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Parity and the Risk of Type 2 Diabetes
Per Ovesen1, Sidsel Ipsen1, Søren Lundbye-Christensen2, Steen Rasmussen3, Lone Krebs3, Niels Jørgen Secher3.
1Department of Obstetrics and Gynecology, Skejby Sygehus, 8200 Aarhus N, University of Aarhus, 2University of Aalborg and 3University of Copenhagen, Denmark
Parity and incidence of diabetes Mellitus
Abstract
The relationship between parity and the risk of diabetes remains controversial. Some investigations show that parity, particularly five or more births, might be associated with higher incidence of
diabetes, whereas others found no association.
We performed a population-based cohort study including all Danish women who gave birth during year 1982-1983 (n = 100238). The cohort was identified in the National Birth Register and
information on maternal age and parity was retracted from the register. The women were followed in the National Patient Register through year 2004 and information on type, date, interval from
birth to diagnosis of diabetes was recorded.
A total of 1717 cases were diagnosed with diabetes in the follow-up period of 23 years. The women in the study were between 13 and 50 years old at the time of delivery. We grouped the study
population according to age: the young (age 13-22 years) comprising 19% of the total births, middle group (23-29 years) comprising 55% of the births and old group (30-50 years) comprising
26% of the births. In all groups there was a significant effect of parity on the development of diabetes. In the middle group we found a 10 fold increased risk of diabetes in the group with 5 or
more deliveries. In the old group there was a 4 fold increased risk of diabetes in the group with 5 or more deliveries. In the young group the effect of parity 4 or 5+ is very questionable, because
of the very few women in these groups. Still a significant effect of parity in the same order of magnitude as in the middle group was found
In conclusion these data shows that parity is associated with an increased risk of diabetes.
BACKGROUND
• Diabetes is a growing problem in the industrialised world. Most of the cases are due to
Table 1 Parity in relation to diabetes
+ diabetes -diabetes
parity
1
2
3
4
5+
639 (1,4%)
535 (1,4%)
286 (2,2%)
146 (4,6%)
111 (9,1%)
44817
37107
12429
3052
1107
9
9
8
8
7
7
6
6
5
5
4
4
3
1
2
0
1
1
Para 1
Para 2
Para 3
Para 4
3
4
5 and
more
Parity
Para 5+
A total of 1717 cases were diagnosed with diabetes in the follow-up period
of 23 years. This correlates to 1.7% of the cohort.
We found a 7-fold increased risk of diabetes in the group with 5 or more
deliveries compared with 1 delivery.
The women in the study were between 13 and 50 years old at the time of
delivery. We grouped the study population in age groups:
% diabetes
10
The young (age 13-22 years) comprising 19% of the total births, middle
group (23-29 years) comprising 55% of the births and old group (30-50
years) comprising 26% of the births.
8
Para 5+
Para 4
Para 3
Para 2
Para 1
6
4
2
birth during year 1982-1983.
• The cohort was identified in the National Birth Register and information on maternal
age and parity was retracted from the register.
•100.238 cases were included in the study, all non-diabetics.
•The women were followed in the National Patient Register through year 2004 and
information on type, date, interval from birth to diagnosis of diabetes was recorded
2
SUMMARY
12
• We performed a population-based cohort study including all Danish women who gave
30-50 yr
2
• An effect of parity on subsequent risk of diabetes is biologically plausible, because
pregnancy is associated with insulin resistance. Whether this metabolic stress during
pregnancy confers an increased risk of diabetes or other disease states remains an
unsolved question.
DESIGN and METHODS
13-22 yr
3
• The relationship between parity and diabetes remains controversial. Some – but not all
- investigations show that parity, particularly five or more births, might be associated
with higher incidence of diabetes.
To evaluate the relationship between parity and incidence of diabetes in a Danish
register study.
23-29 yr
10
10
0
type 2 diabetes, many of whom are diagnosed in young people. Certain risk factors such
as age, adiposity and gestational diabetes are well known.
AIM
Hazard-ratio
0
33-50
23-32
13-22
Age (years)
In all groups there was a significant effect of parity on the development of
diabetes.
In the middle group we found a 10 fold increased risk of diabetes in the
group with 5 or more deliveries. In the old group there was a 4 fold
increased risk of diabetes in the group with 5 or more deliveries.
In the young group the effect of parity 4 or 5+ is very questionable,
because of the low sample size. Still a significant effect of parity in the
same order of magnitude as in the middle group was found
CONCLUSION
These data shows that parity is associated with an increased risk of
diabetes