Oral Contraceptive Use Research Articles

Analysis of Risk Factors Associated with Gestational Diabetes Mellitus: A Retrospective Case-Control Study.

Gestational diabetes mellitus (GDM) is a complication of abnormal glucose tolerance during pregnancy, with incidence is on the rise. There are inconsistent results on the risks of GDM and it has not been reported in our region. The purpose of this study is to explore the risk factors of GDM. A total of 383 pregnant women were analyzed, including 67 (17.5%) pregnant women with GDM and 316 (82.5%) with normal glucose tolerance (NGT). The relationship of personal history, family history and reproductive history of pregnant women, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), inflammatory markers in blood cell analysis at the first prenatal examination, and fetal ultrasound indices and the risk of GDM were analyzed. The fetal biparietal diameter, head circumference, and femur length were negatively correlated with HCG level, but not inflammatory markers. The proportion of pregnant women aged ≥30 years old, body mass index (BMI) in early pregnancy≥24.0 kg/m2, history of polycystic ovary syndrome (PCOS), cesarean section, adverse pregnancy, and oral contraceptive use, and pregnant women who conceived through assisted reproduction in GDM group were higher than those in NGT group. Logistic regression analysis showed that age of pregnant woman ≥30 years old (≥30 vs <30 years old, odds ratio (OR): 2.142, 95% confidence interval (CI): 1.183-3.878, p=0.012), BMI≥24.0 kg/m2 (≥24.0 kg/m2 vs 18.5-23.9 kg/m2, OR: 1.887, 95% CI: 1.041-3.420, p=0.036), history of adverse pregnancy (yes vs no, OR: 1.969, 95% CI: 1.022-3.794, p=0.043), and history of oral contraceptive use (yes vs no, OR: 2.868, 95% CI: 1.046-7.863, p=0.041) were associated with GDM. Age of pregnant woman ≥30 years old, BMI≥24.0 kg/m2, history of adverse pregnancy and oral contraceptive use were independent risk factors for GDM.

P225 RISK FACTORS FOR CEREBROVASCULAR DISEASE IN WOMEN ADMITTED TO THE INTERNAL MEDICINE SERVICE OF THE EMERGENCY DEPARTMENT OF THE CENTRAL HOSPITAL IN SAN CRISTOBAL (TACHIRA, VENEZUELA)

Background and objective: Cerebrovascular disease is a leading cause of mortality and disability worldwide. Research has focused on determining the risk factors for cerebrovascular disease independent of gender; however, it has been important to differentiate between men and women due to the variety of causes that occur in the latter. Therefore, the aim was to determine the risk factors for cerebrovascular disease in women admitted to the internal medicine service of the Central Hospital of San Cristóbal (Táchira, Venezuela). Methods: A case-control study was performed. Cases were female patients diagnosed with acute cerebrovascular disease (24 to 72 hours after symptom onset). Controls were hospitalized or community-based female subjects without pathologies associated with cardiovascular disorders. The case-control ratio was 1:2, of equal age or ± 5 years. All participants signed the informed consent form and completed the data collection form. Odds ratios (OR) were calculated, with 95% confidence intervals. Results: In the period between February 2 to July 15, 2020, 111 female participants entered the study, 37 cases (26 with ischemic cerebrovascular disease and 11 with hemorrhagic cerebrovascular disease) and 74 controls. Of the risk factors studied: arterial hypertension, diabetes mellitus, dyslipidemia, physical inactivity, smoking, alcohol consumption, overweight, obesity, atrial fibrillation, use of oral contraceptives, use of hormone replacement therapy, autoimmune diseases, only association was found between atrial fibrillation (OR 9.1736, 95% CI 3.3638-25.0173), autoimmune diseases (OR 9.1736, 95% CI 3.3638-5.0173) and ischemic cerebrovascular disease. No association was found with any risk factor and hemorrhagic cerebrovascular disease. Conclusions: The risk factors for cerebrovascular disease in the female population are modifiable and treatable, being pertinent to determine their presence and carry out the necessary actions to reduce morbimortality in this population group.

