Parous Women Research Articles

Comparison of robot-assisted vs. traditional laparoscopic sacral colpopexy for pelvic organ prolapse: Outcomes and quality of life

Background Pelvic organ prolapse is a prevalent condition affecting women of varying ages and ethnicities globally. The prevalence of pelvic organ prolapse is substantial, with estimates suggesting that up to 50% of parous women may experience some degree of prolapse during their lifetime. Objective This retrospective evaluation aimed to compare the outcomes of robot-assisted sacral colpopexy (RASC) and traditional laparoscopic sacral colpopexy (LSC) in the treatment of pelvic organ prolapse, focusing on surgical outcomes, postoperative pain, quality of life, complications, and recurrence rates. Methods A total of 138 patients treated for pelvic organ prolapse and undergoing sacral colpopexy from December 2021 to December 2023 were included in the study. The patients were categorized into two groups based on the procedure utilized: RASC or LSC. Demographic characteristics, surgical outcomes, postoperative pain scores, quality of life, complications, and recurrence rates were compared between the two groups. Results The demographic characteristics of the study population demonstrated comparable baseline profiles for the RASC and LSC groups. RASC was associated with shorter surgery duration, lower intraoperative blood loss, shorter operative time for apical prolapse repair, and significantly lower postoperative pain scores at 24, 48, and 72 h postoperatively compared to LSC. Additionally, patients undergoing RASC demonstrated significantly better quality of life across various domains compared to those undergoing LSC. There were no statistically significant differences in the incidence of complications between the two groups. Furthermore, the RASC group demonstrated consistently lower recurrence rates at 1, 2, and 5 years postoperatively compared to the LSC group. Conclusion Robot-assisted sacral colpopexy offers potential advantages over traditional laparoscopic sacral colpopexy in the treatment of pelvic organ prolapse, with favorable surgical outcomes, reduced postoperative pain, improved quality of life, comparable complication rates, and lower recurrence rates. These findings support the consideration of RASC as a promising surgical approach for addressing pelvic organ prolapse and provide valuable insights for informing clinical decision-making and refining the approach to pelvic organ prolapse treatment.

Machine-Learning-Based Predictive Model for Bothersome Stress Urinary Incontinence Among Parous Women in Southeastern China.

Accurate identification of female populations at high risk for urinary incontinence (UI) and early intervention are potentially effective initiatives to reduce the prevalence of UI. We aimed to apply machine-learning techniques to establish, internally validate, and provide interpretable risk assessment tools. Data from a cross-sectional epidemiological survey of female urinary incontinence conducted in 2022 were used. Sociodemographic and obstetrics-related characteristics, comorbidities, and urinary incontinence questionnaire results were used to develop multiple prediction models. Seventy percent of the individuals in the study cohort were employed in model training, and the remainder were used for internal validation. Model performance was characterized by area under the receiver-operating characteristic curve (AUC) and calibration curves, as well as Brier scores. The best-performing model was finally selected to develop an online prediction tool. The results showed that bothersome stress urinary incontinence (BSUI) occurred in 9.6% (849 out of 8,830) of parous women. The XGBoost model achieved the best prediction performance (training set: AUC 0.796, 95% confidence interval [CI]: 0.778-0.815, validation set: AUC 0.720, 95% CI: 0.686-0.754). Additionally, the XGBoost model achieved the lowest (best) Brier score among the models, with sensitivity of 0.657, specificity of 0.690, accuracy of 0.688, positive predictive value of 0.231, and negative predictive value of 0.948. Based on this model, the top five risk factors for the development of BSUI among parous women were ranked as follows: body mass index, age, vaginal delivery, constipation, and maximum fetal birth weight. An online calculator was provided for clinical use. The application of machine-learning algorithms provides an acceptable, though not perfect, prediction of BSUI risk among parous women, requiring further validation and improvement in future research.

Fetal rotation examined with ultrasound in a sub-Saharan population: A longitudinal cohort study.

