Human urinary epidermal growth factor: effects of age, sex and pregnancy

Urinary concentrations of immunoreactive human epidermal growth factor (hEGF) were determined by specific homologous radioimmunoassay in 169 healthy men (aged 20-69 years), 275 healthy women (20-8 years). healthy women (20-68 years) and 413 pregnant women (20-39 years). Relative hEGF concentrations in urine (micrograms/g creatinine) decreased significantly in both sexes between 24 and 64 years of age. The relative concentrations of hEGF in urine were significantly higher in women than in men at ages 20-69 years. The mean values of relative urinary hEGF concentrations in pregnant women in their twenties and thirties (30.0 +/- 0.7 micrograms/g creatinine and 29.6 +/- 1.2 micrograms/g creatinine) were significantly higher than those in age-matched nonpregnant women (27.3 +/- 1.8 micrograms/g creatinine and 22.8 +/- 0.7 micrograms/g creatinine). Among the trimesters, it was highest in the 2nd trimester of women in the twenties and thirties (33.4 +/- 1.3 micrograms/g creatinine and 31.7 +/- 1.9 micrograms/g creatinine). The significance of the increased urinary excretion of hEGF (micrograms/g creatinine) in pregnancy is not known. Further studies are required to find a source of hEGF in urine and a possible relation between increased hEGF excretion and fetoplacental growth and development.     

Heat-Attributable Deaths between 1992 and 2009 in Seoul,South Korea

BackgroundClimate change may significantly affect human health. The possible effects of high ambient temperature must be better understood, particularly in terms of certain diseases’ sensitivity to heat (as reflected in relative risks [RR]) and the consequent disease burden (number or fraction of cases attributable to high temperatures), in order to manage the threat.PurposeThis study investigated the number of deaths attributable to abnormally high ambient temperatures in Seoul, South Korea, for a wide range of diseases.MethodThe relationship between mortality and daily maximum temperature using a generalized linear model was analyzed. The threshold temperature was defined as the 90^th percentile of maximum daily temperatures. Deaths were classified according to ICD-10 codes, and for each disease, the RR and attributable fractions were determined. Using these fractions, the total number of deaths attributable to daily maximum temperatures above the threshold value, from 1992 to 2009, was calculated. Data analyses were conducted in 2012–2013.ResultsHeat-attributable deaths accounted for 3,177 of the 271,633 deaths from all causes. Neurological (RR 1.07; 95% CI, 1.04–1.11) and mental and behavioral disorders (RR 1.04; 95% CI, 1.01–1.07) had relatively high increases in the RR of mortality. The most heat-sensitive diseases (those with the highest RRs) were not the diseases that caused the largest number of deaths attributable to high temperatures.ConclusionThis study estimated RRs and deaths attributable to high ambient temperature for a wide variety of diseases. Prevention-related policies must account for both particular vulnerabilities (heat-sensitive diseases with high RRs) and the major causes of the heat mortality burden (common conditions less sensitive to high temperatures).     

Incidence of symptomatic vertebral fractures in women of childbearing age newly treated with high-dose glucocorticoid