Frequency and outcome of cerebral venous thrombosis attributed to oral contraceptive pills

Background: Oral contraceptive (OCP) use is a significant risk factor for cerebral venous thrombosis (CVT). There is limited research on its association with CVT development in Islamic countries. Therefore, our study aimed to assess the risk of different OCPs in developing CVT and their prognosis. Methods: This is an observational retrospective single-center cohort study that included CVT patients between March 2018 and March 2021. All CVT participants were registered in the organized registry system (CVT registry code: 9001013381) at the Neurology Research Center of Shiraz University of Medical Science. Univariate analysis and multivariable binary logistic regression modeling were applied to determine the associated factors leading to poor outcome. Results: A total of 204 patients (139 women, 65 men) were enrolled in the study. Seventy-four females (53.25% of total female patients) used OCPs, with second-generation OCPs being the most commonly used type (70%). OCP consumption was associated with a lower mortality rate (P=0.004, aOR=11.732) and a better 3-month follow-up outcome (p=0.001, aOR=9.882) than their female counterparts who did not use OCPs. The duration and generation of OCPs did not affect the follow-up outcome (P=0.148, P=0.428, respectively) or mortality (P=0.555, P=0.569, respectively). In multivariable analysis, the use of OCPs was a predictor of a favorable 3-month follow-up outcome in females (aOR =4.423, 95% CI: 0.423-46.248). Conclusion: These results suggest that OCPs may have a positive impact on the prognosis of CVT in women. However, further research is required to understand the underlying mechanisms and validate these findings.

PFAS Levels, Early Life Factors, and Mammographic Breast Density in Premenopausal Women.

Mammographic breast density (MBD) is a strong risk factor and an intermediate phenotype for breast cancer, yet there are limited studies on how environmental pollutants are associated with MBD. We investigated associations of perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonate (PFHxS) levels with measures of MBD and evaluated if early life factors modified any associations. Metabolon performed metabolomics analysis using ultrahigh-performance liquid chromatography/tandem accurate mass spectrometry in fasting blood from 705 premenopausal women completing their annual screening mammogram in St. Louis, Missouri. We calculated least square means (LSM) of mammographic volumetric percent density (VPD), dense volume (DV), and nondense volume (NDV) by quartiles (Q) of PFOS, PFOA, and PFHxS from multivariable linear regression modeling overall and stratified by recruitment period, race, age at menarche, and body shape at age 10. Models were adjusted for age, age at menarche, body fat percentage, race, family history of breast cancer, oral contraceptive use, alcohol consumption, parity/age at first birth, and body shape at age 10. PFOS, PFOA, and PFHxS were not significantly associated with VPD or NDV. PFHxS was significantly positively associated with DV (, , , ; ). PFOS was positively associated with DV (, , , ; ) with DV being 8.1%, 12%, and 12.3% higher in Q2, Q3, and Q4 compared to Q1. Among women who were underweight/normal weight at age 10, PFOS was positively associated with VPD (, , , ; ) while there was an inverse association among women who were overweight/obese at age 10 (, , , ; ) (). We report novel associations of PFHxS and PFOS with DV in premenopausal women. PFOS, PFOA, and PFHxS were not associated with VPD and NDV. In addition, body shape at age 10 may modify the associations of PFOS with MBD. Further studies are needed to validate our findings and to evaluate the associations of other per- and polyfluoroalkyl substances (PFAS), as well as mixtures of PFAS, with MBD. https://doi.org/10.1289/EHP14065.

Reproductive Factors and Thyroid Cancer Risk: The Multiethnic Cohort Study.

