Large Cohort Of Women Research Articles

Lower endoscopic ultrasound in preoperative evaluation of rectosigmoid endometriosis.

Background and study aims Endometriosis affects a significant proportion of reproductive-aged women and involves the bowel in up to one-third of patients with the condition. Lower endoscopic ultrasound (LEUS) in assessment of endometriosis of the rectosigmoid colon was first described 20 years ago in European populations. The current study aimed to describe the diagnostic characteristics of this imaging modality at a tertiary US referral center in a large cohort and its impact on surgical planning. Patients and methods This was a retrospective cohort study of adult women evaluated for rectosigmoid endometriosis by LEUS at an American tertiary referral center between January 2003 through June 2017. The reference standard for rectosigmoid endometriosis was surgical evaluation regardless of whether tissue was obtained for histologic evaluation. Two separate analyses were run; one comparing EUS to laparoscopic findings and another comparing EUS to histologic findings. Results LEUS demonstrated a positive predictive value (PPV) of 93.8 % (CI:68.1,99.1) and negative predictive value (NPV) of 96.4 % (CI:87.8,99.0) in the diagnosis of rectosigmoid endometriosis. Test sensitivity was 88.2 % (CI:63.6,98.5) and specificity was 98.2 % (CI:90.1,99.9). Overall diagnostic accuracy of the test was 95.8 % (CI:88.1,99.1). Conclusions In this large cohort of women at an American tertiary referral center undergoing evaluation for rectosigmoid endometriosis, LEUS demonstrated high PPV and NPV as well as excellent diagnostic accuracy. In addition, the LEUS findings provided important information to the referring gynecologic surgeon. This minimally-invasive imaging modality should be utilized in preoperative evaluation of women undergoing surgery for suspected or known endometriosis.

Outcomes after adjuvant radiotherapy in breast cancer patients with and without germline mutations: A large, single-institutional experience.

1502 Background: Women with germline mutations in DNA repair pathways are at an increased risk of developing breast cancer. We posit that tumors arising in these patients may be more sensitive to radiotherapy and, therefore, patients may experience improved locoregional control and survival outcomes following adjuvant radiotherapy as compared to patients without DNA repair pathway mutations. Methods: We evaluated the records of 2,221 women with stage 0-III de novo primary breast cancer treated with surgery and adjuvant radiotherapy who all underwent genetic testing at our institution from 1993 to 2018. Mutations were categorized as pathogenic variant, variant of unknown significance (VUS), or negative. The Kaplan-Meier method was used to estimate the locoregional recurrence rate (LRR), rate of distant metastasis (DM), disease-free survival (DSS), and overall survival (OS) from the time of surgery. Results: The median age at diagnosis was 45 years (range 19-84). Median follow-up time was 7 years (95% confidence interval 6.6-7.4). Among 1,960 patients with evaluable radiation records, 752 (38.4%) received breast only radiation, 12 (0.6%) received chest wall only radiation, and 1,196 (61.0%) received breast/chest wall and regional nodal radiation. A total of 255 (11.4%) and 162 (7.3%) patients had a pathogenic variant mutation and a VUS only, respectively. Pathogenic variant and VUS in BRCA1/2 mutations were detected in 216 (9.7%) and 82 (3.7%) patients, respectively. Perturbations in ATM, CHEK2, MLH, MSH2/6, MUTYH, PALB2, RAD50/51, and/or TP53 were detected in 71% (85/119) of patients who tested positive for a non- BRCA1/2 pathogenic variant or VUS. On univariate analysis, there was no significant association between BRCA1/2 mutation status or any genetic mutation and rate of LRR or DM, DSS, or OS ( p > 0.10 for all). Clinicopathological features including advanced stage and lymphovascular invasion were associated with higher cumulative incidence of LRR and DM as well as shorter DFS and OS ( p < 0.01 for all). Conclusions: Herein we report on the largest cohort of women with breast cancer treated with adjuvant radiotherapy at a single institution who have undergone germline testing. Our findings suggest that the overall prognosis of breast cancer treated with adjuvant radiotherapy in patients with germline BRCA1/2 or other genetic predisposition is similar to patients with sporadic breast cancer. Further investigation to evaluate acute or late toxicities and secondary cancers as a result of radiotherapy is warranted.

