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Girschik C, Stolpe S, Kowall B. Association between number of children and incident heart disease and stroke in parents - results from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Public Health 2023; 23:2324. [PMID: 37996848 PMCID: PMC10668373 DOI: 10.1186/s12889-023-17254-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND In former studies, parity was associated with adverse cardiovascular outcomes in parents. This study aims to extend the limited existing data regarding the association between the number of children and heart disease and/or stroke in a large longitudinal study in different European countries in both men and women. METHODS For 42 075 subjects (18 080 men, 23 995 women; median age 58 years (interquartile range: 53 to 65)) from 19 European countries and Israel in the Survey of Health, Ageing and Retirement in Europe (SHARE), odds ratios (OR) for the association between number of children and incident self-reported heart disease and/or stroke (HDS) were estimated using logistic regression analyses. Persons with one or two children were used as reference. The final model was adjusted for baseline age, sex, education, region, and marital status. All analyses were stratified by sex. RESULTS Women with seven or more children had the highest OR for the association between the number of children and incident HDS (OR = 2.12 [95% CI: 1.51 to 2.98]), while men with six children showed the highest OR (OR = 1.62 [1.13 to 2.33]). Stratified by education, across all education levels, men and women with five or more children had the highest ORs for this association. The highest OR was observed in both women and men in the group with primary education (OR = 1.66 [1.29 to 2.15] and OR = 1.60 [1.19 to 2.14], respectively). Stratified by region, both men and women with five or more children showed the highest ORs in Southern Europe (OR = 2.07 [1.52 to 2.82] and OR = 1.75 [1.25 to 2.44], respectively). CONCLUSION In this long-term follow-up study in various countries in Europe and Israel we found a positive association between number of children and incident HDS. This association was more pronounced in lower educated subjects and showed regional variations.
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Affiliation(s)
- Carolin Girschik
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Susanne Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Bernd Kowall
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital of Essen, Hufelandstraße 55, 45147, Essen, Germany
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Stannard S, Berrington A, Alwan NA. Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70). PLoS One 2023; 18:e0282795. [PMID: 37053250 PMCID: PMC10101483 DOI: 10.1371/journal.pone.0282795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife. METHOD The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. RESULTS For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included. CONCLUSIONS Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.
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Affiliation(s)
- Sebastian Stannard
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Ann Berrington
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
- ESRC Centre for Population Change, University of Southampton, Southampton, United Kingdom
| | - Nisreen A. Alwan
- Faculty of Medicine, School of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
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Super-additive associations between parity and education level on mortality from cardiovascular disease and other causes: the Japan Collaborative Cohort Study. BMC Womens Health 2022; 22:278. [PMID: 35794595 PMCID: PMC9261019 DOI: 10.1186/s12905-022-01805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background While women’s parity status and education level have independent associations with cardiovascular and other diseases, no studies have evaluated the additive interaction of these two factors. Therefore, we examined the additive interaction between parity and education level on mortality from stroke, coronary heart disease, total cardiovascular disease, cancer, non-cardiovascular disease, and non-cancer causes, and all causes in Japanese women. Methods This study followed 41,242 women aged 40–79 years without a history of cardiovascular disease or cancer from 1988 to 1990 until 2009. Baseline parity and education level were classified into four categories, with highly educated parous women as the reference group. Cox proportional hazards regression analyses were performed to calculate the risk of mortality. We also assessed the additive interactions between parity and education level on mortality from cardiovascular disease and other causes using the relative excess risk due to interaction obtained using Cox models. Results During the median follow-up period of 19.1 years, we identified 6299 deaths. In a multivariable model adjusted for cardiovascular disease and other disease risk factors, nulliparous women with low education levels had increased multivariable-adjusted hazard ratios of 1.67 (95% confidence interval [CI] 1.13, 2.47) for stroke, 1.98 (95% CI 1.15, 3.39) for coronary heart disease, 1.71 (95% CI 1.34,2.18) for total cardiovascular disease, 1.69 (95% CI 1.33, 2.14) for non-cardiovascular and non-cancer, and 1.51 (95% CI 1.30, 1.75) for all-cause mortality when compared with highly educated parous women. Moreover, we observed significant additive interactions between parity and education level on total cardiovascular disease mortality (P = 0.04), non-cardiovascular disease and non-cancer mortality (P = 0.01), and all-cause mortality (P = 0.005). Conclusions Nulliparity and low education levels are super-additively associated with total cardiovascular disease, non-cardiovascular and non-cancer, and all-cause mortality risks, suggesting that nulliparous women with low education levels need specific support for preventing mortality related to cardiovascular and other diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01805-y.
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Magnus MC, Fraser A, Rich-Edwards JW, Magnus P, Lawlor DA, Håberg SE. Time-to-pregnancy and risk of cardiovascular disease among men and women. Eur J Epidemiol 2021; 36:383-391. [PMID: 33492547 PMCID: PMC8076115 DOI: 10.1007/s10654-021-00718-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/05/2021] [Indexed: 01/01/2023]
Abstract
A few studies indicate that women with prolonged time-to-pregnancy (TTP) have an increased risk of cardiovascular disease (CVD). This has not been studied in men. We evaluated CVD risk by self-reported TTP among parous women (n = 64,064) and men (n = 50,533) participating in the Norwegian Mother, Father and Child Cohort Study. TTP was categorized as 0–3 (reference), 4–12 and > 12 months. CVD diagnosed between 2008 and 2017 were available from the national patient and general practitioner databases. Risk of CVD by TTP was estimated using Cox regression adjusting for baseline age, education, BMI, smoking, diabetes, and number of offspring in both sexes, and history of endometriosis, ovarian cysts, preterm birth and pre-eclampsia for women. Mean age was 33 for women and 35 for men at baseline (years). The rate of any CVD was 24 per 1000 person years among women and 22 per 1000 person years among men. Longer TTP was associated with increased rate of CVD among women, with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.03, 1.09) for TTP 4–12 months and 1.14 (1.08, 1.20) for TTP > 12 months. Among men, respective HRs for CVD were 1.06 (1.00, 1.10) for TTP 4–12 months and 1.07 (1.01, 1.14) for TTP > 12 months. We observed sex-differences in the relationship with CVD subtypes but none were statistically significant. In conclusion, both men and women with a prolonged TTP had a small increased risk of CVD, clinical significance of which is unclear. Further studies are necessary to investigate in detail what underlying causes of prolonged TTP might be reflected in the increased risk of CVD. Longer follow-up is required to confirm these preliminary findings.
