Effects of Olive Oil on Striae Gravidarum in Primiparous Women: A Randomized Controlled Clinical Study.

Context: The development of striae gravidarum (SG), stretch marks, is one of the most common skin changes during pregnancy. The number of studies conducted on the reduction or prevention of SG, especially on the effects of olive oil, is limited. Objective: The study intended to evaluate the clinical efficacy of olive oil in reducing the severity and preventing the progression of SG when used from the third trimester of pregnancy to the child's birth. Design: The study was designed as a randomized controlled trial. Setting: The data was collected at the private Medipol Nisa Hospital. The trial registry number is NCT04489901. Participants: Participants were 156 Turkish women having their first pregnancies and in their third trimester. Intervention: Participants were randomly assigned to either the intervention or the control group. Women in the intervention group applied olive oil to their abdomens twice a day, in the morning and evening. The control group used no intervention. Outcome Measures: The participants' striae levels were assessed using the Fitzpatrick Skin Type Scale and Davey's Severity Score. Results: A statistically significant difference existed between the intervention and the control groups in terms of incidence and type of striae gravidarum, with the intervention group having a 50% incidence and 85.9% type 2 striae compared to the control group's 69.2% incidence and 35.9% type 4 striae. According to Davey's Severity Score, the severity of striae was significantly lower in the intervention group compared to the control group, with the scores being 2 and 4, respectively. Conclusions: Using olive oil was very effective in reducing the severity and preventing the progression of striae gravidarum.

Striae Distensae: A Cross-Sectional Study of Risk Factors and Quality of Life among Nigerians.

BACKGROUND: Striae distensae is a common affliction of darkly pigmented skin. The pattern, risk factors and impact of striae distensae on the Quality of Life (QoL) have not been widely examined. OBJECTIVE: To document the prevalence, pattern, risk factors and impact of striae distensae on the QoL of sufferers. METHODS: 520 adults were included through a crosssectional design. Demographic and striae distensae-related clinical parameters were documented and QoL evaluated using Skindex-29 and DLQI. RESULTS: Mean age of participants was 24.10±5.44years. Participants with striae distensae were significantly females (71.9% vs 28.1%, p<0.001) and mild (61.9%) and moderate (32.5%) striae distensae were prevalent. Higher total mean ± SD and mean ranked scores correlated with single status (p<0.001 and p=0.017) and striae distensae severity (p<0.001 and p=0.035) on Skindex and DLQI, respectively. Singles with striae distensae had significantly higher scores on symptom/feeling (p<0.001), daily activities (p=0.003), relationship (p=0.043), leisure (p=0.004), treatment (p=0.011) and work/school (p=0.014) on DLQI. Striae distensae was associated with higher emotion (p<0.001) and functioning (p<0.001) scores on Skindex-29. In regression analysis, age < 30years OR-1.219 (CI: 1.062, 1.400, p=0.005), was a predictor of severe QoL impairment on Skindex-29 and age <30 years OR-1.130 (CI: 1.022, 1.250, p=0.017), obesity OR=1.091, 95% (CI 1.008;1.181, p=0.032) and concern about striae distensae OR-2.482 (CI: 1.392, 4.425, p=0.002) on DLQI. CONCLUSION: Psychologic evaluation might be indicated in cases of singles with moderate-severe striae distensae and impaired QoL. Predictors of impaired QoL include young age, high BMI, and concerns about striae distensae.

