1
|
Hawk LW, Murphy TF, Hartmann KE, Burnett A, Maguin E. A randomized controlled trial of a team science intervention to enhance collaboration readiness and behavior among early career scholars in the Clinical and Translational Science Award network. J Clin Transl Sci 2023; 8:e6. [PMID: 38384923 PMCID: PMC10877513 DOI: 10.1017/cts.2023.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Despite the central importance of cross-disciplinary collaboration in the Clinical and Translational Science Award (CTSA) network and the implementation of various programs designed to enhance collaboration, rigorous evidence for the efficacy of these approaches is lacking. We conducted a novel randomized controlled trial (RCT; ClinicalTrials.gov identifier: NCT05395286) of a promising approach to enhance collaboration readiness and behavior among 95 early career scholars from throughout the CTSA network. Methods Participants were randomly assigned (within two cohorts) to participate in an Innovation Lab, a week-long immersive collaboration experience, or to a treatment-as-usual control group. Primary outcomes were change in metrics of self-reported collaboration readiness (through 12-month follow-up) and objective collaboration network size from bibliometrics (through 21 months); secondary outcomes included self-reported number of grants submitted and, among Innovation Lab participants only, reactions to the Lab experience (through 12 months). Results Short-term reactions from Innovation Lab participants were quite positive, and controlled evidence for a beneficial impact of Innovation Labs over the control condition was observed in the self-reported number of grant proposals in the intent-to-treat sample. Primary measures of collaboration readiness were near ceiling in both groups, limiting the ability to detect enhancement. Collaboration network size increased over time to a comparable degree in both groups. Conclusions The findings highlight the need for systematic intervention development research to identify efficacious strategies that can be implemented throughout the CTSA network to better support the goal of enhanced cross-disciplinary collaboration.
Collapse
Affiliation(s)
- Larry W. Hawk
- Department of Psychology, University at
Buffalo, Buffalo, NY, USA
| | - Timothy F. Murphy
- Jacobs School of Medicine & Biomedical Sciences,
University at Buffalo, Buffalo, NY,
USA
- Clinical and Translational Science Institute, University at
Buffalo, Buffalo, NY, USA
| | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt
University, Nashville, TN,
USA
- Department of Medicine, Vanderbilt University,
Nashville, TN, USA
- Vanderbilt Institute for Clinical and Translational Research,
Vanderbilt University, Nashville,
TN, USA
| | | | - Eugene Maguin
- Department of Psychology, University at
Buffalo, Buffalo, NY, USA
| |
Collapse
|
2
|
Sundermann AC, Slaughter JC, Velez Edwards DR, Hartmann KE. Time-Varying Exposures and Miscarriage: A Comparison of Statistical Models Through Simulation. Am J Epidemiol 2023; 192:790-799. [PMID: 36721373 PMCID: PMC10423631 DOI: 10.1093/aje/kwad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/13/2022] [Accepted: 01/30/2023] [Indexed: 02/02/2023] Open
Abstract
Epidemiologists face a unique challenge in measuring risk relationships involving time-varying exposures in early pregnancy. Each week in early pregnancy is distinct in its contribution to fetal development, and this period is commonly characterized by shifts in maternal behavior and, consequently, exposures. In this simulation study, we used alcohol as an example of an exposure that often changes during early pregnancy and miscarriage as an outcome affected by early exposures. Data on alcohol consumption patterns from more than 5,000 women in the Right From the Start cohort study (United States, 2000-2012) informed measures of the prevalence of alcohol exposure, the distribution of gestational age at cessation of alcohol use, and the likelihood of miscarriage by week of gestation. We then compared the bias and precision of effect estimates and statistical power from 5 different modeling approaches in distinct simulated relationships. We demonstrate how the accuracy and precision of effect estimates depended on alignment between model assumptions and the underlying simulated relationship. Approaches that incorporated data about patterns of exposure were more powerful and less biased than simpler models when risk depended on timing or duration of exposure. To uncover risk relationships in early pregnancy, it is critical to carefully define the role of exposure timing in the underlying causal hypothesis.
Collapse
Affiliation(s)
| | | | | | - Katherine E Hartmann
- Correspondence to Katherine E. Hartmann, Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203 (e-mail: )
| |
Collapse
|
3
|
Jasper EA, Hellwege JN, Piekos JA, Jones SH, Hartmann KE, Mautz B, Aronoff DM, Edwards TL, Edwards DRV. Genetically-predicted placental gene expression is associated with birthweight and adult body mass index. Sci Rep 2023; 13:322. [PMID: 36609580 PMCID: PMC9822919 DOI: 10.1038/s41598-022-26572-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
The placenta is critical to human growth and development and has been implicated in health outcomes. Understanding the mechanisms through which the placenta influences perinatal and later-life outcomes requires further investigation. We evaluated the relationships between birthweight and adult body mass index (BMI) and genetically-predicted gene expression in human placenta. Birthweight genome-wide association summary statistics were obtained from the Early Growth Genetics Consortium (N = 298,142). Adult BMI summary statistics were obtained from the GIANT consortium (N = 681,275). We used S-PrediXcan to evaluate associations between the outcomes and predicted gene expression in placental tissue and, to identify genes where placental expression was exclusively associated with the outcomes, compared to 48 other tissues (GTEx v7). We identified 24 genes where predicted placental expression was significantly associated with birthweight, 15 of which were not associated with birthweight in any other tissue. One of these genes has been previously linked to birthweight. Analyses identified 182 genes where placental expression was associated with adult BMI, 110 were not associated with BMI in any other tissue. Eleven genes that had placental gene expression levels exclusively associated with BMI have been previously associated with BMI. Expression of a single gene, PAX4, was associated with both outcomes exclusively in the placenta. Inter-individual variation of gene expression in placental tissue may contribute to observed variation in birthweight and adult BMI, supporting developmental origins hypothesis.
Collapse
Affiliation(s)
- Elizabeth A Jasper
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Jacklyn N Hellwege
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
| | | | - Sarah H Jones
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine E Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian Mautz
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN, USA
- Population Analytics, Analytics and Insights, Data Sciences, Janssen Research & Development, Spring House, PA, USA
| | - David M Aronoff
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Todd L Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA.
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
4
|
Adgent MA, Vereen S, McCullough A, Jones SH, Torstenson E, Velez Edwards DR, Hartmann KE, Carroll KN. Periconceptional folic acid supplementation and child asthma: a Right From the Start follow-up study. J Matern Fetal Neonatal Med 2022; 35:10232-10238. [PMID: 36117404 PMCID: PMC9810277 DOI: 10.1080/14767058.2022.2122795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE High maternal folic acid exposure has been studied as a risk factor for child asthma with inconclusive results. Folic acid supplementation that begins before pregnancy may propagate high exposures during pregnancy, particularly in regions with fortified food supplies. We investigated whether folic acid supplementation initiated periconceptionally is associated with childhood asthma in a US cohort. MATERIALS AND METHODS We re-contacted mother-child dyads previously enrolled in a prospective pregnancy cohort and included children age 4 to 8 years at follow-up (n = 540). Using first trimester interviews, we assessed whether initial folic acid-containing supplement (FACS) use occurred near/before estimated conception ("periconceptional") or after (during the "first trimester"). Follow-up questionnaires were used to determine if a child ever had an asthma diagnosis ("ever asthma") or asthma diagnosis with prevalent symptoms or medication use ("current asthma"). We examined associations between FACS initiation and asthma outcomes using logistic regression, excluding preterm births and adjusting for child age, sex, maternal race, maternal education, and parental asthma. RESULTS Approximately half of women initiated FACS use periconceptionally (49%). Nine percent of children had "ever asthma" and 6% had "current asthma." Periconceptional initiation was associated with elevated odds of ever asthma [adjusted odds ratio (95% Confidence Interval): 1.65 (0.87, 3.14)] and current asthma [1.87 (0.88, 4.01)], relative to first trimester initiation. CONCLUSION We observed positive, but imprecisely estimated associations between periconceptional FACS initiation and child asthma. Folic acid prevents birth defects and is recommended. However, larger studies of folic acid dosing and timing, with consideration for childhood asthma, are needed.
Collapse
Affiliation(s)
- Margaret A. Adgent
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Shanda Vereen
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- College of Public Health, University of South Florida, Tampa, FL
| | - Alexis McCullough
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah H. Jones
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology; Vanderbilt University Medical Center, Nashville, TN
- Women’s Health Research at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Eric Torstenson
- Department of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology; Vanderbilt University Medical Center, Nashville, TN
- Women’s Health Research at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology; Vanderbilt University Medical Center, Nashville, TN
- Women’s Health Research at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Kecia N. Carroll
- Division of General Pediatrics, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
5
|
Sundermann AC, Velez Edwards DR, Hartmann KE. Maternal alcohol metabolism predicted by alcohol dehydrogenase genotype and the association between alcohol consumption and miscarriage. Am J Obstet Gynecol 2022; 227:786-788.e2. [PMID: 35597276 DOI: 10.1016/j.ajog.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Ave., Ste. 800, Nashville, TN 37203; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
6
|
Murff HJ, Greevy RA, Sanghani RS, Hartmann KE, Hartert TV, Graves CR, Lee SS, Tindle HA. Investigating N-3 Fatty Acids to prevent Neonatal Tobacco-related outcomeS (INFANTS): study protocol for a double-blind, randomized, placebo-controlled parallel clinical trial of n-3 polyunsaturated fatty acids in pregnant smokers. Trials 2021; 22:922. [PMID: 34906201 PMCID: PMC8669400 DOI: 10.1186/s13063-021-05865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes, increasing the risk of preterm birth, intrauterine growth restriction and sudden infant death syndrome. Fewer than half of pregnant smokers can quit on their own. Identifying safe and effective therapies to prevent tobacco-related adverse pregnancy outcomes and/or increase smoking cessation in pregnant women would have a substantial public health impact. Cigarette smoking is associated with a relative deficiency in circulating n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) levels. A recent analysis found that smokers taking n-3 LCPUFAs during pregnancy had a reduction in preterm labor risk when compared to non-smokers. Studies have shown that supplemental n-3 LCPUFAs may also reduce nicotine cravings and daily cigarette use. Thus, smokers may benefit from supplemental n-3 LCPUFAs by lowering the risk of preterm labor and/or increased smoking cessation. To address important remaining knowledge gaps, we propose the Investigating N-3 Fatty Acids to prevent Neonatal Tobacco related outcomeS (INFANTS). METHODS The INFANTS study is a multicenter, randomized, double-blind, placebo-controlled study that will randomize 400 pregnant smokers to either supplemental n-3 LCPUFAs or placebo. Participants will be enrolled between 12 and 24 weeks' gestation and followed until 6 weeks after delivery. We will recruit from clinical centers throughout Middle Tennessee. We will assess smoking behavior after 12 weeks of supplementation using self-report and validated biomarkers of tobacco exposure. We will measure response to supplementation using biological markers of n-3 LCPUFA status. Our primary endpoint will be preterm labor as reflected by gestational age at delivery. Our secondary endpoint will be change from baseline in cigarettes per day at 12 weeks. DISCUSSION This study tests the hypothesis that smoking-induced n-3 LCPUFA deficiencies contribute to tobacco-related adverse pregnancy outcomes and that supplementation of n-3 LCPUFAs in pregnant smokers may prevent these complications. If our study demonstrates that supplemental n-3 LCPUFAs are effective at reducing the risk of tobacco-related adverse neonatal outcomes and/or reducing tobacco use during pregnancy, our results could have an immediate and major impact on pregnancy care and neonatal outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04417595. Registered on April 21, 2020.
Collapse
Affiliation(s)
- Harvey J Murff
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37232, USA.
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Reesha S Sanghani
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, USA
| | - Katherine E Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, USA
| | - Tina V Hartert
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | | | - Scott S Lee
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37232, USA
| | - Hilary A Tindle
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37232, USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
7
|
Szczygiel LA, Jones RD, Drake AF, Drake WP, Ford DE, Hartmann KE, Libby AM, Marshall BA, Regensteiner JG, Yaffe K, Jagsi R. Insights from an Intervention to Support Early Career Faculty with Extraprofessional Caregiving Responsibilities. Womens Health Rep (New Rochelle) 2021; 2:355-368. [PMID: 34476418 PMCID: PMC8409229 DOI: 10.1089/whr.2021.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/03/2022]
Abstract
Background: Insufficient support for balancing career and family responsibilities hinders retention of physician-scientists. Programs to improve retention of this important group of faculty are crucial. Understanding the experiences of program implementers is key to refining and improving program offerings. Methods: We conducted an interpretive, descriptive, and qualitative study as part of an ongoing evaluation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS) awards. We conducted telephone interviews with 12 program directors representing all 10 US medical schools who received the Doris Duke funding in 2016. Results: Of the 12 participants, 10 were women (83.3%). Participating program directors perceived the FRCS award as capable of producing paradigmatic changes regarding how responsibilities at home and work in academic medicine are viewed and integrated by early-career faculty members. The main qualitative themes that captured directors' experiences implementing the program were as follows: (1) championing a new paradigm of support, (2) lessons learned while implementing the new paradigm, (3) results of the new paradigm, and (4) sustaining the paradigm. Conclusions: These findings may help to inform development of similar programs to retain and support the career progress of physician-scientists with extraprofessional caregiving responsibilities. The interviews illuminate ways in which the Doris Duke FRCS award has driven institutional culture change by normalizing discussion and prompted reassessment of extraprofessional challenges and how best to aid early-career faculty members in overcoming these challenges.
