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Janet W Richedwards - One of the best experts on this subject based on the ideXlab platform.
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association of Spontaneous Abortion with all cause and cause specific premature mortality prospective cohort study
BMJ, 2021Co-Authors: Yixin Wang, Joann E Manson, Lidia Minguezalarcon, Audrey J Gaskins, Stacey A Missmer, Janet W RichedwardsAbstract:Abstract Objective To investigate the association of Spontaneous Abortion with the risk of all cause and cause specific premature mortality (death before the age of 70). Design Prospective cohort study. Setting The Nurses’ Health Study II (1993-2017), United States. Participants 101 681 ever gravid female nurses participating in the Nurses’ Health Study II. Main outcomes measures Lifetime occurrence of Spontaneous Abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of Spontaneous Abortion, estimated with time dependent Cox proportional hazards models. Results During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of Spontaneous Abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more Spontaneous Abortions (1.47 per 1000 person years) and for women reporting their first Spontaneous Abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of Spontaneous Abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent Spontaneous Abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more Spontaneous Abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for Spontaneous Abortions occurring early in a woman’s reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of Spontaneous Abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous Abortion was not related to premature death from cancer (1.08, 0.94 to 1.24). Conclusions Spontaneous Abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.
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maternal prepregnancy folate intake and risk of Spontaneous Abortion and stillbirth
Obstetrics & Gynecology, 2014Co-Authors: Audrey J Gaskins, Stacey A Missmer, Janet W Richedwards, Russ Hauser, Paige L Williams, Matthew W Gillman, Elizabeth S Ginsburg, Jorge E ChavarroAbstract:OBJECTIVE:To evaluate prospectively the relationship between prepregnancy folate intake and risk of Spontaneous Abortion and stillbirth.METHODS:Women in the Nurses' Health Study II who self-reported a pregnancy between 1992 and 2009 were included in this analysis. Dietary folate and supplement use w
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occupational exposures among nurses and risk of Spontaneous Abortion
American Journal of Obstetrics and Gynecology, 2012Co-Authors: Christina C Lawson, Elizabeth A Whelan, Carissa M Rocheleau, Eileen Lividoti Hibert, Barbara Grajewski, Donna Spiegelman, Janet W RichedwardsAbstract:Objective We investigated self-reported occupational exposure to antineoplastic drugs, anesthetic gases, antiviral drugs, sterilizing agents (disinfectants), and X-rays and the risk of Spontaneous Abortion in US nurses. Study Design Pregnancy outcome and occupational exposures were collected retrospectively from 8461 participants of the Nurses' Health Study II. Of these, 7482 were eligible for analysis using logistic regression. Results Participants reported 6707 live births, and 775 (10%) Spontaneous Abortions ( Conclusion This study suggests that certain occupational exposures common to nurses are related to risks of Spontaneous Abortion.
Walter C Willett - One of the best experts on this subject based on the ideXlab platform.
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induced and Spontaneous Abortion and incidence of breast cancer among young women
2015Co-Authors: Karin B Michels, Fei Xue, Graham A Colditz, Walter C WillettAbstract:ported a history of Spontaneous Abortions. The hazard ratio for breast cancer among women who had 1 or more induced Abortions was 1.01 (95% confidence interval, 0.88-1.17) after adjustment for established breast cancer risk factors; among women with 1 or more Spontaneous Abortions, the covariate-adjusted hazard ratio was 0.89 (95% confidence interval, 0.78-1.01). The relation between induced Abortion and the incidence of breast cancer did not differ materially by number of Abortions (P for trend=.98), age at Abortion (P for trend=.68), parity (P for interaction=.54), or timing of Abortion with respect to a full-term pregnancy (P for interaction=.10). Conclusion: Among this predominantly premenopausal population, neither induced nor Spontaneous Abortion was associated with the incidence of breast cancer.
