title: Alcohol dependence and reproductive onset: findings in two Australian twin cohorts.
abstract: BACKGROUND
  Although early alcohol use is a strong predictor of future alcohol problems and adolescent drinking is associated with risky sexual behavior predictive of early childbearing, reproductive dysfunctions associated with delayed childbearing have been reported in adult drinkers. We examine the relationship between lifetime history of alcohol dependence (AD) and timing of first childbirth across reproductive development.
  
  
  METHODS
  Data were drawn from two cohorts of Australian twins born between 1893 and 1964 (3634 female and 1880 male twins) and between 1964 and 1971 (3381 female and 2748 male twins). Survival analyses were conducted using Cox proportional hazards regression models predicting age at first childbirth from AD, with sociodemographic characteristics, regular smoking, history of psychopathology, and family and childhood risks included as control variables in adjusted models.
  
  
  RESULTS
  Results suggest alcoholic women in both cohorts show overall delayed reproduction, with little effect of AD on timing of first reproduction in men. Effects of AD are particularly strong for women in the older cohort, where AD is associated with 73% decreased likelihood of first childbirth after age 29 [hazard ratio (HR) = 0.27, 95% CI: 0.10-0.75]. In adjusted models, effects reduce only slightly (HR = 0.29, 95% CI: 0.11-0.80). For women in the young cohort, AD is associated with delayed reproduction after age 24, with 40% decreased likelihood of first childbirth (HR = 0.60, 95% CI: 0.48-0.75). AD remains predictive in adjusted models, but without age interaction (HR = 0.72, 95% CI: 0.62-0.85).
  
