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Objective: To estimate the association of pregnancy loss with common air pollutant exposure. Ambient air pollution exposure has been linked to adverse pregnancy outcomes, but few studies have investigated its relationship with pregnancy loss.Design: Prospective cohort study.Setting: Not applicable.Patient(s): A total of 343 singleton pregnancies in a multisite prospective cohort study with detailed protocols for ovulation and pregnancy testing.Intervention(s): None.Main Outcome Measure(s): Timing of incident pregnancy loss (from ovulation).Result(s): The incidence of pregnancy loss was 28% (n = 98). Pollutant levels at women's residences were estimated using modified Community Multiscale Air Quality models and averaged during the past 2 weeks (acute) and the whole pregnancy (chronic). Adjusted Cox proportional hazards models showed that an interquartile range increase in average whole pregnancy ozone (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.07-1.17) and particulate matter <2.5 μm (HR 1.13, 95% CI 1.03-1.24) concentrations were associated with faster time to pregnancy loss. Sulfate compounds also appeared to increase risk (HR 1.58, 95% CI 1.07-2.34). Last 2 weeks of exposures were not associated with loss.Conclusion(s): In a prospective cohort of couples trying to conceive, we found evidence that exposure to air pollution throughout pregnancy was associated with loss, but delineating specific periods of heightened vulnerability await larger preconception cohort studies with daily measured air quality. [ABSTRACT FROM AUTHOR]

Objective To examine preconception serum concentrations of perfluorooctanoic acid (PFOA) and six other PFCs in relation to gestational diabetes (GDM) risk. Design Prospective cohort with longitudinal follow-up. Setting Not applicable. Patient(s) Among 501 women recruited upon discontinuing contraception for the purpose of becoming pregnant, 258 (51%) became pregnant and were eligible for the study, of which 28 (11%) reported having physician-diagnosed GDM during follow-up. Intervention(s) None. Main Outcome Measure(s) The odds ratios (ORs) and 95% confidence intervals (CIs) of GDM associated with each standard deviation (SD) increment of preconception serum PFOA concentration (ng/mL, log-transformed) and six other PFCs were estimated with the use of logistic regression after adjusting for age, prepregnancy body mass index, smoking, and parity conditional on gravidity. Result(s) Preconception geometric mean (95% CI) PFOA concentrations (in ng/mL) were higher for women with than without GDM (3.94 [3.15–4.93] vs. 3.07 [2.83–3.12], respectively). Each SD increment in PFOA was associated with a 1.87-fold increased GDM risk (adjusted OR 1.86 [95% CI 1.14–3.02]). A slightly increased risk associated with each SD increment for the six other PFCs was observed as well (all ORs >1.0, range 1.06–1.27), although the associations were not statistically significant. Conclusion(s) Our findings suggested that higher environmentally relevant concentrations of PFOA were significantly associated with an increased risk of GDM. If corroborated, these findings may be suggestive of a possible environmental etiology for GDM. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between environmental chemicals and couple fecundity or time to pregnancy (TTP). Design: Prospective cohort. Setting: Communities of targeted populations with reported exposure. Patient(s): 501 couples recruited upon discontinuing contraception to become pregnant, 2005–2009. Intervention(s): None. Main Outcome Measure(s): Fecundability odds ratios (FORs) and 95% confidence intervals (CIs) estimated for each partner’s chemical concentrations adjusted for age, body mass index, cotinine, creatinine, and research site while accounting for time off contraception. Result(s): Couples completed interviews and anthropometric assessments and provided the urine specimens for quantification of bisphenol A (BPA) and 14 phthalate metabolites, which were measured using high-performance liquid chromatography with electrospray triple-quadrupole mass spectrometer. Women recorded menstruation and pregnancy test results in daily journals. Couples were evaluated until a positive human-chorionic gonadotropin pregnancy test or 12 cycles without pregnancy. Neither female nor male BPA concentration was associated with TTP (FOR 0.98; 95% CI, 0.86, 1.13 and FOR 1.04; 95% CI, 0.91, 1.18, respectively). Men’s urinary concentrations of monomethyl, mono-n-butyl, and monobenzyl phthalates were associated with a longer TTP (FOR 0.80; 95% CI, 0.70, 0.93; FOR 0.82, 95% CI, 0.70, 0.97; and FOR 0.77, 95% CI, 0.65 0.92, respectively). Conclusion(s): Select male but not female phthalate exposures were associated with an approximately 20% reduction in fecundity, underscoring the importance of assessing both partners’ exposure to minimize erroneous conclusions. [Copyright &y& Elsevier]

