an affected newborn.

Abortion, Induced↗
PubMed1997

Leptin in human reproduction: serum leptin levels in pregnant and lactating women.

Experiments in ob/ob female mice demonstrated that leptin injections not only reduced weight and fat mass, but also restored fertility and partial lactation. To explore factors regulating ob gene expression in reproductive women, we measured serum leptin, body fat, energy expenditure, and milk production in 65 women at 36 weeks of gestation, and at 3 and 6 months postpartum. Serum leptin was measured by solid-phase sandwich enzyme immunoassay, and serum insulin and PRL by solid-phase 125I RIA. Total body water by deuterium dilution, body volume by hydrodensitometry, and bone density by dual-energy x-ray absorptiometry were used to estimate body fat. Serum leptin per unit fat mass was significantly higher at 36 weeks of pregnancy than at 3 and 6 months postpartum (1.25 vs. 0.75, 0.73 ng.mL-1.kg-1). Postpartum normalization of leptin was associated with changes not only in weight and fat mass, but also serum insulin. Leptin was not different between lactating and nonlactating women. Leptin may have affected milk production indirectly through its negative effect on serum PRL. Adjusted for fat-free mass and fat mass, rates of energy expenditure were not significantly correlated with leptin. Our results provide evidence that factors other than fat mass alone modulate serum leptin in reproductive women.

Adult↗
PubMed1994

[Cytogenetic study in disorders of human reproduction].

We reviewed 1347 cytogenetic studies performed in a period of eight years to analyze chromosomal translocations and their relation with reproductive failure. Twenty nine index cases were detected representing a global incidence of 2.2% thirteen (45%) were balanced reciprocal translocations between autosomes, thirteen (45%) were robertsonian translocations and three (10%) were X; autosomal translocations. The most frequent indication for the study were, for each group, respectively, recurrent abortion, a child with congenital malformations and ovarian dysfunction. Our results are compared with those of other authors and the mechanisms and figure risks for unbalanced offspring are discussed.

Abnormalities, Multiple↗
PubMed2001

Association of the maternal experience and changes in adiposity measured by BMI, waist:hip ratio and percentage body fat in urban Brazilian women.

The aim of the present study was to determine the association between the maternal experience and changes in adiposity measured by BMI, percentage body fat (PBF) and waist:hip ratio (WHR). In a cross-sectional study, 203 women were recruited at health care and educational facilities in Brasilia, Brazil. These women were divided into three groups: fifty-three nulliparous (no full-term pregnancy); sixty-three primiparous (one full-term pregnancy); eighty-seven multiparous (two or more full-term pregnancies). Socio-economic, behavioural, reproductive and dietary data were collected. All the women were measured for weight, height, skinfold thicknesses and waist and hip circumferences. Analysis of covariance was used to measure the differences among the three groups in relation to BMI, PBF, and WHR, controlling for the following covariates: age; socio-economic status; use of oral contraceptives; smoking; energy intake level; cooking oil intake; physical activity level; lactation score; parity. The three groups of women differed significantly for BMI (P = 0.04), PBF (P = 0.0008), and WHR (P = 0.0001). Multiparous women presented higher BMI (P = 0.01) and PBF (P = 0.03) compared with primi- and nulliparous groups. PBF was also associated with age and high socio-economic status. Primi- and multiparous women showed a higher WHR than nulliparous women (P < 0.0001). Age and smoking habit were also factors associated with higher WHR.

Adipose Tissue↗
PubMed2005

Evolution of Spanish scientific production in international obstetrics and gynecology journals during the period 1986-2002.

OBJECTIVE: The present bibliometric study analyzes Spanish scientific work published in the field of obstetrics and gynecology in the most important journals during the period 1986-2002. STUDY DESIGN: The material studied (779 original documents) was selected in accordance with the science citation index (SCI) of 2001, obstetrics and gynecology section, using the EMBASE: Obstetrics and Gynecology database. We applied the customary rules of bibliometrics: Price's Law of increase in scientific literature, Bradford's Law of scattering of scientific literature and Lotka's Law of author productivity. Furthermore, we analyzed participation index (PaI), the collaboration index and the superior (%SUP). RESULTS: The material studied is closer to an exponential adjustment (r = 0.958) than to a linear adjustment (r = 0.856). The journal with the largest number of originals is Human Reproduction (Bradford's first area), with 217 articles and that with the highest PaI is Menopause (4.07). The total number of authors is 1829, who are responsible for 3938 authorships (2.79% of the authors have a productivity index (PI) > or = 1 and 70.09% have a PI = 0). The majority of the studies were carried out in hospitals (47.62%) and universities (23.36%). CONCLUSION: Spanish productivity in the field of obstetrics and gynecology increased considerably in the period 1986-2002.

Bibliometrics↗
PubMed2004

Miscarriage but not fecundity is associated with progression of joint destruction in rheumatoid arthritis.