Background: The treatment and prevention of glucocorticoid (GC)-induced osteoporosis have been controversial in premenopausal women during their childbearing years.Objective: This study assessed the incidence and risk factors for symptomatic vertebral fracture in women of childbearing age newly treated with high-dose GC.Methods: An observational cohort study was conducted at the rheumatic center of Shimoshizu National Hospital in Chiba, Japan, from 1986 to 2006. The prevalence of symptomatic vertebral fractures, as determined by x-rays, was assessed in premenopausal (aged <50 years) women with collagen vascular disease newly treated with high-dose GC (≥20 mg/d prednisolone equivalent) compared with their counterparts who did not receive GC. Differences in the incidences of vertebral fractures were compared between groups by the Kaplan-Meier method and evaluated by the log-rank test. Hazard ratios (HRs) with 95% CIs were estimated using the Cox proportional hazards regression model.Results: A total of 373 women were assessed: 292 patients in the high-dose GC treatment group (mean [SD] initial age, 32.4 [8.2] years; initial dose, 43.8 [14.9] mg/d; follow-up time, 124.2 [75.4] months) and 81 patients in the non-GC control group (initial age, 39.3 [7.8] years; follow-up time, 106.5 [79.7] months). Symptomatic vertebral fractures occurred more frequently in the high-dose GC group (11.3%) than in the non-GC group (1.2%). Using the Cox model, the adjusted HR for the high-dose GC group was 13.96 (95% CI, 1.87–104.22) relative to the non-GC group. In the high-dose GC group, Kaplan-Meier analyses revealed that the incidence of fractures in women in their forties was significantly higher in comparison with those in their twenties (P < 0.001) and thirties (P < 0.05), and that the incidence of fractures in those who consumed alcohol (>80 g/wk of pure alcohol) was significantly higher than in those who did not (P < 0.05). The Cox model also revealed that the risk was independently higher with every 10-year increment of initial age (HR = 2.27; 95% CI, 1.46–3.53), with every GC dose increase (HR = 2.28; 95% CI, 1.58–3.31), and with each 1-gram decrease of cumulative GC dose (HR = 0.95; 95% CI, 0.93–0.98).Conclusions: In this study, high-dose GC use was associated with a significantly high prevalence of symptomatic vertebral fractures in premenopausal women with collagen vascular disease during their childbearing years. However, the fracture risk was relatively low in women of childbearing age, especially those in their twenties and thirties during the early years of treatment.     

“单独两孩”政策对上海市医疗卫生行业的影响研究

目的 了解单独两孩政策的出台对上海市医疗卫生行业的影响,并由此提出有关对策建议。方法 通过宏观层面分析、焦点组访谈、问卷调研等多形式的调查手段,综合分析评估单独两孩政策实施后对上海市医疗卫生系统的需求和影响。结果 单独两孩政策实施对上海市医疗卫生行业的分别产生了三大影响和挑战：（1）影响：未来几年上海市将增加至少10%的年分娩量,2016年可能面临一个生育小波峰; 妊娠风险增加,高风险、高技术含量的产科任务增加;儿科医疗服务量的增加将逐渐出现,呈叠加之势。（2）挑战：政策调整将加剧产科医疗资源使用的不均衡,首要受到冲击的是优质产科机构;妊娠风险增加将进一步考验上海高危产科的整体应对能力;出生人口的增加和不断叠加将使本已短缺的儿科医疗资源雪上加霜。结论 单独两孩政策的影响辐射结果提示了政府主导辅以市场机制调控的重要性和迫切性;需要尽快扭转孕妇自由选择分娩医院的无序状态,保证优质产科资源真正为高危孕产妇服务;整合区域内不同层次产儿科医疗资源,以提高对高危产科的整体应对水平。     

Do gravidity and age affect pregnancy outcome?

Abstract

Fetal loss has generally been found to vary with gravidity, previous experience of fetal loss, and maternal age, but the literature is divided on the reasons for these associations. In this paper we examine pregnancy histories obtained retrospectively from a nationally representative one‐in‐one‐thousand sample of women in Australia aged 20 to 59 years. The relations of fetal loss ratios with both gravidity and previous outcome are consistent with heterogeneity of risk over the study population and a stopping rule, whereby high‐risk women undertake more pregnancies than low‐risk women to achieve the same number of live births. Evidence is presented that elevated loss ratios in the teens indicate not higher risk but a selection for short gestation intervals, while loss ratios beyond the mid‐thirties do not point unequivocally to a substantial increase in risk at the older reproductive ages.     

Duration of ovarian hormone exposure and gynecological cancer risk in Korean women: the Korean Heart Study

BackgroundAlthough reproductive and hormonal factors – such as early menarche and late menopause – have been reported as independent risk factors for cancer, few studies have examined these factors in East Asian populations.MethodsWe performed a large prospective cohort study of 66,466 women. Ovarian hormone exposure was defined as length of time between menarche and menopause. Incidence rates for breast, ovarian, endometrial and cervical cancers were examined separately in relation to reproductive lifespan defined as age at menopause minus age at menarche. Multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated using the Cox proportional hazards model.ResultsWomen with early menarche were at increased risk for developing breast cancer (HR, 1.57, 95% CI, 1.17–2.10) for age at menarche ≤12 years compared to women with age at menarche ≥17 years. Women with late age at menopause (≥52 years) had increased risks for cancers of the breast (HR, 1.59, 95%CI, 1.11–2.28) and ovary (HR, 3.22, 95% CI, 1.09–9.55) compared to women with early menopause (≤45 years of age). Women with longer duration of ovarian hormone exposure (≥40 years) were at increased risk for developing breast cancer (HR, 2.23, 95% CI, 1.35–3.68) as well as endometrial cancer (p for trend, 0.0209).ConclusionsWe showed that longer reproductive spans are associated with an increased risk of breast and endometrial cancer in Korean women.     