Objective: To assess semen parameters and couple fecundity as measured by time to pregnancy (TTP). Design: Observational prospective cohort with longitudinal measurement of TTP. Setting: Sixteen Michigan/Texas counties. Patient(s): A total of 501 couples discontinuing contraception were followed for 1 year while trying to conceive; 473 men (94%) provided one semen sample, and 80% provided two samples. Intervention(s): None. Main Outcome Measure(s): Using prospectively measured TTP, fecundability odds ratios (FORs) and 95% confidence intervals (CIs) were estimated for 36 individual semen quality parameters accounting for repeated semen samples, time off contraception, abstinence, enrollment site, and couples' ages, body mass indices, and serum cotinine concentrations. Result(s): In adjusted models, semen quality parameters were associated with significantly shorter TTP as measured by FORs >1: percent motility, strict and traditional morphology, sperm head width, elongation factor, and acrosome area. Significantly longer TTPs or FORs <1 were observed for morphologic categories amorphous and round sperm heads and neck/midpiece abnormalities. No semen quality parameters achieved significance when simultaneously modeling all other significant semen parameters and covariates, except for percent coiled tail when adjusting for sperm concentration (FOR 0.99; 95% CI 0.99–1.00). Male age was consistently associated with reduced couple fecundity (FOR 0.96; 95% CI 0.93–0.99), reflecting a longer TTP across all combined models. Female but not male body mass index also conferred a longer TTP (FOR 0.98; 95% CI 0.96–0.99). Conclusion(s): Several semen measures were significantly associated with TTP when modeled individually but not jointly and in the context of relevant couple-based covariates. [Copyright &y& Elsevier]

