Early maternal age at first birth is associated with chronic diseases and poor physical performance in older age: cross-sectional analysis from the International Mobility in Aging Study

Age at first birth is associated with the likelihood of frailty in middle-aged and older women: A population-based analysis from NHANES 1999-2018

OBJECTIVES

This study examined whether age at first birth (AFB) is associated with the prevalence of frailty in middle-aged and older women.

METHODS

The study included 10,828 women (age ≥ 45 years) from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) in the United States. AFB data were collected using a standardized reproductive health questionnaire. Frailty was measured using a 53-item frailty index and was diagnosed if the score on that index was over 0.21. Survey-weighted logistic regression models were used to assess the association between AFB and the prevalence of frailty. A survey-weighted restricted cubic spline (RCS) model was used to determine the dose-response relationship between AFB and frailty. Mediation analyses were performed to estimate the mediated effects of education levels, family poverty income ratio, and parity on the association between AFB and the likelihood of frailty. Finally, sensitivity and subgroup analyses were conducted to validate the robustness of our findings.

RESULTS

Among the 10,828 women, 3828 (35.4 %) had frailty. The RCS depicted a U-shaped association between AFB and frailty. Compared with the women in the reference group (AFB: 33-35 years), women in the other groups (AFB: < 18, 18-20, 21-23, and 24-26 years) had a higher likelihood of frailty, with respective odds ratios (95 % confidence intervals) of 3.02 (1.89-4.83), 2.32 (1.54-3.50), 1.83 (1.19-2.81), and 1.64 (1.07-2.53). However, no statistically significant differences were detected for women with AFB of 27-29, 30-32, or > 35 years compared with the reference group. Education levels, family poverty income ratio, and parity significantly mediated the approximately linear negative association between AFB and frailty in the subset of women with AFB of ≤32 years and the mediation proportions were 23.4 %, 32.4 %, and 18.3 %, respectively (all p < 0.001).

CONCLUSIONS

Based on our results, we conclude that early AFB is associated with a higher likelihood of frailty in middle-aged and older women.

Investigating time to first birth among women of reproductive age in Bangladesh: a survival analysis of nationwide cross-sectional survey data

BACKGROUND

The birth of the first child is an important turning point in a woman's life as it is the starting point of the demanding responsibilities of motherhood and childcare. This study aimed to explore the waiting time and the significant indicators of time to the first birth of aged 15-49 years of ever-married women in Bangladesh.

METHODS

The study considered the most recent country-representative data collected from Bangladesh Demographic and Health Survey (BDHS) in 2017/18. The log-rank test was used to assess the statistical significance of the observed difference between waiting time to first birth and various socio-economic and demographic factors. The Cox proportional hazard model is applied to identify the influential factors for waiting time to first birth.

RESULTS

About 55% of the respondents' age at their first birth was less than 18 years. More than 21% of them were 20 years and above at their first birth. Findings revealed a higher mean age at first birth in urban areas than in rural areas. Also, in Dhaka and Sylhet region, women have a higher age at first than in other regions of Bangladesh. Results show that the place of residence, region, age at first marriage, age at first sex, respondent's education, employment status, contraceptive use, and mass media exposure were found to be statistically significant determinants of the age of respondents at the time of first birth. Findings also show that a woman from rural areas was likely to be 5% smaller in age at the time of first birth than their counterpart (aHR 1.05; 95% CI 1.01-1.10). The age at first birth of a woman in Chattogram was 24% shorter, while in Rangpur and Barishal, that age was increased by 14% and 8%, respectively. A woman with no education, primary, and secondary education had 28%, 38%, and 29%, respectively, shorter age at first birth than that of the higher educated women. Mass media unexposed women were shorter aged at first birth by 27% (aHR 1.27; 95% CI 1.10-1.47) compared to the women who were mass media exposed.

CONCLUSION

It is necessary to increase the age of mothers at first birth which may help to reduce the prevalence of child marriage in Bangladesh. The study findings will be helpful to the policymakers in identifying the gap and designing the programmes targeting the early timing of first birth to reduce child mortality as well as poor maternal outcomes which will be beneficial for achieving the Sustainable Development Goal-3 in Bangladesh.

Factors influencing sex ratio at birth in Krosno, Poland

The secondary sex ratio (SSR) is a widely used descriptor that reflects the living conditions and health status during pregnancy. The aim of study was to assess the impact of maternal factors, season of birth, and air pollution with the heating season on the sex ratio at birth in the Subcarpathian population from the Krosno district, Poland. A retrospective study involving 11,587 births was occurred at the John Paul II Podkarpackie Province Hospital in Krosno between 2016 and 2020. Sex of the newborn, the season of their birth, as well as the maternal age, birth order, the interval between births, and the season of birth were analysed. Furthermore, the relationship between the SSR and the level of air pollution during the heating season was investigated. To determine the significance of differences in sex ratios, chi-square analysis and multifactorial regression were used, with a significance level set at p < 0.05. At the chi-square level, all the studied factors indicated a statistically significant relationship with the SSR. However, the regression model used shows that maternal age and birth order were the most important factors in shaping the SSR in the study group.

Female Reproductive Factors and Risk of New-Onset Heart Failure: Findings From UK Biobank

BACKGROUND

A comprehensive evaluation of woman-specific risk factors in relation to incident heart failure (HF) is limited.

OBJECTIVES

This study sought to investigate the association of multiple female reproductive factors with the risk of HF.

METHODS

Between 2007 and 2010, 229,026 women (mean age: 56.5 years) without prevalent HF from the UK Biobank cohort were included and followed until December 2020. The relation between (self-reported) reproductive factors and HF was analyzed using Cox proportional hazards models with adjustment for potential confounding.

RESULTS

Menarche at age <12 years, compared to age 12-13 years, carried a 9% larger risk of HF (HR: 1.09 [95% CI: 1.01-1.18]). Younger age at menopause was associated with a higher risk of HF (HRage <45 y vs 50-51 y: 1.15 [95% CI: 1.03-1.28]; HRage 45-49 y vs 50-51 y: 1.11 [95% CI: 1.01-1.23]). Younger maternal age at first live birth (HRage <21 y vs 24-26 y: 1.42 [95% CI: 1.28-1.59]; HRage 21-23 y vs 24-26 y: 1.14 [95% CI: 1.03-1.26]) and at last live birth (HRage <26 y vs 29-31 y: 1.19 [95% CI: 1.07-1.33]) were associated with higher risk of HF. Compared to women with 1 or 2 children, having 3 or 4 children (HR: 1.09 [95% CI: 1.02-1.17]) or >4 children (HR: 1.24 [95% CI: 1.05-1.47]) was associated with higher HF risk. Experiencing miscarriages or abortions was not significantly associated with incident HF, whereas experiencing 1 stillbirth and recurrent stillbirths conferred a 20% and 43% larger risk of HF, respectively, compared to no stillbirth.

CONCLUSIONS

The findings emphasize the importance of female reproductive history in the assessment of HF risk.