Collapse
Affiliation(s)
- Lauren A. Szczygiel
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rochelle D. Jones
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amelia F. Drake
- Division of Pediatric Otolaryngology, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Wonder P. Drake
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Daniel E. Ford
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology and Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Anne M. Libby
- Department of Emergency Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bess A. Marshall
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Judith G. Regensteiner
- Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
Sundermann AC, Aldridge TD, Hartmann KE, Jones SH, Torstenson ES, Edwards DRV. Uterine fibroids and risk of preterm birth by clinical subtypes: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:560. [PMID: 34404387 PMCID: PMC8369624 DOI: 10.1186/s12884-021-03968-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fibroids are present in approximately one in ten pregnancies and are inconsistently linked with preterm birth. We sought to determine the association between fibroids and preterm birth in a prospective cohort with standardized research ultrasounds for characterizing fibroids in early pregnancy while accounting for the clinical paths that precede preterm birth. Methods Participants who were pregnant or planning a pregnancy were recruited from communities in three states between 2000 and 2012. Members of this prospective cohort had a research ultrasound in the first trimester to establish pregnancy dating and to record detailed information about the presence, size, number, and location of fibroids. Baseline information from time of enrollment and a detailed first trimester interview contributed key information about candidate confounders. Birth outcomes, including clinical classification of type of preterm birth (preterm labor, preterm premature rupture of membranes, and medically indicated preterm birth) were cross-validated from participant report, labor and delivery records, and birth certificate data. Results Among 4,622 women with singleton pregnancies, 475 had at least one fibroid (10.3%) and 352 pregnancies resulted in preterm birth (7.6%). Prevalence of fibroids was similar for women with preterm and term births (10.2% vs. 10.3%). Fibroids were not associated with increased risk of preterm birth after taking into account confounding (risk ratio adjusted for race/ethnicity and maternal age, 0.88; 95% confidence interval, 0.62–1.24) nor any clinical subtype of preterm birth. No fibroid characteristic or combination of characteristics was associated with risk. Conclusions If fibroids increase risk of preterm birth, the effect is substantially smaller than previous estimates. Given lack of effect in a large population of women from the general population, rather than higher risk academic tertiary populations previously most studied, we encourage a reconsideration of the clinical impression that presence of fibroids is a major risk factor for preterm birth.
Collapse
Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Tiara D Aldridge
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA. .,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA. .,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA.
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Eric S Torstenson
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Women's Health Research at Vanderbilt, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, USA.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
| |
Collapse
|
9
|
Jones RD, Miller J, Vitous CA, Krenz C, Brady KT, Brown AJ, Daumit GL, Drake AF, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Kalet AL, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Jagsi R. From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities. J Womens Health (Larchmt) 2020; 29:1547-1558. [PMID: 32286931 PMCID: PMC7864110 DOI: 10.1089/jwh.2019.7999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Research is needed to improve understanding of work-life integration issues in academic medicine and to guide the implementation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS), a national initiative offering financial support to physician-scientists facing caregiving challenges. Materials and Methods: In 2018, as part of a prospective program evaluation, the authors conducted a qualitative study to examine FRCS program participants' initial impressions, solicit descriptions of their career and caregiving experiences, and inquire how such factors might influence their professional advancement. The authors invited all 33 awardees who had been granted FRCS funding in the first year of the program to participate in the study, of whom 28 agreed to complete an interview. Analysts evaluated de-identified transcripts and explicated the data using a thematic analysis approach. Results: While participants described aspects of a culture that harbor stigma against caregivers and impede satisfactory work-life integration, they also perceived an optimistic cultural shift taking place as a result of programs like the FRCS. Their comments indicated that the FRCS has the potential to influence culture if institutional leadership simultaneously fosters a community that validates individuals both as caregivers and as scientists. Conclusions: Insights garnered from this qualitative study suggest that there is a pressing need for institutional leaders to implement programs that can foster awareness and normalization of caregiving challenges. In addition to providing funding and other tangible resources, interventions should strive to reinforce a broader culture that affirms the presence of work-life integration challenges and openly embraces solutions.
Collapse
Affiliation(s)
- Rochelle D. Jones
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacquelyn Miller
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - C. Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Chris Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kathleen T. Brady
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ann J. Brown
- Department of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gail L. Daumit
- Departments of Health Policy and Management and Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amelia F. Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Victoria J. Fraser
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology & Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Judith S. Hochman
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Susan Girdler
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Adina L. Kalet
- Stephen and Shelagh Roell Endowed Chair of the Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anne M. Libby
- CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Judith G. Regensteiner
- CU School of Medicine, Judith and Joseph Wagner Chair of Women's Health Research, and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kimberly Yonkers
- Departments of Psychiatry, Epidemiology, and of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
10
|
Permar SR, Ward RA, Barrett KJ, Freel SA, Gbadegesin RA, Kontos CD, Hu PJ, Hartmann KE, Williams CS, Vyas JM. Addressing the physician-scientist pipeline: strategies to integrate research into clinical training programs. J Clin Invest 2020; 130:1058-1061. [PMID: 32039914 DOI: 10.1172/jci136181] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Sallie R Permar
- Department of Pediatrics.,Duke Human Vaccine Institute, and.,Duke Office of Physician-Scientist Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A Ward
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine J Barrett
- Department of Pediatrics.,Duke Office of Physician-Scientist Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stephanie A Freel
- Department of Pediatrics.,Duke Office of Physician-Scientist Development, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Office of Clinical Research
| | - Rasheed A Gbadegesin
- Department of Pediatrics.,Duke Office of Physician-Scientist Development, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Molecular Physiology Institute, and
| | - Christopher D Kontos
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Christopher S Williams
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jatin M Vyas
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Choo E, Mathis S, Harrod T, Hartmann KE, Freund KM, Krousel-Wood M, Curry TE, Guise JM. Contributors to Independent Research Funding Success from the Perspective of K12 BIRCWH Program Directors. Am J Med Sci 2020; 360:596-603. [PMID: 33129440 DOI: 10.1016/j.amjms.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Faculty training awards are an important means of advancing early career faculty in research. The National Institutes of Health (NIH) Building Interdisciplinary Research Careers in Women's Health (BIRCWH) is a long-running K12 career development program and has been integral in promoting the research success of faculty nationally. We surveyed BIRCWH program directors to understand factors likely to influence long-term research careers and funding success. MATERIALS AND METHODS We developed an online survey containing open-ended questions about individual and programmatic attributes and activities that promote success in achieving independent research funding. Domains of interest included: 1) strategies for funding success; 2) traits for predicting success; 3) groups considered vulnerable to attrition; and 4) existing resources and means of support. RESULTS Fifteen institutions (75%) were included in the final analysis. Passion for research, persistence, resilience, and strong mentorship relationships were identified by all directors as factors important to scholar success. Responses also revealed an important pattern: program directors attributed attrition either to individual or organizational characteristics. This distinction has meaningful consequences for framing efforts to diminish attrition. Faculty who were clinicians, women, parents and underrepresented minorities were identified as vulnerable to attrition from the research careers. Common perceived challenges in these groups included isolation/feeling alienated, juggling numerous priorities, inadequate research time, lack of role models, and work-life balance issues. CONCLUSION K12 BIRCWH directors identified persistence and resilience and developing community, networks, and other support opportunities as elements of scholar success. Programs and mentors can help early career faculty by teaching skills and providing tools they can use to maximize the value of these opportunities and expand their mentees' research relationships. Our study also highlights the importance of social factors, particularly isolation, on clinicians, women, and minoritized scholars on career success.
Collapse
Affiliation(s)
- Esther Choo
- Department of Emergency Medicine OHSU, Oregon Health & Science University, Portland, OR.
| | - Shammarie Mathis
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Tabria Harrod
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Katherine E Hartmann
- Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Thomas E Curry
- Department of Obstetrics & Gynecology, University of Kentucky College of Medicine, Lexington, KY
| | - Jeanne-Marie Guise
- Department of Emergency Medicine OHSU, Oregon Health & Science University, Portland, OR; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR; Oregon Health & Science University-Portland State University School of Public Health & Preventive Medicine, Portland, OR
| |
Collapse
|
12
|
Patrick SW, Richards MR, Dupont WD, McNeer E, Buntin MB, Martin PR, Davis MM, Davis CS, Hartmann KE, Leech AA, Lovell KS, Stein BD, Cooper WO. Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder. JAMA Netw Open 2020; 3:e2013456. [PMID: 32797175 PMCID: PMC7428808 DOI: 10.1001/jamanetworkopen.2020.13456] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Medications for opioid use disorder, including buprenorphine hydrochloride and methadone hydrochloride, are highly effective at improving outcomes for individuals with the disorder. For pregnant women, use of these medications also improves pregnancy outcomes, including the risk of preterm birth. Despite the known benefits of medications for opioid use disorder, many pregnant and nonpregnant women with the disorder are not receiving them. OBJECTIVE To determine whether pregnancy and insurance status are associated with a woman's ability to obtain an appointment with an opioid use disorder treatment clinician. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study with random assignment of clinicians and simulated-patient callers (performed in "secret shopper" format), outpatient clinics that provide buprenorphine and methadone were randomly selected from publicly available treatment lists in 10 US states (selected for variability in opioid-related outcomes and policies) from March 7 to September 5, 2019. Pregnant vs nonpregnant woman and private vs public insurance assigned randomly to callers to create unique patient profiles. Simulated patients called the clinics posing as pregnant or nonpregnant women to obtain an initial appointment with a clinician. MAIN OUTCOMES AND MEASURES Appointment scheduling, wait time, and out-of-pocket costs. RESULTS A total of 10 871 unique patient profiles were assigned to 6324 clinicians. Among all women, 2312 of 3420 (67.6%) received an appointment with a clinician who prescribed buprenorphine, with lower rates among pregnant vs nonpregnant callers (1055 of 1718 [61.4%] vs 1257 of 1702 [73.9%]; relative risk, 0.83; 95% CI, 0.79-0.87). For clinicians who prescribed methadone, there was no difference in appointment access for pregnant vs nonpregnant callers (240 of 271 [88.6%] vs 237 of 265 [89.4%]; relative risk, 0.99; 95% CI, 0.93-1.05). Insurance was frequently not accepted, with 894 of 3420 buprenorphine-waivered prescribers (26.1%) and 174 of 536 opioid treatment programs (32.5%) granting appointments only when patients agreed to pay cash. Median wait times did not differ between pregnant and nonpregnant callers among buprenorphine prescribers (3 days [interquartile range, 1-7 days] vs 3 days [interquartile range, 1-7 days]; P = .43) but did differ among methadone prescribers (1 day [interquartile range, 1-4 days] vs 2 days [interquartile range, 1-6 days]; P = .049). For patients agreeing to pay cash, the median out-of-pocket costs for initial appointments were $250 (interquartile range, $155-$300) at buprenorphine prescribers and $34 (interquartile range, $15-$120) at methadone prescribers. CONCLUSIONS AND RELEVANCE In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
Collapse
Affiliation(s)
- Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - William D. Dupont
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth McNeer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda B. Buntin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter R. Martin
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew M. Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashley A. Leech
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim S. Lovell
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley D. Stein
- RAND Corporation, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - William O. Cooper
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
13
|
Zhao SK, Wu P, Jones SH, Torstenson ES, Hartmann KE, Velez Edwards DR. Association of uterine fibroids with birthweight and gestational age. Ann Epidemiol 2020; 50:35-40.e2. [PMID: 32741603 DOI: 10.1016/j.annepidem.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine if fibroids or their characteristics are associated with birthweight and/or gestational age, and to assess the impact of race or ethnicity. METHODS Right from the Start (2000-2012) is a prospective cohort that enrolled women from the southern US in early pregnancy. Transvaginal ultrasounds were used to measure fibroid characteristics and confirm gestational age. Date of birth and birthweight were obtained from vital or medical records. We assessed whether fibroid presence, number, type, and volume were associated with birthweight and/or gestational age using multivariate analysis of covariance, accounting for a priori confounders. RESULTS Among 3926 women, 416 had one or more fibroids. Mean infant birthweight and gestational age were similar among women with and without fibroids. When adjusting for race or ethnicity, all associations were attenuated. Overall, women with and without fibroids had infants of similar birthweight (-20 grams, 95% confidence interval [CI] -77, 36) and gestational age (0.4 days, 95% CI -0.9, 1.8). Women with three or more fibroids were more likely to have lighter infants (-201 grams, 95% CI -345, -58). CONCLUSIONS Race or ethnicity substantially confounds the associations. The clinical belief that uterine fibroids impair fetal growth is supported only by a significant decrease in birthweight for women with multiple fibroids.
