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1.
PLoS One ; 16(2): e0247757, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33635908

RESUMO

Younger age at menarche (AAM) is associated with higher body mass index (BMI) for young women. Considering that continuous trends in decreasing AAM and increasing BMI are found in many countries, we attempted to assess whether the observed negative association between AAM and young adult BMI is causal. We included 4,093 women from the Korean Genome and Epidemiology Study (KoGES) and Healthy twin Study (HTS) with relevant epidemiologic data and genome-wide marker information. To mitigate the remarkable differences in AAM across generations, we converted the AAM to a generation-standardized AAM (gsAAM). To test causality, we applied the Mendelian randomization (MR) approach, using a genetic risk score (GRS) based on 14 AAM-associated single nucleotide polymorphisms (SNPs). We constructed MR models adjusting for education level and validated the results using the inverse-variance weighted (IVW), weighted median (WM), MR-pleiotropy residual sum and outliers test (MR-PRESSO), and MR-Egger regression methods. We found a null association using observed AAM and BMI level (conventional regression; -0.05 [95% CIs -0.10-0.00] per 1-year higher AAM). This null association was replicated when gsAAM was applied instead of AAM. Using the two-stage least squares (2SLS) approach employing a univariate GRS, the association was also negated for both AAM and gsAAM, regardless of model specifications. All the MR diagnostics suggested statistically insignificant associations, but weakly negative trends, without evidence of confounding from pleiotropy. We did not observe a causal association between AAM and young adult BMI whether we considered the birth cohort effect or not. Our study alone does not exclude the possibility of existing a weak negative association, considering the modest power of our study design.

2.
Environ Health Prev Med ; 26(1): 20, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33573606

RESUMO

BACKGROUND: Mounting evidence implicates an association between ambient air pollution and impaired reproductive potential of human. Our study aimed to assess the association between air pollution and ovarian reserve in young, infertile women. METHODS: Our study included 2276 Korean women who attended a single fertility center in 2016-2018. Women's exposure to air pollution was assessed using concentrations of particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3) that had been collected at 269 air quality monitoring sites. Exposure estimates were computed for 1, 3, 6, and 12 months prior to the ovarian reserve tests. Anti-Müllerian hormone (AMH) ratio (defined as an observed-to-expected AMH based on age) and low AMH (defined as < 0.5 ng/mL) were employed as indicators of ovarian reserve. We included a clustering effect of 177 districts in generalized estimating equations approach. A secondary analysis was conducted restricting the analyses to Seoul residents to examine the association in highly urbanized setting. RESULTS: The mean age was 36.6 ± 4.2 years and AMH level was 3.3 ± 3.1 ng/mL in the study population. Average AMH ratio was 0.8 ± 0.7 and low AMH was observed in 10.3% of women (n=235). The average concentration of six air pollutants was not different between the normal ovarian reserve and low AMH groups for all averaging periods. In multivariable models, an interquartile range (IQR)-increase in 1 month-average PM10 was associated with decrease in AMH ratio among total population (ß= -0.06, 95% confidence interval: -0.11, 0.00). When we restrict our analysis to those living in Seoul, IQR-increases in 1 and 12 month-average PM2.5 were associated with 3% (95% CI: -0.07, 0.00) and 10% (95% CI: -0.18, -0.01) decrease in AMH ratio. The ORs per IQR increase in the six air pollutants were close to null in total population and Seoul residents. CONCLUSIONS: In a cohort of infertile Korean women, there was a suggestive evidence of the negative association between ambient PM concentration and ovarian reserve, highlighting the potential adverse impact of air pollution on women's fertility.

3.
Sci Rep ; 11(1): 4159, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33603191

RESUMO

The prevalence of diabetes during pregnancy and the need for the treatment are increasing. We aimed to investigate antidiabetic medications (ADM) use among pregnant women and their characteristics. Using Korea's nationwide healthcare database, we included women aged 15-49 years with births during 2004-2013. The prevalence and secular trend of ADM use were assessed in 3 periods: pre-conception period, first trimester, and second/third trimesters. To compare maternal characteristics between pregnancies with and without ADM prescription, we used the χ2 or Fisher's exact test and Cochran-Armitage trend test. The prescription patterns analyzed by calendar year, age, insurance type, income, area, and medical institution. Of 81,559 pregnancies, 222 (0.27%) and 305 (0.37%) were exposed ADM during pre-conception and pregnancy periods, respectively. ADM prescriptions increased significantly by an 11.3-fold in second/third trimesters, while a 2.9-fold in first trimester. ADM use is more prevalent in women aged older and living in urban areas. Metformin was most used in the pre-conception period, while insulins were most during pregnancy. About 0.4% of women received ADM during pregnancy; a rate was lower than that in western countries. Non-recommended medications were more common in first trimester, which warrants pregnancy screening for women taking ADM.

