{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:59:04Z","timestamp":1787162344651,"version":"build-2736575974"},"reference-count":35,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["P01HL154996"],"award-info":[{"award-number":["P01HL154996"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Laney Graduate School, Emory University","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]},{"name":"Emory Global Diabetes Research Center of the Woodruff Health Sciences Center at Emory University","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2025,7,25]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We investigated the association of reproductive history with cardiometabolic health in ethnically diverse women across five continents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We pooled cross-sectional survey data on non-pregnant women aged 30\u201349 years from 15 countries. Multilevel models were used to examine associations between menopausal status, age at first birth (\u226520\u2009vs &lt;20 years), parity (1, 2, 3, 4+ vs 0 births) and cardiometabolic indicators: body mass index (BMI), systolic blood pressure (SBP) and fasting blood glucose (FBG), adjusting for age and socioeconomic status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 413\u2009802\u2009women (median age 38 years; 14% postmenopausal). Being in a postmenopausal state was associated with lower BMI (\u22120.22, 95%\u2009CI \u22120.27 to \u20130.17\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and higher SBP (0.35, 95%\u2009CI 0.18, 0.52\u2009mm Hg). In parous premenopausal women (n=332\u2009569), later age at first birth was associated with lower BMI (\u22120.33, 95%\u2009CI \u22120.36 to \u20130.30\u2009kg\/m\u00b2) and lower SBP (\u22120.59, 95%\u2009CI \u22120.69 to \u20130.48\u2009mm Hg); higher parity was associated with higher BMI (0.11\u20130.14\u2009kg\/m\u00b2 for 1\u20133 births) and lower SBP (\u22120.77 to \u22122.04\u2009mm Hg for 1\u20134+ births). Among parous postmenopausal women (n=55\u2009788), later age at first birth was associated with lower BMI (\u22120.15, 95%\u2009CI \u22120.23 to \u20130.07\u2009kg\/m\u00b2), lower SBP (\u22120.38, 95%\u2009CI \u22120.67 to \u20130.08\u2009mm Hg) and higher FBG (2.08, 95%\u2009CI 0.08 to 4.11\u2009mg\/dL); higher parity was associated with lower SBP (\u22121.60 to \u22123.06\u2009mm Hg for 1\u20134+ births).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Irrespective of menopausal status, later age at first birth was associated with lower BMI and SBP, while higher parity was associated with lower SBP. Reproductive history has implications for cardiometabolic risk in women across diverse settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jech-2025-223994","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T02:15:58Z","timestamp":1754878558000},"page":"858-865","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Reproductive history, menopause and cardiometabolic health in women: a multicountry analysis"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-8398","authenticated-orcid":false,"given":"Wilhemina","family":"Quarpong","sequence":"first","affiliation":[{"name":"Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suchitra","family":"Chandrasekaran","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, USA"},{"name":"Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K M Venkat","family":"Narayan","sequence":"additional","affiliation":[{"name":"Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA"},{"name":"Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Emory University, Atlanta, Georgia, USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Tandon","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani Anil","family":"Patel","sequence":"additional","affiliation":[{"name":"Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA"},{"name":"Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Emory University, Atlanta, Georgia, USA"},{"name":"Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,10]]},"reference":[{"key":"2025100902150804000_79.11.858.1","unstructured":"Institute for Health Metrics and Evaluation (IHME) . GBD results. Seattle, WA IHME, University of Washington; 2024. Available: https:\/\/vizhub.healthdata.org\/gbd-results\/ [accessed 05 Aug 2024]"},{"key":"2025100902150804000_79.11.858.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m3502","article-title":"Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review","volume":"371","author":"Okoth","year":"2020","journal-title":"BMJ"},{"key":"2025100902150804000_79.11.858.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0210329","article-title":"Cardiovascular risk prediction models for women in the general population: A systematic review","volume":"14","author":"Baart","year":"2019","journal-title":"PLoS One"},{"key":"2025100902150804000_79.11.858.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-017-4519-x","article-title":"Age at first birth and risk of later-life cardiovascular disease: a systematic review of the literature, its limitation, and recommendations for future research","volume":"17","author":"Rosendaal","year":"2017","journal-title":"BMC Public Health"},{"key":"2025100902150804000_79.11.858.5","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1089\/jwh.2015.5581","article-title":"Associations Between Parity, Obesity, and Cardiovascular Risk Factors Among Middle-Aged Women","volume":"25","author":"Chung","year":"2016","journal-title":"J Womens Health (Larchmt)"},{"key":"2025100902150804000_79.11.858.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-024279","article-title":"Association between parity and persistent weight gain at age 40-60 years: a longitudinal prospective cohort study","volume":"9","author":"Zoet","year":"2019","journal-title":"BMJ Open"},{"key":"2025100902150804000_79.11.858.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.319895"},{"key":"2025100902150804000_79.11.858.