Occiput posterior (OP) position rates at birth are 5%-8% in studies mainly comprising white European women. The anthropoid pelvis is common in black African women. This pelvic shape has a narrow anterior segment and an ample room posteriorly. The fetal head is wider posteriorly, and the OP position may be favorable in women with an anthropoid pelvic shape. We aimed to examine the fetal rotation with ultrasound longitudinally during the active phase of labor in a sub-Saharan population. We also aimed to examine associations between fetal position, delivery mode, and duration of labor. The study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania from the 19th of November 2023 to 13th of April 2024. Women with a single fetus in cephalic presentation, gestational age >37 weeks, without previous or pre-labor cesarean section were eligible. Fetal position was classified as occiput anterior (OA) from 10 to 2 o'clock, occiput transverse (OT) at 3 or 9 o'clock, and OP position from 4 to 8 o'clock. The study participants comprised 215 women. Fetal positions at admission, in the first and second stage of labor and at birth are presented in the graphical figure. In all, 65/215 (30.2%) fetuses were in OP position at admission, 59/204 (28.9%) in the first stage, 38/210 (18.1%) in the second stage and 35/215 (16.3%) were delivered in OP position. The OP rates at birth were 25/92 (27.2%) in nulliparous and 10/123 (8.1%) in parous women. The operative delivery rate was 10/157 (6.4%) in women with ultrasound assessed fetal position as OA in the second stage (six cesarean section and four vacuum extractions), and 28/48 (58.3%) in the non-OA group (27 cesarean section and one vacuum extraction) (p < 0.01). The hazard ratio for delivery in the second stage was 0.26 (95% CI 0.13-0.52) for the non-OA versus the OA group in nulliparous women and 0.25 (95% CI 0.12-0.52) in parous women. The persistent OP position rate at birth was higher than previously reported, and the operative intervention rate was nine time higher in women with the fetus in non-OA versus OA position in the second stage.

Early pregnancy metal levels in maternal blood and pregnancy outcomes

Prenatal exposure to heavy metals such as Lead (Pb), arsenic (As), cadmium (Cd), and selenium (Se) is associated with various adverse pregnancy outcomes. This study examines the association between early pregnancy maternal blood levels of these metals and adverse pregnancy outcomes, while also addressing the differences between low-risk and high-risk groups based on having a history of preterm birth (PTB). This prospective cohort study recruited parous women during first trimester, categorized into low-risk and high-risk groups. Participants completed a questionnaire, and heavy metal levels were measured in blood samples. Pregnancy outcomes including PTB, low birth weight (LBW), gestational age at delivery, birth weight and head circumference were recorded following delivery. Multivariable analyses were conducted to evaluate the independent associations between heavy metal levels and pregnancy outcomes, while adjusting for maternal age, BMI, employment, smoking, fertility treatments and education. Among 404 participants, the mean (± SD) levels were Pb: 3.12 ± 1.82 µg/L, As: 0.41 ± 0.4 µg/L, Cd: 0.26 ± 0.34 µg/L, and Se: 119.84 ± 21.05 µg/L. Significant differences in Pb, Se, Cd and As levels were observed between the low-risk and high-risk groups, with higher levels in the low-risk group. However, no significant associations were found between heavy metal levels and any of the study outcomes in either univariable comparison or multivariable models. These findings highlight the need for further research to understand the potential impact of these metals on pregnancy, considering population-specific factors and exposure timing.

A History of Cesarean Birth as a Risk Factor for Postpartum Hemorrhage Even After Successful Planned Vaginal Birth.

It is unclear if a history of cesarean birth (CB) is a risk factor for postpartum hemorrhage (PPH) even after a successful planned vaginal birth. A historical retrospective cohort study from all deliveries (42,456) between 2004 and 2019. Inclusion criteria were as follows: (i) women with only one previous CB; (ii) liveborn cephalic singleton pregnancy and term spontaneous labor; (iii) successful planned vaginal birth; (iv) no operative vaginal delivery; and (v) no history of PPH. Women who experienced intrapartum uterine rupture leading to CB were excluded. Those who experienced uterine rupture diagnosed after vaginal birth were not excluded. The labor after cesarean (LAC) group (109 women with previous CB and current vaginal birth) were compared with 2 control groups to consider the parity: control group 1 (1633 nulliparous women) and control group 2 (4197 parous women). The main outcome was the rate of PPH (> 500 mL). Multivariate analysis was performed to investigate whether previous CB was an independent risk factor for PPH. Bivariate analysis and causal framework was used to determine the relation between variables of clinical interest. The PPH rates in the LAC group, control group 1, and control group 2 were 12.8%, 5.3%, and 6.4%, respectively. Irrespective of the group control (1 or 2), a history of CB was associated with an increased risk of PPH: adjusted odds ratio (aOR) 2.38 [95% confidence interval (CI) 1.28-4.44] (adjusted with maternal age, overweight, hyperthermia, and use of oxytocin) and aOR 2.16 [95% CI 1.20-3.87] (adjusted with maternal age and overweight) for Groups 1 (parous) and 2 (nulliparous), respectively. A history of cesarean birthcould be a risk factor for PPH even after successful planned vaginal delivery.