Background: Women are three times more likely to be diagnosed with thyroid cancer than men, with incidence rates per 100,000 in the United States of 20.2 for women and 7.4 for men. Several reproductive and hormonal factors have been proposed as possible contributors to thyroid cancer risk, including age at menarche, parity, age at menopause, oral contraceptive use, surgical menopause, and menopausal hormone therapy. Our study aimed to investigate potential reproductive/hormonal factors in a multiethnic population. Methods: Risk factors for thyroid cancer were evaluated among female participants (n = 118,344) of the Multiethnic Cohort Study. The cohort was linked to Surveillance, Epidemiology, and End Results cancer incidence and statewide death certificate files in Hawaii and California, with 373 incident papillary thyroid cancer cases identified. Exposures investigated include age at menarche, parity, first pregnancy outcome, birth control use, and menopausal status and type. Multivariable Cox proportional hazards models were used to obtain relative risk (RR) of papillary thyroid cancer and their 95% confidence intervals (CI). Covariates included age, race and ethnicity, reproductive history, body size, smoking, and alcohol consumption. Results: We observed a statistically significant increased risk of papillary thyroid cancer for oophorectomy (adjusted RR 1.58, 95% CI: 1.26, 1.99), hysterectomy (adjusted RR 1.65, 95% CI: 1.33, 2.04), and surgical menopause (adjusted RR 1.55, 95% CI: 1.22, 1.97), and decreased risk for first live birth at ≤20 years of age versus nulliparity (adjusted RR 0.66, 95% CI: 0.46, 0.93). These associations did not vary by race and ethnicity (p het > 0.44). Conclusion: The reproductive risk factors for papillary thyroid cancer reported in the literature were largely confirmed in all racial and ethnic groups in our multiethnic population, which validates uniform obstetric and gynecological practice.

Oral contraception use and depression: Review

Oral contraception use and depression: Review

Paracentral Acute Middle Maculopathy and Risk of Cardiovascular Disease, Stroke, and Death: A Longitudinal Study

To evaluate the risk of acute cardiovascular events (CVE), including cardiovascular diseases, cerebrovascular diseases, and all-cause mortality in patients with paracentral acute middle maculopathy (PAMM). Retrospective cohort study METHODS: We studied 43 individuals with optical coherence tomography -documented PAMM attending Moorfields Eye Hospital between January 2014 and June 2021. We excluded patients with preceding (< 2 years) major adverse cardiac events. We stratified patients by age (<50 years & ≥50 years) and whether associated with retinal vascular diseases (RVD) or isolated (iPAMM). We assessed risk factors, clinical characteristics, and visual prognosis of the patients. CVE risk was estimated using Kaplan-Meier curves, the log-rank test, and Cox proportional hazards regression. In young patients with iPAMM patients (n=12), underlying predisposing factors included six (50%) sickle cell disease and five (41.6%) others, including breakthrough bleeding in pregnancy, migraine, genetic cardiomyopathy, amphetamine use; among those with PAMM+RVD (n=12) one (9%) had a vascular disorder, and four (44.4%) oral contraceptive use. In the older group of 20 patients, 15 (75%) had at least one coronary risk factor. During a median follow-up of 14 months (range 12-54), older subjects with iPAMM had a higher risk of developing CVE than those with PAMM+RVD (p<0.001). Notably, iPAMM displayed a significantly earlier peak in peri-PAMM CVE risk compared to PAMM+RVD (median: 1 month, range 1-40 months vs. 36 months, range 12-54 months). Relative to those with PAMM+RVD, risk of CVE was significantly higher in patients with iPAMM, adjusted for age and sex (hazard ratio: 6.37, 95% Confidence Interval 1.68-24.14, p=0.017). No young patients experienced adverse CVE. At baseline, older iPAMM patients mean best corrected visual acuity of 0.7 (0-1.8) LogMAR, which improved significantly to 0.2 (0-1.30) LogMAR at the latest visit (p=0.033). Young individuals with iPAMM have a higher prevalence of predisposing factors compared to those presenting with combined PAMM+RVD. Older patients with iPAMM had a higher risk of CVE than those with PAMM+RVD, especially in the peri-onset timeframe. This suggests the need for a prompt cardiovascular assessment to rule out systemic etiologies and optimize cardiovascular risk factors, in addition to ongoing ophthalmology input.

Effects of Hormonal Contraception and the Menstrual Cycle on Maximal Strength and Power Performance.

