Multiparity in women + cardiovascular disease: a South Asian perspective

Cardiovascular disease (CVD) is the leading cause of mortality in women worldwide. While increasing parity has been associated with greater CVD risk in several populations, limited data exist on this association in South Asian women who experience some of the highest fertility rates globally. This narrative review synthesizes current literature examining the relationship between multiparity and CVD in South Asian women, including epidemiologic patterns, proposed biological mechanisms, and the influence of sociocultural factors. Evidence from South Asia suggests a possible association between high parity (particularly ≥ 4 or 5 births) and increased risk of hypertension, obesity, metabolic syndrome, and coronary heart disease. However, the available data are limited, largely cross-sectional, and occasionally contradictory. Some studies found no association or even protective effects at lower parity levels, suggesting a potential threshold or nonlinear effect. Biologically, proposed mechanisms include insulin resistance, endothelial dysfunction, and dysregulation of adipokines. Sociocultural factors such as male child preference, restricted contraceptive access, and limited autonomy in family planning decisions may also contribute to high parity and indirectly affect cardiovascular health. Although global research supports a positive association between multiparity and CVD, the evidence specific to South Asian populations remains inconsistent and underexplored. Further region-specific, longitudinal research is essential to clarify causality and inform culturally tailored screening and prevention strategies.