The epidemiology of gynaecologic health: contemporary opportunities and challenges

Hoffman, Sarah R.; Farland, Leslie V.; Doll, Kemi M.; Nicholson, Wanda K; Wright, Mark S.; Robinson, Whitney R.

doi:10.1136/jech-2019-213149

Cited by 16 publications

(19 citation statements)

References 23 publications

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“…The preenrollment questionnaire was completed by all participants and the early-life questionnaire by 1628 participants (96%), of whom 1425 (88%) got answers directly from their mothers. We created 2 exposure variables: maternal history of fibroids (diagnosed vs not diagnosed) populated by data from the early-life (1495 [97%]) and preenrollment (52 [3%]) questionnaires and age at maternal fibroid diagnosis (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), or Ն40 years vs not diagnosed).…”

Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 99%

Family History and Uterine Fibroid Development in Black and African American Women

Langton,

Harmon,

Baird

2024

JAMA Netw Open

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ImportanceUterine fibroids are an understudied condition, with earlier onset in Black than White women. Prior studies of the importance of family history on fibroid development are limited by reliance on hospital-based participant selection, poorly defined measures of family history, and nonsystematic fibroid assessment.ObjectiveTo examine whether family history is a risk factor for fibroid development using prospective ultrasonography data to identify incident fibroids and measure fibroid growth and standardized methods to ascertain family history.Design, Setting, and ParticipantsThis prospective community cohort of Black and African American women from the Detroit, Michigan, area was conducted from January 1, 2010, to December 31, 2018, using 4 standardized ultrasonographic examinations during 5 years to detect fibroids 0.5 cm or larger in diameter and measure fibroid growth. Data analysis was performed between May 2022 and January 2024.ExposuresMaternal fibroid history data were gathered directly from participants’ mothers when possible (1425/1628 [88%]), and 2 exposure variables were created: maternal history of fibroids (diagnosed vs not diagnosed) and age at maternal fibroid diagnosis (20-29, 30-39, or ≥40 years vs not diagnosed).Main Outcomes and MeasuresFibroid incidence was assessed using multivariable Cox proportional hazards regression models; fibroid growth was calculated as change in log-volume per 18 months for fibroids matched at successive ultrasonograms.ResultsA total of 1610 self-identified Black and/or African American women aged 23 to 35 years (mean [SD] age, 29.2 [3.4] years) with no prior clinical diagnosis of fibroids at enrollment were available for analysis. Of 1187 fibroid-free participants at enrollment, 442 (37%) had mothers who were diagnosed with fibroids. Compared with participants without a maternal history of fibroids, those reporting maternal history had an adjusted hazard ratio (AHR) of 1.21 (95% CI, 0.96-1.52). Risk was strongest in those whose mothers were diagnosed at a younger age (20-29 years: AHR, 1.56; 95% CI, 1.11-2.21; 30-39 years: AHR, 1.03; 95% CI, 0.71-1.49; ≥40 years: AHR, 1.11; 95% CI, 0.81-1.52; P = .053 for trend). Fibroid growth rates were higher when mothers were diagnosed with fibroids vs not diagnosed (8.0% increased growth; 95% CI, −1.2% to 18.0%).Conclusions and RelevanceIn this prospective cohort study, results supported maternal history of fibroids as a risk factor for incident fibroids, especially when mothers were diagnosed at a younger age. Maternal history was also associated with increased fibroid growth. Asking patients about their family history of fibroids could encourage patient self-advocacy and inform care.

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Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 99%

Family History and Uterine Fibroid Development in Black and African American Women

Langton,

Harmon,

Baird

2024

JAMA Netw Open

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“…Second to sonography, prospective tracking of self-reported onset of menses along with progesterone levels and/or urinary luteinizing hormone also yields accurate menstrual phase identification (A. M. Allen et al, 2016). However, these approaches are costly, burdensome, and often not practical in biobehavioral research settings, especially with large, geographically diverse study samples and/or with cross-sectional methodological approaches (Hoffman et al, 2020). Therefore, by drawing on the existing knowledge generated from past research on fertility and ovulation, we sought to develop a stand-alone questionnaire that can accurately identify the follicular and luteal phases, without relying on additional methodology.…”

mentioning

confidence: 99%

Menstrual Phase Identification Questionnaire (MPIQ): Development and validation of a cross-sectional survey to identify follicular and luteal phases.

