Abstract
BACKGROUND: We investigated the association of reproductive history with cardiometabolic health in ethnically diverse women across five continents. METHODS: We pooled cross-sectional survey data on non-pregnant women aged 30-49 years from 15 countries. Multilevel models were used to examine associations between menopausal status, age at first birth (≥20 vs <20 years), parity (1, 2, 3, 4+ vs 0 births) and cardiometabolic indicators: body mass index (BMI), systolic blood pressure (SBP) and fasting blood glucose (FBG), adjusting for age and socioeconomic status. RESULTS: We included 413 802 women (median age 38 years; 14% postmenopausal). Being in a postmenopausal state was associated with lower BMI (-0.22, 95% CI -0.27 to -0.17 kg/m(2)) and higher SBP (0.35, 95% CI 0.18, 0.52 mm Hg). In parous premenopausal women (n=332 569), later age at first birth was associated with lower BMI (-0.33, 95% CI -0.36 to -0.30 kg/m²) and lower SBP (-0.59, 95% CI -0.69 to -0.48 mm Hg); higher parity was associated with higher BMI (0.11-0.14 kg/m² for 1-3 births) and lower SBP (-0.77 to -2.04 mm Hg for 1-4+ births). Among parous postmenopausal women (n=55 788), later age at first birth was associated with lower BMI (-0.15, 95% CI -0.23 to -0.07 kg/m²), lower SBP (-0.38, 95% CI -0.67 to -0.08 mm Hg) and higher FBG (2.08, 95% CI 0.08 to 4.11 mg/dL); higher parity was associated with lower SBP (-1.60 to -3.06 mm Hg for 1-4+ births). CONCLUSIONS: Irrespective of menopausal status, later age at first birth was associated with lower BMI and SBP, while higher parity was associated with lower SBP. Reproductive history has implications for cardiometabolic risk in women across diverse settings.