Adolescent childbirth and mobility disability among women ages 15-49: an analysis of population health surveys from 14 low-income and middle-income countries

OBJECTIVES

Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability.

DESIGN

Cross-sectional analysis.

SETTING

Population health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15-49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana.

PARTICIPANTS

The sample included 157 988 women ages 15-49 years.

PRIMARY OUTCOME MEASURE

Adolescent childbirth was defined as 10-19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20-45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth.

RESULTS

Prevalence of adolescent childbirth (17.5%-66.2%) and mobility disability (0.32%-21.45%) varied widely across countries. Adolescent childbirth was significantly (p<0.05) associated with greater mobility disability in six of eight countries using standard disability measures. Among the six countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (pooled PR 1.19, 95% CI 1.06-1.31).

CONCLUSIONS

This analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability.

Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019

Background

Being a mother for the first time is the most significant event in a woman's life. "Age at first birth" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level.

Methods

Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors.

Results

The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086).

Conclusion

The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.

Characteristics of reproductive history, use of exogenous hormones and walking speed among women: Data from the CONSTANCES French Cohort Study

OBJECTIVE

To investigate the cross-sectional associations of reproductive history and use of exogenous hormones with fast walking speed (WS) in women.

STUDY DESIGN

Between 2012 and 2020, 33,892 French women aged 45 years or more, recruited at health centers, underwent physical function tests and self-reported information on reproductive history and use of exogenous hormones. Linear mixed models with the center as random intercept were used to estimate the association of exposures with WS.

MAIN OUTCOME MEASURES

Fast WS.

RESULTS

Mean WS was 172.2 cm/s. WS increased with age at menarche (β_+1y = 0.23, 95 % confidence interval = 0.05 to 0.40), age at first birth (β_+1y = 0.20, 95 % CI = 0.13 to 0.27) and duration of breastfeeding (β_{for ≥10 vs ≤5months} = 1.38; 95 % CI = 0.39 to 2.36). In addition, parity was quadratically associated with WS, with women with 3 children having the highest WS (p for U-shaped relationship < 0.01). Menopausal status had no impact on WS but age at menopause was positively associated with WS (β_+5y = 0.52, 95 % CI = 0.17 to 0.87) and partly explained the deleterious impact of artificial menopause on WS. WS increased with reproductive lifetime duration (β_+5y = 0.49, 95 % CI = 0.16 to 0.83) and decreased with time since onset of menopause (β_+5y = -0.65, 95 % CI = -0.99 to -0.31). By contrast, there was no association of WS with oral contraception and postmenopausal hormone therapy.

CONCLUSION

Our findings suggest that reproductive life characteristics may be associated with WS and timing of exposure could play a role.

The Mediating Role of Body Mass Index in the Association Between Age at First Childbirth and Lung Function Among Chinese Postmenopausal Women

Objective

Little is known about the effect of age at first childbirth on lung function. We aimed to investigate the association between age at first childbirth and lung function in Chinese women and further test whether this association is mediated by body mass index (BMI).

Methods

This cross-sectional study is a partial survey of the China Kadoorie Biobank (CKB) which was conducted in Xinxiang City, Henan Province between 2004 and 2008. A total of 16,584 postmenopausal women aged 30-79 years were enrolled. Multiple linear and logistic regression were used to investigate the association between age at first childbirth and lung function and overweight/obesity. The mediation analysis was performed using the PROCESS procedure for SPSS.

Results

The mean (SD) age at first childbirth was 23.1 (2.7) years. Women with first childbirth aged ≤19 years and 20-22 years had lower lung function than women who gave first childbirth aged 23-25 years. Per 1-year increase in the age at first childbirth was associated with a 3.31 mL increase in FEV1 (95% CI = 1.27-5.35), 3.91 mL increase in FVC (95% CI = 1.63-6.18), 0.15% increase in FEV1, % predicted (95% CI = 0.05-0.24) and 0.14% increase in FVC, % predicted (95% CI = 0.05-0.22). There was no clear association between age at first childbirth and FEV1/FVC ratio. BMI played a contribution to the association between age at first childbirth and FEV1 and the proportion was 16.4% (indirect effect: β = 0.65, 95% CI = 0.46-0.89; total effect: β = 3.96, 95% CI = 1.92-5.99). Similarly, the proportion to FVC, FEV1, % predicted, and FVC, % predicted was 25.0%, 16.6%, and 25.0%, respectively.

Conclusion

Early age at first childbirth was associated with lower lung function and BMI mediated the association. It is important to test lung function and popularize the knowledge of weight control in women who gave first childbirth at an early age.

Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70)

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.

Fertility History and Risk of Cognitive Impairment Among Older Parents in the United States

OBJECTIVES

I work from a gendered life-course perspective to examine the association between older parents' fertility history (i.e., timing and parity) and their risk of cognitive impairment in the United States.

METHODS

I analyze nationally representative data from 9 waves over 16 years of the Health and Retirement Study (2000-2016). The sample includes 14,543 respondents (6,108 men and 8,435 women) aged 50 and older at the baseline survey. I examine the relationship between parity, age at first birth, and age at last birth with risk of cognitive impairment using nonlinear discrete-time hazard models.

RESULTS

Adjusting for the effects of full covariates, there are U-shaped relationships between women's age at last birth and risk of cognitive impairment and between women's parity and risk of cognitive impairment. In the sensitivity tests, the relationships remain robust when sampling weights are applied, or mortality selection is corrected.

DISCUSSION

Fertility timing and parity are likely factors associated with the risk of cognitive impairment for older women. Understanding fertility history and its impact on cognition can help identify the most vulnerable subpopulations, so that more effective interventions can be made to improve cognitive functioning among older adults.

Number of Births and Risk of Diabetes in China's Older Women

As an important life event in individuals' life, childbirth will affect the health of women to different degrees. More and more attention has been paid to whether the number of births will affect the incident diabetes in elderly women, but there are few related studies. Based on the data of the Chinese Longitudinal Healthy Longevity Survey in 2018, 6,159 older women are selected as the study population. Logistic regression analyses are used to estimate the relationship between the number of births and diabetes risk. For each additional birth, the odds ratio of maternal diabetes will decrease by 6.9% and the result is significant at the 1% level, especially among mothers having four children or less. The conclusion is equally applicable in the sample of fathers and urban mothers, but the increase in the number of births will increase the risk of diabetes in rural mothers, although this result is not statistically significant. Later age at first birth, later age at last birth, the longer childbearing period, and birth interval will significantly reduce the risk of diabetes.

Maternal age at marriage and child nutritional status and development: evidence from Serbian Roma communities

OBJECTIVE

This study aimed to assess whether maternal age at first marriage is associated with nutritional and developmental penalties in Roma children.

DESIGN

Roma nationally representative population-based study. Proxies for child nutritional outcomes included children's individual-level height-for-age z (HAZ) and weight-for-age z (WAZ) scores, HAZ and WAZ scores below two standard deviations from the median of WHO's reference population (children aged 0-59 months), and Early Child Development (children aged 36-59 months). Multiple and logistic regressions were used to estimate the association between maternal age at marriage and the outcomes, and other sociodemographic determinants as possible confounders.