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induced and Spontaneous Abortion and incidence of breast cancer among young women a prospective cohort study
JAMA Internal Medicine, 2007Co-Authors: Karin B Michels, Fei Xue, Graham A Colditz, Walter C WillettAbstract:Background Induced Abortion has been inconsistently associated with breast cancer risk in case-control studies. Retrospective cohort studies using registry information in Scandinavia have not suggested an increase in the incidence of breast cancer, although data on individual reproductive factors were not accounted for. Methods We examined the association between induced and Spontaneous Abortion and the incidence of breast cancer in a prospective cohort of young women, the Nurses' Health Study II. The study included 105 716 women 29 to 46 years old at the start of follow-up in 1993. Information on induced or Spontaneous Abortions was collected in 1993 and updated biennially. During 973 437 person-years of follow-up between 1993 and 2003, 1458 newly diagnosed cases of invasive breast cancer were ascertained. Results A total of 16 118 participants (15%) reported a history of induced Abortion, and 21 753 (21%) reported a history of Spontaneous Abortions. The hazard ratio for breast cancer among women who had 1 or more induced Abortions was 1.01 (95% confidence interval, 0.88-1.17) after adjustment for established breast cancer risk factors; among women with 1 or more Spontaneous Abortions, the covariate-adjusted hazard ratio was 0.89 (95% confidence interval, 0.78-1.01). The relation between induced Abortion and the incidence of breast cancer did not differ materially by number of Abortions ( P for trend = .98), age at Abortion ( P for trend = .68), parity ( P for interaction = .54), or timing of Abortion with respect to a full-term pregnancy ( P for interaction = .10). Conclusion Among this predominantly premenopausal population, neither induced nor Spontaneous Abortion was associated with the incidence of breast cancer.
Jon Traerup Andersen - One of the best experts on this subject based on the ideXlab platform.
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evaluation of association between oral and topical terbinafine use in pregnancy and risk of major malformations and Spontaneous Abortion
JAMA Dermatology, 2020Co-Authors: Niklas Worm Andersson, Simon Francis Thomsen, Jon Traerup AndersenAbstract:Importance Terbinafine is a commonly used antifungal agent, but safety data of its use in pregnancy are limited. Objective To examine the association between oral and topical terbinafine exposure in pregnancy and the risk of major malformations and Spontaneous Abortion. Design, Setting, and Participants A nationwide, registry-based cohort study was conducted in Denmark from January 1, 1997, to December 31, 2016, in a cohort of 1 650 649 pregnancies. Data analysis was performed from July 11 to October 20, 2019. Pregnancies were matched on propensity scores comparing oral terbinafine exposed vs unexposed (1:10 ratio), topical terbinafine exposed vs unexposed (1:10), and oral vs topical terbinafine exposed (1:1). Exposures Filled prescriptions for oral or topical terbinafine. Main Outcomes and Measures Logistic regression was used to compute prevalence odds ratios for the primary outcome of major malformations and Cox proportional hazards regression was used to compute hazard ratios for the secondary outcome of Spontaneous Abortion. Results Based on a cohort of 1 650 649 pregnancies, oral terbinafine-exposed (n = 891 pregnancies; mean [SD] age, 30.4 [6] years) and topical terbinafine-exposed (n = 3174; mean [SD] age, 29.5 [5.4] years) pregnancies were identified; up to a total of 40 650 unexposed pregnancies were included for the matched outcome analyses. In propensity-matched comparisons of the risk of major malformations, the prevalence odds ratios were 1.01 (95% CI, 0.63-1.62) for oral terbinafine-exposed vs unexposed pregnancies (absolute risk difference [ARD], 0.04%; 95% CI, −1.69% to 1.76%), 1.08 (95% CI, 0.81-1.44) for topical terbinafine-exposed vs unexposed pregnancies (ARD, 0.26%; 95% CI, −0.73% to 1.26%), and 1.18 (95% CI, 0.61-2.29) for oral vs topical terbinafine-exposed pregnancies (ARD, 0.59%; 95% CI, −1.71% to 2.88%). For the risk of Spontaneous Abortion, the hazard ratios were 1.06 (95% CI, 0.86-1.32) for oral terbinafine-exposed vs unexposed pregnancies (ARD, 0.13%; 95% CI, −1.97% to 2.24%), 1.04 (95% CI, 0.88-1.21) for topical terbinafine-exposed vs unexposed pregnancies (ARD, 0.17%; 95% CI, −0.64% to 0.98%), and 1.19 (95% CI, 0.84-1.70) for oral vs topical terbinafine-exposed (ARD, 1.13%; 95% CI, −2.23% to 4.50%) pregnancies. Conclusions and Relevance Among pregnancies exposed to oral or topical terbinafine, no increased risk of major malformations or Spontaneous Abortion was identified.
