title: MECHANISMS IN ENDOCRINOLOGY: Parity and risk of type 2 diabetes: a systematic review and dose-response meta-analysis.
abstract: OBJECTIVE
  Epidemiologic studies regarding the association between parity and risk of type 2 diabetes have yielded inconsistent results. Therefore, we performed a systematic review and dose-response meta-analysis to determine the relation between parity and type 2 diabetes risk.
  
  
  METHODS
  We searched PubMed and Embase for published epidemiologic studies that assessed the relation between parity and risk of type 2 diabetes up to 31 March 2016. A dose-response random-effects model was used to combine study-specific relative risks (RRs) and 95% confidence intervals (CIs). Potential sources of heterogeneity were explored by meta-regression and subgroup analyses.
  
  
  RESULTS
  Seven cohort studies, 1 case-control study and 9 cross-sectional studies including 296 923 participants were eligible for inclusion. The combined RR for the highest versus lowest category of parity indicated a 54% increment in type 2 diabetes risk (95% CI: 29-83%). In the cubic spline model, a nonlinear association was found between parity and risk of type 2 diabetes (P = 0.02 for nonlinearity). Compared with nulliparous women, the estimated RR (95% CI) of type 2 diabetes for women with one to seven children was 1.01 (0.96-1.07), 1.08 (1.00-1.16), 1.20 (1.12-1.30), 1.32 (1.22-1.42), 1.37 (1.27-1.48), 1.39 (1.26-1.52) and 1.39 (1.23-1.57) respectively.
  
  
  CONCLUSIONS
  Higher parity is significantly associated with an increased risk of type 2 diabetes. Further studies are warranted to fully adjust for the potential confounders and explore the causality between parity and type 2 diabetes risk.
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors.forename: Peiyun
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors.forename: Zhilei
authors.initials: Z
authors.lastname: Shan
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Pathology and Laboratory MedicineEmory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Manling
authors.initials: M
authors.lastname: Xie
authors.affiliation: Department of EpidemiologyCollege of Public Health, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Bao
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Rong
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China lgliu@mails.tjmu.edu.cn yw8278@hotmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Nutrition and Food HygieneHubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China MOE Key Lab of Environment and HealthSchool of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China lgliu@mails.tjmu.edu.cn yw8278@hotmail.com.
authors.forename: Liegang
authors.initials: L
authors.lastname: Liu
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D005260:Female; D006801:Humans; D010298:Parity / Q000502:physiology*; D011247:Pregnancy; D012306:Risk