Factors related to knowledge, attitudes, and behaviors regarding cervical cancer among Yemeni women.

BACKGROUND: Cervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries where preventive strategies are often lacking. We studied the knowledge, attitudes, and practices regarding CxCa among Yemeni women. METHODS: This cross-sectional study was conducted in 2019 among 399 women in five major hospitals in Sanaa, the capital city of Yemen. Data were collected through face-to-face interviews using structured questionnaires. We used logistic regression models to analyze the likelihood of hearing about CxCa, believing that CxCa is treatable and preventable, awareness of the Pap smear test, and ever having this test, in relation to participant's age, education level, working outside the household, and family history of CxCa. RESULTS: Only 66.7% of the women had heard of CxCa. Women with higher education, working outside the household, and with a family history of CxCa were more likely to be aware of CxCa. Working outside the household was the only variable related to a higher likelihood of knowing that CxCa is a treatable and preventable. Furthermore, women with a family history of CxCa were more likely to have knowledge about Pap smear test and were more likely to have Pap smear test in the past. CONCLUSION: This study identified a low awareness of CxCa and its prevention among Yemeni women. In order to reduce the burden of CxCa in Yemen and save women's lives, it is necessary to raise women's awareness of this disease, especially among those with lower education and those not involved in work outside their homes.

Experimental and cross-cultural evidence that parenthood and parental care motives increase social conservatism.

Differences in attitudes on social issues such as abortion, immigration and sex are hugely divisive, and understanding their origins is among the most important tasks facing human behavioural sciences. Despite the clear psychological importance of parenthood and the motivation to provide care for children, researchers have only recently begun investigating their influence on social and political attitudes. Because socially conservative values ostensibly prioritize safety, stability and family values, we hypothesized that being more invested in parental care might make socially conservative policies more appealing. Studies 1 (preregistered; n = 376) and 2 (n = 1924) find novel evidence of conditional experimental effects of a parenthood prime, such that people who engaged strongly with a childcare manipulation showed an increase in social conservatism. Studies 3 (n = 2610, novel data from 10 countries) and 4 (n = 426 444, World Values Survey data) find evidence that both parenthood and parental care motivation are associated with increased social conservatism around the globe. Further, most of the positive association globally between age and social conservatism is accounted for by parenthood. These findings support the hypothesis that parenthood and parental care motivation increase social conservatism.

Human Milk Oligosaccharide Compositions Illustrate Global Variations in Early Nutrition.

BACKGROUND: Human milk oligosaccharides (HMOs) are an abundant class of compounds found in human milk and have been linked to the development of the infant, and specifically the brain, immune system, and gut microbiome. OBJECTIVES: Advanced analytical methods were used to obtain relative quantitation of many structures in approximately 2000 samples from over 1000 mothers in urban, semirural, and rural sites across geographically diverse countries. METHODS: LC-MS-based analytical methods were used to profile the compounds with broad structural coverage and quantitative information. The profiles revealed their structural heterogeneity and their potential biological roles. Comparisons of HMO compositions were made between mothers of different age groups, lactation periods, infant sexes, and residing geographical locations. RESULTS: A common behavior found among all sites was a decrease in HMO abundances during lactation until approximately postnatal month 6, where they remained relatively constant. The greatest variations in structural abundances were associated with the presence of α(1,2)-fucosylated species. Genomic analyses of the mothers were not performed; instead, milk was phenotyped according to the abundances of α(1,2)-fucosylated structures. Mothers from the South American sites tended to have higher proportions of phenotypic secretors [mothers with relatively high concentrations of α(1,2)-fucosylated structures] in their populations compared to the rest of the globe, with Bolivia at ∼100% secretors, Peru at ∼97%, Brazil at ∼90%, and Argentina at ∼85%. Conversely, the cohort sampled in Africa manifested the lowest proportion of secretors (South Africa ∼ 63%, the Gambia ∼ 64%, and Malawi ∼ 75%). Furthermore, we compared total abundances of HMOs in secretors compared with nonsecretors and found that nonsecretors have lower abundances of HMOs compared to secretors, regardless of geographical location. We also observed compositional differences of the 50+ most abundant HMOs between milk types and geographical locations. CONCLUSIONS: This study represents the largest structural HMO study to date and reveals the general behavior of HMOs during lactation among different populations.

