Pregnancy, childrearing, and risk of stroke in Chinese women

Effects of breastfeeding promotion intervention and dietary treatment in postpartum women with overweight and obesity: Results from a randomized controlled trial on weight and cardiometabolic risk factors

BACKGROUND

Childbearing increases the risk of weight gain and cardiometabolic disease. The reset hypothesis suggests that lactation has protective cardiometabolic effects in the mother. The hypothesis is based on observational studies and the possible interacting role of weight loss needs to be elucidated.

OBJECTIVE

To examine the individual and interaction effects of a breastfeeding promotion intervention (BPI) and dietary intervention for weight loss postpartum (Diet) on body weight and cardiometabolic risk factors at 6 mo postpartum.

METHODS

Pregnant women (n = 156) with a pre-pregnancy BMI of 25-35 kg/m2 were randomized to 4 groups in a 2x2 factorial design: BPI, Diet, both treatments or no treatment. BPI consisted of individual counseling by a lactation consultant during pregnancy, at childbirth, and thereafter monthly or more frequently based on individual needs. Diet was initiated at 11 wk postpartum. Body weight, body composition, waist- and hip circumference, markers of lipid and glucose metabolism and blood pressure were measured at 2 wk and 6 mo postpartum.We analyzed main and interaction effects using 2-way ANCOVA adjusted for baseline values.

RESULTS

Among the participants attending both visits (n = 108), 99% practiced any breastfeeding at baseline and 97% at follow-up. The BPI did not affect rates of exclusive or partial breastfeeding, age at introduction of complementary foods or have main effects on body weight or cardiometabolic risk factors. There was a main effect of Diet reducing body weight, fat mass, fat-free mass, percent fat mass, waist- and hip circumference, fasting glucose and insulin (all p ≤ 0.03), with no interactions between the treatments.

CONCLUSIONS

There were no effects of BPI on body weight or cardiometabolic risk factors at 6 mo postpartum. Diet caused weight loss and had favorable effects on risk factors for cardiovascular disease and type 2 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03580057).

Reproductive factors and cardiometabolic disease among middle-aged and older women: a nationwide study from CHARLS

Background

Cardiometabolic disease is skyrocketing to epidemic proportions due to the high prevalence of its components and the aging of the worldwide population. More efforts are needed to improve cardiometabolic health. The aim of this nationally representative study based on the China Health and Retirement Longitudinal Study (CHARLS, 2014-2018) was to examine the association between reproductive factors and cardiometabolic disease among Chinese women aged ≥45 years.

Methods

The CHARLS is an ongoing longitudinal study initiated in 2011, and the latest follow-up was completed in 2018. In total, 6,407 participants were analyzed. Effect-sizes are expressed as odds ratios (OR) and 95% confidence intervals (CI). Confounding was considered from statistical adjustment, subsidiary exploration, and unmeasured confounding assessment aspects.

Results

Of 6,407 accessible participants, 60.9% were recorded as having one or more of five predefined cardiovascular or metabolic disorders. Compared to those with two children, participants who had 0-1 child were found to have a lower risk of cardiometabolic disease (OR = 0.844, 95% CI: 0.714-0.998), and those who had ≥3 children had a greater risk (OR = 1.181, 95% CI: 1.027-1.357). Age at menarche of 16-18 years was a protective factor compared with ≤16 years of age (OR = 0.858, 95% CI: 0.749-0.982). In contrast, participants with a history of abortion were 1.212 times more likely to have cardiometabolic disorders (OR = 1.212, 95% CI: 1.006-1.465). The likelihood for the presence of unmeasured confounding was low, as reflected by E-values.

Conclusions

Our findings demonstrate that number of children, age at menarche, and history of abortion were associated with a significant risk of cardiometabolic disease among Chinese women aged ≥45 years.

Pregnancy, cardiovascular health, and microchimerism

PURPOSE OF REVIEW

To provide an updated review of scientific literature concerning associations between pregnancy and cardiovascular health among women, and to discuss a possible impact of microchimerism on the association.

RECENT FINDINGS

In most studies, pregnancy and childbirth is associated with increased risk of cardiovascular disease in women. Some ascribe the association mainly to lifestyle, whereas others suggest that pregnancy itself negatively affects women's cardiovascular health. Pregnancy is a natural source of microchimerism, which in turn markedly affects female health. The only study published in the area surprisingly shows that among middle-aged women, male-origin microchimerism (MOM) is associated with half the risk of developing ischemic heart disease (IHD). No similar association is found between MOM and ischemic stroke.

SUMMARY

The sparse evidence published suggests reduced risk of developing IHD among MOM-positive women. Despite the association being biologically plausible, replication of the findings is warranted to support that this is not a chance finding.

Life-course fertility and multimorbidity among middle-aged and elderly women in China: Evidence from China health and retirement longitudinal study

Background

Multimorbidity has become an important public health problem in China, especially among middle-aged and elderly women. Few studies have been reported on the association between multimorbidity and female fertility, which is an important stage in the life course. This study aimed to explore the association between multimorbidity and fertility history among middle-aged and elderly women in China.

Methods

Data from 10,182 middle-aged and elderly female participants in the China Health and Retirement Longitudinal Study (CHARLS) in 2018 were used in this study. Multimorbidity was defined as the presence of at least two or more chronic conditions. Logistic regression analysis, negative binomial regression analysis, and restrictive cubic splines (RCSs) were used to analyze the relationship between female fertility history and multimorbidity or the number of chronic conditions. Multivariable linear regression was used to analyze the relationship between female fertility history and multimorbidity pattern factor scores.