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Affiliation(s)
- Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222, 0213, Skøyen, Oslo, Norway. .,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK. .,Population Health Sciences, Bristol Medical School, Bristol, UK.
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - Janet W Rich-Edwards
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, USA.,Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222, 0213, Skøyen, Oslo, Norway
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol NIHR Biomedical Research Centre, Bristol, UK
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222, 0213, Skøyen, Oslo, Norway
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Moazzeni SS, Toreyhi H, Asgari S, Azizi F, Tehrani FR, Hadaegh F. Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up. BMC Pregnancy Childbirth 2021; 21:28. [PMID: 33413159 PMCID: PMC7792076 DOI: 10.1186/s12884-020-03499-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women. Methods In this population-based cohort study, which included 3929 women and 2571 men aged ≥30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors. Results During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariable analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01–1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97–3.56, p-value = 0.061). Among men, in comparison with participants who had 1 child, multivariable HRs of having 2, 3, and ≥ 4 children were 1.97 (1.24–3.12), 2.08 (1.31–3.31), and 2.08 (1.30–3.34), respectively. Conclusion To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03499-2.
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Affiliation(s)
- Seyyed Saeed Moazzeni
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
Evolutionary theories of senescence, such as the ‘disposable soma’ theory, propose that natural selection trades late survival for early fecundity. ‘Frailty’, a multidimensional measure of health status, may help to better define the long-term consequences of reproduction. We examined the relationship between parity and later life frailty (as measured by the Frailty Index) in a sample of 3,534 adults aged 65 years and older who participated in the English Longitudinal Study of Ageing. We found that the most parous adults were the most frail and that the parity-frailty relationship was similar for both sexes. Whilst this study provided some evidence for a ‘parity-frailty trade-off’, there was little support for our hypothesis that the physiological costs of childbearing influence later life frailty. Rather, behavioural and social factors associated with rearing many children may have contributed to the development of frailty in both sexes.
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Sironi M, Ploubidis GB, Grundy EM. Fertility History and Biomarkers Using Prospective Data: Evidence From the 1958 National Child Development Study. Demography 2020; 57:529-558. [PMID: 32133595 PMCID: PMC7162827 DOI: 10.1007/s13524-020-00855-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Research on the later-life health implications of fertility history has predominantly considered associations with mortality or self-reported indicators of health. Most of this previous research has either not been able to account for selection factors related to both early-life and later-life health or has had to rely on retrospectively reported accounts of childhood circumstances. Using the 1958 National Child Development Study, and in particular the biomedical survey conducted in 2002-2003, we investigate associations between fertility histories (number of children and age at first and at last birth) and biomarkers for cardiometabolic risk and respiratory function in midlife among both men and women. Results from models that adjusted for a very wide range of childhood factors, including early-life socioeconomic position, cognitive ability, and mental health, showed weak associations between parity and biomarkers. However, we found an inverse association between age at first birth and biomarkers indicative of worse cardiometabolic health, with poorer outcomes for those with very young ages at entry to parenthood and increasingly better outcomes for those becoming parents at older ages. A very young age at last birth was also associated with less favorable biomarker levels, especially among women. Results highlight the value of prospectively collected data and the availability of biomarkers in studies of life course determinants of health in midlife and later.
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Affiliation(s)
- Maria Sironi
- Department of Social Science, University College London, 55-59 Gordon Square, London, WC1H 0NU United Kingdom
| | - George B. Ploubidis
- Department of Social Science, University College London, 55-59 Gordon Square, London, WC1H 0NU United Kingdom
- UCL Center for Longitudinal Studies, University College London, 55-59 Gordon Square, London, WC1H 0NU United Kingdom
| | - Emily M. Grundy
- Institute for Social & Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ United Kingdom
- Centre for Fertility and Health, Norwegian Institute for Public Health, Lovisenberggata 8, 0456 Oslo, Norway
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8
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Stentz NC, Koelper N, Barnhart KT, Sammel MD, Senapati S. Infertility and mortality. Am J Obstet Gynecol 2020; 222:251.e1-251.e10. [PMID: 31526792 DOI: 10.1016/j.ajog.2019.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infertility affects 1 in 10 American reproductive-age women. The impact of this disease beyond the reproductive years is largely unknown. OBJECTIVE The objective of the study was to determine the association of infertility history with all-cause and cause-specific mortality. STUDY DESIGN This secondary analysis of a multicenter randomized clinical trial included 75,784 women (aged 55-74 years) prospectively enrolled in the Prostate, Lung, Colorectal, and Ovarian cancer-screening trial from 1992 through 2001 and followed up a minimum of 10 years for health-related outcomes and death (856,935 person-years). We examined the association of infertility history (inability to conceive for 1 year or greater) of all-cause and cause-specific mortality using disease risk score-adjusted Cox-proportional hazard regression models. RESULTS Infertile women had a 10% increased risk of death (from any cause) during the study period compared with the unexposed (adjusted hazard risk, 1.10, 95% confidence interval, 1.02-1.18, P = .010). This effect was predominantly noted in women at an otherwise low risk of mortality who had a 26% increased risk of death (adjusted hazard risk, 1.26, 95% confidence interval, 1.12-1.42, P < .001). No differences in cardiovascular or diabetic mortality were noted. The risk of cancer death at any time over the study period was increased by 23% in infertile women compared with the unexposed (adjusted hazard risk, 1.23, 95% confidence interval, 1.10-1.37, P < .001). This effect was predominantly noted in women at an otherwise low risk of cancer mortality who had a 47% increased risk of cancer death (adjusted hazard risk, 1.47, 95% confidence interval, 1.25-1.73, P < .001). While no differences are seen in the risk of death from endometrial or ovarian cancer, the risk of death from breast cancer was more than doubled in infertile women at an otherwise low risk of breast cancer death compared with the unexposed (adjusted hazard risk, 2.64, 95% confidence interval, 1.71-4.08, P < .001). CONCLUSION Infertility is a harbinger of future morbidity and mortality. Infertile women are at an increased risk of all-cause and cancer-related mortality. Consideration of infertility history in health care maintenance presents an opportunity for screening and early intervention for long-term health outcomes.
