title: Physical and mental health correlates of pregnancy following breast cancer.
abstract: BACKGROUND
  The safety of pregnancy after breast cancer is an important issue for many younger breast cancer survivors and their health care providers. Current research does not indicate that pregnancy negatively affects survival, but the 'healthy mother bias,' suggesting that survivors who go on to become pregnant are a self-selected healthier group based on their prognosis, has led to cautious interpretation of these findings. No studies have systematically evaluated the potential for this bias.
  
  
  METHODS
  This nested case-control study includes 81 younger participants from the Women's Healthy Eating and Living (WHEL) study (N=3088). Our sample includes 27 cases who had children after breast cancer and 54 controls, matched on age and stage at diagnosis. We used hierarchical linear modeling to accommodate longitudinal data with individuals nested within matched sets (cases and controls). The primary aim was to evaluate the association between summary scores of health and childbearing after breast cancer. Covariates were added for adjustment and to improve model precision.
  
  
  RESULTS
  Controlling for other variables in the model, physical health scores were not different between cases and controls (B=0.14, p=0.96). Mental health scores were marginally higher among cases (B=6.40, p=0.08), as compared with controls, a difference considered clinically significant.
  
  
  CONCLUSIONS
  This preliminary study did not find evidence of a healthy mother bias based on physical health. However, mental health was 6 points higher (p=0.08) among those who had children, indicating that the role of mental health needs evaluation in future research. Larger studies are needed to verify these findings.
authors.affiliation: Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, La Jolla, San Diego, CA 92093-0901, USA.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Gorman
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roesch
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.forename: Lisa
authors.initials: L
authors.lastname: Madlensky
authors.forename: Nazmus
authors.initials: N
authors.lastname: Saquib
authors.forename: Vicky A
authors.initials: VA
authors.lastname: Newman
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000523:psychology*; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000209:etiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013534:Survival; D013997:Time Factors