Objective To estimate risk of parental cardiovascular disease mortality by offspring birthweight.Design Population-based cohort study.Setting and population Norwegian mothers and fathers with singleton births during 1967-2002 were followed until 2009 by linkage to the Norwegian cause of death registry.Methods Hazard ratios by offspring absolute birthweight in grams and birthweight adjusted for gestational age (z-score) were calculated using Cox regression and adjusted for parental age at delivery and year of first birth. Stratified analyses on preterm and term births were performed.Main outcome measures Maternal and paternal cardiovascular mortality.Results We followed 711 726 mothers and 700 212 fathers and found a strong link between maternal cardiovascular mortality and offspring birthweight but only slight evidence of associations in fathers. Adjusting birthweight for gestational age (by z-score) uncovered an unexpected strong association of large birthweight (z-score > 2.5) with mothers' cardiovascular mortality (hazard ratio 3.0, 95% CI 2.0-4.6). This risk was apparently restricted to preterm births. In stratified analyses (preterm and term births) hazard ratios for maternal cardiovascular mortality were 1.5 (1.03-2.2) for large preterm babies and 0.9 (0.7-1.2) for large term babies (P-value for interaction = 0.02), using normal weight preterm and term, respectively, as references. ConclusionWomen having large preterm babies are at increased risk of both diabetes and cardiovascular mortality. The birth of a large preterm baby should increase clinical vigilance for onset of diabetes and other cardiovascular disease risk factors.Keywords Cardiovascular mortality, diabetes, offspring birthweight.Tweetable abstract Birth of a large preterm baby should increase vigilance for cardiovascular-disease risk factors.
consideration of prevention options; decision-making processes and networks, and psychosocial well-being. Transcribed data are analyzed with NVivo 10, using grounded theory methods. Results: Prevention decision making by women who have had close contact with the cancer diagnosis and treatment of a loved one (most often a mother or grandmother, but sometimes a sister, cousin, or close friend) is importantly influenced by these experiences. The process of deciding whether and when to undertake prophylactic mastectomy or oophorectomy, chemoprevention, enhanced surveillance, and/or genetic testing is substantially different in women who have and have not had close personal experience with the cancer of a loved one. Women who have experienced the deaths of one or more loved ones express strong motivation and willingness to undertake definitive interventions; most often this means prophylactic surgery, but this can also include chemoprevention. These women often feel that they are likely to be diagnosed with breast cancer eventually, and seek decisive methods to avoid what they perceive as a life-threatening diagnosis. Women whose loved ones have survived and thrived after a cancer diagnosis are more oriented toward careful surveillance through screening tests and physician checks. These women usually see breast cancer as a challenge they may have to deal with in the future, and they are motivated to set the stage for treatment success by establishing ongoing relationships with highly competent healthcare providers, and by being diagnosed as early as possible. Conclusions: Cancer care has strong effects beyond the cancer patient herself, affecting the decisionmaking processes and the prevention-related decisions of loved ones as well. Future prevention research for women at elevated risk should consider how their prior experiences with the cancer of friends or family members structure women's expectations of cancer risk, prevention, and outcomes. Active Tobacco Smoke and Environmental Tobacco Smoke Exposure During Potential Biological Windows of Susceptibility in Relation to Breast CancerWhite AJ, D'Aloisio AA, Nichols HB, DeRoo LA, Sandler DP Purpose: Our objective was to prospectively examine active smoking and environmental tobacco smoke (ETS) in relation to breast cancer risk, with a focus on exposures during potential windows of susceptibility. Methods: Sister Study cohort participants (n ¼ 50,884) were enrolled between 2003 and 2009 and were followed for a breast cancer diagnosis. Women ages 35-74 in the United States and Puerto Rico were eligible if they had a sister who had been diagnosed with breast cancer. Study participants completed extensive telephone and paper questionnaires including information on established breast cancer risk factors as well as active smoking history and exposure to ETS while in utero and during childhood and adult years. Cox regression analysis was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for invasive breast cancer incidence associated wi...
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