Association of adverse pregnancy outcomes and multiple gestation with natural menopause: A population-based cohort study. (January 2023)

• Record Type: Journal Article
• Authors: Langton, Christine R.; Whitcomb, Brian W.; Purdue-Smithe, Alexandra C.; Harmon, Quaker E.; Hankinson, Susan E.; Manson, JoAnn E.; Rosner, Bernard A.; Bertone-Johnson, Elizabeth R.
• Is Part Of: Maturitas. Volume 167(2023)
• Page Start: 82
• Page End: 89
• Publication Date: 2023-01
• Subjects: APO adverse pregnancy outcome -- ART assisted reproductive technologies -- BMI body mass index -- CI confidence interval -- CVD cardiovascular disease -- GDM gestational diabetes -- HDP hypertensive disorders of pregnancy -- HR hazard ratio -- HT hormone therapy -- NHS2 Nurses' Health Study II cohort -- OC oral contraceptive -- PCOS polycystic ovary syndrome; Gestational diabetes -- Hypertensive disorders of pregnancy -- Menopause -- Multiple gestation -- Preterm birth -- Women's health; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2022.10.003
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: In this study, multiple gestation was associated with increased risk of early natural menopause. Preterm birth with spontaneous labor was associated with younger age at natural menopause. Gestational diabetes and hypertensive disorders of pregnancy were associated with older age at natural menopause. Abstract: Objective: Adverse pregnancy outcomes (APOs) and early menopause are each associated with increased risk of cardiovascular disease (CVD); whether APOs are associated with age at menopause is unclear. We examined the association of gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preterm birth, and multiple gestation with age at natural menopause. Study design: Observational, prospective study within the Nurses' Health Study II cohort (1989–2019). Main outcomes measures: Risk of early natural menopause, defined as occurring before the age of 45 years, and age at onset of natural menopause (hazard ratio (HR) >1 indicates younger age at menopause). Results: The mean [SD] baseline age of 69, 880 parous participants was 34.5 [4.7] years. Compared with participants who had a term singleton first birth, those with a term multiple-gestation first birth had higher risk of early menopause (HR: 1.65, 95% CI: 1.05, 2.60) and younger age at natural menopause (HR: 1.46, 95% CI: 1.31, 1.63). Estimates for preterm multiple gestation were of similar magnitude. Menopause occurred at a younger age for those with a preterm birth with spontaneous labor (HR: 1.08, 95% CI: 1.03, 1.14) compared to those with a term birth with spontaneous labor. Conversely, estimates for GDM (HR: 0.95, 95% CI: 0.89, 1.02) and HDP (preeclampsia, HR: 0.93, 95% CI: 0.89, 0.97) suggested an association with older age at menopause. Conclusions: In this large cohort study, several statistically significant associations between APOs and age at natural menopause were observed. A deeper understanding of the relationships among APOs, menopause, and CVD is needed to help identify people at higher risk for early menopause and later CVD.