4.
J Korean Med Sci ; 36(4): e26, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33496085

RESUMO

The Korean Society of Maternal Fetal Medicine proposed the first Korean guideline on prenatal aneuploidy screening and diagnostic testing, in April 2019. The clinical practice guideline (CPG) was developed for Korean women using an adaptation process based on good-quality practice guidelines, previously developed in other countries, on prenatal screening and invasive diagnostic testing for fetal chromosome abnormalities. We reviewed current guidelines and developed a Korean CPG on invasive diagnostic testing for fetal chromosome abnormalities according to the adaptation process. Recommendations for selected 11 key questions are: 1) Considering the increased risk of fetal loss in invasive prenatal diagnostic testing for fetal genetic disorders, it is not recommended for all pregnant women aged over 35 years. 2) Because early amniocentesis performed before 14 weeks of pregnancy increases the risk of fetal loss and malformation, chorionic villus sampling (CVS) is recommended for pregnant women who will undergo invasive prenatal diagnostic testing for fetal genetic disorders in the first trimester of pregnancy. However, CVS before 9 weeks of pregnancy also increases the risk of fetal loss and deformity. Thus, CVS is recommended after 9 weeks of pregnancy. 3) Amniocentesis is recommended to distinguish true fetal mosaicism from confined placental mosaicism. 4) Anti-immunoglobulin should be administered within 72 hours after the invasive diagnostic testing. 5) Since there is a high risk of vertical transmission, an invasive prenatal diagnostic testing is recommended according to the clinician's discretion with consideration of the condition of the pregnant woman. 6) The use of antibiotics is not recommended before or after an invasive diagnostic testing. 7) The chromosomal microarray test as an alternative to the conventional cytogenetic test is not recommended for all pregnant women who will undergo an invasive diagnostic testing. 8) Amniocentesis before 14 weeks of gestation is not recommended because it increases the risk of fetal loss and malformation. 9) CVS before 9 weeks of gestation is not recommended because it increases the risk of fetal loss and malformation. 10) Although the risk of fetal loss associated with invasive prenatal diagnostic testing (amniocentesis and CVS) may vary based on the proficiency of the operator, the risk of fetal loss due to invasive prenatal diagnostic testing is higher in twin pregnancies than in singleton pregnancies. 11) When a monochorionic twin is identified in early pregnancy and the growth and structure of both fetuses are consistent, an invasive prenatal diagnostic testing can be performed on one fetus alone. However, an invasive prenatal diagnostic testing is recommended for each fetus in cases of pregnancy conceived via in vitro fertilization, or in cases in which the growth of both fetuses differs, or in those in which at least one fetus has a structural abnormality. The guidelines were established and approved by the Korean Academy of Medical Sciences. This guideline is revised and presented every 5 years.

5.
J Korean Med Sci ; 36(4): e27, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33496086

RESUMO

In 2019, the Korean Society of Maternal-Fetal Medicine developed the first Korean clinical practice guidelines for prenatal aneuploidy screening and diagnostic testing. These guidelines were developed by adapting established clinical practice guidelines in other countries that were searched systematically, and the guidelines aim to assist in decision making of healthcare providers providing prenatal care and to be used as a source for education and communication with pregnant women in Korea. This article delineates clinical practice guidelines specifically for maternal serum screening for fetal aneuploidy and cell-free DNA (cfDNA) screening. A total of 19 key questions (12 for maternal serum and 7 for cfDNA screening) were defined. The main recommendations are: 1) Pregnant women should be informed of common fetal aneuploidy that can be detected, risks for chromosomal abnormality according to the maternal age, detection rate and false positive rate for common fetal aneuploidy with each screening test, limitations, as well as the benefits and risks of invasive diagnostic testing, 2) It is ideal to give counseling about prenatal aneuploidy screening and diagnostic testing at the first prenatal visit, and counseling is recommended to be given early in pregnancy, 3) All pregnant women should be informed about maternal serum screening regardless of their age, 4) cfDNA screening can be used for the screening of trisomy 21, 18, 13 and sex-chromosome aneuploidy. It is not recommended for the screening of microdeletion, 5) The optimal timing of cfDNA screening is 10 weeks of gestation and beyond, and 6) cfDNA screening is not recommended for women with multiple gestations. The guideline was reviewed and approved by the Korean Academy of Medical Sciences.

