Associação entre aspectos relacionados à gestação e fatores de risco cardiometabólicos

Abstract

Pregnancy is a sporadic event in women life, but it has been suggested that it may have long-lasting consequences. Parity would be positively associated with cardiovascular risk factors. And, lower exposure to estrogen among parous women would be a possible mechanism. Furthermore, metabolic and hemodynamic adaptations due to pregnancy could have potential long-term consequences on women’s life, by increasing body mass index, blood pressure, risk of diabetes, or impairing lipids control. This thesis was aimed at assessing the association of parity with metabolic cardiovascular outcomes among young women. The thesis was composed by three manuscripts. Firstly, we systematically reviewed the evidence on the association between parity and metabolic cardiovascular risk factors. We also carried out a meta-analysis and used meta-regression to evaluate the sources of heterogeneity among the studies. Parity is associated with higher risk of obesity. But, parity was not related with risk of hypertension and DM, among high-quality studies. Suggesting that residual confounding may have overestimated the associations, initially, observed. The second and the third manuscripts aimed at assessing the association of parity with body composition and metabolic cardiovascular outcomes, respectively, among women enrolled in the 1982 Pelotas Birth Cohort. The analyses were replicated among the cohort men as a sensitivity analysis. Parity was positively associated with body mass index and waist circumference among women. However, similar results among men suggest that there is no causal effect of parity in these associations. Regarding metabolic cardiovascular outcomes, parity was inversely associated with blood pressure [Systolic -1.97mmHg (95%CI: -3.26; -0.68); Diastolic -2.40mmHg (95%CI: -3.40; -1.40)], total (-6.22; 95%CI -10.22; -2.22) and HDL cholesterol (-5.87; 95%CI -7.36; -4.37) and sensitivity analysis suggests that the association is causal. In conclusion, this thesis suggests that there is no causal association of parity and cardiovascular risk factor. Further studies should focus on the cardiovascular diseases associated with parity.