To evaluate the effects of oral contraceptive (OC) and hormonal intrauterine device (H-IUD) use, compared to an eumenorrheic (EUM) cycle, on maximal strength and power between hormone phases. One repetition max (1RM) leg press and bench press, peak force (PF) from knee extension and upright row isometric dynamometry, and power from vertical jump height (VJH) and reactive strength index (RSI; cm/s) were measured in 60 healthy, active women (mean ± standard deviation [SD]; Age: 26.5 ± 7.0 yrs, BMI: 22.5 ± 3.7 kg/m2) who were monophasic OC users for ≥6 months (n = 21), had a H-IUD for ≥6 months (n = 20), or had regularly naturally occurring menstrual cycle for ≥3 months or were using a non-hormonal IUD (EUM; n = 19). Participants were randomly assigned to begin in the follicular phase/placebo pill (low hormone phase; LHP) or in the luteal phase/active pill (high hormone phase; HHP) and were tested once in each phase. Estimates of total lean mass (LM), leg LM, and arm LM were measured via dual energy x-ray absorptiometry. Separate univariate ANCOVAs were used to assess the change from HHP to LHP between groups, with LM and progesterone as covariates. Leg press 1RM was significantly different across phases between groups (p = 0.027), with higher leg press 1RM in the HHP for the OC group (mean difference[∆HHP-LHP] ± standard error: ∆7.4 ± 15.9 kg; p = 0.043) compared to the H-IUD group (∆-8.9 ± 23.8 kg; p = 0.043). All groups demonstrated similar bench press 1RM, PF, VJH, and RSI between phases (p > 0.05). Lower body strength was greater in the HHP for OC users (5.6% increase) suggesting lower body maximal strength outcomes may be influenced by hormonal contraception type.

Thrombosis and Thrombotic Risk in Athletes.

The hemostatic system is characterized by a delicate balance between pro- and anticoagulant forces, and the smallest alteration can cause serious events such as hemorrhages or thrombosis. Although exercise has been shown to play a protective role in athletes, several factors may increase the risk of developing venous thromboembolism (VTE), including hemoconcentration induced by exertion, immobilization following sports injuries, frequent long-distance flights, dehydration, and the use of oral contraceptives in female athletes. Biomarkers such as D-dimer, Factor VIII, thrombin generation, inflammatory cytokines, and leukocyte count are involved in the diagnosis of deep vein thrombosis (DVT), although their interpretation is complex and may indicate the presence of other conditions such as infections, inflammation, and heart disease. Therefore, the identification of biomarkers with high sensitivity and specificity is needed for the screening and early diagnosis of thromboembolism. Recent evidence about the correlation between the intensity of physical activity and VTE is divergent, whereas the repeated gestures in sports such as baseball, hockey, volleyball, swimming, wrestling, or, on the other hand, soccer players, runners, and martial art training represent a risk factor predisposing to the onset of upper and lower DVT. Anticoagulant therapy is the gold standard, reducing the risk of serious complications such as pulmonary embolism. The aim of this review is to provide a general overview about the interplay between physical exercise and the risk of thromboembolism in athletes, focusing on the main causes of thrombosis in professional athletes and underlying the need to identify new markers and therapies that can represent a valid tool for safeguarding the athlete's health.

Epidemiological breast cancer prediction by country: A novel machine learning approach.

Breast cancer remains a significant contributor to cancer-related deaths among women globally. We seek for this study to examine the correlation between the incidence rates of breast cancer and newly identified risk factors. Additionally, we aim to utilize machine learning models to predict breast cancer incidence at a country level. Following an extensive review of the available literature, we have identified a range of recently studied risk factors associated with breast cancer. Subsequently, we gathered data on these factors and breast cancer incidence rates from numerous online sources encompassing 151 countries. To evaluate the relationship between these factors and breast cancer incidence, we assessed the normality of the data and conducted Spearman's correlation test. Furthermore, we refined six regression models to forecast future breast cancer incidence rates. Our findings indicate that the incidence of breast cancer is most positively correlated with the average age of women in a country, as well as factors such as meat consumption, CO2 emissions, depression, sugar consumption, tobacco use, milk intake, mobile cells, alcohol consumption, pesticides, and oral contraceptive use. As for prediction, the CatBoost Regressor successfully predicted future breast cancer incidence with an R squared value of 0.84 ± 0.03. An increased incidence of breast cancer is mainly associated with dietary habits and lifestyle. Our findings and recommendations can serve as a baseline for developing educational programs intended to heighten awareness amongst women in countries with heightened risk.

