Pregnancy outcomes in women with inflammatory bowel disease: a 10-year nationwide population-based cohort study.

BACKGROUND: Data relating to the association between inflammatory bowel disease (IBD) and pregnancy outcomes are lacking in Korea. AIMS: To determine the incidence rates of pregnancy outcomes in women with IBD. METHODS: A nationwide population study was performed using the Korean National Health Insurance claims database. A total of 2058 women with IBD consisting of ulcerative colitis (UC, n = 1469) and Crohn's disease (CD, n = 589) were pregnant between 2007 and 2016. We compared their incidence of pregnancy outcomes with 20 580 age-matched controls without IBD. We also stratified the patients into those with quiescent to mild and moderate to severe IBD and compared the outcomes between them. RESULTS: The pregnancy rate of women with IBD was lower than that of women without (25.7% vs 32.3%, P < 0.001). Caesarean section (46.5% vs 38.8%, odds ratio [OR] 1.43, 95% confidence interval [CI]: 1.17-1.75), and intrauterine growth retardation (IUGR) (3.0% vs 1.0%, OR 2.89, 95% CI: 1.59-5.26) were increased in CD patients than the controls. In regards to disease severity, there were no significant differences in pregnancy outcomes between patients with quiescent to mild IBD and the controls. However, the live birth rate of patients with moderate to severe IBD was lower than that of the controls (65.0% vs 69.9%, OR 0.79, 95%CI: 0.66-0.94). In addition, moderate to severe IBD was significantly associated with spontaneous abortion (14.9% vs 11.9%, OR 1.33, 95% CI: 1.04-1.68), caesarean section (46.4% vs 38.8%, OR 1.41, 95% CI: 1.14-1.74) and IUGR (3.4% vs 1.0%, OR 3.20, 95% CI: 1.75-5.84). CONCLUSIONS: With the exception of moderate to severe disease, the incidences of adverse pregnancy outcomes in women with IBD are similar to that of the general population.

Quantitative evaluation of mammographic densities: a comparison of methods of assessment.

Differences in the proportion of the breast occupied by mammographic densities have been shown to be associated with differences in breast cancer risk. However, estimation of these densities by radiologists may be subject to error, and it is likely that quantitative measurement will reduce misclassification of densities and strengthen their association with risk of breast cancer. The objective of this study was to compare the extent of mammographic densities estimated subjectively by an experienced radiologist with the measured extent of densities using a digital planimeter. A total of 225 sets of mammograms from women aged 40-49 years and enrolled in the Canadian National Breast Screening Study (NBSS) were selected. The extent of the radiological densities was estimated visually by one radiologist. Independently, the total area of the breast and the areas of density were traced and measured using a digital planimeter. Visual estimations and measurements of mammographic densities were then compared to determine the extent of agreement between the two methods. In general, the two methods showed good agreement (kappa = 0.78). The measured area of mammographic densities tended to be slightly greater than the radiologist's estimations. Both methods were highly reproducible (radiologist-dependent method, kappa = 0.89; quantitative method, r = 0.95, P = 0.0001). Our results indicate that measurement of the area of mammographic density using a quantitative method is reliable, and correlates well with assessment by an experienced radiologist. The method may be useful for identifying women at increased risk of breast cancer.

A review of the methods used by studies of dietary measurement.

Studying the association between diet and disease requires reliable and valid methods for the assessment of diet. The authors reviewed the literature concerned with the assessment of these aspects of the measurement of dietary intake. Studies were examined for the stated purpose and scope of the dietary instrument, for a description of the instrument itself, for any methods employed to train individuals in its use and for the methods used to assess its reliability and validity. Of the 59 studies reviewed, 54% described fully the dietary method used. Of the 39 studies that described the results using questionnaires, 51% gave specific information on questions asked and only 18% included the questionnaire itself. Reliability was assessed in 26 studies and 74% (19) used the test-retest reliability and 22% (6) used proxies to assess reliability. Validity was assessed in 46 studies and 83% (38) used indirect methods that compared the results of one dietary method (e.g. 24 hr recall) with another more extensive one (e.g. diet history). Thirty five percent (16) used biochemical and 15% (7) used other methods. This review suggests several directions that might be usefully followed in conducting and reporting further research in the development of methods to assess diet.

Compliance in a randomized clinical trial of dietary fat reduction in patients with breast dysplasia.

Dietary compliance was studied in 57 women participating for 1 y in a randomized clinical trial of dietary fat reduction. Nutrient analysis of food records, collected at 0, 6, and 12 mo, was compared with changes observed in lipid profiles and with chemical analysis of duplicate diets. Both food records and duplicate meals showed a significant decrease in fat intake (from 36 to 23% of total calories, p less than 0.0001) and a significant increase in carbohydrate (from 43 to 56% of total calories, p less than 0.0001) in the intervention group. The calculated nutrient intake from food records tended to overestimate the intake of protein, fat, and carbohydrate compared with the chemically analyzed method. The mean level of plasma cholesterol in the intervention group was significantly reduced (7.3%, p less than 0.01) in the first 6 mo after a reduction in dietary fat but the levels observed did not differ significantly between the groups at any time.