Cardiometabolic Risk Clusters and Their Reproductive Correlates: A Latent Class Analysis of Indian Women

Background: Cardiometabolic conditions are rising among women in low- and middle-income countries and appearing at younger ages. The role of female reproductive characteristics in cardiometabolic risk fs not well understood.

Methods: We analyzed seven reproductive characteristics and seven cardiometabolic indicators obtained from 644,191 non-pregnant women aged 15–49 years in the 2019–2021 India National Family and Health Survey (NFHS-5). We conducted a latent class analysis of cardiometabolic indicators (systolic and diastolic blood pressure, random blood glucose, body mass index, waist circumference, and use of anti-hyperglycemic and antihypertensive pharmacotherapy) to identify risk clusters. Multinomial logistic regression models accounting for age and sociodemographic characteristics assessed associations between reproductive characteristics (age at menarche, age at first birth, natural or surgical menopause, parity, time since last birth, experience of pregnancy loss, current contraceptive use) and cluster membership.

Results: Women had a median age of 29.4 (IQR: 21.5–38.4) years, were mostly married (71%), and resided in rural areas (68%). Five cardiometabolic clusters emerged: normal (36%), high-normal (46%), isolated-overweight (12%), hypertension-overweight (6%), and glucose dysregulation-overweight (1%). Early menarche (<13 years), early age at first birth (<20 years), and natural or surgical menopause were positively associated with two or more high-risk clusters (ORs: 1.13–1.62). Higher parity was associated with higher relative odds of isolated-overweight (ORs: 1.31–1.39), while longer time since last birth (≥ 8 years) was associated with hypertension-overweight (OR: 1.25 95% CI: 1.18–1.31) and glucose dysregulation-overweight (OR: 1.21, 95% CI: 1.07–1.37). Pregnancy loss increased the odds of all high-risk clusters (ORs: 1.21–1.42), while contraceptive use decreased the odds (ORs: 0.88–0.93).

Conclusions: Five cardiometabolic risk clusters were identified in Indian women, with cluster membership linked to reproductive characteristics. The timing of fertility milestones and reproductive history appear relevant for early risk stratification among women in early to middle adulthood.

Key Messages

• Indian women aged 15–49 years exhibited 5 distinct patterns of cardiometabolic risk clustering: normal, high-normal, isolated-overweight, hypertension-overweight, and glucose dysregulation-overweight clusters.
• Early age at menarche (<13 years), early age at first birth (<20 years), natural or surgical menopause, higher parity, longer time since last birth, and pregnancy losses were associated with at least one of the high-risk cardiometabolic clusters.
• Reproductive history and the timing of reproductive milestones may improve early disease risk stratification in Indian women.