Henrik Zetterberg - One of the best experts on this subject based on the ideXlab platform.
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Methylenetetrahydrofolate reductase and transcobalamin genetic polymorphisms in human Spontaneous Abortion: biological and clinical implications
Reproductive Biology and Endocrinology, 2004Co-Authors: Henrik ZetterbergAbstract:The pathogenesis of human Spontaneous Abortion involves a complex interaction of several genetic and environmental factors. The firm association between increased homocysteine concentration and neural tube defects (NTD) has led to the hypothesis that high concentrations of homocysteine might be embryotoxic and lead to decreased fetal viability. There are several genetic polymorphisms that are associated with defects in folate- and vitamin B_12-dependent homocysteine metabolism. The methylenetetrahydrofolate reductase (MTHFR) 677C>T and 1298A>C polymorphisms cause elevated homocysteine concentration and are associated with an increased risk of NTD. Additionally, low concentration of vitamin B_12 (cobalamin) or transcobalamin that delivers vitamin B_12 to the cells of the body leads to hyperhomocysteinemia and is associated with NTD. This effect involves the transcobalamin (TC) 776C>G polymorphism. Importantly, the biochemical consequences of these polymorphisms can be modified by folate and vitamin B_12 supplementation. In this review, I focus on recent studies on the role of hyperhomocysteinemia-associated polymorphisms in the pathogenesis of human Spontaneous Abortion and discuss the possibility that periconceptional supplementation with folate and vitamin B_12 might lower the incidence of miscarriage in women planning a pregnancy.
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gene gene interaction between fetal mthfr 677c t and transcobalamin 776c g polymorphisms in human Spontaneous Abortion
Human Reproduction, 2003Co-Authors: Henrik Zetterberg, Lars Rymo, Demetrios A Spandidos, A Zafiropoulos, Kaj BlennowAbstract:BACKGROUND: Genetic polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) and transcobalamin (TC) genes influence homocysteine metabolism which in turn may influence the risk of Spontaneous Abortion. It was hypothesized that there may be a significant interaction between MTHFR and TC genotypes which affects the pathogenesis of Spontaneous Abortion. METHODS AND RESULTS: A total of 76 fetal tissue samples from Spontaneous Abortions between weeks 6 and 20 of pregnancy, and 114 control samples from healthy blood donors were genotyped for the MTHFR 677C>T and 776C>G polymorphisms. Subjects with combined MTHFR 677TT/TC 776GG and combined MTHFR 677TT/TC 776CG genotypes gave an odds ratio for Spontaneous Abortion of 3.8 (95% confidence interval 1.4-9.9, P = 0.005). CONCLUSIONS: Embryos that have combined MTHFR 677TT and TC 776CG or 776GG genotypes; genotypes that individually are associated with impaired homocysteine metabolism in adults, are at increased risk for Spontaneous Abortion compared with embryos that have only one of these genotypes.
