Parous Women Research Articles

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.

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 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=1381) study of invasive YOBC (aged <50 years), cases were identified from the Los Angeles County and Metropolitan Detroit SEER registries, 2010-2015. Area-based, frequency-matched controls were sampled from the 2010 Census. General adiposity (body mass index (BMI)) and central adiposity (waist circumference (WC), waist-to-height ratio (WHtR)) across adulthood and covariates were collected from in-person interviews and measurements. Odds ratios (ORs) and 95% confidence intervals (CIs) for adiposity and YOBC tumor subtypes (i.e., luminal A, luminal B, HER2+, 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 non-significant. Similarly, adult overweight and obese BMIs were inversely associated with luminal A (respectively OR=0.66, 95% CI 0.48-0.91 and OR=0.59, 95% CI 0.46-0.87), but not other subtypes. Conversely, larger WC was associated with higher odds of luminal B and TN YOBC (respectively OR=1.48, 95% CI 1.01-2.15 and OR=2.48, 95% CI 1.52-3.88), but not other subtypes (with similar results for WHtR); highest odds were among parous women. Findings show greater general adult adiposity is associated with reduced odds of luminal A YOBC, while 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.

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.

Association between mean platelet volume and the risk of type 2 diabetes mellitus among women with history of gestational diabetes mellitus

AimsThe present study aimed to investigate the relationship between mean platelet volume (MPV) and the risk of type 2 diabetes mellitus (T2DM), among women with and without a history of gestational diabetes mellitus (GDM).MethodsEight thousand one hundred eighty-one parous women of the ‘2007–2018 National Health and Nutrition Examination Survey (NHANES)’ were classified into GDM and non-GDM groups based on self-reported GDM history. We investigated the independent association between the MPV and the risk of T2DM in these groups via multivariable regression analysis. A subgroup analysis was done for the GDM group.ResultsAfter comprehensive adjustment for potential covariates, a significant positive correlation was observed between MPV and the risk of T2DM in women with a history of GDM (OR = 1.50, 95% CI 1.13–2.01, P = 0.006). There was a linear relationship between MPV and T2DM among women with a history of GDM, with each unit increase in MPV increasing the risk of T2DM by 50%. Subgroup analysis and interaction tests revealed a stronger significant effect on women with GDM history who had HbA1c ≥ 7%.ConclusionsMPV is strongly associated with the incidence of T2DM among U.S. parous women with prior GDM, indicating that MPV may be a potential biomarker of T2DM among women with a history of GDM.

Pelvic floor disorder prevalence and risk factors in a cohort of parous Ugandan women.

The aim of this study was to determine the prevalence of pelvic floor disorders (PFDs) and associated risk factors among parous Ugandan women. We performed a cross-sectional study of parous Ugandan women. Demographics and assessment for PFD were obtained. The presence of PFD was defined by participant symptom report, standardized questionnaires, and standard physical examination (pelvic organ prolapse quantification [POP-Q] and cough stress test [CST]). A total of 159 women were enrolled in the study between June 2022 and June 2023. The median age was 35 years and median parity was 4. Forty-four (28%) women in the cohort reported symptoms of urinary incontinence. No women reported symptoms of pelvic organ prolapse or anal incontinence. Seventy-two (46%) participants had a positive CST and 93 (58.3%) had stage II or greater prolapse based on the POP-Q. Cesarean section was found to have a protective effect for the development of PFD (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07-0.59, P = 0.004). PFDs are prevalent among parous Ugandan women at rates similar to cohorts in other low- and middle-income countries. Cesarean section seems to be a protective factor against developing PFDs.

The Effect of Maternal Parity on Preterm Birth Risk in Women with Short Mid-Trimester Cervical Length: A Retrospective Cohort Study.