Association Between Vulvovaginal Discomfort and Activity of Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBD) affect 200-400 people per 100,000 in the United States, about half of whom are women. We aimed to define the prevalence of vulvovaginal symptoms and association with IBD activity in a large cohort of women. Women more than 18 years old with IBD (1250) completed an online survey querying the presence and severity of vulvar or vaginal itch, burn, or irritation, vaginal discharge or dryness, and vulvovaginal pain. The survey collected information on demographic features and IBD activity (categorized using the Manitoba index). Women with and without symptoms were compared using bivariate analyses. Logistic regression evaluated associations between IBD severity and vulvovaginal symptoms, adjusted for diagnosis, menopause, smoking, depression, and use of medications to treat IBD. A total of 512 (41%) women reported at least 1 moderate-severe vulvovaginal symptom. All vulvovaginal symptoms except vaginal dryness were more common in women with active IBD. In a multivariate model controlled for menopause, smoking, t-score from the PROMIS depression instrument, and use of IBD medications, women with constant or frequent active IBD, based on Manitoba index scores, had increased odds for moderate-severe vulvovaginal symptoms (odds ratio, 1.68; 95% CI, 1.22-2.32) compared to women in remission. Vulvovaginal discomfort frequently or always decreased interest in sex (n=336; 28%) or ability to have sex (n=207; 16%). In an online survey of 1250 women, we found that women with more active IBD have increased prevalence of vulvovaginal discomfort, compared to women in remission. These symptoms affect sexual health.

Pregnant Women Become Sweeter: A Population-Based Study of Trends in Glucose Challenge Test Results Over a Decade.

Background: Glucose challenge tests (GCTs) are widely used to screen for gestational diabetes mellitus. Women with high normal GCT results may be at increased risk for immediate obstetric complications and future diabetes. We analyzed the ∼10-year trend in mean GCT results and incidence of high normal (125-140 mg/dL) and abnormal GCT results (>140 mg/dL) in a large cohort of women in Israel. Materials and Methods: Data on all GCTs performed between 2005 and 2016 were gathered from the computerized database of the Central District of Clalit Health Services, the largest Health Maintenance Organization in Israel. Trends over time were studied by time series analysis, and a multivariable logistic model was constructed to study the risk for abnormal results, while adjusting for maternal age and body mass index (BMI). Results: Altogether 101,359 GCTs were analyzed. Over the study period, mean maternal age increased from 28.7 ± 5.1 to 30.1 ± 5.1 years and mean GCT results from 101.7 to 114.6 mg/dL (p < 0.001, for both), whereas the incidence of women with abnormal GCT (>140 mg/dL) increased from 10.6% to 18.1% (p < 0.001) and of those with high normal GCT (>125 mg/dL) from 20.2% to 31.3% (p < 0.001). A multivariable logistic model revealed that later years were associated with an increased risk for abnormal GCT result, while adjusting for maternal age and BMI (adjusted odds ratio = 1.07; 95% confidence interval 1.07-1.08). Conclusions: Over ∼10 years, mean GCT results and high GCT incidence have significantly increased. These findings are in line with the worldwide diabetes epidemic and demonstrate the worsening in glucose metabolism also in relatively young women.

Phenotype of POLE-mutated endometrial cancer.

Background and purposeIndividualized therapy in endometrial cancer, the most common gynaecologic cancer in the developed world, focuses on identifying specific molecular subtypes. Mutations in the exonuclease domain of the DNA polymerase epsilon (POLE) gene define one such subtype, which causes an ultra-mutated tumour phenotype. These tumours may have an improved progression-free survival and may be receptive to specific therapies. However, the clinical phenotype of these tumours is unknown. The objective of this study was to evaluate the clinical and genetic features of POLE-mutated tumours from a large cohort of women whose cases are characterized by: (1) the availability of detailed clinical and lifestyle data; (2) mutation analysis; and (3) long-term follow-up.MethodsA total of 604 patients with endometrial cancer were included in the study. Data from a detailed questionnaire, including lifestyle and family history information, provided extensive pertinent information on the patients. Sequencing of exons 9–14 of the POLE gene was performed. Follow-up data were gathered and analysed.ResultsHotspot pathogenic POLE mutations were identified in N = 38/599 patients (6.3%). Patients with a POLE-mutated tumour were significantly younger, were more often nulliparous, and had a history of smoking. POLE-mutated tumours were more frequently aneuploid. Prognosis for patients with hotspot POLE-mutated tumours was significantly better in comparison with patients with non-mutated tumours; however careful selection of pathogenic mutations is essential to the definition of this prognostically favourable group.ConclusionsThis study demonstrates that POLE-mutated endometrial cancer is significantly associated with previously unknown clinicopathologic characteristics. Outcome in POLE-mutated tumours was excellent in cases with hotspot mutations. Our results suggest that prediction of excellent outcome in cases of POLE-mutated EMCA should be restricted to cases of EMCA with hotspot mutations until further data are available on the rising number of mutations with unknown significance.