Impacts of inequalities in utilization of key maternal health service on fertility preference among high parity women in four selected regions of Ethiopia

BackgroundFertility is one of the three main components which determines the size, structure, and composition of a population, and fertility preferences are important measures for forecasting fertility levels of a population. Therefore, this study aims to assess the impacts of the inequalities in the utilization of key maternal health services on fertility preference among high parity women in four selected regions (i.e., Afar, Beninshangul-Gumuz, Gambella and Somali) of Ethiopia.MethodsThe study used data collected for the 2016 Ethiopian Demographic and Health Surveys (EDHS) survey. It includes a total of 977 high parity women (104 urban and 873 rural) residing in the four regions of the study. Bivariate logistic regression was used to select the potential variables by using a cut off p-value < 0.2 and then the multivariable logistic regression analyses were performed to assess the association between the selected explanatory variables (i.e., control and exposure variables) and the outcome variable (i.e. fertility preference). Further, the study employed a Population Attributable Fractions (PAFs) to examine the population level impacts of the inequalities in maternal and child health service variables on fertility preference.ResultsThe results showed that religion, household wealth index, place of delivery and contraceptive use were significantly associated with fertility preference. The results of the PAFs analysis indicated that contraceptive use had the biggest impact (80%), meaning that non-use of contraceptive increased fertility preference among women in the four regions. Similarly, out of health facility delivery increased fertility preference by 37%.ConclusionThe study findings underscore the critical factors influencing women’s fertility preferences in the studied regions. Low utilization of maternal health services had an impact on fertility preference, accounting for more than half of the observed variations in fertility preferences. To address this issue, targeted interventions are recommended: enhancing access to maternal health services, strengthening fertility control programs, promoting the benefits of using these services, and actively addressing inequalities.

The effects of pregnancy on disease progression of retinitis pigmentosa

PurposeRetinitis pigmentosa (RP) is the most common diagnosis in the ophthalmic genetics’ clinic. Women with RP are often diagnosed during their reproductive years, posing significant challenges for family planning. The effects of pregnancy on RP progression is a frequently unanswered concern for these patients. DesignRetrospective cohort study. SubjectsWomen who attended Moorfields Eye Hospital (London, UK) and met the following inclusion criteria were included in this study: (i) had their most recent visit at 30 years old or more, (ii) were diagnosed with RP, (iii) had information in their medical records about having had children, and (iv) were found to have biallelic rare or likely disease-causing variants in USH2A. MethodsThe cohort was divided into parous and nulliparous, and multivariate Cox regressions adjusting for multiple confounding effects was performed. A further analysis also included number of children as a variable. Main outcome measuresRP severity criteria based on visual acuity (VA) and ellipsoid zone (EZ) width, and national registration of sight impairment. Results142 women were included in the study, 98 parous (69%) and 44 nulliparous (31%). In the parous group, 21% had cystoid macular oedema (CMO) requiring treatment and 46% had cataracts or were pseudophakic, versus 18% with CMO and 59% with cataracts in the nulliparous. Women had a median of 2 children. A significant association was only found in parous women having 3.04 (1.23-7.48) times increased risk of having VA worse than LogMAR 0.7 than nulliparous (p= 0.016), after adjusting for baseline age, phenotype, cataract status, and CMO. ConclusionsThis is the first large-scale objective study analysing the effects of pregnancy in genetically-confirmed women with RP. Women with USH2A-associated RP who had children appeared to have 3.04 times the risk of reaching VA below 6/24 than those who did not have children. It is possible that other factors besides retinal degeneration are affecting central vision and causing this increased risk. A significant association between faster or slower EZ loss and pregnancy was not present in our cohort. We believe these findings will be relevant to all women with RP considering starting a family; although further studies are needed.