Results

The results of this study showed that high parity and early childbearing were significantly associated with an increased risk of multimorbidity and an increased number of chronic conditions among middle-aged and elderly women in China. Late childbearing was significantly associated with reduced risk of multimorbidity and lessened diseases. Parity and age of first childbirth were significantly correlated with the odds of multimorbidity. The association between fertility history and multimorbidity was found to be influenced by age and urban-rural dual structure. Women with high parity tend to have higher factor scores of cardiac-metabolic, visceral-arthritic, and respiratory-psychiatric patterns. Women with early childbearing tended to have higher factor scores of the visceral-arthritic pattern and those with late childbearing tended to have lower factor scores of the cardiac-metabolic pattern.

Conclusion

Fertility history has a significant effect on multimorbidity in the middle and later lives of Chinese women. This study is of great importance for reducing the prevalence of multimorbidity among Chinese women through their life course and promoting health during their middle and later lives.

Fertility Histories and Heart Disease in Later Life in China

Purpose

Based on life course theories, health among older people is driven by a continuous and cumulative process that develops over the life course. To better understand the aging process, it is important to assess associations between parity and heart disease in older people of China.

Method

The associations between heart disease prevalence and number of births, number of boys or girls ever born were evaluated among 5,990 samples (mean age 64.1 years) using the Probit regression model based on the data from China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013 and 2018. The model was adjusted only for rural or urban residents, and multivariate regression models were run separately by gender.

Results

Our results showed that more than three children or more than two boys ever born were associated with a higher risk of heart disease. However, the number of girls ever born had no significant effect on heart disease in the elderly. We further analyzed the group difference between urban and rural residents using the regression model. More than three children or more than two boys ever born were associated with a high risk of heart disease in rural areas. Compared to urban residents, rural residents were more likely to be suffering from heart disease due to high parity. When considering the digender difference the paper found that more than three children ever born were associated with a high risk of heart disease in the female group. Late age at the time of giving birth for the first time was associated with a poorer risk level of heart disease in the rural residents, because the phenomenon of early childbearing was serious in the rural residents. But after considering the impact on the physical health of using chronic diseases, the first birth and the last birth both increased the risk of heart disease.

Conclusions

Some policy implications were being put forward. Firstly, parents who were ready to give birth should be aware of the possible health loss of high parity. Postpartum nutrition supplements and chronic disease prevention were suggested to prevent heart disease in later life. Secondly, the elderly in rural areas should pay more attention to heart diseases. Participating in more daily exercise and physical examinations was a good choice to reduce the risk of heart disease. Thirdly, women who give birth prematurely have a higher risk of CVD. Based on our results, age at entry to parenthood was closely related to the risk of heart disease in later life.

Impact of Male-Origin Microchimerism on Cardiovascular Disease in Women: A Prospective Cohort Study

Increasing parity is associated with an increased risk of ischemic heart disease (IHD) and stroke in women. This is probably attributable to biological responses of pregnancy. Male cells of presumed fetal origin are commonly present in women years after pregnancy-a phenomenon termed male-origin microchimerism (MOM). In this study, we investigated whether MOM was associated with risk of IHD and ischemic stroke in women. We evaluated the association between MOM and ischemic events in a cohort of 766 Danish women enrolled in the Diet, Cancer and Health cohort during 1993-1997 when aged 50-64 years. Of these women, 545 (71.2%) tested positive for MOM through targeting of the Y chromosome (DYS14 DNA sequence) in their blood. Multiple Cox regression models were used to calculate hazard ratios with 95% confidence intervals. We found that MOM was associated with a significantly reduced rate of IHD (hazard ratio = 0.44, 95% confidence interval: 0.23, 0.83) but not ischemic stroke (hazard ratio = 0.80, 95% confidence interval: 0.46, 1.41). Our findings show that microchimerism positivity is associated with a lower rate of later IHD development in women. Although the underlying mechanisms are presently unknown, MOM may be relevant in women's cardiovascular health. More studies are needed to confirm these findings.

Menopausal symptoms in women with premature ovarian insufficiency: prevalence, severity, and associated factors

OBJECTIVE

To comprehensively investigate and evaluate the prevalence, severity, and associated factors of menopausal symptoms in women with premature ovarian insufficiency (POI). In this study, the specific symptomatology experienced by women with POI and women with natural menopause was also compared.

METHODS

In this cross-sectional study, 293 Chinese women with POI from an outpatient clinic were recruited between June 2014 and January 2019. The prevalence and severity of menopausal symptoms were assessed with modified Kupperman Menopausal Index. Participants completed a structured questionnaire, including medical history, menstrual characteristics, and sociodemographic data. Serum levels of reproductive hormones were measured.

RESULTS

Among 293 women with POI (33.76 ± 5.47 y), the most prevalent symptoms were mood swings (73.4%), insomnia (58.7%), sexual problems (58.7%), and fatigue (57.3%). Moderate-to-severe mood swings were most frequently reported (23.9%), followed by formication (17.4%) and hot flashes/sweating (17.1%). Compared with women with natural menopause, women with POI exhibited significantly higher risks for fatigue (odds ratio  = 1.42; 95% confidence interval, 1.04-1.94), melancholia (3.12; 1.94-5.01), mood swings (3.57; 2.33-5.45), insomnia (1.41; 1.02-1.96), and significantly lower risks for moderate-to-severe sexual problems (0.40; 0.23-0.69), any and moderate-to-severe muscle/joint pain (0.41; 0.27-0.62 and 0.45; 0.25-0.78, respectively). Living in urban areas and higher gravidity were independently associated with menopausal symptoms in women with POI.

CONCLUSIONS

Women with POI experienced a high prevalence of menopausal symptoms, particularly related to psychological and sexual domains. Furthermore, women with POI tended to have more distressing menopausal symptoms compared with women with natural menopause.

Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up

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.

Number of Pregnancies and Trajectory of Frailty Index: English Longitudinal Study of Ageing

OBJECTIVES

Women are frailer than men across different populations and age groups. However, the mechanisms are still not fully understood. One possible cause is pregnancy and motherhood. The objective of this study was to examine trajectories of Frailty Index over time according to the number of pregnancies.