SETTING

Aggregated data from UNICEF's fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements.

SUBJECTS

Children (n= 2652) aged 0-59 months born to ever-married women aged 15-48.

RESULTS

64% of women married before age 18, 19% of children were stunted, 9% wasted, and Early Child Development score was low. Maternal age at first marriage was not associated with either nutritional status or early development of Roma children. Weight at birth (children aged 0-24) emerged as the main predictor of children's nutritional status. Boys were more likely to be shorter, more stunted and wasted than girls. Child's age, maternal parity and unimproved toilet facility negatively impacted nutritional status, while maternal literacy mitigated against poor nutritional and developmental outcomes.

CONCLUSIONS

Roma children up to 5 years of age bear no negative consequences of maternal early marriage. The underlying determinants of children's wellbeing include improved sanitation, child characteristics, maternal literacy and reproductive behavior, and parental investment.

Relationship between physical activity level and balance in middle-aged and older women

Abstract Introduction: Physical exercise may improve motor skills, such as static standing balance. However, the association between physical activity level based on activities of daily living and static balance is unknown. Objective: To assess the association between the physical activity level and static balance in middle-aged and older women. Methods: This cross-sectional study involved 589 community-dwelling women. Static balance was assessed using the single-leg stance test (SLST) with eyes open and closed. Physical activity level was assessed using the International Physical Activity Questionnaire Short Form and classified as high, moderate, or low. Kruskal-Wallis test compared balance performance between participants with different physical activity levels. Multiple quantile regression analyses assessed the association between variables adjusted for age, family income, educational level, body mass index, comorbidities, and parity. Results: Participants with low physical activity level showed worse SLST performance with eyes open and closed than participants with high physical activity level in the bivariate analysis. However, physical activity level and SLST performance were not associated in the analysis adjusted for covariates. Conclusion: Our results suggested that only being active in daily living activities is not associated with better standing balance in middle-aged and older women. Specific physical exercise programs should be implemented to improve balance in this population.

Reproductive history and blood cell DNA methylation later in life: the Young Finns Study

Background

Women with a history of complications of pregnancy, including hypertensive disorders, gestational diabetes or an infant fetal growth restriction or preterm birth, are at higher risk for cardiovascular disease later in life. We aimed to examine differences in maternal DNA methylation following pregnancy complications.

Methods

Data on women participating in the Young Finns study (n = 836) were linked to the national birth registry. DNA methylation in whole blood was assessed using the Infinium Methylation EPIC BeadChip. Epigenome-wide analysis was conducted on differential CpG methylation at 850 K sites. Reproductive history was also modeled as a predictor of four epigenetic age indices.

Results

Fourteen significant differentially methylated sites were found associated with both history of pre-eclampsia and overall hypertensive disorders of pregnancy. No associations were found between reproductive history and any epigenetic age acceleration measure.

Conclusions

Differences in epigenetic methylation profiles could represent pre-existing risk factors, or changes that occurred as a result of experiencing these complications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13148-021-01215-1.

Cut-off points to screening for sarcopenia in community-dwelling older people residents in Brazil

BACKGROUND

At a time when the world's population is aging, one of the most important challenges for the healthcare field is to control the decline of the musculoskeletal system. This decline consists of a reduction in muscle mass and function, which is called sarcopenia and is associated with adverse health outcomes. Although there has been an increase in the number of publications on sarcopenia and its consequences, the reported prevalence varies widely, since these depend on the characteristics of the population studied, the definitions found in the literature and the cut-off points adopted. In this perspective, the heterogeneity in the classification and the different reference values has a critical impact on the epidemiology of sarcopenia, since neither the procedures, the components and the cut-off points are consistent.

OBJECTIVES

To develop cut-off points for the screening of sarcopenia in community-dwelling older people residents in the northeast of Brazil and compare the prevalences between the values defined by the consensus and the values of the population studied.

METHODS

Community-dwelling older men and women living in three cities in the countryside of Rio Grande do Norte were evaluated. Cutoff points were defined for the variables used to screen for sarcopenia (handgrip strength, SMI, gait speed and SPPB) using the 20th percentile of their population distributions.

RESULTS

The sample was composed of 1,290 older people (62.5% female and 37.5% male), with an average of 69.5 (± 6.05) years of age. Regarding the cutoff points, the handgrip values were defined as 25.3 kg and 16 kg for men and women, respectively. Considering the SMM adjusted according to their height, the values of 7.88 kg/m2 were adopted for men and 5.52 kg/m2 for women. When adjusting by BMI we obtained 0.73 kg/BMI for men and 0.41 kg/BMI for women. For gait speed it was defined 0.71 m/s for men and 0.63 m/s for women. In the case of SPPB, the result was the same for both genders (≤8). When applying the values found in the studied population, a variation in prevalence was observed for both men and women, depending on the cut-off points and consensus used.

CONCLUSION

The cutoff values found in our population were lower than those adopted by international consensus (EWGSOP2, IWGS and FNIH), except for HGS in woman and SMI/m2 for men. Therefore, using specific cutoff points for different populations can provide an accurate assessment of the presence of sarcopenia and better target health prevention strategies for the older people living in the community.

Time to first birth and its determinants among married female youths in Ethiopia, 2020: survival analysis based on EDHS 2016

Introduction

The first birth is the most significant events in a woman's life that indicates the beginning of undertaking the intensive responsibilities of motherhood and childcare. Age at first birth has health, economic and social consequences and implications. But little has been known on the time to first birth and its determinants in Ethiopia. Therefore, this research is planned to address this issue.

Objectives of the study

To assess the time to first birth and its determinants among married female youths in Ethiopia, 2020.

Methods

The data was accessed freely through (https://www.dhsprogram.com). Survival analysis of time to first birth was done based on EDHS 2016 data among 2597 weighted study subjects. The data was extracted using STATA version 14.0. Kaplan Meier’s survival and Log rank test were used to compare survival experiences of respondents using categorical variables. Proportional hazard assumption was checked and was not violated. Cox proportional hazard model was applied, hazard ratio with 95% CI was computed and variables with p value < 0.05 in the multivariable analysis were taken as significant determinants.

Results

Overall median survival time was 18 years (IQR = 17–20). The significant determinants of time to first birth are place of residence (being rural (AHR = 1.49, 95% CI 1.13, 1.97),Religion (being Muslim [AHR = 1.57, 95% CI 1.22, 2.02),being protestant (AHR = 1.73, 95% CI 1.34, 2.24)], age at first sex [first sex < 15 years (AHR = 1.68, 95% CI 1.23, 2.29)] and first sex between 15 and 17 years (AHR = 1.54, 95% CI 1.29, 1.85), age at first marriage (marriage < 15 years (AHR = 6.52, 95% CI 4.91, 8.64), marriage between 15 and 17 (AHR = 2.63, 95% CI 2.20, 3.14), unmet need for family planning (AHR = 1.23, 95% CI 1.00, 1.52)

Conclusion

In this study, the median age at first birth was 18 years. This show, about 50% of study participants give birth for the first time before their 18th birth day. This age is the ideal age for schooling and to do other personal development activities. Therefore giving birth before 18 year will limit female youths from attending school and performing personal development activities in addition to health and demographic consequences of early child bearing.

