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PubMed1994

The effects of running activity on the reproductive axes of rodents.

Access to a running wheel causes gonadal recrudescence in Syrian hamsters whose reproductive axes have been suppressed by housing them under short day lengths (Borer et al. 1983). The first experiment tested the generality of this phenomenon in a population of rodents that is genetically heterogeneous for reproductive photoresponsiveness. Male meadow voles (Microtus pennsylvanicus) of the two extreme phenotypes--reproductively photoresponsive and non-responsive--were either provided with a running wheel or housed without one. After 4 weeks with a wheel, the responsive voles had recovered full reproductive function, while the reproductive axes of responsive voles housed without wheels remained suppressed. Three experiments queried whether the use of a wheel would have reproductively stimulative effects in other rodents. First, intact male mice given access to wheels showed no increase in testis size when compared to mice housed without wheels. Likewise, locomotor activity had no effect on male rats whose testes were partially regressed in response to testosterone implants or on female mice whose estrous cycles were pheromonally suppressed by housing them in groups. Thus the neuroendocrine pathway used by locomotor activity to enhance the secretion of gonadotropin is specifically allied with the pathway used by photoperiod to control GnRH secretion.

Analysis of Variance↗

PubMed1996

Immunohistochemical detection and distribution of the 1,25-dihydroxyvitamin D3 receptor in rat reproductive tissues.

Vitamin D3, via its active metabolite 1,25-dihydroxyvitamin D3, plays a critical part in male and female reproduction in the rat. 1,25-Dihydroxyvitamin D3 activity is mediated by an intracellular receptor (VDR). VDR distribution in reproductive tissue has not been studied using antibodies against the receptor. We developed a polyclonal antibody against the VDR and used it to examine VDR distribution in male and female rat reproductive tissues. In rat testes, VDR epitopes were observed in seminiferous tubules, specifically in spermatogonia, Sertoli cells and spermatocytes. Spermatozoa stained faintly. Epithelial cells of the epididymis, seminal vesicles and prostate also expressed VDR epitopes. In the female rat reproductive tract, immunostaining for VDR was seen in ovarian follicles, specifically in granulosa cells. Weaker VDR immunostaining was observed in follicular thecal cells and in the ovarian stroma and germinal epithelium. Corpus luteal cells stained intensely for VDR. Epithelium of fallopian tubes and the uterus also contained VDR epitopes. Both nuclear and cytoplasmic VDR immunostaining was observed in male and female rat reproductive tissues. We conclude that the VDR is widely distributed in male and female reproductive tissues and that it is likely to mediate actions of 1,25-dihydroxyvitamin D3 in the tissues.

Animals↗

PubMed1995

Annexin I in female rabbit reproductive organs: varying levels in relation to maturity and pregnancy.

The level of annexin I, a 36 kDa calcium-dependent phospholipid-binding protein (36 kDa PLBP) in the reproductive organs of young, mature, and pregnant rabbits was determined immunologically with antibodies raised against purified rabbit lung annexin I. In the cytosolic fractions of the ovary, fallopian tube, uterus, and placenta, annexin I was the only major immunoreactive protein. The reproductive organs appeared to have higher annexin I levels than most nonreproductive organ tissues, except the lung and the spleen which were also rich in annexin I. A small amount of annexin I and a nearly equal amount of its hydrolytic product, a 33 kDa polypeptide, were detected in the amniotic fluid between 21 and 27 days gestation. Structural similarity of annexin I in the reproductive organs and in the lung was suggested by their identical isoelectric point values. Annexin I in the ovary of adult rabbits was 70% higher than that in the respective organ of immature rabbits. The uterus of pregnant rabbits had about 84% higher annexin I contents than that of the nonpregnant rabbits. The placenta had more annexin I per mg cytosolic protein than either the ovary or the uterus during pregnancy. The high concentration of annexin I in the reproductive organs may reflect specific functions of these organs in the reproductive years and during the reproductive cycle.

Amniotic Fluid↗

PubMed2004

The right dorsolateral prefrontal cortex is essential in time reproduction: an investigation with repetitive transcranial magnetic stimulation.