Collapse
Affiliation(s)
- Sifang Kathy Zhao
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Pingsheng Wu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Eric S Torstenson
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
14
|
Jones RD, Miller J, Vitous CA, Krenz C, Brady KT, Brown AJ, Daumit GL, Drake AF, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Jagsi R. The Most Valuable Resource Is Time: Insights From a Novel National Program to Improve Retention of Physician-Scientists With Caregiving Responsibilities. Acad Med 2019; 94:1746-1756. [PMID: 31348060 DOI: 10.1097/acm.0000000000002903] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To enhance understanding of challenges related to work-life integration in academic medicine and to inform the ongoing implementation of an existing program and the development of other interventions to promote success of physician-scientists. METHOD This study is part of a prospective analysis of the effects of the Fund to Retain Clinical Scientists (FRCS), a national program launched by the Doris Duke Charitable Foundation at 10 U.S. institutions, which provides financial support to physician-scientists facing caregiving challenges. In early 2018, 28 of 33 program awardees participated in semistructured interviews. Questions were about challenges faced by physician-scientists as caregivers and their early perceptions of the FRCS. Multiple analysts reviewed deidentified transcripts, iteratively revised the coding scheme, and interpreted the data using qualitative thematic analysis. RESULTS Participants' rich descriptions illuminated 5 interconnected themes: (1) Time is a critical and limited resource, (2) timing is key, (3) limited time resources and timing conflicts may have a particularly adverse effect on women's careers, (4) flexible funds enable reclamation and repurposing of time resources, and (5) FRCS leaders should be cognizant of time and timing conflicts when developing program-related offerings. CONCLUSIONS Programs such as the FRCS are instrumental in supporting individuals to delegate time-consuming tasks and to control how they spend their valuable time. Qualitative analysis suggests that access to and command of valuable time resources are crucial to career advancement, research productivity, and work-life flexibility, especially during critical time points along the physician-scientist trajectory.
Collapse
Affiliation(s)
- Rochelle D Jones
- R.D. Jones is research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan. J. Miller is research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0003-0110-0567. C.A. Vitous is qualitative research analyst, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. C. Krenz is research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-0514-4586. K.T. Brady is distinguished university professor, Medical University of South Carolina, Charleston, South Carolina. A.J. Brown is professor of medicine, Duke University School of Medicine, Durham, North Carolina. G.L. Daumit is Samsung Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. A.F. Drake is Newton D. Fischer Distinguished Professor, University of North Carolina School of Medicine, Chapel Hill, North Carolina. V.J. Fraser is Adolphus Busch Professor of Medicine and chair, Washington University School of Medicine, St. Louis, Missouri. K.E. Hartmann is professor, Vanderbilt University School of Medicine, Nashville, Tennessee. J.S. Hochman is Harold Snyder Family Professor of Cardiology, NYU School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-5889-5981. S. Girdler is professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-0190-0938. A.M. Libby is professor, CU School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-4564-9407. C. Mangurian is professor, University of California, San Francisco School of Medicine, San Francisco, California. J.G. Regensteiner is professor, CU School of Medicine, and director, Center for Women's Health Research, Judith and Joseph Wagner Chair in Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-9331-3908. K. Yonkers is professor, Yale School of Medicine, New Haven, Connecticut. R. Jagsi is professor, Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6562-1228
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Wu P, Velez Edwards DR, Gorrindo P, Sundermann AC, Torstenson ES, Jones SH, Chan RL, Hartmann KE. Association between First Trimester Antidepressant Use and Risk of Spontaneous Abortion. Pharmacotherapy 2019; 39:889-898. [PMID: 31278762 DOI: 10.1002/phar.2308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE The potential for maternal antidepressant use to influence the risk of spontaneous abortion, one of the most important adverse pregnancy outcomes, is not clear. We aimed to assess whether first trimester antidepressant exposure was associated with an increased risk of spontaneous abortion. DESIGN Community-based prospective cohort study (Right from the Start). SETTING Eight metropolitan areas in North Carolina, Tennessee, and Texas. PARTICIPANTS A total of 5451 women (18 years of age or older) who were planning to conceive or were pregnant (before 12 weeks of completed gestation) and were enrolled in the study between 2000 and 2012; of those women, 223 used antidepressants (selective serotonin reuptake inhibitors [SSRIs] only [170], SSRIs and non-SSRIs [9], and non-SSRIs only [44]) during their first trimester, and 5228 did not (never users). Measurements and Main Results First trimester antidepressant use was determined during a first trimester telephone interview. Spontaneous abortion was self-reported and verified by medical records. The association of first trimester antidepressant use and spontaneous abortion was assessed by using Cox proportional hazard regression. Among the 5451 women enrolled, 223 (4%) reported first trimester antidepressant use, and 659 (12%) experienced a spontaneous abortion. SSRIs were the most common class of antidepressants used (179 [80%]). Compared with women who never used antidepressants during the first trimester of pregnancy, women who reported antidepressant use were 34% (adjusted hazard ratio [aHR] 1.34, 95% confidence interval [CI] 0.97-1.85) more likely to experience a spontaneous abortion after adjusting for covariates. Women who reported ever using SSRIs were 45% (aHR 1.45, 95% CI 1.02-2.06) more likely to experience a spontaneous abortion compared with never users. When time of loss relative to the time of interview was taken into consideration, the association between first trimester SSRI use and spontaneous abortion was significant only among those with losses before the interview (aHR 1.49, 95% CI 1.04-2.13) but was not significant among those with losses after the interview (aHR 0.43, 95% CI 0.06-3.15). CONCLUSION The association between use of first trimester antidepressants, particularly SSRI use, and spontaneous abortion was significant only among women whose exposure status was assessed after loss. In this instance, reporting bias may create a spurious association. Future studies should take the timing of data collection relative to the timing of loss into consideration.
Collapse
Affiliation(s)
- Pingsheng Wu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip Gorrindo
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexandra C Sundermann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric S Torstenson
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah H Jones
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ronna L Chan
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, North Carolina
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
16
|
Sundermann AC, Zhao S, Young CL, Lam L, Jones SH, Velez Edwards DR, Hartmann KE. Alcohol Use in Pregnancy and Miscarriage: A Systematic Review and Meta-Analysis. Alcohol Clin Exp Res 2019; 43:1606-1616. [PMID: 31194258 DOI: 10.1111/acer.14124] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
Abstract
To systematically review and critically evaluate studies reporting alcohol exposure during pregnancy and miscarriage. We searched PubMed, EMBASE, PsycINFO, and ProQuest Theses for publications from January 1970 to January 2019. We identified studies about alcohol exposure during pregnancy and miscarriage. Information about study population, alcohol exposure assessment, outcome definition, covariates, and measures of association was collected. We assessed study quality using an adapted Newcastle-Ottawa Scale. Data were abstracted by 2 investigators independently. We conducted a random-effects meta-analysis to calculate the association between alcohol exposure and miscarriage risk and performed subgroup analyses to determine robustness of results to study differences. For studies reporting dose-specific effects, a pooled dose-response association was estimated using generalized least squares regression with and without restricted cubic spline terms for number of drinks consumed per week. Of 2,164 articles identified, 24 were eligible for inclusion. Meta-analysis of data from 231,808 pregnant women finds those exposed to alcohol during pregnancy have a greater risk of miscarriage compared to those who abstained (odds ratio [OR] 1.19, 95% confidence intervals [CI] 1.12, 1.28). Estimates did not vary by study design, study country, or method of alcohol ascertainment. For alcohol use of 5 or fewer drinks per week, each additional drink per week was associated with a 6% increase in miscarriage risk (OR 1.06, 95% CI 1.01, 1.10). Common study limitations reflect challenges inherent to this research, including difficulty recruiting participants early enough in pregnancy to observe miscarriage and collecting and quantifying information about alcohol consumption during pregnancy that accurately reflects use. This review provides evidence that alcohol consumption during pregnancy is associated with a dose-mediated increase in miscarriage risk. Future studies evaluating change in alcohol use in pregnancy are needed to provide insight into how alcohol consumption prior to pregnancy recognition impacts risk.
Collapse
Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sifang Zhao
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chantay L Young
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - LeAnn Lam
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
17
|
Edwards TL, Giri A, Hellwege JN, Hartmann KE, Stewart EA, Jeff JM, Bray MJ, Pendergrass SA, Torstenson ES, Keaton JM, Jones SH, Gogoi RP, Kuivaniemi H, Jackson KL, Kho AN, Kullo IJ, McCarty CA, Im HK, Pacheco JA, Pathak J, Williams MS, Tromp G, Kenny EE, Peissig PL, Denny JC, Roden DM, Velez Edwards DR. A Trans-Ethnic Genome-Wide Association Study of Uterine Fibroids. Front Genet 2019; 10:511. [PMID: 31249589 PMCID: PMC6582231 DOI: 10.3389/fgene.2019.00511] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/10/2019] [Indexed: 01/02/2023] Open
Abstract
Uterine fibroids affect up to 77% of women by menopause and account for up to $34 billion in healthcare costs each year. Although fibroid risk is heritable, genetic risk for fibroids is not well understood. We conducted a two-stage case-control meta-analysis of genetic variants in European and African ancestry women with and without fibroids classified by a previously published algorithm requiring pelvic imaging or confirmed diagnosis. Women from seven electronic Medical Records and Genomics (eMERGE) network sites (3,704 imaging-confirmed cases and 5,591 imaging-confirmed controls) and women of African and European ancestry from UK Biobank (UKB, 5,772 cases and 61,457 controls) were included in the discovery genome-wide association study (GWAS) meta-analysis. Variants showing evidence of association in Stage I GWAS (P < 1 × 10-5) were targeted in an independent replication sample of African and European ancestry individuals from the UKB (Stage II) (12,358 cases and 138,477 controls). Logistic regression models were fit with genetic markers imputed to a 1000 Genomes reference and adjusted for principal components for each race- and site-specific dataset, followed by fixed-effects meta-analysis. Final analysis with 21,804 cases and 205,525 controls identified 326 genome-wide significant variants in 11 loci, with three novel loci at chromosome 1q24 (sentinel-SNP rs14361789; P = 4.7 × 10-8), chromosome 16q12.1 (sentinel-SNP rs4785384; P = 1.5 × 10-9) and chromosome 20q13.1 (sentinel-SNP rs6094982; P = 2.6 × 10-8). Our statistically significant findings further support previously reported loci including SNPs near WT1, TNRC6B, SYNE1, BET1L, and CDC42/WNT4. We report evidence of ancestry-specific findings for sentinel-SNP rs10917151 in the CDC42/WNT4 locus (P = 1.76 × 10-24). Ancestry-specific effect-estimates for rs10917151 were in opposite directions (P-Het-between-groups = 0.04) for predominantly African (OR = 0.84) and predominantly European women (OR = 1.16). Genetically-predicted gene expression of several genes including LUZP1 in vagina (P = 4.6 × 10-8), OBFC1 in esophageal mucosa (P = 8.7 × 10-8), NUDT13 in multiple tissues including subcutaneous adipose tissue (P = 3.3 × 10-6), and HEATR3 in skeletal muscle tissue (P = 5.8 × 10-6) were associated with fibroids. The finding for HEATR3 was supported by SNP-based summary Mendelian randomization analysis. Our study suggests that fibroid risk variants act through regulatory mechanisms affecting gene expression and are comprised of alleles that are both ancestry-specific and shared across continental ancestries.
