Abstract P193: Parity and Cardiovascular Disease Prevalence and Mortality Among the Old Order Amish
Background: Prior data shows a J-shaped association between parity and cardiovascular disease (CVD) (nadir of risk = 2 pregnancies). These studies have been limited by the presence of potential sociodemographic confounders, including cultural norms of parity. Thus, we sought to determine the association between parity and mortality within a socioeconomically uniform population with high median parity.
Methods: This is a population-based cohort study of 518 Old Order Amish women, a socioeconomically homogenous group with a high average number of children per family. Women underwent cardiovascular screening in 1987 and were followed prospectively for CVD and mortality outcomes. The mean length of follow up to event was 13.52 years. We employed age and multivariate adjusted Cox proportional hazard models. Covariates included age at first birth, time to conceive from marriage, diabetes, hypertension, BMI, total cholesterol, HDL-C, LDL-C and triglycerides.
Results: Mean parity was 6.7 (SD 3.6). There was no significant association between nulliparity nor increasing parity and diabetes, hypertension or a composite CVD outcome in this socioeconomically homogeneous population. We found no association between parity and all-cause mortality when adjusted for age (HR 1.00 per additional birth; 95% CI 0.96-1.05; p = 0.85) or covariates (HR 1.00, 95% CI 0.95-1.05; p=0.95). When comparing categories of parity to the referent (8-9 births), none was significantly associated with mortality. Despite the lack of effect of parity on mortality, we observed a positive association of greater parity with higher BMI.
Conclusions: In the Old-Order Amish, a population with high mean parity and relatively homogenous socioeconomic status, there is no association between mortality and parity. Increased parity is significantly associated with increased BMI, however this does not appear to increase CVD or mortality risk.
- © 2013 by American Heart Association, Inc.