The role of multiparity and maternal age at first pregnancy in the association between early menarche and metabolic syndrome among middle-aged and older women

OBJECTIVE

To analyze whether maternal age at first pregnancy and parity are mediators of the association between early menarche and metabolic syndrome in a sample of middle-aged and older women.

METHODS

Cross-sectional study of 428 women (40 to 80 y), who had experienced a pregnancy in their lifetime, was performed between 2014 and 2016. Age at first pregnancy, parity, and early menarche were self-reported. Metabolic syndrome was assessed using the criteria described by the National Cholesterol Education Program's Adult Treatment Panel III. The association between metabolic syndrome and early menarche was assessed by logistic regression analysis. The mediating role of age at first pregnancy and multiparity in the relationship between early menarche and metabolic syndrome was assessed through mediation analysis, adjusted for covariates.

RESULTS

According to adjusted logistic regression models, early menarche was associated with higher odds of prevalent metabolic syndrome (OR: 2.26; 95% CI: 1.15-4.46). Mediation analysis showed a significant direct effect of early menarche on metabolic syndrome (β: 0.808; 95% CI: 0.107-1.508). Of the two mediators tested, age at first pregnancy was significant (β: 0.065; 95% CI: 0.004-0.221), ie, participants with and without early menarche differ, on average, by 0.879 SDs in the log odds of MetS (total effect), of which 0.065 SDs (8%), on average, would be attributable to the effect of early menarche on age at first pregnancy (indirect effect), which, in turn, affects MetS.

CONCLUSIONS

Age at first pregnancy may partially contribute to the association between early menarche and metabolic syndrome among middle-aged and older women who had experienced a pregnancy over their lifetime.

The impacts of parity on spirometric parameters: a systematic review

Introduction: The relationship between parity and health outcomes has been debated in the scientific literature in terms of 'selection-pressure'. However, no previous review has raised the impacts of parity on spirometric parameters. This Systematic Review aimed to review the impacts of parity on spirometric parameters.Areas covered: PubMed and Scopus were searched on October 1^st, 2020, using the combination of the following two medical subject headings: 'Parity' and 'Respiratory Function Tests'. Only original articles published in English/French were retained. Ten studies investigated the impacts of parity on spirometric parameters: six included healthy females, three involved unhealthy females [chronic obstructive pulmonary disease, defect in protease inhibitor, and some other conditions] and one included a mixed population of healthy/unhealthy females. The studies reported conflicting results: no impact, positive impact (multiparity is associated with larger forced-expiratory-volume in one second, forced- and slow- vital-capacity, and inspiratory-capacity), or negative impact (multiparous females has lower bronchial flows, higher static volumes, an accelerated lung-aging, a tendency to an obstructive-ventilatory-defect and/or to lung-hyperinflation, and increased protease inhibitor levels).Expert opinion: The ten studies presented some limitations that made data interpretation relatively difficult. Future research to identify the 'real' impact of parity on spirometric parameters are therefore encouraged.

Child Marriage and Adolescent Motherhood: A Nationwide Vulnerability for Women in Bangladesh

The persistently high prevalence of girl-child marriage and adolescent motherhood is a public health concern in Bangladesh. This study investigated the division-wise prevalence and the influence of education and religious affiliation on child marriage and adolescent motherhood among women in Bangladesh along with their consequences using 15,474 women aged 15-49 years from the Bangladesh Demographic and Health Survey 2017-18. Staggeringly, 82.5% women were married before 18, 43.1% were married before 15, and 61.8% gave birth before 18 years of age. Binary logistic regression models for the complex survey showed that girl-children with primary, secondary, and higher secondary or above education were 16% (95% CI: 0.69, 1.03), 32% (95% CI: 0.55, 0.84), and 87% (95% CI: 0.10, 0.17) less likely to get married <18 years of age, respectively, compared to the uneducated. Also, girl-children with secondary and higher education were 21 and 83% less likely to become adolescent mothers, respectively, than the uneducated. Women married during childhood (<18 years) and adolescent mothers were 36 and 55% less likely to continue studies after marriage, respectively, and expressed that they significantly preferred a late marriage. Policy interventions need to address culturally-laden social norms influenced by religious-related beliefs, especially in rural areas.

Longitudinal changes in HDL-cholesterol concentration are associated with different risk factors in primiparous and nulliparous young women: The NHLBI Growth and Health Study (NGHS)

BACKGROUND

Previous studies report that first pregnancy is associated with persistent decreases in HDL-cholesterol (HDL-C) concentrations.

OBJECTIVE

This study evaluated factors associated with declines in HDL-C concentration in parous and nulliparous young women.

METHODS

This study leverages data from African-American and white women from the NHLBI Growth and Health Study. Parity-related changes in lipids, BMI and percent body fat were assessed longitudinally. A subset of primiparous and nulliparous women with paired lipid measurements were analyzed regarding changes in HDL-C concentrations.

RESULTS

Among 870 women in longitudinal analyses, African-American women had higher parity (p<0.0001), with baseline measurements of each parity group being similar. HDL-C concentration decreased significantly and remained lower after the first pregnancy, while BMI and percent body fat increased with increasing parity. In the subset of 401 women, HDL-C concentration decreased among primiparous women (-4.81 ± 0.93 mg/dl), with no overall change in nulliparous (p = 0.003). In both groups, greater HDL-C concentration declines were independently associated with higher initial HDL-C concentration and greater increases in BMI (both p<0.0001). Among primiparous women, younger delivery age (p = 0.0001) and birth control use (p = 0.004) were associated with greater HDL-C concentration decline. Nulliparous white women's HDL-C concentration increased over time, with no change in African-American women (p = 0.008); no racial difference was seen in primiparous women.

CONCLUSION

Persistent decreases in HDL-C concentration were associated with the first pregnancy, and were greater with higher initial HDL-C concentration. Racial differences in HDL-C concentration emerged over time in nulliparous women, but not primiparous women. Potential impacts of these findings on women's long-term cardiometabolic health should be evaluated.

Life-Space and Cognitive Decline in Older Adults in Different Social and Economic Contexts: Longitudinal Results from the IMIAS Study

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (β = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.

Frailty: A cost incurred by reproduction?

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.

Association between self-rated health and physical performance in middle-aged and older women from Northeast Brazil

Background

Self-rated Health (SRH) is regarded as a simple and valid measure of a person’s health status, given its association to adverse health outcomes, including low physical performance in older populations. However, studies investigating these associations in low- and middle-income settings are scarce, especially for middle-aged populations. Understanding the validity of SRH in relation to objective health measures in low-income populations could assist in decision making about health policy and strategies, especially in under-resourced settings.