CONTEXTE: Striae distensae est une affection courante de la peau à pigmentation foncée. Le modèle, les facteurs de risque et l'impact des stries distensae sur la qualité de vie (QdV) n'ont pas été largement examinés. OBJECTIF: Documenter la prévalence, le profil, les facteurs de risque et l'impact des stries distensae sur la qualité de vie des patients. MÉTHODES: 520 adultes ont été inclus dans le cadre d'un devis transversal. Les paramètres cliniques démographiques et liés aux striae distensae ont été documentés et la qualité de vie évaluée à l'aide du Skindex-29 et du DLQI. RÉSULTATS: L'âge moyen des participants était de 24,10 ± 5,44 ans. Les participants avec des vergetures étaient significativement des femmes (71,9% contre 28,1%, p<0,001) et des vergetures légères (61,9 %) et modérées (32,5 %) étaient prévalentes. Des totaux plus élevés signifient ± SD et des scores classés moyens en corrélation avec le statut unique (p<0,001 et p=0,017) et la sévérité des stries distensae (p<0,001 et p=0,035) sur Skindex et DLQI, respectivement. Les célibataires atteints de stries distensae avaient des scores significativement plus élevés sur les symptômes/émotions (p<0,001), les activités quotidiennes (p=0,003), la relation (p=0,043), les loisirs (p=0,004), le traitement (p=0,011) et le travail/l'école (p=0,014) sur DLQI. Striae distensae était associée à des scores plus élevés d'émotion (p<0,001) et de fonctionnement (p<0,001) sur Skindex-29. Dans l'analyse de régression, l'âge < 30 ans OR-1,219 (IC : 1,062, 1,400, p=0,005), était un prédicteur d'une altération sévère de la qualité de vie sur Skindex-29 et l'âge <30 ans OR-1,130 (IC : 1,022, 1,250, p=0,017), obésité OR=1,091, 95 % (IC 1,008 ; 1,181, p=0,032) et inquiétude concernant les stries distensae OR-2,482 (IC : 1,392, 4,425, p=0,002) sur le DLQI. CONCLUSION: Une évaluation psychologique pourrait être indiquée dans les cas de célibataires présentant des stries distensae modérées à sévères et une qualité de vie altérée. Les prédicteurs d'une qualité de vie altérée comprennent le jeune âge, un IMC élevé et des inquiétudes concernant les stries distensae. MOTS-CLÉS: Striae distensae; Qualité de vie; DLQI; Skindex-29, Psychodermatologie.

Demographic characteristics of teenage boys with horizontal striae distensae of the lower back.

BACKGROUND: This study examines the clinical characteristics and demographics of teenage boys with horizontal striae distensae of the lower back in an outpatient setting. METHODS: Retrospective medical chart reviews and telephone survey studies were completed on an outpatient cohort of 12 boys 11 to 17 years of age with a clinical diagnosis of transverse striae distensae of the lower back at a single-center, university-based, pediatric dermatology practice. We evaluated the clinical features of the striae, participant demographic characteristics, and past medical history. A review of the literature concerning risk factors was conducted using PubMed and Google Scholar. RESULTS: Of the 14 patients we contacted, 12 agreed to participate. The average age of onset for the striae was 14.3 years. All boys were above the 50th percentile in height at the time of onset. Eight (66.7%) reported a significant growth spurt before the appearance of the stretch marks. Most were asymptomatic. None of the boys had a history of unmonitored exogenous steroid use or prior infection with Bartonella henselae or Borrelia burgdorferi. Only one (8.3%) had a chronic medical condition. Eleven (91.7%) had at least one first-degree relative with striae distensae. CONCLUSION: Our results indicate that horizontal striae distensae of the lower back in adolescent boys is associated with a rapid growth spurt, tall stature, and family history of striae distensae. There is no association between this type of striae distensae and any chronic medical condition, bacterial infection, or exogenous steroid use. Thus a careful review of systems and counseling without further medical testing is reasonable management.

Risk factors of striae gravidarum.