Women in Australian Politics: Maintaining the Rage against the Political Machine

Women in Australian Politics: Maintaining the Rage against the Political Machine

72 - Parameters for detrusor underactivity in women: Predictive value towards ineffective voiding in a large cohort of women with urinary incontinence

72 - Parameters for detrusor underactivity in women: Predictive value towards ineffective voiding in a large cohort of women with urinary incontinence

Radiation Therapy After Breast-Conserving Surgery in Women 70 Years of Age and Older: How Wisely Do We Choose?

Despite data from randomized trials supporting omission of radiation therapy (RT) for women ≥ 70years of age with T1, estrogen receptor-positive (ER+) tumors undergoing breast-conserving therapy (BCT), RT usage remains high. We reviewed our institutional experience to determine if risk factors for local recurrence or comorbidities influenced use. Women ≥ 70years of age with T1, ER+, human epidermal growth factor receptor2-negative (HER2-) tumors undergoing BCT in 2010-2012 were identified from a prospectively maintained database. Ten-year estimated mortality was calculated using the Suemoto index. The associations of clinicopathological features and mortality risk on receipt of RT were examined. Overall, 323 patients with 327 cancers were identified. Median age was 75years, median tumor size was 1cm, and all were clinically node negative; 53.7% of patients received RT. RT usage decreased with age (73.6%, age 70-74years; 49.5%, age 75-79years; 33.3%, age 80-84years; 10.7%, ≥ 85years; p < 0.001). Within age groups, estimated mortality did not impact RT usage. On multivariable analysis, only younger age and larger tumor size were associated with RT use. Recurrence-free survival was 98% versus 93% with and without RT, respectively (p = 0.011). Those who received adjuvant radiation also had improved overall survival (92% vs. 89%), although this effect did not reach statistical significance (p = 0.051). Neither the factors associated with risk of local recurrence nor the estimated risk of death in 10years were associated with use of adjuvant radiation in a large cohort of women ≥ 70years of age with small ER+ breast cancers treated with breast-conserving surgery.

Role of discoidin domain receptor 2 (DDR2) and microRNA-182 in survival of women with high-grade serous ovarian cancer.

The objective of this study is to evaluate the relationship between discoidin domain receptor 2 (DDR2) and miR-182 expression with response to platinum-based chemotherapy and survival in women with high-grade serous ovarian cancer (HGSOC). We evaluated 78 women with HGSOC stages I-IV, diagnosed between 1996 and 2013, and followed up until 2016. DDR2 expression was assessed using immunohistochemistry on tissue microarray slides. The microRNAs were evaluated by qRT-PCR. DDR2 expression was high in 11 (14.1%) women. PFS was significantly lower in women with FIGO stage I/II - versus III/IV, post-surgery residual disease and high expression of DDR2. Women with postsurgery residual disease, FIGO stage I/II - versus III/IV and DDR2 expression had worse OS, but only post-surgery residual disease remained an independent prognostic factor for worse OS in multivariable analysis. miR-182 expression levels were significantly lower in patients harboring tumors with higher expression of DDR2 (p < 0.001). In this relatively large cohort of women with HSGOC, higher DDR2 expression was associated with lower miR-182 levels and worse PFS, suggesting that these molecules may be associated with mechanisms of HGSOC progression.

