Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: findings from the China Kadoorie Biobank.
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ABSTRACT:
SUBMITTER: Peters SAE
PROVIDER: S-EPMC5547470 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:Pregnancy and pregnancy loss may be associated with increased risk of diabetes in later life. However, the evidence is inconsistent and sparse, especially among East Asians where reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy and pregnancy loss (miscarriage, induced abortion, and still birth) with the risk of incident diabetes in later life among Chinese women. In 2004-2008, the nationwide China Kadoorie Biobank recruited 302 669 women aged 30-79 years from 10 (5 urban, 5 rural) diverse localities. During 9.2 years of follow-up, 7780 incident cases of diabetes were recorded among 273,383 women without prior diabetes and cardiovascular disease at baseline. Cox regression yielded multiple-adjusted hazard ratios (HRs) for the risk of diabetes associated with pregnancy and pregnancy loss. Overall, 99% of women had been pregnant, of whom 10%, 53%, and 6% reported having a history of miscarriage, induced abortion, and stillbirth, respectively. Among ever pregnant women, each additional pregnancy was associated with an adjusted HR of 1.04 (95% CI 1.03; 1.06) for diabetes. Compared with those without pregnancy loss, women with a history of pregnancy loss had an adjusted HR of 1.07 (1.02; 1.13) and the HRs increased with increasing number of pregnancy losses, irrespective of the number of livebirths; the adjusted HR was 1.03 (1.00; 1.05) for each additional pregnancy loss. The strength of the relationships differed marginally by type of pregnancy loss. Among Chinese women, a higher number of pregnancies and pregnancy losses were associated with a greater risk of diabetes.
| S-EPMC7154020 | biostudies-literature
Project description:BackgroundChronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by airflow blockage. Pregnancy and pregnancy loss may be related to an elevated risk of COPD, although studies have yet to report on this association. Hence, this study aims to investigate the association between pregnancy and pregnancy loss with the risk of COPD among Chinese women.MethodsData on 302,510 female participants from the China Kadoorie Biobank were utilized for this study. Multivariable logistic regression, stratified by sociodemographic and lifestyle factors, was employed to obtain the odds ratio (ORs) and 95% confidence intervals (CIs) for the association between pregnancy and pregnancy loss with COPD.ResultsPregnancy loss was significantly associated with increased risk of COPD (OR 1.19, 95% CI 1.13-1.25), specifically, spontaneous (OR 1.19, 95% CI 1.11-1.29) and induced abortion (OR 1.18, 95% CI 1.12-1.25). Stillbirth, however, was not significantly associated with the risk of COPD (OR 1.09, 95% CI 0.99-1.20). Increasing number of pregnancy losses was associated with increasing risk of COPD (one pregnancy loss: OR 1.14, 95% CI 1.07-1.21, two or more pregnancy loss: OR 1.25, 95% CI 1.17-1.32, and each additional pregnancy loss: OR 1.06, 95% CI 1.03-1.09). A single pregnancy was significantly associated with reduced risk of COPD (OR 0.75, 95% CI 0.59-0.97), although each additional pregnancy was significantly associated with increased risk of COPD (OR 1.03, 95% CI 1.01-1.04).ConclusionPregnancy loss, in particular, spontaneous and induced abortions are associated with increased risk of COPD among Chinese women. A single pregnancy, however, demonstrated protective effects.
| S-EPMC9660272 | biostudies-literature
Project description:BackgroundWomen's parity has been associated with risk of cardiovascular disease (CVD). It is unclear, however, whether it reflects biological effects of childbearing or uncontrolled socio-economic and lifestyle factors associated with childrearing. We assessed the association between number of children and incident CVD outcomes separately in women and men.MethodsIn 2004-08, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30-79 years from 10 diverse regions. During 7 years of follow-up, 24 432 incident cases of coronary heart disease (CHD) and 35 736 of stroke were recorded among 489 762 individuals without prior CVD. Multivariable Cox regression models were used to estimate sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD and stroke associated with number of children.ResultsOverall, 98% of all participants had children and the mean number of children declined progressively from four in older participants to one or two in younger participants. Compared with childless women, women with children had an increased risk of CHD, but not of stroke [HR (95% CI): 1.14 (1.00; 1.30) and 1.03 (0.92; 1.16)]. Corresponding results for men were 1.20 (1.06; 1.35) and 1.13 (1.03; 1.24), respectively. In individuals with children, there was a log-linear association between number of children and CVD outcomes; in women, each additional child was associated with adjusted HRs of 1.02 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke, similar in magnitude to that in men [1.03 (1.01; 1.04) for CHD and 1.02 (1.01; 1.03) for stroke].ConclusionIn Chinese adults, the association between the number of children and risk of CHD and stroke was similar between men and women, suggesting that factors associated with parenthood and childrearing are more likely to affect the risk of CVD outcomes than factors associated with childbearing.