  
  CONCLUSIONS
  Findings of delayed reproductive onset in alcoholic women are consistent with alcohol-related reproductive dysfunctions, although underlying mechanisms remain largely unknown. To better understand AD differences in reproductive onset, continued research on both biological and psychosocial risks is needed.
authors.affiliation: Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA. maryw@matlock.wustl.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Waldron
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Heath
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Bucholz
authors.forename: Pamela A F
authors.initials: PA
authors.lastname: Madden
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Martin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000235:genetics / Q000503:physiopathology*; D001315:Australia; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D016016:Proportional Hazards Models; D012098:Reproduction / Q000502:physiology*; D055703:Reproductive Physiological Phenomena; D019966:Substance-Related Disorders / Q000235:genetics / Q000503:physiopathology*; D016019:Survival Analysis
references.citation: Br J Psychiatry Suppl. 2001 Apr;40:s33-40
references.pmid: 11315223
references.citation: Fam Plann Perspect. 1995 Jan-Feb;27(1):23-8
references.pmid: 7720849
references.citation: Sex Transm Dis. 1997 Jul;24(6):313-9
references.pmid: 9243736
references.citation: J Stud Alcohol. 1997 Sep;58(5):464-73
references.pmid: 9273910
references.citation: Int J Androl. 1996 Dec;19(6):323-37
references.pmid: 9051418
references.citation: Acta Genet Stat Med. 1966;16(3):265-75
references.pmid: 4959152
references.citation: Alcohol Res Health. 2000;24(4):209-14
references.pmid: 15986715
references.citation: Fam Plann Perspect. 1988 May-Jun;20(3):128-36
references.pmid: 3417003
references.citation: Evolution. 2001 Feb;55(2):423-35
references.pmid: 11308097
references.citation: Alcohol Clin Exp Res. 1984 Sep-Oct;8(5):451-8
references.pmid: 6391255
references.citation: Am J Health Behav. 2002 Nov-Dec;26(6):473-85
references.pmid: 12437022
references.citation: J Child Psychol Psychiatry. 2006 Jan;47(1):16-24
references.pmid: 16405636
references.citation: J Adolesc Health. 2000 Jan;26(1):42-8
references.pmid: 10638717
references.citation: Int J Addict. 1995 Sep;30(11):1453-78
references.pmid: 8530215
references.citation: Psychol Med. 1997 Nov;27(6):1381-96
references.pmid: 9403910
references.citation: Alcohol Res Health. 2006;29(3):172-8
references.pmid: 17373405
references.citation: Natl Vital Stat Rep. 2003 Dec 17;52(10):1-113
references.pmid: 14717305
references.citation: J Health Soc Behav. 1996 Dec;37(4):339-49
references.pmid: 8997889
references.citation: Behav Genet. 1985 Mar;15(2):93-109
references.pmid: 3838073
references.citation: Addiction. 2001 Apr;96(4):607-21
references.pmid: 11300964
references.citation: Matern Child Health J. 1997 Jun;1(2):81-8
references.pmid: 10728230
references.citation: Am J Psychiatry. 1997 Oct;154(10):1405-11
references.pmid: 9326823
references.citation: Alcohol Alcohol. 2002 Jan-Feb;37(1):87-92
references.pmid: 11825863
references.citation: Fam Plann Perspect. 1994 Nov-Dec;26(6):257-63
references.pmid: 7867773
references.citation: Am J Health Promot. 1995 Sep-Oct;10(1):27-36
references.pmid: 10155656
references.citation: Am J Psychiatry. 1994 May;151(5):707-15
references.pmid: 8166312
references.citation: J Adolesc Health. 1999 Sep;25(3):179-81
references.pmid: 10475493
references.citation: Behav Genet. 1985 Jul;15(4):305-47
references.pmid: 4041178
references.citation: Addiction. 1999 Sep;94(9):1361-70
references.pmid: 10615721
references.citation: J Pharmacol Exp Ther. 1988 May;245(2):407-12
references.pmid: 3367299
references.citation: Fertil Steril. 1998 Oct;70(4):632-7
references.pmid: 9797089
references.citation: Alcohol Alcohol. 1997 May-Jun;32(3):211-9
references.pmid: 9199721
references.citation: Br J Addict. 1991 Oct;86(10):1269-81
references.pmid: 1836409
references.citation: Addiction. 2000 Feb;95(2):251-65
references.pmid: 10723854
references.citation: Psychol Med. 2006 Oct;36(10):1461-71
references.pmid: 16734942
references.citation: Alcohol Res Health. 2002;26(4):274-81
references.pmid: 12875037
references.citation: Pediatrics. 1996 Jul;98(1):91-6
references.pmid: 8668418
references.citation: Am J Public Health. 1993 Jun;83(6):830-7
references.pmid: 8498620
references.citation: Alcohol Clin Exp Res. 2003 Jan;27(1):93-9
references.pmid: 12544012
references.citation: Fam Plann Perspect. 2000 Jul-Aug;32(4):166-75
references.pmid: 10942352
references.citation: Fam Plann Perspect. 1995 Jan-Feb;27(1):18-22, 33
references.pmid: 7720848
references.citation: J Biosoc Sci. 2002 Apr;34(2):259-75
references.pmid: 11926458
references.citation: Twin Res. 2001 Apr;4(2):73-80
references.pmid: 11665339
references.citation: Am J Health Behav. 2004 Jan-Feb;28(1):3-12
references.pmid: 14977154
references.citation: Alcohol Res Health. 2001;25(4):282-7
references.pmid: 11910706
references.citation: BMJ. 1998 Aug 22;317(7157):505-10
references.pmid: 9712595
references.citation: Am J Psychiatry. 1999 Jan;156(1):34-40
references.pmid: 9892295
references.citation: Am J Public Health. 1994 Jul;84(7):1116-20
references.pmid: 8017535
references.citation: Addict Behav. 1998 May-Jun;23(3):419-25
references.pmid: 9668941
references.citation: Acta Genet Med Gemellol (Roma). 1984;33(3):435-50
references.pmid: 6543278
references.citation: Fam Plann Perspect. 1998 Jul-Aug;30(4):163-9
references.pmid: 9711453
references.citation: Am J Public Health. 1990 Mar;80(3):295-9
references.pmid: 2305908
references.citation: Hum Reprod. 1998 Jun;13(6):1532-9
references.pmid: 9688387
references.citation: Fam Plann Perspect. 1998 Nov-Dec;30(6):271-5
references.pmid: 9859017
references.citation: Addiction. 1999 Oct;94(10):1477-87
references.pmid: 10790900
references.citation: J Subst Abuse. 1997;9:103-10
references.pmid: 9494942
references.citation: J Stud Alcohol. 1994 Mar;55(2):149-58
references.pmid: 8189735
references.citation: JAMA. 1977 Nov 14;238(20):2143
references.pmid: 578821
references.citation: Arch Gen Psychiatry. 2007 Jul;64(7):830-42
references.pmid: 17606817
references.citation: Pediatrics. 1998 Nov;102(5):1185-92
references.pmid: 9794952
references.citation: Alcohol Clin Exp Res. 2007 May;31(5):717-28
references.pmid: 17378921