Objective: To assess the association between self-reported measures of stress, anxiety, depression, and related constructs and fecundity. Design: Prospective cohort study of women trying to conceive. Setting: United Kingdom. Patient(s): Three hundred thirty-nine women aged 18–40 years who were attempting to conceive. Intervention(s): Completed daily diaries for up to six cycles or until pregnancy was detected. For each cycle, stress biomarkers were measured and psychosocial questionnaires were completed. Main Outcome Measures(s): Fecundability odds ratios (FORs) and 95% confidence intervals were calculated using discrete time survival methods, and the day-specific probabilities of pregnancy were calculated using Bayesian statistical techniques. Result(s): Among the 339 women, 207 (61%) became pregnant during the study, 69 (20%) did not become pregnant, and 63 (19%) withdrew. After controlling for maternal age, parity, months trying to conceive before enrollment, smoking, caffeine use, and frequency of intercourse, we found no association between most psychosocial measures and FORs or the day-specific probabilities of pregnancy save for an increased FOR for women reporting higher versus lower levels of social support. Conclusion(s): Self-reported psychosocial stress, anxiety, and depression were not associated with fecundity. Any adverse effect of stress or psychological disturbance on fecundity does not appear to be detectable via the questionnaires administered. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether children conceived using assisted reproductive technology (ART) or ovulation induction (OI) have greater cardiometabolic risk than children conceived without treatment.Design: Clinical assessments in 2018-2019 in the Upstate KIDS cohort.Setting: Clinical sites in New York.Patient(s): Three hundred thirty-three singletons and 226 twins from 448 families.Intervention(s): Mothers reported their use of fertility treatment and its specific type at baseline and approximately 4 months after delivery. High validity of the self-reported use of ART was previously confirmed. The children were followed up from infancy through 8-10 years of age. A subgroup was invited to participate in clinic visits.Main Outcome Measure(s): The measurements of blood pressure (BP), arterial stiffness using pulse wave velocity, anthropometric measures, and body fat using bioelectrical impedance analysis were performed (n = 559). The levels of plasma lipids, C-reactive protein, and hemoglobin A1c were measured using blood samples obtained from 263 children.Result(s): The average age of the children was 9.4 years at the time of the clinic visits Approximately 39% were conceived using fertility treatment (18% using ART and 21% using OI). Singletons conceived using fertility treatment (any type or using ART or OI specifically) did not statistically differ in systolic or diastolic BP, heart rate, or pulse wave velocity. Singletons conceived using OI were smaller than singletons conceived without treatment, but the average body mass index of the latter was higher (z-score: 0.41 [SD, 1.24]) than the national norms. Twins conceived using either treatment had lower BP than twins conceived without treatment. However, twins conceived using OI had significantly higher arterial stiffness (0.59; 95% CI, 0.03-1.15 m/s), which was attenuated after accounting for maternal BP (0.29; 95% CI, -0.03 to 0.46 m/s). Twins did not significantly differ in size or fat measures across the groups. The mode of conception was not associated with the levels of lipids, C-reactive protein, or glycosylated hemoglobin.Conclusion(s): Clinical measures at the age of 9 years did not indicate greater cardiometabolic risk in children conceived using ART or OI compared with that in children conceived without treatment.Clinical Trial Registration Number: ClinicalTrials.gov #NCT03106493. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether deoxyribonucleic acid (DNA) methylation at birth and in childhood differ by conception using assisted reproductive technologies (ART) or ovulation induction compared with those in children conceived without fertility treatment.Design: Upstate KIDS is a matched exposure cohort which oversampled on newborns conceived by treatment.Setting: New York State (excluding New York City).Patient(s): This analysis included 855 newborns and 152 children at approximately 9 years of age.Intervention(s): None.Main Outcome Measure(s): DNA methylation levels were measured using the Illumina EPIC platform. Single CpG and regional analyses at imprinting genes were conducted.Result(s): Compared to no fertility treatment, ART was associated with lower mean DNA methylation levels at birth in 11 CpGs (located in/near SYCE1, SPRN, KIAA2013, MYO1D, GET1/WRB-SH4BGR, IGF1R, SORD, NECAB3/ACTL10, and GET1) and higher mean methylation level in 1 CpG (KLK4; all false discovery rate P<.05). The strongest association (cg17676129) was located at SYCE1, which codes for a synaptonemal complex that plays a role in meiosis and therefore infertility. This CpG remained associated with newborn hypomethylation when the analysis was limited to those conceived with ICSI, but this may be because of underlying male infertility. In addition, nine regions in maternally imprinted genes (IGF1R, PPIEL, SVOPL GNAS, L3MBTL, BLCAP, HYMAI/PLAGL1, SNU13, and MEST) were observed to have decreased mean DNA methylation levels among newborns conceived by ART. In childhood, hypomethylation of the maternally imprinted gene, GNAS, persisted. No CpGs or regions were associated with ovulation induction.Conclusion(s): ART but not ovulation induction was associated with hypomethylation at birth, but only one difference at an imprinting region appeared to persist in childhood. [ABSTRACT FROM AUTHOR]

Objective: To study the associations between maternal polycystic ovary syndrome (PCOS) and hirsutism with offspring attention-deficit/hyperactivity disorder (ADHD), anxiety, conduct disorder, and behavioral problems.Design: Prospective birth cohort study.Setting: Not applicable.Patient(s): A total of 1,915 mother-child dyads.Intervention(s): None.Main Outcome Measure(s): Maternal report of offspring ADHD, anxiety, or conduct disorder diagnosis at 7 to 8 years; emotional symptoms, behavioral problems (including peer relationship, conduct, hyperactivity/inattention), and prosocial problems measured with the Strengths and Difficulties Questionnaire (SDQ) at 7 years.Result(s): Prevalence of PCOS and hirsutism were 12.0% and 3.9%; 84% of women with hirsutism had PCOS. After adjustment for sociodemographic covariates, prepregnancy body mass index, and parental history of affective disorders, children born to mothers with PCOS had higher risk of anxiety (adjusted risk ratio [aRR] 1.62; 95% confidence interval [CI], 1.02-2.57) and borderline emotional symptoms (aRR 1.66; 95% CI, 1.18-2.33) compared with children born to mothers without PCOS. The associations between maternal PCOS and offspring ADHD were positive but imprecise. Maternal hirsutism was related to a higher risk of children's ADHD (aRR 2.33; 95% CI, 1.28-4.24), conduct disorder (aRR 2.54; 95% CI 1.18-5.47), borderline emotional symptoms, peer relationship problems, and conduct problems (aRRs 2.61; 95% CI, 1.69-4.05; 1.92; 95% CI, 1.16-3.17; and 2.22; 95% CI, 1.30-3.79, respectively).Conclusion(s): Maternal PCOS was associated with offspring anxiety, and hirsutism was related to other offspring behavioral problems. These findings should be interpreted with caution as replication is needed in prospective cohort studies that assess PCOS and hirsutism diagnoses using medical records. [ABSTRACT FROM AUTHOR]