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-022-01336-7","article-title":"A review of menopause nomenclature","volume":"19","author":"Ambikairajah","year":"2022","journal-title":"Reprod Health"},{"key":"2025100902150804000_79.11.858.9","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-3362"},{"key":"2025100902150804000_79.11.858.10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.maturitas.2021.06.013","article-title":"Menopause and cardiometabolic diseases: What we (don\u2019t) know and why it matters","volume":"152","author":"Roa-D\u00edaz","year":"2021","journal-title":"Maturitas"},{"key":"2025100902150804000_79.11.858.11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/GME.0000000000002292","article-title":"The association of menopause with cardiometabolic disease risk factors in low- and middle-income countries: a systematic review and meta-analyses","volume":"31","author":"Chikwati","year":"2024","journal-title":"Menopause"},{"key":"2025100902150804000_79.11.858.12","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu094"},{"key":"2025100902150804000_79.11.858.13","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000912"},{"key":"2025100902150804000_79.11.858.14","doi-asserted-by":"publisher","DOI":"10.1097\/MNH.0b013e3283431921"},{"key":"2025100902150804000_79.11.858.15","unstructured":"The Demographic and Health Survey Program . Data from: demographic and health surveys. n.d. Available: https:\/\/dhsprogram.com\/"},{"key":"2025100902150804000_79.11.858.16","unstructured":"Instituto Nacional de Estad\u00edstica e Inform\u00e1tica . Data from: encuesta demogr\u00e1fica y de salud familiar (ENDES 2022). 2022. Available: https:\/\/proyectos.inei.gob.pe\/endes\/documentos.asp"},{"key":"2025100902150804000_79.11.858.17","unstructured":"Instituto nacional de salud p\u00fablica . Data from: encuesta nacional de salud y nutrici\u00f3n (ENSANUT) 2018. 2018. Available: https:\/\/ensanut.insp.mx\/index.php"},{"key":"2025100902150804000_79.11.858.18","unstructured":"National Center for Health Statistics . Data from: national health and nutrition examination survey 2017- March 2020. n.d. Available: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/continuousnhanes\/default.aspx?Cycle=2017-2020"},{"key":"2025100902150804000_79.11.858.19","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1038\/s41586-019-1171-x","article-title":"Rising rural body-mass index is the main driver of the global obesity epidemic in adults","volume":"569","author":"Bixby","year":"2019","journal-title":"Nature New Biol"},{"key":"2025100902150804000_79.11.858.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01330-1"},{"key":"2025100902150804000_79.11.858.21","doi-asserted-by":"crossref","first-page":"2885","DOI":"10.1038\/s41591-023-02610-2","article-title":"Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c","volume":"29","author":"Zhou","year":"2023","journal-title":"Nat Med"},{"key":"2025100902150804000_79.11.858.22","unstructured":"Rutstein SO . Steps to constructing the new DHS wealth index. Rockville, MD: ICF Int,"},{"key":"2025100902150804000_79.11.858.23","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czl029"},{"key":"2025100902150804000_79.11.858.24","unstructured":"National Health and Nutrition Examination Survey . Data documentation, codebook, and frequencies, 2017-March 2020. Income; 2021. Available: https:\/\/wwwn.cdc.gov\/Nchs\/Nhanes\/2017-2018\/P_INQ.htm [Accessed 31 Jan 2024]."},{"key":"2025100902150804000_79.11.858.25","unstructured":"Metreau E , Young KE , Eapen SG . World bank country classifications by income level for 2024-2025. World Bank; 1."},{"key":"2025100902150804000_79.11.858.26","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000001424"},{"key":"2025100902150804000_79.11.858.27","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1097\/GME.0000000000001136","article-title":"Metabolic syndrome and its components in premenopausal and postmenopausal women: a comprehensive systematic review and meta-analysis on observational studies","volume":"25","author":"Hallajzadeh","year":"2018","journal-title":"Menopause"},{"key":"2025100902150804000_79.11.858.28","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.003609","article-title":"Progression of Metabolic Syndrome Severity During the Menopausal Transition","volume":"5","author":"Gurka","year":"2016","journal-title":"JAHA"},{"key":"2025100902150804000_79.11.858.29","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2016-208196"},{"key":"2025100902150804000_79.11.858.30","doi-asserted-by":"crossref","unstructured":"Khalil A . Physiology of pregnancy. In: Fiander A , Thilaganathan B , eds. MRCOG part one: your essential revision guide. Cambridge: Cambridge University Press, n.d.: 439\u201348.","DOI":"10.1017\/CBO9781107587519.031"},{"key":"2025100902150804000_79.11.858.31","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s10654-018-0358-z","article-title":"The impact of parity on life course blood pressure trajectories: the HUNT study in Norway","volume":"33","author":"Haug","year":"2018","journal-title":"Eur J Epidemiol"},{"key":"2025100902150804000_79.11.858.32","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1097\/GME.0000000000002194","article-title":"Association of parity with body mass index and cardiometabolic risk in high-parous women","volume":"30","author":"He","year":"2023","journal-title":"Menopause"},{"key":"2025100902150804000_79.11.858.33","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-037244","article-title":"Gravidity, parity, blood pressure and mortality among women in Bangladesh from the HEALS cohort","volume":"10","author":"Shih","year":"2020","journal-title":"BMJ Open"},{"key":"2025100902150804000_79.11.858.34","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.1097\/HJH.0000000000000325","article-title":"Is there a differential impact of parity on blood pressure by age?","volume":"32","author":"Dratva","year":"2014","journal-title":"J Hypertens"},{"key":"2025100902150804000_79.11.858.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12986-016-0133-7","article-title":"Association between parity and obesity patterns in a middle-aged and older Chinese population: a cross-sectional analysis in the Tongji-Dongfeng cohort study","volume":"13","author":"Li","year":"2016","journal-title":"Nutr Metab (Lond)"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2025-223994","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T13:46:37Z","timestamp":1760622397000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2025-223994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,10]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,10,9]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/jech-2025-223994"],"URL":"https:\/\/doi.org\/10.1136\/jech-2025-223994","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,10]]}}}