Associations of reproductive history with cognitive impairment, depression, and anxiety in older women: a cross-sectional analysis of the CLHLS combined with Mendelian randomization

BACKGROUND: With rapid global population ageing, older women bear a disproportionate burden of cognitive impairment, depression, and anxiety. Reproductive history, a unique and irreversible life course factor, may influence late-life cognitive and mental health. METHODS: We included 4,173 women aged ≥65 years from the 2017-2018 China Longitudinal Healthy Longevity Survey. Standard scales assessed cognition and mood, followed by regression, network, and two-sample MR analyses. RESULTS: After adjustment, having more than four births was associated with a lower risk of cognitive impairment (OR = 0.66, 95% CI: 0.48-0.91). Network analysis identified restlessness and uncontrollable worry as central symptoms, with language and attention as key bridge nodes. MR analyses linked higher parity to poorer cognition and later first birth to better cognition and lower depression risk. CONCLUSION: Reproductive history is linked to late-life cognitive and emotional health through sociocultural and biological mechanisms, highlighting the importance of population-specific precision health strategies.