DESIGN

A prospective study with repeated measures over 14 years.

SETTING AND PARTICIPANTS

A total of 2060 community-dwelling older women aged ≥60 years in England.

METHODS

The number of pregnancies was calculated as a sum of the number of live births and the number of miscarriages, still-births, or abortions. The Frailty Index (FI) was constructed using 60 deficits and repeatedly calculated every 2 years over 14 years. Trajectories of FI according to the number of pregnancies were estimated by a mixed effects model.

RESULTS

Mean FI was 0.15 at baseline. A mixed effects model adjusted for age, smoking, alcohol use, education, and wealth showed that FI increased over time. A higher number of pregnancies were significantly associated with a higher FI (estimate = 0.0047, 95% confidence interval = 0.0020, 0.0074).

CONCLUSIONS AND IMPLICATIONS

The current study showed that a higher number of pregnancies were significantly associated with a higher degree of frailty at baseline and over time. Pregnancy and child rearing may explain some of the observed excess risk of frailty in women. Pregnancy-related factors, such as pregnancy loss, types of delivery, length of pregnancy, childbearing, and child rearing, should be examined in relation to frailty in future studies.

Pregnancy, postpartum and parity: Resilience and vulnerability in brain health and disease

Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors, far less attention has been paid to sex-specific variables that may differentially impact females such as pregnancy and reproductive history. In this review, we focus on nervous system disorders which show a female bias and for which there is data from basic research and clinical studies pointing to modification in disease risk and progression during pregnancy, postpartum and/or as a result of parity: multiple sclerosis (MS), depression, stroke, and Alzheimer's disease (AD). In doing so, we join others (Shors, 2016; Galea et al., 2018a) in aiming to illustrate the importance of looking beyond sex in neuroscience research.

Maternal reproductive history and premenopausal risk of hypertension and cardiovascular disease: a Danish cohort study

OBJECTIVES

The metabolic changes of pregnancy resemble a cardiovascular risk profile and may persist postpartum, with body mass index (BMI) as a potential modifier. We examined the association between the number of live-birth pregnancies and maternal premenopausal risks of hypertension and cardiovascular disease (CVD), accounting for pre-pregnancy BMI as well as abortions and stillbirths.

DESIGN

A prospective cohort study.

SETTING

Mothers from the Danish National Birth Cohort (1996 to 2002). For each of these women, registry data on all pregnancies from 1973 to 2011 were obtained, as were self-reported pre-pregnancy weight and height.

PARTICIPANTS

A total of 44 552 first-time mothers in the Danish National Birth Cohort.

OUTCOME MEASURES

Risks of hypertension and CVD during and between live-birth pregnancies separately and combined as live-birth cycles.

RESULTS

After adjustment for abortions, stillbirths, pre-pregnancy BMI and other covariates, a higher risk of hypertension was observed in the first (HR 1.53, 95% CI: 1.37 to 1.72) and fourth and subsequent live-birth cycles (HR 1.72, 95% CI: 1.15 to 2.58), compared with the second. However, as number of live-birth pregnancies increased, risk of hypertension decreased during live-birth pregnancies and increased between live-birth pregnancies (tests for trend, p<0.01). For CVD, we found an overall J-shaped but non-significant association with number of live-birth pregnancies. No interaction with pre-pregnancy BMI (<25 versus ≥25 kg/m²) was observed.

CONCLUSIONS

Premenopausal women had the highest risk of hypertension and CVD during their first live-birth pregnancy and after their fourth live-birth pregnancy. All risks were independent of BMI before the first live-birth pregnancy and of number of abortions and stillbirths.

Multiple sclerosis and stroke: a systematic review and meta-analysis

BACKGROUND

Multiple sclerosis (MS) and stroke are two common causes of death and disability worldwide. The relationship between these two diseases remains unclear. Effective early preventative measures and treatments are available to reduce the morbidity and mortality of acute stroke. The objectives of our systematic review are to estimate the risk of stroke in patients with MS and to collate related studies to draw preliminary conclusions that may improve clinical practice.

METHOD

Relevant studies were systematically searched in MEDLINE, Embase, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure and the VIP database of Chinese periodicals from January 1983 to May 2017, with no restrictions on language. Patients included in this review were adults who suffered from MS. Review Manager 5.3 software program was used to pool data and calculate the risk ratio (RR) and its 95% confidence interval (CI). We also performed heterogeneity and sensitivity analyses and evaluated bias in the meta-analysis.

RESULTS

Nine studies including more than 380,000 participants that met our inclusion criteria were incorporated into the meta-analysis. During different follow-up periods, patients with MS had an increased risk of any type of stroke [RR = 3.48, 95% CI (1.59, 7.64), P = 0.002 for 1 year; RR = 2.45, 95% CI (1.90, 3.16), P < 0.00001 for 10-13 years]. The total prevalence of stroke (any type) in patients with MS exceeded expectations compared to different groups [Comparing with general veteran: RR = 2, 95% CI (1.19, 3.38), P = 0.009. Comparing with general population: RR = 2.93, 95% CI (1.13, 7.62), P = 0.03]. Furthermore, ischemic stroke was particularly more common in the MS population than in people without MS [RR = 6.09, 95% CI (3.44, 10.77), P < 0.00001].

CONCLUSION

Compared with the general population, people with MS have an increased risk of developing any type of stroke and ischemic stroke in particular. Consistent results were obtained from patients of different sexes and age groups. Preventative measures and treatments should be administered at earlier time points to improve patient outcomes.

