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Durr AJ, Critch EA, Fitzgerald MP, Devlin KM, Fuller KA, Renzelli-Cain RI. Untangling the roots of the West Virginia opioid crisis: relationships in adolescent pregnancy, drug misuse, and future outcomes. J Osteopath Med 2021; 121:191-198. [PMID: 33567090 DOI: 10.1515/jom-2020-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context West Virginia (WV) is afflicted by high rates of teenage pregnancy and births, opioid usage during pregnancy, and Neonatal Abstinence Syndrome births. Current efforts are ineffective at reducing teenage pregnancy and opioid misuse. While pregnancy and opioid usage may appear to be separate issues, a number of associations suggest adolescent pregnancy, opioid use, and other health-related outcomes are part of a cluster of negative health conditions that should be addressed holistically. Objective To determine whether there is an association between teenage pregnancy and negative health outcomes, including opioid misuse, among WV adolescent girls. Methods This study was conducted from July 2018 to March 2019. We obtained the most recently-available aggregate data at the county level for each of the 55 WV counties from the WV Department of Health and Human Resources (WVDHHR) on July 30, 2018, and we analyzed it during the fall of 2018. Raw data regarding pregnancy-related outcomes included WV girls between the ages of 15 and 19, was acquired between 2014 and 2017 by county, and was provided by the WVDHHR as a mean taken across all four years. Raw data regarding opioid misuse outcomes and heart-health variables included WV girls and women of all ages, was collected between 2014 and 2017 by county, and was provided by the WVDHHR as a mean taken across all four years, unless stated otherwise. Pearson correlation analysis was utilized to examine the associations between the teenage pregnancy and birth rates, opioid misuse, pregnancy, and heart-health-related statistics, as well as environmental variables. Results Teenage pregnancy and birth rates were positively associated with fetal death rates (r=0.308, p<0.05 and r=0.261, p<0.10, respectively). The rate of fetal death among mothers aged 15-19 years was higher in counties with higher teenage pregnancy and birth rates. As the pregnancy and birth rates increased, the rate of abortion increased even more (r=0.434 and r=0.304 respectively, both p<0.05). Teenage pregnancy and birth rates were associated with opioid overdose death rates for all WV girls and women (Pearson correlations, r=0.444 and 0.418 respectively, both p<0.01). WV counties with higher pregnancy and birth rates among girls aged 15-19 years had a greater proportion of women dying from opioid overdose. Teenage pregnancy and birth rates were both positively correlated with obesity, physical inactivity, high cholesterol, and high blood pressure (all r>0.39, all p<0.05). Neither the high-school dropout rate nor the number of WVDHHR listed clinics were associated with teenage pregnancy or birth rates (p>0.10). Conclusion Reduction of unintended teenage pregnancy may be viewed as a nontraditional, holistic, method of ameliorating the opioid misuse crisis in the state of WV. This recommendation should be part of a multi-pronged approach to mitigating the opioid epidemic in WV and all of Appalachia.
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Affiliation(s)
- Andrya J Durr
- West Virginia National Center for Excellence in Women's Health, West Virginia University , Morgantown , WV , USA.,Division of Exercise Physiology , West Virginia University , Morgantown , WV , USA
| | - Elizabeth A Critch
- West Virginia National Center for Excellence in Women's Health, West Virginia University , Morgantown , WV , USA
| | - M Paula Fitzgerald
- West Virginia National Center for Excellence in Women's Health, West Virginia University , Morgantown , WV , USA.,John Chambers College of Business and Economics, West Virginia University , Morgantown , WV , USA
| | - Kelly M Devlin
- West Virginia National Center for Excellence in Women's Health, West Virginia University , Morgantown , WV , USA.,Department of Obstetrics and Gynecology , School of Medicine, West Virginia University , Morgantown , WV , USA
| | - Kylie A Fuller
- West Virginia National Center for Excellence in Women's Health, West Virginia University , Morgantown , WV , USA.,Department of Obstetrics and Gynecology , School of Medicine, West Virginia University , Morgantown , WV , USA
| | - Roberta I Renzelli-Cain
- West Virginia National Center for Excellence in Women's Health, West Virginia University , Morgantown , WV , USA.,Department of Obstetrics and Gynecology , School of Medicine, West Virginia University , Morgantown , WV , USA
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Wallace JM. Competition for nutrients in pregnant adolescents: consequences for maternal, conceptus and offspring endocrine systems. J Endocrinol 2019; 242:T1-T19. [PMID: 30615597 DOI: 10.1530/joe-18-0670] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/08/2022]
Abstract
The competition for nutrients that arises when pregnancy coincides with continuing or incomplete growth in young adolescent girls increases the risk of preterm delivery and low birthweight with negative after-effects for mother and child extending beyond the perinatal period. Sheep paradigms involving nutritional management of weight and adiposity in young, biologically immature adolescents have allowed the consequences of differential maternal growth status to be explored. Although nutrient reserves at conception play a modest role, it is the dietary manipulation of the maternal growth trajectory thereafter which has the most negative impact on pregnancy outcome. Overnourishing adolescents to promote rapid maternal growth is particularly detrimental as placental growth, uteroplacental blood flows and fetal nutrient delivery are perturbed leading to a high incidence of fetal growth restriction and premature delivery of low birthweight lambs, whereas in undernourished adolescents further maternal growth is prevented, and depletion of the maternal body results in a small reduction in birthweight independent of placental size. Maternal and placental endocrine systems are differentially altered in both paradigms with downstream effects on fetal endocrine systems, organ development and body composition. Approaches to reverse these effects have been explored, predominantly targeting placental growth or function. After birth, growth-restricted offspring born to overnourished adolescents and fed to appetite have an altered metabolic phenotype which persists into adulthood, whereas offspring of undernourished adolescents are largely unaffected. This body of work using ovine paradigms has public health implications for nutritional advice offered to young adolescents before and during pregnancy, and their offspring thereafter.
