Age at first birth and long-term mortality for mothers: the Ohsaki cohort study

Fertility and pregnancy complications in female orthopaedic surgeons

BACKGROUND

While the number of female medical graduates continues to increase, only a few pursue an orthopaedic career. This is related to challenges regarding pregnancy and the peripartum period during orthopaedic training.

AIMS

To evaluate fertility, pregnancy-related complications and attitudes towards female orthopaedic surgeons in Israel.

METHODS

An electronic anonymous 34-question electronic web-based survey was sent to all Israeli female orthopaedic surgeons. Participation was voluntary. Questions were formulated to determine demographics, obstetrics medical history, teratogenic exposure, medical leave and breastfeeding parameters along with attitude towards pregnancy.

RESULTS

Twenty-six orthopaedic surgeons complied with the survey, 68% of all registered female orthopaedic surgeons. Participants age was 39.5 (±8.8). The average number of children for a female orthopaedic surgeon was 2.2 (±1.4), with an average of 1.3 (±1.1) deliveries during residency. The average age for a first child was 31.1 (±3.7) years. Four surgeons required fertility treatments and six had abortions. Thirty-eight per cent experienced pregnancy complications. Most surgeons were exposed to radiation and bone cement during pregnancy. The average duration of maternity leave was 19.4 (±9.9) weeks and return to work was associated with cessation of breastfeeding. Seventy-six per cent of surgeons felt that pregnancy had negatively influenced their training, and 12% reported negative attitudes from colleagues and supervisors.

CONCLUSIONS

Orthopaedic surgeons in Israel experience a delay in childbirth and higher rates of pregnancy complications. Most feel that their training is harmed by pregnancy. Programme directors should design a personalized support programme for female surgeons during pregnancy and the peripartum period.

Relationship between Gravidity, Parity, and Neurophysiological Features in Carpal Tunnel Syndrome (CTS) Patients with a History of Pregnancy

BACKGROUND

It is not yet clear if gravidity and parity have any relationships with the electrodiagnostic parameters of carpal tunnel syndrome (CTS).

OBJECTIVE

To determine whether there is a relationship between electrodiagnostic findings, gravidity, and parity number in CTS.

MATERIALS AND METHODS

Female patients over 18 years of age with CTS were included in this retrospective cohort study. The gravidity/parity number, median nerve compound muscle action potential (CMAP), and compound nerve action potential (CNAP) of the patients were analyzed. The two subgroups of the Boston carpal tunnel syndrome questionnaire (BCTSQ): The Symptom Severity Scale (SSS) and Functional Severity Scale (FSS) were applied to the patients. CTS patients were divided into two groups aged at first pregnancy ≤20 years and >20 years.

RESULTS

One hundred and eight CTS extremities (seven right-sided CTS, three left-sided CTS, 49 bilateral CTS) of 59 patients were included. The median (interquartile range: 25%-75%) number of gravidity, parity, and abortion were 3 (2-5), 3 (2-4), and 0 (0-0), respectively. Right-sided CTS patients at the age of first pregnancy ≤20 years had higher BCTSQ-SSS/FSS scores and median nerve CMAP latency compared to patients at the age of first pregnancy >20 years (P = 0.029 for SSS; P = 0.042 for FSS; and P = 0.041 for CMAP latency). A negative correlation was found between the gravidity/parity numbers and median nerve CNAP/CMAP amplitudes (P = 0.028/0.031, r = -0.293/-0.289 for CNAP amplitude; and P = 0.006/0.035, r = -0.363/-0.283 for CMAP amplitude).

CONCLUSION

Neurophysiological findings worsen as the number of gravidity and parity increase. Electrodiagnostic and clinical features of CTS may be worsening in females below 20 years at first pregnancy.

Structural transition of parenthood among Chinese nulliparous couples with planned pregnancies, 2013-2019

BACKGROUND

The postponement of parenthood is a global public health issue that has received attention of many public health experts. However, few studies have investigated the postponement in marriage age, marriage and conception interval, and pregnancy age in terms of demographic and regional heterogenicities.

METHODS

This is a cross-sectional, registry-based study, and a total of 13 894 601 nulliparous couples who participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013-2019 were included. We calculated annual percentage change and forest plots for marriage age, marriage and conception interval, and pregnancy age.