OBJECTIVE: To determine whether reproductive history before disease onset is associated with severity of joint destruction in rheumatoid arthritis. METHODS: A special early arthritis clinic (EAC) was established at the department of rheumatology of Leiden University Medical Centre. General practitioners were encouraged to refer patients with joint complaints to this clinic, where the diagnosis of rheumatoid arthritis was made by a rheumatologist. In all, 113 female patients with definite rheumatoid arthritis were included in this study. A structured questionnaire was administered and joint damage was assessed by sequential x rays of the hands and feet, using the modified Sharp score. RESULTS: The length of time of unprotected intercourse until first pregnancy (fecundity) was comparable with data from earlier studies, with 16% of the patients reporting a time to first pregnancy of more than 12 months. Fecundity did not reflect the extent of joint damage over time. The miscarriage rate was 15% per pregnancy, comparable to population figures (12-15%). A significant increase in joint damage over a two year follow up was found in patients with rheumatoid arthritis who had experienced at least one miscarriage compared with those who had never had a miscarriage (mean modified Sharp scores at 2 years, 24 (95% confidence interval, 15 to 32) and 16 (10 to 23), respectively; p<0.05). At baseline, the Sharp scores were similar in the two subgroups. CONCLUSIONS: Miscarriage before disease onset but not fecundity is associated with the progression of joint damage in rheumatoid arthritis.

Abortion, Spontaneous↗
PubMed1992

Male infertility: the impact of assisted reproductive technologies.

Spermatozoal abnormalities are present in up to 40% of infertile couples. Multiple etiologies may be responsible for these disorders, including pretesticular, testicular, and ductal causes. An adequate andrologic consultation, including history, physical examination, and repeated semen analysis, should be performed routinely in these cases. Evaluation of the basic sperm parameters, including sperm concentration, motion parameters (as evaluated by computer-assisted semen analysis), and sperm morphology (as judged by strict criteria), constitute the first obligatory step for a critical evaluation of male factor patients. Patients in whom fertilization disorders are suspected should be evaluated through bioassays of sperm-oocyte interaction, including the heterologous sperm penetration assay and hemizona assay, a bioassay of sperm-zona binding capacity highly predictive of in vitro fertilization outcome. Male disorders can be subjected to specific therapies (surgical or medical), or to empiric therapeutic modalities. Assisted reproductive technologies have enhanced our understanding of the physiopathology of spermatozoal disorders and also have ostensibly improved pregnancy rates in male factor patients.

Female↗
PubMed1996

[Ovarian hyperstimulation in medically assisted reproduction: which practical approach?].

Ovarian hyperstimulation syndrome (OHS) with serious grade could be a live threatening disease, that occurs in 0.5% to 1% of in vitro fertilization program. The prevention of OHS is based on the recognition of risk factors and on ultrasonic and hormonal monitoring, with well adapted treatment in order to reduce the number of follicles. The level of oestradiol will determine the injection of human chorionic gonadotropins: between 2500 and 3000 pg/ml, the injection of HCG is reduced to 5000 U for the induction of ovulation, and the injections of HCG 1500 during the luteal period are avoided: between 3000 and 5000 pg/ml, the injection of HCG is reduced to 5000 U and the replacement of fresh embryos is deferred to an other cycle: after 5000 pg/ml, the injection of HCG must be abandoned. The treatment of the confirmed OHS is based on the rest, with hospitalization, correction of fluid, electrolyte and protein imbalance, prevention of thrombo embolism and aspiration of ascite fluid.

Female↗
PubMed1998

Are overweight women at increased risk of obesity following pregnancy?

Longitudinal studies suggest that women who already have a high BMI are at greater risk of maternal obesity than their lighter counterparts. The aim of the present study was to investigate this possibility by examining the relationship between reproductive history and maternal BMI in a community of 627 women from South Africa with a high prevalence of obesity. Standardized questionnaires were used to obtain detailed sociodemographic and behavioural information, while maternal weight and height were both measured at the time of the interview. Analysis of covariance (ANCOVA) showed that maternal age (r2 0.015, P = 0.001), smoking status (r2 0.012, P = 0.036), and social support (r2 0.011, P = 0.006) were all independently associated with maternal BMI. If overweight women were at increased risk of maternal obesity, then the positive relationship between reproductive history and maternal BMI should be enhanced in this relatively obese community, yet the ANCOVA models showed no independent association between gravidity and maternal BMI after controlling for the effects of confounding factors. Although previous longitudinal studies have found a positive association between prepregnant weight and long-term weight gain, this relationship might arise because overweight women gain more weight over a fixed period of time than normal weight women, and therefore they may appear to be at greater risk of pregnancy-related weight gains. Overweight women are at greater risk of weight gain generally, but there is little unequivocal evidence to suggest that they are at any increased risk of maternal obesity, when compared with women of lower BMI.

