{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:45:05Z","timestamp":1792176305424,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Age at first birth (AFB) is an important reproductive factor influencing long\u2010term metabolic health. This study aimed to examine the associations between AFB and prevalence of cardiovascular\u2010kidney\u2010metabolic (CKM) syndrome among middle\u2010aged and older US women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>US women aged \u2265\u200940\u2009years at the time of the survey were analyzed using 1999\u20132018 National Health and Nutrition Examination Survey data. AFB was ascertained via self\u2010report from a reproductive health questionnaire. CKM syndrome was defined using the 2023 American Heart Association criteria. Multivariate logistic regression models, restricted cubic spline analysis, and subgroup analysis were used for statistical analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6840 women (mean age 63\u2009years; mean AFB 22\u2009years) included, restricted cubic spline curve showed a U\u2010shaped association between AFB and CKM syndrome prevalence, with the nadir at AFB\u2009=\u200924\u2009years. The odds ratios (95% confidence intervals) per 1\u2013year increase in AFB were 0.878 (0.817\u20130.944) for participants with AFB &lt;\u200924\u2009years and 1.019 (0.949\u20131.095) for those with AFB &gt;\u200924\u2009years. Compared with the reference group (AFB 24\u201329\u2009years), women with AFB &lt;\u200918\u2009years had 86.3% higher odds of CKM syndrome. Subgroup analysis revealed a stronger association between AFB and the odds of CKM syndrome among premenopausal women (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u2009=\u20090.023).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early AFB &lt;\u200924\u2009years is associated with a higher likelihood of CKM syndrome in US women aged \u2265\u200940\u2009years, especially among premenopausal women. Prospectively designed cohort studies are needed to establish AFB as an important factor for mid\u2010 to late\u2010life CKM health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71108","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:02:17Z","timestamp":1780920137000},"page":"951-959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age at first birth and risk of cardiovascular\u2010kidney\u2010metabolic syndrome in\n                    <scp>US<\/scp>\n                    women aged 40\u2009years and older: A nationally representative cross\u2010sectional study"],"prefix":"10.1002","volume":"175","author":[{"given":"Yehua","family":"Jing","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, the Affiliated Hospital of Yangzhou University Yangzhou University  Yangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, the Affiliated Hospital of Yangzhou University Yangzhou University  Yangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology Northern Jiangsu People's Hospital  Yangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianquan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, the Affiliated Hospital of Yangzhou University Yangzhou University  Yangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001184"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.45309"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000546618"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.0000000637"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacasi.2025.04.007"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004629"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.2196\/57920"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.31083\/RCM26580"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14536"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0123665"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-023-17207-0"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2022.01.015"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-025-04812-7"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-22767-4"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.6892"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437741.48606.98"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2025.2513016"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-024-02305-1"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S517401"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199905000-00011"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwae215"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.23831"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13073"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.5301\/jn.5000171"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-293"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.8584"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2016.12.001"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2317290121"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17486"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303503"}],"container-title":["International Journal of Gynecology &amp; 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