Effect of Dural Puncture Epidural Technique on Management of Breakthrough Pain for Parous Women Receiving Labor Analgesia during Induced Labor: A Retrospective Cohort Study.

This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor. This single-center retrospective cohort study included term pregnant women with singleton pregnancies who received treatment for breakthrough pain during labor. All participants underwent induced labor, and some parous women among them underwent DPE. The DPE technique consisted of placing an epidural catheter after dural puncture with a 27-gauge spinal needle. Eligible women were allocated into a DPE group and conventional epidural (CE) anesthesia group. Pain was assessed with a numerical rating scale (NRS), and a patient-controlled epidural analgesia (PCEA) bolus was administered when the NRS score was ≥3. Breakthrough pain was defined as an NRS score ≥3 during PCEA management. The primary outcome was the efficacy of rescue interventions in managing breakthrough pain, as determined by a reduction in pain intensity to an NRS score <3 before birth. Among the 55 parous women who received labor analgesia, 44 required additional rescue administration for breakthrough pain. Of the remaining women, 23 received DPE and 19 received CE anesthesia. The DPE group experienced significantly more effective relief of breakthrough pain before birth than did the CE group (DPE: 100%; CE: 68.4%; p=0.005). In parous women, DPE anesthesia was more effective than CE anesthesia in providing analgesia for breakthrough pain immediately before delivery during induced labor.

Comparison Between SGLT2 Inhibitors and Lactation: Implications for Cardiometabolic Health in Parous Women.

Sodium-glucose cotransporter-2 (SGLT2) inhibition and lactation result in the excretion of large amounts of glucose in urine or milk and are associated with a lower risk of cardiovascular events. The respective mechanisms behind this association with cardiovascular protection are not clear. This review compares the contribution of noninsulin-mediated glucose transport during pharmacologic inhibition of SGLT2 with noninsulin-mediated glucose transport during lactation in terms of the implications for the cardiometabolic health of parous women. The search topics used to obtain information on SGLT2 inhibitors included mechanisms of action, atherosclerosis, and heart failure. The search topics used to obtain information on lactation included cardiovascular health and milk composition. Subsequent reference searches of retrieved articles were also used. Active treatment with SGLT2 inhibitors affects glucose and sodium transport in the kidneys and predominantly protects against hospitalization for heart failure soon after the onset of therapy. Active lactation stimulates glucose transport into the mammary gland and improves subclinical and clinical atherosclerotic vascular disease years after delivery. Both SGLT2 inhibitors and lactation have effects on a variety of glucose transporters. Several mechanisms have been proposed to explain the cardiometabolic benefits of SGLT2 inhibition and lactation. Learning from the similarities and differences between both processes will advance our understanding of cardiometabolic health for all people.

Associations of AMH in mid-reproductive years with bone mineral density and turnover markers in mid-life.

Concentration of circulating anti-Müllerian hormone (AMH) predicts short-term (3-5 years) bone loss around menopause. Whether AMH during mid-reproductive years predicts bone health over a decade later is unknown. To study the association of AMH levels in mid-reproductive years with bone density and turnover biomarkers measured after ∼14 years of follow-up. We assessed plasma AMH in 2003-2006 (mean 37.0 years, SD 5.1) among 450 parous women (71% White) in a US longitudinal cohort, and bone mineral density (BMD; spine, hip, and femoral neck, measured by dual-energy X-ray absorptiometry) in 2017-2021 (mean 51.0 years, SD 5.1). Secondary outcomes were plasma levels of procollagen type I N-propeptide (PINP) and C-terminal telopeptide I (CTX-I). In linear regression models adjusted for demographics and lifestyle, compared to women with AMH >3.5 ng/mL, those with AMH <1.0 ng/mL had lower BMD (g/cm2) at follow-up (beta [95% CI]: spine: -0.06 [-0.10, -0.02]; hip: -0.05 [-0.08, -0.02]; femoral neck: -0.03 [-0.06, 0.00]) and higher bone turnover markers (beta [95% CI]: PINP: 0.36 SD [0.10, 0.63]; CTX-I: 0.34 SD [0.07, 0.60]). The association of AMH with spine BMD was more pronounced among post-menopausal women, in contrast to associations with bone turnover markers which were more pronounced among women who had not yet reached menopause. The associations between AMH and BMD were primarily mediated by menopausal status at follow-up. Lower AMH during mid-reproductive years is associated with lower BMD and higher bone turnover 14 years later. Ovarian reserve during mid-reproductive years may be a valuable predictor of long-term bone health.

