Clustered cardiometabolic risk in pregnancy and dysmenorrhea in offspring: Results from a prospective birth cohort study

Abstract

Background: Dysmenorrhea, a common gynaecological complaint, is often underdiagnosed, particularly in adolescents. The Developmental Origins of Health and Disease hypothesis suggests that maternal cardiometabolic conditions during pregnancy may influence offspring reproductive health. We investigated whether cardiometabolic risk (CCMR) is associated with dysmenorrhea risk in offspring and whether early-puberty BMI and menarcheal age mediate these associations. Methods: Data was from the Amsterdam Born Children and their Development cohort. A total of 982 mother-daughter pairs were included. Maternal CCMR included pre-pregnancy body mass index (BMI), blood pressure, glucose, triglycerides and Apolipoprotein A1. Dysmenorrhea was defined as menstrual abdominal/back pain requiring analgesics. Inverse probability weighted multivariable logistic regression examined associations between maternal CCMR or its components and dysmenorrhea in offspring. Multiple imputation was used to handle missing data in the sensitivity analysis. Serial multiple mediation analysis tested the mediating role of offspring's BMI and menarcheal age. Results: Dysmenorrhea was reported in 49.2% of daughters. In the model adjusted for maternal age, socioeconomic status, smoking, alcohol use, anxiety and depressive symptoms, CCMR was not significantly associated with dysmenorrhea (OR: 1.03, 95% CI:.72–1.48). However, higher maternal pre-pregnancy BMI was associated with increased dysmenorrhea risk in offspring (OR: 1.20, 95% CI: 1.02–1.42). A partial mediation via BMI and menarcheal age was observed (indirect effect: 1.01, 95% CI: 1.00–1.03). Conclusion: No evidence was found of maternal CCMR and dysmenorrhea in offspring. However, higher maternal pre-pregnancy BMI increased dysmenorrhea risk, partly mediated by heavier BMI and earlier pubertal timing in offspring. These findings align with the hypothesis of a possible intrauterine origin of menstrual disorders and highlight the importance of early life factors in dysmenorrhea research.