Adverse health outcomes associated with conditions during the reproductive years in U.S. black women
Conditions during women's reproductive years may influence both adult and infant health. Parity, age at first and last birth, and age at menopause, are the common reproductive factors that have been investigated for adult morbidity and mortality, while prepregnancy obesity is one of the most important maternal factors associated with infant health. Relative few studies have provided informative data on these relations in black women, who have a high prevalence of obesity and a disproportionately high morbidity and mortality from many causes. In this dissertation, I examined the relation of several conditions during women's reproductive years to adverse health outcomes in black women. Data from the Black Women's Health Study (BWHS), a cohort study of 59,000 African American women aged 21-69 at baseline in 1995, was used for all three analyses. In the first and second studies, the relations of both childbearing factors and age at natural menopause to all-cause and cause-specific mortality were assessed in 13 years of follow-up in the BWHS. Information on parity, age at first and last birth, lactation duration, menopause type and menopause age was collected at baseline and updated on biennial follow-up questionnaires. The first study results support the hypothesis that somatic resources used for reproduction may compete with resources required for longevity. Among parous women, late age at last birth may be a marker of reduced reproductive or somatic aging. For women who survived beyond 55 years, the impact of reproductive history on all-cause or cause-specific mortality is negligible. The second study results provide support for the theory that an early natural menopause may serve as a marker of accelerated somatic aging. The association between age at natural menopause and mortality appeared to be modified by female hormone use. Third study was a nested case-control analysis of participants aged 21 to 44 years who had delivered 6,687 full-term singleton births during 1995-2003. Mothers of 691 infants with a birth weight ≥4000g (macrosomia) were compared with mothers of 5,996 infants with a birth weight ≤4000g. Our results indicated that overall obesity, gestational weight gain, and waist circumference were independent risk factors for macrosomia.
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