Characteristics and Manifestations of Patients with Cerebral Venous Sinus Thrombosis and Factors Associated with Unfavorable Functional Outcomes

Background: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease that typically affects young females. Objectives: To describe the clinical, laboratory, and neuroimaging characteristics of CVST and evaluate the differences in characteristics of patients with unfavorable versus favorable outcomes. Methods: This retrospective study (2007 - 2018) reviewed all consecutive patients with CVST, assessing their demographic, clinical, laboratory, neuroimaging characteristics, and clinical outcomes. The modified Rankin Scale (mRS) was used to assess the functional outcomes of patients after a three-month follow-up. Factors affecting patients’ outcomes (favorable [mRS ≤ 2] vs. unfavorable [mRS &gt; 2]) were examined using the Independent t-test and chi-squared test. Results: A total of 141 patients (mean age: 38.15 ± 13.71; female-to-male ratio of 2.28) with CVST were included. Most of the admissions (42.6%) were in the summer. Most patients had a subacute disease onset (66.0%), with headaches being the most frequent manifestation (66.0%). Regular oral contraceptive pill use and fasting were the most frequent clinical risk factors (52.0% and 22.7%, respectively). Different types of inherited thrombophilia (deficiency in protein C, protein S, or antithrombin III) were recorded in nearly 13 to 16% of patients. The lateral transverse sinus (61.7%) and the superior sagittal sinus (45.4%) were the most frequently involved. The mortality rates at discharge and after three months were 4.3% and 8.0%, respectively. In the follow-up assessment, 81.3% of patients showed a favorable outcome [mRS ≤ 2], while 18.7% had an unfavorable outcome. Patients with unfavorable outcomes were significantly older compared to those with favorable outcomes (52 ± 5.81 vs. 35.95 ± 1.42, P = 0.017). Significant associations were observed between admission season (P = 0.020), chief complaint (P = 0.028), course of the disease (P = 0.021), previous thromboembolic events (P = 0.001), and antiphospholipid IgG (P = 0.032). Conclusions: The most prevalent risk factors among patients with CVST were being female, a history of using oral contraceptives, and fasting. Older patients with reduced consciousness, an acute disease course, a history of thromboembolic events, and positive antiphospholipid IgG are more likely to have an unfavorable outcome.

Chronic venous disease of the lower extremities as a risk factor for PE when taking combined oral contraceptives: a clinical case

The use of combined oral contraceptives (COCs) is one of the risk factors for thrombotic complications, particularly pulmonary embolism (PE). Although clinical observations suggest that the risk of thrombotic complications with OCs is low and decreases after several months of use, medical counseling is necessary as with any other hormonal therapy. A clinical case of PE in a young patient taking COCs is presented. In the context of early diagnosis, thrombolysis was successful because thrombus retraction had not yet occurred. After completion of treatment of the underlying pathology, the patient was recommended to be followed up with a vascular surgeon for treatment of lower limb venous disease. Exclusion of lower extremity venous disease is critical before prescribing COCs, as it increases the risk of PE at any age.

Investigating the influence of oral contraceptive pill use on multiple sclerosis risk using UK Biobank data

ObjectiveTo investigate the association between oral contraceptive (OC) pill use and the risk of developing Multiple Sclerosis (MS), attempting to address the limitations present in previous studies which produced conflicting results. DesignPopulation-based cohort study using data from the UK Biobank. SubjectsThe study included 181,058 women of white ethnicity born in England between 1937 and 1970, among which 1131 had an MS diagnosis. ExposureOC use, considering the self-reported age of initiation and discontinuation. The exposures of interest include: i) ever use, ii) current use, iii) duration of current use in years, and iv) age and year at initiation. Main Outcome MeasuresMS diagnosis (ICD-10: G35) was used as outcome of interest, and the associations with the exposures of interest were investigated using marginal structural models with a time-to-event approach. To adjust for confounding, we included in the models several variables including MS polygenic risk score (MS-PRS), education level, parity, smoking, fertility problems, obesity, and mononucleosis. We further aimed to evaluate the influence of parity using a mediation analysis. ResultsThe association of both ever and current OC use did not result in a statistically significant MS hazard increase (ever vs never users, HR=1.30 [95%CI:0.93,1.82, p=0.12]; current vs never users, HR=1.35 [95%CI:0.81,2.25, p=0.25]). However, we highlighted parity as an effect modifier for this association. In nulliparous women, ever and current use resulted in a significant two-fold and three-fold MS hazard increase (HR=2.08 [95%CI:1.04,4.17, p=0.04] and HR=3.15 [95%CI:1.43,6.92, p=0.004]). These associations were supported by significant MS hazard increases for a higher duration of current use and for an earlier age at initiation. We further highlighted genetic MS susceptibility as another effect modifier, as a stronger OC-MS hazard association was found in women with a low MS-PRS. ConclusionOur findings highlighted how the association between OC use and MS vary based on individual characteristics such as parity and genetic MS susceptibility. Importantly, current use in nulliparous women was found to be associated with a three-fold increase in MS hazard. We acknowledge the need for cautious causal interpretation and further research to validate these findings across diverse populations and OC types.