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Tanigawa K, Ikehara S, Kimura T, Imano H, Muraki I, Shirai K, Tamakoshi A, Iso H. Relationships Between Reproductive History and Mortality From Cardiovascular Diseases Among Japanese Women: The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study. J Epidemiol 2019; 30:509-515. [PMID: 31735742 PMCID: PMC7557170 DOI: 10.2188/jea.je20190020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Reproductive history has been addressed as a risk factor for cardiovascular disease (CVD). We examined the relationship between reproductive history and CVD mortality in Japanese women. Methods We followed 53,836 women without previous CVD or cancer history from 1988–1990 to 2009 in a prospective cohort study. Hazard ratios (HRs) and 95% confidence intervals (CIs) of CVD mortality were estimated according to the number of deliveries and maternal age at first delivery. Results During the follow-up, 2,982 CVD-related deaths were identified. There was U-shaped association between the number of deliveries and risk of CVD mortality with reference to three deliveries, although the excess risk of CVD mortality associated with ≥5 deliveries was of borderline statistical significance. The corresponding multivariable HRs were 1.33 (95% CI, 1.12–1.58) and 1.11 (95% CI, 0.99–1.24). In addition, higher CVD mortality was associated with maternal age ≥28 years at first delivery than maternal age of 24–27 years at first delivery. The multivariable HRs were 1.22 (95% CI, 1.10–1.36) for 28–31 years at first delivery and 1.26 (95% CI, 1.04–1.52) for ≥32 years at first delivery. Moreover, among women with ≥3 deliveries, maternal age ≥28 years at first delivery was associated with 1.2- to 1.5-fold increased CVD mortality. Conclusion The number of deliveries showed a U-shaped association with risk of CVD mortality. Higher maternal age at first delivery was associated with an increased risk of CVD mortality, and excessive risk in women aged ≥28 years at first delivery was noted in those with ≥3 deliveries.
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Affiliation(s)
- Kanami Tanigawa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | | | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | | | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba
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Abstract
Understanding the association between fertility histories and health later in life is necessary in the context of ageing societies. Past literature has generally found a U-shaped relationship between parity, age at first birth, and several health-related outcomes. However, these findings differed to some extent depending on the country under analysis and on the measures of health considered. As such, using wave 3 (2008-2009) and 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE), this work aimed to answer the question: "Are fertility histories associated with the presence of chronic conditions later in life in Europe?" The analysis included 11 European countries and compared results using two different measures of chronic conditions: self-reported chronic or long-term illness and chronic diseases diagnosed by a doctor. Results showed that age at first birth is more relevant than parity for health outcomes at older ages. Moreover, in socio-democratic and continental countries, the association between fertility and chronic conditions-in particular between age at first birth and long-term illnesses-is statistically significant among women, but not among men. Finally, the association between fertility history and health was similar when using self-reported measures and chronic diseases diagnosed by a doctor.
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Affiliation(s)
- Maria Sironi
- Department of Social Science, University College London, 20 Bedford Way, London, WC1H 0AL UK
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11
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Wu P, Mamas MA, Gulati M. Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics. J Womens Health (Larchmt) 2019; 28:1037-1050. [DOI: 10.1089/jwh.2018.7480] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Pensee Wu
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Unit of Obstetrics and Gynecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona
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12
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Infertility: a marker of future health risk in women? Fertil Steril 2019; 110:783-789. [PMID: 30316412 DOI: 10.1016/j.fertnstert.2018.08.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/28/2022]
Abstract
Infertility, may be a harbinger for future health risk in women, including early mortality. Fertility status itself could serve as an early biomarker, (present in a woman's reproductive years) for risk stratification later in life. The relationship between infertility and early mortality involves the impact of nulliparity on future adverse health events, potential sequelae from the underlying cause(s) of infertility, the risks of fertility treatments, as well as the potential for risk reduction from a healthy pregnancy. This complex interplay coupled with difficulties ascertaining infertility on a population level has presented unique challenges to assessing infertility and early mortality risk. With further study, a better understanding the role of fertility status in health at various stages of life may provide unique opportunities for surveillance and risk reduction.
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13
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Solanke BL. Maternal socio-demographic factors associated with low parity and grand multiparity in Nigeria. Women Health 2019; 59:730-747. [PMID: 30615577 DOI: 10.1080/03630242.2018.1553815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Parity may be categorized as low parity (one or two births), multiparity (three or four births), and grand multiparity (five or more births). In Nigeria, studies have examined factors associated with parity among women. However, these studies have focused on the associated factors of grand multiparity with near exclusion of associated factors of low parity. This study addressed this knowledge gap by examining maternal socio-demographic factors associated with both low parity and grand multiparity in Nigeria. The study analyzed secondary data from 2013 Nigeria Demographic and Health Survey (NDHS). The weighted sample size was 25,852 women. With the use of Stata (version 14), analyses were performed at three levels. Multinomial logistic regression was applied at the multivariate level. Results showed that many of the studied maternal characteristics were significantly associated with either low parity or grand multiparity. Results further showed that while late age at first marriage, improved education, never experiencing child mortality, and polygyny increased the likelihood of low parity, improved education, polygyny, never experiencing child mortality, late age at first marriage, and higher household wealth reduced the likelihood of grand multiparity. These factors should be given prominence in population and women-centered programs in the country.