Ovarian development and insulin-signaling pathways during reproductive differentiation in the queenless ponerine ant Diacamma sp.

In many social hymenopteran species, workers possess functional ovaries that are physiologically inactive in the presence of queens. We investigated the ovarian regulatory mechanism of workers and reproductives in a queenless ponerine ant, Diacamma sp., using histological and molecular techniques. In this ant, clear reproductive differentiation occurs via a highly sophisticated dominance behavioral interaction called “gemmae mutilation”. This clear and rapid bifurcation of reproductive physiology allows us to elucidate the detailed ovarian differentiation process. Histological characteristics of functional ovaries (fusomes and ring canals) were found in both workers and reproductives, suggesting that early oogenesis is not blocked in workers. Since insulin/insulin-like growth factor signaling (IIS) is known to control insect reproduction, orthologs of 2 positive IIS regulators, insulin receptor and serine-threonine kinase Akt (protein kinase B), were cloned in Diacamma (DiaInR, DiaAkt); their expression patterns during reproductive differentiation were examined by real-time quantitative polymerase chain reaction; DiaInR and DiaAkt were strongly expressed in the gasters of reproductives. Whole-mount in situ hybridization of ovaries indicated that DiaInR and DiaAkt were expressed in nurse cells, oocytes, and upper germarial regions of reproductives but not of workers. Our data suggest that the IIS pathway accounts for reproductive differentiation in late oogenesis.     

Experimental Investigation of the Mechanism of Reproductive Differentiation in the Queenless Ant,Diacamma sp., from Japan

We test two hypotheses about regulation of the reproductive division of labour in the permanently queenless ponerine ant, Diacamma sp., from Japan. All workers emerge with gemmae (tiny innervated thoracic appendages), but only one individual keeps them in each colony, and she is the only mated reproductive worker (gamergate). The gemmae of all other workers are mutilated by the gamergate soon after their emergence, and they can never mate. In the presence of gamergate, mutilated workers have inactive ovaries and do not behave aggressively. Two possible consequences of mutilation are: 1. olfactory signal — a pheromone inhibiting the oogenesis of mutilated workers is no longer released by the gemmae; and 2. endocrine degeneration of its afferent neuronal connections interferes reproductive physiology of a gamergate. Gemmae of gamergates were coated with shellac (to prevent pheromone emission) or removed, and over three weeks we studied any changes in ovarian activity of the gamergates as well as nestmate workers. Coating of gemmae did not elicit worker oviposition, suggesting that gemmae pheromones do not have a regulatory function. Experimental mutilation of gamergates resulted in a slight increase in both the frequency of dominance interactions and the ovarian activity of mutilated workers, but this effect was much lower than in colonies where the gamergate was removed. This contrasts with the immediate change in the behaviour (aggressive to timid) of newly emerged workers following mutilation.     

The causes of the decline in fecundability with age

Abstract

Demographers have frequently suggested that women's fecundability reaches a maximum some time in their twenties and thereafter remains at a plateau for some years. Recent work by Bendel and Hua (1978) reinforces the author's previously expressed suspicion that this theory is incorrect. The present note is an effort to synthesize current knowledge about the variation with age of the reproductive parameters underlying fecundability. It is suggested (1) that the major cause of the decline in fecundability across ages 20–40 is a decline in coital rates, and (2) that a smaller part of the decline in fecundability is caused by a rise in risk of unrecognized spontaneous abortion. It is concluded that the “biological capacity to conceive” does not vary much during ages 20–40.     