Adult↗
PubMed2003

The role of leptin in female adolescence.

Leptin, the ob gene product, is related to the onset of puberty in animal models, but its role in human puberty is still rather undefined. In prepubertal girls and boys, leptin concentrations increase slowly with age and body-fat mass. In boys, this increase is interrupted in early puberty, when testosterone and lean body mass increase. In girls, leptin, along with the body-fat mass, continue to increase during puberty. Plasma leptin concentrations are significantly correlated with fat mass at all Tanner stages in males and females. The diurnal variation of leptin concentrations seen in adults is apparent for all age groups with no significant changes in the pattern across puberty. Leptin is bound in blood by a high-affinity binding protein identical with the soluble leptin receptor (sOB-R). In the first year of life, the concentration of sOB-R is high, and then a continuous decline of sOB-R follows until midpuberty. The therapeutic response to leptin treatment in a child with leptin deficiency confirms the importance of leptin in the regulation of body weight in humans, and establishes an important role for this hormone in the regulation of appetite. Still no evidence is available that would indicate leptin is a primary signal that initiates the onset of human puberty. Instead, it may act in a permissive way as one of several metabolic factors to allow pubertal maturation to proceed and later reproduction to occur.

Adipose Tissue↗
PubMed2002

The 'carnivore connection'--evolutionary aspects of insulin resistance.

Insulin resistance is common and is determined by physiological (aging, physical fitness), pathological (obesity) and genetic factors. The metabolic compensatory response to insulin resistance is hyperinsulinaemia, the primary purpose of which is to maintain normal glucose tolerance. The 'carnivore connection' postulates a critical role for the quantity of dietary protein and carbohydrate and the change in the glycaemic index of dietary carbohydrate in the evolution of insulin resistance and hyperinsulinaemia. Insulin resistance offered survival and reproductive advantages during the Ice Ages which dominated human evolution, during which a high-protein low-carbohydrate diet was consumed. Following the end of the last Ice Age and the advent of agriculture, dietary carbohydrate increased. Although this resulted in a sharp increase in the quantity of carbohydrate consumed, these traditional carbohydrate foods had a low glycaemic index and produced only modest increases in plasma insulin. The industrial revolution changed the quality of dietary carbohydrate. The milling of cereals made starch more digestible and postprandial glycaemic and insulin responses increased 2-3 fold compared with coarsely ground flour or whole grains. This combination of insulin resistance and hyperinsulinaemia is a common feature of many modern day diseases. Over the last 50 y the explosion of convenience and takeaway 'fast foods' has exposed most populations to caloric intakes far in excess of daily energy requirements and the resulting obesity has been a major factor in increasing the prevalence of insulin resistance.

Biological Evolution↗
PubMed2003

The association between hormonal and reproductive factors and hand osteoarthritis.

OBJECTIVE: To describe the association of reproductive and hormonal factors with the presence and severity of hand osteoarthritis (OA) in Tasmanian women. METHODS: Cross-sectional study of 348 women from 76 families. A structured questionnaire collected information regarding reproductive history and the use of estrogen containing medications. Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal (CMC) joints, as well as Heberden's nodes (HN) based on hand photography. RESULTS: The prevalence of hand OA was high in this sample at 65-70%. Parity, increasing age at menopause and years of menstruation were associated with both symptomatic hand OA and a more severe DIP score (but not presence of radiographic disease) while both current and ever use of hormone replacement therapy (HRT) were significantly associated with increased prevalence of HN and severity of HN and DIP OA (all P<0.05). HRT usage less than 5 years was associated with increased severity of both DIP disease and HN. No factors were associated with CMC disease apart from ever breast-feeding which was protective (OR 0.37, 95% CI 0.18-0.79). CONCLUSIONS: These results require confirmation in clinical trials or carefully controlled longitudinal studies but suggest that estrogen exposure around the time of disease onset (either endogenous or exogenous) may have a "priming" effect on the severity of DIP OA while breast-feeding in earlier life may be protective for CMC OA.

Aged↗
PubMed2004

Does mammographic density reflect ethnic differences in breast cancer incidence rates?

Breast cancer incidence rates in the United States are substantially lower among Asian-American women than among White or African-American women. The authors determined whether mammographic density reflects these ethnic differences by evaluating mammograms from 442 White, African-American, and Asian-American women without breast cancer who served as controls in one of two population-based, breast cancer case-control studies conducted in Los Angeles, California, in 1994-1998. Absolute and percent mammographic densities were determined with a previously developed and validated computer-assisted method. Data were analyzed using multiple regression methods. Mean age-adjusted percent mammographic density was significantly higher in Asian Americans (35.9%) than in African Americans (27.8%, p < 0.05) but was no longer significant after further adjustment for body mass index. After adjustment for age, body mass index, selected menstrual/reproductive factors, and family history, absolute mammographic density was statistically significantly lower in Asian Americans than in African Americans (p < 0.05) but not than in Whites. The ethnic difference in absolute mammographic density was particularly evident among women older than age 50 years. Additional adjustment for breast size reduced these ethnic differences. This study suggests that absolute but not percent mammographic density reflects the lower breast cancer incidence rates of Asian Americans in relation to those of African Americans and Whites.