Collapse
Affiliation(s)
- Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ayush Giri
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic, Rochester, MN, United States
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Michael J Bray
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah A Pendergrass
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA, United States
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jacob M Keaton
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah H Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Radhika P Gogoi
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States
| | - Helena Kuivaniemi
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States.,SAMRC-SHIP South African Tuberculosis Bioinformatics Initiative, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kathryn L Jackson
- Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Abel N Kho
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Catherine A McCarty
- Department of Family Medicine and Behavioral Health, University of Minnesota Medical School, Duluth, MN, United States
| | - Hae Kyung Im
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, United States
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Gerard Tromp
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States.,SAMRC-SHIP South African Tuberculosis Bioinformatics Initiative, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Center for Statistical Genetics, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peggy L Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Joshua C Denny
- Department of Biomedical Informatics and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, United States
| |
Collapse
|
18
|
Sundermann AC, Mukherjee S, Wu P, Velez Edwards DR, Hartmann KE. Gestational Age at Arrest of Development: An Alternative Approach for Assigning Time at Risk in Studies of Time-Varying Exposures and Miscarriage. Am J Epidemiol 2019; 188:570-578. [PMID: 30521025 PMCID: PMC6395168 DOI: 10.1093/aje/kwy267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/12/2018] [Accepted: 12/04/2018] [Indexed: 11/12/2022] Open
Abstract
The time between arrest of pregnancy development and miscarriage represents a window in which the pregnancy is nonviable and not developing. In effect, the pregnancy loss has already occurred, and additional exposure cannot influence its outcome. However, epidemiologic studies of miscarriage traditionally use gestational age at miscarriage (GAM) to assign time in survival analyses, which overestimates duration of exposure and time at risk. In Right From the Start, a pregnancy cohort study (2000-2012), we characterized the gap between estimated gestational age at arrest of development (GAAD) and miscarriage using transvaginal ultrasound in 500 women recruited from 3 states (North Carolina, Tennessee, and Texas). We compared effect estimates from models using GAAD with GAM to assign time at risk through a simulation study of several exposure patterns with varying effect sizes. The median gap between GAAD and miscarriage was 23 days (interquartile range, 15-32). Use of GAAD decreased the bias and variance of the estimated association for time-varying exposures, whereas half the time using GAM led to estimates that differed from the true effect by more than 20%. Using GAAD to assign time at risk should result in more accurate and consistent characterization of miscarriage risk associated with time-varying exposures.
Collapse
Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Sudeshna Mukherjee
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pingsheng Wu
- Department of Biostatistics, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, School of Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, School of Medicine, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
19
|
Hartmann KE, Sundermann AC, Helton R, Bird H, Wood A. The Scope of Extraprofessional Caregiving Challenges Among Early Career Faculty: Findings From a University Medical Center. Acad Med 2018; 93:1707-1712. [PMID: 29596083 PMCID: PMC6211778 DOI: 10.1097/acm.0000000000002229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Academic scientists work in competitive environments, and many institutions invest in career development supports. These investments may be imperiled when extraprofessional demands challenge a faculty member's reserve capacity. This research assessed prevalence of caregiving challenges and estimated incidence of stressful life events. METHOD In 2015-2016, the authors surveyed recipients of career development awards supporting ≥ 75% effort and individuals within the funding period of their first National Institutes of Health R01 or equivalent at Vanderbilt University Medical Center. Domains included family structure, hospitalizations of family members, responsibility for coordination of caregiving, and an inventory of stressful life events. RESULTS Seventy-two percent (152 of 210) of early career researchers responded. Over half endorsed experiencing one or more substantial caregiving challenges in the prior year. This included 35 (23%) having a child or adult in the household hospitalized in the prior year and 36 (24%) being responsible for health care needs for a child or adult in the household, or for coordinating elder care, assisted living, or hospice care. The majority experienced one or more caregiving challenges. Stressful life events increased relative risk of "thinking about leaving academics" by 70% (risk ratio: 1.7; 95% confidence interval: 1.2, 2.4). Prevalence and incidence of caregiving demands did not differ by gender. CONCLUSIONS Leaders, administrators, mentors, and faculty should anticipate that most women and men early career researchers will experience substantial caregiving challenges and life events in any given year. Sufficient need exists to warrant investigation of institutional programs to address caregiving challenges.
Collapse
Affiliation(s)
- Katherine E. Hartmann
- K.E. Hartmann is associate dean, Office of Clinical Translational Scientist Development, and professor of obstetrics & gynecology and medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0002-1465-9653
| | - Alexandra C. Sundermann
- A.C. Sundermann is an MD/PhD candidate, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0002-6790-5539
| | - Rebecca Helton
- R. Helton is program manager, Office of Clinical Translational Scientist Development, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0002-6775-3782
| | - Helen Bird
- H. Bird is program manager, Partnership in Actively Retaining Talented Early-career Researchers in Science Program (PARTNERS), Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-8899-0341
| | - Ashley Wood
- A. Wood is manager of faculty development programs, Office of Faculty Affairs, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-2472-1921
| |
Collapse
|
20
|
Jagsi R, Jones RD, Griffith KA, Brady KT, Brown AJ, Davis RD, Drake AF, Ford D, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Escobar-Alvarez S, Myers ER. An Innovative Program to Support Gender Equity and Success in Academic Medicine: Early Experiences From the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists. Ann Intern Med 2018; 169:128-130. [PMID: 29554690 DOI: 10.7326/m17-2676] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Reshma Jagsi
- University of Michigan, Ann Arbor, Michigan (R.J., R.D.J., K.A.G.)
| | - Rochelle D Jones
- University of Michigan, Ann Arbor, Michigan (R.J., R.D.J., K.A.G.)
| | - Kent A Griffith
- University of Michigan, Ann Arbor, Michigan (R.J., R.D.J., K.A.G.)
| | - Kathleen T Brady
- Medical University of South Carolina, Charleston, South Carolina (K.T.B., R.D.D.)
| | - Ann J Brown
- Duke University School of Medicine, Durham, North Carolina (A.J.B.)
| | - Randal D Davis
- Medical University of South Carolina, Charleston, South Carolina (K.T.B., R.D.D.)
| | - Amelia F Drake
- University of North Carolina School of Medicine, Chapel Hill, North Carolina (A.F.D.)
| | - Daniel Ford
- Johns Hopkins School of Medicine, Baltimore, Maryland (D.F.)
| | - Victoria J Fraser
- Washington University School of Medicine, St. Louis, Missouri (V.J.F.)
| | | | - Judith S Hochman
- New York University Langone Medical Center, New York, New York (J.S.H.)
| | - Susan Girdler
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (S.G.)
| | - Anne M Libby
- University of Colorado School of Medicine, Aurora, Colorado (A.M.L., J.G.R.)
| | - Christina Mangurian
- University of California, San Francisco, School of Medicine, San Francisco, California (C.M.)
| | | | | | | | | |
Collapse
|
21
|
Hartmann KE, Velez Edwards DR, Savitz DA, Jonsson-Funk ML, Wu P, Sundermann AC, Baird DD. THE AUTHORS REPLY. Am J Epidemiol 2018; 187:1133-1134. [PMID: 29547991 DOI: 10.1093/aje/kwy033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN
| | - David A Savitz
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI
- Department of Obstetrics and Gynecology, Brown Alpert Medical School, Brown University, Providence, RI
| | - Michele L Jonsson-Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Pingsheng Wu
- Department of Biostatistics, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| |
Collapse
|
22
|
Phillippi JC, Hartmann KE. Differentiating Research, Quality Improvement, and Case Studies to Ethically Incorporate Pregnant Women. J Midwifery Womens Health 2018; 63:104-114. [PMID: 29283211 PMCID: PMC7608624 DOI: 10.1111/jmwh.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 01/14/2023]
Abstract
Pregnant women have been called therapeutic orphans because data supporting common interventions, medications, health teaching, and models of care are meager. The generation of quality evidence benefits from proactive approaches that ensure ethical standards are met to protect participants. The purpose of this article is to differentiate among health care, quality improvement, and research and to discuss ethical involvement of women who are pregnant and potentially childbearing in these initiatives. Health care is provided to protect and improve individual health. Quality improvement aims to enhance delivery of care for all those receiving care in particular settings. Research, whether retrospective or prospective, is designed to contribute to generalizable knowledge. This review includes vignettes to distinguish between research, quality improvement, and case study dissemination and to highlight the value of publication of information with applicability beyond a single site. As a community, perinatal care providers will be able to contribute more evidence to guide care if they err on the side of seeking institutional review board approval for activities that examine the care and outcomes of pregnant women and the fetus. Traditional research activities, including clinical trials, remain crucial. However, to fill gaps in knowledge, we must expedite our ability to report informative cases, examine clinical data, share lessons learned during quality improvement campaigns, and publish and disseminate these findings. Accelerating improvements in care demands expansion of the evidence base.
Collapse
|
23
|
Bray MJ, Edwards TL, Wellons MF, Jones SH, Hartmann KE, Velez Edwards DR. Admixture mapping of uterine fibroid size and number in African American women. Fertil Steril 2017; 108:1034-1042.e26. [PMID: 29202956 PMCID: PMC5728674 DOI: 10.1016/j.fertnstert.2017.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the relationship between genetic ancestry and uterine fibroid characteristics. DESIGN Cross-sectional study. SETTING Not applicable. PATIENT(S) A total of 609 African American participants with image- or surgery-confirmed fibroids in a biorepository at Vanderbilt University electronic health record biorepository and the Coronary Artery Risk Development in Young Adults studies were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Outcome measures include fibroid number (single vs. multiple), volume of largest fibroid, and largest fibroid dimension of all fibroid measurements. RESULT(S) Global ancestry meta-analyses revealed a significant inverse association between percentage of European ancestry and risk of multiple fibroids (odds ratio: 0.78; 95% confidence interval 0.66, 0.93; P=6.05 × 10-3). Local ancestry meta-analyses revealed five suggestive (P<4.80 × 10-3) admixture mapping peaks in 2q14.3-2q21.1, 3p14.2-3p14.1, 7q32.2-7q33, 10q21.1, 14q24.2-14q24.3, for number of fibroids and one suggestive admixture mapping peak (P<1.97 × 10-3) in 10q24.1-10q24.32 for volume of largest fibroid. Single variant association meta-analyses of the strongest associated region from admixture mapping of fibroid number (10q21.1) revealed a strong association at single nucleotide polymorphism variant rs12219990 (odds ratio: 0.41; 95% confidence interval 0.28, 0.60; P=3.82 × 10-6) that was significant after correction for multiple testing. CONCLUSION(S) Increasing African ancestry is associated with multiple fibroids but not with fibroid size. Local ancestry analyses identified several novel genomic regions not previously associated with fibroid number and increasing volume. Future studies are needed to explore the genetic impact that ancestry plays into the development of fibroid characteristics.
Collapse
Affiliation(s)
- Michael J Bray
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee
| | - Todd L Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee; Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Division of Epidemiology, Vanderbilt University, Nashville, Tennessee
| | | | - Sarah H Jones
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
| | - Katherine E Hartmann
- Department of Medicine, Vanderbilt University, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee; Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee.
| |
Collapse
|
24
|
Abstract
OBJECTIVE To assess whether interpregnancy interval length after a pregnancy loss is associated with risk of repeat miscarriage. METHODS This analysis includes pregnant women participating in the Right From the Start (2000-2012) community-based prospective cohort study whose most recent pregnancy before enrollment ended in miscarriage. Interpregnancy interval was defined as the time between a prior miscarriage and the last menstrual period of the study pregnancy. Miscarriage was defined as pregnancy loss before 20 weeks of gestation. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios and 95% CIs for the association between different interpregnancy interval lengths and miscarriage in the study pregnancy. Adjusted models included maternal age, race, parity, body mass index, and education. RESULTS Among the 514 study participants who reported miscarriage as their most recent pregnancy outcome, 15.7% had a repeat miscarriage in the study pregnancy (n=81). Median maternal age was 30 years (interquartile range 27-34) and 55.6% of participants had at least one previous livebirth (n=286). When compared with women with interpregnancy intervals of 6-18 months (n=136), women with intervals of less than 3 months (n=124) had the lowest risk of repeat miscarriage (7.3% compared with 22.1%; adjusted hazard ratio 0.33, 95% CI 0.16-0.71). Neither maternal race nor parity modified the association. Attempting to conceive immediately was not associated with increased risk of miscarriage in the next pregnancy. CONCLUSION An interpregnancy interval after pregnancy loss of less than 3 months is associated with the lowest risk of subsequent miscarriage. This implies counseling women to delay conception to reduce risk of miscarriage may not be warranted.
Collapse
Affiliation(s)
- Alexandra C. Sundermann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1100 Medical Center North, Nashville, TN, 37232
| | - Sarah H. Jones
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
| | - Eric S. Torstenson
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1100 Medical Center North, Nashville, TN, 37232
| |
Collapse
|
25
|
Hartmann KE, Velez Edwards DR, Savitz DA, Jonsson-Funk ML, Wu P, Sundermann AC, Baird DD. Prospective Cohort Study of Uterine Fibroids and Miscarriage Risk. Am J Epidemiol 2017; 186:1140-1148. [PMID: 28591761 DOI: 10.1093/aje/kwx062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/05/2017] [Indexed: 12/14/2022] Open
Abstract
We sought to determine the relationship of fibroids to pregnancy loss in a prospective cohort in which fibroid status was uniformly documented in early pregnancy. Participants had an intake interview, transvaginal ultrasonography, computer-assisted telephone interview, and follow-up assessment of outcomes. We recruited diverse participants for the Right From the Start study from 8 metropolitan areas in 3 states in the United States during 2000-2012. Participants were at least 18 years of age, trying to become pregnant or at less than 12 weeks' gestation, not using fertility treatments, fluent in English or Spanish, and available for telephone interviews. Miscarriage was defined as loss before 20 weeks' gestation. Fibroid presence, number, type, and volume were assessed using standardized ultrasonography methods. We used proportional hazards models to estimate associations. Among 5,512 participants, 10.4% had at least 1 fibroid, and 10.8% experienced a miscarriage. Twenty-three percent had experienced a prior miscarriage and 52% prior births. Presence of fibroids was associated with miscarriage in models without adjustments. Adjusting for key confounders indicated no increase in risk (adjusted hazard ratio = 0.83, 95% confidence interval: 0.63, 1.08). No characteristic of fibroids was associated with risk. Prior evidence attributing miscarriage to fibroids is potentially biased. These findings imply that surgical removal of fibroids to reduce risk of miscarriage deserves careful scrutiny.