The association between intake of dietary lycopene and other carotenoids and gestational diabetes mellitus risk during mid-trimester: a cross-sectional study

This study aimed to determine whether increased carotenoids intake was associated with reduced risk of gestational diabetes mellitus (GDM). We performed a cross-sectional analysis using data from Tongji Maternal and Child Health Cohort study. The dietary carotenoids intake of 1978 pregnant women was assessed using a researcher-administered FFQ before undertaking an oral glucose tolerance test at 24–28 weeks. Multivariate logistic and linear regression analyses were used to obtain the effect estimates. Participants in the highest quartile of lycopene intake showed a lower risk of GDM (OR 0·50; 95 % CI 0·29, 0·86; Pfor trend = 0·007) compared with those in the lowest quartile; each 1 mg increase in lycopene consumption was associated with a 5 % (95 % CI 0·91, 0·99; Pfor trend = 0·020) decrease in GDM risk. No significant association was found between α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin intake and GDM risk. Multiple linear regression analysis suggested an inverse association between lycopene intake and fasting blood glucose (FBG) (Pfor trend < 0·001); each 1 mg increase in lycopene intake was associated with 0·005 (95 % CI 0·002, 0·007; Pfor trend < 0·001) mmol/l decrease in FBG. Interaction analysis indicated consistent effect on each age or pre-BMI subgroup; however, a stronger protective effect of lycopene intake against GDM was observed among primigravid women (OR 0·20; 95 % CI 0·07, 0·55 in the highest v. the lowest quartile of intake; Pfor interaction = 0·036). In conclusion, dietary lycopene intake was mainly assumed via reducing FBG to decrease GDM risk, and the protection was relatively increased among primigravid women.

Parity and risk of maternal cardiovascular disease: A dose-response meta-analysis of cohort studies

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.

Parity As a Protective Biomarker Against Silent Brain Infarction in Community-Dwelling Older Adults: The Sefuri Study

BACKGROUND

Although several studies have reported an association between parity and increased risk of stroke, this relationship remains controversial.

AIMS

The present study aimed to determine whether parity is associated with silent brain infarction (SBI), independent of other confounders.

METHODS

We analyzed the brain magnetic resonance imaging findings in 576 of community-dwelling older adults with a mean age of 72.1 years. All female participants were asked to provide information regarding the total number of live births, their age at the last parity, and their age at menopause.

RESULTS

The prevalence of SBI and the number of infarcts per participant were higher in men than in women. Although all women who had given birth (0, 1-2, 3-4, or 5+ times) exhibited lower age-adjusted odds ratios (ORs) for SBI than men, a significant difference was observed between women with ≧5 births and men after adjustment for common vascular risk factors (OR: .348, 95% confidence interval [95% CI]: .123-.986). Among women who had given birth, the relationship between fertility and SBI was attenuated, but was enhanced after adjustment for age at the last parity (OR: .300, 95% CI: .102-.886).

CONCLUSIONS

Our findings indicate that fertile women may be protected against SBI or cerebral small vessel disease via the biological effects associated with reproductive activity, and that high fertility may be a marker of protection against SBI. However, late childbearing may blunt protective effects of fertility against SBI.

Cardiovascular Health of Mothers in the United States: National Health and Nutrition Examination Survey 2007-2014

Background: Pregnancy and childrearing can impact women's health and alter chronic disease trajectories in later life, including cardiovascular disease. The purpose of this study was to assess measures of women's cardiovascular health by time since last live birth. Materials and Methods: Data were from 4,021 nonpregnant U.S. women, 20-44 years of age, participating in the 2007-2014 National Health and Nutrition Examination Survey (NHANES). Cardiovascular health was assessed using physical measures, laboratory measures, self-reported behaviors, medical conditions, and selected psychosocial factors by time since last live birth. Results: Women reported their last live birth within the past 12 months ("mothers of infants"; 7.4%), >12 months, but <3 years ago ("mothers of toddlers"; 10.0%), or ≥3 years ago ("mothers of older children"; 45.2%); 37.3% were nulliparous. Compared with nulliparous women, mothers of older children had a higher prevalence of selected cardiovascular risk factors, including unhealthy diet (75.6% vs. 68.8%) and smoking (28.1% vs. 21.9%), after adjustment for sociodemographics (including age). Mothers of toddlers had a higher prevalence of unhealthy diet (78.0% vs. 68.8%). Mothers also had poorer metabolic health as indicated by a higher prevalence of low HDL cholesterol among mothers of toddlers and older children (44.2% and 40.4%, respectively, vs. 33.6%), and a higher prevalence of high waist circumference among mothers of infants (65.6% vs. 53.8%). Some mothers also had a higher prevalence of other cardiovascular risk factors, including low physical activity and poor sleep. Conclusion: Prior pregnancy and childrearing may be associated with selected cardiovascular risk factors among nonpregnant reproductive-aged U.S. women.

Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk

BACKGROUND

: The incidence of stroke in pregnant women is low but trending upward. There are few studies of the topic in women of Asian ethnicity.

AIM

We aim to evaluate stroke risk in Asian women during and after pregnancy.

DESIGN

: Using the Taiwan National Health Insurance database, we designed a retrospective study that included 18-45-year-old pregnant women between the years 2000 and 2010. We selected a 1:1 age-matched control group of non-pregnant women. The endpoint was any type of stroke during pregnancy or the postpartum period; otherwise, the patients were tracked until 31 December 2010.

METHODS

: The risk factors for stroke were found using Cox proportional regression to calculate the hazard ratio (HR) with a 95% CI compared with the control group.

RESULTS

: The incidence of stroke within 1 year postpartum was 71/100,000. The risk of postpartum stroke within 1 year was an HR of 1.208 (95% CI: 1.001-5.129). The occurrence of stroke was associated with hypertension, diabetes mellitus, coagulation disorders, migraine, obesity, cerebrovascular malformation and parity. Women with third and fourth parity carried increased risks of 13.3% and 2.5%, respectively, compared with first parity women. In long-term follow-ups, stroke risk was significantly lower, with an adjusted HR of 0.362 (95% CI: 0.269-0.489).