RESULTS

Late marriage (marriage age ≥ 35 years), long marriage and conception interval (marriage and conception interval ≥ 2 years), and advanced pregnancy (pregnancy age ≥ 35 years) increased from 1.20%, 22.01%, and 1.88% in 2013 to 1.69%, 32.75%, and 2.79% in 2019, respectively. The corresponding annual percentage changes were 6.55%, 8.44%, and 8.17%. Participants without higher education had a higher annual percentage change, but comparable prevalence for long marriage and conception interval with participants with higher education. Participants residing in second- or new first-tier cities, and the northeast of China who had a higher prevalence of parenthood postponement also had higher corresponding annual percentage changes.

CONCLUSIONS

Structural postponement of parenthood with demographic and regional heterogenicities was observed among Chinese nulliparous couples with planned pregnancies during 2013-2019. Inclusive and comprehensive parenting support should be developed and implemented in mainland China to minimize the negative health effects arising from the postponement, especially for couples without higher education and living in new first/second-tier cities or the northeast China.

Fertility behaviors and mid-late-life health status in China: From a life-course perspective

Despite extensive research on the impact of fertility behaviors on mid-late-life health, conclusions remain inconsistent, and understanding is limited regarding the role of fertility-correlated life events in this causality. This study uses the 2018 wave and life-history information of the China Health and Retirement Longitudinal Study (CHARLS) dataset to explore how the number of children born (NCB) and age at first birth (AFB) influence later-life health. It also examines the effects of early-life educational attainment and mid-late-life caregiving on later-life health from a life-course perspective. Health measures include the Health Deficit Index (HDI), Activities of Daily Living (ADL), and Mini-Mental State Examination (MMSE). Results from the instrumental variables (IV) approach indicate that higher NCB predicts worse health, while later AFB predicts better later-life health. These findings remain robust with different measures of fertility behaviors, and in models that control for cohort and community fixed-effects. However, introducing education variables could disrupt the causality between fertility behaviors and later-life health, but not with caregiving variables. This suggests a potential "horse race" effect between education and fertility behaviors, both of which significantly influence later-life health. Therefore, understanding this causality and formulating policy for an aging society from a life-course perspective is essential.

Primiparity at an Advanced Age: Emerging Pattern Needing Courtesy to Achieve SDG Maternal Health Targets

Primiparity at an advanced age, which means having a first birth at age 35 years and beyond, is a recent emerging phenomenon in low- and middle-income countries that significantly affects maternal and child health. However, this evolving phenomenon has not been given due attention as many countries still deal with health-related issues during early-age pregnancies. This paper describes the emerging trend of primiparity during advanced age, focusing on low- and middle-income countries, elaborates on the linked adverse feto-maternal outcomes, and outlines potential interventions to bring the scenario to policymakers' and practitioners' attention.

Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019

Background

Being a mother for the first time is the most significant event in a woman's life. "Age at first birth" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level.

Methods

Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors.

Results

The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086).

Conclusion

The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.

Age at first birth and risk of urinary incontinence after delivery: a dose-response meta-analysis

Studies investigating the impact of age at first birth on urinary incontinence after delivery have reached inconsistent conclusions. We performed this systematic review and meta-analysis of studies assessing the risk of urinary incontinence after delivery, regardless of the type, with age at first birth. MEDLINE via PubMed and Web of science databases were searched up to March 13, 2021. Restricted cubic splines were used to model the dose–response association. Twelve publications were included in this meta-analysis. The summary odds ratio (OR) and 95% confidence interval (CI) per 1-year increase in age at first birth were 1.01 (95% CI (0.99, 1.02)) for urinary incontinence (America: 1.00 (0.99, 1.00); Europe: 1.03 (1.00, 1.06); Asian: 0.99 (0.89, 1.10)). A non-linear dose–response (P_nonlinearity < 0.01) indicated that age at first birth older than 32 (P < 0.05) increases the risk of urinary incontinence. First birth before age 32 make decrease the risk of urinary incontinence after delivery.

Bayesian Shared Frailty Models for Time to First Birth of Married Women in Ethiopia: Using EDHS 2016

Introduction

The primary effect of the fertility process is the birth of the first child. The ages at which women establish marital union and give their first birth depend on and result in varying demographic features. This research demonstrates how to examine the effect of numerous factors on married women's delay to first birth in Ethiopia using Bayesian parametric models with gamma shared frailty distribution.

