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.
Abbreviations:
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)Keywords
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Article Info
Publication History
Published online: October 21, 2022
Accepted:
October 16,
2022
Received in revised form:
September 2,
2022
Received:
June 30,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
