title: Association of number of live births with left ventricular structure and function. The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  Pregnancy is associated with marked maternal cardiovascular/hemodynamic changes. A greater number of pregnancies may be associated with long-term subclinical changes in left ventricular (LV) remodeling.
  
  
  METHODS
  Among 2,234 white, black, Hispanic, and Chinese women (mean age 62 years) in the MESA, we used linear regression to relate live births and cardiac magnetic resonance imaging LV measures. Covariates included age, ethnicity, height, income, education, birth country, smoking, menopause, and oral contraceptive duration. Models were additionally adjusted for potential mediators: systolic blood pressure, antihypertensive use, total/high-density lipoprotein cholesterol, triglycerides, diabetes, and body mass index. We performed sensitivity analyses excluding 763 women in the lowest socioeconomic group: annual income <$25,000 and lower high school level of education.
  
  
  RESULTS
  With each live birth, LV mass increased 1.26 g; LV end-diastolic volume, 0.74 mL; and LV end-systolic volume, 0.45 mL; LV ejection fraction decreased 0.18% (P trend <0.05). Changes were most notable for the category of women with ≥5 pregnancies. Upon adjustment for potential biologic mediators, live births remained positively associated with LV mass and end-systolic volume. Live births remained significantly associated with LV end-systolic, end-diastolic volumes, and LV mass (P trend ≤0.02) after excluding women in the lowest socioeconomic group.
  
  
  CONCLUSIONS
  Number of live births is associated with key LV structural and functional measures in middle to older ages, even after adjustment for sociodemographic factors and cardiovascular disease risk factors. Hemodynamic changes during pregnancy may be associated with cardiac structure/function beyond childbearing years.
authors.affiliation: Division of Cardiology, Queens Medical Center and John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA. nparikh@queens.org
authors.forename: Nisha I
authors.initials: NI
authors.lastname: Parikh
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: João A
authors.initials: JA
authors.lastname: Lima
authors.forename: David
authors.initials: D
authors.lastname: Bluemke
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050498:Live Birth / Q000208:ethnology*; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure; D020257:Ventricular Remodeling / Q000502:physiology*