Joint effect of particulate matter and cigarette smoke on women's sex hormones.

BACKGROUND: Although relationships between exposure to air pollution and reproductive health are broadly studied, mechanisms behind these phenomena are still unknown. The aim of the study was to assess whether exposure to particulate matter (PM10) and tobacco smoking have an impact on menstrual profiles of 17ß-estradiol (E2) and progesterone (P) and the E2/P ratio. METHODS: Levels of sex hormones were measured daily in saliva during the entire menstrual cycle among 132 healthy, urban women. Exposure to smoking (active or passive) was assessed by questionnaire, whilst exposure to PM10 with municipal monitoring data. RESULTS: During the early luteal phase, profiles of E2 were elevated among women with higher versus lower exposure to PM10 (p = 0.02, post-hoc tests). Among those who were exposed versus unexposed to tobacco smoking, the levels of mean E2 measured during the entire cycle were higher (p = 0.02). The difference in mean E2 levels between the group of joint exposure (i.e. to high PM10 and passive or active smoking) versus the reference group (low PM10, no smoking) was statistically significant at p = 0.03 (18.4 vs. 12.4 pmol/l, respectively). The E2/P ratios were higher among women with higher versus lower exposure to PM10 and this difference was seen only in the early luteal phase (p = 0.01, exploratory post-hoc tests). CONCLUSIONS: We found that PM10 and tobacco smoking affect ovarian hormones independently and do not interact with each other. Both exposures appear to have estrogenic effects even though women's susceptibility to these effects differs across the menstrual cycle. We propose that the hormonal mechanisms are involved in observed relationships between air pollution and smoking with women's reproductive health.

Biomarkers of fetal conditions: Finger ridge-counts, facial fluctuating asymmetry, and digit ratio (2D:4D)-are they correlated in women?

OBJECTIVES: Fetal environmental conditions are crucial for life-long health. Direct measurements of developmental conditions are limited in humans; thus, several biomarkers of those conditions have been proposed: that is, finger ridge-counts, level of facial fluctuating asymmetry (FA), and digit ratio (2D:4D). Since all of these biomarkers share a similar gestational time of formation, we hypothesize that their values are significantly correlated. MATERIALS AND METHODS: Data were collected at the Mogielica Human Ecology Study Site in southern Poland among 234 women. Finger ridge-counts, level of facial FA, and 2D:4D have been measured. The two-step analyses included Pearson's correlations of simple values of the biomarkers and correlations of composite variables calculated based on principal component analysis. RESULTS: We did not find any statistically significant correlations between finger ridge-counts, FA, and 2D:4D in women. Similarly, we did not observe any correlations between three composites created from the biomarkers. DISCUSSION: Our results indicate that there are no relationships between the biomarkers, suggested as proxies of the quality of prenatal conditions, in a single population. This is the first study analyzing three different markers simultaneously. The lack of correlations may indicate that the tested biomarkers reflect, in fact, different environmental conditions, occurring in separate "critical windows" of development, or that the biomarkers are not valid as proxies of developmental conditions.

Inflammaging: Blame the sons. Relationships between the number of sons and the level of inflammatory mediators among post-reproductive women.

OBJECTIVES: Reproduction is costly, but sons and daughters differently influence maternal physiology, also in older age. In particular, having sons may negatively influence maternal health and may be associated with a shorter life span of mothers. Sons may also contribute to increased inflammaging, a chronic sub-clinical systemic inflammatory state characterized by elevated levels of serum inflammatory mediators. The aim of this study was to examine the impact of the total number of children, and the number of daughters and sons separately on concentrations of C-reactive protein (CRP), and proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α). MATERIALS AND METHODS: The participants were 378 women aged 45-92 who had 3.9 (SD 2.12, median = 4, range = 0-13) children, including 2.1 (SD 1.46, median = 2, range = 0-8) sons and 1.8 (SD 1.44, median = 2, range = 0-7) daughters on average. RESULTS: We found a positive relationship between the overall number of children and IL-6 levels. CRP and IL-6 concentrations were positively associated with the number of sons but not with the number of daughters. Each son increased maternal CRP level by 11%, and IL-6 level by 6%. Neither the total number of children nor the number of daughters or sons were related to the TNF-α concentration. DISCUSSION: Aging-associated inflammation in post-reproductive mothers with a higher number of sons supports the hypothesis of trade-offs between reproduction and health. Furthermore, these results provide new evidence contributing to the idea that having sons may have more detrimental effects on the maternal organism than having daughters.