This study used repetitive transcranial magnetic stimulation (rTMS) to investigate the roles of the right dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA) in short (500 ms) and long (2 s) interval timing. The results were compared with rTMS over the leg area of motor cortex, an area not thought to be involved with time estimation. rTMS was delivered during one of two phases of a time reproduction task: at the onset of the Estimation Phase (presentation of the interval to be timed) and at the onset of the Reproduction Phase (subjects' reproduction of the timed interval). There was a significant main effect of Site (SMA vs. right DLPFC vs. leg motor area) due to the fact that rTMS over the right DLPFC caused subjects to underestimate time intervals compared with rTMS over the leg motor area. There was also a significant three-way interaction between Site, Duration and Phase (Estimation Phase vs. Reproduction Phase) that post hoc analyses showed was due to underestimation of long intervals when rTMS was given over the right DLPFC at the start of the Reproduction Phase. There was no effect of rTMS over the right DLPFC or SMA in the short interval task. This is consistent with previous studies showing that the right DLPFC is important in estimating time intervals in the seconds-range. In addition, we suggest that the selectivity of the rTMS effect for the Reproduction Phase indicates that the right DLPFC plays a particular role in memory processes.

Adult↗

PubMed2006

Effects of food abundance, density and climate change on reproduction in the sparrowhawk Accipiter nisus.

The reproductive success of predators depends on abiotic environmental conditions, food abundance and population density, and food abundance, density and their interactions may respond to changes in climatic conditions. Timing of reproduction by five of the eight numerically most common prey of the sparrowhawk Accipiter nisus advanced significantly since 1971, during a period of temperature increase. There was no evidence that mean laying date or any other reproductive parameter of sparrowhawks changed consistently during the study period 1977-1997. Laying date advanced and percentage of unsuccessful female sparrowhawks decreased with beech mast in the current year, an index of food abundance for avian prey. Mean laying date of sparrowhawks was advanced in warmer springs, and although mean clutch size was not larger in warm than in cold springs, mean brood size of successful pairs and breeding success increased in such springs, showing that sparrowhawks enjoyed a fitness gain when reproducing early. The timing of sparrowhawk reproduction with respect to the peak in abundance of fledgling prey increased, from a good match between mean timing of fledging by prey and maximum demand for food by the predator in 1977, to reproduction occurring later than the peak in fledging prey availability in 1997. The size of the breeding population of sparrowhawks was not predicted by mean spring temperature, the size of the breeding population the previous year or beech mast crop. The size of the post-breeding population was predicted by size of the breeding and post-breeding population the previous year and by the proportion of unsuccessful females the current year. These findings imply that sparrowhawks did not respond to change in climate, although climate changed the timing of reproduction by the main prey species.

Animals↗

PubMed1988

The reproductive autoimmune failure syndrome.

The association between reproductive failure and abnormal autoimmune function has been recognized for decades in association with such established autoimmune diseases as systemic lupus erythematosus. Recent investigations have expanded this association to women who demonstrate similar humoral abnormalities as patients with defined autoimmune diseases but do not express any of the clinical symptoms required for the diagnosis of an autoimmune disease. The observation that abnormal autoimmune function in clinically asymptomatic patients can lead to reproductive failure has led us to define the reproductive autoimmune failure syndrome as a diagnostic entity. The present article summarizes evidence suggesting that the occurrence of reproductive autoimmune failure syndrome may be teleologically related to the woman's need for increased self-tolerance in face of antigenic exposure to the maternal haplotype of the fetus during normal pregnancy. This need for increased self-tolerance is documented by higher normal autoantibody levels in women than in men and may also be responsible for the highly increased incidence of autoimmune diseases in women in comparison with men. Under this concept, abnormal autoimmune function may lead to reproductive failure at different stages of the reproductive process, depending on the quality and possibly quantity of the abnormal autoimmune response.

Abortion, Habitual↗

PubMed1992

Worldwide variations in the lifetime probability of reproductive cancer in women: implications of best-case, worst-case, and likely-case assumptions about the effect of oral contraceptive use.

Cancer incidence in countries representative of three patterns of reproductive cancer and age-specific mortality was used to estimate the effect of oral contraceptive use on the lifetime probability of reproductive cancer under three sets of assumptions about the effects of oral contraceptives. Under the set of assumptions considered likely, oral contraceptives were estimated to reduce or increase only slightly the lifetime probability of any reproductive cancer in each setting. Under worst-case assumptions, oral contraceptives were estimated to increase the lifetime probability of reproductive cancer only modestly in settings with low cancer rates and in settings with high rates of breast, ovarian, and endometrial cancer, but it might have a large impact on lifetime probability of reproductive cancer in settings with high cervical cancer rates. Under best-case assumptions, oral contraceptives were estimated to decrease the lifetime probability of reproductive cancer in each setting; this reduction was estimated to be greatest in settings where endometrial and ovarian cancer incidence are high.