Objective: To study the association between salivary stress biomarkers and the secondary sex ratio. Design: Prospective, longitudinal cohort study. Setting: Community setting in the United Kingdom. Patient(s): On discontinuation of contraception for purposes of becoming pregnant, 338 women aged 18–40 years with complete data (90%) were followed until pregnant or up to six menstrual cycles. Intervention(s): None. Main Outcome Measure(s): Secondary sex ratio. Result(s): Human chorionic gonadotropin pregnancies were detected in 207 (61%) women of whom 130 (63%) delivered singleton infants with available gender data. The adjusted odds ratio for a male birth was decreased for women in the highest quartile (AOR = 0.26; 95% confidence interval = 0.09, 0.74) of salivary cortisol relative to women in the lowest quartile during cycle 1. An inverse relation was observed between α-amylase and the 2° sex ratio, though not statistically significant. Conclusion(s): Our findings are consistent with a reversal in the 2° sex ratio with increasing preconception salivary cortisol concentrations. This relation suggests that activation of the hypothalamus–pituitary–adrenal axis may have implications in sex allocation and requires further study. [ABSTRACT FROM AUTHOR]

Objective: To assess salivary stress biomarkers (cortisol and α-amylase) and female fecundity.Design: Prospective cohort design.Setting: United Kingdom.Patient(s): 274 women aged 18 to 40 years who were attempting pregnancy.Intervention(s): Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection.Main Outcome Measure(s): Salivary cortisol (μg/dL) and α-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively.Result(s): Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio=0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples' ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of α-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029).Conclusion(s): Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway. [ABSTRACT FROM AUTHOR]

Caffeine consumption has been equivocally associated with miscarriage, despite an absence of prospective longitudinal measurement of caffeine intake during sensitive windows of human development. In response to this critical data gap, we analyzed daily caffeine consumption while attempting pregnancy through 12 menstrual cycles at risk for pregnancy and found that caffeine consumption did not increase the risk or hazard of miscarriage, even after adjusting for relevant covariates. [Copyright &y& Elsevier]

