Background information

The research was based on the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which is one of the largest cohort studies in the world, with more than half a million participants recruited across 10 European countries and followed for almost 15 years. The study used data from EPIC-Heart study; a subset of the main EPIC study investigates the impact that genetic, environmental and metabolic factors have on CHD using lifestyle information and blood tests from 11, 299 women from 10 European countries.

Main findings

The study indicates that the risk of CHD is positively associated with the number of children a woman has, presenting an increased risk (47% higher than women with no children) in women with four or more children. Each new pregnancy was found to have a detrimental effect on the level of LDL-cholesterol, triglycerides, lipids and on the coagulation process [1], [2], which may translate later in life in to an increased risk of hypertension [3], weight variability and body fat distribution [4], [5]. This risk of CHD was not assessed in this study.

Life-style related risks seemed to have most impact on women’s health rather than subsequent biological and psychological changes such as weight gained due to child bearing . Generally, each new pregnancy can potentially lead to increased stress levels owing to increased responsibilities, financial stress and sleep deprivation. It may also encourage sedentary behaviour and smoking [6] [7] [8] , change to a poorer diet and a lower level of physical activity [9]. In our study, however, the socio-economic status, education level, smoking and alcohol intake were not independent risk factors. This may suggest the need for new directions of research looking at the role played by stress level, dietary intake, and physical activity. Given the positive impact that moderate physical activity, consumption of vegetables and stress therapy has on general health [10], [11], a future analysis of these factors would hopefully clarify the mechanisms around reproductive health and CHD.

Conclusion

The study suggests a positive association between the number of children produced and the risk of CHD, indicating an increased risk in women with four or more children. It is also worth looking at the links with ethnicity. Although gender segmented data of Roma communities is scarce, previous studies suggest that they have a higher risk of cardiovascular disease, including CHD [12], [13], and a higher mortality as a result [14] than non-Roma in Bulgaria, Slovakia and Serbia. Roma women tend to have children from and early age, hence they have large families. They also face a number of barriers related to their traditional roles [15], limited educational and employment opportunities, poorer living conditions and physical [16] and social isolation [17], [18]. They are also more likely to experience stress, loneliness and depression as a result of their subordinate role in the Roma community as highlighted in a thematic study issued in 2012 in Slovenia by the Fundamental Rights Agency. [19] Therefore, their health is at stake and worth further consideration.

Reflections

Broadly, the study opens up new lines of enquiry in understanding what makes someone susceptible to CHD in the first place. It may also act as an incentive for women to consider the risks that could accompany having an expanded family. The findings may point towards new directions of research looking at the role that stress level, diet and physical activity play in different ethnic groups.

Diana Pirjol,

EPHA Roma Health Fellow


- EPHA Roma Fellowship Programme


- Related EPHA articles


Footnotes

[1] Ness RB, Schotland HM, Flegal KM, Shofer FS. Reproductive history and coronary heart disease risk in women. Epidemiol Rev 1994;16:298-314.

[2] Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA 1991;265:1861-67.

[3] Skilton MR. Parity and risk of stroke: Fetal origins of adult disease? Neurology 2010;74:1408-9.

[4] Ness RB, Schotland HM, Flegal KM, Shofer FS. Reproductive history and coronary heart disease risk in women. Epidemiol Rev 1994;16:298-314.

[5] Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA 1991;265:1861-67.

[6] Teo KK, Ounpuu S, Hawken S, Pandey MR, Valentin V, Hunt D, Diaz R, Rashed W, Freeman R, Jiang L, Zhang X, Yusuf S. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet 2006;368:647-58.

[7] Lawlor DA, Emberson JR, Ebrahim S, Whincup PH, Wannamethee SG, Walker M, Smith GD. Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women’s Heart and Health Study and the British Regional Heart Study. Circulation 2003;107:1260-1264.

[8] Lawlor DA, Emberson JR, Ebrahim S, Whincup PH, Wannamethee SG, Walker M, Smith GD. Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women’s Heart and Health Study and the British Regional Heart Study. Circulation 2003;107:1260-1264.

[9] Zhang X, Shu XO, Gao YT, Yang G, Li H, Zheng W. Pregnancy, childrearing, and risk of stroke in Chinese women. Stroke 2009;40:2680-2684.

[10] Lawlor DA, Emberson JR, Ebrahim S, Whincup PH, Wannamethee SG, Walker M, Smith GD. Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women’s Heart and Health Study and the British Regional Heart Study. Circulation 2003;107:1260-1264.

[11] Hardy R, Lawlor DA, Black S, Wadsworth ME, Kuh D. Number of children and coronary heart disease risk factors in men and women from a British birth cohort. BJOG 2007;114:721-30.

[12] Vozar J, Hanson R, de Court, Zahorakova A, Egyenes HP, Tataranni A et al. Higher prevalence rates of cardiovascular disease in gypsies compared to Caucasians in Slovakia. Diabetologia 2002; 45:A95.

[13] Sudzinova AF, Nagyova IF, Studencan MF, Rosenberger JF, Skodova ZF, Vargova HF et al. Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma.

[14] Bogdanovic DF, Nikic DF, Petrovic BF, Kocic BF, Jovanovic JF, Nikolic MF et al. Mortality of Roma population in Serbia, 2002-2005. Croat Med Journal 2007; 48(5):720-726.

[15] FRA Country thematic studies on the situation of Roma, June 2013. Available at: http://fra.europa.eu/en/country-dat....

[16] Todorova IF, Baban AF, Alexandrova-Karamanova AF, Bradley J. Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania.

[17] Todorova IF, Baban AF, Alexandrova-Karamanova AF, Bradley J. Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania.

[18] Kosa Z, Szeles G, Kardos L, Kosa K, Nemeth R, Orszagh S et al. A comparative health survey of the inhabitants of Roma settlements in Hungary. Am J Public Health 2007; 97(5):853-859.

[19] FRA Country thematic studies on the situation of Roma, June 2013. Available at: http://fra.europa.eu/en/country-dat....

Last modified on October 8 2015.