Psychological Stress and BMI in the Prevalence of Uterine Leiomyoma Among Young Adult Women: Results from Project ELEFANT

Abstract Background: Uterine leiomyoma (UL) is a benign tumour with a prevalence of 4-21% in Western populations and UC occurrence is associate with impaired quality of life. Few studies have studied on psychological stress with the prevalence of UL in non-Western populations. We sought to identify the association of psychological stress with the prevalence of UL and mediation by BMI. Methods: Analysis was performed in a cross-sectional, population-based Project Young ELEFANT study. We analysed clinical data collected from young Chinese women (age 20-40; n=178205) who were residents of Tianjin, China. Work-related, social and financial stress were evaluated by questionnaire and categorised by intensity (none, low, intermediate, and high). Odds ratios of UL were determined by binary logistic regression models adjusted for age at enrolment, smoking, passive smoking, alcohol consumption, BMI, education, occupation, residence, age at menarche, parity, oral contraceptive use, and diagnosis of type 2 diabetes and hypertension. Results: UL prevalence in young adult women was associated with psychosocial stress by cause and intensity. High levels of work-related, social and financial stress were associated with ORs (95% CI) of 1.72 (1.41, 2.10), 1.48 (1.18, 1.84) and 1.44 (1.11, 1.88) respectively. The risk of UL with psychosocial stress showed interaction with BMI, with underweight women at greatest risk. Conclusions: In young adult Chinese women, psychological stress is associated with UL prevalence. While BMI was positively associated with UL incidence, underweight and healthy weight women with psychosocial stress showed highest risk of UL.