Lifetime abuse victimization and risk of uterine leiomyomata in black women

doi:10.1016/j.ajog.2012.12.034

American Journal of Obstetrics and Gynecology

Volume 208, Issue 4, April 2013, Pages 272.e1-272.e13

Presented at the 25th annual meeting of the Society for Pediatric and Perinatal Epidemiology, Minneapolis, MN, June 25-26, 2012; the 46th annual meeting of the Society for Epidemiologic Research, Minneapolis, MN, June 27-30, 2012; and OB/GYN Grand Rounds, Mayo Clinic, Rochester, MN, June 24, 2012.

https://doi.org/10.1016/j.ajog.2012.12.034 Get rights and content

Objective

Uterine leiomyomata (UL) are a major contributor to gynecologic morbidity and medical costs, and black women are disproportionately affected by the condition. Previous studies have linked UL to psychosocial stress, including child abuse. We assessed the association between lifetime abuse victimization and UL among 9910 premenopausal women.

Study Design

Data were derived from the Black Women's Health Study, a prospective cohort study. In 2005, participants reported their experiences of physical and sexual abuse within each life stage (childhood, adolescence, adulthood). Biennial follow-up questionnaires from 2005 through 2011 ascertained new UL diagnoses. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Cox regression.

Results

There were 1506 incident UL cases diagnosed by ultrasound or surgery. UL incidence was higher among women who reported child abuse, particularly sexual abuse. Relative to no abuse across the life span, RRs were 1.16 (95% CI, 1.02−1.33) for physical abuse only, 1.34 (95% CI, 1.09−1.66) for sexual abuse only, and 1.17 (95% CI, 0.99−1.39) for both physical and sexual abuse in childhood. RRs for 1-3 and 4 or more incidents of child sexual abuse were 1.29 (95% CI, 1.04−1.61) and 1.41 (95% CI, 1.07−1.85), respectively, whereas the RRs for low, intermediate, and high frequencies of child physical abuse were 1.19, 1.04, and 1.23, respectively. The association was strongest for the highest category of child abuse severity (RR, 1.57; 95% CI, 1.19−2.07). No associations were found for teen or adult abuse.

Conclusion

In the present study, child sexual abuse was an independent risk factor for UL, supporting the hypothesis that childhood adversity increases UL risk.

Section snippets

Study population

The Black Women's Health Study is an ongoing prospective cohort study of 59,000 African American women aged 21-69 years at entry.⁴⁵ In 1995, Essence magazine subscribers were mailed an invitation to enroll in a long-term health study by completing a comprehensive self-administered baseline questionnaire. Biennially, participants complete follow-up questionnaires to update their exposure and medical information; cohort retention has exceeded 80% through 2011. Participants reside in more than 17

Results

Baseline characteristics of participants according to type of abuse, within each life stage, are shown in Table 1. Fifty-one percent reported abuse in childhood (43% physical and 19% sexual), 38% in adolescence (28% physical and 20% sexual), and 39% in adulthood (29% physical and 19% sexual). Relative to no abuse across the life span, child abuse was associated with younger age at baseline, younger maternal age, lower parental education, greater exposure to childhood passive smoking, lower

Comment

In this prospective cohort study of black women, child sexual abuse was positively associated with UL incidence. The association remained unchanged after control for early life covariates as well as several health-related behaviors associated with psychosocial stress, including smoking, physical inactivity, and alcohol consumption. The association for child sexual abuse frequency was weaker among those with higher coping skills. Results based on all incident cases, with follow-up starting in

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Citation Excerpt :
Vines et al. (69) noted that their questionnaire did not include certain stressful life events that might be more common among Black individuals (i.e., racial discrimination). Wise et al. (70) also found that compared with no lifetime abuse, individuals who experienced child abuse, particularly sexual abuse, had a higher risk of UF later in life. Four studies in multi-racial/ethnic study populations investigated SES or life experiences and UF risk.
To systematically review and summarize the literaure on nongenetic risk factors that may contribute to the racial disparity in uterine fibroids (UF) that disproportionality impacts Black individuals at 2-3 times the rate of White individuals and how the racial disparity has been studied to date.
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol checklist guided the systematic review process. From January 1 to June 1, 2021, relevant articles were retrieved from PubMed, EMBASE, Web of Science, and Cochrane Library. Multiple investigators screened, assessed, extracted, and critically appraised the data.
A total of 44 articles examined the relationship among UFs, race/ethnicity, and nongenetic risk factors, including cardiometabolic features, comorbidities, diet, chemical exposures, vitamin D levels, reproductive characteristics and socioeconomic factors, and life experiences. Most studies reported on the same 3 cohort study populations, and there was inconsistent statistical reporting of the race/ethnicity, risk factors, and UF relationship.
Many potential risk factors related to the racial disparity in UF have been studied thus far. There is still little conclusive evidence regarding which risk factors are the greatest contributors to racial disparities in UF. Promising areas of research deserve greater attention and a greater diversity of study populations and analytical methods.
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A total of 661 girls (aged 13–18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled.
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Medical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes.

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: This study was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development grant number HD069602 (principal investigator Dr Wise) and National Cancer Institute grant number CA58420 (principal investigator Dr Rosenberg).

: The content is solely the responsibility of the authors and does not necessarily represent the official view of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, or the National Institutes of Health.

: The authors report no conflict of interest.

: Cite this article as: Wise L, Palmer JR, and Rosenberg L. Lifetime abuse victimization and risk of uterine leiomyomata in black women. Am J Obstet Gynecol 2013;208:272.e1-13.

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ResearchGeneral gynecologyLifetime abuse victimization and risk of uterine leiomyomata in black women

Objective

Study Design

Results

Conclusion

Section snippets

Study population

Results

Comment

Obstet Gynecol

Lancet

Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Womens Health Issues

J Psychosom Res

Neurobiol Aging

Metabolism

Biol Psychiatry

Biol Psychiatry

Am J Clin Nutr

Am J Clin Nutr

Obstet Gynecol

Lancet

Am J Obstet Gynecol

Child Abuse Negl

Fertil Steril

Am J Obstet Gynecol

Obstet Gynecol

Womens Health Issues

Am J Prev Med

Am J Prev Med

Am J Prev Med

Child Abuse Negl

Uterine leiomyomata: etiology, symptomatology, and management

Fertil Steril

Hysterectomy in the United States, 1988-1990

Obstet Gynecol

Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample

J Womens Health

High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence

Am J Obstet Gynecol

Uterine leiomyomas: racial differences in severity, symptoms, and age at diagnosis

J Reprod Med

Hysterectomy and race

Obstet Gynecol

The socioeconomic correlates of hysterectomies in the United States

Am J Public Health

Biology of uterine myomas and myometrium in vitro

Semin Reprod Endocrinol

Childhood abuse and fibroids

Epidemiology

Perceived racial discrimination and risk of uterine leiomyomata

Epidemiology

Abuse in childhood and risk of uterine leiomyoma: the role of emotional support in biologic resilience

Epidemiology

Psychosocial sequelae of violent victimization in a national youth sample

J Consult Clin Psychol

The effects of family and community violence on children

Annu Rev Psychol

Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood

JAMA

Protective and damaging effects of stress mediators: allostasis and allostatic load

N Engl J Med

Protective and damaging effects of mediators of stressElaborating and testing the concepts of allostasis and allostatic load

Ann N Y Acad Sci

Research
General gynecology
Lifetime abuse victimization and risk of uterine leiomyomata in black women