The association of reproductive history with all-cause and cardiovascular mortality in older women: the Rancho Bernardo Study

Capsule:
Associations of childbearing history with all-cause and cardiovascular disease (CVD) mortality in postmenopausal women were examined. High gravidity (4) was associated with reduced CVD and non–coronary heart disease CVD mortality, independent of covariates.

Authors:
Marni B. Jacobs, M.P.H., Donna Kritz-Silverstein, Ph.D., Deborah L. Wingard, Ph.D., Elizabeth Barrett-Connor, M.D.
Volume 97, Issue 1 , Pages 118-124, January 2012

Objective:
To examine associations of gravidity and parity with all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in postmenopausal women.

Design:
Prospective cohort study.

Setting:
Rancho Bernardo, a southern California community.

Patient(s):
One thousand two hundred ninety-four postmenopausal women ages 50–96 who attended a 1984–87 research clinic visit at which reproductive and medical histories were obtained and who were followed through 2007.

Intervention(s):
None.

Main Outcome Measure(s):
All-cause, CVD, CHD, and non-CHD CVD mortality, determined by nosologist-coded death certificates.

Result(s):
Average baseline age was 70.6 ± 9.2. Numbers of pregnancies ranged from 0 to 13 (median = 2); births ranged from 0 to 11 (median = 2). During a median of 19.3 years of follow-up, 707 women (54.6%) died, with 46.5% attributed to CVD, 20.5% to CHD, and 26.0% to non-CHD CVD. Trend analyses showed inverse associations of gravidity with CVD mortality and non-CHD CVD mortality. Women with four or more pregnancies were less likely than nulligravidas to have fatal CVD (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.40–0.99) and non-CHD CVD (HR = 0.48, 95% CI = 0.26–0.91) independent of age, years postmenopause, obesity, and HDL. Associations increased after the first decade of follow-up. Parity and gravidity were not associated with overall or CHD mortality.

Conclusion(s):
High gravidity was associated with reduced CVD and non-CHD CVD mortality in postmenopausal women. Protective associations could reflect biological mechanisms that occur with repeated pregnancy or greater social support related to family size among multiparous women.

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