Collapse
|
26
|
Hellwege JN, Jeff JM, Wise LA, Gallagher CS, Wellons M, Hartmann KE, Jones SF, Torstenson ES, Dickinson S, Ruiz-Narváez EA, Rohland N, Allen A, Reich D, Tandon A, Pasaniuc B, Mancuso N, Im HK, Hinds DA, Palmer JR, Rosenberg L, Denny JC, Roden DM, Stewart EA, Morton CC, Kenny EE, Edwards TL, Velez Edwards DR. Erratum to: A multi-stage genome-wide association study of uterine fibroids in African Americans. Hum Genet 2017; 136:1497-1498. [PMID: 28975356 PMCID: PMC5909202 DOI: 10.1007/s00439-017-1846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
The article "A multi-stage genome-wide association study of uterine fibroids in African Americans", written by Jacklyn N. Hellwege, was originally published Online First without open access. After publication in volume 136, issue 10, page 1363-1373 the author decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to
Collapse
Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Melissa Wellons
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah F Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Dickinson
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Nadin Rohland
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Alexander Allen
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - David Reich
- Department of Genetics, Harvard Medical School, Boston, MA, USA.,Howard Hughes Medical Institute, Chevy Chase, MD, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Arti Tandon
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Bogdan Pasaniuc
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas Mancuso
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hae Kyung Im
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth A Stewart
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic and Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cynthia C Morton
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.,University of Manchester Academic Health Science Centre, Manchester, England, UK.,Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA. .,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
27
|
Hellwege JN, Jeff JM, Wise LA, Gallagher CS, Wellons M, Hartmann KE, Jones SF, Torstenson ES, Dickinson S, Ruiz-Narváez EA, Rohland N, Allen A, Reich D, Tandon A, Pasaniuc B, Mancuso N, Im HK, Hinds DA, Palmer JR, Rosenberg L, Denny JC, Roden DM, Stewart EA, Morton CC, Kenny EE, Edwards TL, Velez Edwards DR. A multi-stage genome-wide association study of uterine fibroids in African Americans. Hum Genet 2017; 136:1363-1373. [PMID: 28836065 PMCID: PMC5628188 DOI: 10.1007/s00439-017-1836-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022]
Abstract
Uterine fibroids are benign tumors of the uterus affecting up to 77% of women by menopause. They are the leading indication for hysterectomy, and account for $34 billion annually in the United States. Race/ethnicity and age are the strongest known risk factors. African American (AA) women have higher prevalence, earlier onset, and larger and more numerous fibroids than European American women. We conducted a multi-stage genome-wide association study (GWAS) of fibroid risk among AA women followed by in silico genetically predicted gene expression profiling of top hits. In Stage 1, cases and controls were confirmed by pelvic imaging, genotyped and imputed to 1000 Genomes. Stage 2 used self-reported fibroid and GWAS data from 23andMe, Inc. and the Black Women's Health Study. Associations with fibroid risk were modeled using logistic regression adjusted for principal components, followed by meta-analysis of results. We observed a significant association among 3399 AA cases and 4764 AA controls at rs739187 (risk-allele frequency = 0.27) in CYTH4 (OR (95% confidence interval) = 1.23 (1.16-1.30), p value = 7.82 × 10-9). Evaluation of the genetic association results with MetaXcan identified lower predicted gene expression of CYTH4 in thyroid tissue as significantly associated with fibroid risk (p value = 5.86 × 10-8). In this first multi-stage GWAS for fibroids among AA women, we identified a novel risk locus for fibroids within CYTH4 that impacts gene expression in thyroid and has potential biological relevance for fibroids.
Collapse
Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Melissa Wellons
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah F Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Dickinson
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Nadin Rohland
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Alexander Allen
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - David Reich
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Arti Tandon
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Bogdan Pasaniuc
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas Mancuso
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hae Kyung Im
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth A Stewart
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic and Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cynthia C Morton
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Manchester Academic Health Science Centre, Manchester, England, UK
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
28
|
Giri A, Edwards TL, Hartmann KE, Torstenson ES, Wellons M, Schreiner PJ, Velez Edwards DR. African genetic ancestry interacts with body mass index to modify risk for uterine fibroids. PLoS Genet 2017; 13:e1006871. [PMID: 28715450 PMCID: PMC5536439 DOI: 10.1371/journal.pgen.1006871] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/31/2017] [Accepted: 06/15/2017] [Indexed: 01/20/2023] Open
Abstract
Race, specifically African ancestry, and obesity are important risk factors for uterine fibroids, and likely interact to provide the right conditions for fibroid growth. However, existing studies largely focus on the main-effects rather than their interaction. Here, we firstly provide evidence for interaction between categories of body mass index (BMI) and reported-race in relation to uterine fibroids. We then investigate whether the association between inferred local European ancestry and fibroid risk is modified by BMI in African American (AA) women in the Vanderbilt University Medical Center bio-repository (BioVU) (539 cases and 794 controls) and the Coronary Artery Risk Development in Young Adults study (CARDIA, 264 cases and 173 controls). We used multiple logistic regression to evaluate interactions between local European ancestry and BMI in relation to fibroid risk, then performed fixed effects meta-analysis. Statistical significance threshold for local-ancestry and BMI interactions was empirically estimated with 10,000 permutations (p-value = 1.18x10-4). Admixture mapping detected an association between European ancestry and fibroid risk which was modified by BMI (continuous-interaction p-value = 3.75x10-5) around ADTRP (chromosome 6p24); the strongest association was found in the obese category (ancestry odds ratio (AOR) = 0.51, p-value = 2.23x10-5). Evaluation of interaction between genotyped/imputed variants and BMI in this targeted region suggested race-specific interaction, present in AAs only; strongest evidence was found for insertion/deletion variant (6:11946435), again in the obese category (OR = 1.66, p-value = 1.72x10-6). We found nominal evidence for interaction between local ancestry and BMI at a previously reported region in chromosome 2q31-32, which includes COL5A2, and TFPI, an immediate downstream target of ADTRP. Interactions between BMI and SNPs (single nucleotide polymorphisms) found in this region in AA women were also detected in an independent European American population of 1,195 cases and 1,164 controls. Findings from our study provide an example of how modifiable and non-modifiable factors may interact to influence fibroid risk and suggest a biological role for BMI in fibroid etiology.
Collapse
Affiliation(s)
- Ayush Giri
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Todd L. Edwards
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Katherine E. Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Eric S. Torstenson
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melissa Wellons
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Pamela J. Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Digna R. Velez Edwards
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| |
Collapse
|
29
|
Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol 2017; 217:11-26.e3. [PMID: 28188775 DOI: 10.1016/j.ajog.2017.01.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/20/2016] [Accepted: 01/31/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies evaluating the association between obesity and pelvic organ prolapse report estimates that range from negative to positive associations. Heterogeneous definitions for pelvic organ prolapse and variable choices for categorizing obesity measures have made it challenging to conduct meta-analysis. OBJECTIVE We systematically evaluated evidence to provide quantitative summaries of association between degrees of obesity and pelvic organ prolapse, and identify sources of heterogeneity. STUDY DESIGN We searched for all indexed publications relevant to pelvic organ prolapse up until June 18, 2015, in PubMed/MEDLINE to identify analytical observational studies published in English that reported risk ratios (relative risk, odds ratio, or hazard ratio) for body mass index categories in relation to pelvic organ prolapse. Random effects meta-analyses were conducted to report associations with pelvic organ prolapse for overweight and obese body mass index categories compared with women in the normal-weight category (referent: body mass index <25 kg/m2). RESULTS Of the 70 studies that reported evidence on obesity and pelvic organ prolapse, 22 eligible studies provided effect estimates for meta-analysis of the overweight and obese body mass index categories. Compared with the referent category, women in the overweight and obese categories had meta-analysis risk ratios of at least 1.36 (95% confidence interval, 1.20-1.53) and at least 1.47 (95% confidence interval, 1.35-1.59), respectively. Subgroup analyses showed effect estimates for objectively measured clinically significant pelvic organ prolapse were higher than for self-reported pelvic organ prolapse. Other potential sources of heterogeneity included proportion of postmenopausal women in study and reported study design. CONCLUSION Overweight and obese women are more likely to have pelvic organ prolapse compared with women with body mass index in the normal range. The finding that the associations for obesity measures were strongest for objectively measured, clinically significant pelvic organ prolapse further strengthens this evidence. However, prospective investigations evaluating obesity and pelvic organ prolapse are few.
Collapse
Affiliation(s)
- Ayush Giri
- Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jacklyn N Hellwege
- Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Todd L Edwards
- Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
30
|
Giri A, Hartmann KE, Aldrich MC, Ward RM, Wu JM, Park AJ, Graff M, Qi L, Nassir R, Wallace RB, O'Sullivan MJ, North KE, Velez Edwards DR, Edwards TL. Admixture mapping of pelvic organ prolapse in African Americans from the Women's Health Initiative Hormone Therapy trial. PLoS One 2017; 12:e0178839. [PMID: 28582460 PMCID: PMC5459562 DOI: 10.1371/journal.pone.0178839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/19/2017] [Indexed: 12/27/2022] Open
Abstract
Evidence suggests European American (EA) women have two- to five-fold increased odds of having pelvic organ prolapse (POP) when compared with African American (AA) women. However, the role of genetic ancestry in relation to POP risk is not clear. Here we evaluate the association between genetic ancestry and POP in AA women from the Women’s Health Initiative Hormone Therapy trial. Women with grade 1 or higher classification, and grade 2 or higher classification for uterine prolapse, cystocele or rectocele at baseline or during follow-up were considered to have any POP (N = 805) and moderate/severe POP (N = 156), respectively. Women with at least two pelvic exams with no indication for POP served as controls (N = 344). We performed case-only, and case-control admixture-mapping analyses using multiple logistic regression while adjusting for age, BMI, parity and global ancestry. We evaluated the association between global ancestry and POP using multiple logistic regression. European ancestry at the individual level was not associated with POP risk. Case-only and case-control local ancestry analyses identified two ancestry-specific loci that may be associated with POP. One locus (Chromosome 15q26.2) achieved empirically-estimated statistical significance and was associated with decreased POP odds (considering grade ≥2 POP) with each unit increase in European ancestry (OR: 0.35; 95% CI: 0.30, 0.57; p-value = 1.48x10-5). This region includes RGMA, a potent regulator of the BMP family of genes. The second locus (Chromosome 1q42.1-q42.3) was associated with increased POP odds with each unit increase in European ancestry (Odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28, 2.22; p-value = 1.93x10-4). Although this region did not reach statistical significance after considering multiple comparisons, it includes potentially relevant genes including TBCE, and ACTA1. Unique non-overlapping European and African ancestry-specific susceptibility loci may be associated with increased POP risk.