Allen

Valenti

Linde-Krieger

et al. 2024

Experimental and Clinical Psychopharmacology

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Evidence continues to accumulate on the influence of the menstrual phase on several biobehavioral outcomes (e.g., substance misuse). Expansion of this knowledge is limited due to the burdensomeness of accurate menstrual phase assessment. Thus, we sought to create and validate a questionnaire that can be used as a stand-alone item within low-resource settings and numerous study designs (e.g., cross-sectional) to accurately identify both the follicular phase (FP) and the luteal phase (LP). Participants completed the selfadministered four-item Menstrual Phase Identification Questionnaire (MPIQ) in two recently completed clinical trials. We assessed the accuracy of two MPIQ scoring criteria (less restrictive and more restrictive), as compared to self-report of onset of menses alone, with progesterone confirmation via dried blood spots. Participants (n = 59) were, on average, 33.7 (standard deviation [SD]: ±4.3) years old and provided a total of 83 responses. Assessing FP and LP using the self-reported onset of menses alone classified 65.1% of the responses with an overall phase identification accuracy of 60.2%. While the more restrictive MPIQ scoring classified 100% of the responses, it yielded a similar accuracy (68.4%). In contrast, the less restrictive MPIQ scoring classified 100% of the responses and also significantly improved phase identification accuracy to 92.1% ( p < .001). The MPIQ, as a stand-alone item, allows all cross-sectional responses to be classified with a high level of accuracy. This low-burden questionnaire can be used alone to identify FP and LP in studies that may be otherwise limited by study design, finances, and/or participant burden. Public Health SignificanceSelf-report of vaginal sensations and discharge plus the onset of menses improves the identification of follicular and luteal menstrual phases as compared to the self-reported onset of menses alone (60.2% accuracy vs. 92.1% accuracy; p < .001). The use of the Menstrual Phase Identification Questionnaire (MPIQ) alone will allow more biobehavioral research to identify follicular and luteal menstrual phases, especially research that may be limited by study design (e.g., cross-sectional), finances (e.g., unable to include hormonal biomarkers), and/or participant burden.

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“…While the detection of fibroids on cohort entry was incidental to the main study findings, 1 it highlights the substantial underdiagnosis of uterine fibroids in Black women, which may suggest an overall underascertainment of the magnitude of racial inequities that exist for uterine fibroids at a population level. 7 When considering the epidemiologic burden of disease, it must be interrogated whether the absence of a diagnosis truly reflects the absence of a disease. In understanding the population-level burden of disease for conditions like uterine fibroids we must ask ourselves who, and what counts?…”

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confidence: 99%

“…The presence of a mother reporting a fibroids diagnosis represents a particularly high level of access to health care that emphasizes the complex associations between health care delivery and epidemiology for conditions like uterine fibroids. While the detection of fibroids on cohort entry was incidental to the main study findings, it highlights the substantial underdiagnosis of uterine fibroids in Black women, which may suggest an overall underascertainment of the magnitude of racial inequities that exist for uterine fibroids at a population level …”

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confidence: 99%

The Intersection of Structural Racism and Health Services Research in Characterizing the Epidemiology of Uterine Fibroids

Roberson

2024

JAMA Netw Open

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This study by Langton et al 1 explores the association between maternal family history and the development of uterine fibroids among a cohort of Black women who were fibroid-free at baseline. By ascertaining maternal fibroid history through direct surveying of the mothers, Langton et al 1 provide a more robust assessment of family history of fibroids than has been captured previously using variable methods. Despite this enhanced method, this investigation by Langton et al 1 offers a critical example of how structural racism intersects with health services delivery that affects the fundamental epidemiologic understanding of a medical condition disproportionately experienced by Black women.

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The epidemiology of gynaecologic health: contemporary opportunities and challenges

Cited by 16 publications

References 23 publications

Family History and Uterine Fibroid Development in Black and African American Women

Family History and Uterine Fibroid Development in Black and African American Women

Menstrual Phase Identification Questionnaire (MPIQ): Development and validation of a cross-sectional survey to identify follicular and luteal phases.

The Intersection of Structural Racism and Health Services Research in Characterizing the Epidemiology of Uterine Fibroids

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