Season of birth and biomarkers of early-life environment.

OBJECTIVE: Early-life conditions play an important role in human development, affecting health status and survival. Conditions in utero partly depend on the external environment and thus vary in relation to the season of birth. The aim of this study was to investigate if people born in different seasons of the year differ in values of biomarkers that reflect conditions during fetal development. METHODS: The study was conducted among Polish rural women recruited at the Mogielica Human Ecology Study Site. The participants were 234 women aged 45 to 92 (mean = 60.2; SD = 10.44). The indicators of early-life environment analyzed in the study were: Absolute Finger Ridge Count (AFRC), the difference between mean number of ridge counts in both thumbs and both little fingers (Md15), overall facial fluctuating asymmetry (OFA), central facial asymmetry (CFA), right and left hand 2D:4D. RESULTS: Values of biomarkers of fetal development did not vary among groups of women born in different seasons of the year. CONCLUSIONS: Lack of differences in values of biomarkers according to birth season may indicate that: (a) season of birth is not a good indicator of early-life conditions; (b) tested biomarkers do not reliably reflect the prenatal environment; (c) season of birth does not fully overlap with the sensitive periods of biomarker development and thus fails to capture differences in developmental conditions.

Bone density and frame size in adult women: Effects of body size, habitual use, and life history.

OBJECTIVE: Bone mineral density (BMD) and frame size are important predictors of future bone health, with smaller frame size and lower BMD associated with higher risk of later fragility fractures. We test the effects of body size, habitual use, and life history on frame size and cortical BMD of the radius and tibia in sample of healthy adult premenopausal women. METHODS: We used anthropometry and life history data from 123 women (age 18-46) from rural Poland. Standard techniques were used to measure height, weight, and body fat. Life history factors were recorded using surveys. Grip strength was measured as a proxy for habitual activity, wrist breadth for skeletal frame size. Cortical BMD was measured at the one-third distal point of the radius and mid-point of the tibia using quantitative ultrasound (reported as speed of sound, SoS). RESULTS: Radial SoS was high (mean t-score 3.2 ± 1.6), but tibia SoS was average (mean t-score 0.35 ± 1.17). SoS was not associated with age, although wrist breadth was positively associated with age after adjusting for height. Radius SoS was not associated with measures of body size, habitual use, or life history factors. Wrist breadth was associated with body size (p < .05 for all), lean mass, and grip strength. Tibia SoS was associated with height. Life history factors were not associated with frame size or cortical SoS. CONCLUSIONS: Habitual use and overall body size are more strongly associated with frame size and cortical SoS than life history factors in this sample of healthy adult women.

Accelerated senescence as a cost of reproduction: Testing associations between oxidative stress and reproductive effort in rural and urban women.

OBJECTIVES: Oxidative stress is hypothesized to contribute to age-related somatic deterioration. Both reproductive and ecological context may necessitate tradeoffs that influence this outcome. We examined whether measures of lifetime reproductive effort were related to levels of oxidative stress biomarkers in peri- and post-menopausal women and whether associations were moderated by rural or urban residence. METHODS: We surveyed 263 healthy women (age 62.1 ± 10.0 SD) from rural (N = 161) and urban Poland (N = 102), collecting sociodemographic data and urine samples to analyze biomarkers of oxidative stress (8-oxo-2'-deoxyguanosine, 8-OHdG) and antioxidative defense (copper-zinc superoxide dismutase, Cu-Zn SOD). Linear regression models, adjusted for residence, were used to test for associations between reproductive effort and 8-OHdG and Cu-Zn SOD. RESULTS: Univariate models demonstrated significant associations between gravidity and the biomarkers of oxidative stress (8-OHdG: R2  = 0.042, P ≤ .001; Cu-Zn SOD: R2  = 0.123, P ≤ .001). Multivariate models incorporating potential confounding variables, as well as cross-product interaction terms, indicated that gravidity was associated with 8-OHdG (P < .01, R2 adj  = 0.067) and Cu-Zn SOD (P = .01, R2 adj  = 0.159). Residence (ie, urban vs rural) did not significantly moderate the associations between the biomarkers and reproductive effort. CONCLUSIONS: Higher lifetime reproductive effort contributes to increases in oxidative stress and antioxidative defenses. Our results provide evidence of potential mechanisms underlying the physiological tradeoffs influencing senescence for women with high reproductive effort. We illustrate the value of applying an evolutionary perspective to elucidate variation in human health and senescence.