Collapse
Affiliation(s)
- Ayush Giri
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melinda C. Aldrich
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Renee M. Ward
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jennifer M. Wu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Amy J. Park
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia, United States of America
| | - Mariaelisa Graff
- Department of Epidemiology, Gillings School of Global Public health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lihong Qi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, United States of America
| | - Rami Nassir
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, California, United States of America
- Department of Internal Medicine, University of California, Davis, Davis, California, United States of America
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Mary J. O'Sullivan
- Department of Obstetrics and Gynecology, Miller School of Medicine, Miami, Florida, United States of America
| | - Kari E. North
- Department of Epidemiology, Gillings School of Global Public health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Todd L. Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| |
Collapse
|
31
|
Velez Edwards DR, Hartmann KE, Wellons M, Shah A, Xu H, Edwards TL. Evaluating the role of race and medication in protection of uterine fibroids by type 2 diabetes exposure. BMC Womens Health 2017; 17:28. [PMID: 28399866 PMCID: PMC5387248 DOI: 10.1186/s12905-017-0386-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Uterine fibroids (UF) affect 77% of women by menopause, and account for $9.4 billion in annual healthcare costs. Type-2-diabetes (T2D) has inconsistently associated with protection from UFs in prior studies. To further evaluate the relationship between T2D and UFs we tested for association between T2D and UF risk in a large clinical population as well as the potential differences due to T2D medications and interaction with race. METHODS This nested case-control study is derived from a clinical cohort. Our outcome was UF case-control status and our exposure was T2D. UF outcomes and T2D exposure were classified using validated electronic medical record (EMR) algorithms. Logistic regression, adjusted for covariates, was used to model the association between T2D diagnosis and UF risk. Secondary analyses were performed evaluating the interaction between T2D exposure and race and stratifying T2D exposed subjects by T2D medication being taken. RESULTS We identified 3,789 subjects with UF outcomes (608 UF cases and 3,181 controls), 714 were diabetic and 3,075 were non-diabetic. We observed a nominally significant interaction between T2D exposure and race in adjusted models (interaction p = 0.083). Race stratified analyses demonstrated more protection by T2D exposure on UF risk among European Americans (adjusted odds ratio [aOR] = 0.50, 95% CI 0.35 to 0.72) than African Americans (aOR = 0.76, 95% CI 0.50 to 1.17). We also observed a protective effect by T2D regardless of type of T2D medication being taken, with slightly more protection among subjects on insulin treatments (European Americans aOR = 0.42, 95% CI 0.26 to 0.68; African Americans aOR = 0.60, 95% CI 0.36 to 1.01). CONCLUSIONS These data, conducted in a large population of UF cases and controls, support prior studies that have found a protective association between diabetes presence and UF risk and is further modified by race. Protection from UFs by T2D exposure was observed regardless of medication type with slightly more protection among insulin users. Further mechanistic research in larger cohorts is necessary to reconcile the potential role of T2D in UF risk.
Collapse
Affiliation(s)
- Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA. .,Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Genetics Institute, Vanderbilt University Medical Center , Nashville, TN, USA. .,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA.,Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Wellons
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anushi Shah
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hua Xu
- The University of Texas School Health Science Center, School of Biomedical Informatics, Houston, TX, USA
| | - Todd L Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA.,Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center , Nashville, TN, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
32
|
Sundermann AC, Hartmann KE, Jones SH, Torstenson ES, Velez Edwards DR. Validation of maternal recall of early pregnancy medication exposure using prospective diary data. Ann Epidemiol 2016; 27:135-139.e2. [PMID: 28012836 DOI: 10.1016/j.annepidem.2016.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/05/2016] [Accepted: 11/30/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Data about maternal recall accuracy for classifying early pregnancy medication exposure are meager. Nonetheless, studies often rely on recall to evaluate potential impact of pharmaceuticals on the developing fetus. METHODS Right from the Start is a community-based pregnancy cohort that enrolled women from North Carolina, Tennessee, and Texas. A subset of 318 women participated in daily medication diaries initiated before conception (2006-2012). We examined nonsteroidal anti-inflammatory drugs (NSAIDs) as an example of a drug type that is difficult to study due to its intermittent and primarily over-the-counter use as well as its incomplete documentation in medical and pharmaceutical records. Selective serotonin reuptake inhibitors (SSRI) were assessed as a prescription medication comparator. Maternal recall of NSAID and SSRI use in early pregnancy was examined by comparing diary data (gold standard) to first-trimester interview. RESULTS Sensitivity and specificity for recall of NSAID exposure were 78.6% and 62.3%, respectively (kappa statistic: 0.41), with 72.3% agreement for exposure classification. Sensitivity and specificity for recall of SSRI exposure were 77.8% and 99.0%, respectively (kappa statistic: 0.79), with 97.8% agreement. CONCLUSIONS Our findings suggest the validity of maternal recall varies with medication type and prospective data collection should be prioritized when studying early pregnancy drug exposures.
Collapse
Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah H Jones
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Eric S Torstenson
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
33
|
Burrows CK, Kosova G, Herman C, Patterson K, Hartmann KE, Velez Edwards DR, Stephenson MD, Lynch VJ, Ober C. Expression Quantitative Trait Locus Mapping Studies in Mid-secretory Phase Endometrial Cells Identifies HLA-F and TAP2 as Fecundability-Associated Genes. PLoS Genet 2016; 12:e1005858. [PMID: 27447835 PMCID: PMC4957750 DOI: 10.1371/journal.pgen.1005858] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/20/2016] [Indexed: 12/29/2022] Open
Abstract
Fertility traits in humans are heritable, however, little is known about the genes that influence reproductive outcomes or the genetic variants that contribute to differences in these traits between individuals, particularly women. To address this gap in knowledge, we performed an unbiased genome-wide expression quantitative trait locus (eQTL) mapping study to identify common regulatory (expression) single nucleotide polymorphisms (eSNPs) in mid-secretory endometrium. We identified 423 cis-eQTLs for 132 genes that were significant at a false discovery rate (FDR) of 1%. After pruning for strong LD (r2 >0.95), we tested for associations between eSNPs and fecundability (the ability to get pregnant), measured as the length of the interval to pregnancy, in 117 women. Two eSNPs were associated with fecundability at a FDR of 5%; both were in the HLA region and were eQTLs for the TAP2 gene (P = 1.3x10-4) and the HLA-F gene (P = 4.0x10-4), respectively. The effects of these SNPs on fecundability were replicated in an independent sample. The two eSNPs reside within or near regulatory elements in decidualized human endometrial stromal cells. Our study integrating eQTL mapping in a primary tissue with association studies of a related phenotype revealed novel genes and associated alleles with independent effects on fecundability, and identified a central role for two HLA region genes in human implantation success. Little is known about the genetics of female fertility. In this study, we addressed this gap in knowledge by first searching for genetic variants that regulate gene expression in uterine endometrial cells, and then testing those functional variants for associations with the length of time to pregnancy in fertile women. Two functional genetic variants were associated with time to pregnancy in women after correcting for multiple testing. Those variants were each associated with the expression of genes in the HLA region, HLA-F and TAP2, which are have not previously been implicated female fertility. The association between HLA-F and TAP2 genotypes on the length of time to pregnancy was replicated in an independent cohort of women. Because HLA-F and TAP2 are involved in immune processes, these results suggest their role in specific immune regulation in the endometrium during implantation. Future studies will characterize these molecules in the implantation process and their potential as drug targets for treatment of conditions related to implantation failure.
Collapse
Affiliation(s)
- Courtney K. Burrows
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Gülüm Kosova
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Catherine Herman
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Kristen Patterson
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Katherine E. Hartmann
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Departments of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Digna R. Velez Edwards
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Departments of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mary D. Stephenson
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
| | - Vincent J. Lynch
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
| | - Carole Ober
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, United States of America
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
| |
Collapse
|
34
|
Abstract
BACKGROUND Few studies comment on the association between fibroids and symptoms among pregnant women. These studies generally are retrospective and do not to assess the influence of number of tumours or their volume on risk of symptoms. METHODS Right from the Start is a prospective cohort that enrolled pregnant women from the southeastern USA between 2000 and 2012. In the first trimester, all participants had standardised ultrasounds to determine the presence or absence of fibroids. Symptoms were queried in a telephone survey. We used polytomous logistic regression to model odds of bleeding, pain, or both symptoms in relation to increasing total fibroid number and volume among white and black women. RESULTS Among 4509 participants, the prevalence of fibroids was 11%. Among those reporting symptoms (70%), 11% reported only bleeding, 59% reported only pain, and 30% reported both symptoms. After adjusting for age, race, parity, hypertension, smoking, alcohol use, and study site, increasing number of fibroids was associated with pain [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.00, 1.33] and both symptoms [OR 1.25, 95% CI 1.08, 1.45] but not with bleeding among all women. Fibroid volume was not associated with symptoms among black women, but white women with the smallest fibroid volumes were more likely to report both symptoms than those without fibroids [OR 1.79, 95% CI 1.17, 2.72]. CONCLUSIONS Very large tumours are not requisite for experiencing symptoms, as small fibroids and increasing number of tumours are associated with pain and both symptoms.
Collapse
Affiliation(s)
- Kara A. Michels
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee,Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin R. Archer
- Department of Orthopedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee,Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Fei Ye
- Division of Cancer Statistics, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
35
|
Giri A, Wu JM, Ward RM, Hartmann KE, Park AJ, North KE, Graff M, Wallace RB, Bareh G, Qi L, O'Sullivan MJ, Reiner AP, Edwards TL, Velez Edwards DR. Genetic Determinants of Pelvic Organ Prolapse among African American and Hispanic Women in the Women's Health Initiative. PLoS One 2015; 10:e0141647. [PMID: 26545240 PMCID: PMC4636147 DOI: 10.1371/journal.pone.0141647] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/12/2015] [Indexed: 12/14/2022] Open
Abstract
Current evidence suggests a multifactorial etiology to pelvic organ prolapse (POP), including genetic predisposition. We conducted a genome-wide association study of POP in African American (AA) and Hispanic (HP) women from the Women's Health Initiative Hormone Therapy study. Cases were defined as any POP (grades 1-3) or moderate/severe POP (grades 2-3), while controls had grade 0 POP. We performed race-specific multiple logistic regression analyses between SNPs imputed to 1000 genomes in relation to POP (grade 0 vs 1-3; grade 0 vs 2-3) adjusting for age at diagnosis, body mass index, parity, and genetic ancestry. There were 1274 controls and 1427 cases of any POP and 317 cases of moderate/severe POP. Although none of the analyses reached genome-wide significance (p<5x10-8), we noted variants in several loci that met p<10-6. In race-specific analysis of grade 0 vs 2-3, intronic SNPs in the CPE gene (rs28573326, OR:2.14; 95% CI 1.62-2.83; p = 1.0x10-7) were associated with POP in AAs, and SNPs in the gene AL132709.5 (rs1950626, OR:2.96; 95% CI 1.96-4.48, p = 2.6x10-7) were associated with POP in HPs. Inverse variance fixed-effect meta-analysis of the race-specific results showed suggestive signals for SNPs in the DPP6 gene (rs11243354, OR:1.36; p = 4.2x10-7) in the grade 0 vs 1-3 analyses and for SNPs around PGBD5 (rs740494, OR:2.17; p = 8.6x10-7) and SHC3 (rs2209875, OR:0.60; p = 9.3x10-7) in the grade 0 vs 2-3 analyses. While we did not identify genome-wide significant findings, we document several SNPs reaching suggestive statistical significance. Further interrogation of POP in larger minority samples is warranted.
Collapse
Affiliation(s)
- Ayush Giri
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jennifer M. Wu
- Department of Obstetrics and Gynecology, Center for Women’s Health Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Renee M. Ward
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Katherine E. Hartmann
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Amy J. Park
- Department of Obstetrics and Gynecology and Urology, Georgetown University Medical Center, Washington, DC, United States of America
| | - Kari E. North
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Mariaelisa Graff
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Gihan Bareh
- Department of Obstetrics and Gynecology, Loma Linda University, Loma Linda, California, United States of America
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, California, United States of America
| | - Mary J. O'Sullivan
- Department of Obstetrics and Gynecology, University of Miami, Miami, Florida, United States of America
| | - Alexander P. Reiner
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Todd L. Edwards
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Digna R. Velez Edwards
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee, United States of America
| |
Collapse
|
36
|
Feingold-Link L, Edwards TL, Jones S, Hartmann KE, Velez Edwards DR. Enhancing uterine fibroid research through utilization of biorepositories linked to electronic medical record data. J Womens Health (Larchmt) 2015; 23:1027-32. [PMID: 25495367 DOI: 10.1089/jwh.2014.4978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine leiomyomata (fibroids) affect up to 77% of women by menopause and account for $9.4 billion in yearly healthcare costs. Most studies rely on self-reported diagnosis, which may result in misclassification of controls since as many as 50% of cases are asymptomatic and thus undiagnosed. Our objective was to evaluate the performance and accuracy of a fibroid phenotyping algorithm constructed from electronic medical record (EMR) data, limiting to subjects with pelvic imaging. METHODS Our study population includes women from a clinical population at Vanderbilt University Medical Center (2008-2012). Analyses were restricted to women 18 years and older with at least one fibroid diagnosis confirmed by imaging for cases or at least two separate pelvic imaging procedures without a diagnosis for controls. We randomly reviewed 218 records to evaluate the accuracy of our algorithm and assess the indications for pelvic imaging. Participant characteristics and indications for imaging were compared between cases and controls in unadjusted and adjusted logistic regression analyses. RESULTS Our algorithm had a positive predictive value of 96% and negative predictive value of 98%. Increasing age (odds ratio=1.05, 95% confidence interval 1.03-1.08) and Black race (odds ratio=2.15, 95% confidence interval 1.18-3.94) were identified as risk factors for fibroids. The most common indications for imaging in both cases and controls were pain, bleeding, and reproductive factors, and the most common imaging modality was a pelvic ultrasound. CONCLUSIONS These data suggest that using biorepositories linked to EMR data is a feasible way to identify populations of imaged women that facilitate investigations of fibroid risk factors.
