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The American Journal of Geriatric... Feb 2020Although it has become increasingly clear that pregnancy-related health predicts later-life cardiometabolic health, the relationship between reproductive history and...
BACKGROUND
Although it has become increasingly clear that pregnancy-related health predicts later-life cardiometabolic health, the relationship between reproductive history and cognitive health is less frequently studied. Although some research has identified associations between parity or hypertensive disorders of pregnancy and cognitive changes, the evidence is mixed.
OBJECTIVE
To examine the association between reproductive history and midlife cognition in a community-based population.
STUDY DESIGN
Seven hundred and thirty midlife women in the Bogalusa Heart Study completed a brief cognitive battery (memory, attention, executive function, and processing speed) and were interviewed about their reproductive history. Reproductive history (parity, age at first pregnancy, and breastfeeding) and pregnancy complications (low birthweight, preterm birth, hypertensive disorders, and miscarriage) were examined as predictors of cognitive function, with adjustment for potential confounders.
RESULTS
Nulliparous women had an overall lower cognitive score (adjusted beta -1.50, standard error [SE]: 0.41). Adolescent birth was associated with a somewhat better performance on the Trail Making Test (beta -0.31, SE: 0.15 for birth <16 years), while high parity was not strongly associated with any of the cognitive measures. History of pregnancy complications was not strongly associated with cognitive function, whereas history of miscarriage was associated with better cognitive function, as was a history of breastfeeding (beta overall score 0.90, SE: 0.29), particularly noticeable for semantic memory and in those with more total breastfeeding time (beta for overall score among those with >24 weeks lifetime breastfeeding, beta 1.21, SE: 0.44).
CONCLUSION
Nulliparity and breastfeeding are associated with midlife cognition in women. Future studies should examine possible mechanisms by which these associations are created.
Topics: Cognition; Cognitive Aging; Female; Humans; Longitudinal Studies; Middle Aged; Pregnancy; Pregnancy Complications; Reproductive History
PubMed: 31350162
DOI: 10.1016/j.jagp.2019.07.002 -
JAMA Network Open Sep 2023Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries.
IMPORTANCE
Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries.
OBJECTIVE
To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023.
EXPOSURES
Reproductive factors were assessed using a questionnaire in each cohort.
MAIN OUTCOMES AND MEASURES
The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs.
RESULTS
A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk.
CONCLUSIONS AND RELEVANCE
This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.
Topics: Humans; Female; Pregnancy; Middle Aged; Prospective Studies; Cohort Studies; Endometrial Neoplasms; Reproductive History; Parity
PubMed: 37669051
DOI: 10.1001/jamanetworkopen.2023.32296 -
Breast Cancer (Tokyo, Japan) Oct 2012The fact that reproductive factors have significant influence on the risk of breast cancer is well known. Early age of first full-term birth is highly protective against... (Review)
Review
The fact that reproductive factors have significant influence on the risk of breast cancer is well known. Early age of first full-term birth is highly protective against late-onset breast cancers, but each pregnancy, including the first one, increases the risk of early-onset breast cancer. Estradiol and progesterone induce receptor activator of NF-kappa B ligand (RANKL) in estrogen receptor (ER)- and progesterone receptor (PgR)-positive luminal cells. RANKL then acts in a paracrine fashion on the membranous RANK of ER/PgR-negative epithelial stem cells of the breast. This reaction cascade is triggered by chorionic gonadotropin during the first trimester of pregnancy and results in the morphological and functional development of breast tissue. On the other hand, the administration of non-steroidal anti-inflammatory drugs in the early steps of weaning protects against tumor growth through reduction of the acute inflammatory reaction of post lactation remodeling of breast tissue. This is experimental evidence that may explain the short-term tumor-promoting effect of pregnancy. The protective effect of prolonged breast feeding may also be explained, at least in a part, by a reduced inflammatory reaction due to gradual weaning. Delay of first birth together with low parity and short duration of breast feeding are increasing social trends in developed countries. Therefore, breast cancer risk as a result of reproductive factors will not decrease in these countries in the foreseeable future. In this review, the significance of reproductive history with regard to the risk of breast cancers will be discussed, focusing on the age of first full-term birth and post lactation involution of the breast.