Digit ratio (2D:4D) is not related to cardiovascular diseases or their risk factors in menopausal women.

OBJECTIVES: Digit ratio (2D:4D) is widely used as a biomarker of prenatal hormonal environment linked to the growing number of adult health and disease-related characteristics. It has been suggested that 2D:4D is a good predictor of cardiovascular diseases (CVD) risk among men, but results in women are still inconclusive. Here we test the relationship between 2D:4D and the incidence of cardiovascular diseases (CVD), and their risk factors in Polish, rural women. METHODS: The participants were 410 women age 50 and older. Structured questionnaire was used to gather personal and medical data, including the history of CVD diagnosed by a medical doctor. Anthropometric measurements of body height, weight, and finger lengths were performed. Right-hand and left-hand 2D:4D, mean 2D:4D, Dl-r , and BMI were calculated afterward. For a subgroup of participants (n = 329) fasting blood sample was collected (in order to assess the lipid profile and glucose levels) and blood pressure was measured. Age, education level and BMI were included as potential covariates. RESULTS: No statistically significant association was observed between 2D:4D markers and the incidence of CVD (eg, heart attack, stroke) or CVD risk factors (dyslipidaemia, dysglycaemia or hypertension), when controlled for age, education and BMI. CONCLUSIONS: The results of our study add to the growing number of studies investigating the sex-difference of the association between 2D:4D and cardiac health. We conclude that from a public health perspective 2D:4D may not be a valuable biomarker of elevated risk of CVDs in women.

Declining ages at menarche in an agrarian rural region of Poland.

OBJECTIVE: Age at menarche in Poland has varied with political and socioeconomic changes. An increase in age at menarche corresponded to a period of economic crisis and food rationing between 1976 and 1989. Experiencing food shortages in utero or during childhood development can affect menarcheal timing, but this national effect may be buffered in local agrarian regions growing their own food. Here we examine patterns of age at menarche over time in the rural, agrarian Beskid Wyspowy region of southern Poland. METHODS: This study examined menarcheal timing using data collected from Polish women (n = 1326) recruited at the Mogielica Human Ecology Study Site between 2003 and 2018. Simple linear regressions were used to assess changing ages at menarche over time. Comparisons between ages at menarche for women born before and after the fall of communism in 1989 were assessed via one-way analysis of variance. RESULTS: Age at menarche has declined over time in the Beskid Wyspowy region of southern Poland from 1920 to 2000 (R2 = .08, P < .0001). There was not a statistically significant increase or decrease in age at menarche for women born and growing up during the period of food rationing. CONCLUSIONS: The declining age at menarche is likely reflective of a transitioning environment, suggesting that major socioeconomic changes affect life history traits like pubertal timing. Living in agricultural regions may have helped buffer the increasing ages at menarche seen in other areas of Poland during times of food rationing.

Disgust sensitivity in relation to menstrual cycle phase in women with and without an infection.

OBJECTIVES: The compensatory prophylaxis hypothesis (CPH) proposes that evolved psychological mechanisms enhance the avoidance of potential contaminants during periods of reproductive immunomodulation in order to decrease a chance of infection. However, the results of previous studies are inconclusive. Our aim was to investigate the differences in disgust sensitivity during phases of menstrual cycle in regularly cycling young healthy women and among women who reported having an infection. METHODS: The disgust sensitivity was measured using Two Domains of the Three Domain Disgust Scale (TDDS), Padua Inventory (PI), and photographs during the internet-based survey. Women (N = 527) were divided by phases of menstrual cycle using two different methods on the basis of reported cycle length and the number of days since the onset of their most recent menstrual bleeding. RESULTS: The women who had an infection and who were in luteal phase had higher scores in Pathogen Disgust Domain than women in follicular phase. However, they did not differ in other assessments of disgust sensitivity. CONCLUSIONS: The results provide weak support for the CPH hypothesis. We found differences in disgust sensitivity in women who declared having an infection-participants in the luteal phase scored higher in the Pathogen Domain Scale of TDDS than women in the follicular phase. We suggest that future studies should measure levels of sex steroids and immunological markers of infection.