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The relationships between timing of first childbirth, parity, and health-related quality of life. Qual Life Res 2017; 27:937-943. [PMID: 29280040 DOI: 10.1007/s11136-017-1770-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE A few studies have investigated the relationship between age at first childbirth and health-related quality of life (HRQoL). This study examined the relationship between age at first childbirth and HRQoL and whether parity mediates this timing of the first childbirth-HRQoL relationship in women aged 50 years or above. METHODS The study population included 5146 parous women ≥ 50 years in the cross-sectional survey, the Korea National Health and Nutrition Examination Survey 2010-2012. HRQoL was evaluated by the EuroQol five-dimensional descriptive system. Participants were grouped according to quartiles of age at first childbirth (ranges: 13-21, 22-23, 24-25, and 26-44 years). This study used linear regression analysis to examine the relationship between age at first childbirth and HRQoL and on each dimension. Mediation analysis was used to examine the contribution of age at first childbirth to HRQoL and to each dimension. RESULTS This study found the increasing pattern of HRQoL across quartiles of age at first childbirth (P for trend = 0.030). Odds of problems in self-care and anxiety/depression dimensions significantly increased across the quartiles. Women with later age at first childbirth tended to have better HRQoL (B = 0.352, P = 0.003); parity significantly contributed to this relationship. Decreasing parity accounted for 33.5% of the relationship between late first childbirth and increased HRQoL. Early age at first childbirth significantly increased odds of the mobility problem through increasing parity. CONCLUSIONS Women of an early age at first childbirth tended to have lower HRQoL through giving more deliveries. Our findings suggest that more attention needs to be given to women with early pregnancy and more delivery to prevent impaired HRQoL.
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Rosendaal NTA, Alvarado B, Wu YY, Velez MP, da Câmara SMA, Pirkle CM. Adolescent Childbirth Is Associated With Greater Framingham Risk Scores for Cardiovascular Disease Among Participants of the IMIAS (International Mobility in Aging Study). J Am Heart Assoc 2017; 6:e007058. [PMID: 29092844 PMCID: PMC5721784 DOI: 10.1161/jaha.117.007058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous studies observe associations between lifetime parity and cardiovascular disease, but relatively fewer investigate age at first childbirth (AFB). Herein, we examine the association of AFB with a summary cardiovascular risk measure (Framingham Risk Score [FRS]). METHODS AND RESULTS As part of the IMIAS (International Mobility in Aging Study), data were collected in 2012 among 1047 women, aged 65 to 74 years, from Canada, Albania, Colombia, and Brazil. FRSs were calculated to describe cardiovascular risk profiles, and linear regression analyses were performed, adjusting for early life and socioeconomic variables. Women with an AFB of <20 years were compared with women with an AFB of 20 to 24, 25 to 29, and ≥30 years, as well as nulliparous women. We also compared FRS between combinations of AFB and parity categories: nulliparous women, parity 1 to 3 combined with AFB <20 years, parity ≥4 with AFB <20 years, parity 1 to 3 with AFB ≥20 years, and parity ≥4 with AFB ≥20 years. Women with an AFB of <20 years had a higher mean FRS compared with all other AFB groups. Compared with the lowest AFB risk group (25-29 years), women with an AFB of <20 years had a 5.8-point higher mean FRS (95% confidence interval, 3.4-8.3 points). Nulliparous women presented the lowest mean FRS in all analyses. The analysis comparing combinations of AFB and parity categories showed no meaningful differences in FRS between women who had 1 to 3 childbirths and those who had ≥4 childbirths within the stratum of AFB <20 years, and in the stratum of AFB ≥20 years. CONCLUSIONS Our analyses suggest that nulliparity and AFB, rather than increasing parity, drive the association with cardiovascular disease risk.