Methods

This study analyzed data from the 2016 EDHS on factors related to the time of married women to first birth. A sample of 8810 married women from all parts of Ethiopia participated in the study. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to compare several parametric models with gamma shared frailty distributions to find the best model (BIC). Finally, when the prior data was taken into account, the chosen model was proven to be accurate (Bayesian approach).

Results

The median survival time for the first birth after marriage is 24 years (95% CI; 23.4, 25.3). The result shows that the place of residence, the access to media, the level of education of the mother, the education level of the husband, the use of the head of the contraceptives, and the sex of the household are statistically associated with the time to first birth of married women. The Weibull-gamma shared frailty model under the Bayesian approach was found to be the best model that fit the time to first birth data in this study. The result also showed that there is heterogeneity between regions of married women.

Conclusion

To slow the increase in the Ethiopian population, families must be taught how to use contraception, and rural populations must be educated on the necessity of increasing the length of the first birth gap rather than encouraging early marriage. In general, attempts to reduce fertility by raising the age of the first marriage must consider the social and cultural settings in which marriage takes place. On the other hand, the campaign against early marriage should focus on the sociocultural, physiological, and psychological effects, as well as the reduction of reproduction.

Age at first birth and lung cancer: a two-sample Mendelian randomization study

Background

Growing evidence suggests that female reproductive factors, like age at first birth (AFB), may play a potential role in the progression of lung cancer (LC). However, previous studies are susceptible to confounding factors, inadequate attention to variation by histology or reverse causality. Few studies have comprehensively evaluated their association and the causal effect remains unclear.

Methods

We aimed to determine whether AFB is causally correlated with the risk of LC, by means of utilizing aggregated data from the large genome-wide association studies conducted on AFB (251,151 individuals) and data of LC from International Lung and Cancer Consortium (ILCCO, 11,348 cases and 15,861 controls). We used 10 AFB-related single nucleotide polymorphisms as instrument variables and applied several two-sample Mendelian randomization (MR) methods. Secondary results according to different histological subtypes of lung cancer were also implemented.

Results

Conventional inverse-variance weighted method indicated that genetic predisposition towards number unit (1 year) increase of AFB was associated with a 18% lower risk of LC [odds ratio (OR) =0.82, 95% confidence interval (CI): 0.69–0.97; P=0.029]. When results were examined by histotypes, an inverse association was observed between genetically predisposed number unit (1 year) increase of AFB and lung adenocarcinoma (OR =0.75, 95% CI: 0.59–0.97, P=0.017) but not with squamous cell lung cancer (OR =0.77, 95% CI: 0.57–1.05, P=0.103). The results demonstrated no association between number unit decrease of AFB and LC. Pleiotropy was not presented through sensitivity analyses including MR pleiotropy residual sum and outlier test (P=0.412). Genetic predisposition towards older AFB was additionally associated with longer years of schooling (OR =1.12, 95% CI: 1.08–1.16, P<0.001), lower body mass index (OR =0.93, 95% CI: 0.88–0.98, P=0.004) and less alcohol consumption (OR =0.99, 95% CI: 0.99–1.00, P=0.004).

Conclusions

Our study suggested that older AFB was a causal protective factor in the progression of LC. Further studies elucidating the potential mechanisms are needed.

Factors associated with age of mother at first birth in Albania: application of quantile regression model

The objective of this study was to explore the risk factors that can determine the age of mother at first birth in Albania. The necessary information was extracted from a nationally representative sample survey, Albania Demographic and Health Survey, 2017-18 dataset. To identify the possible risk factors of the age of mother at first birth, we applied quantile regression model. The mean age of mother at first birth was found to be 22.38 years with standard deviation of 3.56 years. The minimum and maximum age was reported 15 and 45 years, respectively. From the result of quantile regression, respondent's current age, education level and partner's higher education level were found positive impact on age of the mother at first birth. However, rural area, partner's age and smoking status found negative impact on age of the mother at first birth. This study suggests that women's education should be more prioritized because it can interfere with the idea of early marriage. Awareness can also be raised by social activities since the improvement of social conditions and reduction of social deprivation can increase the age of mother at first birth.

Time to first birth and its predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

BACKGROUND

High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival.

