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(Stroke. 2009;40:2680.)
© 2009 American Heart Association, Inc.

Original Contributions

Pregnancy, Childrearing, and Risk of Stroke in Chinese Women

Xianglan Zhang, MD, MPH; Xiao-Ou Shu, MD, PhD; Yu-Tang Gao, MD; Gong Yang, MD, MPH; Honglan Li, MD Wei Zheng, MD, PhD

From the Department of Medicine (X.Z., X.-O.S., G.Y., W.Z.), Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tenn; and the Department of Epidemiology (Y.-T.G., H.L.), Shanghai Cancer Institute, Shanghai, China.

Correspondence to Xianglan Zhang, MD, MPH, Vanderbilt Epidemiology Center, Institute for Medicine & Public Health, Vanderbilt University Medical Center, Sixth Floor, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738. E-mail xianglan.zhang{at}vanderbilt.edu

Background and Purpose— Although it has been suggested that high gravidity and parity increase the risk for coronary heart disease, their associations with stroke are unclear.

Methods— We evaluated associations of gravidity and parity with incidence of stroke in the Shanghai Women’s Health Study (SWHS), a population-based cohort study of 74 942 Chinese women aged 40 to 70 years at enrollment (1996 to 2000). We also examined the association between number of children and stroke prevalence in both SWHS participants and their husbands. Stroke cases were ascertained through in-person interviews and linkage with vital statistics registries.

Results— During a mean follow-up of 7.3 years, 2343 incident cases of stroke were identified. Women with more pregnancies or live births had a significantly increased risk for incident stroke. After adjustment for socioeconomic status and other potential confounders, women with 5 pregnancies had a hazard ratio for incident stroke of 1.45 (95% CI, 1.18 to 1.77) compared with those with only one pregnancy. At baseline recruitment, 859 and 1274 prevalent cases of stroke were reported among SWHS participants and their husbands, respectively. Stroke prevalence increased with increasing number of children in both women and men. Adjusted ORs of prevalent stroke for having 5 children versus having one child were 1.61 (95% CI, 1.16 to 2.23) in women and 1.45 (1.11 to 1.89) in men.

Conclusions— High gravidity or parity may be related to increased risk of stroke in women. Chronic stress and adverse lifestyle factors related to childrearing may contribute importantly to the increased risk.

Key Words: pregnancy • stroke • women