title: Parity and the association with diabetes in older women.
abstract: OBJECTIVE
  To examine the relationship of parity with diabetes and markers of glucose homeostasis in older women.
  
  
  METHODS
  We used data from the female participants in the Cardiovascular Health Study, a longitudinal cohort of adults aged >or=65 years. These data included an assessment of parity (baseline) and fasting serum levels of glucose, insulin, and medication use (baseline and follow-up). We estimated both the cross-sectional relationship of parity with baseline diabetes and the relationship of parity with incident diabetes.
  
  
  RESULTS
  In unadjusted analyses, women with grand multiparity (>or=5 live births) had a higher prevalence of diabetes at baseline compared with those with fewer births and with nulliparous women (25 vs. 12 vs. 15%; P < 0.001). In regression models controlling for age and race, grand multiparity was associated with increased prevalence of diabetes (prevalence ratio 1.57 [95% CI 1.20-2.06]); with addition of demographic and clinical factors to the model, the association was attenuated (1.33 [1.00-1.77]). In final models that included body anthropometrics, the association was no longer significant (1.21 [0.86-1.49]). In those without diabetes at baseline, parity was not associated with incident diabetes or with fasting glucose; however, there was a modest association of parity with fasting insulin and homeostasis assessment model of insulin resistance.
  
  
  CONCLUSIONS
  Grand multiparity is associated with diabetes in elderly women in cross-sectional analyses. This relationship seems to be confounded and/or mediated by variation in body weight and sociodemographic factors by parity status. In older nondiabetic women, higher parity does not pose an ongoing risk of developing diabetes.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. afowler@bidmc.harvard.edu
authors.forename: Angela G
authors.initials: AG
authors.lastname: Fowler-Brown
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.forename: Janet M
authors.initials: JM
authors.lastname: Catov
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000368:Aged; D001835:Body Weight / Q000502:physiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D010298:Parity / Q000502:physiology*; D011247:Pregnancy; D012959:Socioeconomic Factors