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How can we determine whether pregnancy is beneficial or detrimental to the mother's health

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Jamila
Jamila Nov 12, 2020
How can we determine if pregnancy is beneficial for the mother's health or not?

There is an unsolved debate regarding pregnancies! We still don't know if pregnancies are beneficial for the mother's health. Specifically, does pregnancy promote or suppress maternal longevity?

There are two theories regarding pregnancy and maternal health: The regeneration theory and the disposable soma theory. The disposable soma theory says that pregnancy is not beneficial for the mother's health. During pregnancy, the maternal resources are all used up to develop the child; this compromises the mother's health. On the other hand, you have the regeneration theory. This theory indicates that pregnancies are beneficial because they might rejuvenate maternal organs – similar to what is seen in heterochronic parabiosis.

In a previous idea, I suggested using the epigenetic age to determine whether pregnancies make mothers age faster or slower.

Are there any other methods that we can use to solve this debate? How can we find out if pregnancy improves the mother's health or not?

[1]Michaeli, Tal Falick, Yehudit Bergman, and Yuval Gielchinsky. "Rejuvenating effect of pregnancy on the mother." Fertility and Sterility 103.5 (2015): 1125-1128.

[2]Ziomkiewicz, Anna, et al. "Evidence for the cost of reproduction in humans: high lifetime reproductive effort is associated with greater oxidative stress in post-menopausal women." PloS one 11.1 (2016): e0145753.

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Creative contributions

Statistics

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J
Juran Nov 13, 2020
The first thing that crossed my mind was to check general data on the length of life of women that were pregnant and those who didn't. The statistics on a huge sample (normal distribution of data) could show us whether pregnancy helps or not.
I am never sure if this is a good approach, but it would definitely be cool to see.

Also, I read some articles claiming that if women gave birth at the age of 30-35, they are more likely to live longer. I wonder if it's because pregnancy had a beneficial effect or the bad effect of it happened later in life and thus, influenced less on the mother's lifespan.


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MW
Melanie Well3 days ago
One problem I see with this approach is that data is in a way 'biased', as the mother's health already correlates in several ways with pregnancy: Women with preexisting conditions might have a harder time to conceive (whether they know it or not) or deliberately choose not to become pregnant due to their health condition. Also, you'd have to factor in the effects of actually raising children (after pregnancy) on length of life. You'd have to use data of women who were pregnant, gave birth but did not raise the child to compare the effects of pregnancy with women who were never pregnant, right?
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J
Juran3 days ago
You are definitely right, Melanie Well. Women with life-length-influencing conditions could have a harder time conceiving.

So do you agree that we should have:
1) a random sample of women,
2) healthy women who do not want to have children (determine the "healthy" precisely),
3) woman who gave birth once and raised a child,
4) women who gave birth but didn't raise a child and
5) women who gave multiple births (they probably raised them, too)

We should pay attention that all groups have a number of participants big enough to eliminate the minor health, financial, or state-of-mind factors. What are your thoughts on this?
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MW
Melanie Well3 days ago
J. I think that the different groups you suggested are suitable to address these concerns. It would surely also help to shed some light on health-related factors that play a role in pregnancy/giving birth/raising one or multiple children. A mixed-methods approach and longitudinal studies would be needed to gain a better understanding of significant differences (if there are any!) in health-related outcomes of the women in the different groups over the course of their lifespan. I'm thinking of statistical analysis, but also qualitative studies to look into how different women experience or interpret health-related changes themselves (both physically and psychologically) during pregnancy, after giving birth, and when raising children.

Psychological tests

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Martina Pesce
Martina Pesce Dec 17, 2020
While we are trying to answer this question, I believe it is essential to remember and consider the huge psychological effects of pregnancy on women.
Also, even if we would like to exclude mental health to make our discussion simpler, I would say it is way too tighten up with physical health to be done.

Some psychological tests, to verify stress levels, for example, should be done to monitor the psychological effects in the short and long term.
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MW
Melanie Well3 days ago
That is very true. And it is probably hard to determine whether pregnancy has positive or negative effects on stress levels, symptoms of depression, etc. as this might be different for every woman, depending on her unique circumstances.

Defining the parameters that constitute "mother's health"

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Shubhankar Kulkarni
Shubhankar Kulkarni Dec 17, 2020
To solve the debate of whether pregnancies are beneficial or detrimental to a woman's health, we may first need to define what parameters of the woman's health we are interested in. It may so happen that pregnancies might be beneficial for one of those but detrimental for some others and have no effect on the remaining parameters. This might have led to the confusion and the debate in the first place.

Here, I will try to define the parameters that constitute a woman's health in relation to pregnancy:
  1. During-pregnancy effects on health:
a. Psychological - well-being (affected due to the effect of pregnancy on work), mood changes due to underlying hormonal changes
b. Physiological - morphometric changes, immunity, pregnancy-related changes (like morning sickness)

2. Short-term post-pregnancy effects on health: Affected due to extensive maternal care (lack of sleep, disturbed meal timings, etc.), breastfeeding, etc.
a. Psychological - post-partum depression, well-being, the joy of maternal care
b. Physiological - morphometric changes, regularizing the menstrual cycle

3. Long-term post-pregnancy effects on health
a. Psychological - affected by maternal care, child-raising
b. Physiological - lifespan, other diseases, risk of cancer (mentioned separately since it is studied widely), less painful periods

4. Complications in pregnancies including stillbirths add another dimension of parameters that can have short-term as well as long-term effects on the woman's health. As an example, the protective effect of pregnancy on the risk of future breast cancer is observed if the pregnancy continues after the 34th week. If the pregnancy is terminated before that, the risk of breast cancer is not reduced. Moreover, the authors found that parity, socioeconomic status, and vital status of the child at birth does not affect the risk of breast cancer, suggesting that the effect is maximally (if not entirely) physiological.