Objectives: To evaluate the effect of maternal parity on the association between mid-trimester cervical length and preterm birth to elucidate the potential intricacies of this relationship. Methods: A retrospective cohort study using Electronic Medical Records (EMR) data. The study population included pregnant women with a singleton fetus and a short mid-trimester cervical length, recorded in the EMR system at a large health maintenance organization. Women were categorized by parity in the current pregnancy, and a statistical analysis was conducted to examine the relationship between parity and premature delivery. Results: Data were collected from 1144 records of cervical length measurements of 738 pregnancies obtained from the HMO database. The study population consisted of 259 nulliparous women (35.1%), 451 multiparous women (61.1%), and 28 grand multiparous women (3.8%). The results from the multivariate analysis of the primary outcome showed that nulliparity was significantly associated with an increased risk of premature delivery, with a risk of 1.557 for nulliparous women compared to parous women. Conclusions: In this study, a statistically significant association was found between nulliparity and preterm birth among women with a short mid-trimester cervical length. Nulliparous women were found to have a higher risk of preterm birth in the current pregnancy compared to parous women. Further research is needed to understand the underlying mechanisms and to develop targeted interventions to reduce the risk of premature birth in this population. These findings highlight the need to consider nulliparity as a potential risk factor in the management of pregnancies with a shortened cervix.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and risk of endometrial cancer among US adults: A population-based study.

123 Background: Endometrial cancer, as one of the metabolic-related malignancies, is becoming a significant public health concern worldwide. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has emerged as a comprehensive biomarker of various lipid-related metabolic disorders. However, the association of NHHR with endometrial cancer risk remains unclear to date. Therefore, we conducted this nationwide cross-sectional study to investigate the association of NHHR with the risk of endometrial cancer among US adults. Methods: Data were obtained from the National Health and Nutrition Examination Survey (1999–2018). Female participants who provided complete data on the NHHR and endometrial cancer were enrolled. The association of the NHHR with endometrial cancer was assessed by multivariate logistic regression analyses, adjusted by multiple potential confounders. Meanwhile, sensitivity analyses and subgroup analyses were conducted. Results: A total of 25,411 eligible participants were enrolled, including 214 (0.8%) women with endometrial cancer. The fully-adjusted multivariate logistic model showed a significantly positive association of NHHR with the endometrial cancer risk (odds ratio [OR] 1.15, 95% confidence interval [CI]: 1.05–1.25; P=0.003). Comparing the highest to the lowest quartile of NHHR, the fully-adjusted OR was 1.52 (95% CI: 1.02–2.28, P for trend=0.017). In subgroup analyses, the significantly positive association between NHHR and the risk of endometrial cancer was also found in non-obese women (OR 1.18, 95% CI: 1.04–1.35, P=0.012), women without diabetes (OR 1.15, 95% CI: 1.02–1.30, P=0.027), women with hypertension (OR 1.15, 95% CI: 1.03–1.28, P=0.012), women who use oral contraceptives (OR 1.16, 95% CI: 1.04–1.30, P=0.009) and in parous women(OR 1.15, 95% CI: 1.05–1.27, P=0.003). Additionally, in the sensitivity analysis by excluding participants with NHHR below 5% or above 95% in total cohort, the positive association of NHHR with endometrial cancer risk remained significant (OR 1.21, 95% CI: 1.03–1.42, P=0.018). Conclusions: This population-based study found that a higher NHHR correlated with an increased risk of endometrial cancer among the US population. Our findings suggested that NHHR might be a promising tool for the risk assessment of endometrial cancer. Prospective studies are necessary to further verify these findings. [Table: see text]

Frequency of internet use and hypertension risk among men and women in Kenya: an analysis of the 2022 demographic and health survey

