Citation

Wise LA, Palmer JR, Rosenberg L. Am. J. Obstet. Gynecol. 2013; 208(4): 272.e1-272.e13.

Affiliation

Slone Epidemiology Center, Boston University, Boston, MA, 02215. Electronic address: lwise@bu.edu.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.ajog.2012.12.034

PMID

23295977

Abstract

OBJECTIVE: Uterine leiomyomata (UL) are a major contributor to gynecologic morbidity and medical costs, and black women are disproportionately affected by the condition. Previous studies have linked UL to psychosocial stress, including child abuse. We assessed the association between lifetime abuse victimization and UL among 9,910 premenopausal women. STUDY DESIGN: Data were derived from the Black Women's Health Study, a prospective cohort study. In 2005, participants reported their experiences of physical and sexual abuse within each life stage (childhood, adolescence, adulthood). Biennial follow-up questionnaires from 2005 through 2011 ascertained new UL diagnoses. Rate ratios (RR) and 95% confidence intervals (CI) were estimated using Cox regression. RESULTS: There were 1,506 incident UL cases diagnosed by ultrasound or surgery. UL incidence was higher among women who reported child abuse, particularly sexual abuse. Relative to no abuse across the lifespan, RRs were 1.16 (CI, 1.02-1.33) for physical abuse only, 1.34 (CI, 1.09-1.66) for sexual abuse only, and 1.17 (CI, 0.99-1.39) for both physical and sexual abuse in childhood. RRs for 1-3 and ≥4 incidents of child sexual abuse were 1.29 (CI, 1.04-1.61) and 1.41 (CI, 1.07-1.85), respectively, while RRs for low, intermediate, and high frequencies of child physical abuse were 1.19, 1.04, and 1.23, respectively. The association was strongest for the highest category of child abuse severity (RR=1.57, CI, 1.19-2.07). No associations were found for teen or adult abuse. CONCLUSIONS: In the present study, child sexual abuse was an independent risk factor for UL, supporting the hypothesis that childhood adversity increases UL risk.

Language: en