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Abstract/Syllabus:
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Reproductive and Perinatal Epidemiology
Spring 2007
Instructor
Ronald Gray
Offered By
Department of Population, Family, and Reproductive Health
Description
This course focuses on current research, controversial issues, and methodological problems in the epidemiology of reproductive and perinatal health. Lectures and analyses of research papers present reproductive health issues such as conception and infertility, contraception and hormone supplementation safety including effects on reproductive cancers , as well as perinatal issues such as complications of pregnancy, infections in pregnancy, maternal mortality, adverse pregnancy outcomes, and birth defects.
Syllabus
Course Description
This course focuses on current research, controversial issues, and methodological problems in the epidemiology of reproductive and perinatal health. Lectures and analyses of research papers present reproductive health issues such as conception and infertility, contraception and hormone supplementation, and reproductive health cancers as well as perinatal issues such as complications of pregnancy, infections in pregnancy, maternal mortality, adverse pregnancy outcomes, and birth defects.
Course Objectives
- To review the epidemiology of female and male reproduction, including contraception, reproductive associated neoplasias and STDs, and the epidemiology of pregnancy and perinatal outcomes.
- To provide information on the sociodemographic, behavioral, and biologic risk factors for adverse outcomes, to review the biologic mechanisms for observed epidemiologic associations.
- To apply epidemiologic findings to clinical and public health concerns in developed and developing countries.
- To critically review scientific literature in the field of reproductive and perinatal epidemiology.
Readings
There is no required textbook for this course.
A l ist of required readings is assigned to accompany each lecture.
Course Requirements
Midterm Exam: The midterm exam focuses on the material on reproductive health covered in the first half of the term. The midterm contributes 30% of the final grade.
Final Exam: The final exam is cumulative, and may include the following formats: true/false, matching, short answer, and essay. The exam contributes 50% to the final grade.
Class Group Discussion: Discussion and presentation sessions begin with the second meeting of the course and will be given during the final 30 minutes of the session. The class is divided into fixed discussion groups of 4-5 students per group. Groups are given 15 minutes to discuss 2 to 3 questions that relate to that day's lecture topic and/or assigned readings. Discussion questions are distributed before class. Each group must briefly summarize their group's discussion of the assigned issues to the class and lead a class discussion of these issues (not more than 5 minutes per group presentation). The presentations and class discussions contribute 20% to the final grade.
Schedule
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| 1 |
Physiology and Introduction to Reproductive Health |
Lecture 1 - Ronald Gray
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| 2 |
Conception and Pregnancy Loss |
Lecture 2 - Ronald Gray
Discussion
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| 3 |
Female and Male Infertility |
Lecture 3 - Ronald Gray
Discussion
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| 4 |
Contraception Evaluation |
Lecture 4 - Ronald Gray
Discussion
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| 5 |
Adverse Effects of Hormonal Contraception and Hormone Supplementation |
Lecture 5 - Ronald Gray
Discussion
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| 6 and 7 |
Female and Male Reproductive Tract Cancers I and II |
Lecture 6/7 - Ronald Gray
Discussion
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| 8 |
Complications of Labor/Delivery and Maternal Mortality |
Lecture 8 - Cynthia Stanton
Discussion
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| 9 |
HIV and STDs in Pregnancy |
Lecture 9 - Ronald Gray
Discussion
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Midterm Exam |
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| 10 |
Epidemiology of LBW, PTD, IUGR I |
Lecture 10 - Ronald Gray
Discussion
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| 11 |
Epidemiology of LBW, PTD, IUGR II |
Lecture 11 - Ronald Gray
Discussion
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| 12 |
12a: Complications of Pregnancy
12b: Congenital Malformations, Stillbirths and Perinatal Deaths
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Lecture 12a - Ronald Gray
Lecture 12b - Ronald Gray
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| 13 |
Neural Tube Defects
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Lecture 13 - James Mills
Discussion
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| 14 |
Environmental and Occupational Hazards and Adverse Birth Outcomes
Violence against Women and Reproductive Outcomes |
Lecture 14a - Ronald Gray
Lecture 14b - Ronald Gray
Discussion
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Final Exam |
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Further Reading:
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Readings
| Lecture 1: Physiology and Introduction to Reproductive Health |
No Reading
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| Lecture 2: Conception and Pregnancy Loss |
Wilcox AJ, et al. The timing of the "fertile window" in the menstrual cycle: day specific estimates from a prospective study.
BMJ. 2000 Nov 18;321(7271):1259-62.
Nichols HB, Trentham-Dietz A, Hampton JM, Titus-Ernstoff L, Egan KM, Willett WC, Newcomb PA. From menarche to menopause: trends among US Women born from 1912 to 1969. Am J Epidemiol. 2006 Nov 15;164(10):1003-11. Epub 2006 Aug 23.
