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

ABSTRACT 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.

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Pregnancy History as an Important Predictor of Body Mass Index (BMI) in 45–54 Year-old Women (P21-047-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz041.p21-047-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Diana Pacyga ◽

Melissa Henning ◽

Jodi Flaws ◽

Rita Strakovsky

Keyword(s):

Live Birth ◽

Family Income ◽

Metabolic Diseases ◽

Smoking Status ◽

Menopausal Status ◽

Health Study ◽

Age At First Birth ◽

First Birth ◽

Pregnancy History ◽

Menopausal Women

Abstract Objectives In mid-life, women have elevated risks of cardiovascular and metabolic diseases. Pregnancy causes substantial metabolic changes in women, but it is unclear whether these changes persist life-long. Thus, we investigated associations between pregnancy history and mid-life overweight/obesity, accounting for the menopausal transition. Methods Pre- and peri-menopausal women (ages 45–54, n = 772) in the Baltimore Mid-Life Women's Health Study reported their demographics, health habits, and pregnancy history (numbers of live births/pregnancies and age at first birth/last pregnancy) via questionnaires. Height and weight were measured to calculate BMI. Multivariable logistic regression models assessed overall and stratified (by menopausal status) associations of pregnancy history and risk of mid-life overweight/obesity (BMI ≥ 25 kg/m2), controlling for race, employment, health, alcohol intake, smoking status, physical activity, and menopausal status (unstratified models). Results Women had a median age of 48, 65% were pre- and 35% were peri-menopausal, 65% were white, 63% had graduated college, and 74% had a family income ≥$50,000. Mean (SD) BMI was 28.5 (7.4) kg/m2, and was higher in peri- vs. pre-menopausal women (29.8 vs. 27.8 kg/m2; P < 0.005). Ages at first birth or last pregnancy were not associated with mid-life BMI. Women whose pregnancies either did or did not result in a live birth had 44% (OR: 0.56; 95% CI: 0.32, 0.99; P < 0.05) and 59% (OR: 0.41; 95% CI: 0.19, 0.87; P < 0.05), respectively, lower odds of being overweight/obese at age 45–54 compared to women who had never been pregnant. However, in women who had been pregnant, the odds of being overweight/obese increased by 19% with every live birth (OR: 1.19; 95% CI: 1.02, 1.40; P < 0.05). In stratified analyses, these associations remained significant only in pre-menopausal women. Conclusions In pre-menopausal women, having a history of pregnancy appears to be protective against overweight/obesity, but the protective effects diminish with every live birth. In peri-menopausal women, pregnancy history was not related to BMI, suggesting the importance of other lifestyle or physiological factors in determining BMI during menopause. The discrete findings in pre- vs. peri-menopausal women warrant studies examining relationships of pregnancy history with BMI after menopause. Funding Sources This study was made possible by funding from NIH/NIEHS, USDA, and Michigan AgBioResearch.

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Identifying an Optimal Cutpoint for the Diagnosis of Hypertriglyceridemia in the Nonfasting State

Clinical Chemistry ◽

10.1373/clinchem.2015.241752 ◽

2015 ◽

Vol 61 (9) ◽

pp. 1156-1163 ◽

Cited By ~ 27

Author(s):

Khendi T White ◽

M V Moorthy ◽

Akintunde O Akinkuolie ◽

Olga Demler ◽

Paul M Ridker ◽

...

Keyword(s):

Cardiovascular Events ◽

Menopausal Status ◽

Heart Association ◽

Hdl Cholesterol ◽

Health Study ◽

Youden Index ◽

Logistic Regression Models ◽

European Guidelines ◽

C Statistic ◽

Diagnostic Threshold

Abstract BACKGROUND Nonfasting triglycerides are similar or superior to fasting triglycerides at predicting cardiovascular events. However, diagnostic cutpoints are based on fasting triglycerides. We examined the optimal cutpoint for increased nonfasting triglycerides. METHODS We obtained baseline nonfasting (<8 h since last meal) samples from 6391 participants in the Women's Health Study who were followed prospectively for ≤17 years. The optimal diagnostic threshold for nonfasting triglycerides, determined by logistic regression models by use of c-statistics and the Youden index (sum of sensitivity and specificity minus 1), was used to calculate hazard ratios (HRs) for incident cardiovascular events. Performance was compared to thresholds recommended by the American Heart Association (AHA) and European guidelines. RESULTS The optimal threshold was 175 mg/dL (1.98 mmol/L), with a c-statistic of 0.656, statistically better than the AHA cutpoint of 200 mg/dL (c-statistic 0.628). For nonfasting triglycerides above and below 175 mg/dL, after adjusting for age, hypertension, smoking, hormone use, and menopausal status, the HR for cardiovascular events was 1.88 (95% CI 1.52–2.33, P < 0.001), and for triglycerides measured at 0–4 and 4–8 h since the last meal, 2.05 (1.54– 2.74) and 1.68 (1.21–2.32), respectively. We validated performance of this optimal cutpoint by use of 10-fold cross-validation and bootstrapping of multivariable models that included standard risk factors plus total and HDL cholesterol, diabetes, body mass index, and C-reactive protein. CONCLUSIONS In this study of middle-aged and older apparently healthy women, we identified a diagnostic threshold for nonfasting hypertriglyceridemia of 175 mg/dL (1.98 mmol/L), with the potential to more accurately identify cases than the currently recommended AHA cutpoint.

