Abstract
Aims/hypothesisIn women, higher parity has been associated with increased risk of diabetes later in life. It is unclear, however, whether this association is mainly due to biological effects of childbearing, or to socioeconomic and lifestyle factors associated with childrearing. We assessed the association between number of children and diabetes risk separately in women and men.MethodsBetween 2004 and 2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30–79 (mean 51 years) from ten diverse regions across China. During 7 years of follow-up, 8,840 incident cases of diabetes were recorded among 463,347 participants without prior cardiovascular diseases or diabetes. Multivariable Cox regression yielded sex-specific HRs and 95% CIs for incident diabetes by number of children.ResultsOverall, ∼98% of all participants had children. In women, there was a J-shaped association between number of children and risk of diabetes. Compared with women with one child, the adjusted HRs for diabetes were 1.39 (95% CI 1.11, 1.73) for childless women, 1.12 (95% CI 1.07, 1.18) for those with two children, 1.23 (95% CI 1.16, 1.31) for those with three children, and 1.32 (95% CI 1.21, 1.44) for those with four or more children. In men, there was a similar association with risk of diabetes; the corresponding HRs were 1.28 (95% CI 1.02, 1.60), 1.19 (95% CI 1.12, 1.26), 1.32 (95% CI 1.21, 1.44) and 1.41 (95% CI 1.24, 1.60), respectively. In both sexes, the findings were broadly similar in different population subgroups.Conclusions/interpretationThe similarity between women and men in the association between number of children and risk of diabetes suggests that parenthood is most likely to affect diabetes risk through factors associated with childrearing rather than via biological effects of childbearing.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-016-3980-x) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
Highlights
Pregnancy causes marked alterations in women’s metabolic profile, including reduced insulin sensitivity, increased production of insulin, and accumulation and redistribution of body fat
We examined the relationship between parenthood and the risk of incident diabetes in both women and men in the China Kadoorie Biobank (CKB) [20], a prospective study of 500,000 individuals recruited from ten diverse regions in China
The prevalence of current smoking and weekly alcohol use was considerably higher in men than in women across all parenthood categories
Summary
Pregnancy causes marked alterations in women’s metabolic profile, including reduced insulin sensitivity, increased production of insulin, and accumulation and redistribution of body fat. These changes could lead to gestational diabetes and may increase the mother’s risk of developing diabetes and associated cardiometabolic diseases later in life [1,2,3]. A number of studies found that parity, grand multiparity, is associated with an increased risk of diabetes [4,5,6,7,8,9,10,11], but this was not supported by other studies [12,13,14].
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