Field endoscopy for identifying gender, reproductive stage and gonadal anomalies in free-ranging sturgeon (Scaphirhynchus) from the lower Mississippi River

Thirty-six sturgeon ( Scaphirhynchus spp.) were captured from the lower Mississippi River using baited trot-lines, anesthetized using tricaine methanesulfonate, and subjected to endoscopic evaluation of their coelom (coelioscopy) on the river bank. Using a 2.7 mm rod-lens telescope and gravity–fed sterile saline infusion, gender and reproductive stage were determined in the field, and later re-evaluted and confirmed by histology of endoscopic biopsies in the laboratory. Gender and reproductive stage were determined endoscopically in all fish without complication, and proved to correlate 100% with biopsy histology. Modern rod-lens telescopes and sterile saline insufflation can be used under field conditions, provide superior visualization of sturgeon gonads, and offer a high degree of accuracy even with inactive gonads. Rigid endoscopy is recommended as a minimally-invasive means of assessing the reproductive organs of sturgeon and other fish.     

金毛弓背蚁行为谱与社会分工的研究

本研究在室内模拟自然蚁巢的结构和条件下,使用个体标记和直接观察法对一巢金毛弓背蚁Componotus tonkinus的行为类型和社会分工进行了研究。共34只来自同一巢穴的工蚁被标记。在持续一周的观察过程中对每只蚂蚁所执行的每种行为的频率进行了统计和聚类分析。结果表明：金毛弓背蚁可以区分出12种基本行为类型;该蚂蚁的成员大致可以分为5个功能组, 即繁殖（蚁后1个）、觅食（由10个工蚁组成,主要负责觅食）、巢穴内的维护及护育（由16个工蚁组成,主要负责巢穴的维修、清理及护育）、巢穴的防卫（包括3个工蚁,行巢穴防卫）及不活跃型（含5个工蚁）。     

BMI, waist circumference, and incident urinary incontinence in older women

Overall body fat and central adiposity may reflect different mechanisms leading to urinary incontinence (UI). We examined the associations of BMI and waist circumference with incident UI, including the independent associations of BMI and waist circumference with UI type, among women aged 54-79 years in the Nurses' Health Study. Study participants reported their height in 1976 and their weight and waist circumference in 2000. From 2000 to 2002, we identified 6,790 women with incident UI at least monthly among 35,754 women reporting no UI in 2000. Type of incontinence was determined on questionnaires sent to cases with at least weekly incontinence. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression. There were highly significant trends of increasing risk of UI with increasing BMI and waist circumference (P for trend <0.001 for both). Multivariable RRs of developing at least monthly UI were 1.66 (95% CI 1.45-1.91) comparing women with a BMI of > or =35 kg/m(2) to women with BMI 21-22.9 kg/m(2) and 1.72 (95% CI 1.53-1.95) comparing women in extreme quintiles of waist circumference. When BMI and waist circumference were included in models simultaneously, BMI was associated with urge and mixed UI (P for trend 0.003 and 0.03, respectively), but not stress UI (P for trend 0.77). Waist circumference was associated only with stress UI (P for trend <0.001). These results suggest that women who avoid high BMI and waist circumference may have a lower risk of UI development.     

Formaldehyde exposure and leukemia: a new meta-analysis and potential mechanisms

Formaldehyde is an economically important chemical, to which more than 2 million U.S. workers are occupationally exposed. Substantially more people are exposed to formaldehyde environmentally, as it is generated by automobile engines, is a component of tobacco smoke and is released from household products, including furniture, particleboard, plywood, and carpeting. The International Agency for Research on Cancer (IARC) recently classified formaldehyde as a human carcinogen that causes nasopharyngeal cancer and also concluded that there is "strong but not sufficient evidence for a causal association between leukemia and occupational exposure to formaldehyde". Here, we review the epidemiological studies published to date on formaldehyde-exposed workers and professionals in relation to lymphohematopoietic malignances. In a new meta-analysis of these studies, focusing on occupations known to have high formaldehyde exposure, we show that summary relative risks (RRs) were elevated in 15 studies of leukemia (RR=1.54; confidence interval (CI), 1.18-2.00) with the highest relative risks seen in the six studies of myeloid leukemia (RR=1.90; 95% CI, 1.31-2.76). The biological plausibility of this observed association is discussed and potential mechanisms proposed. We hypothesize that formaldehyde may act on bone marrow directly or, alternatively, may cause leukemia by damaging the hematopoietic stem or early progenitor cells that are located in the circulating blood or nasal passages, which then travel to the bone marrow and become leukemic stem cells. To test these hypotheses, we recommend that future studies apply biomarkers validated for other chemical leukemogens to the study of formaldehyde.     