Adolescent↗

PubMed1988

Cytochrome oxidase activity in brown fat varies with reproductive response and use of torpor in deer mice.

Reproductive responses and thermogenic properties of brown adipose tissue (BAT) were evaluated in individuals from an outbred population of deer mice (Peromyscus maniculatus nebrascensis) after 10 weeks exposure to short photoperiod (8:16 light:dark) and cold ambient temperature (2 degrees C). Deer mice populations are composed of phenotypes that differ in their reproductive response to environmental cues. These phenotypes also differ in body temperature regulation as indicated by their use of daily torpor. By comparing BAT responses among individuals of different phenotypes, we were able to assess the association between environmentally induced changes in reproduction and metabolism. Short/cold days caused increased proliferation of BAT and higher cytochrome oxidase activity. However, the magnitude of these changes varied with reproductive phenotype and use of daily torpor. BAT weight in short/cold day exposed males with normal sized testes more than doubled while total cytochrome oxidase activity increased by 30% as compared to controls. In contrast, short/cold day exposed deer mice with atrophic testes that employed daily torpor exhibited a 64% increase in BAT weight and 100% increase in total cytochrome oxidase activity, compared to control mice. Cytochrome oxidase activity in nontorpid deer mice with atrophic testes was intermediate to these two groups. Our results demonstrate a response of BAT to short/cold days that varies with individual reproductive response. This finding suggests that there exists a common integrative mechanism for temperature and photoperiod to regulate both seasonal reproductive and metabolic adjustments.

Adipose Tissue, Brown↗

PubMed1987

Reproductive performance and productive traits of beef bulls selected for different levels of testosterone response to GnRH.

In two separate studies, one with four Hereford-Shorthorn and one with three Zebu x British crossbred bulls, the efficacy of using the testosterone response to gonadotrophin-releasing hormone (GnRH; Lutal, Hoechst) to predict differences in reproductive performance was assessed. Young bulls (17 or 29 months of age) selected for low to high (3.1 to 10.3 ng/ml) peak plasma testosterone 2 to 2.5 hours after the intramuscular injection of GnRH (62.5 to 2000 ng/kg LWT) were each later individually joined with groups of 19 to 30 cows in which estrus had been synchronized. In both studies, the rankings of bulls for overall fertility (capable cows pregnant), for libido (estrous cows mounted), and for fertilizing ability (mounted cows pregnant) were in close agreement with rankings for testosterone responses to GnRH. In the Bos indicus bulls rankings for both reproductive performance and testosterone response to GnRH were repeatable when measured at two and four years of age. Other reproductive measurements (semen quality, scrotal circumference, pen-type serving capacity tests) were less reliable predictors of reproductive performance. Measurements of liveweight gains and parasite resistance indicated that bulls superior for these characteristics do not always have satisfactory reproductive performance. These studies suggest that the testosterone response to GnRH could be a useful test to ensure that bulls selected for productive traits have adequate reproductive potential.

Journal Article↗

PubMed1995

The educational implications of reproductive problems identified during investigations at Michigan dairy farms.

This study constitutes the review of 44 dairy herd investigations that were initiated because of complaints relating to decreased reproductive efficiency. Each investigation was conducted at the request of the veterinary practitioner who provided the routine reproductive examinations and consultations at the farm. Thus the types of problems identified were those not resolved by routine veterinary care and management practices. A total of 4.5, 27.3 and 31.8% of the farms, respectively, failed to keep reproductive records, failed to maintain accurate records on events such as breeding dates, or failed to evaluate available summary reports with the local veterinary practitioner. Of the 44 farms, 50.0, 38.6, 54.5 and 11.4%, respectively, reported problems related to estrus detection rate, number of days to first service (for reasons other than estrus detection), conception rate and early embryonic death. Within each of these reproductive parameters specific problems were defined and discussed. Reproductive inefficiency was found to be most commonly associated with ineffective estrus detection and decreased conception rate. Most importantly, farm managers and employees frequently misunderstood the relationship between the accuracy of estrus detection and the conception rate (61.4% of the farms). We therefore identified factors which have an impact on dairy herd reproductive efficiency to suggest topics for training programs for producers and practicing veterinarians as well as for elective courses for veterinary students in the area of theriogenology.