6.
Int J Infect Dis ; 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33217571

RESUMO

OBJECTIVES: We estimated the impact of universal hepatitis B immunization using an 18-year data of women who are in childbearing age in South Korea. METHODS: We used hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) data of 145,993 women aged 20-49 years during 2001-2018 at the Gangnam CHA Medical Center. Annual prevalences of HBsAg and anti-HBs positivity were calculated and tested for linear trend. We conducted age-period-cohort (APC) analysis to obtain period and cohort effect. RESULTS: Overall proportion of HBsAg positivity was 3.5% (n = 5,050) and anti-HBs positivity was 75.3% (n = 109,907) during the study period. HBsAg positivity percentage decreased from 5.1% in 2001 to 2.5% in 2018 (P < 0.001) while anti-HBs positivity increased from 59.9% to 75.8% (P = 0.002). Average annual percent change of HBsAg positivity was -5.9% (95% confidence interval (CI): -6.9%, -4.8%). The period and cohort RR curve identified a consistent decrease in HBsAg positivity over time and across generations. CONCLUSIONS: We observed a concurrent decrease in HBsAg and an increase in anti-HBs seropositivity among Korean women in childbearing age, implicating the success in preventing vertical transmission.

7.
PLoS One ; 15(11): e0240689, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147280

RESUMO

With increased population and urban development, there are growing concerns regarding health impacts of environmental noise. We assessed the relationship between nighttime environmental noise and semen quality of men who visited for fertility evaluation. This is a retrospective cohort study of 1,972 male patient who had undertaken semen analysis between 2016-2018 at a single fertility center of Seoul, South Korea. We used environmental noise data of National Noise Information System (NNIS), Korea. Using semiannual nighttime noise measurement closest to the time of semen sampling, individual noise exposures at each patient's geocoded address were estimated with empirical Bayesian kriging method. We explored the association between environmental noise and semen quality indicators (volume, concentration, % of progressive motility, vitality, normal morphology, total motile sperm count, oligozoospermia, asthenozoospermia, and severe teratozoospermia) using multivariable regression and generalized additive models. Estimated exposure to nighttime environmental noise level in the study population was 58.3±2.2 Leq. Prevalence of oligozoospermia, asthenozoospermia, and severe teratozoospermia were 3.3%, 14.0%, and 10.1%. Highest quartile nighttime noise was associated with 3.5 times higher odds of oligozoospermia (95% CI: 1.18, 10.17) compared to lowest quartile. In men whose noise exposure is in 3rd quartile, odds ratio (OR) of severe teratozoospermia was 0.57 (95% CI: 0.33, 0.98). The OR for 4th quartile noise were toward null. In generalized additive model, the risk of oligozoospermia increases when the nighttime noise is 55 Leq dB or higher. Our study adds an evidence of potential impact of environmental noise on semen quality in men living in Seoul. Additional studies with more refined noise measurement will confirm the finding.