A Review of Concordance and Quality in Clinical Guidelines for Hormonal Contraceptives to Mitigate Drug-Drug Interactions in Women With Epilepsy.

Concomitant use of hormonal contraceptive agents (HCAs) and enzyme-inducting antiepileptic drugs (EIAEDs) may lead to contraceptive failure and unintended pregnancy. This review identified and evaluated concordance and quality of clinical treatment guidelines related to the use of HCAs in women with epilepsy (WWE) receiving EIAEDs. Relevant clinical guidelines were identified across four databases and were independently evaluated for quality utilizing the AGREE-II protocol instrument. Quality in this context is defined as the rigor and transparency of the methodologies used to develop the guideline. Guidelines were further assessed in terms of concordance and discordance with the latest body of knowledge concerning the use of hormonal contraception in the presence of EIAEDs. A total of n = 5 guidelines were retrieved and evaluated. Overall guideline scores ranged from 17% to 92%, while individual domain scores ranged from 0% to 100%. Contraceptive guidelines consistently recommended the use of intrauterine systems and long-acting injectables in the presence of EIAEDs, recommended against the use of oral, transdermal, and vaginal ring contraceptives, and differed regarding recommendations related to implants. Guidelines agreed regarding recommendations that women treated with EIAEDs should receive intrauterine systems and long-acting injectables; however, the suggested frequency of administration of injectable contraceptives differed. The use of intrauterine systems in this population is supported by evidence, but there is uncertainty surrounding the use of long-acting injectables and contraceptive implants. To mitigate the risk of unintended pregnancy and its consequences, recommendations related to implants and long-acting injectable contraceptives should be evidence-based.

Neuropsychiatric Manifestations, As a Rare Presentation of Venous Sinus Thrombosis Two Weeks After Cesarean Section: First Report in the Gambia

Cerebral venous sinus thrombosis (CVST) is a rare and potentially fatal condition, accounting for about 0.5% of all cerebrovascular disease cases globally. It is challenging to diagnose due to its rarity and diverse clinical presentations that can mimic other acute neurological conditions [1]. The reported worldwide incidence of CVST during pregnancy and postpartum is approximately 3 to 4 cases per million, with superior sagittal sinus thrombosis (SSST) being the most prevalent type. Risk factors include the prothrombotic state of pregnancy in the third trimester, obesity, accidental dural puncture, deficiencies in protein C and S, antiphospholipid syndrome, and the use of oral contraceptives among others. Symptoms typically manifest within the first three weeks postpartum, with severe headache being the most common complaint. The low number of reported cases in sub-Saharan Africa suggests underdiagnosing or underreporting, with infection being the primary cause in this region. We report a case at our facility who, two weeks after a cesarean section, presented with severe headache, confusion, irritability, restlessness, and later developed a focal motor deficit. Imaging studies were crucial in diagnosing SSST and ruling out other conditions causing acute brain injury. This is the first reported case in The Gambia, and one of the few described in West Africa related to an obstetric procedure. The onset, characterized by neuropsychiatric symptoms, is unusual and interesting, as these manifestations are less common than the typical headache, seizure, and focal motor deficit described in the literature.

Ultra-Processed Food Intake and Risk of Systemic Lupus Erythematosus among Women followed in the Nurses' Health Study Cohorts.