LABOR DURATION IS DEFINED BY THE TIME OF DAY OF LABOR INDUCTION.

Spontaneous labor and birth peak during the late evening and early morning hours, indicating an endogenous rhythm in labor onset and birth. We hypothesize that the time-of-day of labor induction will define labor duration and the risk of cesarian section. In a retrospective study of pregnant women who were induced for labor (n =3,688), time-of- day of labor induction was studied across maternal phenotypes. Survival analysis and Cox Proportional Hazards model were used to identify differences in time-to-birth as a result of inducing labor at a specific time-of-day. Labor induction was circadian (p<0.05, Lomb-Scargle test), with a gradual lengthening in labor duration when labor induction was initiated later in the day, peaking at 23:00 hours (average labor duration of 20.72 hours) as compared to induction at 5:00 hours (average labor duration of 14.74 hours, p<0.01, Kruskal-Wallis test). The optimal time-of-day of labor induction was conditioned by maternal phenotype with significant differences in probability of giving birth as a result of the time-of-day labor was induced for nulliparous obese (p<0.05, Two-way ANOVA), and parous obese women (p<0.05). Labor duration in response to induction is circadian, with the shortest labor duration when induced during early morning hours. The optimal time-of-day of labor induction is conditioned by maternal phenotype and should be considered as a labor management practice.

Major Adverse Cardiovascular Events Following Coronary Artery Stenting by History of Hypertensive Disorder of Pregnancy.

A history of hypertensive disorders of pregnancy is associated with at least twice the risk of incident ischemic heart disease. Whether the long-term outcome following treatment with coronary artery stenting is associated to the history of hypertensive disorders of pregnancy is unknown. We included 8364 women (age ≤65 years) undergoing first coronary artery stenting 2006 to 2022 following their first delivery in 1973 or later, linking nationwide data on percutaneous coronary intervention and delivery history. In total, 1122 women (13.4%) had a history of hypertensive disorders of pregnancy. The main outcome, a major adverse cardiovascular event, was defined as any incident myocardial infarction, ischemic heart disease, cardiac arrest, arrhythmias, angina pectoris, heart failure, cerebral infarction, or sudden death. During a median follow-up time of 5 years, 258 women with a history of hypertensive disorders of pregnancy had a major adverse cardiovascular event, compared with 1465 women without a history of hypertensive disorders of pregnancy (23% versus 20.2%, P=0.028 for log-rank test). Estimates adjusted for patient- and procedural characteristics in proportional hazards regression models suggested that the hazard rate increased only after 4-8 years of follow-up (hazard ratio [HR], 1.36 [95% CI, 1.05-1.78]) and was primarily driven by women with history of gestational hypertension (HR, 2.15 [95% CI, 1.49-3.11]). Women with a history of hypertensive disorders of pregnancy have an increased risk of a major adverse cardiovascular event following coronary artery stenting compared with other parous women. A history of hypertensive disorders of pregnancy warrants further attention in the secondary prevention setting of coronary artery disease.

Comparison of pelvic floor morphometry in supine and standing in women with and without pelvic organ prolapse: A cross-sectional exploratory study

Introduction:Intra-abdominal pressure (IAP) and gravity may both challenge pelvic organ support and contribute to the development or worsening of pelvic organ prolapse (POP). This study aimed to assess whether pelvic floor morphometry differs between supine and standing positions in women with and without POP, at rest and with elevated IAP, and to compare the change in measures from the supine to standing position between groups. Methods:Thirty premenopausal vaginally parous women with (n=15) and without (n=15) POP were included. Transperineal ultrasound was used to assess pelvic floor morphometry (bladder neck [BN], rectal ampulla [RA], levator plate angle [LPA], anorectal angle [ARA], levator anteroposterior distance [LAP], and levator hiatal area [LHA]) in supine and standing, at rest and bearing down. Measures were compared between positions (supine and standing) and groups (women with and without POP). Results:At rest, BN and RA were lower and LPA was smaller in standing than supine for all participants (all p<0.04), and LHA and LAP distance were greater in standing than supine for women with POP (p<0.001). In standing rest, BN and RA were lower and LHA was greater in women with than without POP (p<0.001). There were no differences between women with and without POP in these measures in supine (all p>0.23). ARA was greater in women with POP than without POP in both positions at rest (p=0.002). During bearing down, BN and RA were lower, ARA and LPA were smaller, and LHA and LAP distance were larger in standing than in supine for all participants (all p<0.023). In bearing down in both positions, BN and RA were lower and ARA and LHA were greater in women with than without POP (all p=0.013). Conclusion:Our findings indicate lower pelvic floor support in women with POP compared to women without POP that is evident during bearing down in supine, and at rest and during bearing down in standing. These findings underscore the utility of transperineal ultrasound to assess pelvic floor morphometry in standing to guide management of women with POP.