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Continuity of maternal healthcare services utilisation in Indonesia: analysis of determinants from the Indonesia Demographic and Health Survey

Family Medicine and Community Health ◽

10.1136/fmch-2021-001389 ◽

2021 ◽

Vol 9 (4) ◽

pp. e001389

Author(s):

Helen Andriani ◽

Salma Dhiya Rachmadani ◽

Valencia Natasha ◽

Adila Saptari

Keyword(s):

Health Survey ◽

Employment Status ◽

Quality Care ◽

Community Empowerment ◽

Health Facilities ◽

Demographic And Health Survey ◽

Age At First Birth ◽

First Birth ◽

Level Of Education ◽

Live Births

ObjectiveWHO recommends that every pregnant woman and newborn receive quality care throughout the pregnancy, delivery and postnatal periods. However, Maternal Mortality Ratio in Indonesia for 2015 reached 305 per 100 000 live births, which exceeds the target of Sustainable Development Goals (<70 per 100 000 live births). Receiving at least four times antenatal care (ANC4+) and skilled birth attendant (SBA) during childbirth is crucial for preventing maternal and neonatal deaths. The study aims to assess the determinants of ANC4 +and SBA independently, evaluate the distribution of utilisation of ANC4 + and SBA services, and further investigate the associations of two levels of continuity of services utilisation in IndonesiaDesignData from the Indonesia Demographic and Health Survey, a cross-sectional and large-scale national survey conducted in 2017 were used.SettingThis study was set in Indonesia.ParticipantsThe study involved ever-married women of reproductive age (15–49 years) and had given birth in the last 5 years prior to the survey (n=15 288). The dependent variables are the use of ANC4 + and SBA. Individual, family and community factors, such as age, age at first birth, level of education, employment status, parity, autonomy in healthcare decision-making, level of education, employment status of spouses, household income, mass media consumption residence and distance from health facilities were also measured.ResultsResults showed that 11 632 (76.1%) women received ANC4 + and SBA during childbirth. Multivariate analysis revealed that age, age at first birth, and parity have a statistically significant association with continuity of services utilisation. The odds of using continuity of services were higher among women older than 34 years (adjusted OR (aOR) 1.54; 95% CI 1.31 to 1.80) compared with women aged 15–24 years. Women with a favourable distance from health facilities were more likely to receive continuity of services utilisation (aOR 1.39; 95% CI 1.24 to 1.57).ConclusionsThe continuity of services utilisation is associated with age, reproductive status, family influence and accessibility-related factors. Findings demonstrated the importance of enhancing early reproductive health education for men and women. The health system reinforcement, community empowerment and multisectoral engagement enhance accessibility to health facilities, reduce financial and geographical barriers, and produce strong quality care.

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Changes in the reproduction of Vojvodina population

Zbornik Matice srpske za drustvene nauke ◽

10.2298/zmsdn0621197d ◽

2006 ◽

pp. 197-206

Author(s):

Mirjana Devedzic

Keyword(s):

Economic Situation ◽

Age At First Birth ◽

Fertility Rates ◽

First Birth ◽

Live Births ◽

Cohort Fertility

Important changes in the reproduction of Vojvodina population happened in the second half of XX century. In the end of the century, the society was ruined. A large inflow of refugees in that period, as well as a social and economic situation inappropriate for making birthgiving decisions, raised the questions like how such conditions have influenced the fertility in the population, and whether the trends have continued. This paper analyzes several fertility indicators in Vojvodina over the last five decades focusing especially on the 1990s and early 2000s, in order to explain the major tendencies and the intensity of changes. It shows changes in the number of live births, specific fertility rates, total fertility rates, cohort fertility, woman?s age at first birth, and divorce frequency.

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Abstract P396: Association of Subjective Social Status With Allostatic Load in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Circulation ◽

10.1161/circ.141.suppl_1.p396 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Amanda C McClain ◽

Linda Gallo ◽

Carmen R Isasi ◽

Robert Kaplan ◽

Michelle I Cardel ◽

...