BACKGROUND: Stretch marks are a common skin disorder. Pregnancy-related lesions are defined as striae gravidarum. The root cause of striae formation remains unknown. OBJECTIVE: The aim of this paper was to identify the risk factors associated with striae gravidarum (SG) development. PATIENTS AND METHODS: The study was conducted at Plastic, Reconstructive and Aesthetic Surgery Clinic and Obstetrics Outpatient Department among 299 Caucasian women maximum 6 months after the delivery, regardless of whether they were primiparas or multiparas. RESULTS: Among the women participating in the study, 71.2% (213 of 299) developed striae gravidarum at least in one site. Logistic regression analysis showed that four of the analysed factors were independent predictors of striae gravidarum occurrence: family history of SG, BMI before pregnancy, the lack of chronic diseases and birthweight (P < 0.0001). It has been found that the presence of striae distensae on the breasts increases the risk of SG development (71.4% vs. 28.6%, P = 0.0008), whereas the presence of these lesions on the thighs decreases the risk (23% vs. 77%, P = 0.0076). CONCLUSION: In this study, we presented a model that can help to predict the risk of SG formation, including family history of SG, BMI before pregnancy, birthweight and chronic diseases. Moreover, women with stretch marks on their breasts should know that the risk of SG development is significantly higher, whereas lesions on the thighs do not increase such a risk.

Risk factors of striae gravidarum and chloasma melasma and their effects on quality of life.

OBJECTIVE: This study aims to determine the risk factors associated with striae gravidarum (SG) and chloasma melasma (CM) and their effects on the quality of life. METHODS: This descriptive and cross-sectional study was carried out in Turkey with 1000 pregnant women at 36 weeks of gestation and above. Personal information form, Quality of Life (SF36) Scale, Skindex-29 Scale, and MelasQoL-TR questionnaire were applied to pregnant women. Besides, skin types of pregnant women were determined using Fitzpatrick Skin Type Classification. Davey's score was used to determine the severity of SG. RESULTS: In the study, the prevalence of SG was found as 67.9% (n = 679), and the prevalence of CM 23.5% (n = 235). There was a significant relationship between young age, low education level, high BMI before pregnancy, history of SG in her previous pregnancy, family history of SG, and development of SG in pregnant women (p = 0.001). There was a significant relationship between CM in her previous pregnancy and family history of CM and development of CM (p = 0.001). The quality of life of pregnant women with SG was found to be lower than without SG (p < 0.001). The quality of life of pregnant women with CM was found to be lower than without CM (p < 0.001). CONCLUSIONS: As a result, in the study, it was determined that young age, low education level, high BMI, history of SG in previous pregnancy, and family history of SG were risk factors for SG. The risk factors of CM, on the other hand, were found as the history of CM in the previous pregnancy and the family. It was identified that SG and CM have adverse effects on the quality of life.

Prevalence and risk factors of striae gravidarum in a cohort of multiracial postpartum Nepalese population.

BACKGROUND: Striae gravidarum (SG), popularly called as stretch marks, is a common pregnancy-related asymptomatic skin condition, but is a cosmetic concern for females. A few epidemiological studies have been reported from Asian countries. However, no such study has been done in Nepal. AIMS: This study was aimed to know the prevalence and risk factors associated with SG in a cohort of multi-ethnic postpartum Nepalese women who had delivered after completion of 36 weeks. PATIENTS/METHOD: A cross-sectional comparative study was conducted among 420 postpartum females who had delivered after completion of 36 weeks of gestation. Data were collected in the form of a questionnaire and relevant physical examination was done. The severity of SG was assessed by using Davey's scoring. RESULT: Out of 420 females, 260 (62%) had SG while 160 (38%) did not. According to the results of logistic regression analysis, young age (<25 years), large abdominal circumference (>100 cm), increased weight gain during pregnancy (>15 kg), presence of family history of SG, gestational diabetes mellitus, altered bowel movement, and presence of striae on the breasts, thighs, and buttocks were found to be independent risk factors for SG. CONCLUSIONS: Future expectant mothers must be informed about the risk factors of SG development. They need to be made aware that SG can be prevented by considering the modifiable risk factors, such as excessive weight gain. They should also be informed that SG is permanent and currently there is no definite treatment.

Striae gravidarum, vitamin C and other related factors.