Objective

Assess the relationship between SRH and physical performance measures in middle-aged and older women in a low-income setting of Brazil.

Methods

This is a cross-sectional study of 571 middle-aged (40–59 years old) and older (60–80 years old) women living in Parnamirim and Santa Cruz in the Northeast region of Brazil. Participants reported their health status and were allocated to the “SRH good” or “SRH poor” groups. The physical performance evaluation included: handgrip strength, one-legged balance with eyes open and closed and chair stand test. The relationship between SRH and physical performance for middle-aged and older women was assessed by quantile regression (modeling medians) adjusted for potential confounders (age, socioeconomic variables, body mass index, menopause status, age at first birth, parity, chronic conditions and physical activity).

Results

Middle-aged women from the “SRH good” group presented better physical performance with 1.75 kgf stronger handgrip strength (95% CI [0.47–3.02]; p = 0.004), 1.31 s longer balance with eyes closed ([0.00–2.61]; p = 0.030), and they were 0.56 s faster in the chair stand test ([0.18–0.94]; p = 0.009) than those who reported “SRH poor”. No association was found for balance with eyes open. For older women, there was no evidence of associations between physical performance and SRH.

Conclusion

This study showed that SRH is significantly associated with objective measures of physical performance in a sample of low-income middle-aged women. SRH can be an important tool to indicate the need for further evaluation of physical performance among middle-aged women and can be particularly useful for low-income communities.

Fertility History and Biomarkers Using Prospective Data: Evidence From the 1958 National Child Development Study

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.

Associations of Pregnancy History with BMI and Weight Gain in 45-54-Year-Old Women

BACKGROUND

Midlife women have a higher risk of cardiometabolic disease than younger women, but the lifelong biological/lifestyle factors responsible for this increase are unclear.

OBJECTIVES

We investigated whether pregnancy history is a risk factor for midlife overweight/obesity and evaluated potential hormonal mechanisms.

METHODS

The Baltimore Midlife Women's Health Study, a prospective cohort, recruited 772 women aged 45-54 y. Women reported pregnancy characteristics via questionnaires, trained staff measured weight/height to calculate midlife BMI, and serum hormones were assessed by ELISA. Logistic regression models assessed associations of pregnancy history with risk of midlife overweight/obesity and BMI gain since age 18. We additionally explored whether associations differed by menopausal status, and whether midlife hormones mediated relationships of pregnancy history and midlife BMI.

RESULTS

These premenopausal or perimenopausal women were 66% Caucasian/White and 30% African American/Black, with a median of 2 live births (range: 0-11) and median age at first birth of 27 y (range: 12-46 y). Women with 0 and ≥2 live births had lower odds of overweight/obesity than those with 1 birth (OR = 0.47; 95% CI: 0.23, 0.96; P = 0.04, and OR = 0.58; 95% CI: 0.35, 0.95; P = 0.03, respectively). Women with ≥2 live births also had lower odds of BMI gain than those with 1 birth (OR = 0.66; 95% CI: 0.41, 1.06; P = 0.08). Furthermore, women who were older at their first birth had lower odds of overweight/obesity (OR = 0.96; 95% CI: 0.92, 1.00; P = 0.03) and BMI gain (OR = 0.97; 95% CI: 0.93, 1.00; P = 0.06). Number of pregnancies and age at last pregnancy were not associated with midlife overweight/obesity or BMI gain. Associations did not differ by menopausal status and were not explained by midlife hormones.

CONCLUSIONS

Earlier childbirth and having 1 child increased women's risk of midlife overweight/obesity and BMI gain since age 18. Additional studies should focus on women's childbearing years as a critical determinant of midlife metabolic health.

Association between age at first childbirth and type 2 diabetes in Chinese women

AIMS/INTRODUCTION

The present study aims to explore the relationship between age at first childbirth and developing type 2 diabetes, and analyze potential modifiers of its relationship.

MATERIALS AND METHODS

The data were obtained from the baseline survey of a large-scale cohort study in 10 diverse areas of China. Multivariate logistic regressions were used to analyze the association between developing type 2 diabetes and the age at first childbirth. Adjustments were made in each model on sociodemographic, socioeconomic and reproductive covariates. Subgroup analyses were further carried out to investigate the effects of reproductive factors, body mass index at 25 years of age and hypertension on the above-mentioned association.

RESULTS

Women who have their first child at age <20 years (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.22-1.44) and between the ages of 20 and 24 years (OR 1.16, 95% CI 1.10-1.23) were more likely to be diagnosed with type 2 diabetes compared with those who have their first child between the ages of 25 and 29 years; equal to or more than three parities (OR 1.44, 95% CI 1.30-1.60), premenopausal status (OR 1.58, 95% CI 0.99-2.54), overweight at age 25 years (OR 1.62, 95% CI 1.37-1.93) and hypertension (OR 1.37, 95% CI 1.22-1.53) are all conditions found to increase the odds of developing type 2 diabetes in those who have their their first child at an early age (<20 years).

CONCLUSIONS

The study concluded that having the first child at an early age is associated with an increased likelihood of developing type 2 diabetes later in life; reproductive factors, overweight at age 25 years and status of hypotension could modify such an association.

The impacts of parity on lung function data (LFD) of healthy females aged 40 years and more issued from an upper middle income country (Algeria): A comparative study

BACKGROUND

Studies evaluating the impacts of parity on LFD of healthy females presented controversial conclusions.

AIM

To compare the LFD of healthy females broken down according to their parities.

METHODS

A medical questionnaire was administered and anthropometric data were determined. Two groups [G1 (n = 34): ≤ 6; G2 (n = 32): > 6] and three classes [C1 (n = 15): 1-4; C2 (n = 28): 5-8; C3 (n = 23): 9-14] of parities were identified. LFD (plethysmography, specific airway resistance (sRaw)] were determined. Student's t-test and ANOVA test with post-Hoc test were used to compare the two groups' and the three classes' data.

RESULTS

G1 and G2 were age and height matched; however, compared to G1, G2 had a lower body mass index (BMI). C1, C2 and C3 were height, weight and BMI matched; however, compared to C2, C3 was older. G1 and G2 had similar values of FEV1, forced- and slow- vital capacities (FVC, SVC), maximal mid-expiratory flow (MMEF), forced expiratory flow at x% of FVC (FEFx%), peak expiratory flow (PEF), expiratory and inspiratory reserve volumes (ERV, IRV, respectively), inspiratory capacity (IC), sRaw, FEV1/FVC, FEV1/SVC, and residual volume/total lung capacity (RV/TLC). The three classes had similar values of MMEF, FEFx%, PEF, thoracic gas volume (TGV), ERV, IRV, FEV1/FVC, FEV1/SVC and RV/TLC. Compared to G1, G2 had higher TGV (2.68±0.43 vs. 3.00±0.47 L), RV (1.80±0.29 vs. 2.04±0.33 L) and TLC (4.77±0.62 vs. 5.11±0.67 L). Compared to C1, C2 had higher FEV1 (2.14±0.56 vs. 2.47±0.33 L), FVC (2.72±0.65 vs. 3.19±0.41 L), SVC (2.74±0.61 vs. 3.24±0.41 L), TLC (4.47±0.59 vs. 5.10±0.58 L), IC (1.92±0.41 vs. 2.34±0.39 L) and sRaw (4.70±1.32 vs. 5.75±1.18 kPa*s). Compared to C1, C3 had higher TLC (4.47±0.59 vs. 5.05±0.68 L) and RV (1.75±0.29 vs. 2.04±0.30 L).

