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The effect of bearing and rearing a child on blood pressure: a nationally representative instrumental variable analysis of 444?611 mothers in India
Authors: Felix Teufel, Pascal Geldsetzer, Nikkil Sudharsanan, Malavika Subramanyam, H. Manisha Yapa, Jan-Walter De Neve, Sebastian Vollmer, AND Till Bärnighausen
Source: International Journal of Epidemiology, Volume 50, Issue 5, DOI:
Topic(s): Blood pressure
Pregnancy outcomes
Women's health
Country: Asia
Published: JUL 2021
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?