Abuse in childhood and risk of uterine leiomyoma: the role of emotional support in biologic resilience.
BACKGROUND
Childhood adversities are associated with adult health. We hypothesize that exposure to physical and sexual abuse in childhood and adolescence will be associated with incidence of clinically symptomatic uterine leiomyomas (fibroids) through influences on health behaviors and reproductive hormone regulation.


METHODS
Participants included 68,505 women enrolled in the Nurses' Health Study II, an ongoing prospective cohort study of premenopausal women from 14 US states aged 25-42 years at enrollment (1989), who completed a retrospective questionnaire on childhood violence exposure (2001). A cumulative indicator of severity and chronicity of child/teen violence exposure was derived using factor analysis. We used a Cox proportional-hazards model to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs).


RESULTS
During the 728,865 woman-years of follow-up (1989-2005), 9823 incident diagnoses of ultrasound- or hysterectomy-confirmed uterine leiomyomas were reported; 65% reported any physical or sexual abuse. A dose-response association between cumulative abuse and fibroid risk was found. Compared with those who reported no abuse, multivariable IRRs for ultrasound or hysterectomy-confirmed uterine leiomyomas were 1.08 (95% CI = 1.03-1.13), 1.17 (1.10-1.24), 1.23 (1.14-1.33), 1.24 (1.10-1.39), and 1.36 (1.18-1.54), for cumulative exposures ranging from mildest to most severe. Increased emotional support in childhood also attenuated associations.


CONCLUSIONS
Severity and chronicity of child/teen sexual and physical abuse was associated with increasing risk of clinically detected fibroids among premenopausal women.
Division of General Pediatrics, Boston University School of Medicine, Boston, MA 02118, USA. renee.boyntonjarrett@bmc.org
Renée
R
Boynton-Jarrett
Janet W
JW
Rich-Edwards
Hee-Jin
HJ
Jun
Eileen N
EN
Hibert
Rosalind J
RJ
Wright
D000293:Adolescent; D000328:Adult; D002649:Child Abuse; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D015438:Health Behavior; D006801:Humans; D007889:Leiomyoma / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012742:Sex Offenses; D012944:Social Support; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000453:epidemiology*; D055815:Young Adult
D012739:Gonadal Steroid Hormones