Parity and the Association With Diabetes in Older Women

  1. Kenneth J. Mukamal, MD1
  1. 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
  2. 2Division of Nephrology, University of Washington, Seattle, Washington;
  3. 3Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania;
  4. 4Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
  5. 5Department of Biostatistics, University of Washington, Seattle, Washington;
  6. 6Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania;
  7. 7Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington.
  1. Corresponding author: Angela G. Fowler-Brown, afowler{at}bidmc.harvard.edu.

Abstract

OBJECTIVE To examine the relationship of parity with diabetes and markers of glucose homeostasis in older women.

RESEARCH DESIGN AND METHODS We used data from the female participants in the Cardiovascular Health Study, a longitudinal cohort of adults aged ≥65 years. These data included an assessment of parity (baseline) and fasting serum levels of glucose, insulin, and medication use (baseline and follow-up). We estimated both the cross-sectional relationship of parity with baseline diabetes and the relationship of parity with incident diabetes.

RESULTS In unadjusted analyses, women with grand multiparity (≥5 live births) had a higher prevalence of diabetes at baseline compared with those with fewer births and with nulliparous women (25 vs. 12 vs. 15%; P < 0.001). In regression models controlling for age and race, grand multiparity was associated with increased prevalence of diabetes (prevalence ratio 1.57 [95% CI 1.20–2.06]); with addition of demographic and clinical factors to the model, the association was attenuated (1.33 [1.00–1.77]). In final models that included body anthropometrics, the association was no longer significant (1.21 [0.86–1.49]). In those without diabetes at baseline, parity was not associated with incident diabetes or with fasting glucose; however, there was a modest association of parity with fasting insulin and homeostasis assessment model of insulin resistance.

CONCLUSIONS Grand multiparity is associated with diabetes in elderly women in cross-sectional analyses. This relationship seems to be confounded and/or mediated by variation in body weight and sociodemographic factors by parity status. In older nondiabetic women, higher parity does not pose an ongoing risk of developing diabetes.

Footnotes

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  1. Diabetes Care vol. 33 no. 8 1778-1782
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