Highlights
- •Greater numbers of live births were associated with worse left ventricular systolic function and cardiac mechanics.
- •Further research is required to understand better the mechanism by which higher levels of live births are associated with LV systolic dysfunction in order to improve the long-term cardiovascular health of multiparous women.
- •Contemporary cardiovascular datasets should routinely capture pregnancy and reproductive histories of participants.
ABSTRACT
Objective
Greater parity has been associated with cardiovascular disease risk. We sought to
find whether the effects on cardiac remodeling and heart failure risk are clear.
Methods
We examined the association of number of live births with echocardiographic measures
of cardiac structure and function in participants of the Framingham Heart Study (FHS)
using multivariable linear regression. We next examined the association of parity
with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction
using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635
participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of
Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary
analyses included major cardiovascular disease, myocardia infarction and stroke.
Results
Among n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births
were associated with worse left ventricular fractional shortening (multivariable β
-1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including
global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes,
women with ≥ 5 live births were at higher risk of developing future HFrEF compared
with nulliparous women (HR 1.93, 95% CI 1.19–3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37–0.91;
P = 0.02).
Conclusions
Greater numbers of live births are associated with worse cardiac structure and function.
There was no association with overall HF, but a higher number of live births was associated
with greater risk for incident HFrEF.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: January 10, 2023
Accepted:
December 15,
2022
Received in revised form:
December 15,
2022
Received:
August 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
