Associations of parity and age at first pregnancy with overall and cause-specific mortality in the Cancer Prevention Study II

Although associations of parity and age at first birth with overall mortality were small, women who had 6 births, compared with 2, had a 26% higher risk of diabetes mortality.

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Volume 107, Issue 1, Pages 179-188


Mia M. Gaudet, Ph.D., Brian D. Carter, M.P.H., Janet S. Hildebrand, M.P.H., Alpa V. Patel, Ph.D., Peter T. Campbell, Ph.D., Ying Wang, Ph.D., Susan M. Gapstur, Ph.D.



To evaluate the association of parity, number of live births, and age at first birth with mortality using multivariable-adjusted Cox proportional hazards regression models.


Observational cohort.


Not applicable.


A total of 424,797 women.



Main Outcome Measure(s)

All-cause and cause-specific mortality.


During median follow-up of 24.93 years, 238,324 deaths occurred. Parous, compared with nulliparous, women had lower rates of all-cause (hazards ratio [HR] = 0.94, 95% confidence interval [CI] 0.93–0.96) mortality, driven by heart disease and overall cancer mortality. A linear trend was found for more births and diabetes mortality (P<.001) with having ≥6 births, compared with 2, associated with an HR of 1.28 (95% CI 1.15–1.43). Compared with age at first birth from 20–22 years, age at first birth <20 years was associated with higher mortality rates overall (HR = 1.04, 95% CI 1.02–1.06), driven by heart disease and chronic obstructive pulmonary disease mortality; whereas, ≥35 years was associated with higher overall cancer mortality (HR = 1.13, 95% CI 1.06–1.20).


Although parity was associated with a slight reduction in rates of all-cause mortality resulting in a minimal impact on average lifespan, the higher diabetes mortality in grand multiparous women might warrant continuous monitoring, particularly for abnormal glucose metabolism, among these women.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.