8.
Pregnancy Hypertens ; 22: 167-174, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33002737

RESUMO

OBJECTIVES: Hypertensive disorder is a common medical condition in pregnancy. However, the recommendations for antihypertensive use during pregnancy are based on limited evidence and various factors affect their selection in clinical practice. We aim to assess the prevalence of antihypertensive use and describe which medications are being used in pregnancy. STUDY DESIGN: We conducted a cohort study of all pregnancies resulted in a live birth between 2013 and 2017, by using the Health Insurance Review and Assessment (HIRA) database of South Korea. Based on duration of drug supplied, we examined antihypertensive use during the pre-pregnancy, pregnancy, and postpartum periods. We described the patterns of discontinuing, continuing, switching, and initiating antihypertensive medications during pregnancy. RESULTS: We included 2,030,821 pregnancies, of whom 0.9%, 3.1%, and 1.8% were dispensed antihypertensives in the pre-pregnancy, pregnancy, and postpartum periods, respectively. The most frequent medications used were dihydropyridines (40.7%), beta-blockers (38.4%) and Angiotensin II Receptor Blockers (16.8%) in the first trimester, and dihydropyridines (89.7%) and vasodilators (11.5%) in the third trimester. Among women exposed to antihypertensives during pregnancy, this was the first use in 86.3% of women. Among women receiving antihypertensives before pregnancy, 77.9% discontinued treatment during pregnancy, whereas 13.2% continued to take their pre-pregnancy medications. CONCLUSION: The prevalence of antihypertensive use during pregnancy was 3.1% in South Korea. Overall, while dihydropyridines were predominant, other types of antihypertensives were also commonly dispensed during pregnancy. It suggests a need to investigate the effect of exposure to various types of antihypertensives of which safety remains unclear during pregnancy.

9.
Andrologia ; 52(11): e13809, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32882055

RESUMO

Total motile sperm count is an important parameter for predicting the probability of natural pregnancy. We have externally validated the Samplaski's post-varicocele repair semen analysis nomogram to confirm the predictive accuracy of total motile sperm count. A total of 300 patients who had undergone varicocelectomy between July 2016 and July 2019 from 4 treatment centres were included in this validation cohort study. The predictive performance of the externally validated nomogram was revealed by applying the Pearson correlation coefficient (R = 0.328; 95% confidence interval (CI) 0.220-0.435; p < .001). Compared to Samplaski's nomogram result (R = 0.581; 95% CI 0.186-0.729), our study also revealed a statistically significant rate. However, it had a relatively lower correlation coefficient rate. Notably, the predicted total motile sperm count was lower than the observed post-varicocelectomy total motile sperm count. The calibration plot revealed that the discrepancy between the predicted and observed total motile sperm count was plausible. However, it had low explanatory power in this nomogram model. This validation study demonstrates that the post-varicocele repair Samplaski's nomogram predicts a relatively lower total motile sperm count than the observed count.

10.
Yonsei Med J ; 61(9): 805-815, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32882765

RESUMO

PURPOSE: We explored the role of parental social class in preterm birth (PTB) and low birth weight (LBW) in association with child mortality in Korea. MATERIALS AND METHODS: A total of 7,302,732 births in Korea between 1995 and 2007 were used for designing the national retrospective cohort study. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the risk of child death after adjusting for covariates. RESULTS: Parental social class was associated with adverse birth outcomes and child mortality in Korea. Parental social class increased the strength of the relationship of adverse birth outcomes with child mortality. Child mortality was higher among PTB and LBW infants from parents with a lower social class than normal births from parents with a higher social class. In particular, the disparity in child mortality according to parental social class was greater for LBW and PTB than intrauterine growth retardation births. When one of the parents had a middle-school education or lower, the disparity in child mortality due to adverse birth outcomes was large regardless of the other spouse's educational status. Inactive economic status for the father, as well as an occupation in manual labor by the mother, increased the risk of child mortality. CONCLUSION: Strong relationships for social inequalities and adverse birth outcomes with inequalities in child mortality in South Korea were found in this study. Tackling social inequalities, as well as reducing adverse birth outcomes, are needed to reduce the disparities in child mortality in South Korea.


Assuntos
Mortalidade da Criança , Nascimento Prematuro/epidemiologia , Classe Social , Adulto , Criança , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos
11.
Environ Res ; 191: 110096, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32871145