Discussion Questions
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| Lecture 3: Female and Male Infertility |
Schieve LA, et al. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med. 2002 Mar 7;346(10):731-7.
Jain T, Missmer SA, Hornstein MD. Trends in embryo-transfer practice and in outcomes of the use of assisted reproductive technology in the United States. N Engl J Med. Apr 15 2004;350(16):1639-1645.
Discussion Questions
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| Lecture 4: Contraception Evaluation |
Hubacher D, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001 Aug 23;345(8):561-7.
Darney PD. Time to pardon the IUD? N Engl J Med. 2001 Aug 23;345(8):608-10.
Joyce T, Kaestner R, Colman S. Changes in abortions and births and the Texas parental notification law. N Engl J Med. 2006 Mar 9;354(10):1031-8.
Discussion Questions
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| Lecture 5: Adverse Effects of Hormonal Contraception and Hormone Supplementation |
Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet. 1997 Apr 26;349(9060):1202-9.
Khader YS, Rice J, John L, Abueita O. Oral contraceptives use and the risk of myocardial infarction: a meta-analysis. Contraception. Jul 2003;68(1):11-17.
Beral V, Hermon C, Kay C, Hannaford P, Darby S, Reeves G. Mortality associated with oral contraceptive use: 25 year follow up of cohort of 46 000 women from Royal College of General Practitioners' oral contraception study. BMJ. Jan 9 1999;318(7176):96-100.
Discussion Questions
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| Lecture 6: Female and Male Reproductive Tract Cancers I |
Chlebowski RT, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. JAMA. 2003 Jun 25;289(24):3243-53.
Discussion Questions
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| Lecture 7: Female and Male Reproductive Tract Cancers II |
Tannock IF. Eradication of a disease: how we cured symptomless prostate cancer. Lancet. 2002 Apr 13;359(9314):1341-2.
Holmberg L, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002 Sep 12;347(11):781-9.
Discussion Questions
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| Lecture 8: Complications of Labor/Delivery and Maternal Mortality |
Hill K, et al. How should we measure maternal mortality in the developing world? A comparison of household deaths and sibling history approaches. Bulletin of the World Health Organization 2006;84:173-180
Derman RJ, et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. The Lancet 2006;368:1248-1253
Discussion Questions
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| Lecture 9: HIV and STDs in Pregnancy |
Klebanoff MA, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001 Aug 16;345(7):487-93.
Kigozi GG, et al. Treatment of Trichomonas in pregnancy and adverse outcomes of pregnancy: a subanalysis of a randomized trial in Rakai , Uganda . Am J Obstet Gynecol. 2003 Nov;189(5):1398-400.
Discussion Questions
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| Lecture 10: Epidemiology of LBW, PTD, IUGR I |
Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P. Maternal stress and preterm birth. Am J Epidemiol. Jan 1 2003;157(1):14-24.
Copper et al. The preterm prediction study: Maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks'gestation. Am J Obstet Gynecol 1996;175:1286-92
Discussion Questions
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| Lecture 11: Epidemiology of LBW, PTD, IUGR II |
Christian P et al. Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal : double blind randomized community trial. BMJ. 2003 Mar 15;326(7389):571.
Fawzi WW et al. Randomized trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998;351:1477-82.
Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Miguel Belizan J, Farnot U, et al. WHO0 antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. May 19 2001;357(9268):1551-1564.
Discussion Questions
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| Lecture 12a: Complications of Pregnancy |
Seth SS, Chalmers I. Magnesium for preventing and treating eclampsia: time for international action. Lancet. 2002 Jun 1;359(9321):1872-3.
Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, Smith D; Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002 Jun 1;359(9321):1877-90.
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| Lecture 12b: Congenital Malformations, Stillbirths and Perinatal Deaths |
Hansen M. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med. 2002 Mar 7;346(10):725-30.
Discussion Questions
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| Lecture 13: Neural Tube Defects |
Mills JL, Signore C. Neural Tube Defect Rates before and after Food Fortification with Folic Acid. Birth Defects Research (Part A) 70:844–845 (2004)
Rader JI, Schneeman BO. Prevalence of Neural Tube Defects, Folate Status, and Folate Fortification of Enriched Cereal-Grain Products in the United States . Pediatrics 2006;117;1394-1399
Brent RL, Oakley GP. The Folate Debate. Pediatrics 2006;117;1418-1419
Discussion Questions
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| Lecture 14: Violence against Women and Reproductive Outcomes |
Koenig M.A., Zablotska I., Lutalo T., Nalugoda F., Kiwanuka N., Serwadda D., Wawer M., and Gray R. Coerced First Intercourse and Reproductive Health among Adolescent Women in Rakai, Uganda. IFPP 2004;30:156-63.
Ahmed S, Koenig MA, Stephenson R. Effects of domestic violence on perinatal and early childhood mortality: evidence from north India . Am J Public Health. 2006 Aug; 96(8):1423-8.
Discussion Questions
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