Abstract 16710: Racial Disparities in Outcomes in Women Undergoing Percutaneous Intervention

Introduction: Cardiovascular disease is the leading cause of death in men and women, blacks and whites. Women are underrepresented in clinical studies. African-American women have a higher coronary heart disease mortality risk than their white counterparts. However, there exists limited outcomes data for black women (BW) compared to white women (WW) after percutaneous coronary intervention (PCI). Hypothesis: The aim of this retrospective analysis was to evaluate the 1 year major cardiovascular events (MACE) in patients undergoing PCI based on gender and race Methods: Within our PCI database we identified 4776 patients who underwent PCI from 2003 to 2016. Of those 1,916 were BW and 2,860 were WW. MACE/target vessel revascularization (TVR) at 30 days and 1 year were assessed and proportional Cox hazard model analyses was performed to assess outcomes after adjustment for confounding factors (i.e. age, BMI, presentation with acute M, diabetes, smoking, history of CAD, family history of CAD, hyperlipidemia, hypertension, prior coronary intervention, chronic kidney disease (CKD)). Results: Characteristics of the patient population is shown in the table. BW presented at younger age and had significantly higher rate of risk factors. BW were significantly sicker than WW. Periprocedural and in-hospital were similar between the 2 groups except for vascular complications more likely in WW (4.3% vs 2.6%; p=0.003). At 30 days and 1 year, the rate of MI, TVR and stent thrombosis (ST) was significantly higher in BW (Figure). There was a large difference in median income, $102,250 for WW vs. $80,150 for BW, but it had no effect on the outcome (HR = 1.00, p = 0.362). After adjusting for confounding factors BW were 1.6 times more likely to experience MI at 1 year than WW (HR 1.6, 05%CI 1.04-2.49, p= 0.03). Conclusions: In this large cohort of women with coronary artery disease undergoing PCI we observed significant race disparities in MI rate at 1 year even after adjustment for clinical presentation and cardiovascular risk factors

Self-Reported Vaginal Laxity—Prevalence, Impact, and Associated Symptoms in Women Attending a Urogynecology Clinic

IntroductionVaginal laxity is increasingly recognized as an important condition, although little is known regarding its prevalence and associated symptoms. AimTo report the prevalence of self-reported vaginal laxity in women attending a urogynecology clinic and investigate its association with pelvic floor symptoms and female sexual dysfunction. MethodData were analyzed from 2,621 women who completed the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF). Main Outcome MeasureResponse data from ePAQ-PF questionairre. ResultsVaginal laxity was self-reported by 38% of women and significantly associated with parity, symptoms of prolapse, stress urinary incontinence, overactive bladder, reduced vaginal sensation during intercourse, and worse general sex life (P < .0005). Clinical ImplicationsClinicians should be aware that vaginal laxity is prevalent and has an associated influence and impact on sexual function. Strength & LimitationsThe main strength of this study is the analysis of prospectively collected data from a large cohort of women using a validated questionnaire. The main limitation is lack of objective data to measure pelvic organ prolapse. ConclusionVaginal laxity is a highly prevalent condition that impacts significantly on a woman’s sexual health and quality of life.Campbell P, Krychman M, Gray T, et al. Self-reported vaginal laxity—Prevalence, impact, and associated symptoms in women attending a urogynecology clinic. J Sex Med 2018;15:1515–1517.

Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study

BackgroundThe view that 2 l of crystalloid and 1.5 l of colloid can be infused while awaiting compatible blood for patients with major postpartum haemorrhage is based on expert opinion documents. We describe real-world changes in levels of coagulation parameters after the administration of different volumes of clear fluids to women suffering from major postpartum haemorrhage.MethodsWe performed a nationwide retrospective cohort study in the Netherlands among 1038 women experiencing severe postpartum haemorrhage who had received at least four units of red cells or fresh frozen plasma or platelets in addition to red cells. The volume of clear fluids administered before the time of blood sampling was classified into three fluid administration strategies, based on the RCOG guideline: < 2 L, 2–3.5 L and > 3.5 L. Outcomes included haemoglobin, haematocrit, platelet count, fibrinogen, aPTT and PT levels.ResultsHaemoglobin, haematocrit, platelet count, fibrinogen and aPTT were associated with volumes of clear fluids, which was most pronounced early during the course of postpartum haemorrhage. During the earliest phases of postpartum haemorrhage median haemoglobin level was 10.1 g/dl (IQR 8.5–11.6) among the women who received < 2 L clear fluids and 8.1 g/dl (IQR 7.1–8.4) among women who received > 3.5 L of clear fluids; similarly median platelet counts were 181 × 109/litre (IQR 131–239) and 89 × 109/litre (IQR 84–135), aPTT 29 s (IQR 27–33) and 38 s (IQR 35–55) and fibrinogen 3.9 g/L (IQR 2.5–5.2) and 1.6 g/L (IQR 1.3–2.1).ConclusionsIn this large cohort of women with severe postpartum haemorrhage, administration of larger volumes of clear fluids was associated with more severe deterioration of coagulation parameters corresponding to dilution. Our findings provide thus far the best available evidence to support expert opinion-based guidelines recommending restrictive fluid resuscitation in women experiencing postpartum haemorrhage.Trial registrationNetherlands Trial Register (NTR4079), registration date July 17, 2013.

Risk of lung cancer and physical activity by smoking status and body mass index, the Norwegian Women and Cancer Study.

We aimed to investigate physical activity (PA) and risk of different histological subtypes of lung cancer according to smoking status and body mass index using repeated measurements in a large cohort of women in Norway. The study sample for the multiple imputation analyses consisted of 86,499 and for the complete-case analysis 80,802 women. Repeated measurements of PA level, smoking habits, weight, and height were available for 54,691 women (63.2%), who were included in repeated measurement analyses combined with multiple imputation to address attrition. Cox proportional hazards regression models were used to calculate hazard ratios with 95% confidence intervals. During a median follow-up of 12.9years, 866 cases of primary lung cancer were identified. We found an inverse association between PA and lung cancer overall. The results were consistent from multiple imputed data analysis to complete-case analysis of PA and possible confounders. We observed a similar trend for adenocarcinoma, but not for squamous cell or small cell carcinomas. Our findings suggest a more pronounced association between lung cancer overall and PA levels in current and former smokers, and in normal-weight and overweight participants with increasing PA levels. The potential of a modifiable lifestyle factor as PA to reduce the risk of lung cancer independently of smoking status is important in public health.

Associations between obesity, smoking and lymph node status at breast cancer diagnosis in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

IntroductionThere is evidence suggesting that smoking and obesity prior to a breast cancer diagnosis is associated with poorer outcomes. In this study, we investigate the associations between smoking and obesity prior to a breast cancer diagnosis and the presence of lymph node metastases at diagnosis.MethodsWomen with stage I-III breast cancer (n = 3,304) were identified from the National Cancer Institute’s Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Univariable and multivariable log-binomial models were used to estimate relative risks (RR) and 95% confidence intervals (CIs) for associations between lymph node positive breast cancer and; i) smoking, and ii) obesity prior to diagnosis.ResultsPre-diagnostic smoking/obesity was not associated with lymph node metastasis at diagnosis in multivariable analyses; (RR 0.82, 95%CI 0.61, 1.10) and (RR 0.95, 95% CI 0.81, 1.12), respectively.ConclusionObesity and smoking information was recorded a number of years prior to breast cancer diagnosis, therefore these findings should to be replicated in a larger cohort of women, with more detailed smoking and obesity information.

Vascular measures of atherosclerosis in detrusor overactivity and controls.

The mechanisms leading to the development of detrusor overactivity (DO) are still relatively poorly understood, however, animal studies suggest that atherosclerosis and reduced blood flow to the bladder may be one etiological pathway. Thus, the aim of this study was to evaluate signs of atherosclerosis in a large cohort of women with detrusor overactivity, using two precise measures of atherosclerotic vascular impairment, Ankle Brachial Index (ABI), and Brachial-ankle Pulse Wave Velocity (baPWV). A prospective cohort study measuring ABI and baPWV of women with DO and controls was conducted. The ABI and baPWV were measured using an automated oscillometric blood pressure machine, to evaluate the degree of atherosclerosis in patients with DO and controls. Associations between ABI and baPWV and important confounding variables were assessed by a linear regression model. Ninety-eight women with DO, and 98 controls without any symptoms of DO were studied. Multivariate analysis showed an increase in left baPWV of approximately 96 cm/s units of velocity (95%CI 20.65-172.05, P = 0.01) is predicted significantly by the presence or absence of detrusor overactivity (as well by independent factors of age, diastolic blood pressure and body mass index). A similar effect was seen for right baPWV. On linear regression modeling, the presence of DO was a strong predictor for an increased PWV when controlling for age, BMI and diastolic blood pressure (DBP), thus supporting the hypothesis that atherosclerosis may contribute to the etiology of DO.

