Association of reproductive and gender-related characteristics with cardiovascular risk factors of women in India: an analysis of nationally representative data

Introduction Women have unique characteristics based on their biological sex and gender that could contribute to their cardiovascular risk. This paper investigates the association between reproductive and gender-related characteristics on cardiovascular risk factors (CVRF) among women in India. Methods This cross-sectional analysis included 54,200 women aged 18-49 years from the National Family Health Survey-5, restricted to participants interviewed for the state or domestic violence module. Associations of reproductive characteristics (age at first birth, use of contraception, the total number of children born, pregnancy loss) and gender-related characteristics (age at first union, access to financial resources, owning property, currently working, experience of intimate partner violence) with CVRF (diabetes, hypertension, overweight or obesity) were estimated with Poisson regression. Analyses stratified by socioeconomic status, measured by education, were also performed. Results Women who had their first childbirth before the age of 20 years had a higher prevalence of all assessed CVRF across socioeconomic groups. Pregnancy loss was associated with a higher prevalence of being overweight or obese [prevalence ratio (PR) (95% CI): 1.16 (1.09, 1.23)], while an early age at first union (< 20 years) was linked to a greater prevalence of hypertension [PR (95% CI): 1.09 (1.02, 1.17)] that persisted across socioeconomic groups. Intimate partner violence was associated with a higher prevalence of hypertension in women with a primary school education or lower [PR (95% CI): 1.15 (1.05, 1.25) ]. Conclusion The association of reproductive and gender-related characteristics with CVRF across the socioeconomic spectrum underscores the importance of integrated consideration of biological and social determinants to evaluate cardiovascular risk in women.