The effect of bearing and rearing a child on blood pressure: a nationally representative instrumental variable analysis of 444 611 mothers in India

Abstract Background At the individual level, it is well known that pregnancies have a short-term effect on a woman’s cardiovascular system and blood pressure. The long-term effect of having children on maternal blood pressure, however, is unknown. We thus estimated the causal effect of having childr...

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Bibliographic Details
Published in:International journal of epidemiology 2021-11, Vol.50 (5), p.1671-1683
Main Authors: Teufel, Felix, Geldsetzer, Pascal, Sudharsanan, Nikkil, Subramanyam, Malavika, Yapa, H Manisha, De Neve, Jan-Walter, Vollmer, Sebastian, Bärnighausen, Till
Format: Article
Language:English
Subjects:
Blood Pressure
Cross-Sectional Studies
Female
Humans
Hypertension - epidemiology
India - epidemiology
Male
Miscellaneous
Mothers
Pregnancy
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Summary:Abstract Background At the individual level, it is well known that pregnancies have a short-term effect on a woman’s cardiovascular system and blood pressure. The long-term effect of having children on maternal blood pressure, however, is unknown. We thus estimated the causal effect of having children on blood pressure among mothers in India, a country with a history of high fertility rates. Methods We used nationally representative cross-sectional data from the 2015–16 India National Family and Health Survey (NFHS-4). The study population comprised 444 611 mothers aged 15–49 years. We used the sex of the first-born child as an instrumental variable (IV) for the total number of a woman’s children. We estimated the effect of an additional child on systolic and diastolic blood pressure in IV (two-stage least squares) regressions. In additional analyses, we stratified the IV regressions by time since a mother last gave birth. Furthermore, we repeated our analyses using mothers' husbands and partners as the regression sample. Results On average, mothers had 2.7 children [standard deviation (SD): 1.5], a systolic blood pressure of 116.4 mmHg (SD: 14.4) and diastolic blood pressure of 78.5 mmHg (SD: 9.4). One in seven mothers was hypertensive. In conventional ordinary least squares regression, each child was associated with 0.42 mmHg lower systolic [95% confidence interval (CI): –0.46 to –0.39, P 
ISSN:0300-5771
1464-3685
DOI:10.1093/ije/dyab058