CONCLUSION

Increasing parity induced a tendency towards lung-hyperinflation.

Frailty and physical performance in the context of extreme poverty: a population-based study of older adults in rural Burkina Faso

Background: Little is known about the prevalence of frailty and about normal values for physical performance among older individuals in low-income countries, in particular those in sub-Saharan Africa. We describe the prevalence of phenotypic frailty, and values and correlates of several physical performance measures in a cohort of middle-aged and older people living in rural Burkina Faso, one of the world's poorest communities. Methods: We analysed data collected from participants aged over 40 in Nouna district, Burkina Faso. We measured handgrip strength, four metre walk speed, chair rise time, and derived the Fried frailty score based on grip strength, gait speed, body mass index, self-reported exhaustion, and physical activity. Frailty and physical performance indicators were then correlated with health and sociodemographic variables including comorbid disease, marital status, age, sex, wealth and activity impairment. Results: Our sample included 2973 individuals (1503 women), mean age 54 years. 1207 (43%) were categorised as non-frail, 1324 (44%) as prefrail, 212 (7%) as frail, and 167 (6%) were unable to complete all five frailty score components. Lower grip strength, longer chair stand time, lower walk speed and prevalence of frailty rose with age. Frailty was more common in women than men (8% vs 6%, p=0.01) except in those aged 80 and over. Frailty was strongly associated with impairment of activities of daily living and with lower wealth, being widowed, diabetes mellitus, hypertension, and self-reported diagnoses of tuberculosis or heart disease. With the exception of grip strength, which was higher in women than prior international normative values, women had greater deficits than men in physical performance. Conclusions: Phenotypic frailty and impaired physical performance were associated as expected with female sex, co-morbidities, increasing age and impaired activities of daily living. These results support the use of frailty measurements for classification of ageing related syndromes in this setting.

Fertility histories and chronic conditions later in life in Europe

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.

Symptoms of urinary incontinence and pelvic organ prolapse and physical performance in middle-aged women from Northeast Brazil: a cross-sectional study

Background

Reproductive history and urogynecological disorders have been associated with limitations in physical function. However, little is known about the relationship between symptoms of urinary incontinence and pelvic organ prolapse, and physical performance. Therefore, the purpose of this study was to examine whether symptoms of urinary incontinence and pelvic organ prolapse are independently associated factors with indicators of lower physical performance in middle-aged women from Northeast Brazil.

Methods

This is a cross-sectional study of 381 women between 40 to 65 years old living in Parnamirim, Northeast Brazil. Physical performance was assessed by gait speed, chair stand and standing balance tests. Urinary incontinence and pelvic organ prolapse were self-reported. Multiple linear regression analyses were performed to model the effect of self-reported urinary incontinence and pelvic organ prolapse on each physical performance measure, adjusted for covariates (age, family income, education, body mass index, parity).

Results

In the analysis adjusted for confounders, women reporting urinary incontinence spent, on average, half a second longer to perform the chair stand test (β = 0.505 95% CI: 0.034: 0.976). Those reporting pelvic organ prolapse shortened the balance time with eyes open by 2.5 s on average (β = − 2.556; CI: − 4.769: − 0.343).

Conclusions

Symptoms of pelvic organ prolapse and urinary incontinence are associated to worse physical performance in middle-aged women. These seemingly small changes in physical performance levels are of clinical importance, since these conditions may influence women’s physical ability, with implications for other tasks important to daily functioning and should be addressed by health policies targeting women’s health and functionality.

Competition for nutrients in pregnant adolescents: consequences for maternal, conceptus and offspring endocrine systems

The competition for nutrients that arises when pregnancy coincides with continuing or incomplete growth in young adolescent girls increases the risk of preterm delivery and low birthweight with negative after-effects for mother and child extending beyond the perinatal period. Sheep paradigms involving nutritional management of weight and adiposity in young, biologically immature adolescents have allowed the consequences of differential maternal growth status to be explored. Although nutrient reserves at conception play a modest role, it is the dietary manipulation of the maternal growth trajectory thereafter which has the most negative impact on pregnancy outcome. Overnourishing adolescents to promote rapid maternal growth is particularly detrimental as placental growth, uteroplacental blood flows and fetal nutrient delivery are perturbed leading to a high incidence of fetal growth restriction and premature delivery of low birthweight lambs, whereas in undernourished adolescents further maternal growth is prevented, and depletion of the maternal body results in a small reduction in birthweight independent of placental size. Maternal and placental endocrine systems are differentially altered in both paradigms with downstream effects on fetal endocrine systems, organ development and body composition. Approaches to reverse these effects have been explored, predominantly targeting placental growth or function. After birth, growth-restricted offspring born to overnourished adolescents and fed to appetite have an altered metabolic phenotype which persists into adulthood, whereas offspring of undernourished adolescents are largely unaffected. This body of work using ovine paradigms has public health implications for nutritional advice offered to young adolescents before and during pregnancy, and their offspring thereafter.

History of adolescent birth and diabetes in adulthood: a cross-sectional study of a nationally representative sample of American women

Background: In the USA, 12-14% have type 2 diabetes mellitus and the incidence is rising. Adolescent birth has been shown to be associated with significant gestational weight gain and obesity in adulthood.Objective: We sought to evaluate the association between the history of adolescent birth and diabetes in adulthood.Study design: We conducted a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) data, examining 2-year cycles from 2005 to 2014. In a population of adult women who had experienced at least one live birth and who were not currently pregnant, we examined the prevalence of type 2 diabetes mellitus by the history of adolescent birth (live birth prior to 20 years of age). Sample characteristics were compared using survey-weighted chi-square tests. Multivariate logistic regression was used to examine the association between diabetes mellitus and adolescent birth history, with progressive adjustments for birth cohort, race/ethnicity, education level, and body mass index (BMI).Results: In a survey sample of 6507 individuals, we found that 38% of the women had experienced adolescent birth. Significant differences were found between those who had experienced adolescent birth and those who had not by birth cohort, race/ethnicity, federal poverty level, education attainment, parity, and BMI (p < .001 for all). The prevalence of type 2 diabetes was higher in women with a history of adolescent birth in adulthood than in women without a history of adolescent birth (17.2 versus 12.1%, p < .001; BMI-adjusted odds ratio = 1.27; 95% confidence interval, 1.03-1.58, p = .03).Conclusion: American women with a history of adolescent birth are at a significantly higher risk of type 2 diabetes mellitus in adulthood. Greater attention must be paid to preventing metabolic disease in women who experience early parity.