CONCLUSION

The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous (≥3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.

Parenthood and the risk of cardiovascular diseases among 0.5 million men and women: findings from the China Kadoorie Biobank

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.

Parity, weight change, and maternal risk of cardiovascular events

BACKGROUND

High parity has been suggested to increase risk of maternal cardiovascular disease independent of body mass index measured after childbearing. Pregnancy is, however, associated with persistent weight gain and metabolic changes that, independent of parity, increase the risk of cardiovascular disease. It could therefore be questioned if high parity independently increases the risk of cardiovascular disease or if this association may be confounded, mediated, or modified by other parity-related factors.

OBJECTIVE

We sought to investigate the association between parity and risk of cardiovascular disease, and secondary outcomes in terms of myocardial infarction and cerebral infarction, with particular focus on potential mediation by anthropometric measures and effect modification by lactation.

STUDY DESIGN

We used data from 16,515 female participants (age 44.5-73.6 years) of the population-based Malmö Diet and Cancer Study with baseline examination from 1991 through 1996. The Malmö Diet and Cancer Study was followed up throughout 2010, with a median follow-up of 15.8 years. We used Cox proportional hazards model to examine the association between parity and cardiovascular disease.

RESULTS

Adjusted for age and other potential confounders, grand multiparous women (≥5 children) had an increased risk of cardiovascular disease (hazard ratio, 1.60; 95% confidence interval, 1.20-2.14), myocardial infarction (hazard ratio, 1.68; 95% confidence interval, 1.15-2.45), and cerebral infarction (hazard ratio, 1.74; 95% confidence interval, 1.18-2.58) compared to women with 2 children. Additional adjustment for baseline body mass index and weight change since age 20 years attenuated the risk, but the increased risk for cardiovascular disease (hazard ratio, 1.38; 95% confidence interval, 1.02-1.87) and myocardial infarction (hazard ratio, 1.53; 95% confidence interval, 1.04-2.26) in grand multiparous women remained significant. Models stratified by lactation time showed that risk was only raised in grand multiparous women who had a mean lactation time of <4 mo/child. In sensitivity analyses excluding women with a history of diabetes at baseline, risk estimates for grand multiparous women became nonsignificant in the full model.

CONCLUSION

Part of the increased risk of cardiovascular disease and myocardial infarction in grand multiparous women seems to be mediated by weight gain and potentially by higher likelihood of type 2 diabetes mellitus. Lactation may modify the increased risk of grand multiparity in that longer duration might offset the cardiovascular disease risk.

Racial Differences in the Association between Parity and Incident Stroke: Results from the REasons for Geographic and Racial Differences in Stroke Study

BACKGROUND

Circulatory and vascular changes across consecutive pregnancies may increase the risk of later-life cerebrovascular health outcomes.

METHODS

The association between parity and incident stroke was assessed among 7674 white and 6280 black women, aged 45 years and older, and enrolled in the REasons for Geographic and Racial Differences in Stroke Study from 2003 to 2007. Parity was assessed at baseline, and incident stroke was ascertained from physician-adjudicated medical records through September 2014. Cox proportional hazards models were used to estimate hazard ratios (HR) for the association between parity and stroke, adjusting for baseline measures.

RESULTS

At baseline, 12.7% of white women and 16.2% of black women reported 1 live birth, while 8.2% and 19.0%, respectively, reported 5 or more live births. Mean follow-up time was 7.5 years (standard deviation = 2.8); there were 447 incident strokes. A significant interaction between race and parity was detected (P = .05). Among white women, those with 5 or more live births had a higher stroke risk than those with 1 live birth (HR = 1.57; 95% confidence interval [CI] .93-2.65). However, the association was eliminated after adjustment for baseline characteristics (HR = 1.00, 95% CI .59-1.71). For black women, those with 5 or more live births had the highest stroke risk compared with those with 1 live birth (HR = 1.91, 95% CI 1.25-2.93), but the association was attenuated and no longer statistically significant after adjustment for confounders (HR = 1.40, 95% CI .89-2.18).

CONCLUSIONS

In adjusted models, no statistically significantassociations were observed between parity and stroke risk in a diverse cohort of U.S. women. Further studies are needed to elucidate the role of lifestyle and psychosocial factors in the race-specific associations that were observed.

Parity and serum lipid levels: a cross-sectional study in chinese female adults

Reproductive factors have been shown to correlate with lipid metabolism. The aim of this study was to investigate the relationship between parity and serum lipid levels in community-based Chinese female adults. A total of 4,217 female participants were enrolled. Parity was recorded according to questionnaire and serum lipid profile, including triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), was measured. Logistic regression models were used to analyze the association of parity to serum lipid levels, while adjusting for demographics and metabolic risk factors. Parity in this population ranged from 0 to 7. After adjusting for potential confounders, it indicated that females with more than 2 parities appeared to be less likely to suffer from abnormal serum TC level compared with nulliparae (parity = 2, odds ratio (OR) = 0.457, 95% confidence interval (CI) = 0.284–0.736; parity ≥ 3, OR = 0.363, 95% CI = 0.202–0.653). These findings suggested that parity could correlate with lipid metabolism in Chinese women. Individuals with higher parity appeared to have a lower total cholesterol in blood.