| S-EPMC5837253 | biostudies-literature
Project description:PurposeTo determine whether family history of cardiovascular disease (CVD) is a risk factor for pregnancy loss, given potential shared etiology, including vascular mechanisms involved in reproduction and placentation.MethodsIn a prospective study, first-degree family histories were self-reported before pregnancy among women with 1-2 previous losses. Women were followed for up to 6 menstrual cycles while attempting pregnancy and through pregnancy. Pregnancies were ascertained by urinary human chorionic gonadotropin and confirmed by ultrasound. Risk ratios and 95% confidence intervals for pregnancy loss were estimated using weighted Poisson regression models with robust standard errors adjusted for covariates including prepregnancy body mass index and sociodemographics.ResultsOf 1228 women enrolled, 742 had a clinically confirmed pregnancy, and of these, 18% experienced a clinical pregnancy loss. Forty six percent of women reported family history of CVD, diabetes, hypertension, or hypercholesterolemia/dyslipidemia. Family history of CVD was not associated with the risk of pregnancy loss overall (1.01; 95% confidence interval: 0.64, 1.59) or among women with 2 previous losses (1.05; 0.51, 2.17). Family history of hypertension was also not associated with pregnancy loss (0.98; 0.65, 1.46).ConclusionsFamily history of CVD is not providing additional information helpful in determining the risk of subsequent pregnancy loss in an at-risk group.
| S-EPMC6548640 | biostudies-literature
Project description:AimsTo assess the associations of problem drinking with wellbeing and mortality in Chinese men.DesignPopulation-based prospective cohort study.SettingTen diverse areas across China.ParticipantsA total of 210 259 men aged 30-79 years enrolled into China Kadoorie Biobank between 2004 and 2008.MeasurementsSelf-reported alcohol intake and indicators of problem drinking (i.e. drinking in the morning, unable to stop drinking, unable to work due to drinking, negative emotions after drinking, having shakes after stopping drinking) were assessed by questionnaire at baseline, along with stressful life events (e.g. divorce, income loss, violence) and wellbeing-related measures (e.g. life satisfaction, sleep problems, depression, anxiety). Problem drinking was defined as reporting at least one of the drinking problem indicators. Follow-up for mortality and hospitalized events was through linkage to death registries and national health insurance systems. Multivariate logistic regression models assessed cross-sectional relationships between problem drinking and stressful life events/wellbeing. Cox proportional hazards regression models estimated prospective associations of problem drinking with mortality/hospitalized events.FindingsA third of men were current regular drinkers (i.e. drank alcohol at least weekly), 24% of whom reported problem drinking: 8% of all men. Experience of stressful life events in the past 2 years, especially income loss [odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.45-2.39], was associated with increased problem drinking. Compared with low-risk drinkers (i.e. intake < 200 g/week, no reported problem drinking or habitual heavy drinking episodes), men with problem drinking had poorer self-reported health, poorer life satisfaction and sleep problems, and were more likely to have symptoms of depression and anxiety. Men with two or more problem drinking indicators had an approximately twofold higher risk for all-cause mortality as well as mortality and morbidity from external causes (i.e. injuries), respectively, and 15% higher risk for any hospitalization, compared with low-risk drinkers (all P < 0.01).ConclusionEight per cent of men in China are problem drinkers, and this is associated with significantly increased risk of physical and mental health problems and premature death.