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Affiliation(s)
| | - Beatriz Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Yan Yan Wu
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | - Maria P Velez
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Saionara M Aires da Câmara
- Faculty of Health Sciences of Trairí, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
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Abstract
OBJECTIVE No studies have addressed the relationship between the timing of first childbirth and primary open-angle glaucoma (POAG). The aim of the study was to identify the relationship between age at first childbirth and POAG and to examine the contribution of parity to the age at first childbirth-POAG relationship in postmenopausal women. METHODS The study population comprised postmenopausal women aged 50 or above in the cross-sectional Korea National Health and Nutrition Examination Survey from 2010 to 2012. Participants were grouped into quintiles by age at first childbirth for analysis. This study used logistic regression and mediation analyses with accommodations for the complex sampling structure of the survey. RESULTS Of the 4,057 women in the study population, the mean age at first childbirth was 23.7 years, and POAG prevalence was 3.4%. Prevalence of POAG was lowest in women whose first childbirth was between the ages of 27 and 44 (1.8%). Their risk for POAG (odds ratio [OR], 0.25; 95% CI, 0.10-0.65) was significantly lower than in those whose first childbirth was between the ages of 13 and 20, after adjustments for covariates. Late first delivery (≥27 y) was directly (OR, 0.57) and totally (OR, 0.85) associated with the decreased risk of POAG; decreased parity in women who delivered their first child at an older age attenuated the age at first childbirth-POAG relationship (OR of indirect effect, 1.50). CONCLUSIONS First childbirth at the age of 27 years or above decreases the risk of POAG in postmenopausal women. Decreased parity, caused by late first childbirth, attenuated the magnitude of the total effects of age at first childbirth on POAG.
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Abstract
OBJECTIVE No studies investigated the effects of age at first childbirth on cataract formation. This study was performed to determine the relationships of age at first childbirth to age-related cataract in postmenopausal women. METHODS Study population included 7,021 postmenopausal women in the Korea National Health and Nutrition Examination Survey, 2008 to 2012. Participants were subdivided in quartiles according to the age at first childbirth as follows: 13 to 21, 22 to 23, 24 to 25, and 26 to 44 years. We used odds ratios (ORs) and 95% confidence intervals (CIs) to address the relationships between age at first childbirth and age-related cataract with adjustments for confounders. RESULTS Mean participants' age and age at first childbirth were 64.4 and 23.6 years, respectively. The prevalence of any subtype of age-related cataract was 64.9%. Nuclear cataract prevalence was significantly higher in postmenopausal women with later age at first childbirth (24-25 and 26-44 years) compared with those with the earliest age at first childbirth (13-21 years): ORs (95% CIs) were 1.23 (1.05-1.45) and 1.24 (1.05-1.46), respectively. A significant linear trend across quintile was observed (P = 0.006). Age at first childbirth linearly 4% (OR 1.04, 95% CI 1.01-1.06) and 2% (OR 1.02, 95% CI 1.00-1.04) increased risk for nuclear and cortical cataract formation, respectively. The population-attributable fraction of nuclear cataract caused by the first childbirth at 24 years or later was 4.9% (95% CI 1.20%-8.59%, P = 0.009). CONCLUSIONS Later age of first childbirth was independently associated with higher risks of nuclear and cortical cataract in postmenopausal women. Further prospective studies are needed to elucidate the role of age at first childbirth in developing age-related cataract.
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Hall PS, Nah G, Howard BV, Lewis CE, Allison MA, Sarto GE, Waring ME, Jacobson LT, Manson JE, Klein L, Parikh NI. Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women's Health Initiative. J Am Coll Cardiol 2017; 69:2517-2526. [PMID: 28521890 PMCID: PMC5602586 DOI: 10.1016/j.jacc.2017.03.557] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF). OBJECTIVES This study examined the association between key reproductive factors and the incidence of HF. METHODS Women from a cohort of the Women's Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models. RESULTS Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52). CONCLUSIONS In post-menopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.
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Affiliation(s)
- Philip S Hall
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Gregory Nah
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Hyattsville, Maryland
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew A Allison
- Division of Preventive Medicine, University of California, San Diego, La Jolla, California
| | - Gloria E Sarto
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Molly E Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lisette T Jacobson
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liviu Klein
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Nisha I Parikh
- Division of Cardiology, University of California, San Francisco, San Francisco, California.
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