The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in
Clare Oliver-Williams1,2, Catherine J Vladutiu3, Laura R Loehr4
11 Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Insights
High parity (5+ births) increases coronary heart disease (CHD) and myocardial infarction (MI) risk, independent of breastfeeding. Prior pregnancy without live birth also elevates CHD and heart failure risk in women.
Area of Science:
- Cardiovascular epidemiology
- Reproductive health
- Public health
Background:
- Inconclusive evidence exists on parity's link to cardiovascular disease (CVD).
- Few studies have examined multiple CVD outcomes or breastfeeding's influence.
- This study investigates parity and CVD associations, adjusting for breastfeeding.
Purpose of the Study:
- To examine the relationship between parity and multiple cardiovascular outcomes.
- To determine if parity-CVD associations are independent of breastfeeding.
- To analyze associations in a diverse cohort of US women.
Main Methods:
- Utilized data from 8,583 women aged 45-64 in the Atherosclerosis Risk in Communities Study.
- Ascertained coronary heart disease (CHD), myocardial infarction (MI), heart failure, and stroke events over 30 years.
- Employed Cox proportional hazards regression, adjusting for sociodemographic, clinical, lifestyle factors, and breastfeeding.
Main Results:
- Women with 5+ live births showed increased risk of CHD and hospitalized MI (HR 1.29-1.38).
- Prior pregnancy with no live birth was linked to higher incident CHD and heart failure risk (HR 1.64-1.46).
- Associations for 5+ births remained significant after adjusting for breastfeeding.
Conclusions:
- A history of 5+ live births is associated with increased CHD and MI risk, independent of breastfeeding.
- Prior pregnancy without live birth is linked to elevated CHD and heart failure risk.
- Findings highlight the importance of considering reproductive history in cardiovascular risk assessment.
Abstract:
Background: Previous studies are inconclusive on the relationship between parity and cardiovascular disease (CVD), with few evaluating multiple cardiovascular outcomes. It is also unclear if any relationship between parity and CVD is independent of breastfeeding. We examined the associations between parity and cardiovascular outcomes, including breastfeeding adjustment. Materials and Methods: Data were from 8,583 White and African American women, 45-64 years of age, in the Atherosclerosis Risk in Communities Study. Coronary heart disease (CHD), myocardial infarction (MI), heart failure, and strokes were ascertained from 1987 to 2016 by annual interviews and hospital surveillance. Parity and breastfeeding were self-reported. Cox proportional hazards regression estimated hazard ratios (HR) for the association between parity and cardiovascular outcomes, adjusting for baseline sociodemographic, clinical and lifestyle factors, and breastfeeding. Results: Women reported no pregnancies (6.0%), or having 0 (1.6%), 1-2 (36.2%), 3-4 (36.4%), or 5+ (19.7%) live births. During 30 years follow-up, there were 1,352 CHDs, 843 MIs, 750 strokes, and 1,618 heart failure events. Compared with women with 1-2 prior births, those with prior pregnancies and no live births had greater incident CHD (HR = 1.64, 95% confidence interval 1.14-2.42) and heart failure risk (1.46, 1.04-2.05), after adjustment for baseline characteristics. Women with 5+ births had greater risk of CHD (1.29, 1.10-1.52) and hospitalized MI (1.38, 1.13-1.69), after adjustment for baseline characteristics and breastfeeding. Conclusions: In a diverse U.S. cohort, a history of 5+ live births is associated with CHD risk, specifically, MI, independent of breastfeeding. Having a prior pregnancy and no live birth is associated with greater CHD and heart failure risk.
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