We examined the relationship of body mass index (BMI), diabetes and smoking to endometrial cancer risk in a cohort of 36 761 Norwegian women during 15.7 years of follow-up. In multivariable analyses of 222 incident cases of endometrial cancer, identified by linkage to the Norwegian Cancer Registry, there was a strong increase in risk with increasing BMI (P-trend or=40 kg m(-2). Women with known diabetes at baseline were at three-fold higher risk (RR 3.13, 95% CI: 1.92-5.11) than those without diabetes; women who reported current smoking at baseline were at reduced risk compared to never smokers (RR 0.55, 95% CI: 0.35-0.86). The strong linear positive association of BMI with endometrial cancer risk and a strongly increased risk among women with diabetes suggest that any increase in body mass in the female population will increase endometrial cancer incidence.
Department of Obstetrics and Gynaecology and Medical Faculty Division, Akershus University Hospital, Lørenskog, Norway Department of Mathematics, University of Oslo, Oslo, Norway Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
Please cite this paper as: Sarfraz A, Samuelsen S, Eskild A. Changes in fetal death during 40 years-different trends for different gestational ages: a population-based study in Norway. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02819.x. Objective To study changes in gestational-age-specific fetal death risks during a 40-year period. Design Register-based observational study. Setting The Medical Birth Registry of Norway. Population All pregnancies after 16 weeks of gestation in Norway from 1967 to 2006 (n = 2 182 756). Method Changes in fetal death risk since 1967-1971 (reference) were estimated as absolute risks (rates) and relative risks (RR) in ongoing pregnancies at the following gestational weeks; 16-22, 23-29, 30-36 and 37-43. Main outcome measures Fetal death. Results In all pregnancies lasting longer than 22 weeks, the fetal death rate decreased during 1967-2006. The greatest decline was in term pregnancies (37-43 weeks) from 10.8 to 3.3 fetal deaths per 1000 at risk (crude RR 0.35; 95% CI 0.31-0.38) comparing 1967-1971 with 2002-2006. In pregnancies at 30-36 weeks the fetal death rate declined from 4.5 to 1.1 per 1000 (crude RR 0.23; 95% CI 0.21-0.26). At 23-29 weeks, the rate declined from 2.8 to 1.3 per 1000 (crude RR 0.46; 95% CI 0.40-0.52). An opposite trend was observed at early gestation (16-22 weeks) with an increase from 1.7 to 3.4 fetal deaths per 1000 ongoing pregnancies (crude RR 2.05; 95% CI 1.84-2.27). Adjustments for maternal age, parity, multiple pregnancies, paternal age and pre-eclampsia did not significantly alter the estimated associations. Conclusion Since 1967 the risk of fetal death has been reduced by almost 70% in pregnancies lasting longer than 22 weeks; however, at 16-22 weeks of gestation there was an increase in risk. The causes of this increase should be further explored because it may be attributed to an increase in early delivery caused by the increased proportion of women being treated with cervical cone excision before pregnancy.
OBJECTIVES: To assess the association between maternal parvovirus B19 infection and fetal death, birthweight and length of gestation. DESIGN: Case-control study. SETTING: Population based. POPULATION: Cases were all 281 women with fetal death within a cohort of 35 940 pregnant woxmen in Norway. The control group consisted of a random sample of 957 women with a live born child. METHOD: Information on pregnancy outcome was obtained from the Medical Birth Registry of Norway. First trimester serum samples were tested for antibodies against parvovirus B19 (IgM and IgG). In seronegative women, further serum was analysed to detect seroconversion during pregnancy. MAIN OUTCOME MEASURES: Fetal death, length of gestation and birthweight. RESULTS: Two of 281 (0.7%) of the women who experienced fetal death and nine of 957 (0.9%) of the controls had presence of IgM antibodies, crude odds ratio 0.8; 95% CI (0.2-3.5). In initially, seronegative women, 3.1% (2/65) with fetal death and 2.6% (8/307) with a live birth seroconverted, crude odds ratio 1.2; 95% CI (0.2-5.7). Presence of maternal parvovirus-specific IgG or IgM antibodies in the first trimester, or seroconversion during pregnancy were not associated with lower birthweight or reduced length of gestation in live born children, but was associated with low birthweight in stillborn offspring. CONCLUSION: Maternal parvovirus B19 infection was not associated with fetal death in our study. Very few cases of fetal death may be attributed to maternal parvovirus B19 infection.
OBJECTIVE: Frequency of termination of pregnancy (TOP) and associated risk factors according to immigration status were studied. DESIGN: Population-based registry study linking hospital data with information from the Central Population Registry of Norway. SETTING: Oslo, Norway. POPULATION: All women 15-49 years undergoing TOP and resident in Oslo, Norway from 1 January 2000 to 31 July 2003. METHODS: TOP rates per 1000 women/year were calculated. The association of socio-economic variables such as maternal age, marital status, number of children and education level within the study groups were estimated as odds ratios and using logistic regression. MAIN OUTCOME MEASURE: Termination of pregnancy. RESULTS: Refugees (30.2, 95% CI = 28.5-31.8) and labour migrants (19.9, 95% CI = 18.7-21.3) had significantly higher TOP rates than nonmigrants (16.7, 95% CI = 16.3-17.1). Except in women less than 25 years, labour migrants had higher TOP rates than nonmigrants. Refugees had the highest rates in all age groups. Being unmarried was associated with a substantially increased risk of TOP among the nonmigrants; such effect was not observed among labour migrants and refugees. Two or more children were associated with increased risk among nonmigrants and refugees compared with four or more among the labour migrants. Generally, higher education showed a protective effect that was most pronounced among nonmigrants. Compared with nonmigrants, adjusted risk of TOP was 1.37 (95% CI = 1.25-1.50) for labour migrants and 1.94 (95% CI = 1.79-2.11) for refugees. CONCLUSION: Public health efforts to increase the use of contraceptives among refugees and labour migrants above 25 years should be encouraged.