Topics: Breast Feeding; Breast Neoplasms; Female; Humans; Maternal Age; Pregnancy; Receptors, Estrogen; Receptors, Progesterone; Reproductive History; Risk Factors
PubMed: 22711317
DOI: 10.1007/s12282-012-0384-8 -
BMC Medicine Mar 2022Women's reproductive factors include their age at menarche and menopause, the age at which they start and stop having children and the number of children they have....
BACKGROUND
Women's reproductive factors include their age at menarche and menopause, the age at which they start and stop having children and the number of children they have. Studies that have linked these factors with disease risk have largely investigated individual reproductive factors and have not considered the genetic correlation and total interplay that may occur between them. This study aimed to investigate the nature of the relationships between eight female reproductive factors.
METHODS
We used data from the UK Biobank and genetic consortia with data available for the following reproductive factors: age at menarche, age at menopause, age at first birth, age at last birth, number of births, being parous, age first had sexual intercourse and lifetime number of sexual partners. Linkage disequilibrium score regression (LDSC) was performed to investigate the genetic correlation between reproductive factors. We then applied Mendelian randomisation (MR) methods to estimate the causal relationships between these factors. Sensitivity analyses were used to investigate directionality of the effects, test for evidence of pleiotropy and account for sample overlap.
RESULTS
LDSC indicated that most reproductive factors are genetically correlated (r range: |0.06-0.94|), though there was little evidence for genetic correlations between lifetime number of sexual partners and age at last birth, number of births and ever being parous (r < 0.01). MR revealed potential causal relationships between many reproductive factors, including later age at menarche (1 SD increase) leading to a later age at first sexual intercourse (beta (B) = 0.09 SD, 95% confidence intervals (CI) = 0.06,0.11), age at first birth (B = 0.07 SD, CI = 0.04,0.10), age at last birth (B = 0.06 SD, CI = 0.04,0.09) and age at menopause (B = 0.06 SD, CI = 0.03,0.10). Later age at first birth was found to lead to a later age at menopause (B = 0.21 SD, CI = 0.13,0.29), age at last birth (B = 0.72 SD, CI = 0.67, 0.77) and a lower number of births (B = -0.38 SD, CI = -0.44, -0.32).
CONCLUSION
This study presents evidence that women's reproductive factors are genetically correlated and causally related. Future studies examining the health sequelae of reproductive factors should consider a woman's entire reproductive history, including the causal interplay between reproductive factors.
Topics: Age Factors; Child; Female; Humans; Menarche; Mendelian Randomization Analysis; Menopause; Parturition; Pregnancy; Reproductive History; Risk Factors
PubMed: 35321746
DOI: 10.1186/s12916-022-02293-5 -
BMC Women's Health Apr 2022During menopause, women experience annoying symptoms which may affect their daily activities and quality of life. This study aimed to determine whether reproductive...
BACKGROUND
During menopause, women experience annoying symptoms which may affect their daily activities and quality of life. This study aimed to determine whether reproductive history, an important indicator of estrogen exposure across the lifetime, is associated with the severity of menopausal symptoms in women.
METHODS
This study was a cross-sectional study conducted on 214 women aged 35-65 who were randomly selected, and data was collected by a predesigned structured questionnaire. Each item was graded by subjects and a total score was obtained by summing all subscale scores.
RESULTS
There was a significant association between the somatic, psychological, and urogenital menopausal symptoms and reproductive characteristics. Women with a history of abortion had greater total (β = 0.194, p = 0.009), and psychological (β = 0.230, p = 0.002) symptoms score. Women with higher number of children were more likely to have higher somatic (β = 0.212, p = 0.005) symptoms than others.
CONCLUSIONS
Our findings showed reproductive factors may have an influence on the severity of menopausal symptoms. After confirmation by further studies, these findings may help target women at risk of more severe menopausal symptoms at later ages.
Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Menopause; Middle Aged; Quality of Life; Reproductive History; Surveys and Questionnaires
PubMed: 35477386
DOI: 10.1186/s12905-022-01715-z -
BMC Cancer Jul 2023Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like [TNBC]). In this systematic review and meta-analysis, we summarized the associations between reproductive factors and BC subtypes.
METHODS
Studies from 2000 to 2021 were included if BC subtype was examined in relation to one of 11 reproductive risk factors: age at menarche, age at menopause, age at first birth, menopausal status, parity, breastfeeding, oral contraceptive (OC) use, hormone replacement therapy (HRT), pregnancy, years since last birth and abortion. For each reproductive risk factor, BC subtype, and study design (case-control/cohort or case-case), random-effects models were used to estimate pooled relative risks and 95% confidence intervals.
