Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Womenʼs Health Initiative

Erin S. LeBlanc, Kristopher Kapphahn, Haley Hedlin, Manisha Desai, Nisha I. Parikh, Simin Liu, Donna R. Parker, Matthew Anderson, Vanita Aroda, Shannon Sullivan, Nancy F. Woods, Molly E. Waring, Cora E. Lewis, Marcia Stefanick

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: The aim of the study was to understand the association between womenʼs reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk. METHODS:: Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Womenʼs Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes. RESULTS:: In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37% (95% CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40?y). Women with the longest (45+ y) reproductive periods had a 23% (95% CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95% CI, 0.99-1.09 and HR 1.08; 95% CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment. CONCLUSIONS:: Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.

Original languageEnglish (US)
JournalMenopause
DOIs
StateAccepted/In press - Jul 25 2016

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Reproductive History
Women's Health
Type 2 Diabetes Mellitus
Menarche
Reproduction
Social Adjustment
Menstruation
Proportional Hazards Models
Self Report
Life Style
Counseling
Estrogens
Cohort Studies
Incidence

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

LeBlanc, E. S., Kapphahn, K., Hedlin, H., Desai, M., Parikh, N. I., Liu, S., ... Stefanick, M. (Accepted/In press). Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Womenʼs Health Initiative. Menopause. https://doi.org/10.1097/GME.0000000000000714

Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women : findings from the Womenʼs Health Initiative. / LeBlanc, Erin S.; Kapphahn, Kristopher; Hedlin, Haley; Desai, Manisha; Parikh, Nisha I.; Liu, Simin; Parker, Donna R.; Anderson, Matthew; Aroda, Vanita; Sullivan, Shannon; Woods, Nancy F.; Waring, Molly E.; Lewis, Cora E.; Stefanick, Marcia.

In: Menopause, 25.07.2016.

Research output: Contribution to journalArticle

LeBlanc, ES, Kapphahn, K, Hedlin, H, Desai, M, Parikh, NI, Liu, S, Parker, DR, Anderson, M, Aroda, V, Sullivan, S, Woods, NF, Waring, ME, Lewis, CE & Stefanick, M 2016, 'Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: findings from the Womenʼs Health Initiative', Menopause. https://doi.org/10.1097/GME.0000000000000714
LeBlanc, Erin S. ; Kapphahn, Kristopher ; Hedlin, Haley ; Desai, Manisha ; Parikh, Nisha I. ; Liu, Simin ; Parker, Donna R. ; Anderson, Matthew ; Aroda, Vanita ; Sullivan, Shannon ; Woods, Nancy F. ; Waring, Molly E. ; Lewis, Cora E. ; Stefanick, Marcia. / Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women : findings from the Womenʼs Health Initiative. In: Menopause. 2016.
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abstract = "OBJECTIVE:: The aim of the study was to understand the association between womenʼs reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk. METHODS:: Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Womenʼs Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes. RESULTS:: In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37{\%} (95{\%} CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40?y). Women with the longest (45+ y) reproductive periods had a 23{\%} (95{\%} CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95{\%} CI, 0.99-1.09 and HR 1.08; 95{\%} CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment. CONCLUSIONS:: Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.",
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T2 - findings from the Womenʼs Health Initiative

AU - LeBlanc, Erin S.

AU - Kapphahn, Kristopher

AU - Hedlin, Haley

AU - Desai, Manisha

AU - Parikh, Nisha I.

AU - Liu, Simin

AU - Parker, Donna R.

AU - Anderson, Matthew

AU - Aroda, Vanita

AU - Sullivan, Shannon

AU - Woods, Nancy F.

AU - Waring, Molly E.

AU - Lewis, Cora E.

AU - Stefanick, Marcia

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N2 - OBJECTIVE:: The aim of the study was to understand the association between womenʼs reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk. METHODS:: Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Womenʼs Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes. RESULTS:: In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37% (95% CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40?y). Women with the longest (45+ y) reproductive periods had a 23% (95% CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95% CI, 0.99-1.09 and HR 1.08; 95% CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment. CONCLUSIONS:: Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.

AB - OBJECTIVE:: The aim of the study was to understand the association between womenʼs reproductive history and their risk of developing type 2 diabetes. We hypothesized that characteristics signifying lower cumulative endogenous estrogen exposure would be associated with increased risk. METHODS:: Prospective cohort analysis of 124,379 postmenopausal women aged 50 to 79 years from the Womenʼs Health Initiative (WHI). We determined age of menarche and final menstrual period, and history of irregular menses from questionnaires at baseline, and calculated reproductive length from age of menarche and final menstrual period. Presence of new onset type 2 diabetes was from self-report. Using multivariable Cox proportional hazards models, we assessed associations between reproductive variables and incidence of type 2 diabetes. RESULTS:: In age-adjusted models, women with the shortest (<30 y) reproductive periods had a 37% (95% CI, 30-45) greater risk of developing type 2 diabetes than women with medium-length reproductive periods (36-40?y). Women with the longest (45+ y) reproductive periods had a 23% (95% CI, 12-37) higher risk than women with medium-length periods. These associations were attenuated after full adjustment (HR 1.07 [1.01, 1.14] for shortest and HR 1.09 [0.99, 1.22] for longest, compared with medium duration). Those with a final menstrual period before age 45 and after age 55 had an increased risk of diabetes (HR 1.04; 95% CI, 0.99-1.09 and HR 1.08; 95% CI, 1.01-1.14, respectively) compared to those with age of final menstrual period between 46 and 55 years. Timing of menarche and cycle regularity was not associated with risk after full adjustment. CONCLUSIONS:: Reproductive history may be associated with type 2 diabetes risk. Women with shorter and longer reproductive periods may benefit from lifestyle counseling to prevent type 2 diabetes.

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