BackgroundThe proliferation of internet use in the 21st century has brought about a pluralistic effect on health. Users of the internet are more exposed to health information, thus, making them more health literate and more likely to adopt healthy behaviors. However, frequent use of the internet has been found to adversely affect mental health (e.g., depression), social wellbeing, and obesity. Yet, the link between internet use and physical health outcomes such as hypertension remains less explored. We examined the association between frequency of internet use and hypertension risk among women and men in Kenya using data from the 2022 Kenyan demographic and health survey.ResultsOverall, the prevalence of hypertension was higher among women (1,398 [8.69%]) compared to men (504 [3.49%]). Those who reported using the internet often reported higher prevalence of hypertension (women: n = 638 [10.49%]; men: n = 279 [3.98%]). The mean age was 29.3 years (SD = 9.6) for women and 29.9 years for men (SD = 10.9). After adjusting for potential confounders, women who reported often using the internet also demonstrated a significant association [AOR = 1.21; 95%CI: 1.03–1.43]. However, we found no significant association between frequency of internet use and hypertension among men after adjusting for confounders.ConclusionOur study concludes that frequent use of internet is positively associated with hypertension risk among women but not men. Policymakers may consider implementing guidelines or regulations to promote healthy internet usage habits and encourage breaks or limits on screen time, especially for individuals at risk of hypertension (i.e., older women of reproductive age, women with higher education, married and previously married women, those in affluent households, parous women, those who consume alcohol and those overweight/obese). Healthcare providers should educate patients about the potential health consequences of prolonged internet usage and incorporate discussions about screen time management into routine clinical encounters.

Impact of Rumination, and Dyadic Coping on Parenting Sense of Competence Among Puerperal Women in China: A Cross-sectional Study

This study aimed to explore the potential categories of parenting sense of competence and to analyze the influence of rumination and dyadic coping on the potential categories of parenting sense of competence. A total of 199 postpartum women who met the criteria were surveyed from a tertiary grade-A hospital in Shanxi (China) from May 2023 to August 2023. The instruments included the general demographic characteristics, Chinese version of parenting sense of competence scale, Chinese event related rumination inventory, and Chinese version of dyadic coping inventory. Latent profile analysis (LPA) was used to classify the parenting sense of competence in postpartum women, and logistic regression analysis was used to identify the influencing factors. The characteristics of parenting sense of competence in postpartum women can be divided into two potential categories, namely, easy-to-satisfy group (39.3%) and strict-demand group (60.7%). Logistic regression analysis showed that years of marriage, place of residence, deliberate rumination, and dyadic coping were the influencing factors of the potential categories of parenting sense of competence in postpartum women (p<.05). Through Latent profile analysis (LPA) analysis, it was found that postpartum women's parenting sense of competence exhibits different characteristics. Clinical workers should identify the characteristics and influencing factors of different categories of women and adopt targeted intervention strategies to promote the level of parenting sense of competence.

Assessing the effect of concerns about contraceptive-induced fertility impairment on hormonal contraceptive use by parity and residence: evidence from PMA Ethiopia 2020 cross-sectional survey

ObjectivesThis study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence.DesignWe use data...

Contribution of pre-diagnostic host factors to shaping the stromal microenvironment of breast cancer among sub-Saharan African women.

The stromal microenvironment (SME) is integral to breast cancer (BC) biology, impacting metastatic proclivity and treatment response. Emerging data indicate that host factors may impact the SME, but the relationship between pre-diagnostic host factors and SME phenotype remains poorly characterized, particularly among women of African ancestry. We conducted a case-only analysis involving 792 BC patients (17-84 years) from the Ghana Breast Health Study (GBHS). High-accuracy machine-learning algorithms were applied to standard H&E-stained images to characterize SME phenotypes (including percent tumor-associated connective tissue stroma, Ta-CTS (%), and tumor-associated stromal cellular density, Ta-SCD (%)). Associations between pre-diagnostic host factors and SME phenotypes were assessed in multivariable linear regression models. Decreasing Ta-CTS and increasing Ta-SCD were associated with aggressive, mostly high-grade tumors (p-value<0.001). Several pre-diagnostic host factors were associated with Ta-SCD independently of tumor characteristics. Compared with nulliparous women, parous women had higher levels of Ta-SCD [mean (standard deviation, SD) = 31.3% (7.6%) vs. 28.9% (7.1%); p-value=0.01]. Similarly, women with a positive family history of breast cancer had higher levels of Ta-SCD than those without family history [mean (SD) = 33.0% (7.5%)] vs. 30.9% (7.6%); p-value=0.03]. Conversely, increasing body size was associated with decreasing Ta-SCD [mean (SD) = 32.0% (7.4%), 31.3% (7.3%), and 29.0% (8.0%) for slight, average, and large body sizes, respectively, p-value=0.005]. Epidemiological risk factors were associated with varying degrees of stromal cellularity in tumors, independently of clinicopathological characteristics. The findings raise the possibility that epidemiological risk factors may partly influence tumor biology via the SME.