Collapse
|
37
|
Patrick SW, Dudley J, Martin PR, Harrell FE, Warren MD, Hartmann KE, Ely EW, Grijalva CG, Cooper WO. Prescription opioid epidemic and infant outcomes. Pediatrics 2015; 135:842-50. [PMID: 25869370 PMCID: PMC4411781 DOI: 10.1542/peds.2014-3299] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS). METHODS We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics. RESULTS Of 112,029 pregnant women, 31,354 (28%) filled ≥ 1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P < .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P < .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of daily cigarettes smoked (P < .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS. CONCLUSIONS Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS.
Collapse
Affiliation(s)
- Stephen W Patrick
- Departments of Pediatrics, Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy,
| | | | | | | | | | - Katherine E Hartmann
- Vanderbilt Center for Health Services Research, Nashville, Tennessee; Obstetrics and Gynecology, and
| | - E Wesley Ely
- Vanderbilt Center for Health Services Research, Nashville, Tennessee; Medicine, Vanderbilt University, Nashville, Tennessee; Veteran's Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy, Veteran's Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | - William O Cooper
- Departments of Pediatrics, Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy
| |
Collapse
|
38
|
Giri A, Edwards TL, LeGrys VA, Lorenz CE, Funk MJ, Schectman R, Heiss G, Robinson JG, Hartmann KE. Subclinical hypothyroidism and risk for incident ischemic stroke among postmenopausal women. Thyroid 2014; 24:1210-7. [PMID: 24827923 PMCID: PMC4106389 DOI: 10.1089/thy.2014.0106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is postulated to increase stroke risk via atherogenic changes associated with abnormal thyroid function. However, the direct relationship of SCH with subsequent stroke is poorly studied. METHODS In this nested case-cohort study, we prospectively evaluated the association between any SCH and severity of SCH in relation to incident ischemic stroke risk among postmenopausal women in the Women's Health Initiative Observational Study. Trained Women's Health Initiative staff, masked to thyroid status, adjudicated stroke cases. We assessed thyroid function using baseline blood specimens. Women with normal free thyroxine levels and thyrotropin (TSH) levels ≥4.69 mU/L were considered to have SCH. Primary analysis included 639 ischemic stroke cases and 2927 randomly selected subcohort members with an average of seven years of follow-up. RESULTS The multivariable adjusted hazard ratios (HR) from weighted Cox models were 1.06 (95% confidence interval [CI]: 0.77, 1.46) and 0.99 (95% CI: 0.67, 1.47) for women with any SCH and with mild SCH (TSH 4.69 to 6.99 mU/L), when compared with women with normal thyroid function. The HR for moderate/severe SCH (TSH ≥7.00 mU/L) was modestly elevated (HR: 1.22; 95% CI: 0.73, 2.05). CONCLUSIONS We found no evidence to suggest an association between SCH and ischemic stroke among healthy postmenopausal women.
Collapse
Affiliation(s)
- Ayush Giri
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
| | - Todd L. Edwards
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
| | - Vicky A. LeGrys
- Division of Clinical Laboratory Science, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Carol E. Lorenz
- Department of Epidemiology, Center for Women's Health Research, University of North Carolina, Chapel Hill, North Carolina
| | - Michele Jonsson Funk
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Robin Schectman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer G. Robinson
- Departments of Epidemiology and Medicine, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Katherine E. Hartmann
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
- Department of Obstetrics and Gynecology, Vanderbilt University Medical School, Nashville, Tennessee
| |
Collapse
|
39
|
Aldridge TD, Hartmann KE, Michels KA, Velez Edwards DR. First-trimester antihistamine exposure and risk of spontaneous abortion or preterm birth. Pharmacoepidemiol Drug Saf 2014; 23:1043-50. [PMID: 24789281 DOI: 10.1002/pds.3637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/18/2014] [Accepted: 03/31/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE We tested whether antihistamine exposure during early pregnancy is associated with spontaneous abortion (SAB) or preterm birth (PTB). METHODS Women were enrolled in Right from the Start (2004-2010), a prospective pregnancy cohort. Data about first-trimester antihistamine use were obtained from screening and first-trimester interviews. Self-reported outcomes included SAB and PTB and were verified by medical records. Cox proportional hazards models were used to test for an association between antihistamine use and each outcome, both performed adjusting for confounders. RESULTS Among the 2685 pregnancies analyzed, 14% (n = 377) reported use of antihistamines. Among antihistamine users, 12% (n = 44) experienced SABs, and 6% (n = 21) had PTBs. Antihistamine exposure was not associated with SAB (adjusted hazard ratio [aHR] = 0.88, 95% confidence interval [CI] 0.64, 1.21) or PTB, which was modified by maternal race (aHR = 1.03, 95%CI 0.61, 1.72 among White women and aHR = 0.43, 95%CI 0.14, 1.34 among Black women). CONCLUSIONS Despite the biologic plausibility that antihistamine use may influence pregnancy outcomes, we did not detect evidence of an association with SAB or PTB. These data demonstrate the utility of large prospective cohorts for evaluating drug safety in pregnancy when concerns are raised from animal models.
Collapse
Affiliation(s)
- Tiara D Aldridge
- Vanderbilt Epidemiology Center, Nashville, TN, USA; Vanderbilt University, Institute of Medicine and Public Health, Nashville, TN, USA; Vanderbilt University, Department of Obstetrics and Gynecology, Nashville, TN, USA
| | | | | | | |
Collapse
|
40
|
Velez Edwards DR, Hartmann KE. Racial differences in risk of spontaneous abortions associated with periconceptional over-the-counter nonsteroidal anti-inflammatory drug exposure. Ann Epidemiol 2013; 24:111-115.e1. [PMID: 24331921 DOI: 10.1016/j.annepidem.2013.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most common medications reported in pregnancy. NSAIDs directly impact prostaglandin pathways and have been proposed as potential risk factors for spontaneous abortions (SABs, gestation <20 weeks). SAB risk and drug response across several medications differ by race; therefore, we evaluated whether associations between NSAIDs and SAB risk differ by race. METHODS Women were enrolled in the Right from the Start (2004-2010) prospective cohort. Data regarding over-the-counter NSAIDs up to the sixth week of pregnancy were obtained from interviews. Race was self-reported. Cox proportional hazards regression models were used to estimate the association between NSAID exposure and SAB, adjusted for confounders. RESULTS Among 2493 pregnancies, 12% were African American and 88% were Caucasian. NSAID exposure was reported by 40% (n = 124) of African Americans and 43% (n = 945) of Caucasians. Race-stratified analyses showed protection from SAB among African Americans (adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.73-0.96) but no effect in Caucasians (aHR, 1.01; 95% CI 0.88-1.16). CONCLUSIONS Our findings suggest that risk for SAB due to over-the-counter NSAIDs in early pregnancy is modified by race. Further investigation of dose, timing in gestation, and indication may help to further reconcile the relationship between race, NSAIDs, and SAB.
Collapse
Affiliation(s)
- Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN; Institute of Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN; Center for Human Genetics Research, Vanderbilt University, Nashville, TN.
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, TN; Institute of Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN
| |
Collapse
|
41
|
Michels KA, Velez Edwards DR, Baird DD, Savitz DA, Hartmann KE. Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging. Ann Epidemiol 2013; 24:122-6. [PMID: 24321612 DOI: 10.1016/j.annepidem.2013.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/18/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine if women with leiomyomata detected using uniform ultrasound methods are at increased risk of cesarean birth, without regard to indication. METHODS Women were enrolled in Right from the Start (2000-2010), a prospective pregnancy cohort. Leiomyomata were counted, categorized, and measured during first trimester ultrasounds. Women provided information about demographics and reproductive history during first trimester interviews. Route of delivery was extracted from medical records or vital records, if the former were unavailable. Generalized estimating equations were used to calculate risk ratios (RR) and 95% confidence intervals (CIs) for the risk of cesarean birth by leiomyoma presence and characteristics. RESULTS Among 2635 women, the prevalences of leiomyomata and cesarean birth were 11.2% and 29.8%, respectively. Women with leiomyomata, compared with those without, had a 27% increase in cesarean risk (RR, 1.27; CI, 1.17-1.37). The association was weaker following adjustment for maternal body mass index and age (adjusted risk ratio [ARR], 1.11; CI, 1.02-1.20). The adjusted risk was elevated for women with a single leiomyoma 3 cm or more in diameter (ARR, 1.22; CI, 1.14-1.32) and women with the largest total leiomyoma volumes (ARR, 1.59; CI, 1.44-1.76). CONCLUSIONS Women with leiomyomata were at increased risk for cesarean birth particularly, those with larger tumor volumes.
Collapse
Affiliation(s)
- Kara A Michels
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Center for Human Genetics Research, Vanderbilt University, Nashville, TN.
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - David A Savitz
- Department of Epidemiology, Brown University, Providence, RI; Department of Obstetrics and Gynecology, Brown University, Providence, RI
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
42
|
Velez Edwards DR, Baird DD, Hartmann KE. Association of age at menarche with increasing number of fibroids in a cohort of women who underwent standardized ultrasound assessment. Am J Epidemiol 2013; 178:426-33. [PMID: 23817917 DOI: 10.1093/aje/kws585] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Age at menarche has been associated with several reproductive conditions, and frequencies differ by race. Racial disparities also impact fibroid risk. We comprehensively examined the relationship between age at menarche, fibroid characteristics, and race. Women were enrolled in Right From the Start (2001-2010), a multistate study that systematically screened for fibroids during very early pregnancy. Endovaginal ultrasounds were conducted, and fibroid presence, number, type, volume, and diameter were recorded according to standardized definitions. Generalized estimating equations adjusted for correlations within study site were used to estimate associations between age at menarche and fibroid status and to test for interactions with race. Of 5,023 participants, 11% had a fibroid. Seven percent underwent menarche before 11 years of age and 11% at 15 years or later. We did not observe interactions between age at menarche and race. A 1-year increase in age at menarche was inversely associated with fibroids (adjusted risk ratio = 0.87, 95% confidence interval: 0.82, 0.91). Early age at menarche had a similar positive association in individual analyses with fibroid size, type, and location but was stronger for multiple fibroids (adjusted risk ratio = 0.75, 95% confidence interval: 0.68, 0.83). Our findings confirm other reports of an association between age at menarche and fibroid development (regardless of characteristics), demonstrate no effect modification by race, and suggest a stronger association for women with multiple fibroids, possibly reflecting a stronger association for early-onset disease.
Collapse
Affiliation(s)
- Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee 37203, USA.
| | | | | |
Collapse
|
43
|
Edwards TL, Hartmann KE, Velez Edwards DR. Variants in BET1L and TNRC6B associate with increasing fibroid volume and fibroid type among European Americans. Hum Genet 2013; 132:1361-9. [PMID: 23892540 DOI: 10.1007/s00439-013-1340-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/14/2013] [Indexed: 12/18/2022]
Abstract
Uterine fibroids (UFs) affect 77 % of women by menopause and account for $9.4 billion in yearly healthcare costs. We recently replicated findings from the first UF genome-wide association study (GWAS), conducted in the Japanese. Here we tested these GWAS-discovered SNPs for association with UF characteristics to further assess whether risk varies by sub-phenotypes of UFs. Women were enrolled in Right from the Start (RFTS) and the BioVU DNA repository (BioVU). UF status was determined by pelvic imaging. We tested the top GWAS-associated SNPs for association with UF characteristics (RFTS: type, number, volume; BioVU: type) using covariate adjusted logistic and linear regression. We also combined association results of UF type using meta-analysis. 456 European American (EA) cases and 1,549 controls were examined. Trinucleotide repeat containing 6B (TNRC6B) rs12484776 associated with volume in RFTS (β = 0.40, 95 % CI 0.05-0.75, p = 0.024). RFTS analyses evaluating stratified quartiles of volume showed the strongest OR at rs12484776 for the largest volume (16.6-179.1 cc, odds ratio (OR) = 2.19, 95 % confidence interval (CI) 1.07-4.46, p = 0.031). Meta-analysis showed a strong association at blocked early in transport 1 homolog (BET1L) rs2280543 for intramural UFs (meta-OR = 0.51, standard error (SE) = 0.14, Q = 0.590, I = 0, p = 2.48 × 10(-6)), which is stronger than the overall association with UF risk. This study is the first to evaluate these SNPs for association with UF characteristics and suggests these genes associate with increasing UF volume and protection from intramural UF in EAs.
