American journal of obstetrics and gynecology · 2025
Associations between parity, age at childbirth, and later-life mortality in postmenopausal women mediated by premature menopause.
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Xing Zailing, Kirby Russell S, Chen Henian, Cain Mary Ashley, Alman Amy C
Аннотация
OBJECTIVE: We aimed to examine the long-term effects of parity, age at first childbirth, and age at last childbirth on mortality in postmenopausal women.
STUDY DESIGN: The data were from the Women's Health Initiative involving 106,760 postmenopausal women. 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 multilevel Cox proportional hazard models to estimate hazard ratios and 95% confidence intervals to examine the associations of parity and age at childbirth with mortality. We conducted multiple mediation analyses to estimate the effects of potential mediators on the associations.
RESULTS: Compared to parity of 2, the hazard ratios (95% confidence intervals) for the association of all-cause mortality with parity of 0, 1, 3, 4, and 5+ were 1.09 (1.05-1.13), 1.11 (1.06-1.16), 1.01 (0.99-1.04), 1.00 (0.97-1.03), and 1.00 (0.96-1.03), respectively. Age at first childbirth of <20, age at last childbirth of <25, and age at last childbirth ≥40 years were associated with increased mortality risks, with the corresponding hazard ratios (95% confidence intervals) of 1.14 (1.09-1.19), 1.06 (1.02-1.11), and 1.07 (1.00-1.15), respectively. Women with parity of 0, 4+, or age at first childbirth <25 years had shorter lifespans than the reference groups. Premature menopause was a pivotal mediator in the associations of parity and age at first childbirth with mortality.
CONCLUSION: We found long-term adverse impacts of nulliparity and young age at first childbirth on women's mortality risk and lifespan. Premature menopause may operate as a critical intermediate between childbirth and later-life mortality, underscoring the importance to identify at-risk women early.
STUDY DESIGN: The data were from the Women's Health Initiative involving 106,760 postmenopausal women. 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 multilevel Cox proportional hazard models to estimate hazard ratios and 95% confidence intervals to examine the associations of parity and age at childbirth with mortality. We conducted multiple mediation analyses to estimate the effects of potential mediators on the associations.
RESULTS: Compared to parity of 2, the hazard ratios (95% confidence intervals) for the association of all-cause mortality with parity of 0, 1, 3, 4, and 5+ were 1.09 (1.05-1.13), 1.11 (1.06-1.16), 1.01 (0.99-1.04), 1.00 (0.97-1.03), and 1.00 (0.96-1.03), respectively. Age at first childbirth of <20, age at last childbirth of <25, and age at last childbirth ≥40 years were associated with increased mortality risks, with the corresponding hazard ratios (95% confidence intervals) of 1.14 (1.09-1.19), 1.06 (1.02-1.11), and 1.07 (1.00-1.15), respectively. Women with parity of 0, 4+, or age at first childbirth <25 years had shorter lifespans than the reference groups. Premature menopause was a pivotal mediator in the associations of parity and age at first childbirth with mortality.
CONCLUSION: We found long-term adverse impacts of nulliparity and young age at first childbirth on women's mortality risk and lifespan. Premature menopause may operate as a critical intermediate between childbirth and later-life mortality, underscoring the importance to identify at-risk women early.