Journal Article↗

PubMed1996

Reproductive phenotpes of the progesterone receptor null mutant mouse.

Although progesterone has been traditionally associated with the establishment and maintenance of mammalian pregnancy, a number of studies have implicated physiological roles of this steroid hormone in other reproductive events. At present most of the downstream molecular and cellular mechanisms by which progesterone exerts its effects are unclear; however, the progesterone signal is known to be mediated initially by the progesterone receptor (PR), a member of the nuclear receptor superfamily of transcription factors. In most tissues studied, the PR is induced by ovarian estrogen via the estrogen receptor (ER), thereby implying that many of the observed reproductive physiological responses attributed to PR could conceivably be due to the combined effects of progesterone and estrogen. Therefore, to define clearly the distinct roles of progesterone and estrogen in vivo and to understand better progesterone function in a physiological context, we recently have generated a novel mouse strain in which both forms of the PR were ablated using gene targeting/embryonic stem cell techniques. Surprisingly, both male and female embryos, homozygous for the PR null mutation, developed to adulthood at the normal Mendelian frequency with no deviation in the sex ratio. Although developmental defects have yet to be detected in the adult male PR homozygote, extensive reproductive abnormalities were observed in the female. The reproductive phenotypes consisted of an inability to ovulate, uterine hyperplasia and inflammation, severely limited mammary gland development and an impairment in the induction of a sexual behavioral response. Collectively, these results provide direct in vivo evidence for progesterone's role as a pleiotropic coordinator of diverse reproductive events that together ensure female fertility. Finally, we believe that this animal model will be an invaluable tool in exploring the effects of progesterone in physiological systems other than reproduction and may, in the future, help to redefine progesterone not just as a sex steroid hormone but also as a key regulator of diverse physiological processes.

Animals↗

PubMed1995

Reproductive health in young women with cystic fibrosis: knowledge, behavior and attitudes.

PURPOSE: The improved life-expectancy in cystic fibrosis (CF) results in the fact that the majority of affected young women now survive to face the same reproductive health decisions as other women, in addition to those that specifically relate to CF. The aim of this study was to assess the reproductive health knowledge of women with CF, to investigate the range of their reproductive health problems, and to review their reproductive health attitudes and behaviors. METHODS: Women aged 18 years and over attending CF services in the state of Victoria, Australia were invited to complete a reproductive health questionnaire. Comparison subjects (n = 76) were enrolled from 2 primary care practices. RESULTS: Fifty-five women participated (89%), with a median age of 22 years (range 18-50). There was no significant difference in marital status between the two groups and a similar proportion were sexually active, yet women with CF were less likely to use contraception. A majority of women with CF believed that fertility was reduced, and there was poor knowledge of the potentially deleterious effect of pregnancy. A relatively high proportion were planning to become pregnant in the near future. Twenty-two percent had tried to conceive, with a success rate of 67%. CONCLUSIONS: Women with CF are currently lacking important information about reproductive health that potentially has a major impact on their health and their lives.

Adolescent↗

PubMed2006

Altered gene expression: a mechanism for reproductive toxicity in zebrafish exposed to benzo[a]pyrene.

Exposure of fish to polycyclic aromatic hydrocarbons (PAHs) has consistently been shown to have a negative impact on reproduction (e.g. decreased spawning success, decreased ovarian somatic index (OSI) and lower circulating levels of 17beta-estradiol and vitellogenin). While an understanding of the mechanism behind these changes has yet to be fully elucidated, it has been proposed that PAHs can alter the expression of genes important in regulating reproduction. The objectives of this study were to: (1) determine the effect of exposure to waterborne benzo[a]pyrene (B[a]P) (0, 1.5 and 3.0 microg/L) for 56 days on egg production and OSI in female zebrafish (Danio rerio) and (2) determine the effect of B[a]P on transcription of genes involved in reproduction including gonadotropins (follicle stimulating hormone (FSH) and luteinizing hormone (LH)), steroidogenic enzymes (CYP11A1, CYP17, CYP19A1, CYP19A2 and 20beta-HSD), estrogen receptor beta (ERbeta) and vitellogenin. Cytochrome P4501A1 (CYP1A1) was also measured in the liver and heads as an indicator of exposure to B[a]P. A reduction in total egg output was observed in B[a]P exposed fish as well as a decrease in OSI in fish exposed to 3.0 microg/L B[a]P. A significant increase in CYP1A1 expression in the heads as compared to the control was observed whereas no significant difference in CYP1A1 was detected in livers. A significant increase in 20beta-HSD mRNA occurred in heads and pre-vitellogenic oocytes from fish exposed to 1.5 and 3.0 microg/L as compared to the controls. CYP19A2 and vitellogenin were significantly increased following exposure to 3.0 microg/L in the heads and liver, respectively. No effects on the expression of FSH, LH, CYP19A1 or ERbeta were observed. Results from this study demonstrate that reproduction in zebrafish is affected by waterborne exposure to B[a]P and that altered transcription of genes important in regulating reproduction (20beta-HSD, CYP19A2 and vitellogenin) may be one of the underlying mechanisms of B[a]P-induced reproductive toxicity.