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Affiliation(s)
- Bola Lukman Solanke
- a Department of Demography and Social Statistics , Obafemi Awolowo University , Ile-Ife , Nigeria
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14
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Li W, Ruan W, Lu Z, Wang D. Parity and risk of maternal cardiovascular disease: A dose-response meta-analysis of cohort studies. Eur J Prev Cardiol 2018; 26:592-602. [PMID: 30567461 DOI: 10.1177/2047487318818265] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Parity has been reported to play an important role in the development of cardiovascular disease; however, the results are still controversial. We aimed to conduct a meta-analysis of cohort studies to assess quantitatively the association between parity and cardiovascular disease risk. METHODS PubMed and Web of Science databases were searched to 1 June 2018, supplemented by manual searches of the bibliographies of retrieved articles. And multivariate-adjusted relative risks were pooled by using random-effects models. Restricted cubic spline analysis with four knots was used to explore the relationship of parity and the risk of cardiovascular disease. RESULTS Ten cohort studies involving 150,512 incident cases of cardiovascular disease among 3,089,929 participants were included in the meta-analysis. A significant association between parity and cardiovascular disease risk was observed while comparing parity with nulliparity, with a summarised relative risk of 1.14 (95% confidence interval (CI) 1.09-1.18; I2 = 62.0%, P = 0.002). In the dose-response analysis, we observed a potential non-linear J-shaped dose-response relationship between the number of parity and cardiovascular disease risk, the summary risk estimates for an increase of one live birth was 1.04 (95% CI 1.02-1.05), with significant heterogeneity ( I2 = 89.6%). In addition, the similar J-shaped associations between parturition number and cardiovascular disease, ischaemic heart disease or stroke risk were also observed. CONCLUSIONS Our findings suggest that ever parity is related to cardiovascular disease risk and there is an association between the number of pregnancies and the risk of cardiovascular disease. Since the number of included studies was limited, further studies are warranted to confirm our findings.
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Affiliation(s)
- Wenzhen Li
- 1 Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Wenyu Ruan
- 2 Department of Clinical Medicine, Xi'an Medical University, China
| | - Zuxun Lu
- 1 Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Dongming Wang
- 3 Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, China
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Solanke BL, Banjo OO, Oyinloye BO, Asa SS. Maternal grand multiparity and intention to use modern contraceptives in Nigeria. BMC Public Health 2018; 18:1207. [PMID: 30373559 PMCID: PMC6206733 DOI: 10.1186/s12889-018-6130-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Grand multiparity and low contraceptive prevalence are dominant among Nigerian women. These elevate the risk of unintended pregnancies, high-risk fertility and adverse maternal and child health outcomes among women in the country, particularly grand multiparous women. Studies have examined predictors of intention to use modern contraceptives among women of reproductive age. However, these studies did not ascertain the extent to which grand multiparity is associated with intention to use modern contraceptives. This study examined association between grand multiparity and intention to use modern contraceptives in Nigeria. METHODS The study pooled data from 2003 to 2013 Nigeria Demographic and Health Surveys. The weighted sample size analysed was 34,302 women. The outcome variable was intention to use contraceptive. The main explanatory variable was parity with specific attention to grand multiparity. Unadjusted multinomial logistic regression coefficients were used to examine association between specific explanatory or control variables and intention to use contraceptives while the adjusted multinomial logistic regression was applied to further examine associated factors of intention to use contraceptives relative to being uncertain about future contraceptive use. Four multinomial logistic regression models were fitted using Stata 14. RESULTS More than half of respondents do not intend to use contraceptives, while less than one-fifth of respondents intend to use contraceptives in the future. Across the four fitted models, the relative risks of intention to use compared with being uncertain about future contraceptive use were significantly lower among grand multiparous women. Results further revealed pregnancy termination, fertility planning status, exposure to mass media family planning messages, knowledge of modern contraceptives, ideal family size, remarriage, household power relations, and maternal education as other key factors influencing expected risk of intention to use contraceptives relative to being uncertain about future contraceptive use. CONCLUSION Maternal grand multiparity is significantly associated with intention to use contraceptives among women in Nigeria. The development of a specific population and health programme to target grand multiparous women is imperative in the country. Such programme could be integrated into existing national family planning programme through specific contraceptive education, counselling and information for high parous women.
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Affiliation(s)
- Bola Lukman Solanke
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Bosede Odunola Oyinloye
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Soladoye Sunday Asa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Gerbrand Zoet GA, Anna Sverrisdóttir AK, Anouk Eikendal ALM, Arie Franx A, Tim Leiner T, Bas van Rijn BB. MRI-derived aortic characteristics after pregnancy: The AMBITYON study. Pregnancy Hypertens 2018; 13:46-50. [PMID: 30177070 DOI: 10.1016/j.preghy.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Pregnancy and pregnancy complications have been associated with increased arterial stiffness even at young age. In this study we assessed the impact of parity on CMR-derived aortic characteristics as early markers of atherosclerosis and arterial stiffness in healthy women between 25 and 35 years. STUDY DESIGN We studied 68 women who participated in the AMBITYON study, a prospective population-based cohort study for assessment of atherosclerotic burden by MRI and traditional CVD risk factors in healthy, young adults. Of these women, 40 (58.8%) were nulliparous, 13 (19.1%) were primiparous and 15 (22.1%) were multiparous. MAIN OUTCOME MEASURES Descending thoracic aortic wall thickness (AWT) and pulse wave velocity (PWV) were measured using 3.0T CMR. RESULTS AWT measurements were similar between nulliparous women and primi- or multiparous women (1.6 mm ± 0.2 mm vs. 1.6 mm ± 0.2 mm; p = 0.79). Correction for age and systolic blood pressure did not change these results. Applying percentile based cut-off values showed a non-significant increase in AWT in parous women. PWV measurements did not differ between nulliparous women and parous women (4.5 m/s ± 0.7 m/s vs. 4.5 m/s ± 0.8 m/s; p = 0.78). Correction for age and systolic blood pressure did not influence these results. Using percentile based cut-off values, showed an increasing likelihood of higher PWV-values in parous women, although not statistically significant. CONCLUSIONS Direct measurement of aortic AWT and PWV by CMR showed no difference between nulliparous and parous women, probably indicating limited effect of pregnancy on arterial stiffness and early markers of atherosclerosis. TRIAL REGISTRATION Netherlands Trial Register (NTR) number: 4742.