Parity and Risk of Coronary Heart Disease in Middle-aged and Older Chinese Women

Pregnancy leads to physiological changes in lipid, glucose levels, and weight, which may increase the risk of coronary heart disease (CHD) in later life. The purpose of this study was to examine whether parity is associated with CHD in middle-aged and older Chinese women. A total of 20,207 women aged 37 to 94 years from Dongfeng-Tongji Cohort who completed the questionnaire, were medically examined and provided blood samples, were included in our analysis. CHD cases were determined by self-report of physician diagnosis through face-to-face interviews. Logistic regression models were used to estimate the association between parity and CHD. The rate of CHD was 15.8%. Parity had a positive association with CHD without adjustment of covariates. After controlling for the potential confounders, increasing risk of coronary heart disease was observed in women who had two (OR, 1.65; 95% CI, 1.41-1.93), three (OR, 1.76; 95% CI, 1.44-2.16), and four or more live births (OR, 1.71; 95% CI, 1.33-2.20) compared with women with just one live birth. High parity was significantly associated with increasing risk of CHD in Chinese women. This suggests that multiparity may be a risk factor for CHD among Chinese women.

Parity and Risk of Stroke among Chinese Women: Cross-sectional Evidence from the Dongfeng-Tongji Cohort Study

Epidemiological studies have investigated the association between parity and the risk of stroke, but the results have been inconsistent. The objective of this study was to assess the association among middle-aged and older Chinese women. We used data from the Dongfeng-Tongji Cohort Study. In total, 14,277 women were included in the analysis. Participants were classified into four groups according to parity. Stroke cases were self-reported during face-to-face interviews. Multivariable logistic regression models were used to investigate the association between parity and the risk of stroke while controlling for potential confounders. The prevalence of stroke among the study subjects was 2.7% (380 of 14,277). In the fully adjusted model, women who had experienced two, three, or four or more live births had 1.24 times (95% CI, 0.85-1.81), 1.97 times (95% CI, 1.30-2.98) and 1.86 times (95% CI, 1.14-3.03), higher risk of stroke, respectively, compared with women who had experienced one live birth. High parity was associated with an increasing risk of stroke in the present study. Further longitudinal studies are needed to confirm the association and to explore the unclear mechanism underlying the link between parity and stroke risk.

Parity and Cardiovascular Disease Mortality: a Dose-Response Meta-Analysis of Cohort Studies

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.

Do fertility control policies affect health in old age? Evidence from China's one-child experiment

How do fertility control policies contribute to the welfare of women, and their husbands, particularly as they get older? We consider whether the reduction in fertility resulting from population control policies has had any effect on the health of elderly parents in China. In particular, we examine the influence of this fertility decline, experienced due to China's one-child policy, on several measures of the health of parents in middle and old age. Overall, our results suggest that having fewer children has a positive effect on self-reported parental health but generally no effect on other measures of health. The results also suggest that upstream financial transfers have a positive effect on several measures of parental health.

Increased risk of ischaemic stroke among patients with multiple sclerosis

BACKGROUND AND PURPOSE

Inflammatory processes including autoimmune diseases which ignite endothelial dysfunction and atherosclerosis may promote development of cardiovascular diseases including ischaemic stroke. This study aimed to evaluate whether multiple sclerosis (MS) increases stroke risk.

METHODS

A national insurance claim data set of 22 million enrollees in Taiwan was used to identify 1174 patients with MS and 4696 randomly selected age- and gender-matched controls from 1 January 1997 to 31 December 2010. Both cohorts were followed up until the occurrence of stroke or censor. Relevant covariates, such as age, gender, hypertension, diabetes, hyperlipidaemia, coronary artery disease, congestive heart failure and pregnancy, were included for further survey. The hazard ratio (HR) of stroke was assessed using a Cox proportional hazards regression model.

RESULTS

After adjusting for the relevant covariates, the MS cohort had an increased risk of stroke (adjusted HR = 12.1 for 1 year; adjusted HR = 4.69 for 2-5 years) compared with the control cohort within 5 years of follow-up. Amongst participants without comorbidities, the MS cohort was still at a greater stroke risk than the control cohort [HR 4.93, 95% confidence interval (CI) 2.85-8.55]. Moreover, in the population aged ≤40, MS was associated with a significantly increased risk of stroke (HR 12.7, 95% CI 3.44-46.7).

CONCLUSIONS

Multiple sclerosis is declared to be associated with an increased risk in developing stroke, which requires closer attention to this group of patients for stroke prevention, especially in the younger population.

Temporal trends of main reproductive characteristics in ten urban and rural regions of China: the China Kadoorie biobank study of 300 000 women

BACKGROUND

Chinese women's reproductive patterns have changed significantly over the past several decades. However, relatively little is known about the pace and characteristics of these changes either overall or by region and socioeconomic status.

METHODS

We examined the cross-sectional data from the China Kadoorie Biobank cohort study that recruited 300 000 women born between 1930 and 1974 (mean age: 51 years) from 10 socially diverse urban and rural regions of China. Temporal trends in several self-reported reproductive characteristics, and effect modification of these trends by area and education (as a surrogate for socioeconomic status), were examined.

RESULTS

The overall mean age at menarche was 15.4 (standard deviation 1.9) years, but decreased steadily over the 45 birth cohorts from 16.1 to 14.3 years, except for an anomalous increase of ∼1 year for women exposed to the 1958-61 famine in early adolescence. Similarly large changes were seen for other characteristics: mean parity fell (urban: 4.9 to 1.1; rural: 5.9 to 1.4); mean age at first birth increased (urban: 19.0 to 25.9 years; rural: 18.3 to 23.8 years); and birth spacing increased after 1980 to over 5 years. Breastfeeding declined after 1950 in urban and, after 1980, in rural women; and 68% of urban and 48% of rural women experienced a terminated pregnancy. Mean age at menopause increased from 47.9 to 49.3 years.

CONCLUSIONS

There have been striking changes in reproductive factors over time and between areas among these Chinese women. Their effects on major chronic diseases should be investigated.