Objective: To assess parental health status inclusive of infertility and infant outcomes.Design: Birth cohort with cross-sectional analysis of parental health status and infant outcomes.Setting: Not applicable.Patient(s): Parents (n = 4,886) and infants (n = 5,845) participating in the Upstate KIDS birth cohort.Intervention(s): None.Main Outcome Measure(s): Infertility was defined as [1] sexually active without contraception for 1+ years without pregnancy, [2] ever requiring ≥12 months to become pregnant, and [3] requiring ≥12 months for index pregnancy. Multivariable linear regression with generalized estimating equations estimated the change (β coefficient and 95% confidence interval [CI]) in infant outcomes (gestation, birthweight, length, head circumference, ponderal index) and relative to each disease, including infertility after adjusting for age, body mass index, and infertility treatment.Result(s): Prevalence of parental chronic diseases ranged from <1% to 19%, and 21% to 54% for infertility. Maternal hypertension was negatively associated with gestation (β, -0.64; 95% CI, -1.03, -0.25) and birthweight (-151.98; -262.30, -41.67) as was asthma and birthweight (-75.01; -130.40, -19.62). Maternal kidney disease was associated with smaller head circumference (-1.09; -2.17, -0.01), whereas paternal autoimmune disease was associated with larger head circumference (0.87; 0.15, 1.60). Infertility was negatively associated with birthweight (-62.18; -103.78, -20.58), length (-0.33; -0.60, -0.06), and head circumference (-0.35; -0.67, -0.03).Conclusion(s): Infertility was significantly associated with reduced infant size even after accounting for infertility treatment, although the magnitude of reduction varied by definition of infertility. Absence of pregnancy within a year of being at risk may be informative about health. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between preconception parental stress and the secondary sex ratio, defined as the ratio of males to females at birth.Design: A population-based preconception cohort.Setting: Not applicable.Patient(s): A total of 235 couples who were enrolled before conception in Michigan and Texas between 2005 and 2009 and who had a singleton birth during the follow-up period. Couples were interviewed separately at baseline to obtain information on perceived stress (Cohen's Perceived Stress Scale) and lifetime history of physician-diagnosed anxiety and/or mood disorders. Female partners were also trained to collect basal saliva samples for the measurement of salivary stress markers, alpha-amylase and cortisol.Intervention(s): None.Main Outcome Measure(s): Birth outcome data including infant sex were collected upon delivery. Modified Poisson regression models were used to estimate the relative risks (RRs) of a male birth for each stress marker.Result(s): After adjusting for potential confounders, we observed a 76% increase in the risk of fathering a male infant (RR 1.76; 95% confidence interval 1.17-2.65) in men diagnosed with anxiety disorders compared with those who were not diagnosed. When lifetime history of physician-diagnosed anxiety disorders was modeled jointly for the couple, the association was slightly strengthened (RR 2.03; 95% confidence interval 1.46-2.84).Conclusion(s): This prospective cohort study suggests that paternal lifetime history of physician-diagnosed anxiety disorders may be associated with an increase in the secondary sex ratio, resulting in an excess of male births. [ABSTRACT FROM AUTHOR]

Objective: To identify associations between fertility treatment use (assisted reproductive technologies, ovulation induction, and artificial insemination) and subsequent infant feeding practices.Design: The Upstate KIDS population-based cohort enrolled mothers who delivered live births in New York (2008-2010), sampling on fertility treatment and plurality.Setting: Not applicable.Patient(s): Data regarding singletons and one randomly selected infant between twins were used.Intervention(s): Not applicable.Main Outcome Measure(s): Mothers reported breast feeding and formula feeding practices at 4, 8, and 12 months postpartum. Modified Poisson regression was used to compare risks for feeding practices by mode of conception. Marginal structural models were used to estimate the controlled direct effects of fertility treatment on feeding, independent of preterm birth.Result(s): Among 4,591 mothers, 1,361 (30%) conceived with the use of fertility treatments. Mothers who used fertility treatments were less likely to breast feed to 12 months after birth and were more likely to provide formula, solids, and juice by 4 months than mothers who did not conceive with treatments. Fertility treatment remained associated with breast feeding cessation and formula feeding in mediation analyses, suggesting that preterm birth does not fully explain these associations.Conclusion(s): Women who conceived with the use of fertility treatments were less likely to breast feed later in infancy and were more likely to provide formula, solids, and juice earlier in infancy. Our analyses accounted for confounding and preterm birth, but other contributing factors may include difficulties feeding twins or workplace breast feeding accommodations. [ABSTRACT FROM AUTHOR]