RESULTS
A total of 75 studies met the inclusion criteria for systematic review. Among the case-control/cohort studies, later age at menarche and breastfeeding were consistently associated with decreased risk of BC across all subtypes, while later age at menopause, later age of first childbirth, and nulliparity/low parity were associated with increased risk of luminal A, luminal B, and HER2 subtypes. In the case-only analysis, compared to luminal A, postmenopausal status increased the risk of HER2 and TNBC. Associations were less consistent across subtypes for OC and HRT use.
CONCLUSION
Identifying common risk factors across BC subtypes can enhance the tailoring of prevention strategies, and risk stratification models can benefit from subtype specificity. Adding breastfeeding status to current BC risk prediction models can enhance predictive ability, given the consistency of the associations across subtypes.
Topics: Female; Pregnancy; Humans; Triple Negative Breast Neoplasms; Risk Factors; Reproductive History; Parity; Breast
PubMed: 37430191
DOI: 10.1186/s12885-023-11049-0 -
Current Hypertension Reports Nov 2019Risks for developing cardiovascular disease and cognitive decline increase with age. In women, these risks may be influenced by pregnancy history. This review provides... (Review)
Review
PURPOSE OF REVIEW
Risks for developing cardiovascular disease and cognitive decline increase with age. In women, these risks may be influenced by pregnancy history. This review provides an integrated evaluation of associations of pregnancy history with hypertension, brain atrophy, and cognitive decline in postmenopausal women.
RECENT FINDINGS
Atrophy in the occipital lobes of the brain was evident in women who had current hypertension and a history of preeclampsia. Deficits in visual memory in women with a history of preeclampsia are consistent with these brain structural changes. The blood velocity response to chemical and sympathoexcitatory stimuli were altered in women with a history of preeclampsia linking impairments in cerebrovascular regulation to the structural and functional changes in the brain. Having a history of preeclampsia should require close monitoring of blood pressure and initiation of anti-hypertensive treatment in perimenopausal women. Mechanisms by which preeclampsia affects cerebrovascular structure and function require additional study.
Topics: Atrophy; Blood Pressure; Brain; Brain Diseases; Cognitive Dysfunction; Female; Humans; Hypertension; Postmenopause; Pre-Eclampsia; Pregnancy; Reproductive History
PubMed: 31741134
DOI: 10.1007/s11906-019-0997-9 -
JACC. Heart Failure Sep 2023A comprehensive evaluation of woman-specific risk factors in relation to incident heart failure (HF) is limited.
BACKGROUND
A comprehensive evaluation of woman-specific risk factors in relation to incident heart failure (HF) is limited.
OBJECTIVES
This study sought to investigate the association of multiple female reproductive factors with the risk of HF.
METHODS
Between 2007 and 2010, 229,026 women (mean age: 56.5 years) without prevalent HF from the UK Biobank cohort were included and followed until December 2020. The relation between (self-reported) reproductive factors and HF was analyzed using Cox proportional hazards models with adjustment for potential confounding.
RESULTS
Menarche at age <12 years, compared to age 12-13 years, carried a 9% larger risk of HF (HR: 1.09 [95% CI: 1.01-1.18]). Younger age at menopause was associated with a higher risk of HF (HR: 1.15 [95% CI: 1.03-1.28]; HR: 1.11 [95% CI: 1.01-1.23]). Younger maternal age at first live birth (HR: 1.42 [95% CI: 1.28-1.59]; HR: 1.14 [95% CI: 1.03-1.26]) and at last live birth (HR: 1.19 [95% CI: 1.07-1.33]) were associated with higher risk of HF. Compared to women with 1 or 2 children, having 3 or 4 children (HR: 1.09 [95% CI: 1.02-1.17]) or >4 children (HR: 1.24 [95% CI: 1.05-1.47]) was associated with higher HF risk. Experiencing miscarriages or abortions was not significantly associated with incident HF, whereas experiencing 1 stillbirth and recurrent stillbirths conferred a 20% and 43% larger risk of HF, respectively, compared to no stillbirth.
CONCLUSIONS
The findings emphasize the importance of female reproductive history in the assessment of HF risk.