BACKGROUND: Striae gravidarum, a clinical condition commonly seen in pregnant women, produces serious cosmetic problems and may lead to psychological problems. AIM: The present study investigated whether there was any relation between the presence of striae in primigravid pregnant women and blood vitamin C levels, and factors thought to contribute to the formation of striae such as family history, weight gained during pregnancy, smoking status, abdominal and thigh circumference, and age. METHODS: Overall, 69 primigravid women attending routine antenatal follow-up and, using prophylactic iron and vitamin preparations, underwent investigation. All were pregnant 36 or more weeks. Scoring was based on striae examination and whether striae were present. The relation between the presence of striae, vitamin C blood levels, and other factors was investigated. RESULTS AND CONCLUSIONS: Multiple logistic regression analysis showed a significant relation between the presence of striae and blood vitamin C levels (p = 0.046) and between the presence of striae and family history (p = 0.023). No significant relation was found between the presence of striae and age, weight gained during pregnancy, abdominal and thigh circumference, or smoking status. It was concluded that further, more comprehensive studies on the issue are required.

Striae Distensae: Scars without Wounds.

SUMMARY: Striae distensae, or stretch marks, are common linear lesions of atrophic skin characterized histologically by epidermal atrophy, absent rete ridges, and alterations in connective tissue architecture. Hormonal excess, mechanical stress, and genetic predisposition are all associated with striae distensae, but their exact pathogenesis remains unknown. Despite a multitude of options, no single treatment has yet proven effective. In this article, the authors describe an up-to-date overview of striae distensae in terms of their etiology, pathophysiology, and therapeutic options. Further research is required to better elucidate their pathophysiology and to develop targeted effective treatments.

Association between serum 25-hydroxyvitamin D levels and the presence and severity of striae gravidarum in primigravid women.

BACKGROUND: Striae gravidarum (SG) are a form of scarring on the skin observed during pregnancy and an important cosmetic problem. Vitamin D plays an important role in the skin. AIMS: To assess the association between serum 25-hydroxyvitamin D (25(OH)D) levels and the presence and severity of SG in primigravid women. METHODS: The study included 91 primigravid women at the gestational age of 36-41 weeks. Patients were examined and divided into two groups with respect to whether they had SG or not. Striae were scored using the numerical scoring system of Atwal et al. The serum 25(OH)D levels were evaluated. RESULTS: While 55 patients (60.5%) had SG, 36 (39.5%) did not. The mean serum 25(OH)D level of women with SG was 17.69 ± 9.81 ng/mL and of women without SG was 21.18 ± 11.71 ng/mL. There was no statistically significant difference between two groups (P = .144). Multivariate logistic regression analysis has shown that women who have normal values of serum 25(OH)D (≥30 ng/mL) have a lower risk of having SG than women who have scarce levels of serum 25(OH)D (<20 ng/mL) after adjusting for confounding factors (adjusted odds ratio = 0.18, 95% confidence interval: 0.04-0.72, P = .015). According to the results of the linear-by-linear test, the association between serum 25(OH)D levels and the severity of SG was not found significant (P = .82). CONCLUSIONS: This is the first study to show that having normal values of serum 25(OH)D is linked to a lower risk of having SG than scarce levels. Therefore, management of vitamin D deficiency might help prevent SG in primigravid women.

Investigation of coenzyme Q10 levels and predisposing factors in patients with striae gravidarum.

BACKGROUND: Striae gravidarum (SG) can cause pregnant women severe psychological stress. OBJECTIVE: This study aimed to compare primigravidas with and without SG concerning fasting blood coenzyme Q10 (CoQ10), age, skin type, family history, gestational weight gain, pre- and post-pregnancy BMI, daily water consumption during pregnancy, gender and weight of baby, and the educational level. METHODS: The study included 79 primigravidas in the gestational week of 36 or above. The patients were divided into two groups based on the presence of SG. The fasting blood CoQ10 levels and other associated parameters were compared between the groups. RESULTS: Of the 79 primigravidas, 35 (44.3%) had SG. There was no statistically significant relationship between striae and CoQ10 (P = 0.144 and P = 0.189, respectively). Predisposing factors for striae were young pregnancy, light skin color, family history, high pre- and post-pregnancy BMI, increased gestational weight gain, and increased newborn weight. There was no significant relationship between striae development and educational level or water consumption during pregnancy. CONCLUSION: This is the first study to show that CoQ10 did not significantly differ between women with and without SG. Further studies with a larger case series are needed to elucidate predisposing factors for striae and involvement of CoQ10 in this condition.