Adiposity throughout Adulthood and Risk of Young-Onset Breast Cancer Tumor Subtypes in the Young Women's Health History Study.

The role of adult adiposity in young-onset breast cancer (YOBC) subtype risk is not well understood. In this population-based case (n = 1812)-control (n = 1,381) study of invasive YOBC (ages <50 years), cases were identified from the Los Angeles County and Metropolitan Detroit Surveillance, Epidemiology, and End Results registries, 2010 to 2015. Area-based, frequency-matched controls were sampled from the 2010 Census. General adiposity [body mass index (BMI)] and central adiposity (waist circumference and waist-to-height ratio) across adulthood and covariates were collected from in-person interviews and measurements. ORs and 95% confidence intervals (CI) for adiposity and YOBC tumor subtypes [i.e., luminal A, luminal B, HER2+, and triple negative (TN)] were calculated, overall and by parity, using multivariable weighted logistic regression. Obese young adult BMI was inversely associated with luminal A YOBC (OR = 0.35, 95% CI, 0.16-0.79); other subtype associations were nonsignificant. Similarly, adult overweight and obese BMIs were inversely associated with luminal A (OR = 0.66, 95% CI, 0.48-0.91 and OR = 0.59, 95% CI, 0.46-0.87, respectively), but not other subtypes. Conversely, larger waist circumference was associated with higher odds of luminal B and TN YOBC (OR = 1.48, 95% CI, 1.01-2.15 and OR = 2.48, 95% CI, 1.52-3.88, respectively), but not other subtypes (with similar results for weight-to-height ratio); highest odds were among parous women. Findings show greater general adult adiposity is associated with reduced odds of luminal A YOBC, whereas greater central adiposity is associated with increased odds of luminal B and TN YOBC, particularly among parous women. Additional studies of central adiposity and YOBC subtype risk, especially incorporating pregnancy history, are warranted.

Reproductive factors and mammographic density within the International Consortium of Mammographic Density: A cross-sectional study

BackgroundElevated mammographic density (MD) for a woman’s age and body mass index (BMI) is an established breast cancer risk factor. The relationship of parity, age at first birth, and breastfeeding with MD is less clear. We examined the associations of these factors with MD within the International Consortium of Mammographic Density (ICMD).MethodsICMD is a consortium of 27 studies with pooled individual-level epidemiological and MD data from 11,755 women without breast cancer aged 35–85 years from 22 countries, capturing 40 country-& ethnicity-specific population groups. MD was measured using the area-based tool Cumulus. Meta-analyses across population groups and pooled analyses were used to examine linear regression associations of square-root (√) transformed MD measures (percent MD (PMD), dense area (DA), and non-dense area (NDA)) with parity, age at first birth, ever/never breastfed and lifetime breastfeeding duration. Models were adjusted for age at mammogram, age at menarche, BMI, menopausal status, use of hormone replacement therapy, calibration method, mammogram view and reader, and parity and age at first birth when not the association of interest.ResultsAmong 10,988 women included in these analyses, 90.1% (n = 9,895) were parous, of whom 13% (n = 1,286) had ≥ five births. The mean age at first birth was 24.3 years (Standard deviation = 5.1). Increasing parity (per birth) was inversely associated with √PMD (β: − 0.05, 95% confidence interval (CI): − 0.07, − 0.03) and √DA (β: − 0.08, 95% CI: − 0.12, − 0.05) with this trend evident until at least nine births. Women who were older at first birth (per five-year increase) had higher √PMD (β:0.06, 95% CI:0.03, 0.10) and √DA (β:0.06, 95% CI:0.02, 0.10), and lower √NDA (β: − 0.06, 95% CI: − 0.11, − 0.01). In stratified analyses, this association was only evident in women who were post-menopausal at MD assessment. Among parous women, no associations were found between ever/never breastfed or lifetime breastfeeding duration (per six-month increase) and √MD.ConclusionsAssociations with higher parity and older age at first birth with √MD were consistent with the direction of their respective associations with breast cancer risk. Further research is needed to understand reproductive factor-related differences in the composition of breast tissue and their associations with breast cancer risk.