Adult↗
PubMed2006

[Reproductive dysfunctions in female patients during therapy with atypical antipsychotics].

To specify interrelations between clinical and hormonal aspects of reproductive dysfunctions appearing during therapy with atypical antipsychotic agents (clozapine, olanzapine, quetiapine), 131 female patients with paranoid schizophrenia and schizoaffective disorder have been studied. Distinctive features of dynamics of prolactin as well as hypothalamic-pituitary-gonadal hormones levels for each medication studied and correlations between hormone indices and clinical presentations of reproductive dysfunctions (galactorrhea, disturbances of menstrual cycle and libido) were found.

Adolescent↗
PubMed1996

The relationship of body mass index to reproductive factors in pre- and postmenopausal African-American women with and without breast cancer.

To date, there are virtually no existing data on the relationship between obesity, menopausal status, and breast cancer in African-Americans. Therefore, the present study was designed to test the following hypotheses in an African-American population: (1) there exists a positive association between BMI and breast cancer among postmenopausal women; (2) there exists an inverse association between BMI and breast cancer among premenopausal women; and (3) similar associations between BMI and reproductive factors exist for both pre- and postmenopausal breast cancer cases. The study population comprised 357 African-American women (n = 193 breast cancer cases; n = 164 controls). No significant differences were observed between premenopausal cases and controls for BMI, obesity categories, and reproductive factors. Among the postmenopausal women, the cases had significantly lower weight and BMI levels than the controls. Age at first pregnancy and parity were significantly lower among postmenopausal cases than their controls. No significant associations were revealed between body mass index and breast cancer for pre- and postmenopausal women. In the present study, early age at menarche was the only reproductive factor that was an independent predictor of BMI for both pre- and postmenopausal women, irrespective of breast cancer status. Also, these findings strongly suggest the need to consider reproductive factors, particularly age at menarche, as a covariate of BMI and other obesity-related diseases.

Adult↗
PubMed1993

Influence of breastfeeding and other reproductive factors on bone mass later in life.

The influence of reproductive factors on bone mass at six skeletal sites was assessed in an age-stratified random sample of white women residing in Rochester, Minnesota. After age-adjustment, whether or not women had ever breastfed, total duration of breastfeeding and duration of breastfeeding per child were not associated with reduced bone mineral, but breastfeeding for more than 8 months was associated with greater bone mineral at some sites. There were no consistent effects on bone mineral, after adjusting for age, of gravidity or parity, age at menarche, age at first delivery, use of oral contraceptives or estrogen replacement therapy, various sex hormones, nor any of the other reproductive factors assessed. There was a strong protective effect of obesity, which was also correlated with a number of the reproductive variables. While animal studies suggest that pregnancy and lactation may be associated with calcium loss from the skeleton, these data indicate that such factors have little long-term impact on bone mass in humans and little potential for identifying women at high risk of osteoporosis later in life.

Adult↗
PubMed2005

Hormone replacement therapy, reproductive history, and colorectal adenomas: data from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial (United States).

OBJECTIVE: Findings from some epidemiologic studies of colorectal cancer and adenoma suggest that the protective effect of post-menopausal hormone replacement therapy (HRT) may differ across categories of age and body mass index (BMI). We conducted an analysis of women participating in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial to investigate the relationship between HRT use and prevalent adenoma, both overall and across different population subgroups. METHODS: Women aged 55-74 were randomized to screening by flexible sigmoidoscopy at ten PLCO screening centers between September 1993 and September 2001. We identified 1468 women with at least one left-sided adenoma and 19,203 without adenoma or colorectal cancer. Information about HRT and reproductive factors was obtained from a self-administered questionnaire. RESULTS: Compared to never use of HRT, current use was associated with a decreased prevalence of left-sided adenoma (odds ratio (OR) 0.85; 95% confidence interval (CI) 0.75-0.97). We found no evidence of dose-response with increasing duration of use for current or former users. The association with current HRT use was stronger among women aged 65+ (OR 0.69; 95% CI 0.56-0.84), with a BMI<30 (OR 0.82; 95% CI 0.71-0.95) and who regularly use aspirin or ibuprofen (OR 0.77; 95% CI 0.65-0.91). Other reproductive factors were not significantly associated with adenoma prevalence. CONCLUSIONS: Our findings suggest that current HRT use may protect against colorectal adenoma, and that this protective effect is short-lived following cessation of use.

Adenoma↗