We assessed ultra-processed food (UPF) intake and SLE incidence within the prospective Nurses' Health Study cohorts. 204,175 women were followed, NHS: 1984 - 2016; NHSII: 1991 - 2017. Semi-quantitative food frequency questionnaires were completed every 2-4 years. UPF intake was determined as per the Nova classification. Nurses self-reported new doctor-diagnosed SLE, confirmed by medical records. Time-varying Cox regressions estimated hazard ratios (HR, 95% confidence intervals) for incident SLE and SLE by anti-double stranded DNA antibody (dsDNA) at diagnosis, according to cumulatively-updated daily: a) UPF servings, b) total intake (gms + mls), and c) % total intake. Analyses adjusted for age, race, cohort, caloric and alcohol intakes, household income, smoking, body mass index (BMI), physical activity, menarchal age, and oral contraceptive use. We tested for interaction with BMI and examined UPF categories. Mean baseline age was ~50 years (NHS) and ~36 years (NHSII); 93% self-reported White race. 212 incident SLE cases were identified. SLE risk was higher in 3rd vs. 1st UPF tertile (servings/day pooled multivariable [MV] HR 1.56 (1.04-2.32); p trend 0.03). Results were stronger for dsDNA+ SLE (servings/day pooled MV HR 2.05 (1.15-3.65); p trend 0.01), and for absolute (servings or total) than % total intake. Sugar/artificially-sweetened beverages were associated with SLE risk (3rd vs. 1st tertile MV HR 1.45 (1.01-2.09). No BMI interactions were observed. Higher cumulative-average daily UPF intake was associated with >50% increased SLE risk, and with doubled risk for anti-dsDNA+ SLE. Many deleterious effects on systemic inflammation and immunity are postulated.

Non-genetic factors and breast cancer: an umbrella review of meta-analyses

BackgroundPrevious research has found associations between various non-genetic factors and breast cancer (BrCa) risk. This study summarises and appraises the credibility of the available evidence on the association between non-genetic factors and BrCa risk.MethodsWe conducted an umbrella review of meta-analyses. Medline, Scopus, and the Cochrane databases were systematically searched for meta-analyses examining non-genetic factors and BrCa incidence or mortality. The strength of the evidence was graded in four categories (i.e., weak, suggestive, highly suggestive, convincing).ResultsA total of 781 meta-analyses from 280 publications were evaluated and graded. We included exposures related to anthropometric measurements, biomarkers, breast characteristics and diseases, diet and supplements, environment, exogenous hormones, lifestyle and social factors, medical history, medication, reproductive history, and pregnancy. The largest number of examined associations was found for the category of diet and supplements and for exposures such as aspirin use and active smoking. The statistically significant (P-value < 0.05) meta-analyses were 382 (49%), of which 204 (53.4%) reported factors associated with increased BrCa risk. Most of the statistically significant evidence (n = 224, 58.6%) was graded as weak. Convincing harmful associations with heightened BrCa risk were found for increased body mass index (BMI), BMI and weight gain in postmenopausal women, oral contraceptive use in premenopausal women, increased androstenedione, estradiol, estrone, and testosterone concentrations, high Breast Imaging Reporting and Data System (BIRADS) classification, and increased breast density. Convincing protective factors associated with lower BrCa risk included high fiber intake and high sex hormone binding globulin (SHBG) levels while highly suggestive protective factors included high 25 hydroxy vitamin D [25(OH)D] levels, adherence to healthy lifestyle, and moderate-vigorous physical activity.ConclusionsOur findings suggest some highly modifiable factors that protect from BrCa. Interestingly, while diet was the most studied exposure category, the related associations failed to reach higher levels of evidence, indicating the methodological limitations in the field. To improve the validity of these associations, future research should utilise more robust study designs and better exposure assessment techniques. Overall, our study provides knowledge that supports the development of evidence-based BrCa prevention recommendations and guidance, both at an individual level and for public health initiatives.Trial registrationPROSPERO CRD42022370675.

A systematic approach to the management of menses prophylaxis and suppression in pre-menopausal hematologic cancer patients.

Hematologic malignancies in women of reproductive age carry significant additional morbidity due to menstrual bleeding in conjunction with disease and treatment-associated cytopenias. Several agents for menses prophylaxis and suppression exist, but there is a paucity of data comparing these therapies, particularly in the cancer setting. A thorough literature review and evaluation of available data was conducted via PubMed search and combined with clinical expertise. The goal of prophylaxis therapy is to induce amenorrhea until it is considered safe to resume menstrual cycles. GnRH agonists remain the management of choice in achieving menses control and amenorrhea. Suppression is more likely achieved when the therapy is initiated in the late luteal phase or with the concomitant use of oral contraceptives. The effective use of oral contraceptives is achievable in appropriately selected patients. Although attractive as prophylactic agents, GnRH agonists have a slow onset of amenorrhea and can be associated with an initial increase in bleeding, thus are of limited value in immediate menorrhagia management. We recommend prioritizing estrogen therapy given its documented efficacy, and adding tranexamic acid as a secondary agent for severe or refractory bleeding. Thus far in the literature, this is the most comprehensive proposed pathway for the prevention and suppression of menorrhagia in hematologic cancer patients. Our protocol provides a step-wise approach for the management of menses prophylaxis and suppression to provide standardization amongst clinicians and adaptations for patient-specific needs.

