Multiparity and Ideal Cardiovascular Health Among Women in the MESA Study

This MESA sub-analysis examined the association between multiparity — having three or more pregnancies — and ideal cardiovascular health as defined by the American Heart Association’s Life’s Simple 7 score in 3,430 women.

Women with multiparity (≥3 pregnancies) had lower Life’s Simple 7 scores compared with women with fewer pregnancies, primarily driven by worse body mass index, physical activity, and glucose metrics. The association persisted after adjustment for age, race/ethnicity, education, and income.

The study provides cross-sectional evidence that multiparity is associated with worse cardiovascular health metrics in midlife. The mechanism is likely multifactorial: each pregnancy imposes metabolic demands, and multiparity may be associated with socioeconomic factors that independently affect cardiovascular health (income, healthcare access, time for exercise). The causal pathway from parity to cardiovascular risk is not established by a cross-sectional design.

Reproductive history is increasingly recognized as a component of women’s cardiovascular risk assessment, alongside prior preeclampsia, gestational diabetes, and premature menopause. Multiparity adds to this picture, though effect sizes here are modest.

We rate the evidence limited. A cross-sectional association study with important residual confounding. Relevant for women’s cardiovascular health assessment but not directly actionable for individual clinical decision-making.