Canadian Journal of Cardiology

Parity History and Later Life Sex Hormone Levels in the Multi-Ethnic Study of Atherosclerosis (MESA)

Published:September 07, 2022DOI:



      Multiparity is a risk factor for cardiovascular disease (CVD). A more androgenic sex hormone profile, with a higher testosterone/estradiol (T/E2) ratio, is associated with worse CVD outcomes in women and may be one mechanism linking multiparity to increased CVD risk. We investigated the relationship between parity and sex hormones at mid-to-older age.


      We performed a cross-sectional analysis of 2,979 women with data on parity and endogenous sex hormone levels from MESA, a community-based cohort. Parity and gravidity (our exposures) were categorized as 0 (reference), 1-2, 3-4, or ≥5. Our outcome measures were testosterone (T), estradiol (E2), sex-hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), and T/E2 ratio. Progressively-adjusted linear regression was used to evaluate the association of parity/gravidity with sex hormones.


      In multivariable-adjusted models, there were no significant associations of parity with E2, DHEA, and SHBG. Compared to nulliparity, after adjustment for CVD risk factors, women with 1-2 and 3-4 live births had higher T, but this was not significant for grand multiparity (≥5 live births). However, grand multigravidity (≥5 pregnancies) was associated with 10% (95% CI: 1%, 20%) higher T and 14% (1%, 29%) higher T/E2, compared to null-gravidity. Grand multiparity was associated with an 18% (4%, 34%) higher T/E2 ratio compared to nulliparity, after adjustment for CVD risk factors.


      In this multiethnic cohort, women with grand multigravidity and grand multiparity had higher T/E2 levels, reflecting a more androgenic sex hormone profile. Longitudinal studies evaluating sex hormones’ influence on the relationship between multiparity and CVD are warranted.

      Graphical abstract


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