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Affiliation(s)
- G A Gerbrand Zoet
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands.
| | - A K Anna Sverrisdóttir
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - A L M Anouk Eikendal
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A Arie Franx
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands
| | - T Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B B Bas van Rijn
- Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Lundlaan 6, PO Box 85090, 3508 AB Utrecht, The Netherlands; Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, Coxford Road, Southampton SO16 5YA, United Kingdom
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Number of Offspring and Cardiovascular Disease Risk in Men and Women: The Role of Shared Lifestyle Characteristics. Epidemiology 2018; 28:880-888. [PMID: 28696997 PMCID: PMC5625954 DOI: 10.1097/ede.0000000000000712] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Previous studies of the number of offspring and cardiovascular disease (CVD) report conflicting findings. We re-examined this association in both sexes to clarify the role of the cardiometabolic changes that women experience during pregnancy versus shared lifestyle characteristics. Methods: We studied 180,626 women and 133,259 men participating in the UK Biobank cohort who were free of CVD at baseline. CVD events were obtained from hospital and death registers. Analyses were conducted using Cox proportional hazards regression. Results: The incidence rates of overall CVD were six per 1000 person-years for women and nine per 1000 person-years for men. Number of children showed an association with risk of CVD among women; the adjusted HR (95% CI) was 1.2 (1.1, 1.3) for one, 1.1 (1.0, 1.2) for two, 1.2 (1.1, 1.3) for three, and 1.2 (1.1, 1.4) for four or more as compared to none. Number of children was also associated with CVD among men; the adjusted HR (95% CI) was 1.1 (1.0, 1.2) for one, 1.0 (0.96, 1.1) for two, 1.1 (1.0, 1.2) for three, and 1.1 (1.0, 1.3) for four or more as compared to none. There was no evidence of heterogeneity in the associations between sexes (Pinteraction = 0.80). Number of offspring also showed similar associations with ischemic heart disease and hypertensive disorders in both sexes. Conclusions: We observed similar associations between number of offspring and CVD in both sexes. The association among women might therefore be largely explained by unobserved behavioral and lifestyle characteristics.
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Yasukawa S, Eguchi E, Ogino K, Tamakoshi A, Iso H. "Ikigai", Subjective Wellbeing, as a Modifier of the Parity-Cardiovascular Mortality Association - The Japan Collaborative Cohort Study. Circ J 2018; 82:1302-1308. [PMID: 29618706 DOI: 10.1253/circj.cj-17-1201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nulliparity is associated with an excess risk of cardiovascular disease (CVD). "Ikigai", subjective wellbeing in Japan, is associated with reduced risk of CVD. The impact of ikigai on the association between parity and the risk of CVD, however, has not been reported.Methods and Results:A total of 39,870 Japanese women aged 40-79 years without a history of CVD, cancer or insufficient information at baseline in 1988-1990, were enrolled and followed until the end of 2009. They were categorized into 7 groups according to parity number 0-≥6. Using Cox regression hazard modeling, the associations between parity and mortality from stroke, coronary artery disease, and total CVD were investigated. During the follow-up period, 2,121 total CVD deaths were documented. No association was observed between parity and stroke and CVD mortality in women with ikigai, but there was an association in those without ikigai. The multivariable hazard ratios of stroke and total CVD mortality for nulliparous women without ikigai vs. those with 1 child were 1.87 (95% CI: 1.15-3.05) and 1.46 (95% CI: 1.07-2.01), respectively, and that for stroke mortality in high parity women without ikigai was 1.56 (95% CI: 1.00-2.45). CONCLUSIONS Nulliparous or high parity women without ikigai had higher mortality from stroke and/or total CVD, suggesting that ikigai attenuated the association between parity and CVD mortality in Japanese women.
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Affiliation(s)
- Sumiyo Yasukawa
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.,Department of Nursing, Okayama University Graduate School of Health Sciences
| | - Eri Eguchi
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Keiki Ogino
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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19
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Calderon-Margalit R, Paltiel O. Women's health in Israel. Lancet 2018; 391:538-539. [PMID: 29617241 DOI: 10.1016/s0140-6736(17)32446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Ora Paltiel
- Braun School of Public Health, Hadassah-Hebrew University, Jerusalem 91120, Israel
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20
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Peters SAE, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Wang S, Yang L, Hu Y, Liu J, Wang T, Chen J, Peto R, Li L, Woodward M, Chen Z. Parenthood and the risk of cardiovascular diseases among 0.5 million men and women: findings from the China Kadoorie Biobank. Int J Epidemiol 2017; 46:180-189. [PMID: 27649806 PMCID: PMC5837253 DOI: 10.1093/ije/dyw144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background Women's parity has been associated with risk of cardiovascular disease (CVD). It is unclear, however, whether it reflects biological effects of childbearing or uncontrolled socio-economic and lifestyle factors associated with childrearing. We assessed the association between number of children and incident CVD outcomes separately in women and men. Methods In 2004-08, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 years from 10 diverse regions. During 7 years of follow-up, 24 432 incident cases of coronary heart disease (CHD) and 35 736 of stroke were recorded among 489 762 individuals without prior CVD. Multivariable Cox regression models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD and stroke associated with number of children. Results Overall, 98% of all participants had children and the mean number of children declined progressively from four in older participants to one or two in younger participants. Compared with childless women, women with children had an increased risk of CHD, but not of stroke [HR (95% CI): 1.14 (1.00; 1.30) and 1.03 (0.92; 1.16)]. Corresponding results for men were 1.20 (1.06; 1.35) and 1.13 (1.03; 1.24), respectively. In individuals with children, there was a log-linear association between number of children and CVD outcomes; in women, each additional child was associated with adjusted HRs of 1.02 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke, similar in magnitude to that in men [1.03 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke]. Conclusion In Chinese adults, the association between the number of children and risk of CHD and stroke was similar between men and women, suggesting that factors associated with parenthood and childrearing are more likely to affect the risk of CVD outcomes than factors associated with childbearing.
