Parity and coronary heart disease risk factors among Palestinian women in two refugee camps on the West Bank

Background: Evidence from the USA and Europe suggests that women with many births have roughly a 50-80% increase in the risk of developing CHD. The mechanisms underlying this association are unclear, but plausible biological pathways (changes in adiposity, blood glucose and lipid levels associated with pregnancy and continuing after reproduction has ceased) exist. Palestinian women have a greater exposure to high parity than do women in most populations where heart disease and parity have previously been studied, so are expected to be at higher risk. Objectives: To examine the association of parity with CHD risk factors including obesity, lipids, diabetes and hypertension; MS and reported CHD in a sample of women with a high parity. Methods: A population based cross sectional survey of 515 Palestinian women aged 40- 65 years from two refugee camps communities in the West Bank. Results: Mean parity was 7.3 (3.69) with a range of 0-21. Prevalence of overall obesity (BMI>30) was 69.2%, abdominal obesity (WC2: 88 cm) was 84.2%, and central obesity (W/H ratio>0.85) was 51.9%. Prevalence of diabetes was 22.3% and hypertension was 42.7%. After adjustment for covariates (age, own education, husband's education, marital status), regression analyses showed that each extra birth was associated with an increase of 0.30 kg/m2 in BMI (p< 0.0001), 0.58 in waist circumference (p< 0.001), and an increase of 0.036 mmol/L in triglycerides (p= 0.033). Gravidity, but not parity was associated with fasting blood sugar (FBS); after adjustment for covariates, each extra pregnancy was associated with an increase of 0.14 mmol/L (95% Cl: 0.05 to 0.23, p=0.002) in FBS. The metabolic syndrome presented in 58.3% of the women. Women with the metabolic syndrome had significantly higher parity and gravidity, (p= 0.003 and p= 0.024 respectively); each extra birth was associated with a 7% increase in the prevalence of the metabolic syndrome (p= 0.042). Parity was not found to be significantly associated with systolic or diastolic blood pressure or with self-reported CHD. Conclusion: Among these Palestinian women, increased parity is significantly associated with obesity (as measured by BMI and waist circumference), triglycerides and an increased risk of the metabolic syndrome. Any of these, alone or in combination, could result in increased CHD risk for this group of women.