Early Life Adversities and the Risk of Uterine Fibroids

Project Summary (Abstract): The racial disparity in uterine leiomyomata (fibroids) is profound among Black/African American women (BW) – with an earlier age of onset by 10-15-years, a significantly higher incidence, and greater rates of hysterectomy, a major surgical procedure, compared to White women (WW). The impact of fibroids is significant for

reproductive age women, especially BW who experience more symptomatology such as excessive bleeding, pain, and reproductive problems. Therefore, research on the risk factors for fibroids is important. Earlier onset of fibroids among BW may explain their larger fibroid size and increased symptomatology. Our main

hypotheses are that exposure to adverse childhood events (ACEs) contributes to incident fibroids and greater growth and that psychosocial resources may buffer the risk. We will use data from the National Institute of Environmental Health Sciences Study of Lifestyle & Fibroids (SELF) that enrolled 1308 BW ages 23-34-years

without a clinical diagnosis of fibroids and collected extensive data at baseline and across 3 follow-up visits on early childhood social and environmental factors, reproductive and sexual histories, and demographic, economic, behavioral, and psychosocial factors. We will evaluate the hypotheses by pursuing three specific

aims: 1) Describe the prevalence ACEs occurring before age 12 by type, cumulative risk, and latent class profiles, and examine the association between each ACE measure and childhood and adult contextual factors; 2) Describe each ACE measure in relationship to the trajectory of C-reactive protein (CRP); and 3) Examine

the association between each ACE measure and the incidence and growth of uterine fibroids, and then evaluate the modifying effect of psychosocial resources. This proposed ancillary research study will elucidate the association between ACEs and incident fibroids with less bias than previous research due to improved

ascertainment of both the exposure (i.e., 7 ACEs) and outcome (i.e., repeated and standardized ultrasound exams in fibroid-free participants at study entry). Fibroids pose a major public health concern with an estimated total associated cost (medical, work-related, etc.) of up to $34.4 billion annually. Determining risk factors for

fibroids, such as the early life stress of ACEs, will provide key information to improve the quality of life for Black women, who are more likely to experience missed days from work and disruption in physical activities and social relationships due to fibroids. It will also provide a strong research foundation that sheds light on potential

intervention targets to reduce morbidity and surgical disparities, set the stage for identifying biological mechanisms for prevention, and elucidate the context of early life stressors on fibroid risk.