Association between parity and markers of inflammation: The multi-ethnic study of atherosclerosis

Angelica Ezeigwe, Oluseye Ogunmoroti, Anum S Minhas, Carla P Rodriguez, Brigitte Kazzi, Oluwaseun E Fashanu, Olatokunbo Osibogun, Lara C Kovell, Colleen M Harrington, Erin D Michos, Angelica Ezeigwe, Oluseye Ogunmoroti, Anum S Minhas, Carla P Rodriguez, Brigitte Kazzi, Oluwaseun E Fashanu, Olatokunbo Osibogun, Lara C Kovell, Colleen M Harrington, Erin D Michos

Abstract

Introduction: Multiparity has been associated with increased risk of cardiovascular disease (CVD). Inflammation may be a mechanism linking parity to CVD. We investigated the association between parity and later-life markers of inflammation.

Methods: We studied 3,454 female MESA participants aged 45-84, free of CVD, who had data on parity and inflammatory markers. Parity was categorized as 0 (reference), 1-2, 3-4, or ≥5. Linear regression was used to evaluate the association between parity and natural log-transformed levels of fibrinogen, D-dimer, GlycA, high sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL-6).

Results: Mean age was 62 ± 10 years. The proportion of women with nulliparity, 1-2, 3-4, and ≥5 live births were 18, 39, 29, and 14%, respectively. There was no association between parity and fibrinogen. Women with grand multiparity (≥5 live births) had 28, 10, and 18% higher levels of hsCRP, IL-6 and D-dimer, respectively, compared to nulliparous women, after adjustment for demographic factors. After additional adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher hsCRP and women with 1-2 live births had higher GlycA.

Conclusion: In this diverse cohort of middle-to-older aged women, we found that higher parity was associated with some inflammatory markers; however, these associations were largely attenuated after adjustment for CVD risk factors. There was no clear dose-response relationship between parity and these inflammatory markers. Future studies are needed to evaluate how inflammation may influence the link between parity and CVD and whether healthy lifestyle/pharmacotherapies targeting inflammation can reduce CVD risk among multiparous women.

Clinical trial registration: The MESA cohort design is registered at clinicaltrials.gov as follows: https://ichgcp.net/clinical-trials-registry/NCT00005487.

Keywords: D-dimer; GlycA; IL-6; fibrinogen; hsCRP; inflammation; parity; pregnancy.

Conflict of interest statement

Unrelated to this work, Author EM has served on advisory boards for Pfizer, Esperion, Novartis, Novo Nordisk, Bayer, Boehringer Ingelheim, Amarin, and Astra Zeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Ezeigwe, Ogunmoroti, Minhas, Rodriguez, Kazzi, Fashanu, Osibogun, Kovell, Harrington and Michos.

Figures

Figure 1
Figure 1
Box plot of inflammatory markers by parity categories. The lower and upper boundaries of the rectangles denote the 25th and 75th percentiles while the horizontal line within the rectangles is the median. Lines extend from the rectangles to the smallest and largest values within 1.5 × interquartile range.

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