Parity is associated with a short–term increase in breast cancer (BC) risk followed by a long–term decrease in risk. BC diagnosed 5–7 years after a completed pregnancy is associated with worse outcomes. BC is not a single disease. The dual effect of pregnancy could account for the BC characteristics at presentation (i.e. younger age and more advanced disease) and worse outcomes observed among Hispanics, relative to Non–Hispanic Whites. The purpose of this study was to investigate the association of reproductive characteristics by tumor subtype in a case series of women of Mexican–descent. Cases diagnosed ≤10 years following a birth had nearly 3 times the odds of a diagnosis with HER2+ tumors, relative to ER+/PR+ tumors. HER2+ tumors are associated with reduced survival compared to ER+/PR+ tumors. Diagnosis within a recent pregnancy may contribute to the aggressiveness of BC observed among women of Mexican descent ≤50 years of age.

Recent studies have shown that postmenopausal follicle stimulating hormone (FSH) levels may be predictive of future cardiovascular disease risk. However, little is known about postmenopausal FSH levels, including the level of variation between women and factors associated with this variation. We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at baseline (1998-2001). Reproductive factors were assessed at baseline, along with FSH levels. After adjustment for sex steroids, adiposity measures, plasma lipids, blood pressure, and behavioral factors, we observed that women with 3 or more births and an age at first birth of 25 or later had mean FSH levels that were significantly 7.6 IU/L lower than those of women with a 1 to 2 births and an age at first birth of 24 or less. Number of miscarriages was inversely correlated with FSH levels. Women reporting a 7 or more years of OC use and 4-6 or 7 or more years of HT use each had significantly higher mean FSH levels than women who had never used OCs or HT. In summary, multiple reproductive factors were associated with postmenopausal FSH levels, independent of estradiol, adiposity, and other factors. These findings warrant replication and further exploration of potential underlying mechanism.

Den Hintergrund der vorliegenden Arbeit bildet die 1990 initiierte Studie European Investigation into Cancer and Nutrition, kurz EPIC, deren Ziel es ist, die Zusammenhänge zwischen Ernährung und chronischen Erkrankungen, dabei insbesondere Krebserkrankungen, zu untersuchen. Um den Einfluß von Ernährungsfaktoren auf diese Krankheiten feststellen zu können, ist es unabdingbar, die Verteilungen auch anderer bereits bekannter oder vermuteter Risikofaktoren in den Studienkohorten zu kennen und bei den Berechnungen zu berücksichtigen. Im Hinblick auf Frauen spielen bei diesen Nicht-Ernährungsfaktoren die reproduktiven Faktoren eine zentrale Rolle. Dieser Arbeit standen die reproduktiven Daten der Frauen aus den beiden deutschen EPIC-Zentren Potsdam (N=16630) und Heidelberg (N=13616) zur Verfügung. Die Aufgabe bestand in der Beschreibung dieser Daten und in einem diesbezüglichen Vergleich der beiden Kohorten. Wie die vorliegenden Ergebnisse zeigen, unterscheiden sie sich zum Teil erheblich von einander: so liegt der Anteil der Nullipara in Potsdam bei 10% und Heidelberg bei 20,3%, das mittlere Alter bei der ersten Geburt in Potsdam bei 23,2 Jahren und in Heidelberg bei 25,6 Jahren. Diese und weitere Unterschiede zeigen sich besonders bei den vorwiegend sozial und gesellschaftlich beeinflußten Faktoren und werden in den altersabhängigen Darstellungen noch deutlicher. Vorwiegend biologisch determinierte Faktoren wie das Alter bei Menarche zeigen dagegen kaum Unterschiede. Auffallend ist, daß sich die Daten zur Einnahme exogener Hormone in beiden Kohorten sehr ähneln, obwohl diese Faktoren zu den vorwiegend sozial und gesellschaftlichen beeinflußten Faktoren gehören. Im Hinblick auf die im Verlauf der EPIC-Studie stattfindenden Analysen der Zusamenhänge zwischen Ernährung und chronischen Erkrankungen, bei denen für die in dieser Arbeit behandelten Faktoren kontrolliert werden muß, legen die vorliegenden Ergebnisse nahe, daß im Einzelfall geprüft