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Affiliation(s)
- Sanne AE Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Yiping Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Iona Y Millwood
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Shaojie Wang
- Qingdao CDC NCDs Prevention and Control Department, Qingdao, Shandong, China
| | - Liqiu Yang
- Nangang CDC, Haerbin, Heilongjiang, China
| | - Yihe Hu
- Suzhou CDC NCDs Prevention and Control Department, Suzhou, Jiangsu, China
| | | | - Tao Wang
- Maiji CDC, Tianshui, Gansu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Chaoyang District, Beijing, China
| | - Richard Peto
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
- Department of Public Health, Beijing University, Beijing, China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
- The George Institute for Global Health, University of Sydney, Australia and
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
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21
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Associations of parity and age at first pregnancy with overall and cause-specific mortality in the Cancer Prevention Study II. Fertil Steril 2017; 107:179-188.e6. [DOI: 10.1016/j.fertnstert.2016.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022]
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22
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Peters SA, van der Schouw YT, Wood AM, Sweeting MJ, Moons KG, Weiderpass E, Arriola L, Benetou V, Boeing H, Bonnet F, Butt ST, Clavel-Chapelon F, Drake I, Gavrila D, Key TJ, Klinaki E, Krogh V, Kühn T, Lassale C, Masala G, Matullo G, Merritt M, Molina-Portillo E, Moreno-Iribas C, Nøst TH, Olsen A, Onland-Moret NC, Overvad K, Panico S, Redondo ML, Tjønneland A, Trichopoulou A, Tumino R, Turzanski-Fortner R, Tzoulaki I, Wennberg P, Winkvist A, Thompson SG, Di Angelantonio E, Riboli E, Wareham NJ, Danesh J, Butterworth AS. Parity, breastfeeding and risk of coronary heart disease: A pan-European case-cohort study. Eur J Prev Cardiol 2016; 23:1755-1765. [PMID: 27378766 PMCID: PMC6217919 DOI: 10.1177/2047487316658571] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/15/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE There is uncertainty about the direction and magnitude of the associations between parity, breastfeeding and the risk of coronary heart disease (CHD). We examined the separate and combined associations of parity and breastfeeding practices with the incidence of CHD later in life among women in a large, pan-European cohort study. METHODS Data were used from European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD, a case-cohort study nested within the EPIC prospective study of 520,000 participants from 10 countries. Information on reproductive history was available for 14,917 women, including 5138 incident cases of CHD. Using Prentice-weighted Cox regression separately for each country followed by a random-effects meta-analysis, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD, after adjustment for age, study centre and several socioeconomic and biological risk factors. RESULTS Compared with nulliparous women, the adjusted HR was 1.19 (95% CI: 1.01-1.41) among parous women; HRs were higher among women with more children (e.g., adjusted HR: 1.95 (95% CI: 1.19-3.20) for women with five or more children). Compared with women who did not breastfeed, the adjusted HR was 0.71 (95% CI: 0.52-0.98) among women who breastfed. For childbearing women who never breastfed, the adjusted HR was 1.58 (95% CI: 1.09-2.30) compared with nulliparous women, whereas for childbearing women who breastfed, the adjusted HR was 1.19 (95% CI: 0.99-1.43). CONCLUSION Having more children was associated with a higher risk of CHD later in life, whereas breastfeeding was associated with a lower CHD risk. Women who both had children and breastfed did have a non-significantly higher risk of CHD.
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Affiliation(s)
- Sanne Ae Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela M Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| | - Michael J Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, CIBERESP, Spain
| | - Vassiliki Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire Rennes, University of Rennes, Villejuif, France
| | - Salma T Butt
- Department of Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Françoise Clavel-Chapelon
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Institut Gustave Roussy, Villejuif, France
| | - Isabel Drake
- Department of Clinical Science, Lund University, Malmö, Sweden
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Camille Lassale
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Giuseppe Matullo
- Human Genetics Foundation, Turin, Italy Department of Medical Sciences, University of Turin, Italy
| | - Melissa Merritt
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Elena Molina-Portillo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Conchi Moreno-Iribas
- Public Health Institute of Navarra, Pamplona, Spain Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Madrid, Spain
| | - Therese H Nøst
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | | | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Antonia Trichopoulou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece Hellenic Health Foundation, Athens, Greece
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Italy
| | | | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Anna Winkvist
- Nutritional Research, Umeå University, Umeå, Sweden Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon G Thompson
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - John Danesh
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - Adam S Butterworth
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, UK The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, UK
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Peters SAE, Yang L, Guo Y, Chen Y, Bian Z, Millwood IY, Bragg F, Zhou X, Ge P, Chen B, Gao Y, Li Y, Chen J, Li L, Woodward M, Chen Z. Parenthood and the risk of diabetes in men and women: a 7 year prospective study of 0.5 million individuals. Diabetologia 2016; 59:1675-82. [PMID: 27193915 PMCID: PMC4930461 DOI: 10.1007/s00125-016-3980-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/18/2016] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS In women, higher parity has been associated with increased risk of diabetes later in life. It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing. We assessed the association between number of children and diabetes risk separately in women and men. METHODS Between 2004 and 2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 (mean 51 years) from ten diverse regions across China. During 7 years of follow-up, 8,840 incident cases of diabetes were recorded among 463,347 participants without prior cardiovascular diseases or diabetes. Multivariable Cox regression yielded sex-specific HRs and 95% CIs for incident diabetes by number of children. RESULTS Overall, ∼98% of all participants had children. In women, there was a J-shaped association between number of children and risk of diabetes. Compared with women with one child, the adjusted HRs for diabetes were 1.39 (95% CI 1.11, 1.73) for childless women, 1.12 (95% CI 1.07, 1.18) for those with two children, 1.23 (95% CI 1.16, 1.31) for those with three children, and 1.32 (95% CI 1.21, 1.44) for those with four or more children. In men, there was a similar association with risk of diabetes; the corresponding HRs were 1.28 (95% CI 1.02, 1.60), 1.19 (95% CI 1.12, 1.26), 1.32 (95% CI 1.21, 1.44) and 1.41 (95% CI 1.24, 1.60), respectively. In both sexes, the findings were broadly similar in different population subgroups. CONCLUSIONS/INTERPRETATION The similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, University of Oxford, 34 Broad Street, Oxford, OX1 3BD, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Xue Zhou
- Department of Prevention and Control of Non-Communicable Diseases, Heilongjiang Center for Disease Control and Prevention, Harbin, Heilongjiang, People's Republic of China
| | - Pengfei Ge
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, People's Republic of China
| | - Biyun Chen
- Department of Prevention and Control of Non-Communicable Diseases, Hunan Center for Disease Control and Prevention, Hunan, Changsha, People's Republic of China
| | - Yulian Gao
- Huixian Center for Disease Control and Prevention, Huixian, Henan, People's Republic of China
| | - Yijun Li
- Department of Prevention and Control of Non-Communicable Diseases, Meilan Center for Disease Control and Prevention, Haikou, Hainan, People's Republic of China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Chaoyang District, Beijing, People's Republic of China
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
- Department of Public Health, Beijing University, Beijing, People's Republic of China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, 34 Broad Street, Oxford, OX1 3BD, UK.