RESUMO

As many studies showed the spatial heterogeneity in the association between particulate matter (PM) air pollution and low birth weight (LBW), few studies focused on the variation of local associations at the national scale and related areal characteristics. This study aimed to explore different approaches to estimating local effects of PM with an aerodynamic diameter ≤10 µm (PM10) on LBW across 235 districts in South Korea, to investigate the spatial pattern of local associations, and to examine the relationship with local socio-demographic and environmental characteristics. LBW was identified in 5,692,650 mothers from birth certificate data for 2001-2013. We estimated individual annual-average concentrations of PM10 at centroids of mothers' residential districts by using a previously-validated prediction model. Then, we estimated district-specific odds ratios of LBW for PM10 using modified geographically weighted logistic regression. Here, we applied four approaches with different neighborhood definitions: the distance-based approach within 20- and 40-km bandwidth and the hybrid approach replacing with adjacent districts for urban districts <100 km2. In addition, we compared district-specific socioeconomic indicators and emission estimates across three groups of districts that showed significantly positive, no, and significantly negative associations. Medians of district-specific estimates of four approaches were similar to the global estimate and between each other. However, their variability differed with some unreasonably high estimates when a small distance was applied as the neighborhood definition, although spatial pattern was generally similar among the four. The hybrid approach based on the different neighborhood definition by urban and rural areas provided stable risk estimates. Higher risk districts in rural areas were found in more socioeconomically-deprived areas, whereas urban areas showed higher risk districts when their air pollution emissions were higher. Our approach and findings will help identify high risk areas and enhance understanding of geographic determinants.

13.
PLoS One ; 15(6): e0234035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584834

RESUMO

Understanding gender differences in health-related behaviors and their impacts is a crucial aspect of effective primary care. We studied gender-based differences in predictors of metabolic syndrome (MetS) resolution among newly diagnosed MetS patients. This study was a secondary analysis of a prospective clinical trial study comprising of 637 middle-aged and older adults (226 men and 411 women) who underwent a regular health checkup and were newly diagnosed with MetS at 16 different health clinics of 14 metropolitan cities and provinces. We conducted Cox proportional hazard analysis to estimate cumulative probability of MetS resolution within a 12-month observation period. Among the 637 patients, 47.6% of participants achieved MetS resolution. The resolution rate was similar among men and women (44.7% and 49.1%, respectively, P = 0.320). Low household income (Hazard ratio = 2.62, 95% confidence interval: 1.13-6.08) and current employment (2.29, 1.26-4.13) were associated with a higher cumulative probability of MetS resolution in men than in women. For women, however, longer sleeping hours (1.18, 1.04-1.34) and living with a partner (1.58, 1.06-2.35) were positive predictors of MetS resolution. Being overweight (0.63, 0.44-0.89) was associated with lower cumulative probability of MetS resolution in women than in men. The factors associated with cumulative probability of MetS resolution within the 12-month follow-up were different between men and women. These findings facilitate further exploration on gender-based differences in risk factors for less optimal improvements in MetS.


Assuntos
Síndrome Metabólica/fisiopatologia , Caracteres Sexuais , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Probabilidade
14.
J Korean Med Sci ; 35(14): e97, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32281314

RESUMO

BACKGROUND: While evidence shows a tendency toward delays in menopause worldwide, whether prevalence of premature (< 40 years) or early menopause (40-44 years) is also reduced in different ethnic groups is uncertain. The aim of this study was to explore birth cohort effect in the prevalence of premature and early menopause in United States (US) and Korea. METHODS: This is a retrospective study using the National Health and Nutrition Examination Survey (NHANES, 1999-2014) and the Korea NHANES (KNHANES, 2007-2012). We analyzed prevalence of premature and early menopause in three ethnic groups of US and Korea. We restricted our analysis to women aged ≥ 45 years at the time of the survey born between 1920 and 1969. The data of both eligible 9,209 US women and 9,828 Korean was included in final analysis. We calculated odds ratios (OR) for each outcome adjusting for biological and socioeconomic factors, respectively. RESULTS: Prevalence of premature menopause was 1.7% in US, 2.8% in Korean women. Early menopause occurred in 3.4% and 7.2% of US and Korean, respectively. In US women, prevalence of premature and early menopause did not change and did not differ across three ethnicities. Korean women showed highest and consistently decreasing prevalence (P < 0.001). When we adjusted for covariates, birth lower risk for premature menopause was evident in US Non-Hispanic black born in 1950s and in Korean born between 1940s and 1960s compared to those born in 1920s. In the analysis of early menopause, excluding premature menopause patients, lower risk of more recent generation (born in 1940s and later) was evident in Korean women. CONCLUSION: The trend and birth cohort effect in occurrence of premature and early menopause among the US and Korea women are different. Prevalences of premature and early menopause decrease only in Korean.


