Gravidity, parity, blood pressure and mortality among women in Bangladesh from the HEALS cohort

Abstract

ObjectivesDespite a hypothesised connection of reproductive history with hypertension and mortality, the nature of this association is poorly characterised. We evaluated the association of parity and gravidity with blood pressure, hypertension and all-cause mortality.DesignProspective cohort study.SettingHealth Effects of Arsenic Longitudinal Study cohort in rural Bangladesh.ParticipantsThere were 21 634 Bangladeshi women recruited in 2000–2002, 2006–2008 and 2010–2014 included in the present analysis.MethodsReproductive history was ascertained through an interviewer-administered questionnaire at the baseline visit. Blood pressure was measured by a trained study physician following a standard protocol at the baseline visit. Vital status was ascertained at the biennial follow-up of study participants through June 2017. Linear and logistic regression models estimated the relationship between parity and gravidity with blood pressure and hypertension, respectively. Cox proportional hazards models estimated the relationship with all-cause mortality only among women aged >45 years.ResultsDiastolic blood pressure was lowest in women with parity one (reference) and elevated in nulliparous women (adjusted % change=3.12; 95% CI 1.93 to 4.33) and women with parity >2 (adjusted % change=1.71; 95% CI 1.12 to 2.31). The associations with nulliparity were stronger for women aged >45 years. Similar association patterns were observed with hypertension. Further, in nulliparous women aged >45 years, 265 deaths (6.6%) were ascertained during the follow-up period (median follow-up time=8 years), and we observed suggestive elevated risks of all-cause mortality (adjusted HR 3.83; 95% CI 0.74 to 19.78). The relationships between reproductive history, blood pressure, hypertension and mortality were similar when modelling reproductive history as gravidity rather than parity.ConclusionsFor women in rural Bangladesh, nulliparity and nulligravidity appear to be associated with higher blood pressure and subsequent elevated risk of mortality.

Live birth/parity number and the risk of incident hypertension among parous women during over 13 years of follow‐up

“…Among Korean women, on the other hand, it was found that parity was inversely correlated with both SBP and DBP 15 . Another cross‐sectional analysis from Bangladesh also showed that among women aged 18–75 years, compared to those with one parity, participants with ≥2 parity had higher levels of DBP and lower level of SBP 34 . Moreover, in some other cross‐sectional studies, live birth/parity number did not significantly associate with BP levels and hypertension, or lose their significance after adjustment for confounders 35–38 …”

Biosocial predictors and blood pressure goal attainment among postmenopausal women with hypertension

“…One possible mechanism for the BPlowering effects is an extended lifespan of breastfeeding. The extended release of oxytocin during lactation has been linked to both short-term reductions in blood pressure and a decreased risk of hypertension and CVD in middle age (39).…”

Factors Affecting the Incidence of Anemia in Pregnant Women at Ampel and Gladagsari Public Health Center Boyolali Regency in 2019

“…In the Ampel Community Health Center sample the OR value (2.517), Gladagsari Health Center obtained an OR (0.410), this result shows that parity of more than 3 children can increase maternal anemia by 2.517 and 0.410 times compared to mothers who gave birth to 1-3 children. A study in a study in Bangladesh, India reported that mothers who gave birth to >2 children were associated with an increased risk of pregnancy complications including anemia, this risk also increased when the mother was >45 years old (23) .…”