20-Hydroxysteroid Dehydrogenases↗

PubMed2005

Recent female mouse models displaying advanced reproductive aging.

Reproductive senescence occurs in all female mammals with resultant changes in numerous body functional systems and several important features may be species-specific. Those features that appear to parallel human menopause and aging include general similarity of hormone profiles across the menopausal transition, progression to cycle termination through irregular cycles, declining fertility with age, disturbances in thermogenesis, age-related gains in body weight, fat distribution and disposition towards metabolic syndrome. Structural and hormonal changes in the brain and ovary play a critical role in determining the onset of reproductive senescence. The short life span of rodents such as mice (compared to humans) and the ability to generate specific and timed gene deletions, provide powerful experimental paradigms to understand the molecular and functional changes that precede and follow the loss of reproductive capacity. In theory, any manipulation that compromises ovarian function either partly or totally would impact reproductive events at various levels followed by other dysfunctions. In this article, we provide an overview of three mouse models for the study of female reproductive aging. They are derived from different strategies and their age related phenotypes have been characterized to varying degrees. The follitropin receptor knockout (FORKO) mouse, in its null and haploinsufficient state as well as the dioxin/aryl hydrocarbon receptor (AhR) knockout mouse, serve as two examples of single gene deletions. A third model, using administration of a chemical toxicant such as 4-vinylcyclohexene diepoxide (VCD) in the adult state, produces ovarian deficiencies accompanied by aging changes. These will serve as useful alternatives to previously used radical ovariectomy in young adults. It is anticipated that these new models and more that will be forthcoming will extend opportunities to understand reproductive aging and resolve controversies that abound on issues related to benefits and risks of hormone replacement therapy or other modalities for improving quality of life.

Aging↗

PubMed2005

Reproductive health education and sexual risk among high-risk female adolescents and young adults.

STUDY OBJECTIVE: The objective of this study was to explore the associations of sources, content, and timing of reproductive health education with cognitive and behavioral sexual risk in a sample of high-risk female adolescents and young adults. DESIGN: Female adolescents and young adults (n=113, median age 17 years) receiving treatment for a sexually transmitted disease (STD) reported sources of reproductive health education, topics covered, and when first formal education occurred. Dependent variables included sexual risk knowledge; condom attitudes, negotiation skills, and use (consistent and at last sex); and number of sexual partners. RESULTS: Most participants reported receiving reproductive health education from both parental (80%) and formal sources (92%). Parents discussed the menstrual cycle (94%) more frequently than other sex education topics, while formal sources focused most on teaching about STDs (91%). Although median age of first formal instruction was 12 years, 26% of girls received their first formal education during or after the year they initiated coitus. Girls with a parental source of education and those receiving formal instruction on pregnancy reported greater ability to negotiate condom use. Girls who received education later in relation to the onset of sexual activity and those with a parental source of education reported more sexual partners. CONCLUSIONS: Early reproductive health education and education from both parental and formal sources is associated with reduced sexual risk among high-risk adolescent girls. Interestingly, receiving parental education is also associated with more sexual partners, suggesting that parental educational efforts may be reactive to their daughters' increasing sexual risk behavior. Future research should examine multiple sources of reproductive health education and the timing of education from these sources to enhance understanding the dynamic interactions between reproductive health education and adolescent sexual risk.

Adolescent↗

PubMed2005

Perinatal exposure to genistein alters reproductive development and aggressive behavior in male mice.