5. Number of previous pregnancies also affects the severity of the changes associated and can, in turn, modulate their effect on the woman's health. In the above study, the authors found that the pregnancies lasting 34 weeks or longer were associated with a substantial reduction in the risk of breast cancer. The average risk was reduced by 12.9% per birth. So a woman with 3 pregnancies has a 3 times lower risk of breast cancer as compared to a woman having 1 pregnancy and parous women have a reduced risk than nulliparous women.

Do let me know if there is any parameter that I have missed. After going through all these parameters, I think calculating a cumulative health effect of pregnancy will average out its effects on the different parameters (underestimate/ overestimate its effect on individual parameters). To avoid that, we can come up with different categories of the parameters. Broadly, there can be six categories - physiological and psychological effects during pregnancy, in the short-term after parturition, and in the long-term. The effect of pregnancy on a woman's health can be defined in terms of these 6 categories.

[1]https://www.todaysparent.com/pregnancy/pregnancy-perks-the-health-benefits-for-mom/

[2]https://www.whattoexpect.com/first-year/photo-gallery/health-benefits-of-pregnancy-and-motherhood.aspx#:~:text=Lower%20Risk%20of%20Other%20Cancers&text=The%20hormonal%20shifts%20that%20occur,risk%20of%20other%20cancers%20too.

[3]Husby A, Wohlfahrt J, Øyen N, Melbye M. Pregnancy duration and breast cancer risk. Nat Commun. 2018;9(1):4255. Published 2018 Oct 23. doi:10.1038/s41467-018-06748-3

Terminology

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SA
Steven Agee Nov 14, 2020
A bit of clarification on the words/terms you are using.
- A woman is not a "mother" unless she has already given birth to the baby.
Therefore, all women who are pregnant are not mothers....yet. If you are focusing on how pregnancy effects "mothers" then you are only addressing women whom already have children or those whom have already given birth. What about those mothers who's babys don't make it (still birth)? They are not mothers but have gone through pregnancy, are they included in this discussion? If we are just looking at how pregnancy affects women long term then they should be included I think. Is there a difference between a women who gives birth (becomes a mother) and those who went through full pregnancies but the baby didn't make it when it comes to the long term effects of pregnancies?
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Shubhankar Kulkarni
Shubhankar Kulkarni6 months ago
Steven Agee Agreed! We probably need answers to all your above-mentioned questions to make an informed statement regarding the effect of pregnancy on a female's health.
1. We need to compare lifespan between parous and non-parous women.
2. We need to compare lifespans across women with different numbers of offspring.
3. We need to compare parous women to those that were pregnant but did not give birth.
4. And what about mothers who have lost their children? Psychology may have a grave impact on the physiology and, hence, the lifespan of a person.

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General comments

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Povilas S
Povilas S6 months ago
That's a good question I never even came up with myself, so thanks for raising it for me!:) I'm curious - aren't there simply statistical studies comparing life spans of different women and different factors that may have influenced them - genetics, environmental, lifestyle, and among those would be pregnancies. It should be relatively simple to rule out statistically how big of influence pregnancies have on this and whether it correlates positively or negatively with chronological age. I know the question is about woman's health in general, but focusing on just the length of life could make it simpler for the start.
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Jamila
Jamila 6 months ago
Povilas S Yes, that's very true. There have been some studies, but they have had conflicting results.
In one study, parity increased Amish ladies' lifespans (only until 14 children). [1] In another study, researchers found no significance between parity and maternal longevity. However, when they divided the women into ethnic groups. It was found that white women with 2, 3, or 4 children were more likely to live longer compared to white women with one child - there were no differences reported for black women. [2] The results aren't clear; it seems that other factors are affecting them. The results could vary due to factors, such as the mother's age, how many children she has had, her risk of diseases, genetics, ethnicity, socioeconomic factors, etc. Due to this, we could try to use multiple methods and then it would hopefully give us the bigger picture. Perhaps we could use lifespan studies with specific factors, epigenetic age, or use some other ways.

References
1. McArdle, Patrick F., et al. "Does having children extend life span? A genealogical study of parity and longevity in the Amish." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61.2 (2006): 190-195.
2. Shadyab, Aladdin H., et al. "Maternal age at childbirth and parity as predictors of longevity among women in the United States: The women's health initiative." American journal of public health 107.1 (2017): 113-119.




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Povilas S
Povilas S6 months ago
Jamila Ahmed Thanks:) Maybe you know about this aspect also - what about women that didn't have any children compared to those who had at least one? That seems to me as the most important starting point for comparision.
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Jamila
Jamila 6 months ago
Povilas S A comparison between no children and one child would help. In a meta-analysis by Zeng, they found a J-shaped association between parity and mortality risk in the parents. In their study, they included 0 to 13 children. The researchers found that 3-4 births reduced the risk of mortality. Having no children and having more than six children had the same impact on parental mortality risk – it didn't reduce the mortality risk.

The study link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725925/