American Journal of Epidemiology Advance Access published online on January 11, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwm351
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Original Contribution |
The Association between In Utero Cigarette Smoke Exposure and Age at Menopause
1 Department of Obstetrics and Gynecology, Tufts-New England Medical Center, Boston, MA
2 Department of Epidemiology, Boston University School of Public Health, Boston, MA
3 Information Management Services, Rockville, MD
4 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
5 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
6 Department of Obstetrics and Gynecology, The Methodist Hospital, Houston, TX
7 Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
8 Department of Pathology, Duke University Medical Center, Durham, NC
9 Department of Epidemiology and Biostatistics, Slone Epidemiology Unit, Boston University School of Public Health, Brookline, MA
10 Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
Correspondence to Dr. William C. Strohsnitter, Department of Obstetrics and Gynecology, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111 (e-mail address: Wstrohsnitter{at}tufts-nemc.org).
Received for publication July 4, 2007. Accepted for publication November 6, 2007.
Menopause onset, on average, occurs earlier among women who smoke cigarettes than among women who do not smoke. Prenatal smoke exposure may also influence age at menopause through possible effects on follicle production in utero. Smoking information was obtained from the mothers of 4,025 participants in the National Cooperative Diethylstilbestrol Adenosis (DESAD) Project, a US study begun in 1975 to examine the health effects of prenatal diethylstilbestrol exposure. Between 1994 and 2001, participants provided information on menopausal status. Cox proportional hazards modeling compared the probability of menopause among participants who were and were not prenatally exposed to maternal cigarette smoke. Participants prenatally exposed to maternal cigarette smoke were more likely than those unexposed to be postmenopause (hazard ratio = 1.21, 95% confidence interval: 1.02, 1.43). The association was present among only those participants who themselves had never smoked cigarettes (hazard ratio = 1.38, 95% confidence interval: 1.10, 1.74) and was absent among active smokers (hazard ratio = 1.03, 95% confidence interval: 0.81, 1.31). In this cohort of participants predominantly exposed to diethylstilbestrol, results suggest that prenatal exposure to maternal cigarette smoke may play a role in programming age at menopause. The possibility that active cigarette smoking modifies this effect is also suggested.
cohort studies; diethylstilbestrol; menopause; prenatal exposure delayed effects; smoke, smoking
Abbreviations: CI, confidence interval; DES, diethylstilbestrol; DESAD, National Cooperative Diethylstilbestrol Adenosis; HR, hazard ratio