Keyword(s):

Heart Rate ◽

Social Status ◽

Allostatic Load ◽

Subjective Social Status ◽

Health Study ◽

Metabolic System ◽

Lower Odds ◽

Logistic Regression Models ◽

One Step ◽

The U.S

Introduction: Subjective social status (SSS) is inversely related to allostatic load (AL) markers, but little is known in Hispanics/Latinos. We assessed the hypotheses that SSS would be inversely associated with total AL and subsystem scores, regardless of objective socioeconomic status (OSS). Methods: Data were from baseline of the HCHS/SOL (n = 12,722, aged 18-74y). We assessed SSS using a 10-step ladder. Participants identified on which step they stood in relation to other people in the U.S. Higher scores indicated higher SSS (range: 1-10). Participants self-reported OSS as household income, educational attainment, and employment status. AL was comprised of 16 physiological markers from the parasympathetic (n=2; heart rate variability), inflammation (n=2; C-reactive protein, white blood cell), metabolic (anthropometrics, lipids, glucose, insulin resistance; n=8), and cardiopulmonary (blood and pulse pressures, resting heart rate, lung function; n=4) subsystems. Each marker was assigned a score of 1 if the value exceeded clinical cut-offs (or high-risk quartiles) or the participant reported taking medication to alter the marker. Otherwise, the marker was assigned a score of 0. Scores were summed across the 16 markers to create an AL score (0-16), with higher scores indicating higher AL. Scores were then dichotomized as high (vs. low) if scores were ≥ AL and subsystem medians. Multivariate-adjusted, survey-weighted linear and logistic regression models tested the association of SSS with AL and subsystem scores. Results: Sample means (95% CI) for SSS and AL were 4.4 (4.3-4.5) and 4.2 (4.1-4.3), respectively. A one-step increase on the SSS ladder was associated with lower AL ((β(SE): -0.1(0.02), p=0.003) and metabolic system (-0.04(0.01), p=0.001) scores. After adjusting for OSS, the association between SSS and AL was attenuated (-0.03(0.02), p=0.09), but remained significant for metabolic system scores (-0.03(0.01), p=0.01). When modeling dichotomized AL, a one-step increase was associated with lower odds of high AL (Odds Ratio (OR); 95% Confidence Intervals (CI): 0.94 (0.91-0.98), p=0.001), high parasympathetic system (0.96 (0.93-1.00), p=0.03), and high metabolic system (0.95 (0.92-0.98)) scores. After adjusting for OSS, higher SSS remained associated with lower odds of high AL (0.95 (0.92-0.99), p=0.01) and high metabolic system (0.96 (0.92-0.99), p=0.01) scores, but the association between SSS and lower parasympathetic subsystem scores was attenuated (0.97 (0.94-1.00), p=0.08). SSS was not associated with inflammation or cardiopulmonary subsystems. Conclusions: Among Hispanics/Latinos living in the U.S, OSS attenuated the relationship between SSS and AL. SSS may be influencing AL through the metabolic system, and could provide unique psychological and biobehavioral targets for reducing metabolic risk disparities among Hispanics/Latinos living in the U.S.

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Education, age at first birth, and the timing of fertility in the United States: recent trends

Journal of Biosocial Science ◽

10.1017/s0021932000017399 ◽

1988 ◽

Vol 20 (2) ◽

pp. 157-165 ◽

Cited By ~ 4

Author(s):

Howard Wineberg

Keyword(s):

United States ◽

Current Population Survey ◽

Population Survey ◽

White Women ◽

The United States ◽

Age At First Birth ◽

First Birth ◽

Younger Women ◽

Recent Trends ◽

Over Time

SummaryThis paper enquires whether education and age at first birth, both strongly associated with completed fertility, are related to the timing of fertility, in particular the timing of the first three births, among once married white women. Analysis of data from the June 1985 United States Current Population Survey indicates that education is related to the timing of fertility; this relationship has remained relatively constant over time. Age at first birth is associated with the timing of fertility among older but not younger women.

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Age at first birth and lifetime fertility

Journal of Biosocial Science ◽

10.1017/s0021932000017405 ◽

1988 ◽

Vol 20 (2) ◽

pp. 167-174 ◽

Cited By ~ 9

Author(s):

T. R. Balakrishnan ◽

K. Vaninadha Rao ◽

Karol J. Krotki ◽

Evelyne Lapierre-Adamcyk

Keyword(s):

Older Women ◽

National Sample ◽

Fertility Survey ◽

Age At First Birth ◽

First Birth ◽

Younger Women ◽

Cumulative Fertility ◽

Catch Up ◽

Late Starters

SummaryAmong a national sample of Canadian women in the Canadian National Fertility Survey of 1984, the excess cumulative fertility of those who started their families early over others has steadily decreased. A difference of approximately two births between early and late starters among older women is reduced to approximately half a child among the younger women. Except for those who start childbearing after age 25, there is little evidence of attempts to catch up after age 30, irrespective of starting age.

