Early Maternal Age at First Birth Is Associated With Chronic Diseases and Poor Physical Performance in Older Age

Cross-Sectional Analysis From the International Mobility in Aging Study

Catherine M Pirkle; Ana Carolina Patrício de Albuquerque Sousa; Beatriz Alvarado; Maria-Victoria Zunzunegui; the IMIAS Research Group

Disclosures

BMC Public Health. 2014;14(293)

Abstract

Background. Early maternal age at first birth and elevated parity may have long-term consequences for the health of women as they age. Both are known risk factors for obstetrical complications with lifelong associated morbidities. They may also be related to diabetes and cardiovascular disease development.

Methods. We examine the relationship between early maternal age at first birth, defined as ≤18 years of age, multiparity (>2 births), and poor physical performance (Short Physical Performance Battery ≤8) in community samples of women between 65 and 74 years of age from Canada, Albania, Colombia, and Brazil (N = 1040). Data were collected in 2012 to provide a baseline assessment for a longitudinal cohort called the International Mobility in Aging Study. We used logistic regression and general linear models to analyse the data.

Results. Early maternal age at first birth is significantly associated with diabetes, chronic lung disease, high blood pressure, and poor physical performance in women at older ages. Parity was not independently associated with chronic conditions and physical performance in older age. After adjustment for study site, age, education, childhood economic adversity and lifetime births, women who gave birth at a young age had 1.75 (95% CI: 1.17 – 2.64) the odds of poor SPPB compared to women who gave birth > 18 years of age. Adjustment for chronic diseases attenuated the association between early first birth and physical performance. Results were weaker in Colombia and Brazil, than Canada and Albania.

Conclusions. This study provides evidence that adolescent childbirth may increase the risk of developing chronic diseases and physical limitations in older age. Results likely reflect both the biological and social consequences of early childbearing and if the observed relationship is causal, it reinforces the importance of providing contraception and sex education to young women, as the consequences of early pregnancy may be life-long.

1 2 3 4 5 6

Next Section

Table 1. Age at first birth and parity by study site (N = 1040).
	Kingston (n = 209)	St Hyacinthe (n = 206)	Tirana (n = 204)	Manizales (n = 200)	Natal (n = 210)
Age at 1st birth¹, mean (SD), yr	25.1 (5.2)	24.3 (4.1)	23.1 (4.1)	21.6 (5.4)	22.2 (5.7)
Women ≤ 18 yr at 1st birth, n (%)	17 (9.3%)	11 (6.4%)	16 (8.4%)	60 (33.3%)	55 (29.0%)
Parity, mean (SD)	2.1 (1.4)	2.1 (1.3)	2.8 (2.2)	4.9 (3.4)	4.9 (3.4)
Women with parity >2, n (%)	65 (31.1%)	74 (35.9%)	101 (49.5%)	153 (76.5%)	154 (73.3%)

¹112 women never gave birth; missing age at first birth data for 14 women.

Table 2. Frequency measures for covariates by study site.
	Kingston (n = 212)	St Hyacinthe (n = 210)	Tirana (n = 206)	Manizales (n = 202)	Natal (n = 210)
Age, mean (SD), yr	69.1 (2.6)	68.6 (2.6)	69.2 (3.1)	69.3 (3.0)	69.3 (2.7)
≤8 yr education, n (%)	4 (2.6%)	45 (21.4%)	97 (47.1%)	172 (85.2%)	190 (90.5%)
Childhood economic adversity, mean (SD)¹	1.0 (0.8)	1.3 (0.7)	1.6 (1.0)	1.5 (0.8)	2.0 (0.9)
*Chronic Conditions* ²
Diabetes, n (%)	23 (10.9%)	34 (16.3%)	60 (29.4%)	33 (16.3%)	66 (31.4%)
Stroke, n (%)	11 (5.2%)	11 (5.2%)	7 (3.4%)	12 (5.9%)	17 (8.1%)
Arthritis, n (%)	129 (60.9%)	116 (55.2%)	135 (65.5%)	79 (39.1%)	106 (50.5%)
Cancer, n (%)	36 (17.0%)	31 (14.8%)	5 (2.4%)	7 (3.5%)	8 (3.8%)
Chronic lung disease, n (%)	30 (14.2%)	26 (12.4%)	31 (15.1%)	34 (16.8%)	18 (8.6%)
Coronary heart disease, n (%)	34 (16.0%)	35 (16. 7%)	59 (28.6%)	33 (16.3%)	36 (17.1%)
Osteoporosis, n (%)	50 (24.1%)	52 (24.8%)	83 (40.3%)	45 (22.3%)	102 (48.6%)
High blood pressure, n (%)	89 (42.0%)	98 (46.7%)	152 (73.8%)	124 (61.4%)	155 (73.8%)
*Outcome* ³
SPPB, mean (SD)	10.2 (2.0)	10.0 (1.7)	8.4 (3.0)	9.4 (1.9)	8.4 (2.4)
SPPB ≤ 8, n (%)⁴	31 (14.6%)	32 (15.2%)	83 (40.3%)	50 (25.9%)	93 (44.3%)

¹Childhood economic adversity scores can vary from 0 to 3. A point was given for each of the following self-reported childhood circumstances: poverty, hunger, and parental unemployment.
²Chronic diseases are self-reported measures.
³SPPB is the Short Physical Performance Battery; scores can vary from 0–12. Scores of 8 or below signify poor physical functioning. ⁴Missing 9 values for Manizales.