The impact of the International Atomic Energy Agency (IAEA) program on radiation and tissue banking in Korea

In 1971, first bone bank was established at the Department of Orthopaedic Surgery in Catholic University of Korea. The first clinical case was reported at the Journal of Korean Orthopaedic Association in 1973. Subsequently, more than 60 surgical bone banks were established in the university and teaching hospitals throughout country. In 1990, the Korea Biomaterial Research Institute (KBRI) organised the IAEA/RCA training course on tissue banking. In this course students from 17 countries participated. In 1994 the first collaboration for cadaver tissue recovery was performed. It is important to single out that the various religious groups in Korea have favourable attitudes towards tissue donation, which contributes to the success of the tissue banking programs in the country. The demands of allograft were getting increased in the Korean medical and dental society. Currently, 62 hospital based bone banks, 5 processing tissue banks, 1 regional tissue bank and more than 30 tissue distributors are working in Korea. Based on the U.S.A. usage of more than 1,000,000 grafts per year, 100,000–200,000 grafts will be needed in Korea. Those findings indicate a greatly increased need for training of tissue bank operators. The Korean society will need at least 20–30 tissue bank operators for training in every year. The National Training Centre (NTC) for tissue bank operators and medical personal using the IAEA Curriculum in the Korean languages was established in 2003. From 2004 to 2006, NTC have been trained 40 tissue bank operators. They have produced at least 10,000 tissues per year. These figures indicate a cost saving of US$ 10 million. Within 5 years, NTC will train 100 tissue bank operators. These individuals and their respective banks will provide an increasing number of high quality grafts to the communities they serve at a cost far less than if they were acquired from abroad.     

Effects of gradient and age on energy expenditure and fat metabolism during aerobic exercise at equal intensity in women

[Purpose]This study aimed to investigate the effects of gradient and age on energy expenditure and fat metabolism during aerobic exercise at equal intensity in women.[Methods] Thirty women in their twenties (n=15) and fifties (n=15) were enrolled. All subjects performed aerobic exercise on a treadmill for 10 min at 0% and 6% gradient repeatedly to elicit 50%, 60%, and 70% VO₂max.[Results]Energy expenditure and fat oxidation were higher during aerobic exercise at 6% of the gradient than at 0%, and there was no significant difference in carbohydrate oxidation in any age group.[Conclusion]Aerobic exercise at a 6% gradient was more favorable for fat oxidation than a 0% gradient in all age groups. In particular, in the case of women in their fifties, walking on a gradient of 6%, which is favorable for increasing fat oxidation, was more effective than walking on flat ground for preventing and reducing obesity. However, to examine the difference in fat oxidation among exercise intensities more accurately, exercise performed for longer than 30 min is required. Follow-up studies are required to investigate the effect of various gradients on physiological and metabolic characteristics when carrying out aerobic exercises for more than 30 min.     

Radiation exposure and cancer incidence in a cohort of nuclear power industry workers in the Republic of Korea, 1992–2005

This study examines for the first time cancer incidence between radiation and non-radiation workers in nuclear power facilities in the Republic of Korea. Radiation workers were defined as persons who were issued with a dosimeter at nuclear power facilities, until 2005. All analyses were conducted on male workers only (in total 16,236 individuals) because of the sparseness of females. Statistical analyses were carried out using the standardized incidence ratio (SIR), to compare the cancer risks of radiation and non-radiation workers with those of the general population, and the χ² trend test was used to investigate any increase in cancer rates with dose. Poisson regression was also used to estimate the rate ratio (RR) and the excess relative risk (ERR) after considering the confounding effect due to smoking. During 1992–2005, 99 cancer cases in 63,503 person-years were observed among 8,429 radiation workers, while 104 cancer cases were observed in 48,301 person-years among 7,807 non-radiation workers. When compared with the site- and age-specific cancer rates for the male population of Korea, the SIR for all cancers combined was 1.07 [95% confidence interval (CI) 0.87–1.30] for radiation workers, and 0.88 (95% CI 0.72–1.06) for non-radiation workers, respectively. The RR for radiation workers compared with non-radiation workers was 1.18 (95% CI 0.89–1.58) for all cancers combined. The SIRs for thyroid cancer were noticeably high for both radiation and non-radiation workers, possibly due to the screening effect, but analysis of the RR showed that there was no statistically significant difference in thyroid cancer incidence rates between the two groups. For lung cancer, radiation workers showed a higher incidence rate as compared to non-radiation workers, with the RR being 3.48 (95% CI 1.19–11.48). A χ² trend test showed that there was no evidence for an increase in cancer rate with increasing cumulative dose for all cancers combined (p = 0.5108). The ERR per Sievert was estimated to be 1.69 (95% CI −2.07 to 8.21) for all cancers combined assuming a 10 years lag time. Consequently, a significant excess of cancer incidence among radiation workers in the nuclear power industry in Korea was not observed. Further follow-up and an expansion of the cohort are needed to overcome the lack of statistical power in the study.     