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the transcobalamin codon 259 polymorphism influences the risk of human Spontaneous Abortion
Human Reproduction, 2002Co-Authors: Henrik Zetterberg, Bjorn Regland, Mona Seibt Palmer, Lars Rymo, Alexandros Zafiropoulos, Demetrios A Arvanitis, Demetrios A Spandidos, Kaj BlennowAbstract:BACKGROUND: The remethylation cycle of methionine is folate and vitamin B12 (cobalamin) dependent and appears to be crucial for embryonic development, probably through effects on synthesis of DNA, proteins and polyamines. Transcobalamin (TC) transports vitamin B12 to the tissues. The objective of the present investigation was to explore the putative association between the major TC genetic polymorphism (Pro259Arg) and human Spontaneous Abortion. METHODS: The prevalence of the TC Pro259Arg polymorphism was determined in DNA samples from embryos that had been Spontaneously aborted between the 6th and 20th week after conception, and adult controls using solid-phase minisequencing technique. RESULTS: The 259-Pro allele was significantly less frequent in the Spontaneous Abortion group than in the control group (42.2 and 57.0% respectively; P 0.005), while the frequency of 259-Arg was significantly increased. There was a lower prevalence of 259-Pro homozygotes in the Spontaneous Abortion group compared with the control group (9.1 and 32.2% respectively; P < 0.001). CONCLUSIONS: The 259-Pro allele seems to have beneficial influences during embryogenesis, conceivably through its positive effect on vitamin B12 intracellular bioavailability. Our results warrant additional investigations addressing the question if vitamin B12 supplementation in addition to folic acid supplementation may prevent Spontaneous Abortion in women planning a pregnancy.
Tony K H Chung - One of the best experts on this subject based on the ideXlab platform.
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expectant medical or surgical treatment for Spontaneous Abortion in first trimester of pregnancy a cost analysis
Human Reproduction, 2005Co-Authors: Joyce H S You, Tony K H ChungAbstract:BACKGROUND Misoprostol and expectant care have been shown to be acceptable alternatives to routine surgical evacuation for treatment of Spontaneous Abortion in the first trimester of pregnancy. The objective of this study was to analyse the cost of expectant care, misoprostol therapy and surgical evacuation. METHODS A decision tree was designed to simulate the clinical outcome and health care resource utilization of surgical evacuation, misoprostol and expectant care for patients presenting with uncomplicated Spontaneous Abortion in the first trimester of pregnancy. Clinical inputs were estimated from literature and the cost analysis was conducted from the perspective of a public health care provider in Hong Kong. RESULTS The base-case analysis showed that the misoprostol group (1000 US dollars per patient) was the least costly alternative, followed by the expectant care (1172 US dollars per patient) and surgical evacuation (2007 US dollars per patient). Rates of complete Abortion using misoprostol and expectant care were identified as influential factors. Monte Carlo simulation (10000 cohorts) showed that the misoprostol and the expectant care groups were less costly than the surgical evacuation group 100 and 88% of the time. The misoprostol group was less costly than the expectant group 100% of the time. CONCLUSIONS Misoprostol therapy appears to be the least costly approach for treatment of uncomplicated Spontaneous Abortion.
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a medical approach to management of Spontaneous Abortion using misoprostol extending misoprostol treatment to a maximum of 48 hours can further improve evacuation of retained products of conception in Spontaneous Abortion
Acta Obstetricia et Gynecologica Scandinavica, 1997Co-Authors: Tony K H Chung, P T Leung, Lai Ping Cheung, Christopher J Haines, A M Z ChangAbstract:Background. To compare a 48 hour non surgical policy in the management of Spontaneous Abortion with a policy of routine, universal uterine curettage.Methods. A prospective, observational study on 354 women admitted to hospital with Spontaneous Abortion. Of these, 225 who had retained products of conception were treated with misoprostol for up to 48 hours after 101 were excluded because they had an empty uterus on transvaginal scan (TVS) and another 28 women because they were unsuitable for conservative management. Follow-up was conducted over a 3 week period to assess morbidity. A reference group of 137 women, all of whom had an evacuation of retained products of cenception (ERPC) as a routine after they had a TVS documenting retained products of conception (POCs), was used for comparison.Results. Evacuation of the uterus occurred within 24 hours in 107 women and in 148 at 48 hours after misoprostol treatment was started. There were three uterine curettages up to 14 days after discharge from hospital for ...