Variations in the use of oxytocin for augmentation of labour in Sweden: a population-based cohort study

National Swedish data shows substantial variation in the use of oxytocin for augmentation of spontaneous labour between obstetric units. This study aimed to investigate if variations in the use of oxytocin augmentation are associated with maternal and infant characteristics or clinical factors. We used a cohort design including women allocated to Robson group 1 (nulliparous women, gestational week ≥ 37 + 0, with singleton births in cephalic presentation and spontaneous onset of labour) and 3 (parous women, gestational week ≥ 37 + 0, with singleton births in cephalic presentation, spontaneous onset of labour, and no previous caesarean birth). Crude and adjusted logistic regression models with marginal standardisation were used to estimate risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) for oxytocin use by obstetric unit. An interaction analysis was performed to investigate the potential modifying effect of epidural. The use of oxytocin varied between 47 and 73% in Robson group 1, and 10% and 33% in Robson group 3. Compared to the remainder of Sweden, the risk of oxytocin augmentation ranged from 13% lower (RD − 13.0, 95% CI − 15.5 to − 10.6) to 14% higher (RD 14.0, 95% CI 12.3–15.8) in Robson group 1, and from 6% lower (RD − 5.6, 95% CI − 6.8 to − 4.5) to 18% higher (RD 17.9, 95% CI 16.5–19.4) in Robson group 3. The most notable differences in risk estimates were observed among women in Robson group 3 with epidural. In conclusion, variations in oxytocin use remained despite adjusting for risk factors. This indicates unjustified differences in use of oxytocin in clinical practice.

Association Between Physical Activity and Pelvic Floor Disorders in Parous Ugandan Women

Introduction and HypothesisThe aim was to assess the association between the degree of physical activity (PA) and the presence of pelvic floor disorders (PFDs) in a cohort of parous Ugandan women.MethodsIn this cross-sectional study, PFDs were measured using symptom assessment, standardized questionnaires (Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire), and a standardized physical examination (POP-Q and cough stress test [CST]). Degree of PA was assessed using the International Physical Activity Questionnaire. Interquartile ranges were used to describe the age, parity, and body mass index (BMI) of participants. To examine the association between PA and PFDs, a log transformation was applied to the weekly minutes of PA variable and a logistic regression model was constructed with weekly minutes of moderate/vigorous PA, age, BMI, and parity as the predictors.ResultsA total of 159 women were enrolled. Median age was 35 (IQR 32–37), median parity 4 (IQR 3–5), and median BMI 29.0 (IQR 24–33). The prevalence of PFD as determined by symptom assessment was 28% (n=44). The most frequent stage of prolapse identified by POP-Q was stage II (57%, n=91). Thirty-six percent of the women (n=58) reported vigorous PA. Ninety-nine percent of the cohort (n=158) reported moderate PA. When controlling for age, parity, and BMI there was a significant positive association between PFD (defined as a combination of stage II prolapse, positive CST, and urinary incontinence (UI)) and moderate PA (OR 2.20, 95% CI 1.08–5.14, p value 0.045).ConclusionsPelvic floor disorders are common among parous Ugandan women and are associated with moderate PA when controlling for age, BMI, and parity. Understanding the risk factors associated with PFD in this population may better equip providers to screen and care for individuals.