The impact of lifetime overweight and obesity on cancer incidence–A population-based study in Icelandic women

Introduction The impact of risk factors on cancer development largely depends on time. In addition to the level of exposure, the time spent exposed or the cumulative exposure might provide a better measure of the cancer risk given a risk factor. In a large cohort of women, we assess the relationship between different patterns of overweight and obesity during adulthood and the incidence of three types of cancer that previously have been found to be associated with BMI; postmenopausal breast, colorectal and endometrial cancer. Methods The study population consisted of 90,299 women who attended organized nationwide screening for cancer of the cervix and breast in Iceland from between 1979 and 1989, corresponding to about 70% of the national adult female population. Data on reproductive factors and anthropometry were available at more than 300,000 occasions and information on cancer incidence was obtained through record linkage with the population-based Icelandic Cancer Registry. Repeated measurements of height and weight during follow-up were used in a growth curve model to predict individual-specific trajectories of body mass index (BMI) and to compute cumulative measures of overweight and obesity. The cumulative time spent above a given BMI value (e.g., 25 for the time spent with overweight and 30 for obesity) and cumulative overweight/obesity-years, taking into account the time spent as well as the degree of overweight/obesity, between ages 20–50 (between early adulthood and menopause), were calculated. To investigate the impact of these time-mediated and cumulative measures of overweight and obesity on the occurrence of postmenopausal breast, endometrial and colorectal cancer, Cox regression models were fitted, adjusting for important confounders. Results The mean BMI at 20 years was 21.9 and BMI was found to increase on average by 0.15 kg/m2 by year. Out of all women included, 64,015 reached age 50 during follow-up and among those, 2886 developed postmenopausal breast cancer. In addition, 891 colorectal and 404 endometrial cancers were observed in this subset of women. Taking into account the effects of relevant confounding factors, overweight and obesity before age 50 were associated with an increased risk of developing postmenopausal endometrial cancer (HR = 1.42, 95% CI: 1.04–1.94 and HR = 1.87, 95% CI: 1.13–3.10, respectively), with a 3% increase in risk for every additional year spent with obesity. The risk of colorectal cancer associated with obesity was HR = 1.34 and increased by 1% for every additional year spent with obesity. In contrast, there was no evidence for any statistically significant effect of mean BMI, overweight duration and cumulative exposure to overweight and obesity during adulthood on the risk of developing postmenopausal breast cancer. Conclusions The role of overweight duration in the aetiology of cancer differed between the three types of cancers. The results indicate that weight control is relevant at all ages. Furthermore, exploring time-dependent and cumulative effects of overweight and obesity increases our understanding of time-varying exposures and their association with disease occurrence. This knowledge is vital for the development of effective and targeted cancer prevention strategies in different stages of the life course.