Collapse
Affiliation(s)
- Todd L Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA
| | | | | |
Collapse
|
44
|
LeGrys VA, Funk MJ, Lorenz CE, Giri A, Jackson RD, Manson JE, Schectman R, Edwards TL, Heiss G, Hartmann KE. Subclinical hypothyroidism and risk for incident myocardial infarction among postmenopausal women. J Clin Endocrinol Metab 2013; 98:2308-17. [PMID: 23539723 PMCID: PMC3667262 DOI: 10.1210/jc.2012-4065] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Subclinical hypothyroidism (SCH) has been associated with an increased risk for cardiovascular disease. However, few studies have specifically examined the association between SCH and myocardial infarction (MI), and the relationship is poorly understood. OBJECTIVES The purpose of this study was to evaluate incident MI risk in relation to SCH and severities of SCH among postmenopausal women. METHODS We used a population-based nested case-cohort design within the Women's Health Initiative observational study to examine the association between SCH and incident first-time MI risk among postmenopausal women in the United States. SCH was assessed using blood specimens collected at baseline. Participants presenting with normal free T4 levels and with thyrotropin levels of greater than 4.68-6.99 mU/L or 7.00 mU/L or greater were defined as having mild SCH or moderate/severe SCH, respectively. MI cases were centrally adjudicated by trained Women's Health Initiative staff. The primary analysis included 736 incident MI cases and 2927 randomly selected subcohort members. Multivariable adjusted Cox-proportional hazard models were used to assess MI risk in relation to SCH. RESULTS Compared with euthyroid participants, the multivariable adjusted hazard ratio (HR) for participants with any SCH was 1.05 [95% confidence interval (CI) 0.77-1.44]. HRs for participants with mild SCH, moderate/severe SCH, and moderate/severe SCH and the presence of antithyroid peroxidase antibodies (TPOAb) were 0.99 (95% CI 0.67-1.46), 1.19 (95% CI 0.72-1.96), and 0.90 (95% CI 0.47-1.74), respectively. CONCLUSION We did not find evidence to suggest that SCH is associated with increased MI risk among a population of predominantly older postmenopausal women with no prior history of MI.
Collapse
Affiliation(s)
- Vicky A LeGrys
- Division of Clinical Laboratory Science, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Wu JM, Ward RM, Allen-Brady KL, Edwards TL, Norton PA, Hartmann KE, Hauser ER, Velez Edwards DR. Phenotyping clinical disorders: lessons learned from pelvic organ prolapse. Am J Obstet Gynecol 2013; 208:360-5. [PMID: 23200709 PMCID: PMC3597745 DOI: 10.1016/j.ajog.2012.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/15/2012] [Accepted: 11/20/2012] [Indexed: 11/24/2022]
Abstract
Genetic epidemiology, the study of genetic contributions to risk for disease, is an innovative area in medicine. Although research in this arena has advanced in other disciplines, few genetic epidemiological studies have been conducted in obstetrics and gynecology. It is crucial that we study the genetic susceptibility for issues in women's health because this information will shape the new frontier of personalized medicine. To date, preterm birth may be one of the best examples of genetic susceptibility in obstetrics and gynecology, but many areas are being evaluated including endometriosis, fibroids, polycystic ovarian syndrome, and pelvic floor disorders. An essential component to genetic epidemiological studies is to characterize, or phenotype, the disorder to identify genetic effects. Given the growing importance of genomics and genetic epidemiology, we discuss the importance of accurate phenotyping of clinical disorders and highlight critical considerations and opportunities in phenotyping, using pelvic organ prolapse as a clinical example.
Collapse
Affiliation(s)
- Jennifer M. Wu
- Department of Obstetrics and Gynecology, Division of Urogynecology, Duke University, Durham, NC
| | - Renée M. Ward
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN
| | - Kristina L. Allen-Brady
- Division of Genetic Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Todd L. Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee
| | - Peggy A. Norton
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Katherine E. Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
| | | | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
46
|
Castel LD, Hartmann KE, Mayer IA, Saville BR, Alvarez J, Boomershine CS, Abramson VG, Chakravarthy AB, Friedman DL, Cella DF. Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort. Cancer 2013; 119:2375-82. [PMID: 23575918 DOI: 10.1002/cncr.28016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/03/2013] [Accepted: 01/31/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND More than 80,000 postmenopausal breast cancer patients in the United States each year are estimated to begin a 5-year course of aromatase inhibitors (AIs) to prevent recurrence. AI-related arthralgia (joint pain and/or stiffness) may contribute to nonadherence, but longitudinal data are needed on arthralgia risk factors, trajectories, and background in postmenopause. This study sought to describe 1-year arthralgia trajectories and baseline covariates among patients with AI and a postmenopausal comparison group. METHODS Patients initiating AIs (n = 91) were surveyed at the time of AI initiation and at 6 repeated assessments over 1 year. A comparison group of postmenopausal women without breast cancer (n = 177) completed concomitantly timed surveys. Numeric rating scales (0-10) were used to measure pain in 8 joint pair groups (bilateral fingers, wrists, elbows, shoulders, hips, knees, ankles, and toes). Poisson regression models were used to analyze arthralgia trajectories and risk factors. RESULTS By week 6, the AI-initiating group had more severe arthralgia than did the comparison group (ratio of means = 1.8, 95% confidence interval = 1.24-2.7, P = .002), adjusting for baseline characteristics. Arthralgia then worsened further over 1 year in the AI group. Menopausal symptom severity and existing joint-related comorbidity at baseline among women initiating AI were associated with more severe arthralgia over time. CONCLUSIONS Patients initiating AI should be told about the timing of arthralgia over the first year of therapy, and advised that it does not appear to resolve over the course of a year. Menopausal symptoms and joint-related comorbidity at AI initiation can help identify patients at risk for developing AI-related arthralgia.
Collapse
Affiliation(s)
- Liana D Castel
- Vanderbilt University Medical Center, Nashville, Tennessee 37203-1738, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Velez Edwards DR, Likis FE, Andrews JC, Woodworth AL, Jerome RN, Fonnesbeck CJ, Nikki McKoy J, Hartmann KE. Progestogens for preterm birth prevention: a systematic review and meta-analysis by drug route. Arch Gynecol Obstet 2013; 287:1059-66. [PMID: 23532387 DOI: 10.1007/s00404-013-2789-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/05/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Progestogen has been investigated as a preventive intervention among women with increased preterm birth risk. Our objective was to systematically review the effectiveness of intramuscular (IM), vaginal, and oral progestogens for preterm birth and neonatal death prevention. METHODS We included articles published from January 1966 to January 2013 and found 27 randomized trials with data for Bayesian meta-analysis. RESULTS Across all studies, only vaginal and oral routes were effective at reducing preterm births (IM risk ratio [RR] 0.95, 95 % Bayesian credible interval [BCI]: 0.88-1.03; vaginal RR 0.87, 95 % BCI: 0.80-0.94; oral RR 0.64, 95 % BCI: 0.49-0.85). However, when analyses were limited to only single births all routes were effective at reducing preterm birth (IM RR 0.77, 95 % BCI: 0.69-0.87; vaginal RR 0.80, 95 % BCI: 0.69-0.91; oral RR 0.66, 95 % BCI: 0.47-0.84). Only IM progestogen was effective at reducing neonatal deaths (IM RR 0.78, 95 % BCI: 0.56-0.99; vaginal RR 0.75, 95 % BCI: 0.45-1.09; oral RR 0.72, 95 % BCI: 0.09-1.74). Vaginal progestogen was effective in reducing neonatal deaths when limited to singletons births. CONCLUSIONS All progestogen routes reduce preterm births but not neonatal deaths. Future studies are needed that directly compare progestogen delivery routes.
Collapse
Affiliation(s)
- Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN 37203, USA.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
LaMorte DL, Hartmann KE, Abramson VG, Mayer IA, Peacock NW, Cella D, Castel LD. Changes in adjuvant endocrine therapy over one year among postmenopausal women with early-stage breast cancer initiating aromatase inhibitors. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11 Background: Aromatase inhibitors (AIs) are standard of care for adjuvant endocrine therapy (AET) to prevent recurrence of early stage breast cancer in postmenopausal women. Previous AET adherence research has focused on the 25-96% adherence observed with, but more information is needed about AI adherence, especially regarding the role of arthralgia (joint pain or stiffness) in AET changes. Our objective was to understand AET changes within a year of AI initiation. Methods: We examined AET switching (either to another AI or to tamoxifen), overall changes in AET (including switching and temporary or permanent discontinuation), and physician- and patient-reported arthralgia, using data abstracted from medical records and self-administered surveys among 93 patients initiating AI. We conducted Chi-square and Wilcoxon univariate analyses. Results: Anastrazole was initially prescribed to 64 patients (69%), letrozole to 28 patients (30%), and exemestane to 1 patient. A year after AI initiation, 64 patients (69%) had no change in AET. Among the 29 patients (31%) who had an AET change, 14 switched to at least one other AI, 11 switched to tamoxifen, 9 temporarily discontinued AET, and 7 entirely discontinued AET (categories not mutually exclusive). Average time to first AET switch was 182.7 days. Average number of AET switches was 1.4. Arthralgia was the most common reason for AET changes, noted in the records of 19 patients (66% of those who changed AET). Patients who changed AET reported more severe arthralgia (median pain from 0-10 among 8 joint groups =1.4, interquartile range [IQR]=0.3-2.6) at week 12 than those who did not (median=0.3, IQR=0-1.1), p=0.03. A higher proportion (46%) of the 28 patients who initiated with letrozole changed AET due to arthralgia, compared with 20% of the 64 patients who initiated with anastrazole (p=0.01). Conclusions: A substantial proportion of women initiating AI change AET over one year. Arthralgia appears to play a key role in AET changes, particularly for letrozole as compared with anastrazole. More longitudinal patient-reported arthralgia data are needed to guide clinical decision making about AI initiation and AET changes.
Collapse
Affiliation(s)
| | | | | | | | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | |
Collapse
|
49
|
Buckley JP, Palmieri RT, Matuszewski JM, Herring AH, Baird DD, Hartmann KE, Hoppin JA. Consumer product exposures associated with urinary phthalate levels in pregnant women. J Expo Sci Environ Epidemiol 2012; 22:468-75. [PMID: 22760436 PMCID: PMC3439834 DOI: 10.1038/jes.2012.33] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/24/2012] [Indexed: 05/20/2023]
Abstract
Human phthalate exposure is ubiquitous, but little is known regarding predictors of urinary phthalate levels. To explore this, 50 pregnant women aged 18-38 years completed two questionnaires on potential phthalate exposures and provided a first morning void. Urine samples were analyzed for 12 phthalate metabolites. Associations with questionnaire items were evaluated via Wilcoxon tests and t-tests, and r-squared values were calculated in multiple linear regression models. Few measured factors were statistically significantly associated with phthalate levels. Individuals who used nail polish had higher levels of mono-butyl phthalate (P=0.048) than non-users. Mono-benzyl phthalate levels were higher among women who used eye makeup (P=0.034) or used makeup on a regular basis (P=0.004). Women who used cologne or perfume had higher levels of di-(2-ethylhexyl) phthalate metabolites. Household products, home flooring or paneling, and other personal care products were also associated with urinary phthalates. The proportion of variance in metabolite concentrations explained by questionnaire items ranged between 0.31 for mono-ethyl phthalate and 0.42 for mono-n-methyl phthalate. Although personal care product use may be an important predictor of urinary phthalate levels, most of the variability in phthalate exposure was not captured by our relatively comprehensive set of questionnaire items.
Collapse
Affiliation(s)
- Jessie P. Buckley
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, North Carolina, USA
| | - Rachel T. Palmieri
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, North Carolina, USA
| | - Jeanine M. Matuszewski
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, North Carolina, USA
| | - Amy H. Herring
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, North Carolina, USA
- Carolina Population Center, Chapel Hill, NC
| | - Donna D. Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Katherine E. Hartmann
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, North Carolina, USA
- Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN
| | - Jane A. Hoppin
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| |
Collapse
|
50
|
Johnson G, MacLehose RF, Baird DD, Laughlin-Tommaso SK, Hartmann KE. Uterine leiomyomata and fecundability in the Right from the Start study. Hum Reprod 2012; 27:2991-7. [PMID: 22811308 DOI: 10.1093/humrep/des263] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous research suggests the removal of uterine leiomyomata may improve ability to conceive. Most of this previous research was conducted in infertility clinics. We investigated the association between leiomyoma characteristics on time to pregnancy among women enrolled from the general population. METHODS We enrolled a cohort study of women in early pregnancy. Participants retrospectively reported their time to conception. Leiomyomata characteristics were determined by first-trimester ultrasound. We used discrete time hazard models to estimate the effects of uterine leiomyomata on time to pregnancy. RESULTS In this population of 3000 women, 11% (324) with one or more leiomyomata, we found no association between leiomyomata presence, type, location, segment or size on time to pregnancy. CONCLUSIONS These results suggest that leiomyomata have little effect on time to pregnancy in this cohort of women. The study excluded women who had been treated for infertility, and this may have resulted in underestimation of the association. However, differences between our study and previous studies in specialty clinics may be, in part, attributable to differences between our community-recruited population of women and women receiving fertility care, as well as difference in leiomyomata size or type in women having myomectomies to treat infertility.
Collapse
Affiliation(s)
- Gayle Johnson
- Division of Biostatistics, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | | | | |
Collapse
|