Pre-pregnancy lifestyle characteristics and risk of miscarriage: the Australian Longitudinal Study on Women's Health.

BACKGROUND: Previous studies of lifestyle characteristics and risk of miscarriage have mostly been retrospective and failed to account for induced abortions. We examine whether pre-pregnancy body-mass index, alcohol intake and smoking influence the risk of miscarriage after accounting for induced abortions. METHODS: We conducted a prospective cohort study of 9213 women with 26,594 pregnancies participating in the Australian Longitudinal Study on Women's Health. We examined whether body-mass index, smoking and alcohol intake prior to pregnancy was associated with miscarriage. We estimated adjusted relative risks (RR) using generalized estimating equations with an exchangeable correlation matrix. We explored the impact of accounting for induced abortion by first excluding all induced abortions, and secondly including 50% of induced abortions in the comparison group. RESULTS: Of the 26,592 pregnancies which occurred during the follow-up period, 19% ended in a miscarriage. We observed an increased risk of miscarriage according to pre-pregnancy obesity compared to normal weight (adjusted RR 1.13; 95% CI 1.05, 1.21), smoking between 10 and 19 cigarettes per day compared to not smoking (adjusted RR 1.13; 95% CI 1.02, 1.25), but not smoking 20 or more cigarettes per day (adjusted RR 1.07; 95% CI 0.94, 1.21) and risky drinking (≥2 units per day; adjusted RR 1.15; 95% CI 1.03, 1.28) compared to low risk drinking (< 2 units per day). The results for smoking (adjusted RR 1.09 for 10-19 cigarettes per day; 95% CI 0.98, 1.21) was attenuated after including 50% of induced abortions in the comparison group. CONCLUSIONS: We observed a modest increased risk of miscarriage according to obesity and risky alcohol intake prior to pregnancy. There was no evidence of a dose-response relationship with smoking, and the association between smoking and risk of miscarriage was attenuated after accounting for induced abortions.

The Long-term relationship between duration of treatment and contracture resolution using dynamic orthotic devices for the stiff proximal interphalangeal joint: a prospective cohort study.

STUDY DESIGN: Descriptive design with a prospective cohort. INTRODUCTION: Little is known about the long-term relationship between the duration of treatment using dynamic orthoses (splints), and contracture resolution in the stiff proximal interphalangeal (PIP) joint. PURPOSE OF THE STUDY: To examine the long-term relationship between weeks of treatment using dynamic orthoses and contracture resolution, in both flexion and extension deficits of the PIP joint. METHODS: Forty-one participants were treated with a dynamic orthotic device (splint) for either a flexion or extension deficit of the PIP joint (n=48 joints). The relationship between contracture resolution and weeks of treatment was examined controlling for baseline range of motion (ROM), weekly total end range time, pretreatment joint stiffness, time since injury, and diagnosis. Outcome was measured via change in torque and active ROM. RESULTS: Outcome with orthotic use was significantly associated with the weeks of treatment (p<0.001). ROM increased in a linear fashion although faster progress was observed when treatment was aimed at improving flexion rather than extension. Flexion deficits appeared to maximize gains with orthotic treatment after 12 weeks. However, extension deficits continued to demonstrate slow and continuous improvement beyond the 17 weeks of recorded data. Less treatment duration (in weeks) was needed to restore flexion than extension. CONCLUSIONS: The duration of orthotic use (weeks of treatment) is significantly associated with the extent of contracture resolution. Slower recovery of ROM and a longer duration of orthotic use may be expected when the treatment goal is to improve extension rather than flexion. LEVEL OF EVIDENCE: 2b.

Hysterectomy and weight gain.

OBJECTIVE: To investigate whether overweight women are more likely to have a hysterectomy and whether hysterectomy leads to increased weight gain. METHODS: Survey data of middle-aged women participating in the Australian Longitudinal Study on Women's health in 1996 (ages 45-50 y; n = 13,125), 1998 (n = 10,612), 2001 (n = 10,293), and 2004 (n = 9309) included self-reported height, weight, and hysterectomy. First, we conducted a cohort analysis, comparing body mass index (BMI) of women categorized according to hysterectomy status. Second, we used a nested case-control analysis to compare weight gain between women who underwent hysterectomy and women who did not have a hysterectomy, matched for prehysterectomy weight, height, menopause status, and educational level. RESULTS: At survey 1, the mean BMI of women who subsequently had a hysterectomy was greater than that of women without a hysterectomy by survey 2 (difference, 1.1 kg/m; 95% CI, 0.5-1.6). Results were similar for surveys 2 to 3 (BMI difference, 0.8 kg/m; 95% CI, 0.3-1.3) and surveys 3 to 4 (BMI difference, 0.8 kg/m; 95% CI, 0.1-1.4). Having a hysterectomy between surveys 1 and 2 was not associated with percentage of weight gain over the 3 or 6 years after survey 2 (odds ratio, 0.98 [95% CI, 0.96-1.01] and 0.99 [95% CI, 0.97-1.01], respectively). Having a hysterectomy between surveys 2 and 3 was weakly associated with percentage of weight gain over 3 years (odds ratio, 1.03 [95% CI, 1.00-1.05]). CONCLUSIONS: Among women older than 45 to 50 years, hysterectomy did not lead to greater weight gain but was more likely to be performed in heavier women.