Objective: To estimate pregnancy loss incidence in a contemporary cohort of couples whose lifestyles were measured during sensitive windows of reproduction to identify factors associated with pregnancy loss for the continual refinement of preconception guidance.Design: Prospective cohort with preconception enrollment.Setting: Sixteen counties in Michigan and Texas.Patient(s): Three hundred forty-four couples with a singleton pregnancy followed daily through 7 postconception weeks of gestation.Intervention(s): None. Couples daily recorded use of cigarettes, caffeinated and alcoholic beverages, and multivitamins. Women used fertility monitors for ovulation detection and digital pregnancy tests. Pregnancy loss was denoted by conversion to a negative pregnancy test, onset of menses, or clinical confirmation depending upon gestation. Using proportional hazards regression and accounting for right censoring, we estimated adjusted hazard ratios and 95% confidence intervals (aHR, 95% CI) for couples' lifestyles (cigarette smoking, alcoholic and caffeinated drinks, multivitamins) during three sensitive windows: preconception, early pregnancy, and periconception.Main Outcome Measure(s): Incidence and risk factors for pregnancy loss.Result(s): Ninety-eight of 344 (28%) women with a singleton pregnancy experienced an observed pregnancy loss. In the preconception window, loss was associated with female age ≥35 years (1.96, 1.13-3.38) accounting for couples' ages, women's and men's consumption of >2 daily caffeinated beverages (1.74, 1.07-2.81; and 1.73, 1.10-2.72, respectively), and women's vitamin adherence (0.45, 0.25-0.80). The findings were similar for lifestyle during the early pregnancy and periconception windows.Conclusion(s): Couples' preconception lifestyle factors were associated with pregnancy loss, although women's multivitamin adherence dramatically reduced risk. The findings support continual refinement and implementation of preconception guidance. [ABSTRACT FROM AUTHOR]

Objective To assess the validity of maternally reported assisted reproductive technologies (ART) use and to identify predictors of reporting errors. Design Linkage study. Setting Not applicable. Patient(s) A total of 5,034 (27%) mothers enrolled, from whom 4,886 (97%) self-reported information about use of infertility treatment, including ART, for the index birth. Intervention(s) None. Main Outcome Measure(s) Four measures of validity (sensitivity, specificity, positive and negative predictive values) and use of net reclassification improvement (NRI) methods to identify predictors associated with concordant/discordant maternal reporting. Result(s) The Upstate New York Infant Development Screening Program (Update KIDS Study) was linked with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) using a defined algorithm for 2008–2010. The sensitivity, specificity, positive and negative predictive values were high (0.93, 0.99, 0.80, and 1.00, respectively). The validity of maternal report was high, reflecting few differences by participant characteristics except for maternal age dichotomized at 29 years as identified with NRI methods. Conclusion(s) Maternally reported ART is valid, with little variation across various characteristics. No strong predictors of discordant reporting were found, supporting the utility of population-based research with SART CORS linkage. [ABSTRACT FROM AUTHOR]

Objective: To explore the relation between bisphenol A and 14 phthalate metabolites and endometriosis. Design: Matched cohort design. Setting: Fourteen clinical centers. Patient(s): The operative cohort comprised 495 women undergoing laparoscopy/laparotomy, whereas the population cohort comprised 131 women matched on age and residence. Intervention(s): None. Main Outcome Measure(s): Surgically visualized or pelvic magnetic resonance imaging diagnosed endometriosis in the two cohorts, respectively. Result(s): Odds ratios (OR) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for age, body mass index, and creatinine. In the population cohort, six phthalate metabolites-mono-n-butyl phthalate, mono-[(2-carboxymethyl) hexyl] phthalate, mono (2-ethyl-5-carboxyphentyl) phthalate, mono (2-ethylhexyl) phthalate, mono (2-ethyl-5-hydroxyhexyl) phthalate, and mono (2-ethyl-5-oxohexyl) phthalate-were significantly associated with an approximately twofold increase in the odds of an endometriosis diagnosis. Two phthalates were associated with endometriosis in the operative cohort when restricting to visualized and histologic endometriosis (monooctyl phthalate; OR 1.38; 95% CI 1.10-1.72) or when restricting comparison women to those with a postoperative diagnosis of a normal pelvis (mono (2-ethylhexyl) phthalate; OR 1.35; 95% CI 1.03-1.78], Conclusion(s): Select phthalates were associated with higher odds of an endometriosis diagnosis for women with magnetic resonance imaging-diagnosed endometriosis. The lack of consistency of find-ings across cohorts underscores the impact of methodology on findings. [ABSTRACT FROM AUTHOR]