The Association of Abdominal Striae With Pelvic Organ Prolapse.

OBJECTIVE: Our objective was to estimate the prevalence of abdominal wall striae among women with and without pelvic organ prolapse (POP) in a population with pelvic floor disorders. METHODS: This cross-sectional study included nonpregnant women with urinary incontinence and POP presenting to a tertiary urogynecology practice between December 2012 and August 2013. Participants completed a nonvalidated questionnaire about striae, and the degree of abdominal wall striae was quantified on physical examination. Baseline demographics, clinical characteristics, and Pelvic Organ Prolapse Quantification (POP-Q) measurements were recorded. RESULTS: One hundred thirty-two women were approached for participation, of which 110 (83%) completed study questionnaires. Of these 110, 59 had POP defined at POP-Q stages 2-4, whereas 51 had normal pelvic support, POP-Q stages 0-1. The mean (SD) age was 55.5 (12) years, and most (78/110) were sexually active. Women with POP were more parous than women without POP (median 2 vs 1, respectively; P = 0.03). However, there was no difference in medical comorbidities, smoking status, or steroid use between groups (P > 0.05). More women with POP reported striae (42/59 [71%] vs 23/51 [45%], P = 0.006) and had quantifiable abdominal wall striae compared with women with normal support (39/59 [66%] vs 22/51 [44%], P = 0.02). On multivariate logistic regression, women with POP were 2.5 times more likely to have striae compared with women without POP after adjusting for skin type and smoking status (odds ratio, 2.5; 95% confidence interval, 1.03-6.06; P = 0.04). CONCLUSION: Women with POP are more likely to have striae compared with women without POP.

Risk factors for the formation of striae gravidarum in women in Jiangsu Province of China.

OBJECTIVE: We study the risk factors that affect the formation of striae gravidarum in women in Jiangsu Province of China under current living habits. MATERIALS AND METHODS: This sample is based on 400 primiparas from obstetric of the Affiliated Hospital of Jiangnan University in Wuxi from February 2017 to October 2017. Among them, there are 200 pregnant women with striae gravidarum and 200 without striae gravidarum. Striae gravidarum predictors were selected such as age, height, pre-pregnancy BMI, postpartum BMI, daily sitting time, weight gain during pregnancy, fetal weight, and diet on maternal. RESULTS: (1) The pregnant women who had striae gravidarum were generally lower in height than those who did not have striae gravidarum and had a higher BMI index than those who did not have striae gravidarum before and after childbirth. (2) In the pregnant women who have had striae gravidarum, the incidence of abdominal striae gravidarum in sedentary women is significantly lower than those in non-sedentary women, the incidence of striae gravidarum in legs is higher than those in non-sedentary women, and no significant difference in hip striae gravidarum. (3) In all pregnant women who have striae gravidarum, abdomen striae gravidarum tend to be lighter and leg striae gravidarum tends to be heavier in sedentary women, but no significant effect on the hip. (4) Regular consumption of honey, milk, trotters, freshwater fish, eggs, and tremella can reduce the incidence of striae gravidarum. CONCLUSION: The lifestyle and eating habits have a certain influence on the formation and severity of stretch marks.

Can striae be used as a marker for the prediction of pelvic organ prolapse?

OBJECTIVE: To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). STUDY DESIGN: Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n=244) consisted of symptomatic patients with POP, and the control group (n=244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. RESULTS: The presence of striae (p=0.001), number of striae (p=0.001) and Davey score (p=0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p=0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p=0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p=0.04, 95% CI 1.14-1.25) and 2.51 fold (p=0.01, 95% CI 1.66-3.78), respectively. CONCLUSION: Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP.

Incidence and risk factors of Striae Distensae following breast augmentation surgery: a cohort study.