Impact of Puumala virus infection on maturation and survival in bank voles: a capture-mark-recapture analysis

Many zoonotic diseases are caused by rodent-borne viruses. Major fluctuations in the transmission of these viruses have been related to large changes in reservoir host population numbers due to external factors. However, the impact of the pathogen itself on the demography of its reservoir host is often overlooked. We investigated the impact of Puumala virus (PUUV) on survival and reproductive maturation probability of its reservoir host, the bank vole (Myodes glareolus). Three years (2004-06) of data from nine independent sites in southern Belgium were collected and analyzed with a capture-mark-recapture (CMR) method that includes statistical correction for the variation in capture probability of voles. A multistate model based on four states of reproductive activity and PUUV immunoglobulin G (IgG) antibody status was used to estimate survival and probability of transition from one reproductive or infection state to another. Although survival estimates for reproductively active voles were similar between infected and noninfected individuals, PUUV infection in reproductively inactive voles decreased mean monthly survival by 14%. PUUV infection was associated with a threefold increase in the probability of reproductive maturation in bank voles. Moreover, the probability of PUUV IgG seroconversion was three times higher for reproductively active voles compared to reproductively inactive voles. Our model indicates that PUUV infection may alter bank vole population dynamics by affecting both survival and maturation in its host. Additional studies, using CMR methodology with shorter time intervals between trapping sessions and possibly a longer duration, are needed to confirm these findings.     

Staphylococcus aureus Bloodstream Infection and Endocarditis - A Prospective Cohort Study

ObjectivesTo update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).MethodsAll consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.ResultsSAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).ConclusionSAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.     

Prepregnancy Obesity and Risks of Stillbirth

BackgroundWe examined the association of maternal obesity with risk of stillbirth, focusing on whether the pattern of results varied by gestational age or maternal race-ethnicity or parity.MethodsAnalyses included 4,012 stillbirths and 1,121,234 liveborn infants delivered in California from 2007–2010. We excluded stillbirths due to congenital anomalies, women with hypertensive disorders or diabetes, and plural births, to focus on fetuses and women without these known contributing conditions. We used Poisson regression to estimate relative risks (RR) and 95% confidence intervals (CI). Separate models were run for stillbirths delivered at 20–23, 24–27, 28–31, 32–36, 37–41 weeks, relative to liveborn deliveries at 37–41 weeks.ResultsFor stillbirth at 20–23 weeks, RRs were elevated for all race-ethnicity and parity groups. The RR for a 20-unit change in BMI (which reflects the approximate BMI difference between a normal weight and an Obese III woman) was 3.5 (95% CI 2.2, 5.6) for nulliparous white women and ranged from 1.8 to 5.0 for other sub-groups. At 24–27 weeks, the association was significant (p<0.05) only for multiparous non-Hispanic whites; at 28–31 weeks, for multiparous whites and nulliparous whites and blacks; at 32–36 weeks, for multiparous whites and nulliparous blacks; and at 37–41 weeks, for all groups except nulliparous blacks. The pattern of results was similar when restricted to stillbirths due to unknown causes and somewhat stronger when restricted to stillbirths attributable to obstetric causes.ConclusionIncreased risks were observed across all gestational ages, and some evidence of heterogeneity of the associations was observed by race-ethnicity and parity.