Exposure to endocrine disrupting chemicals adversely affects reproductive development and behavior in males. The goal of this study was to determine if exposure to genistein, an isoflavone found in soy, during early periods of sex differentiation alters reproductive development and behavior in male mice. Female C57BL/6 mice were fed a phytoestrogen-free diet supplemented with 0, 5 or 300 mg/kg of genistein throughout gestation and lactation. Anogenital distance (AGD) and body mass of male offspring was measured weekly from postnatal days 2-21, timing of preputial separation was assessed at puberty, and in adulthood, reproductive organ masses, sperm and testosterone production, and reproductive and aggressive behaviors were assessed. Exposure to genistein resulted in smaller AGD are reduced body mass, with the low-dose diet exerting a greater effect. Timing of preputial separation, adult reproductive behavior, sperm concentrations and testosterone production were not influenced by genistein treatment at either dose. Aggressive behaviors were decreased, whereas defensive behaviors were increased, in males that received the low-dose genistein diet. Exposure to genistein during critical periods of sex differentiation results in concurrent and persistent demasculinization in male mice. Phenotypic and behavioral abnormalities induced by genistein showed a non-monotonic response, where treatment with a low dose exerted a greater effect than treatment with a high dose of genistein. Given the popularity of soy infant formulas, the influence isoflavone exposure on reproductive and behavioral health in boys and men should be considered.

Administration, Oral↗

PubMed2005

Neonatal manipulation of oxytocin influences female reproductive behavior and success.

During early neonatal development, oxytocin (OT) may influence the expression of adult behavior and physiology. Here we test the prediction that early postnatal exposure to OT or an oxytocin antagonist (OTA) can affect the subsequent expression of sexual receptivity and reproductive success of females. To test this hypothesis, female prairie voles (Microtus ochrogaster) received one of four treatments within 24 h of birth. Three groups received an intraperitoneal injection of OT, OTA, or isotonic saline. A fourth group was handled, but not injected. Around 75 days of age, females were paired with sexually experienced males for 72 h and sexual activity was recorded. Treatment had no effect on the probability of mating. Injection, regardless of treatment, reduced latency to mate compared with handled controls. OT and OTA treatment decreased mating bout frequency compared to saline and handled controls, while OTA treatment increased reproductive success, probability of successfully producing a litter. The results suggest that neonatally OT, both endogenous and exogenous, can affect the expression of adult female reproductive activity and that blocking the effects of endogenous OT during neonatal development can affect female reproductive success. Finally, the results suggest that a number of aspects of reproduction are regulated by OT during the postnatal period, but that the mechanism of action may differ depending upon the reproductive activity.

Age Factors↗

PubMed1998

Reproductive health hospitalizations among women with human immunodeficiency virus infections.

OBJECTIVE: Our goal was to determine types of inpatient admissions among human immunodeficiency virus-infected women both before and after the human immunodeficiency virus diagnosis, so that we might outline opportunities for intervention. STUDY DESIGN: A total of 292 human immunodeficiency virus-infected women were interviewed about the reproductive history and prior hospitalizations. A reproductive health hospitalization was defined as either an obstetric admission or a gynecologic admission. Other admissions were categorized as either human immunodeficiency virus related, possibly human immunodeficiency virus related, or not human immunodeficiency virus related. Assignments were made independently by two human immunodeficiency virus specialists. If there was a conflict, a third reviewer was used. RESULTS: In the 10 years before study entry 44.4% of women had at least one obstetric admission, 30.4% had at least one gynecologic admission, 3.1% had at least one human immunodeficiency virus-related admission, 18.1% had at least one admission that was possibly human immunodeficiency virus related, and 13.3% had at least one admission that was not human immunodeficiency virus related. Overall, 226 (77%) women had been admitted to the hospital; of these, 201 (69%) had been admitted for reproductive health reasons. Similar patterns were seen in the year before diagnosis and the time after diagnosis. Reproductive health admissions were more common among women who were younger, who used drugs, and who had higher CD4+ cell counts. CONCLUSION: Women with human immunodeficiency virus infection are often admitted to hospitals for reproductive health reasons before and after the human immunodeficiency virus status is known. Clinicians providing reproductive health care must be actively engaged in efforts to reduce the heterosexual and perinatal transmission of human immunodeficiency virus, to identify human immunodeficiency virus-infected women early in the course of the disease, and to provide ongoing care to human immunodeficiency virus-infected women.

Adult↗