The Association Between Parity and Subsequent Cardiovascular Disease in Women: The Atherosclerosis Risk in Communities Study.
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.  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.  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.  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.
['Oliver-Williams|Clare|C|', 'Vladutiu|Catherine J|CJ|', 'Loehr|Laura R|LR|', 'Rosamond|Wayne D|WD|', 'Stuebe|Alison M|AM|']
D001741:African Americans D001942:Breast Feeding D002318:Cardiovascular Diseases D015331:Cohort Studies D003327:Coronary Disease D005260:Female D005500:Follow-Up Studies D006333:Heart Failure D006801:Humans D008875:Middle Aged D009203:Myocardial Infarction D010298:Parity D011247:Pregnancy D011256:Pregnancy Outcome D016016:Proportional Hazards Models D012307:Risk Factors D020521:Stroke D014481:United States D044465:Whites
cardiovascular disease breastfeeding pregnancy