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
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O’Flaherty M, Baxter J, Haynes M, Turrell G. The Family Life Course and Health: Partnership, Fertility Histories, and Later-Life Physical Health Trajectories in Australia. Demography 2016; 53:777-804. [DOI: 10.1007/s13524-016-0478-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Grand multiparity and reproductive cancer in the Jerusalem Perinatal Study Cohort. Cancer Causes Control 2015; 27:237-47. [PMID: 26669321 DOI: 10.1007/s10552-015-0701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/24/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Grand multiparity is associated with reduced mortality from reproductive cancers. We aimed to separate the components of mortality, by measuring incidence of and survival after reproductive cancer onset in grand multiparous compared to other parous women. STUDY DESIGN We linked data from the population-based Jerusalem Perinatal Study Cohort, which included women aged 13-55 who delivered 1964-1976, with Israel's National Cancer Registry. We compared breast and gynecologic cancer risk and all-cause survival following a cancer diagnosis, among grand multiparae (GMPs = parity 5+, n = 8,246) versus women with parity 1-4 (n = 19,703), adjusting for reproductive and demographic variables. RESULTS Grand multiparae were at significantly lower risk of breast cancer than others (adjusted hazard ratio (HRadj) = 0.62, 95 % confidence interval (CI) 0.54-0.71), after controlling for age at first birth, education, and other covariates. This reduction was greater among GMPs whose first birth occurred after age 30 (p-interaction = 0.0001) and for cancer occurring before age 50 years (p = 0.002). In contrast, GMPs were at greater risk of death than women with parity <5, following a breast cancer diagnosis (HRadj = 1.69, CI 1.39-2.1). Ovarian, uterine, and cervical cancer incidence did not differ between the groups, but survival was reduced for GMPs with uterine cancer (HRadj = 2.48, CI 1.22-5.03). CONCLUSION Reduced reproductive cancer mortality reported among GMPs masks two opposing phenomena: decreased breast cancer risk and poorer survival after breast and uterine cancers. The latter unfavorable outcome suggests that tumors in GMPs may be particularly aggressive, having perhaps escaped protective mechanisms conferred by parity. This finding calls for heightened clinical attention in this group.
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Parity and Cardiovascular Disease Mortality: a Dose-Response Meta-Analysis of Cohort Studies. Sci Rep 2015; 5:13411. [PMID: 26299306 PMCID: PMC4547137 DOI: 10.1038/srep13411] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/27/2015] [Indexed: 12/03/2022] Open
Abstract
Parity has been shown to inversely associate with cardiovascular disease (CVD) mortality, but the evidence of epidemiological studies is still controversial. Therefore, we quantitatively assessed the relationship between parity and CVD mortality by summarizing the evidence from prospective studies. We searched MEDLINE (PubMed), EMBASE and ISI Web of Science databases for relevant prospective studies of parity and CVD mortality through the end of March 2015. Fixed- or random-effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity among studies was assessed using the I2 statistics. All statistical tests were two-sided. Ten prospective studies were included with a total of 994,810 participants and 16,601 CVD events. A borderline significant inverse association was observed while comparing parity with nulliparous, with summarized RR = 0.79 (95% CI: 0.60–1.06; I2 = 90.9%, P < 0.001). In dose-response analysis, we observed a significant nonlinear association between parity number and CVD mortality. The greatest risk reduction appeared when the parity number reached four. The findings of this meta-analysis suggests that ever parity is inversely related to CVD mortality. Furthermore, there is a statistically significant nonlinear inverse association between parity number and CVD mortality.
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Graham M. Is being childless detrimental to a woman's health and well-being across her life course? Womens Health Issues 2015; 25:176-84. [PMID: 25669856 DOI: 10.1016/j.whi.2014.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childlessness is a growing phenomenon. Previous research examining health and well-being differentials between women with and without children has produced conflicting results. Most of this research has been conducted in the United States or parts of Europe. There has been limited research in Australia that has examined the health and well-being of women with and without children across the life course. The aim of the current study was to examine the association between motherhood status and general physical and mental health and well-being over a 10-year time period. METHODS Using 10 waves of data from the Household, Income and Labour Dynamics in Australia study, longitudinal linear mixed models with time varying variables (both dependent and independent) were constructed to assess the effect of childlessness on health and well-being based on the Short Form-36 Health Survey Version 1 (n=52,381 observations). FINDINGS Findings suggest that childless women experience poorer physical and mental health and well-being during the peak reproductive years; however, this trend is reversed for women aged 65 years or more. Although never-married, childless women experienced better health and well-being compared with mothers, this was not the case for childless women who were divorced, separated, or widowed or in a relationship. CONCLUSION The findings support the notion that whether or not a woman has children does have consequences for her health and well-being; however, this differs across the life course.
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Affiliation(s)
- Melissa Graham
- Centre for Health through Action on Social Exclusion (CHASE), School of Health and Social Development, Deakin University, Burwood, Victoria, Australia.