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REPRODUCTION IN HIGH ALTITUDE AYMARA: PHYSIOLOGICAL STRESS AND FERTILITY PLANNING?

Journal of Biosocial Science ◽

10.1017/s0021932002004637 ◽

2002 ◽

Vol 34 (4) ◽

pp. 463-473 ◽

Cited By ~ 9

Author(s):

E. CROGNIER ◽

M. VILLENA ◽

E. VARGAS

Keyword(s):

High Altitude ◽

Physiological Stress ◽

Late Onset ◽

Cultural Control ◽

Age At Menarche ◽

Reproductive Pattern ◽

Age At First Birth ◽

First Birth ◽

Birth Intervals ◽

Live Births

Reproductive characteristics at high altitude are described based on the reproductive histories of 720 Aymara women, collected in 1998 and 1999 in a group of twelve peasant communities at a mean altitude of 4000 m in the Bolivian Altiplano. The reproductive pattern is shaped by a late onset of childbearing, associated with a rather short reproductive span and large birth intervals. Environmental conditions could explain the particularly late age at menarche of rural girls compared with their urban counterparts, whereas the age at first birth is likely to be under cultural control. The short reproductive span appears to result from a large mean interval between last birth and menopause, which is essentially determined by cultural decisions. The birth intervals, which are longer than in many traditional societies, could be the result of a slower restoration of postpartum fecundability induced by the hard way of life inherent in the Altiplano (including poor sanitary and nutritional conditions and high workload), perhaps aggravated by hypoxia. However, a secular trend in fertility is perceptible, towards earlier menarche, earlier age at first birth, increasing reproductive span and a slight increase in live births and surviving offspring, which is probably the result of a slow improvement in living conditions. The existence of birth control on the one hand, and a total fertility rate averaging six live births among the couples who do not practise contraception on the other, are other arguments against the hypothesis of a low natural fecundity in these Aymara groups.

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Differential fertility in the United States, 1980: continuity or change?

Journal of Biosocial Science ◽

10.1017/s002193200001628x ◽

1986 ◽

Vol 18 (3) ◽

pp. 311-324 ◽

Cited By ~ 2

Author(s):

Howard Wineberg ◽

James McCarthy

Keyword(s):

United States ◽

Population Survey ◽

The United States ◽

Age At First Birth ◽

First Birth ◽

Differential Fertility ◽

Younger Women ◽

Independent Variables ◽

Fertility Expectations ◽

Fertility Differentials

SummaryThis paper considers how changes in women's socio-cultural characteristics have influenced recent patterns of differential fertility in the United States and whether the convergence of fertility differentials observed up to 1970 has continued. Analysis of data from the June 1980 United States Current Population Survey, suggests that there has been no change in differential fertility in recent years. Age at first birth, length of first birth interval, income and education were all negatively associated with fertility, among both older and younger women. When fertility expectations were examined, however, the association of the independent variables with expected completed fertility was weaker among younger women, indicating that there has been some convergence in expected completed fertility. Further narrowing of differentials in actual fertility depends on how successful the younger women are in preventing future unplanned births.

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Association between Dietary Pattern and Periodontitis—A Cross-Sectional Study

Nutrients ◽

10.3390/nu13114167 ◽

2021 ◽

Vol 13 (11) ◽

pp. 4167

Author(s):

Ersin Altun ◽

Carolin Walther ◽

Katrin Borof ◽

Elina Petersen ◽

Berit Lieske ◽

...

Keyword(s):

Cohort Study ◽

Periodontal Diseases ◽

Gingival Recession ◽

Population Based ◽

Cross Sectional Study ◽

Health Study ◽

Sectional Study ◽

Cross Sectional ◽

Lower Odds ◽

Logistic Regression Models

The aim of the study was to investigate the relationship between specific known dietary patterns and the prevalence of periodontal disease in a northern population-based cohort study. We evaluated data from 6209 participants of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov (NCT03934957). Dietary intake was assessed with the food frequency questionnaire (FFQ2). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Ordinal logistic regression models were used to determine the association. Ordinal regression analyses revealed a significant association between higher adherence to the DASH diet/Mediterranean diet and lower odds to be affected by periodontal diseases in an unadjusted model (OR: 0.92; 95% CI: 0.87, 0.97; p < 0.001/OR: 0.93; 95% CI: 0.91, 0.96; p < 0.001) and an adjusted model (age, sex, diabetes) (OR: 0.94; 95% CI: 0.89, 1.00; p < 0.0365/OR: 0.97; 95% CI: 0.94, 1.00; p < 0.0359). The current cross-sectional study identified a significant association between higher adherence to the DASH and Mediterranean diets and lower odds to be affected by periodontal diseases (irrespective of disease severity). Future randomized controlled trials are needed to evaluate to which extent macro- and micronutrition can affect periodontitis initiation/progression.

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