Objective: To assess in utero exposures and the odds of an endometriosis diagnosis.Design: Matched cohort design.Setting: Fourteen participating clinical centers in geographically defined areas in Utah and California.Patient(s): Operative cohort comprised 473 women undergoing laparoscopy/laparotomy, and an age- and residence-matched population cohort comprising 127 women undergoing pelvic magnetic resonance imaging (MRI), 2007-2009.Intervention(s): None.Main Outcome Measure(s): Women completed standardized interviews before surgery or MRI regarding in utero exposures: mothers' lifestyle during the index pregnancy, and the index woman's gestation and birth size. Endometriosis was defined as visually confirmed disease in the operative cohort, and MRI visualized disease in the population cohort. The odds of an endometriosis diagnosis and corresponding 95% confidence intervals (CI) were estimated for each exposure by cohort using logistic regression and adjusting for current smoking, age at menarche, body mass index, and study site.Result(s): Endometriosis was diagnosed in 41% and 11% of women in the operative and population cohorts, respectively. In the primary analysis, adjust odds ratios (AORs) were elevated for maternal vitamin usage (1.27; 95% CI, 0.85-1.91), maternal cigarette smoking (1.16; 95% CI = 0.61-2.24), and low birth weight (1.1; 95% CI, 0.92-1.32). Reduced odds were observed for maternal usage of caffeine (0.99; 95% CI, 0.64-1.54), alcohol (0.82; 95% CI, 0.35-1.94), paternal cigarette smoking (0.72; 95% CI, 0.43-1.19), and preterm delivery (0.98; 95% CI, 0.47-2.03). Sensitivity analyses mostly upheld the primary results except for a decreased AOR for preterm birth (0.41; 95% CI, 0.18-0.94) when restricting to visualized and histologically confirmed endometriosis in the operative cohort.Conclusion(s): In utero exposures were not statistically significantly associated with the odds of an endometriosis diagnosis in either cohort. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence of endometriosis in an operative cohort of women seeking clinical care and in a matched population cohort to delineate more fully the scope and magnitude of endometriosis in the context of and beyond clinical care.Design: Matched-exposure cohort design.Setting: Surgical centers in the Salt Lake City, Utah, and San Francisco, California, areas.Patient(s): The operative cohort comprised 495 women undergoing laparoscopy/laparotomy between 2007 and 2009, and the population cohort comprised 131 women from the surgical centers' catchment areas.Intervention(s): None.Main Outcome Measure(s): Incidence of endometriosis by diagnostic method in the operative cohort and by pelvic magnetic resonance imaged (MRI) disease in the population cohort.Result(s): Endometriosis incidence in the operative cohort ranged by two orders of magnitude by diagnostic method: 0.7% for only histology, 7% for only MRI, and 41% for visualized disease. Endometriosis staging was skewed toward minimal (58%) and mild disease (15%). The incidence of MRI-diagnosed endometriosis was 11% in the population cohort.Conclusion(s): Endometriosis incidence is dependent on the diagnostic method and choice of sampling framework. Conservatively, 11% of women have undiagnosed endometriosis at the population level, with implications for the design and interpretation of etiologic research. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of infertility using a current duration approach for comparison with a traditional constructed measure. Design: Cross-sectional survey. Setting: Not applicable. Patient(s): A nationally representative sample of females aged 15–44 years. Intervention(s): None. Main Outcome Measure(s): Infertility prevalence estimated by two approaches: [1] a constructed measure derived from questions on sexual activity, contraception, relationship status, and pregnancy, and [2] a measure based on estimated time to pregnancy derived from the respondents’ current duration of pregnancy attempt (i.e., current duration approach). Associations with self-reported descriptive characteristics using weighted logistic regression or parametric survival models for each respective approach. Result(s): Infertility prevalence was approximately twofold higher using the current duration approach (15.5%; 95% confidence interval 8.6%–27.5%) vs. the constructed measure (7.0%; 95% confidence interval 6.2%–7.8%). Both methods identified similar patterns of increasing age, lower education, nulliparity, and history of gynecologic disorders as being associated with measures of impaired fecundity, whereas opposing patterns were seen for racial/ethnic identification and poverty status. Conclusion(s): Infertility prevalence based on a current duration approach was consistent with other US prospective cohort studies with preconception enrollment. These findings underscore the importance of definition and methodologic approach for estimating the prevalence of infertility. [ABSTRACT FROM AUTHOR]