Abstract C147: Impact of genetic ancestry in triple-negative breast cancer subtypes

Abstract Background: Triple-negative breast cancer (TNBC) is an aggressive BC subtype characterized by significant molecular and clinical heterogeneity, influenced by genetic, phenotypic, and environmental factors, as well as interactions of the tumor with its surrounding milieu. A significant racial disparity has been observed between African American (AA) and European American (EA) women regarding the incidence and clinical progression of TNBC. TNBC frequently occurs in young parous women who self-identify as AA and in women who harbor a germline BRCA1 mutation. Notably, AA women are diagnosed with TNBC at a younger age and exhibit a higher risk of developing stage IV disease. Studies examining gene expression signatures that distinguish AA and EA TNBC have reported distinct tumor-associated immunologic profiles in AA patients. We have developed a novel cell type-driven subtyping system based on a racially diverse TNBC sample set that identified three TNBC subtypes, each with distinct biology and prognosis: CC1- immune signaling/T-cell response; CC2- pro- migratory/inflammatory; CC3- fatty acid and hormone and nuclear receptor signaling. In this study, we propose to examine ancestry-inferred differences within each TNBC subtype between patients with African and European ancestry. Methods: RNA-Sequencing data for the Louisiana Tumor Registry, a TNBC cohort of 250 diverse women [EA: 123 and AA: 127], was obtained from our collaborators at Louisiana State University Health Sciences Center. Genetic admixture was performed on 227/250 patients using the method described by Pakstis, A. J. et al. Differentially expressed genes (DEGs) were identified in pairwise comparisons at p-adj ≤ 0.05. Survival was assessed using log-rank tests. Results: We investigated DEGs within each subtype between patients with &amp;gt;60% African (Aa, n=102) or &amp;gt;60% European ancestry (Ea, n=99) (identified via admixture analysis). In all three subtypes, upregulated genes, and their associated enrichment in Aa were related to immune pathways, while DEGs in Ea patients were related to epithelial cell regulation. In CC1, Aa was associated with the upregulation of immunoglobulin genes involved in immunoglobulin production and antigen recognition, while Ea was associated with the upregulation of embryonic development genes. In CC2, Aa showed enriched complement activation and immunoglobulin genes, while Ea exhibited upregulation of basal cytokeratin and growth factor EGFR. In CC3, Aa was associated with the upregulation of inflammatory genes, whereas Ea showed upregulation of cellular senescence genes. Survival analysis demonstrated favorable outcomes for Aa in CC1 and less favorable outcomes for Aa in CC2. Conclusion: Our study highlights significant ancestry-inferred differences in gene expression within TNBC subtypes, with Aa patients showing immune pathways enrichment and Ea patients exhibiting differential epithelial cell regulation. These findings underscore the importance of considering genetic ancestry in TNBC prognosis and treatment strategies. Citation Format: Zahra Mesrizadeh, Kavitha Mukund, Fokrul Hossain, Jovanny Zabaleta, Denise Danos, Luis De Valle, Xiao-Cheng Wu, Chindo Hicks, Augusto Ochoa, Lucio Miele, Victoria L. Seewaldt, Shankar Subramaniam. Impact of genetic ancestry in triple-negative breast cancer subtypes [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C147.

PARITAS DENGAN KEPATUHAN ANTENATAL CARE

Compliance with implementation antenatal care for pregnant women, this can be done by looking at the coverage figures for pregnant women's visits to KI and K4. Pregnant women who carry out routine activities antenatal care useful for detecting pregnancy complications. The aim of this research was to determine the relationship between parity and compliance antenatal care pregnant mother. The research design used is an analytical survey method with an approach Cross Sectional. The population of this study were all pregnant women at the Danurejan I Community Health Center, Yogyakarta City, at the time the research was conducted, totaling 47 respondents taken using a simple random sampling technique. The results of this study show that there is a relationship between parity and compliance antenatal care pregnant women at the Danurejan I Community Health Center, Yogyakarta City (ρ value=0.000).

