Age at First Birth and the Risk of Endometrial Cancer Incidence: A Pooled Analysis of Two Prospective Cohort Studies among Japanese Women

The association of female reproductive factors with history of cardiovascular disease: a large cross-sectional study

BACKGROUND

This study aimed to explore the association of female reproductive factors (age at first birth (AFB), age at last birth (ALB), number of pregnancies, and live births) with history of cardiovascular disease (CVD).

METHODS

A total of 15,715 women aged 20 years or over from the National Health and Nutrition Examination Surveys from 1999 to 2018 were included in our analysis. Weighted multivariable logistic regression analysis and restricted cubic spline (RCS) model were used to evaluate the association of AFB and ALB with history of CVD in women. Additionally, the relationship between the number of pregnancies, and live births and history of CVD was also explored.

RESULTS

After adjusting for potential confounding factors, the RCS plot showed a U-curve relationship between AFB, ALB and history of CVD. Among them, AFB was associated with congestive heart failure (CHF), heart attack, and stroke in a U-shaped curve. Additionally, this U-shaped correlation also exists between ALB and CHF and stroke. However, the number of pregnancies and live births was liner positive associated with history of CVD, including coronary heart disease, CHF, angina pectoris, heart attack, and stroke.

CONCLUSIONS

Women with younger or later AFB and ALB have higher odds of CVD in later life. Further study is warranted to verify the underlying mechanisms of this association.

Association between age at first birth and postpartum depression: A two-sample mendelian randomization analysis

Background

Previous observational research has documented an association between age at first childbirth (AFB) and postpartum depression (PPD). However, the causal relationship remains unclear. This study aimed to assess the causal effects of AFB on PPD using a two-sample Mendelian randomization (MR) analysis.

Methods

Three sets of instrumental variables were obtained from the United Kingdom Biobank (UK Biobank), Neale Lab consortium and a meta-analysis of genome-wide association studies (GWAS). Single-nucleotide polymorphisms (SNPs) associated with the PPD phenotype were obtained from the Finngen consortium, which included 13,657 cases and 236,178 controls. Inverse variance weighted (IVW), weighted median, weighted mode, and MR-Egger methods to evaluate causal effects. Heterogeneity was assessed using Cochran's Q test and funnel plots. Horizontal pleiotropy and sensitivity were assessed using the MR-Egger intercept test and "leave-one-out" analysis, respectively. Further meta-analysis was performed to validate the robustness of this relationship. Additionally, the potential mediating effects of risk factors associated with PPD were analyzed.

Results

Strong causal effects between AFB and PPD was found in both IVW and weighted median methods, which was further supported by meta-analysis (IVW, odds ratio [OR] 0.59 [95% confidence interval (CI) 0.36-0.96, p = 0.03]; weighted median, OR 0.59 [95% CI 0.37-0.95, p = 0.03]). The power of the MR supports the robustness of the findings. Heterogeneity or horizontal pleiotropy was not observed. Major depressive disorders, family income levels, and marital stress were identified as potential mediating factors in the causal relationships.

Conclusion

Results of MR analysis supported the causal effect of increased AFB in reducing the risk for PPD.

Sleep duration and the risk of endometrial cancer incidence among Japanese women: A pooled analysis of the Miyagi Cohort Study and the Ohsaki Cohort Study

OBJECTIVE

Endometrial cancer has been increasing worldwide, and is one of the most common female hormone-related cancers. The purpose of this study was to examine the association between sleep duration and risk of endometrial cancer among Japanese women.

METHODS

We conducted a pooled analysis of two prospective studies conducted among residents of Miyagi Prefecture in rural northern Japan. A total of 36,537 women aged 40-79 years participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994. The participants responded to a self-administered questionnaire that including sleep duration. Sleep duration was assessed at the baseline using a self-administered questionnaire. The participants entered the mean integer number representing the hours of sleep taken per day during the previous year. We divided the participants into three groups (≤6 h, 7-8 h, or ≥9 h). Cox proportional hazards regression analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for endometrial cancer incidence.

RESULTS

During 745,993 person-years of follow-up, we identified 146 incident cases of endometrial cancer. Compared with women who slept 7-8 h per day, the multivariate HR (95%CI) for endometrial cancer incidence was 1.07 (0.72-1.60) for those who slept 6 h or less, and 1.05 (0.57-1.93) for those who slept 9 h or longer (p-trend=0.57).

CONCLUSION

In analysis of two population -based prospective cohort studies conducted among Japanese women, we found no significant associations between sleep duration and the incidence of endometrial cancer.

Complications of Pregnancy and the Risk of Developing Endometrial or Ovarian Cancer: A Case-Control Study

BACKGROUND

The association of complications of pregnancy and the risk of developing gynecological cancer is controversial with the limited study. In this study, we investigated the association of preeclampsia, or gestational diabetes mellitus (GDM), or large for gestational age (LGA), or intrauterine growth restriction (IUGR) and the risk of endometrial or ovarian cancer.

METHODS

In this case-control study, 189 women with endometrial cancer and 119 women with ovarian cancer were included. 342 women without gynecological cancers were randomly selected as a control group. Data on the history of pregnancy and age at diagnosis of gynecological cancer as well as the use of intrauterine devices (IUDs) were collected.

RESULTS

Women with a history of preeclampsia or IUGR did not have an increased risk of developing endometrial or ovarian cancer. While women with a history of GDM or with the delivery of LGA infant increased the risk of developing endometrial cancer but not ovarian cancer. The odds of women with a history of GDM or with the delivery of LGA infant developing endometrial cancer was 2.691 (95% CI: 1.548, 4.3635, p=0.0003), or 6.383 (95% CI: 2.812, 13.68, p<0.0001) respectively, compared to the controls. The odds ratio of women who did not use IUDs developing ovarian cancer was 1.606 (95% CI: 1.057, 2.434), compared to the controls. There was no association of age at first birth and developing endometrial or ovarian cancer.

CONCLUSION

Our observational data suggested that GDM and delivery of an LGA infant are associated with an increased risk of endometrial cancer.

Endometrial carcinoma in a 14-year-old: A case report

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We present a case of endometrial carcinoma (EC) in a 14-year-old girl with no risk factors for EC.

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The patient received MPA therapy and endometrial curettage.

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At 47 weeks after her last MPA treatment, she has had no recurrence.

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EC should be considered in diagnosing juveniles with sustained abnormal uterine bleeding, even those without risk factors.