Influence of endogenous and exogenous hormones on the cardiovascular response to lower extremity exercise and group III/IV activation in young females.

Oral contraceptive (OC) use can increase resting blood pressure (BP) in females as well as contribute to greater activation of group III/IV afferents during upper body exercise. It is unknown, however, whether an exaggerated BP response occurs during lower limb exercise in OC users. We sought to elucidate the group III/IV afferent activity-mediated BP and heart rate responses while performing lower extremity tasks during early and late follicular phases in young, healthy females. Females not taking OCs (NOC: n = 8; age: 25 ± 4 yr) and those taking OCs (OC: n = 10; age: 23 ± 2 yr) completed a continuous knee extension/flexion passive stretch (mechanoreflex) and cycling exercise with subsystolic cuff occlusion (exercise pressor reflex), which was followed by a 2-min postexercise circulatory occlusion (PECO) (metaboreflex). Data collection occurred on two occasions: once during the early follicular phase (days 1-4) and once during the late follicular phase (days 10-14) of their menstrual cycle (NOC) or during the placebo and active pill phases (OC). Resting mean arterial BP and heart rate were not different between phases in NOC and OC participants (P > 0.05). Hemodynamic responses to metaboreflex, mechanoreflex, and collective exercise pressor reflex activation were not different between phases in both groups (P > 0.05). In conclusion, although OCs are known to increase BP at rest, our findings indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during large, lower limb muscle exercise with or without group III/IV afferent activation in young, healthy females.NEW & NOTEWORTHY Sex differences in the cardiovascular response to exercise have been demonstrated and may be dependent on sex hormone levels. Furthermore, oral contraceptives (OCs) have been shown to exaggerate the blood pressure response to upper extremity exercise. The results of this study indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during lower extremity dynamic exercise or with group III/IV afferent activation in young, healthy females.

Association between oral contraceptives and cervical cancer: A retrospective case-control study based on the National Health and Nutrition Examination Survey.

Background: Cervical cancer is the fourth most common cancer among females globally, with a high incidence and high mortality among females in developing countries. This retrospective case-control study aimed to investigate the association between oral contraceptives and cervical cancer, on which insufficient evidence still exists. Material and Methods: To examine the association between oral contraceptives and cervical cancer based on 7,496 females aged over 20years from the National Health and Nutrition Examination Survey, multivariable logistic regression conducted from 1999 to 2016 was used. Results: Contraceptive use was positively associated with cervical cancer risk. In model 1 (unadjusted), a 195% increased risk of cervical cancer was observed among those who used oral contraceptives (odds ratio [OR] = 2.27, 95% confidence interval [CI] = 1.39-3.98, p = 0.002) compared to those who did not. In addition, the ORs for the exposed population were 1.74 (95% CI = 1.05-3.08, p = 0.041) and 1.93 (95% CI = 1.16-3.44, p = 0.017) in model 2 (adjusted for age, race, and body mass index [BMI]) and model 3 (adjusted for education level, ratio of family income to poverty, drinking status, smoking status, number of pregnancies, age at first sex, number of sexual partners, and whether to receive the human papillomavirus (HPV) vaccine in addition to model 2), respectively. Furthermore, subgroup analyses stratified by age, smoking status, BMI, age at first sex, number of sexual partners, and whether to receive the HPV vaccine also revealed that oral contraceptives were significantly associated with cervical cancer. Conclusion: This study demonstrated that oral contraceptive use increased the risk of cervical cancer. In addition, the higher risk, including individuals older than 45years, having a high BMI (≥30kg/m2), being current smokers, and having more than five sexual partners, may contribute to the development of cervical cancer.