Parity and incidence of non-insulin-dependent diabetes mellitus

doi:10.1016/0002-9343(92)90674-Z

The American Journal of Medicine

Volume 93, Issue 1, July 1992, Pages 13-18

https://doi.org/10.1016/0002-9343(92)90674-Z Get rights and content

Abstract

purpose: To examine prospectively the association between parity and subsequent incidence of non-insulin-dependent diabetes mellitus (NIDDM). Most previous studies have not controlled for potential confounding by age and obesity.

patients and methods: In a prospective cohort study, 113,606 United States registered nurses aged 30 to 55 years and free of diagnosed diabetes, coronary heart disease, stroke, and cancer at baseline were followed for 12 years. Endpoint was incidence of confirmed NIDDM.

results: During 1,278,188 person-years of follow-up, we confirmed 2,310 incident cases of NIDDM. An apparent association between parity and diabetes was observed in unadjusted analyses (relative risk = 1.56 [95% confidence interval (CI), 1.27 to 1.91] among women with six or more births compared with that in nulliparous women) (p, trend <0.00001). This association was attenuated after adjustment for age (relative risk = 1.19 [CI 0.97 to 1.48], p, trend = 0.06) and was completely abolished after adjustment for both age and body mass index (relative risk = 0.95 [CI 0.75 to 1.19], p, trend = 0.19). Multivariate adjustment for family history of diabetes, age at first birth, hormone use, and other variables did not materially alter these findings. There was no important modifying effect of family history of diabetes on these associations.

conclusions: Despite a temporary diabetogenic effect of pregnancy, parity is not associated with an increased risk of subsequent clinical NIDDM. These data underscore the importance of control for confounding by age and obesity in evaluating these associations.

References (38)

DA Pyke
Parity and the incidence of diabetes
Lancet
(1956)
WPU Jackson
Is pregnancy diabetogenic?
Lancet
(1961)
JB O'Sullivan et al.
The prevalence of diabetes mellitus and related variables: a population study in Sudbury, Massachusetts
J Chronic Dis
(1967)
RA Sicree et al.
The association of noninsulin-dependent diabetes with parity and still-birth occurrence amongst five Pacific populations
Diabetes Res Clin Pract
(1986)
FIR Martin et al.
Glucose tolerance and mortality in diabetes mellitus in Maltese-born residents of Victoria
Med J Aust
(1984)
D Kritz-Silverstein et al.
The effect of parity on the later development of noninsulin dependent diabetes mellitus or impaired glucose tolerance
N Engl J Med
(1989)
JB O'Sullivan et al.
Childbearing and diabetes mellitus
(1966)
MG Fitzgerald et al.
The effect of sex and parity on the incidence of diabetes mellitus
Q J Med
(1961)
F Dreyfuss et al.
A comparison of the number of pregnancies up to the age of 45 in diabetic and nondiabetic women
Isr J Med Sci
(1972)
AJS McFadzean et al.
Diabetes among the Chinese in Hong Kong
Diabetes
(1968)

GD Middleton et al.

Parity and diabetes mellitus

Br J Prev Soc Med

(1968)

DA Pyke et al.

Diabetes in Trinidad

West Indian Med J

(1962)

KM West et al.

Glucose tolerance, nutrition, diabetes in Uruguay, Venezuela, Malaya, and East Pakistan

Diabetes

(1966)

IAM Prior et al.

The epidemiology of diabetes in Polynesians and Europeans in New Zealand and the Pacific

N Z Med J

(1966)

OP Gupta et al.

Aetiological factors in the prevalence of diabetes in urban and rural populations in India

HN Munro et al.

Survey of a Scottish diabetic clinic: a study of the etiology of diabetes mellitus

J Clin Endocrinol

(1949)

EJ Boyko et al.

Effects of childbearing on glucose tolerance and NIDDM prevalence

Diabetes Care

(1990)

B Vinke et al.

Some statistical investigations in diabetes mellitus

Diabetes

(1959)

HC Seftel

Diabetes in the Johannesburg African

Leech

(1964)

Cited by (79)