werden muß, ob es zulässig ist, die Analysen für mehrere Zentren gemeinsam durchzuführen, oder ob sie für jedes Zentrum einzeln durchgeführt werden müssen. Insbesondere kann die Verwendung der Surrogat-Variablen "Ausbildung" zu Schwierigkeiten führen, da sie, wie in dieser Arbeit deutlich wird, in Potsdam und Heidelberg nicht dasselbe abbildet. / This paper deals with parts of the baseline data of the study European Investigation into Cancer and Nutrition (EPIC) which has been initiated in 1990, and which aims at examining links between nutrition and chronic diseases in general as well as cancer diseases in particular. In order to be able to identifying the influence of nutritional factors on these diseases it is crucial to take into account the distribution of other known or alleged risk factors existing in the study cohorts. As far as women are concerned, reproductive factors play an essential role among such non-nutritional factors. This paper takes into account the reproductive data of the women in the two German EPIC centers Potsdam (n=16,630) and Heidelberg (n=13,616) and aims at describing and comparing these data. The results show some significant differences between the two study cohorts, such as in regard to the share of nulliparity, which is 10 per cent among the Potsdam cohort, but reaches 20.3 per cent in the Heidelberg group, and in regard to the average age of the women at first birth, which is 23.2 in Potsdam and 25.6 in Heidelberg. Such evident differences and more, which all must be regarded as primarily social factors, become even more significant when one describes the respective cohorts on the basis of the women s age. By way of contrast, primarily biologically determined factors such as the age of menarche differ hardly between Heidelberg and Potsdam. It is remarkable that the data on the use of HRT and oral contraceptives are very similar in both cohorts, too, even if this factor belongs to the socially and society-influenced factors. As for the analyses of links between nutrition and chronic diseases, which represent the major aim of EPIC, and which have to be controlled in regard to the reproductive factors mentioned in this paper, the results presented in this paper suggest that it any forthcoming study has to verify if it is possible to analyze several centers collectively, or if every center has to be analyzed individually. In particular the use of the surrogate-variable "education" can lead to difficulties or misunderstandings, as it has different implications in Potsdam and Heidelberg respectively.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-28T20:42:32Z No. of bitstreams: 1 deborahfrancogoncalves.pdf: 2366130 bytes, checksum: ce6256d8630479c2c3e6b3547808e7a1 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-07T21:49:09Z (GMT) No. of bitstreams: 1 deborahfrancogoncalves.pdf: 2366130 bytes, checksum: ce6256d8630479c2c3e6b3547808e7a1 (MD5) / Made available in DSpace on 2017-08-07T21:49:09Z (GMT). No. of bitstreams: 1 deborahfrancogoncalves.pdf: 2366130 bytes, checksum: ce6256d8630479c2c3e6b3547808e7a1 (MD5) Previous issue date: 2017-03-28 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Introdução: O excesso de peso é um grave problema de saúde pública e entre as possíveis causas estão os fatores reprodutivos femininos, comuns às mulheres em fase adulta. Fatores como idade da menarca, menopausa, já ter ficado grávida, número de filhos e métodos contraceptivos podem interferir positivamente no ganho excessivo de peso, entretanto não há um consenso entre a associação desses fatores e o excesso de peso em mulheres adultas, sendo necessários mais trabalhos que ajudem a esclarecer essa relação. Objetivo: Identificar a associação entre os fatores reprodutivos e o excesso de peso em mulheres adultas. Métodos: Estudo transversal realizado em 2015, que utilizou dados coletados da pesquisa sobre saúde da mulher realizada em 2011 e 2012, em Juiz de Fora, com participação de 2018 mulheres em idade reprodutiva, de 20 a 59 anos. Foi utilizado o questionário da pesquisa, composto por informações sobre as mulheres participantes. As análises estatísticas