{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T20:07:33Z","timestamp":1778098053795,"version":"3.51.4"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>OBJECTIVE:<\/jats:title>\n            <jats:p>To examine the associations of parity and age at childbirth with maternal cardiovascular disease (CVD).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>The data were from the Women's Health Initiative (1993\u20132022), involving postmenopausal women aged 49\u201381 years without existing CVD. The exposures were parity, age at first childbirth, and age at last childbirth, all referring to pregnancy lasting at least 6 months. The outcome was <jats:italic toggle=\"yes\">incident CVD events<\/jats:italic>, defined as the initial occurrence of coronary heart disease, heart failure, ischemic stroke, or death due to these conditions. We employed propensity score matching to generate matched samples, aligning each exposure group with a reference group according to their propensity scores. We used multilevel Cox proportional hazard models to calculate hazard ratios (HRs) and 95% CIs to estimate the associations among parity, age at childbirth, and CVD. We performed multiple mediation analyses to assess the effect of potential mediators on the associations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Compared with parity of two, there was no significant association between other parity levels and later-life maternal CVD. Compared with age at first childbirth of 25\u201329 years, the HRs (95% CIs) for the association between CVD and age at first childbirth was 1.32 (1.22\u20131.44) for individuals younger than age 20 years, 1.11 (1.05\u20131.17) for those aged 20\u201324 years, 1.03 (0.93\u20131.13) for those aged 30\u201334 years, and 0.93 (0.79\u20131.11) for those aged 35 years or older. When age at last childbirth was younger than 25 years, 30\u201334 years, 35\u201339 years, and 40 years or older, the HRs (95% CIs) for CVD were 1.02 (0.94\u20131.10), 1.05 (0.99\u20131.10), 1.10 (1.03\u20131.18), and 1.09 (0.96\u20131.24), respectively. In multiple mediation analyses, we identified the potential mediation pathway of age at first childbirth younger than 25 years\u2192premature menopause\u2192hypertension\u2192CVD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION:<\/jats:title>\n            <jats:p>Young age at first childbirth was associated with increased maternal CVD risk. Preventing premature menopause and hypertension may be important ways to lower the risk for postmenopausal women.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/og9.0000000000000063","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T22:00:27Z","timestamp":1739484027000},"page":"e063","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Parity, Age at Childbirth, and Later-Life Maternal Cardiovascular Disease in Postmenopausal Women in the Women's Health Initiative Study"],"prefix":"10.1097","volume":"2","author":[{"given":"Zailing","family":"Xing","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell S.","family":"Kirby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henian","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Ashley","family":"Cain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy C.","family":"Alman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,2]]},"reference":[{"key":"R1-20250214","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1161\/CIR.0000000000001139","article-title":"Cardiovascular disease risk factors in women: the impact of race and ethnicity: a scientific statement from the American heart association","volume":"147","author":"Mehta","year":"2023","journal-title":"Circulation"},{"key":"R2-20250214","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart disease and stroke statistics\u20142023 update: a report from the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"R3-20250214","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1093\/cvr\/cvaa155","article-title":"Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart","volume":"117","author":"Perrino","year":"2021","journal-title":"Cardiovasc Res"},{"key":"R4-20250214","doi-asserted-by":"crossref","first-page":"e250821195824","DOI":"10.2174\/1573403X17666210825103653","article-title":"Cardiovascular diseases in pregnancy\u2014a brief overview","volume":"18","author":"Sahu","year":"2022","journal-title":"Curr Cardiol Rev"},{"key":"R5-20250214","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1161\/CIRCRESAHA.121.319895","article-title":"Pregnancy and reproductive risk factors for cardiovascular disease in women","volume":"130","author":"O'Kelly","year":"2022","journal-title":"Circ Res"},{"key":"R6-20250214","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12884-020-03499-2","article-title":"Number of parity\/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up","volume":"21","author":"Moazzeni","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"R7-20250214","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1097\/gme.0b013e31821adb43","article-title":"Reproductive risk factors for cardiovascular disease mortality among postmenopausal women in Korea: the Kangwha Cohort Study, 1985\u20132005","volume":"18","author":"Chang","year":"2011","journal-title":"Menopause"},{"key":"R8-20250214","first-page":"1459","article-title":"Parity and risk of cardiovascular disease in women over 45 years in the United States: National Health and Nutrition Examination Survey 2007\u20132018","volume":"31","author":"Xing","year":"2022","journal-title":"J Womens Health (Larchmt)"},{"key":"R9-20250214","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1177\/2047487318818265","article-title":"Parity and risk of maternal cardiovascular disease: a dose\u2013response meta-analysis of cohort studies","volume":"26","author":"Li","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"R10-20250214","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s10654-011-9598-x","article-title":"Parity and total, ischemic heart disease, and stroke mortality. 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