Diet and exercise interventions among overweight and obese lactating women: randomized trial of effects on cardiovascular risk factors

Objective

To examine the effects of Diet (D) and Exercise (E) interventions on cardiovascular fitness, waist circumference, blood lipids, glucose metabolism, inflammation markers, insulin-like growth factor 1 (IGF-1) and blood pressure in overweight and obese lactating women.

Methods

At 10–14 wk postpartum, 68 Swedish women with a self-reported pre-pregnancy BMI of 25–35 kg/m² were randomized to a 12-wk behavior modification treatment with D, E, both or control using a 2×2 factorial design. The goal of D treatment was to reduce body weight by 0.5 kg/wk, accomplished by decreasing energy intake by 500 kcal/d and monitoring weight loss through self-weighing. The goal of E treatment was to perform 4 45-min walks per wk at 60–70% of max heart-rate using a heart-rate monitor. Effects were measured 12 wk and 1 y after randomization. General Linear Modeling was used to study main and interaction effects adjusted for baseline values of dependent variable.

Results

There was a significant main effect of the D treatment, decreasing waist circumference (P = 0.001), total cholesterol (P = 0.007), LDL-cholesterol (P = 0.003) and fasting insulin (P = 0.042), at the end of the 12-wk treatment. The decreased waist circumference (P<0.001) and insulin (P = 0.024) was sustained and HDL-cholesterol increased (P = 0.005) at the 1-y follow-up. No effects from the E treatment or any interaction effects were observed.

Conclusions

Dietary behavior modification that produced sustained weight loss among overweight and obese lactating women also improved risk factors for cardiovascular disease and type 2 diabetes. This intervention may not only reduce weight-related risks with future pregnancies but also long-term risk for metabolic disease.

Trial registration

ClinicalTrials.gov NCT01343238

Reproductive history and mortality from cardiovascular disease among women textile workers in Shanghai, China

BACKGROUND

Few studies have examined the possible effects of reproductive factors on cardiovascular disease (CVD) risks in Asian women.

METHODS

A cohort of 267,400 female textile workers in Shanghai, China, was administered a questionnaire at enrolment (1989-91) and followed for mortality through 2000. Relative risks (hazard ratios) for ischaemic heart disease (IHD), ischaemic stroke and haemorrhagic stroke were calculated using Cox proportional hazards modelling, adjusting for relevant co-variates.

RESULTS

Risks were not consistently associated with age at menopause, parity, stillbirths, miscarriages or duration of lactation. An increasing trend in IHD mortality risk, but not stroke, was observed with decreasing age at menarche. There was no evidence of increased CVD mortality risk by oral or injectable contraceptive use or induced abortions. As expected, greater mortality rates from CVD and increased CVD risks were also observed with smoking.

CONCLUSIONS

Use of steroid contraceptives, induced abortions and reduced parity from China's one-child-per-family policy has not had an adverse effect on risk of CVD mortality in this cohort.

Dietary patterns are associated with stroke in Chinese adults

We recently featured Chinese dietary patterns that were associated with obesity, hyperglycemia, hypertension, and metabolic syndrome. In this study, we examined the association of those dietary patterns and risk of stroke among 26,276 Chinese adults aged ≥45 y by using data from the 2002 China National Nutrition and Health Survey and explored whether those associations were mediated by obesity, hypertension, hyperglycemia, and other cardiovascular risk factors. The traditional southern Chinese dietary pattern, characterized by high intakes of rice and vegetables and moderate intakes in animal foods, was related to the lowest prevalence of stroke. Compared to the traditional southern dietary pattern, the traditional northern Chinese dietary pattern, characterized by high intakes of refined cereal products, potatoes, and salted vegetables, was associated with an elevated risk of stroke [OR = 1.96 (95% CI = 1.48-2.60); P < 0.0001]. Adjustment for conventional cardiovascular risk factors did not appreciably change the association [multivariate adjusted OR = 1.59 (95%CI = 1.16-2.17); P = 0.004]. The Western dietary pattern characterized by high consumption of beef, fruit, eggs, poultry, and seafood is also associated with an elevated risk of stroke [OR = 2.36 (95%CI = 1.82-3.06); P < 0.0001], but the associations became nonsignificant after adjustment for obesity, hypertension, hyperglycemia, and dyslipidemia. In conclusion, we found that the traditional southern dietary pattern was related to low prevalence of stroke and the traditional northern dietary pattern was associated with an increased stroke risk. The Western dietary patterns also association with high risk of stroke, which was largely mediated by obesity, hypertension, hyperglycemia, and dyslipidemia.

Parity and total, ischemic heart disease and stroke mortality. The Adventist Health Study, 1976-1988

In a prospective study with information about life style and reproductive factors, we assessed the relationship between parity and total, ischemic heart disease, and stroke mortality. The large majority of the 19,688 California Seventh-day Adventist women included did not smoke or drink alcohol, 31 percent never ate meat and physical activity was relatively high. Cox proportional hazard analysis was conducted with parity as the main independent variable and with adjustment for a number of other possible confounders. During follow-up from 1976 through 1988, there were 3,122 deaths; 782 deaths from ischemic heart disease and 367 deaths due to stroke. There were no relationships between parity and total mortality (P-value for overall effect of parity = 0.32). Grand multiparous women (>4 children) had somewhat increased ischemic heart disease mortality (MRR = 1.45, 95% CI: 1.15, 1.84) before adjustment for educational level. After adjustment for educational level and marital status, there were no relationship with mortality from ischemic heart disease (P = 0.29) or stroke (P = 0.72). In parous women, there were, after adjustment for age at first delivery, some suggestions of an increased total mortality in women with one child. For ischemic heart disease and stroke mortality, no associations were found. Stratified and adjusted analyses confirmed these results. Thus, we found no consistent relationships between parity and total, ischemic heart disease or stroke mortality. However, a longer follow-up would have been helpful and the conclusions may be somewhat influenced by the lifestyle of the women included.