METHODS

A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey, 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value < 0.05.

RESULTS

The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR = 2.33, 95% CI 2.08-2.63), secondary education level (AHR = 0.84, 95% CI 0.78-0.96), higher education level (AHR = 0.75, 95% CI 0.65-0.85), intercourse before 15 years in the married stratum (AHR = 23.81, 95% CI 22.22-25.64), intercourse 15-17 years in married stratum (AHR = 5.56, 95% CI 5.26-5.88), spousal age difference (AHR = 1.11, 95% CI 1.05-1.16),and use of contraceptives (AHR = 0.91, 95% CI 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR = 1.16, 95% CI 1.13-1.20) than low risk clusters adjusting for other factors.

CONCLUSION

In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.

Infertility and mortality

BACKGROUND

Infertility affects 1 in 10 American reproductive-age women. The impact of this disease beyond the reproductive years is largely unknown.

OBJECTIVE

The objective of the study was to determine the association of infertility history with all-cause and cause-specific mortality.

STUDY DESIGN

This secondary analysis of a multicenter randomized clinical trial included 75,784 women (aged 55-74 years) prospectively enrolled in the Prostate, Lung, Colorectal, and Ovarian cancer-screening trial from 1992 through 2001 and followed up a minimum of 10 years for health-related outcomes and death (856,935 person-years). We examined the association of infertility history (inability to conceive for 1 year or greater) of all-cause and cause-specific mortality using disease risk score-adjusted Cox-proportional hazard regression models.

RESULTS

Infertile women had a 10% increased risk of death (from any cause) during the study period compared with the unexposed (adjusted hazard risk, 1.10, 95% confidence interval, 1.02-1.18, P = .010). This effect was predominantly noted in women at an otherwise low risk of mortality who had a 26% increased risk of death (adjusted hazard risk, 1.26, 95% confidence interval, 1.12-1.42, P < .001). No differences in cardiovascular or diabetic mortality were noted. The risk of cancer death at any time over the study period was increased by 23% in infertile women compared with the unexposed (adjusted hazard risk, 1.23, 95% confidence interval, 1.10-1.37, P < .001). This effect was predominantly noted in women at an otherwise low risk of cancer mortality who had a 47% increased risk of cancer death (adjusted hazard risk, 1.47, 95% confidence interval, 1.25-1.73, P < .001). While no differences are seen in the risk of death from endometrial or ovarian cancer, the risk of death from breast cancer was more than doubled in infertile women at an otherwise low risk of breast cancer death compared with the unexposed (adjusted hazard risk, 2.64, 95% confidence interval, 1.71-4.08, P < .001).

CONCLUSION

Infertility is a harbinger of future morbidity and mortality. Infertile women are at an increased risk of all-cause and cancer-related mortality. Consideration of infertility history in health care maintenance presents an opportunity for screening and early intervention for long-term health outcomes.

The role of children and their socioeconomic resources for the risk of hospitalisation and mortality - a nationwide register-based study of the total Swedish population over the age 70

Background

Previous studies have shown that mortality in old age is associated with both number of children and their socioeconomic resources. The underlying mechanisms are unclear, as well as when during the process of health deterioration the advantage of parents over non-parents arises. This study aims to examine how the number of children and their socioeconomic resources are associated with different health outcomes among their parents, namely the hazard for i) first hospitalisation, ii) re-admission, iii) mortality after first hospitalisation, and iv) overall mortality.

Method

This longitudinal cohort study includes all individuals born 1920–1940 who were living in Sweden at age 70 years (890,544 individuals). Individuals were linked to their offspring and spouse using administrative registers and followed for up to 25 years. Associations were estimated using multivariable Cox models adjusted for index persons’ education and income, marital status, their partners’ education, and age at first birth.

Results

In this study, having children was associated with reduced mortality risk of their parents, but not with the risk of being hospitalised, which increased as number of children increased. A higher education of children was protective for all parental outcomes independent of number of children and their financial resources. In fact, income of the children was only weakly associated with the health of their parents.

Conclusions

The benefit of having children compared to childlessness for health in old age seems to arise once individuals have become ill rather than before. Children’s education is important for parental health and mortality, in fact more important than the number of children itself in this Swedish cohort.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1134-y) contains supplementary material, which is available to authorized users.