BACKGROUND: The significant increase in the popularity of breast augmentation surgeries has led to an increase in the number and types of complications; among these is the postoperative occurrence of Striae Distensae (SD). The objective of this study was to investigate the incidence of SD and describing its occurrence in association with age, breast implant volume, history of SD, history of pregnancies and breastfeeding, body mass index (BMI), changes in postoperative weight, smoking habits, and use of oral contraceptives. METHODS: A cohort study was conducted and the patient data from a specific social group that underwent augmentation mammaplasty with silicone breast implants in a private clinic was analyzed. RESULTS: 563 patients entered the cohort, while 538 completed the study. The SD incidence was 7.06%. The risk was almost the double at 22-28 years of age and triple in women of 21 years of age or less. The women who did not use oral contraceptives were 2.59 times more likely of developing SD. A higher incidence of SD was observed among those with normal or low BMI values, smokers, and in those who had implants larger than 300 ml. CONCLUSIONS: Young age, larger implant volumes, smoking, and normal or low BMI values were the risk factors responsible for the development of SD; while using oral contraceptives was found to be a protective factor.

Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery.

OBJECTIVE: Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST). METHODS: Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation. RESULTS: Out of the patients with no SG (n = 11), mild SG (n = 10) and severe SG (n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively (p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively (p = 0.561). CONCLUSIONS: To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation.

The effect of olive oil and the Saj® cream in prevention of striae gravidarum: A randomized controlled clinical trial.

OBJECTIVE: To compare the clinical efficacy of olive oil and the Saj(®) cream on the occurrence and severity of striae gravidarum. DESIGN: Parallel randomized controlled clinical trial. SETTING: West Health Centre, Lolagar and Akbarabadi Hospitals, Tehran, Iran. INTERVENTIONS: 360 Nulliparous women at their second trimester of pregnancy randomly (simple randomization) allocated into three groups of olive oil, the Saj(®) cream, and control that finally 150 of them (50 subjects in each group) completed the study. Control group did not receive any medication/intervention. At gestational age of 38-40 weeks the participants were evaluated regarding the occurrence of striae on abdominal skin and its severity that were primary outcome of the study. RESULTS: In the olive oil group, striae occurred in 72% of the participants, which were mild, moderate, and severe in 32%, 26%, and 6% of the cases, respectively. In those who received Saj(®) cream, striae occurred in 64% of the cases, which were mild, moderate and severe in 16%, 34%, and 14% of the cases, respectively. With regard to the control group, striae occurred in 60% of the participants, among which striae were mild, moderate, and severe in 22%, 24%, and 14% of the cases, respectively. There were no statistically significant differences among the three studied groups regarding the incidence or severity of striae. CONCLUSION: Neither olive oil nor the Saj(®) cream were effective in preventing the occurrence of striae gravidarum or affecting its severity. Further studies to examine the effect of other herbal/chemical preparations on occurrence of striae gravidarum are recommended.

Prematurity: is it a risk factor for striae distensae?

BACKGROUND: Although the causes of striae distensae (SD) remain to be elucidated, the condition is known to relate to changes in the structures that provide the skin with its tensile strength and elasticity. OBJECTIVE: This study was conducted to evaluate whether premature birth is a risk factor for SD. METHODS: A total of 15,475 parous women ranging in age from 18-45 years were interviewed between January 2007 and June 2009. After exclusion criteria were applied, a total of 1336 women were included in the study. Group 1 consisted of 1231 women of reproductive age who had been born at term. Group 2 included 105 women of reproductive age who had been born prematurely. The main outcome measure was the prevalence of SD. RESULTS: The overall prevalence of SD was 34.6% (462/1336). Mild SD was significantly more common (P < 0.01) in women who had been born prematurely (49.5%) than in women who had been born at term (31.8%). A multivariate analysis using backward stepwise logistic regression analysis identified that height, weight, gravidity, parity and abortion were found to be significantly associated with SD. CONCLUSIONS: Striae distensae was significantly more common in women who had been born prematurely than in women who had been born at term.