Topics: Child; Humans; Female; Middle Aged; Adolescent; Young Adult; Adult; Heart Failure; Prospective Studies; Reproductive History; Biological Specimen Banks; Risk Factors; United Kingdom
PubMed: 37086244
DOI: 10.1016/j.jchf.2023.02.019 -
Cancer Epidemiology, Biomarkers &... Nov 2022Many studies suggested that menstrual and reproductive factors affected the gender disparity in liver carcinogenesis, but the results were inconsistent. Moreover, there...
BACKGROUND
Many studies suggested that menstrual and reproductive factors affected the gender disparity in liver carcinogenesis, but the results were inconsistent. Moreover, there are few studies in Asian populations. Therefore, our study was to explore the association of menstrual and reproductive factors on liver cancer risk in Chinese women.
METHODS
72,807 women were recruited in 1996 to 2000 and followed until the end of 2016 in Shanghai, China. Cox regression models were used to estimate HRs and 95% confidence intervals (CIs) for the association of menstrual and reproductive factors with liver cancer.
RESULTS
258 liver cancer cases were identified during 1,269,531 person-years of follow-up. In premenopausal and postmenopausal women, hormone replacement therapy (HRT) and injective contraceptives were positively associated with liver cancer risk respectively (HR, 1.23, 95% CI, 1.15-1.30; HR, 1.23, 95% CI, 1.17-1.30; HR, 1.07, 95% CI, 1.05-1.10; HR, 1.08, 95% CI, 1.05-1.11), while older age at menopause, longer reproductive period and fewer live births were associated with reduced risk, especially among postmenopausal women (Ptrend < 0.05). In addition, liver cancer risk was elevated in postmenopausal women who received hysterectomy (HR, 1.07; 95% CI, 1.04-1.11), oophorectomy (HR, 1.05; 95% CI, 1.01-1.10) or oral contraceptives (HR, 1.06; 95% CI, 1.03-1.08). No association was found between age at menarche and liver cancer risk. Similar results were observed when excluding participants with less than 2 follow-up years.
CONCLUSIONS
The findings suggested that female sex hormones could play significant roles in liver carcinogenesis.
IMPACT
Our study was the first population-based cohort to provide epidemiology evidence of menstrual and reproductive factors on liver cancer risk in Chinese women.
Topics: Female; Humans; Reproductive History; Prospective Studies; Risk Factors; China; Menopause; Menarche; Cohort Studies; Liver Neoplasms; Carcinogenesis
PubMed: 35984984
DOI: 10.1158/1055-9965.EPI-22-0439 -
JNCI Cancer Spectrum Jul 2022Hormone-replacement therapy (HRT) is associated with lower colorectal cancer (CRC) risk among postmenopausal women. However, little is known about the effects of...
BACKGROUND
Hormone-replacement therapy (HRT) is associated with lower colorectal cancer (CRC) risk among postmenopausal women. However, little is known about the effects of lifetime exposure of women to varying levels of estrogen and progesterone through reproductive factors such as parity, use of oral contraceptives (OC), breastfeeding, and menstruation on CRC risk.
METHODS
We assessed associations between reproductive factors and CRC risk among 2650 female CRC patients aged 30+ years and 2175 matched controls in a population-based study in Germany, adjusting for potential confounders by multiple logistic regression.
RESULTS
Inverse associations with CRC risk were found for numbers of pregnancies (odds ratio [OR] per pregnancy = 0.91, 95% confidence interval [CI] = 0.86 to 0.97), breastfeeding for 12 months and longer (OR = 0.74, 95% CI = 0.61 to 0.90), and use of either OC or HRT (OR = 0.75, 95% CI = 0.64 to 0.87) or both (OR = 0.58, 95% CI = 0.48 to 0.70). Similar results were found for postmenopausal women only and when adjusting for number of pregnancies and for all reproductive factors analyzed together. Breastfeeding duration of 12 months and longer was associated with lower risk of cancer only in the proximal colon (OR = 0.58, 95% CI = 0.45 to 0.74).
CONCLUSIONS
Several reproductive factors were associated with lower CRC risk in women, including number of pregnancies, breastfeeding duration, and use of OC and HRT. This suggests that women's exposure to female reproductive hormones plays a key role in the difference in CRC risk between women and men and in site-specific CRC risk.
Topics: Case-Control Studies; Colorectal Neoplasms; Contraceptives, Oral; Female; Humans; Male; Odds Ratio; Pregnancy; Reproductive History; Risk Factors
PubMed: 35642982
DOI: 10.1093/jncics/pkac042