Preeclampsia-eclampsia and future cardiovascular risk among women in Taiwan

ObjectiveThis study aims to examine the long-term cardiovascular and cerebrovascular risks in a large cohort of women with past history of preeclampsia and/or eclampsia. Materials and methodsThis is a retrospective longitudinal study using National Health Insurance Research Database from 1996 to 2010. We identified 1295 women with preeclampsia and eclampsia. The control group was 5180 pregnant women without preeclampsia/eclampsia, who were matched for age and date of delivery. The incidences of diabetes, dyslipidemia, hypertension and cardiovascular events after pregnancy were identified from medical records after the date of delivery to the date of an event or the end of the study. ResultsThe median follow-up duration was 9.8 years (interquartile 5.1–12.7 years). The incidences of diabetes, dyslipidemia, hypertension, congestive heart failure and cerebrovascular disease events were significantly greater in women with eclampsia or preeclampsia than those in controls. Eclampsia or preeclampsia increased the risk of diabetes, dyslipidemia, hypertension, congestive heart failure and cerebrovascular disease events (hazard ratio [HR] 3.84 and 5.42, P < 0.0001; HR 2.75 and 3.40, P < 0.0001; HR 6.52 and 7.31, P < 0.0001; HR 9.07, P = 0.0060 and 7.39, P < 0.0001; HR 10.71, P < 0.0001 and 3.47, P = 0.0048, respectively). The survival curves for the development of congestive heart failure and cerebrovascular disease in women with eclampsia/preeclampsia and in control differed significantly (Log-rank test P < 0.0001). From the curve, we can find dramatic increases of congestive heart failure and cerebrovascular disease incidences at roughly 3 years and 10 years since the diagnosis of eclampsia/preeclampsia. ConclusionsOur study revealed that women with a history of preeclampsia/eclampsia were at increased risks for subsequent diagnoses of diabetes, dyslipidemia, hypertension, congestive heart failure and cerebrovascular disease. Preventive counseling, more vigilant screening and management for the modifiable risks should be provided to the affected women. Clinicians should closely monitor these patients in the first three years postpartum and continuously for up to at least a decade.

Outcome of pregnancies in a large cohort of women with acromegaly.

To assess the outcome of pregnancies in a large cohort of women with acromegaly. This is a retrospective analysis of 31 pregnancies in 20 patients with acromegaly. Twenty-seven pregnancies resulted in healthy offspring, and 4 resulted in abortion. Three patients underwent transsphenoidal surgery during pregnancy. IGF-1 levels remained elevated during pregnancy in 4 pregnancies and normalized in 23 cases. Fifteen cases were followed during pregnancy without any medical or surgical treatment, and 13 of these exhibited normal IGF-1 levels. Before or during pregnancy, somatostatin receptor ligands usage was not associated with higher risk for adverse outcomes. Arterial hypertension worsening (45%) and impairment of glucose levels (32%) were the most common complications during pregnancies. There were no maternal or neonatal deaths. One woman delivered twins. Two cases of congenital malformations and one with foetal macrosomia were observed. Caesarean delivery was performed in sixteen cases. Our study confirms the impact of gestation on IGF-1 levels. However, it also indicates that acromegaly still holds an increased risk for worsening of comorbidities, especially in uncontrolled patients.

Association Between Obesity and Weight Change and Risk of Diverticulitis in Women

There is little evidence that adiposity associates with diverticulitis, especially among women. We conducted a comprehensive evaluation of obesity, weight change, and incidence of diverticulitis in a large cohort of women. We conducted a prospective cohort study of 46,079 women enrolled in the Nurses' Health Study who were 61-89 years old and free of diverticulitis, diverticular bleeding, cancers, or inflammatory bowel disease at baseline (in 2008). We used Cox proportional hazards models to examine the associations among risk of incident diverticulitis and body mass index (BMI), waist circumference, waist to hip ratio, and weight change from age 18 years to the present. The primary end point was first incident diverticulitis requiring antibiotic therapy or hospitalization. We documented 1084 incident cases of diverticulitis over 6 years of follow-up, encompassing 248,001 person-years. After adjustment for other risk factors, women with a BMI ≥35.0 kg/m2 had a hazard ratio for diverticulitis of 1.42 (95% confidence interval [CI], 1.08-1.85) compared to women with a BMI <22.5 kg/m2. Compared to women in the lowest quintile, the multivariable hazard ratios among women in the highest quintile were 1.35 (95% CI, 1.02-1.78) for waist circumference and 1.40 (95% CI, 1.07-1.84) for waist to hip ratio; these associations were attenuated with further adjustment for BMI. Compared to women maintaining weight from age 18 years to the present, those who gained ≥20 kg had a 73% increased risk of diverticulitis (95% CI, 27%-136%). During a 6-year follow-up period, we observed an association between obesity and risk of diverticulitis among women. Weight gain during adulthood was also associated with increased risk.

Flow rate parameters and pressure flow studies in a large cohort of women with and without post void residual

Flow rate parameters and pressure flow studies in a large cohort of women with and without post void residual