Assuntos
Menopausa , Adulto , Feminino , Humanos , Menopausa Precoce , Pessoa de Meia-Idade , Avaliação Nutricional , Nascimento Prematuro/epidemiologia , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia
15.
Int J Infect Dis ; 94: 25-28, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32112963

RESUMO

OBJECTIVES: The aim was to examine rubella seronegativity among women of childbearing age after the introduction of rubella-containing vaccine (RCV) among teenage girls and universal MMR programs in South Korea. METHODS: The serum IgG data of 72 114 women aged 20-49 years, who had undergone rubella antibody testing at the Gangnam CHA Medical Center between 2004 and 2018, were examined. A serum IgG level <10.0 IU/ml was considered negative. The study population was divided into three cohorts based on the vaccination policy: cohort 1, 1955-1976 (no national immunization program); cohort 2, 1977-1985 (national rubella only vaccination for high schoolers); cohort 3, 1986-1993 (combination strategy). We compared the rate of seronegativity and the adjusted odds ratio (OR) of seronegativity of each cohort. RESULTS: The overall proportion of seronegative women decreased significantly, from 6.1% in 2004 to 2.5% in 2018 (Kendall tau = -0.89, p < 0.001). The rate of seronegativity was highest among women who were not targeted for national immunization (born in 1955-1977, 5.2%), while it was lowest among candidates receiving routine and catch-up vaccinations (born in 1986-1993, 2.2%). When controlling for the effect of age and year of testing, the OR for seronegativity was lower for cohort 2 (adjusted OR 0.68, 95% confidence interval (CI) 0.60-0.76) and cohort 3 (OR 0.55, 95% CI 0.40-0.75) when compared to cohort 1. CONCLUSIONS: Women who were covered by either vaccination program were less susceptible to rubella infection, supporting the value of both approaches. The study findings will serve as empirical evidence for an immunization program targeted towards young women and children.


Assuntos
Vacina contra Rubéola/imunologia , Rubéola (Sarampo Alemão)/epidemiologia , Adulto , Anticorpos Antivirais/sangue , Estudos de Coortes , Suscetibilidade a Doenças , Feminino , Humanos , Programas de Imunização , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Rubéola (Sarampo Alemão)/imunologia , Vírus da Rubéola/imunologia , Estudos Soroepidemiológicos , Vacinas Combinadas/imunologia , Adulto Jovem
16.
Gynecol Endocrinol ; 36(10): 922-925, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32162570

RESUMO

Current knowledge of the association between peripheral natural killer (NK) cell proportion and ovarian function in reproductive-age women is limited. We explored the association between NK cell proportion and ovarian function in women who underwent in-vitro fertilization (IVF) treatment. This was a retrospective cohort study using the data of 20-44-year-old women with recurrent implantation failure (RIF) who were tested for NK cell proportion and anti-Müllerian hormone (AMH). Indicators of ovarian function included AMH, observed-to-(age-appropriate) reference AMH ratio, high FSH, peak E2 and total number of oocytes during the first IVF cycle following the test. We used different model specification controlling for women's age, and body mass index. Among a total of 936 women, majority showed lower AMH compared to age-appropriate level. Average NK cell proportion was 13.5 ± 5.7%. Number of oocytes showed positive association with NK cell (ß = 0.040, p = .025). In the subgroup with NK ≥ 18%, NK cell proportion was negatively associated with AMH (-0.106, p = .012), AMH ratio (-0.049, p = .014) and number of oocytes (-0.021, p < .001) while the associations with others remain close to null. High NK cell proportion may be harmful to ovarian reserve or function.