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Jaffe D, Kogan L, Manor O, Gielchinsky Y, Dior U, Laufer N. Influence of late-age births on maternal longevity. Ann Epidemiol 2015; 25:387-91. [PMID: 25976022 DOI: 10.1016/j.annepidem.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To examine the association between the mother's age at last birth and maternal long-term survival. METHODS Data from three national censuses (1972, 1983, and 1995) and national birth and death records (1972-2009) were used to examine the association between age at last birth and mortality while accounting for potential confounders, such as parity. Age-adjusted mortality rates and Cox proportional hazard models were used in the analysis. RESULTS A total of 887 women who delivered their last child after 45 years of age were identified from among 178,507 women (1,592,379 person-years). Age-adjusted mortality rates from 55 years of age were highest for childless women (9.2 per 1000) and decreased linearly (P < .001) for parous women with increased age at last birth (5.2 per 1000 for women aged ≥45 years at last birth). In models adjusted for age at first birth and parity, mortality risks were lowest among parous women with late-age births (≥45 years) compared with parous women with their last births before 35 years of age (hazard ratio, 0.58; 95% confidence interval, 0.40-0.86). CONCLUSIONS This study provides new empirical evidence that late-age births are associated with maternal longevity, although a direct causal relation cannot be established with the information available.
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Affiliation(s)
- Dena Jaffe
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
| | - Liron Kogan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Gielchinsky
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Uri Dior
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel; Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Neri Laufer
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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Knipe DW, Fraser A, Lawlor DA, Howe LD. Is interpregnancy interval associated with cardiovascular risk factors in later life? A cohort study. BMJ Open 2014; 4:e004173. [PMID: 24647446 PMCID: PMC3963084 DOI: 10.1136/bmjopen-2013-004173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Pregnancy represents a metabolic challenge to women; in a normal pregnancy, transient metabolic changes occur that support the needs of the growing fetus. It is possible that repeating this challenge within a relatively short amount of time may result in lasting damage to the woman's cardiovascular health. Conversely, it is also possible that a long interpregnancy interval (IPI) may reflect subfertility, which has been found to be associated with cardiovascular disease (CVD). We examine the associations of short and long IPI with measures of cardiovascular health. DESIGN Prospective cohort. SETTING Mothers of the Avon Longitudinal Study of Parents and Children (ALSPAC). PARTICIPANTS Women with two live births in order to control for confounding by parity. OUTCOME MEASURES Arterial distensibility, common carotid intima, adiposity, blood pressure, lipids, glucose, insulin, proinsulin, triglycerides, C reactive protein. RESULTS 25% (n=3451) of ALSPAC mothers had provided sufficient data to determine full reproductive history-of these, 1477 had two live births, with 54% mothers having non-missing data on all variables required for our analyses. A total of 1268 mothers with IPI (interbirth interval minus 9 months' gestation) had CVD risk factors measured/imputed at mean age 48 years. After adjusting for confounding, we found no association of either short (≤15 months) or long (>27 months) IPI and increased levels of cardiovascular risk factors. There was some suggestion that women with long and short IPIs had a more favourable lipid profile compared with women whose IPI was 16-27 months; however, the differences were small in magnitude and imprecisely estimated. CONCLUSIONS This study does not support the hypothesis that either long or short IPI is a risk factor for later cardiovascular health.
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Affiliation(s)
- Duleeka W Knipe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Abigail Fraser
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Laura D Howe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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30
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Dior UP, Hochner H, Friedlander Y, Calderon-Margalit R, Jaffe D, Burger A, Avgil M, Manor O, Elchalal U. Association between number of children and mortality of mothers: results of a 37-year follow-up study. Ann Epidemiol 2012. [PMID: 23176782 DOI: 10.1016/j.annepidem.2012.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the association between parity and long-term, all-cause mortality and mortality owing to specific causes in women. METHODS This prospective population-based study included 40,454 mothers who gave birth in Western Jerusalem, Israel, to 125,842 children and were followed for an average of 37 years after the birth of their first child. Cox proportional hazards models were used to evaluate long-term total and specific-cause mortality of women by their parity. RESULTS We found a U-shaped relationship between the number of offspring and risk of all-cause mortality in mothers. After adjustment for sociodemographic characteristics and maternal health and obstetric conditions, higher mortality rates were observed for mothers of 1 child (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.04-1.4), mothers of 5 to 9 children (HR, 1.21; 95% CI, 1.09-1.33), and mothers of 10 or more children (HR, 1.49; 95% CI, 1.12-1.99) compared with mothers of 2 to 4 children. Mortality risk from specific causes including coronary disease, circulatory disease, and cancer were increased for multiparous women. CONCLUSIONS In this long-term follow-up study, there was an association between number of children and mortality risk for mothers. These findings suggest that maternal pregnancies and postnatal characteristics as reflected by number of children may have consequences for long-term maternal health.
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Affiliation(s)
- Uri P Dior
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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31
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Simons LA, Simons J, Friedlander Y, McCallum J. Childbearing history and late-life mortality: the Dubbo study of Australian elderly. Age Ageing 2012; 41:523-8. [PMID: 22459707 DOI: 10.1093/ageing/afs016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE to examine the association of parity with mortality in later life. DESIGN a longitudinal, community-based study. SETTING semi-rural town of Dubbo, NSW, Australia. SUBJECTS a total of 1,571 women and 1,233 men 60 years and older first examined in 1988-89. OUTCOME MEASURES all-cause and cause-specific mortality rates analysed over 16-year follow-up. Hazard ratios obtained from proportional hazards models employing conventional predictors, potential confounders and measure of parity. RESULTS increasing parity in women was weakly associated with overweight, diabetes and hypertension. All-cause mortality fell progressively with increasing parity in women (hazard ratio and 95% confidence intervals): childless, 1.00; 1 child, 1.03 (0.75-1.43); 2 children, 0.83 (0.61-1.11); 3 children, 0.80 (0.60-1.08); 4 children, 0.91 (0.66-1.25); 5 children, 0.70 (0.49-1.01); 6+ children, 0.60 (0.43-0.85) (trend for parity P<0.002). This result was similar whether or not hypertension, diabetes and overweight were included in multivariate models adjusting for social variables and other confounders. The reduction in all-cause mortality was accompanied by a parallel reduction in deaths from cancer and respiratory conditions, while coronary heart disease mortality increased 60-111% in all parous women. CONCLUSION there was increased all-cause mortality in later life in childless women, accompanied by reduced mortality as parity increased. Underlying mechanisms are unclear but findings may have public health importance.
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Affiliation(s)
- Leon A Simons
- Lipid Department, St Vincent's Hospital, University of NSW, Sydney, New South Wales, Australia.
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