Key result
Higher parity linked to worse LV systolic and diastolic function and increased incident heart failure.
Why the study?
Although each live birth has been associated with increased long-term risk and earlier diagnosis of incident HF in women, the impact of delivering multiple children on cardiac structure prior to HF onset was unknown.
Does an increasing number of liveborn children adversely affect long-term cardiac structure and function prior to the onset of heart failure in post-menopausal women?
Cohort
Yes
Does an increasing number of liveborn children adversely affect long-term cardiac structure and function prior to the onset of heart failure in post-menopausal women?
In post-menopausal women without prevalent heart failure, a higher number of prior live births is associated with adverse long-term changes in left and right ventricular systolic and diastolic function prior to heart failure onset.
Answers are grounded in this paper and cite their sources.
Parity-associated LV systolic decline may precede earlier HF onset in women; hypothesis-generating and should not yet change practice.
Background Evidence from multiple observational cohorts has suggested that each live birth increases the long-term risk of incident heart failure (HF) in women as well as earlier age of HF diagnosis. The impact of delivering multiple children on cardiac structure prior to onset of HF is unknown. Methods Data from the Atherosclerosis Risk in Communities (ARIC), Cardiovascular Health Study (CHS), Framingham Heart Study (FHS), Jackson Heart Study (JHS), and Multiethnic Study of Atherosclerosis (MESA) comprising were obtained from the NHLBI’s BioLINCC resource. Since echocardiography was not performed at each visit, data were extracted from ARIC visit 5, CHS visit 5, FHS Original visit 16, Offspring visit 8, Omni 1 visit 3, Generation 3/Omni 2/Offspring Spouse baseline visit, JHS baseline visit, and MESA visit 5. Post menopausal women who had not developed heart failure at the time of echo were analyzed. Number of liveborn children was determined from reproductive history data. We analyzed groups of women with 0,1,2,3, and 4+ children. Results Echocardiographic characteristics are summarized according to number of liveborn children in Table 1. Although all women were post-menopausal and did not have a diagnosis of HF, women with more children were older at time of echo. Women with more children had a higher rate of incident HF and earlier age of HF onset. Systolic function decreased significantly with having more children by for the left ventricle and nominally for the right ventricle. Increasing number of children was associated with decreased LV chamber volume and increased RV area. Both E/A ratio and mitral valve deceleration time were increasingly abnormal with increased children. Estimated LV filling pressure using lateral E/e’ ratio was significantly higher with more children. Conclusion In this aggregated, diverse cohort of women, increasing number of liveborn children was associated with adverse changes in systolic, and diastolic function prior to the onset of HF, whereas trends in structural changes were less clear. Understanding the mechanism by which childbirth impacts cardiac function decades later may identify opportunities to mitigate this risk.Echo characteristics vs. number of children
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Shalowitz et al. (2026) conducted a cohort in Post-menopausal women free of heart failure. Number of liveborn children (1, 2, 3, and 4+ children) vs. 0 children (nulliparity) was evaluated on Echocardiographic cardiac structure and function (systolic and diastolic function, LV chamber volume, RV area) and incident heart failure. Having more liveborn children (1, 2, 3, or 4+ vs 0) was associated with decreased LV systolic function, worse diastolic function (higher lateral E/e'), and higher rates of incident heart failure.
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