univariada, bivariada e concordância Kappa foram realizadas no programa SPSS 14.0 e os modelos de regressão no programa Stata 11.0. Resultados e Discussão: Foi encontrada elevada prevalência de mulheres com excesso de peso (61,0%) e circunferência abdominal aumentada substancialmente (59,6%). Na análise multivariada com as variáveis reprodutivas, aquelas que apresentaram relação com o excesso de peso foram idade da menarca antes dos 12 anos, uso de contraceptivo não hormonal e ter filhos, sendo que após ajuste do modelo contraceptivo não hormonal perdeu significância. A prevalência de excesso de peso em mulheres que tiveram menarca antes dos 12 anos foi 12,4% maior do que aquelas que tiveram menarca com 12 anos ou mais de idade e a prevalência de excesso de peso em mulheres que tiveram filhos foi 58,2% maior do que as que nunca tiveram. Na análise multivariada considerando circunferência abdominal aumentada substancialmente as variáveis que mantiveram significância foram semelhantes em relação à análise com excesso de peso, sendo que as mesmas variáveis reprodutivas permaneceram significantes no fim do modelo. A análise de concordância Kappa indicou forte concordância entre IMC e circunferência abdominal, mostrando que podem ser usadas de forma combinada e complementar no diagnóstico nutricional, principalmente ao considerar fatores reprodutivos. Conclusão: O cenário encontrado mostra uma grande prevalência de excesso de peso na população estudada, com ênfase na influência dos fatores reprodutivos, que merecem atenção e monitoramento, já que são característicos da população feminina adulta. / Introduction: Overweight is a serious public health problem and among the possible causes are female reproductive factors, common to women in adulthood. Factors such as age of menarche, menopause, having become pregnant, number of children and contraceptive methods may interfere positively with excessive weight gain, however there is no consensus between the association of these factors and excess of weight in adult women, requiring more work to clarify this relationship. Objective: To identifying the association between reproductive factors and excess of weight in adult women. Methods: Cross-sectional study carried out in 2015, using data collected from the women's health survey conducted in 2011 and 2012, in the city of Juiz de Fora, with envollment of 2018 women in reproductive age, from 20 to 59 years. The research questionnaire, composed of information about the women participants, was used. Univariate, bivariate and Kappa concordance statistical analyzes were performed in the SPSS 14.0 program and the regression models in the Stata 11.0 program. Results and Discussion: It was found a high prevalence of excess of weight women (61.0%) and a substantially increased abdominal circumference (59.6%). In the multivariate analysis with the reproductive variables, those that presented relationship with the excess of weight were age of menarche before 12 years old, use of non-hormonal contraceptive and to having children, after adjustment of the non-hormonal contraceptive model, it lost significance. The prevalence of excess of weight in women who had menarche before 12 years old was 12.4% higher than those who had menarche after 12 years old and over, and the prevalence of excess of weight in women who had children was 58.2% higher than the ones that never had. In the multivariate analysis considering abdominal circumference significantly increased, the variables that remained significant were similar in relation to the excess of weight analysis, and the same reproductive variables remained significant at the end of the model. The Kappa concordance analysis indicated a strong concordance between BMI and waist circumference, showing that they can be used in a combined and complementary way in nutritional diagnosis, especially when considering reproductive factors. Conclusion: The scenario shows a high prevalence of excess of weight in the studied population, with an emphasis on the influence of reproductive factors, which deserve attention and monitoring, since they are characteristic of the adult female population.