Physical activity in women of reproductive age in a transitioning rural Polish population.

OBJECTIVE: Health research often focuses on moderate and vigorous intensity physical activity while neglecting low-intensity habitual activities. Our aim was to understand habitual physical activity in women from a transitioning economy using a physical activity monitor. METHODS: This study investigated physical activity in 68 healthy premenopausal women (age 18-46) in rural Poland using FitBit One activity trackers for 1 week. Standard anthropometric techniques were used to measure height, weight, and body fat. Daily physical activity data were analyzed for step counts as well as duration and intensity. RESULTS: This sample of rural Polish women traveled a mean of 8428 (SD = 2650) steps per day. Time spent lightly active, fairly active, and very active were measured as 337.1 (SD = 87.8), 19.6 (SD = 30.5), and 6.7 (SD = 8.6) minutes per day, respectively. Total time active and time spent lightly active were associated with daily steps (P < 0.001 for both), and time lightly active increased with age (P = 0.02). No other significant relationships were observed between physical activity measures and BMI, age, or body fat. CONCLUSIONS: In this sample, women spend a significant amount of time engaged in light-intensity physical activity and travel a relatively high number of steps per day. Our data suggest that in this population, total daily activity does not depend on age in women between 18 and 46. We suggest that measurement methods which include low-intensity activity may better characterize habitual physical activity in women who are expected to be performing large amounts of domestic labor.

Human reproduction and health: an evolutionary perspective.

According to life history theory, increased investment in reproductive function (physiology and behaviour) at different times throughout the life course affects the risk of many diseases and, ultimately, longevity. Although genetic factors contribute to interindividual and interpopulation variation in reproductive traits, the dominant source of variability is phenotypic plasticity during development and adult life. Reproductive traits in both sexes evolved sensitivity to ecological conditions, as reflected in contemporary associations of hormone concentrations with geographical setting, nutritional status, and physical activity level. Lifetime exposure to increased concentrations of sex hormones is associated with the risk of some cancers, hence decreasing fertility patterns contribute to secular increases in their incidence. Conversely, increased investment in reproductive function might compromise somatic investment in health, such that faster sexual maturation and higher parity increases risk of diabetes and cardiovascular disease. An evolutionary perspective on reproductive biology could improve the efficacy of public health efforts to reduce the risk of hormone-sensitive cancers and other non-communicable diseases.

Average ovarian hormone levels, rather than daily values and their fluctuations, are related to facial preferences among women.

Hormones are of crucial importance for human behavior. Cyclical changes of ovarian hormones throughout women's menstrual cycle are suggested to underlie fluctuation in masculinity preference for both faces and bodies. In this study we tested this hypothesis based on daily measurements of estradiol and progesterone throughout menstrual cycle, and multiple measurements of women's preference towards masculinity of faces and bodies of men. We expected that due to a large variation among daily hormonal levels we would not observe a direct effect of daily hormone levels, but rather that average levels of ovarian hormones throughout the cycle (a reliable marker of a probability of conception) would better predict women's preferences. We found a negative relationship between average progesterone levels and facial masculinity preference, but only among women who were in long-term relationships. There was no relationship between facial masculinity preference and either of the estradiol or progesterone daily levels. Similarly, only average levels of hormones were significantly related to facial symmetry preference. For women who were in relationships estradiol was positively related to symmetry preference, while for single women this relationship was opposite. For body masculinity preference there were no significant relationships with neither averaged nor daily hormonal levels. Taken together, our results further suggest that overall cycle levels of ovarian hormones (averaged for a cycle) are better predictors of facial masculinity and symmetry preference than daily levels assessed during preferences' tests. Importantly, including information about relationship status in the investigations of hormonal bases of preferences is crucial.

Women's preferences for men's beards show no relation to their ovarian cycle phase and sex hormone levels.