Number of children and change in markers of metabolic health over 9-years in men and women. Data from the DESIR study

AIM

Parity is associated with an increased risk of coronary heart disease and type 2 diabetes, possibly mediated by long-term modification of metabolic health. Studying associations between the number of children with health and disease in men in addition to women allows for differentiation between the social and lifestyle influences of child-rearing, and the biological influences of childbearing. We sought to determine whether the number of children is associated with the incidence of raised fasting glucose (fasting plasma glucose≥6.1 mmol/L) and changes in glucose, insulin, insulin resistance and β-cell function over 9-years.

METHODS

Analysis of 1798 women and 1737 men from the DESIR study.

RESULTS

The number of children was associated with change in fasting glucose for women (P(trend)=0.02) and men (P(trend)=0.03), and increased incidence of raised fasting glucose by 30% (95% CI: 15, 47%) per child for men, but not women (3% [95% CI: -8, 15%]). There was a J-shaped association between number of children and change in insulin (P=0.01) and insulin resistance (P=0.005) for women, and a reduction in β-cell function in parous women (P=0.07). Men with children had increases in insulin (P=0.02), insulin resistance (P=0.02), and β-cell function (P=0.07).

CONCLUSIONS

The number of children a person has is associated with changes in metabolic health indices long after childbirth for both men and women. The distinct gender differences in deterioration of metabolic health indices emphasize that childbearing and child-rearing are likely to have differential influences on metabolic health.

Childbearing, Child-Rearing, Cardiovascular Risk Factors, and Progression of Carotid Intima-Media Thickness

Background and Purpose— Parity is associated with the risk of clinical cardiovascular events and the severity of preclinical atherosclerosis in older subjects. We sought to determine whether childbearing is associated with concurrent changes in cardiovascular risk factors and the progression of carotid intima-media thickness.

Methods— We examined the association between the number of children born during a 6-year period and concurrent changes in cardiovascular risk factors and progression of carotid intima-media thickness in men and women of reproductive age from the Cardiovascular Risk in Young Finns study. Complete data for parity and carotid intima-media thickness were available for 1786 subjects (1005 females, 781 males).

Results— For females, childbirth during the 6-year follow-up was associated with concurrent reductions in high-density lipoprotein cholesterol ( P trend <0.0001), apolipoprotein A-I ( P trend <0.0001), and apolipoprotein B ( P trend =0.01); a redistribution of adiposity to abdominal deposits; and increased progression of carotid intima-media thickness (7.5±3.2 μm/birth [mean±SEM], P =0.02). The association of childbirth with carotid intima-media thickness progression was not greatly modified by adjustment for concurrent changes in cardiovascular risk factors (fully adjusted: P =0.05). This association was significantly stronger in females than males ( P heterogeneity =0.001), who served as a control group exposed to the social and lifestyle influences of child-rearing but not the biological influences of childbearing.

Conclusions— The progression of carotid atherosclerosis over a 6-year period is increased in females who gave birth during the same period, independent of traditional risk factors. Mechanisms that underlie this observation possibly include parity-induced changes in nontraditional risk factors or an acute influence of pregnancy itself.

Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study

Although brain infarction is more common in men, the male predominance of silent brain infarction (SBI) was inconsistent in the earlier studies. This study was to examine the relationship between sex differences in the risk profile and SBI. We conducted a population-based, cross-sectional analysis of cardiovascular risk factors and SBI on MRI. We asked all the female participants about the age at natural menopause and parity. SBI was detected in 77 (11.3%) of 680 participants (266 men and 414 women) with a mean age of 64.5 (range 40-93) years. In the logistic analysis, age (odds ratio (OR)=2.760/10 years, 95% confidence interval (CI)=2.037-3.738), hypertension (OR=3.465, 95% CI=1.991-6.031), alcohol intake (OR=2.494, 95% CI=1.392-4.466) and smoking (OR=2.302, 95% CI=1.161-4.565) were significant factors concerning SBI. Although SBI was more prevalent among men, this sex difference disappeared on the multivariate model after adjustment for other confounders. In 215 women aged 60 years or older, age at natural menopause, early menopause, duration of menopause, number of children and age at the last parity were not significantly associated with SBI after adjustment for age. Hypertension and age were considered to be the major risk factors for SBI in community-dwelling people. Male predominance in SBI was largely due to higher prevalence of alcohol habit and smoking in men than in women in our population.

Parity and risk of hemorrhagic strokes

OBJECTIVES

The association between parity and risk of hemorrhagic stroke (HS) remains to be clarified. This study assessed the association of parity with the overall risk of HS and compared its contribution to intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).

METHODS

We used a database from a nationwide multicenter case-control study, in which 471 female cases with incident HS were matched at 1:2 with 942 community or hospital controls. A total of 459 HS cases and 918 controls with information on parity were included. Parity was categorized as 0-1, 2, 3, and >or=4. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated by conditional logistic regression. As potential confounders, age, history of hypertension, history of diabetes, family history of stroke, smoking status, alcohol consumption, educational status, age at menarche, and use of oral contraceptives were included in the models.

RESULTS

Compared with nullipara and unipara, women with parity of 2, 3, and >or=4 had significantly higher risk for total HS, ICH, and SAH, respectively. Each additional parity increased the ORs of HS (adjusted OR for total HS = 1.27 [95% CI 1.14-1.41]; adjusted OR for SAH = 1.34 [95% CI 1.13-1.58]; adjusted OR for ICH = 1.27 [95% CI 1.08-1.48]). Likelihood ratio test for trends showed a significantly increased risk with increasing parity for total HS and for both types of HS (p(trend) < 0.05 in all analyses).

CONCLUSIONS

Increased number of childbirths may be related to an increased risk of both intracerebral hemorrhage and subarachnoid hemorrhage.