17.
J Pediatr Adolesc Gynecol ; 33(3): 264-270, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31874313

RESUMO

STUDY OBJECTIVE: This study aimed to investigate the association between age at menarche (AAM) and adverse health indicators in adolescent girls. DESIGN: A retrospective cohort study. SETTING: Population-based survey data. PARTICIPANTS: A total of 319,437 female participants aged 12-18 years from the Korea Youth Risk Behaviour Web-based Survey. INTERVENTIONS AND MAIN OUTCOME MEASURES: We assessed associations between AAM (categorized as ≤10, 11, and ≥12) and health indicators (poor self-rated health, high psychological stress, unhappiness, sexual initiation, and pregnancy). Covariates were individual-level (bodyweight, living with family, parent's education, household wealth, and presence of parents and siblings) and community-level factors (year of birth, single-sex education and level of school, urbanization level of school area, year of survey, and regional deprivation). Odds ratios (ORs) for each adverse health indicator were examined by each AAM group using multivariable regression analyses. For pregnancy, we calculated relative risks (RRs) using a log-binomial regression model. RESULTS: Age at menarche was <12 in 42% of our study population. Nearly one-half of the girls born in the early 2000s went through menarche before the age of 12 years, whereas only one-third of girls born in the early 1990s went through menarche before the age of 12 years. Girls who experienced menarche at age ≤10 or age 11 years were more likely to show self-rated poor health (AAM ≤ 10: OR, 1.28; 95% confidence intervals [CI], 1.22-1.34; AAM = 11: OR, 1.16; 95% CI, 1.12-1.21), high stress (OR, 1.19; 95% CI, 1.14-1.23, and OR, 1.10; 95% CI, 1.06-1.14), and sexual initiation (OR, 2.21; 95% CI, 2.05-2.38, and OR, 1.32; 95% CI, 1.23-1.41) compared to those with AAM ≥12 years when data were adjusted for all covariates. AAM ≤10 years was associated with consistently higher odds for poor health than AAM ≥12 years. The ORs of sexual initiation increased with earlier AAM. Risk of pregnancy was similar across AAM groups when individual- and community-level covariates were controlled for. CONCLUSION: Early menarche, defined as <12 years, can be still a useful indicator in adolescent health interventions to identify high-risk groups in the setting of declining AAM.


Assuntos
Desenvolvimento do Adolescente , Saúde do Adolescente , Menarca , Adolescente , Fatores Etários , Criança , Feminino , Indicadores Básicos de Saúde , Humanos , Gravidez , República da Coreia , Estudos Retrospectivos , Comportamento Sexual
18.
Arch Gynecol Obstet ; 300(4): 975-980, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31440822

RESUMO

PURPOSE: This study aimed to present cases involving in vitro fertilization (IVF) cycles in patients with stage IA endometrial adenocarcinoma (EC) who underwent fertility-sparing conservative treatment. METHODS: Twenty-two patients who underwent IVF cycles in a single fertility center between May 2005 and February 2017 after progestin treatment for stage IA EC were chosen for this study. Outcomes of IVF cycles were analyzed retrospectively. RESULTS: Women of a median age of 34 years (range 26-41 years) underwent a total of 49 embryo transfers within an average of 2 months after their last progestin treatment. The clinical pregnancy rate per transfer was 26.5%, implantation rate was 16.7%, and live birth rate was 14.3%. The cumulative clinical pregnancy rate was 50% (11/22), resulting in 6 live births (27.3%) within 3 cycles of embryo transfer. The median endometrial thickness on the day of human chorionic gonadotropin injection in 34 fresh cycles was 9.0 mm (range 4-10 mm) in live births, 7.5 mm (range 6-9 mm) in miscarriages, and 6.0 mm (range 4-15 mm) in no pregnancy cases. During a median post-cancer treatment follow-up period of 41 months (range 9-150 months), 6 (27.3%) women underwent definitive hysterectomy for EC relapse. CONCLUSIONS: This study showed an acceptable cumulative pregnancy rate after the IVF procedure in patients with early-stage EC who were treated conservatively. Considering the high relapse rate, it is of great importance that these patients are closely monitored after the IVF cycles.


Assuntos
Preservação da Fertilidade , Fertilização In Vitro , Aborto Espontâneo , Adulto , Coeficiente de Natalidade , Implantação do Embrião , Transferência Embrionária/métodos , Neoplasias do Endométrio/tratamento farmacológico , Feminino , Humanos , Nascimento Vivo , Recidiva Local de Neoplasia/epidemiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
19.
BMC Pregnancy Childbirth ; 19(1): 246, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307418