| S-EPMC7156287 | biostudies-literature
Project description:AimsTo examine the relationship of self-reported diabetes, and of random blood glucose levels among individuals without known diabetes, with the prevalence of cardiovascular disease in Chinese adults.MethodsWe examined cross-sectional data from the China Kadoorie Biobank of 0.5 million people aged 30-79 years recruited from 10 diverse regions of China in the period 2004-2008. Logistic regression was used to estimate the odds ratios of prevalent cardiovascular disease associated with self-reported diabetes, and with measured random blood glucose levels among participants with no history of diabetes, adjusting simultaneously for age, sex, area, education, smoking, alcohol, blood pressure and physical activity.ResultsA total of 3.2% of participants had self-reported diabetes (men 2.9%; women 3.3%) and 2.8% had screen-detected diabetes (men 2.6%; women 2.8%), i.e. they had no self-reported history of diabetes but a blood glucose level suggestive of a diagnosis of diabetes. Compared with individuals without a history of diabetes, the odds ratios associated with self-reported diabetes were 2.18 (95% CI 2.06-2.30) and 1.88 (95% CI 1.75-2.01) for prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. Among participants without self-reported diabetes there was a positive association between random blood glucose and ischaemic heart disease and stroke/transient ischaemic attack prevalence (P for trend <0.0001). Below the diabetic threshold (<11.1 mmol/l) each additional 1 mmol/l of random blood glucose was associated with 4% (95% CI 2-5%) and 5% (95% CI 3-7%) higher odds of prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively.ConclusionsIn this adult Chinese population, self-reported diabetes was associated with a doubling of the odds of prevalent cardiovascular disease. Below the threshold for diabetes there was still a modest, positive association between random blood glucose and prevalent cardiovascular disease.
| S-EPMC4114560 | biostudies-literature
Project description:A few studies indicate that women with prolonged time-to-pregnancy (TTP) have an increased risk of cardiovascular disease (CVD). This has not been studied in men. We evaluated CVD risk by self-reported TTP among parous women (n = 64,064) and men (n = 50,533) participating in the Norwegian Mother, Father and Child Cohort Study. TTP was categorized as 0-3 (reference), 4-12 and > 12 months. CVD diagnosed between 2008 and 2017 were available from the national patient and general practitioner databases. Risk of CVD by TTP was estimated using Cox regression adjusting for baseline age, education, BMI, smoking, diabetes, and number of offspring in both sexes, and history of endometriosis, ovarian cysts, preterm birth and pre-eclampsia for women. Mean age was 33 for women and 35 for men at baseline (years). The rate of any CVD was 24 per 1000 person years among women and 22 per 1000 person years among men. Longer TTP was associated with increased rate of CVD among women, with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.03, 1.09) for TTP 4-12 months and 1.14 (1.08, 1.20) for TTP > 12 months. Among men, respective HRs for CVD were 1.06 (1.00, 1.10) for TTP 4-12 months and 1.07 (1.01, 1.14) for TTP > 12 months. We observed sex-differences in the relationship with CVD subtypes but none were statistically significant. In conclusion, both men and women with a prolonged TTP had a small increased risk of CVD, clinical significance of which is unclear. Further studies are necessary to investigate in detail what underlying causes of prolonged TTP might be reflected in the increased risk of CVD. Longer follow-up is required to confirm these preliminary findings.
| S-EPMC8076115 | biostudies-literature
Project description:(1) Background: To investigate whether women suffering from recurrent pregnancy loss (RPL) have a higher prevalence of self-reported depression than healthy controls and to assess the associated risk factors for RPL women self-reporting the symptom of depression. (2) Methods: A cross-sectional study investigating 247 women with histories of RPL and 193 healthy women was performed in Southwest China. The Zung Self-Rating Depression Scale (SDS) was used to measure self-reported depression, and the prevalence of self-reported depression was compared between the two groups. Sociodemographic data for the two groups and clinical information for the RPL group were collected by questionnaires. (3) Results: The prevalence of self-reported depression was higher in the RPL group than in the control group (45.3% vs. 30.1%, p < 0.01). Subgroup analyses indicated that the statistical difference in the prevalence of self-reported depression was significant in the subgroups of women in the first trimester of gestation, age ≥ 36 years, BMI ≥ 18.5 kg/m2, working hours ≤ 8 h/day, university and higher education, and urban residence. Multivariable logistic analysis indicated that age ≥ 36 years, >2 times of spontaneous miscarriages, and no history of live birth were independent risk factors for RPL women self-reporting depression. (4) Conclusions: A higher prevalence of self-reported depression was observed in RPL patients than in healthy women. The psychological status for RPL patients with age ≥ 36 years, >2 times of spontaneous miscarriages, or without a history of a live birth needs to be further addressed.
