Parity, Age at Childbirth, and Later-Life Health-Related Quality of Life in Postmenopausal Women.

Objective

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. Materials and

Methods

The Women's 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.

Results

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]: 0.56-2.24) and 1.3 (95% CI: 0.36-2.24), respectively. Having the last childbirth after 40 was associated with increased overall HRQoL by 2.2 (95% CI: 0.50-4.4). However, the HRQoL for women with age at first childbirth of <20 was reduced by 2.7 (95% CI: 1.66-3.74) compared to age at first childbirth of 25-29. In multiple mediation analyses, we identified the path: age at first childbirth of <20 → premature menopause → reduced HRQoL.

Conclusions

The mixed-effects models demonstrated that age at first childbirth of <20 was related to decreased HRQoL over time, while parity of 4 and ≥5 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.