RESUMO

BACKGROUND: Fetal growth has been known to be associated with particulate matter (PM) air pollution during gestation. Given that regular working may deviate outdoor air pollution exposure, the association between air pollution and fetal growth restriction can be different across maternal working status. This study was to assess possible effect modification by maternal employment in the association between exposure to PM during pregnancy and fetal growth restriction. METHODS: Using hourly PM less than or equal to 10 and 2.5 µm in diameter (PM10 and PM2.5) regulatory monitoring data for 2001-2012 and 2008-2012, respectively, and birth certificate data for 2002-2012, we computed maternal exposures with district-level averages of PM10 and PM2.5 during one year before birth, entire pregnancy, and the 1st, 2nd and 3rd trimesters. The outcomes of fetal growth restriction were assessed by small for gestational age (SGA, weighted <10th percentile in the same gestational age) as well as low birth weight (LBW, < 2.5 kg) at term. We performed logistic regression to examine the association between PM and each of fetal growth restriction outcomes adjusting for individual risk factors. For effect modification by maternal employment, we estimated adjusted odds ratio (OR) of SGA or LBW for interquartile (IQR) increases in PM10 or PM2.5 stratified by employed and non-employed mothers. We also computed relative excess risk due to interaction (RERI) to investigate additive interaction. RESULTS: Among 824,011 singleton term births, 34.0% (279,856) were employed and 66.0% (544,155) were non-employed mothers. Proportions of LBW were 1.5% in employed and 1.6% in non-employed (P < 0.001). SGA occurred in 12.7% of employed and 12.8% of non- employed (P = 0.124) mothers. For non-employed mothers, we observed increased odds of SGA per IQR increase in PM10 for one year before birth (OR = 1.02, 95% confidence intervals (CI): 1.00-1.04, P = 0.028). ORs of SGA for full pregnancy period and the 3rd trimester were also positive but did not reach statistical significance. We did not observe positive association for PM2.5. RERI was not significant both for PM10 and PM2.5. CONCLUSIONS: We did not observe evidence of effect modification by maternal employment in the association between ambient PM and fetal growth restriction. Future studies using more refined exposure measures should confirm this finding.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Emprego/estatística & dados numéricos , Retardo do Crescimento Fetal/etiologia , Exposição Materna/efeitos adversos , Material Particulado/análise , Adulto , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Razão de Chances , Gravidez
20.
Environ Res ; 175: 414-420, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31154231

RESUMO

BACKGROUND: Emerging evidence suggests a potential association between ambient air pollution and risk of gestational diabetes mellitus (GDM), but results have been inconsistent. Accordingly, we assessed the associations between ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) levels with risk of GDM. METHODS: Using linked data from birth certificates, hospital discharge diagnoses, and air pollution estimates informed by the New York City Community Air Survey, we fit conditional logistic regression models to evaluate the association between residential levels of PM2.5 and NO2 with risk of GDM among 256,372 singleton live births of non-smoking mothers in New York City born 2008-2010, adjusting for sociodemographic factors and stratified on zip code of maternal address. RESULTS: GDM was identified in 17,065 women, yielding a risk of GDM in the study sample of 67 per 1000 deliveries. In single pollutant models, 1st and 2nd trimester PM2.5 was associated with a lower and higher risk of GDM, respectively. In models mutually adjusting for PM2.5 levels in both trimesters, GDM was associated with PM2.5 levels in the 2nd trimester (OR: 1.06, 95% CI: 1.02, 1.10 per interquartile range increase in PM2.5), but not the 1st trimester (OR: 0.99, 95% CI: 0.96, 1.02). Conversely, GDM was associated with NO2 during the 1st trimester (OR: 1.05, 95% CI: 1.01, 1.09), but not the 2nd trimester (OR: 1.02, 95% CI: 0.98, 1.06). The positive associations between pollutants and GDM were robust to different model specifications. PM2.5 in the 2nd trimester was more strongly associated with GDM among mothers who were aged <35 years and not Medicaid recipients. NO2 in the 1st trimester was more strongly associated with GDM among overweight and parous women. CONCLUSIONS: In this large cohort of singleton births in New York City, NO2 in the 1st trimester and PM2.5 in the 2nd trimester were associated with higher odds of GDM, while 1st trimester PM2.5 was weakly and inconsistently associated with lower odds of GDM.


Assuntos
Poluentes Atmosféricos , Poluição do Ar/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Exposição Materna/estatística & dados numéricos , Adulto , Feminino , Humanos , Cidade de Nova Iorque/epidemiologia , Dióxido de Nitrogênio , Material Particulado , Gravidez
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