Data gaps in adolescent fertility surveillance in middle-income countries in Latin America and South Eastern Europe: Barriers to evidence-based health promotion

Adolescent health is a major global priority. Yet, as recently described by the World Health Organization (WHO), increased recognition of the importance of adolescent health rarely transforms into action. One challenge is lack of data, particularly on adolescent fertility. Adolescent pregnancy and childbirth are widespread and affect lifetime health and social outcomes of women, men, and families. Other important components of adolescent fertility include abortion, miscarriage, and stillbirth. Access to reliable, consistently-collected data to understand the scope and complexity of adolescent fertility is critical for designing strong research, developing meaningful policies, building effective programs, and evaluating success in these domains. Vital surveillance data can be challenging to obtain in general, and particularly in low- and middle-income countries and other under-resourced settings (including rural and indigenous communities in high-income countries). Definitions also vary, making comparisons over time and across locations challenging. Informed by the Adolescence and Motherhood Research project in Brazil and considering relevance to the Southern Eastern European (SEE) context, this article focuses on challenges in surveillance data for adolescent fertility for middle-income countries. Specifically, we review the literature to: (1) discuss the importance of understanding adolescent fertility generally, and (2) highlight relevant challenges and complexity in collecting adolescent fertility data, then we (3) consider implications of data gaps on this topic for selected middle-income countries in Latin America and SEE, and (4) propose next steps to improve adolescent fertility data for evidence-based health promotion in the middle-income country context.

Pregnancy history and cognitive aging among older women: the Rancho Bernardo Study

OBJECTIVE

The aim of the study was to examine the association of pregnancy history with trajectories of cognitive function in older women.

METHODS

Participants were 1,025 women (mean age = 73.1 ± 9.6 y) enrolled in the Rancho Bernardo Study who attended a clinic visit between 1988 and 1992, when pregnancy history (ever pregnant, number of pregnancies, ages at first and last pregnancy) was recorded and cognitive function was assessed with a battery of four tests repeated up to 7 times through 2016. Linear mixed-effects regression models were used to examine the association between pregnancy history and longitudinal change in cognitive function.

RESULTS

Overall, 77% of women had at least one pregnancy; number of pregnancies ranged from 1 to 14 (mean = 2.9 ± 1.7). Ages at first and last pregnancy ranged from 16 to 44 years (mean = 24.9 ± 4.7) and 16 to 49 years (mean = 30.7 ± 5.5), respectively. Of 16 associations tested (4 pregnancy exposures by 4 cognitive tests), one was statistically significant without correction for multiple comparisons. Women who reported ever being pregnant recalled 0.12 fewer words on the Buschke Selective Reminding Test for every year increase in age than women who had never been pregnant (P = 0.05). No other significant associations of pregnancy history with cognitive decline were observed.

CONCLUSIONS

Our results show no clinically meaningful long-term influence of pregnancy history on age-related change in cognitive function. These reassuring findings suggest childbearing decisions and timing will not affect cognitive function in older age.

Social and Economic Predictors of Worse Frailty Status Occurrence Across Selected Countries in North and South America and Europe

Background

Frailty, a state of vulnerability to poor resolution of homoeostasis after a health stressor, may be a result of cumulative decline in many physiological systems across the life course and its prevalence and incidence rates vary widely depending on the place and population subgroup.

Objective

This study aims to examine social and economic factors as predictors of worse frailty status over 2 years of follow-up in a sample of community-dwelling older adults from the International Mobility in Aging Study.

Methods

We analyzed 2012 baseline and 2014 follow-up (n = 1,724) data on participants from a populational-based, longitudinal study conducted in 4 countries (e.g., Brazil, Colombia, Albania, and Canada). Frailty was defined according to the Fried's phenotype and Poisson regression models with robust standard errors were performed to estimate the relative risks of becoming frail.

Results

In our study, 366 (21.2%) participants migrated to a worse stage of frailty. After statistical adjustment (e.g., participant age, sex, and study site), insufficient income (RR = 1.40; 95% CI = 1.00-1.96) and having partner support (RR = 0.80; 95% CI = 0.64-1.01) were predictors of incident frailty status.

Conclusion

Notably, transitions in frailty status were observed even in a short range of time, with sociodemographic factors predicting incident frailty.

Influence of maternal height on children's health status and mortality: A cross-sectional study in poor Roma communities in rural Serbia

To determine possible variations in children's health status and mortality associated with variations in maternal stature, an anthropometric and demographic study was conducted in a Roma population of poor socio-economic status in rural Serbia. Data were collected during several years of anthropological fieldwork. The sample consisted of 691 women, ranging from 16 to 80 years of age. In addition to stature, Roma women's demographics, reproductive history, reproductive outcomes and health status of their children were collected. The results provide evidence of a significant association between mother's stature and their children's health and mortality, with a shorter mother's stature predisposing children to poor health and survival outcomes. The findings could prompt development of a definition of short stature among Roma women to evaluate the risk based on height distribution among the general Roma population.

Relationship between maximal respiratory pressures and multiple childbearing in Brazilian middle-aged and older women: A cross-sectional community-based study

Objective

Previous studies show that multiparity and a number of chronic conditions are correlated among women. Also, low respiratory muscle strength has been associated to adverse health outcomes such as chronic lung disease and early mortality. This study aimed to investigate associations between the number of lifetime pregnancies and maximal inspiratory/expiratory pressures.

Methods

In a cross-sectional study, 204 women ages 41–80 years-old, from the rural community of Santa Cruz, Brazil, provided data regarding demographics, socioeconomic characteristics, health behaviors, and number of lifetime pregnancies (≤3, 4–6 or ≥7). Maximal respiratory pressures were measured with a digital manometer. Multiple linear regression analysis was used to examine the association of multiple childbearing on maximal respiratory pressures.

Results

Of the participants, 44.1% had ≤3 pregnancies, 30.4% had 4–6 pregnancies and 25.5% had >7 pregnancies. In the unadjusted analyses, maximal inspiratory and expiratory pressures varied significantly according to multiple childbearing categories. After adjustment, the values remained statistically significant only for maximal expiratory pressure. Compared to women with ≤3 lifetime pregnancies, those who had ≥7 pregnancies had significantly lower maximal expiratory pressure values (β = -18.07, p = 0.01)

Conclusion

Multiple childbearing appears to be negatively associated with maximal respiratory pressures; women with a higher number of lifetime pregnancies had lower values of maximal respiratory pressures when compared to those with fewer pregnancies. This association may be due to biomechanical changes in the respiratory muscles promoted by multiple lifetime pregnancies. This finding indicates a need to motivate women, from the prenatal to postpartum period, to safely exercise their respiratory muscles, including abdominal muscle exercises as well as respiratory muscle training.

Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women's Health

OBJECTIVE

To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women.

METHODS

Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973-1978 cohort were used (N = 6899, aged 37-42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression.

RESULTS

14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18-27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval.

