{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:36:47Z","timestamp":1785883007313,"version":"3.56.0"},"reference-count":33,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/100007405","name":"the Danish Heart Foundation","doi-asserted-by":"crossref","award":["grant number 14-R97-A5163"],"award-info":[{"award-number":["grant number 14-R97-A5163"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,9,12]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The metabolic changes of pregnancy resemble a cardiovascular risk profile and may persist postpartum, with body mass index (BMI) as a potential modifier. We examined the association between the number of live-birth pregnancies and maternal premenopausal risks of hypertension and cardiovascular disease (CVD), accounting for pre-pregnancy BMI as well as abortions and stillbirths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Mothers from the Danish National Birth Cohort (1996 to 2002). For each of these women, registry data on all pregnancies from 1973 to 2011 were obtained, as were self-reported pre-pregnancy weight and height.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 44 552 first-time mothers in the Danish National Birth Cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Risks of hypertension and CVD during and between live-birth pregnancies separately and combined as live-birth cycles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After adjustment for abortions, stillbirths, pre-pregnancy BMI and other covariates, a higher risk of hypertension was observed in the first (HR 1.53, 95% CI: 1.37 to 1.72) and fourth and subsequent live-birth cycles (HR 1.72, 95% CI: 1.15 to 2.58), compared with the second. However, as number of live-birth pregnancies increased, risk of hypertension decreased during live-birth pregnancies and increased between live-birth pregnancies (tests for trend, p&lt;0.01). For CVD, we found an overall J-shaped but non-significant association with number of live-birth pregnancies. No interaction with pre-pregnancy BMI (&lt;25 versus \u226525 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Premenopausal women had the highest risk of hypertension and CVD during their first live-birth pregnancy and after their fourth live-birth pregnancy. All risks were independent of BMI before the first live-birth pregnancy and of number of abortions and stillbirths.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030702","type":"journal-article","created":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T07:45:48Z","timestamp":1572939948000},"page":"e030702","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Maternal reproductive history and premenopausal risk of hypertension and cardiovascular disease: a Danish cohort study"],"prefix":"10.1136","volume":"9","author":[{"given":"Shannon X","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"St\u00f8vring","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen Aa","family":"N\u00f8hr","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, the Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Kirkegaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, the Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,11,4]]},"reference":[{"key":"2025121401283044000_9.11.e030702.1","unstructured":"World Health Organ . 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