Contexte – La dépression est le trouble mental le plus répandu, mais son étiologie et les facteurs de risque qui lui sont associés demeurent encore largement inconnus, notamment en post-ménopause. Une influence des facteurs hormonaux et anthropométriques est fortement suggérée sur le risque de symptômes dépressifs (SDS) mais pourrait être différente selon que les SDS en post-ménopause ont été précédés d’un antécédent de trouble psychologique (SDS récurrents) ou non (SDS isolés). Objectif – Les données de la cohorte française E3N ont été utilisées pour évaluer les associations entre les facteurs reproductifs endogènes, l’utilisation de traitements hormonaux de la ménopause (THM), les mesures anthropométriques, la corpulence au cours de la vie, et le risque de SDS chez les femmes post-ménopausées. Résultats – Nos résultats suggèrent que la parité est associée à une diminution de risque, tandis que l’irrégularité des cycles en pré-ménopause et les antécédents de symptômes de la ménopause sont associés à un augmentation de risque de SDS en post-ménopause. Une ménopause plus tardive pourrait avoir un effet bénéfique sur le risque de SDS isolés ou précédés d’un premier trouble en post-ménopause. Notre étude n’a cependant pas mis en évidence d’effet bénéfique à long terme des THM sur les SDS, bien que, chez les utilisatrices en cours, la durée de prise de traitement et la voie orale étaient associées à une diminution de risque de SDS isolé. Un poids ou un indice de masse corporelle élevé n’étaient associés qu’aux SDS récurrents. En revanche, les femmes de plus faible poids ou ayant un faible indice de masse corporelle, mais aussi celles ayant un rapport tour de taille/tour de hanches élevé, avaient un risque augmenté de SDS. Enfin, nos résultats suggèrent que des facteurs anthropométriques précoces, tels qu’un poids de naissance élevé ou une forte corpulence dans l’enfance, peuvent également être associés au risque de SDS isolés en post-ménopause. Les femmes ayant un faible poids de naissance ou dont la corpulence augmentait fortement à la puberté pourraient d’autre part être à risque de SDS récurrents.Conclusion – Notre étude suggère que les associations entre les facteurs hormonaux et anthropométriques et les SDS en post-ménopause dépendent de l’histoire psychologique des femmes et proposent ainsi de nouvelles hypothèses. Ces résultats demandent cependant à être reproduits dans des études prospectives qui permettraient d’apporter de nouveaux arguments en faveur de la causalité. / Background – Depression is the most common mental disorder, but its etiology and associated risk factors in postmenopausal women remains largely unknown. A relationship between hormonal or anthropometric factors and severe depressive symptoms (SDS) has been suggested but could vary according to whether postmenopausal SDS are preceded by a psychological disorder (recurrent SDS) or not (isolated SDS).Objective – We used data from the French E3N cohort to examine the associations of endogenous reproductive factors, the use of menopausal hormone therapy (MHT), different anthropometric measures and body silhouettes throughout life with the risk of SDS in postmenopausal women.Results – Our results suggest that parity is associated with a lower risk, and that menstrual cycle irregularity and menopausal symptoms are associated with a higher risk of postmenopausal SDS. A later age at menopause could have a beneficial effect on isolated SDS or when SDS are preceded by a first psychological disorder in postmenopause. Our study was not able to show an inverse association between long-term MHT use and SDS, although longer MHT duration or oral MHT could have a beneficial effect on isolated SDS in women who were currently using MHT. A higher weight or body-mass index were only associated with recurrent SDS. However, women with a low weight or a low body-mass index, as well as those with a high waist-to-hip ratio had a higher risk of SDS. Finally, our results suggest that early anthropometric factors, such as a high birth weight or a high body-size in childhood could also be associated with a higher risk of isolated SDS. On the other hand, women with a low birth weight or whose silhouette grew strongly at puberty could be at higher risk of recurrent SDS.Conclusion – Our study suggest that associations between hormonal and anthropometric factors and postmenopausal SDS could differ according to women psychological history. New results of large prospective studies are warranted to argue for causality.