According to the ovulatory shift hypothesis, women's mate preferences for male morphology indicative of competitive ability, social dominance, and/or underlying health are strongest at the peri-ovulatory phase of the menstrual cycle. However, recent meta-analyses are divided on the robustness of such effects and the validity of the often-used indirect estimates of fertility and ovulation has been called into question in methodological studies. In the current study, we test whether women's preferences for men's beardedness, a cue of male sexual maturity, androgenic development and social dominance, are stronger at the peri-ovulatory phase of the menstrual cycle compared to during the early follicular or the luteal phase. We also tested whether levels of estradiol, progesterone, and the estradiol to progesterone ratio at each phase were associated with facial hair preferences. Fifty-two heterosexual women completed a two-alternative forced choice preference test for clean-shaven and bearded male faces during the follicular, peri-ovulatory (validated by the surge in luteinizing hormone or the drop in estradiol levels) and luteal phases. Participants also provided for one entire menstrual cycle daily saliva samples for subsequent assaying of estradiol and progesterone. Results showed an overall preference for bearded over clean-shaven faces at each phase of the menstrual cycle. However, preferences for facial hair were not significantly different over the phases of menstrual cycle and were not significantly associated with levels of reproductive hormones. We conclude that women's preferences for men's beardedness may not be related to changes in their likelihood of conception.

Progesterone and women's anxiety across the menstrual cycle.

Animal models and a few human investigations suggest progesterone may be associated with anxiety. Progesterone naturally fluctuates across the menstrual cycle, offering an opportunity to understand how within-person increases in progesterone and average progesterone levels across the cycle correspond to women's anxiety. Across two longitudinal studies, we simultaneously modeled the between- and within-person associations between progesterone and anxiety using multilevel modeling. In Study 1, 100 Polish women provided saliva samples and reported their anxiety at three phases of the menstrual cycle: follicular, peri-ovulatory, and luteal. A significant between-person effect emerged, revealing that women with higher average progesterone levels across their cycles reported higher levels of anxiety than women with lower progesterone cycles. This effect held controlling for estradiol. In Study 2, 61 American women provided saliva samples and reported their attachment anxiety during laboratory sessions during the same three cycle phases. A significant between-person and within-person association emerged: women with higher average progesterone levels reported higher levels of attachment anxiety, and as women's progesterone levels increased across their cycles, so too did their attachment anxiety. These effects held controlling for cortisol. In sum, both studies provide support for a link between menstrual cycle progesterone levels and subjective anxiety.

A Comparison of Masculinity Facial Preference Among Naturally Cycling, Pregnant, Lactating, and Post-Menopausal Women.

Women show cyclical shifts in preferences for physical male traits. Here we investigated how fertility status influences women's facial masculinity preference in men by analyzing a large sample of heterosexual women (N = 3720). Women were regularly either cycling (in both low- and high-conception probability groups), lactating or were currently in a non-fertile state (pregnant or post-menopausal). Analyses simultaneously controlled for women's age and sexual openness. Participants via two alternative forced choice questions judged attractiveness of masculinized and feminized men's faces. After controlling for the effect of age and sociosexuality, regularly cycling and pregnant women showed a stronger preference for masculinity than lactating and post-menopausal women. However, there was no significant difference in masculinity preference between women in the low- and high-conception probability groups. Women's sociosexuality showed a positive, but very weak association with men's facial masculinity preference. We suggest that women's overall, long-term hormonal state (cycling, post-menopausal) is a stronger predictor of preference for sexual dimorphism than changes in hormonal levels through the cycle.

Costs of reproduction are reflected in women's faces: Post-menopausal women with fewer children are perceived as more attractive, healthier and younger than women with more children.

OBJECTIVES: The costs associated with reproduction (i.e., gestation, lactation, childcare) have long-term negative consequences by elevating risk of disease and reducing lifespan. We tested the hypotheses that high parity, and thus high reproductive costs bear by women, is perceived by other people when they evaluate facial appearance of health, attractiveness and age of mothers. MATERIALS AND METHODS: Using computer software we created average facial images based on real photographs of post-menopausal women with varying number of children; 3 parity categories were created (1-2, 4-5, and 7-9 children). Study participants (N = 571) were asked to choose the face they perceived as more attractive, younger and healthier via two-alternative forced choice questions asked in three randomized blocks. RESULTS: Women who had given birth to fewer children were judged both by men and women as more attractive, younger and healthier than women with more children. In each category the lowest scores were received by women from highest parity category (7-9 children). DISCUSSION: Mechanisms behind the observed variation in facial appearance are not known but higher levels of oxidative stress among women with high parity may explain their faster aging and lower attractiveness in older age. These results suggest that costs of reproduction might affect women's physical appearance.