title: Early maternal age and multiparity are associated to poor physical performance in middle-aged women from Northeast Brazil: a cross-sectional community based study.
abstract: BACKGROUND
  Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil.
  
  
  METHODS
  The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥ 3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income.
  
  
  RESULTS
  Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed.
  
  
  CONCLUSIONS
  This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.
authors.affiliation: Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil. saionaraaires@gmail.com.
authors.forename: Saionara Maria Aires
authors.initials: SM
authors.lastname: Câmara
authors.affiliation: Office of Public Health Studies, University of Hawaii-Manoa, 1960 East-West Road, Biomedical D104H, Honolulu, HI, 96822-2319, USA. catherinepirkle@gmail.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pirkle
authors.affiliation: Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil. maylinhaandrade@hotmail.com.
authors.forename: Mayle Andrade
authors.initials: MA
authors.lastname: Moreira
authors.affiliation: Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil. mcarmem_@hotmail.com.
authors.forename: Mariana Carmem Apolinário
authors.initials: MC
authors.lastname: Vieira
authors.affiliation: Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, Canada. 5av14@queensu.ca.
authors.forename: Afshin
authors.initials: A
authors.lastname: Vafaei
authors.affiliation: Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Avenida Senador Salgado Filho, S/N Caixa Postal 1524 - Campus Universitário - Lagoa Nova CEP, Natal, RN, 59072-970, Brazil. alvarohuab@hotmail.com.
authors.forename: Álvaro Campos Cavalcanti
authors.initials: ÁC
authors.lastname: Maciel
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005684:Gait / Q000502:physiology*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008423:Maternal Age; D010809:Physical Fitness / Q000502:physiology*; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D016138:Walking / Q000502:physiology; D055815:Young Adult