CONCLUSION

As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.

Effect of Childbirth Age on Bone Mineral Density in Postmenopausal Women

BACKGROUND

In postmenopausal women, there is rapid bone loss due to estrogen depletion. In women, reproductive factors such as age at menarche, breastfeeding, and parity are considered risk factors of osteoporosis. Many reports suggest that obesity is associated with a reduced risk of osteoporosis. This nationwide, population-based study aims to identify the association between maternal age and osteoporosis risk in postmenopausal women of different obesity classifications.

METHODS

We assessed data from the Korean National Health and Nutrition Examination Survey 2010-2012. The study included 1,328 postmenopausal women, after excluding women with missing data for reproductive history among 4,546 postmenopausal women in the survey. Multivariate regression was used to identify the association between childbirth age and postmenopausal bone mineral density after adjustments for confounding factors.

RESULTS

The prevalence of postmenopausal osteoporosis was 35.24% (n = 468). After dividing the subjects into obese and non-obese groups based on body mass index (BMI) and waist circumference, there were significant differences between non-osteoporosis and osteoporosis groups with regard to age at first childbirth, age at last childbirth, and parity in the BMI-based general obesity group. The prevalence of osteoporosis was highest in women older than 35 years old at last childbirth. The prevalence of osteoporosis was also greater in women with parity ≥ 4 compared to those with lower parity levels.

CONCLUSION

Postmenopausal women of older age at last childbirth and higher parity were at increased risk of osteoporosis in the BMI-based non-general obesity group.

Urinary Incontinence Is Associated With Physical Performance Decline in Community-Dwelling Older Women: Results From the International Mobility in Aging Study

Objective: The objective of this study is to evaluate the influence of urinary incontinence (UI) on physical performance. Method: In prospective analyses from the International Mobility in Aging Study (IMIAS), 915 women (65-74 years) from Canada, Colombia, Albania, and Brazil were evaluated in relation to self-reported UI (past week) and physical performance (Short Physical Performance Battery [SPPB]), with reevaluation after 2 years. Linear mixed models examined the influence of UI on SPPB, adjusted by covariates (age, study site, education, income sufficiency, body mass index [BMI] and parity). Results: Women reporting some UI presented lower SPPB mean (β = -0.41, p = .009) and a greater reduction (β = -0.53, p = .001) over 2 years than those reporting no UI. Discussion: Compared with no reported UI, some UI was associated with worse and more pronounced declines in physical performance over 2 years. This study highlights the importance of practices to reduce UI to contribute to healthier aging.

Fear of Falling in Older Adults with Diabetes Mellitus: The IMIAS Study

ABSTRACTSeveral determinants of developing fear of falling (FoF) overlap with the consequences of diabetes mellitus (DM). We compared the prevalence and severity of FoF in older adults with and without DM and identified which FoF determinants contribute to FoF severity in older adults with DM. We used Canadian baseline data from the International Mobility in Aging Study (IMIAS) which identified 141 older adults with DM (DM-group;age:68.88±2.80years) and 620 without DM (noDM-group;age:68.81±2.68years). FoF was quantified with Falls Efficacy Scale-International (FES-I). FoF determinants were evaluated in demographic/health-related, physical, psychological, and social domains. High concern of FoF was more prevalent and of higher severity in 10/16 FES-I activities in the DM-group compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history, and clinical depressive symptoms. Protocols developed for screening and interventions may reduce FoF severity in this population.

SELF-RATED HEALTH AND TEENAGE PREGNANCIES IN ROMA WOMEN: INCREASING HEIGHT IS ASSOCIATED WITH BETTER HEALTH OUTCOMES

This paper reports on the association between early marriage, age at first reproduction and height, as an indicator of childhood environment, and maternal health outcomes among traditional Roma women in Serbia. Demographic data, marital and reproductive histories, height, weight and self-rated health were collected from 414 Roma women living in rural settlements in Serbia in 2015-2017. Data analysis showed that higher age and weight were associated with a greater risk of poor health, greater height contributed to reduced risk of poor health while reproductive variables were insignificant. The study provides evidence that the long-term effects of early childbearing may not always be associated with poorer health status. As indicated by the differences in height, it is likely that women who were capable of reproducing very early on and staying healthy in later life were probably very healthy to begin with. The results probably reflect both the biological and social differences of early childhood. Aside from height, the traditional Roma marriage pattern and social benefits may have an additional protective effect on the health of women.

Effects of Age at First Childbirth and Other Factors on Central Obesity in Postmenopausal Women: The 2013-2015 Korean National Health and Nutrition Examination Survey

Background

Waist circumference is one of the key components of metabolic syndrome. Recent studies demonstrated that the reproductive profile was associated with metabolic syndrome in postmenopausal women. This study focused on the association between central obesity and age at first childbirth. It also considered other factors associated with central obesity in postmenopausal women.

Methods

This study was based on the 2013–2015 Korean National Health and Nutrition Examination Survey and involved 3,143 naturally postmenopausal women. These women were divided into three groups according to their age at first childbirth: 19 years or younger (n=252), 20–29 years (n=2,695), and 30 years or older (n=196). Multivariate analysis using logistic regression was performed to evaluate the effects of various reproductive factors, including other confounding factors.

Results

During adjustment for confounding factors, in the early age at first childbirth group, odds ratios (95% confidence intervals) for central obesity decreased. In the final model, younger age at first childbirth was not significantly related to central obesity (waist circumference more than 85 cm) in naturally postmenopausal women after adjusting for other confounding factors.

Conclusion

Younger age at first childbirth was not significantly associated with central obesity after adjustment for confounding factors.

Fertility History and Physical and Mental Health Changes in European Older Adults

Previous studies have shown that aspects of reproductive history, such as earlier parenthood and high parity, are associated with poorer health in mid and later life. However, it is unclear which dimensions of health are most affected by reproductive history, and whether the pattern of associations varies for measures of physical, psychological and cognitive health. Such variation might provide more insight into possible underlying mechanisms. We use longitudinal data for men and women aged 50–79 years in ten European countries from the Survey of Health, Ageing and Retirement in Europe to analyse associations between completed fertility history and self-reported and observed health indicators measured 2–3 years apart (functional limitations, chronic diseases, grip strength, depression and cognition), adjusting for socio-demographic, and health factors at baseline. Using multiple imputation and pattern mixture modelling, we tested the robustness of estimates to missing data mechanisms. The results are partly consistent with previous studies and show that women who became mothers before age 20 had worse functional health at baseline and were more likely to suffer functional health declines. Parents of 4 or more children had worse physical, psychological and cognitive health at baseline and were more likely to develop circulatory disease over the follow-up period. Men who delayed fatherhood until age 35 or later had better health at baseline but did not experience significantly different health declines. This study improves our understanding of linkages between fertility histories and later life health and possible implications of changes in fertility patterns for population health. However, research ideally using prospective life course data is needed to further elucidate possible mechanisms, considering interactions with partnership histories, health behaviour patterns and socio-economic trajectories.