Higher parity is associated with increased risk of Type 2 diabetes mellitus in women: A linear dose–response meta-analysis of cohort studies
2017, Journal of Diabetes and its Complications
Citation Excerpt :
The association might have been stronger with the inclusion of the missed information (Druet et al., 2006). Thirdly, some included studies (Fowler-Brown et al., 2010; Manson et al., 1992; Tian et al., 2014) had not evaluated the appropriate population, e.g. the study was hospital based, had age restrictions (≥ 60 or 45 years), which might have led to bias and impacted the association between parity and the T2DM risk (Egger et al., 1997; Higgins & Green, 2011). Fourthly, geographic location and age can be important factors in the risk estimates for T2DM (Chan et al., 2009).
The goal of this study is to investigate the association between higher parity and the risk of occurrence of type 2 diabetes mellitus (T2DM) in women and to quantify the potential dose–response relation.
We searched MEDLINE, and EMBASE electronic databases for related cohort studies up to March 10th, 2016. Summary rate ratios (RRs) and 95% confidence intervals (CIs) for T2DM with at least 3 categories of exposure were eligible. A random-effects dose–response analysis procedure was used to study the relations between them.
After screening a total of 13,647 published studies, only 7 cohort studies (9,394 incident cases and 286,840 female participants) were found to be eligible for this meta-analysis. In the category analysis, the pooled RR for the highest number of parity vs. the lowest one was 1.42 (95% CI: 1.17–1.72, I² = 71.5%, P_{heterogeneity} = 0.002, Power = 0.99). In the dose–response analysis, a noticeable linear dose–risk relation was found between parity and T2DM (P_{for nonlinearity test} = 0.942). For every live birth increase in parity, the combined RR was 1.06 (95% CI: 1.02–1.09, I² = 84.3%, P_{heterogeneity} = 0.003, Power = 0.99). Subgroup and sensitivity analyses yielded similar results. No publication bias was found in the results.
This meta-analysis suggests that higher parity and the risk of T2DM show a linear relationship in women.
Associations of parity and age at first pregnancy with overall and cause-specific mortality in the Cancer Prevention Study II
2017, Fertility and Sterility
To evaluate the association of parity, number of live births, and age at first birth with mortality using multivariable-adjusted Cox proportional hazards regression models.
Observational cohort.
Not applicable.
A total of 424,797 women.
None.
All-cause and cause-specific mortality.
During median follow-up of 24.93 years, 238,324 deaths occurred. Parous, compared with nulliparous, women had lower rates of all-cause (hazards ratio [HR] = 0.94, 95% confidence interval [CI] 0.93–0.96) mortality, driven by heart disease and overall cancer mortality. A linear trend was found for more births and diabetes mortality (P<.001) with having ≥6 births, compared with 2, associated with an HR of 1.28 (95% CI 1.15–1.43). Compared with age at first birth from 20–22 years, age at first birth <20 years was associated with higher mortality rates overall (HR = 1.04, 95% CI 1.02–1.06), driven by heart disease and chronic obstructive pulmonary disease mortality; whereas, ≥35 years was associated with higher overall cancer mortality (HR = 1.13, 95% CI 1.06–1.20).
Although parity was associated with a slight reduction in rates of all-cause mortality resulting in a minimal impact on average lifespan, the higher diabetes mortality in grand multiparous women might warrant continuous monitoring, particularly for abnormal glucose metabolism, among these women.
Parity and incident type 2 diabetes in older Chinese women: Guangzhou Biobank Cohort Study
2023, Scientific Reports
Multiparity increases the risk of diabetes by impairing the proliferative capacity of pancreatic β cells
2023, Experimental and Molecular Medicine
Correlation between parity and metabolic syndrome in Chinese women aged 40 years and older: the Reaction study
2021, BMC Endocrine Disorders
Associations between parity, pregnancy loss, and breastfeeding duration and risk of maternal type 2 diabetes: An observational cohort study
2021, Journal of Diabetes

View all citing articles on Scopus

^☆: This work was supported by research grants (DK 36798, HL 34594, and CA 40356) from the National Institutes of Health.

¹: Dr. Manson was the recipient of a fellowship from the Andrew W. Mellon Foundation.

View full text

Parity and incidence of non-insulin-dependent diabetes mellitus☆

Abstract

Lancet

Lancet

J Chronic Dis

Diabetes Res Clin Pract

Glucose tolerance and mortality in diabetes mellitus in Maltese-born residents of Victoria

Med J Aust

The effect of parity on the later development of noninsulin dependent diabetes mellitus or impaired glucose tolerance

N Engl J Med

Childbearing and diabetes mellitus

The effect of sex and parity on the incidence of diabetes mellitus

Q J Med

A comparison of the number of pregnancies up to the age of 45 in diabetic and nondiabetic women

Isr J Med Sci

Diabetes among the Chinese in Hong Kong

Diabetes

Parity and diabetes mellitus

Br J Prev Soc Med

Diabetes in Trinidad

West Indian Med J

Glucose tolerance, nutrition, diabetes in Uruguay, Venezuela, Malaya, and East Pakistan

Diabetes

The epidemiology of diabetes in Polynesians and Europeans in New Zealand and the Pacific

N Z Med J

Aetiological factors in the prevalence of diabetes in urban and rural populations in India

Survey of a Scottish diabetic clinic: a study of the etiology of diabetes mellitus

J Clin Endocrinol

Effects of childbearing on glucose tolerance and NIDDM prevalence

Diabetes Care

Some statistical investigations in diabetes mellitus

Diabetes

Diabetes in the Johannesburg African

Leech