Table 3. Association between age at first birth and parity and diagnosis with a chronic disease, ¹ adjusted for study site.
	≤ 18 yr at 1st birth (N = 914)²		≥ 3 lifetime births
	OR (95% CI)	p-value	OR (95% CI)	p-value
High blood pressure	2.09 (1.38 – 3.16)	<0.01	1.64 (1.24 – 2.16)	<0.01
Diabetes	1.88 (1.25 – 2.83)	<0.01	1.71 (1.22 – 2.40)	<0.01
Chronic lung disease	2.40 (1.49 – 3.86)	<0.01	1.38 (0.93 – 2.04)	0.11
Stroke	1.91 (0.98 – 3.73)	0.06	1.25 (0.69 – 2.25)	0.46
Coronary heart disease	1.35 (0.87 – 2.09)	0.18	1.34 (0.95 – 1.87)	0.09
Osteoporosis	1.35 (0.92 – 1.99)	0.13	0.95 (0.71 – 1.26)	0.71
Arthritis	1.04 (0.72 – 1.51)	0.81	0.94 (0.72 – 1.23)	0.65
Cancer	1.10 (0.51– 2.38)	0.81	0.80 (0.49 – 1.30)	0.36

¹Chronic diseases are self-reported measures.
²112 women never gave birth; missing age at first birth data for 14 women.

Table 4. Association between age at first birth and poor physical performance, defined as SPPB ≤8 (N = 907).
	Model 1		Model 2		Model 3
	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Age 1st birth
≤18	1.81 (1.21 – 2.69)		1.75 (1.17 – 2.64)		1.48 (0.96 – 2.28)	0.07
>18	1	<0.01	1	<0.01	1
Age¹	1.12 (1.06 – 1.18)	<0.01	1.12 (1.06 – 1.18)	<0.01	1.11 (1.04 – 1.17)	<0.01
Education
≤8 years	1.59 (1.03 – 2.46)		1.58 (1.01 – 2.45)		1.72 (1.08 – 2.72)
>9 years	1	0.04	1	0.04	1	0.02
Childhood economic adversity²	1.22 (1.02 – 1.46)	0.03	1.22 (1.02 – 1.47)	0.03	1.17 (0.97 – 1.42)	0.10
Study Site
St Hyacinthe	1.08 (0.58 – 1.98)	0.82	1.07 (0.58 – 1.98)	0.82	1.05 (0.55 – 2.00)	0.88
Tirana	3.33 (1.89 – 5.87)	<0.01	3.33 (1.89 – 5.86)	<0.01	3.45 (1.86 – 6.40)	<0.01
Manizales	1.13 (0.58 – 2.21)	0.72	1.10 (0.56 – 2.17)	0.78	1.42 (0.70 – 2.89)	0.33
Natal	2.70 (1.41 – 5.18)	<0.01	2.69 (1.40 – 5.18)	<0.01	3.38 (1.66 – 6.87)	<0.01
Kingston	1		1		1	1
Parity
≥3 children			1.04 (0.72 – 1.50)		1.06 (0.72 – 1.56)
<3 children			1	0.82	1	0.77
Diabetes³
Yes					1.68 (1.15 – 2.45)
No					1	<0.01
Stroke
Yes					2.76 (1.43 – 5.32)
No					1	<0.01
Arthritis
Yes					2.08 (1.47 – 2.97)
No					1	<0.01
Cancer
Yes					2.08 (1.10 – 3.93)
No					1	0.02
Lung disease
Yes					2.20 (1.41 – 3.45)
No					1	<0.01
Coronary heart disease
Yes					1.64 (1.11 – 2.41)
No					1	<0.01
Osteoporosis
Yes					0.98 (0.69 – 1.40)
No					1	0.93
High blood pressure
Yes					1.00 (0.70 – 1.44)
No					1	0.99

¹Age was centred at 64 because participants were only eligible for the study if they were between 64 and 75 years of age. The odds ratio corresponds to each addition year of age after 64.
²Childhood economic adversity scores can vary from 0 to 3. A point was given for each of the following self-reported childhood circumstances: poverty, hunger, and parental unemployment.
³Chronic diseases are self-reported measures.

Table 5. Association between age at first birth and the continuous SBBP score, adjusted for age, parity, education, and childhood economic adversity (N = 907).
	Model 1		Model 2
	Estimate (95% CI)	p-value	Estimate (95% CI)	p-value
Intercept	11.24 (10.79; 11.71)	<0.01	11.87 (11.39; 12.34)	<0.01
Age 1st birth
≤18	−0.798 (−1.19; −0.37)		−0.52 (−0.92; −0.12)
>18	-Ref-	<0.01	1	0.01
Study Site
St Hyacinthe	−0.18 (−0.65; 0.30)	0.47	−0.17 (−0.62; 0.28)	0.47
Tirana	−1.51 (−2.00; −1.02)	<0.01	−1.38 (−1.87; −0.88)	<0.01
Manizales	−0.02 (−0.60; 0.57)	0.95	−0.20 (−0.76; 0.37)	0.49
Natal	−0.94 (−1.5; −0.35)	<0.01	−1.00 (−1.59; −0.41)	<0.01
Kingston	1	1	1	1
Diabetes¹
Yes			−0.56 (−0.90; −0.21)
No			1	<0.01
Stroke
Yes			−1.45 (−2.05; −0.85)
No			1	<0.01
Arthritis
Yes			−0.54 (−0.83; −0.25)
No			1	<0.01
Cancer
Yes			−0.46 (−1.00; 0.06)
No			1	0.09
Lung disease
Yes			−0.88 (−1.29; −0.46)
No			1	<0.01
Coronary heart disease
Yes			−0.56 (−0.92; −0.21)
No			1	<0.01
Osteoporosis
Yes			0.01 (−0.30; 0.32)
No			1	0.96
High blood pressure
Yes			−0.14 (−0.44; −0.17)
No			1	0.38