Pregnancy and offspring outcomes after prepregnancy bariatric surgery

BackgroundBariatric surgery is internationally performed as a treatment option in obesity to achieve significant and sustained weight loss. There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies. ObjectiveThis study aimed to describe the type of pre-pregnancy bariatric surgery, to analyse maternal, pregnancy and offspring outcomes compared to matched women and to assess the impact of pre-pregnancy bariatric surgery on fetal growth, particularly proportions of small for gestational (SGA) and large for gestational age (LGA). Study DesignA statewide hospital and perinatal data register linked cross-sectional matched study was performed. In total, n=2,018 births in n=1,677 women with pre-pregnancy bariatric surgery were registered between 2013 and 2018, of those n=1,282 were included and analysed with 1:10 to age, parity, smoking status and Body Mass Index (BMI) matched women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes from International Statistical Classification of Diseases Tenth revision codes (ICD-10AM) and neonatal birth records for outcomes of interest were analysed. Multivariable logistic regression was used to estimate the association between SGA and LGA and pre-pregnancy bariatric surgery. ResultsOf the n=1,282 women, 93% had undergone laparoscopic sleeve gastrectomy. Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), fewer LGA (8.6% vs 14.1%; p<0.001) and more SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Offspring were more likely to be born preterm (10.5% vs 7.8%; p=0.007) to mothers with pre-pregnancy bariatric surgery. Fewer women with previous bariatric surgery were diagnosed with GDM (15% vs 20%; p<0.001) or pregnancy induced hypertension (3.7% vs 5.4%; p=0.01). In the adjusted model, pre-pregnancy bariatric surgery was associated with a lower risk of LGA (OR 0.54, 95% CI 0.44-0.66) and higher risk of SGA (OR 1.78, 95% CI 1.46-2.17). ConclusionsThese data suggest that pre-pregnancy bariatric surgery was associated with a reduction in several obesity related pregnancy complications at the expense of more pre-term births and SGA offspring.

102 Parous women perform less moderate to vigorous physical activity than their nulliparous peers: a population-based study in Denmark

102 Parous women perform less moderate to vigorous physical activity than their nulliparous peers: a population-based study in Denmark

Trial of labor after caesarean section in low risk pregnancies: is it risky?

To evaluate the influence of a previous caesarean section on adverse composite maternal and perinatal outcome in women who attempted a trial of labor. This historical cohort study analyzed maternal and perinatal outcome in women with otherwise low risk pregnancies at term who underwent a trial of labor after a caesarean section (TOLAC). The primary outcome measure was the adverse composite outcome. Secondary outcome measures were amongst others the caesarean section rate and the mode of vaginal delivery. The adverse composite outcome was more frequently in the previous caesarean section group compared to women with no previous caesarean Sect.(22.3% vs. 15.6%, p < 0.0001). The percentage of caesarean Sect.(15.4% vs. 8.2%, p < 0,0001), uterine rupture (1.0% vs. 0.02%, p < 0.0001), placental abruption (1.1% vs. 0.3%, p = 0.0014), vaginal operative delivery (16.0% vs. 8.6%, p < 0.0001), pH < 7.10 (3.7% vs. 2.5%, p = 0.0151), base excess < -12 (3.2% vs. 2.2%, p = 0.0297), abnormal cardiotocography (22.5% vs. 13.9%, p < 0,0001) and fetal blood analysis (6.2% vs. 2.6%, p < 0.0001) was significantly higher in women with a previous caesarean section. Taking the parity into account, these differences could only been seen in women without a previous vaginal delivery. In parous women with a previous vaginal delivery and a caesarean section in history, the adverse composite did not differ between the groups. Only the rate of pH < 7.1 was higher in women after a caesarean Sect.(4.5% vs. 1.8%, p = 0.0436). Trial of labor after caesarean in otherwise low risk pregnancies is associated with a higher rate of complications especially if there is no history of vaginal delivery.