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.
From the aDivision of General Pediatrics, Boston University School of Medicine, Boston, MA; bChanning Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; cDepartment of Epidemiology, Harvard University School of Public Health, Boston, MA; dConnors Center for Women's Health and Gender Biology, Brigham and Women's Hospital Boston, MA; and eDepartment of Environmental Health, Harvard School of Public Health, Boston, MA.
Submitted 18 June 2009; accepted 17 August 2010; posted 10 November 2010.
Supported by William T Grant Foundation, NIH Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 grant (HD43444). Violence exposure assessment was also supported by R01 HL64108.
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Editors' note: A commentary on this article appears on page 15.
Correspondence: Renée Boynton-Jarrett, Division of General Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall 3, Boston MA 02118. E-mail: firstname.lastname@example.org.