| S-EPMC9785000 | biostudies-literature
Project description:Aims/hypothesisGenome-wide association studies (GWAS) have discovered many risk variants for type 2 diabetes. However, estimates of the contributions of risk variants to type 2 diabetes predisposition are often based on highly selected case-control samples, and reliable estimates of population-level effect sizes are missing, especially in non-European populations.MethodsThe individual and cumulative effects of 59 established type 2 diabetes risk loci were measured in a population-based China Kadoorie Biobank (CKB) study of 93,000 Chinese adults, including >7,100 diabetes cases.ResultsAssociation signals were directionally consistent between CKB and the original discovery GWAS: of 56 variants passing quality control, 48 showed the same direction of effect (binomial test, p = 2.3 × 10(-8)). We observed a consistent overall trend towards lower risk variant effect sizes in CKB than in case-control samples of GWAS meta-analyses (mean 19-22% decrease in log odds, p ≤ 0.0048), likely to reflect correction of both 'winner's curse' and spectrum bias effects. The association with risk of diabetes of a genetic risk score, based on lead variants at 25 loci considered to act through beta cell function, demonstrated significant interactions with several measures of adiposity (BMI, waist circumference [WC], WHR and percentage body fat [PBF]; all p interaction < 1 × 10(-4)), with a greater effect being observed in leaner adults.Conclusions/interpretationOur study provides further evidence of shared genetic architecture for type 2 diabetes between Europeans and East Asians. It also indicates that even very large GWAS meta-analyses may be vulnerable to substantial inflation of effect size estimates, compared with those observed in large-scale population-based cohort studies.Access to research materialsDetails of how to access China Kadoorie Biobank data and details of the data release schedule are available from www.ckbiobank.org/site/Data+Access .
| S-EPMC4901105 | biostudies-literature
Project description:BackgroundAdiposity is increasing rapidly in China but little is known about the relevance to it of women's reproductive factors, which differ inter-generationally and from that in the West. We assess associations of adiposity with life-course reproductive factors in Chinese women.MethodsIn 2004-08, the nationwide China Kadoorie Biobank recruited 303?000 women aged 30-79 (mean 50) years from 10 diverse regions. Multivariable linear regression was used to examine associations of reproductive factors (e.g. age at menarche/first birth/menopause, parity, breastfeeding and reproductive years) with measures of general [e.g. body mass index (BMI)] and central [e.g. waist circumference (WC)] adiposity in adulthood.ResultsOverall, the mean BMI was 23.7 (standard deviation 3.3) kg/m 2 , mean age at menarche was 15 (2) years and nearly all had given birth (99%) and breastfed children (98%). Adiposity was associated inversely with age at menarche and at first birth, with 0.19 and 0.05?kg/m 2 lower BMI and 0.38 and 0.12?cm lower WC per 1-year delay respectively ( P ?<?0.001). Among 128?259 post-menopausal women, adiposity was associated positively with age at menopause and reproductive years, with 0.05 and 0.07?kg/m 2 higher BMI and 0.12 and 0.17?cm higher WC per 1-year increase, respectively ( P ?<?0.001). The proportion with overweight/obesity had similar associations with these reproductive factors. Adiposity had a non-linear positive association with parity, but no association with breastfeeding duration.ConclusionAmong Chinese women, earlier age at menarche and at first birth, later age at menopause and longer reproductive years were independently associated with increased adiposity late in life.
| S-EPMC5837303 | biostudies-literature