{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T08:26:05Z","timestamp":1787127965338,"version":"build-2736575974"},"reference-count":60,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We aimed to examine the long-term effects of parity, age at first childbirth, and age at last childbirth on later-life health-related quality of life (HRQoL) in postmenopausal women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>The Women\u2019s Health Initiative data included 15,416 postmenopausal women with repeated measures in HRQoL. We used propensity score matching to create matched samples, where each exposure group was matched with a reference group based on their propensity scores. We employed mixed-effects models to examine the associations of parity and age at childbirth with HRQoL. We performed multiple mediation analyses to assess the effects of potential mediators on the associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The overall HRQoL scores of women with parity of 4 and 5+ compared to parity of 2 significantly increased by 1.4 (95% confidence interval [CI]: 0.56\u20132.24) and 1.3 (95% CI: 0.36\u20132.24), respectively. Having the last childbirth after 40 was associated with increased overall HRQoL by 2.2 (95% CI: 0.50\u20134.4). However, the HRQoL for women with age at first childbirth of &lt;20 was reduced by 2.7 (95% CI: 1.66\u20133.74) compared to age at first childbirth of 25\u201329. In multiple mediation analyses, we identified the path: age at first childbirth of &lt;20 \u2192 premature menopause \u2192 reduced HRQoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The mixed-effects models demonstrated that age at first childbirth of &lt;20 was related to decreased HRQoL over time, while parity of 4 and \u22655 and late age at last childbirth were associated with increased HRQoL. Premature menopause significantly mediated the association between young age at first childbirth and reduced HRQoL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15409996251374597","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T17:05:53Z","timestamp":1759856753000},"page":"1495-1507","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Parity, Age at Childbirth, and Later-Life Health-Related Quality of Life in Postmenopausal Women"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6893-2275","authenticated-orcid":false,"given":"Zailing","family":"Xing","sequence":"first","affiliation":[{"name":"College of Public Health, University of South Florida, Tampa, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy C.","family":"Alman","sequence":"additional","affiliation":[{"name":"College of Public 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