Secular changes in growth and obesity in perinatal population

The survey was conducted during the last 25 years and included 2414 healthy women who delivered in "Sestre milosrdnice" University Hospital Center in Zagreb, Croatia and their newborns. The aim was to establish the secular trend of some anthropological factors through two generations. Anthropological features such as pre-pregnancy weight, body mass index before pregnancy, height, age, place of residence, educational level, parity and the newborn weight were registered. The study was randomized. The mothers from the city of Zagreb and the surrounding villages, rural areas are examined. The women age was different and also different levels of education and socioeconomic status. The study included women who had not given birth yet, who had delivered once, twice, and three or more times. Maternal height in 25 years increased by 3.1cm. and increases with education. The pre-pregnancy weight increased 2.8 kg and increases with age, parity and rural life. The body mass index (BMI) which the women had before pregnancy was calculated, and according to its value the participants were divided in three groups: with normal weight, overweight and fat. Among the studied periods BMI does not differ significantly, but does differ significantly with respect to the ordinal number of births, parity, age and living environment. Higher BMI was associated with deliveries to heavier children.     

Over, under, or about right: misperceptions of body weight among food stamp participants

The purpose of this research was to investigate the associations between misperception of body weight and sociodemographic factors such as food stamp participation status, income, education, and race/ethnicity. National Health and Nutrition Examination Survey (NHANES) data from 1999-2004 and multivariate logistic regression are used to estimate how sociodemographic factors are associated with (i) the probability that overweight adults misperceive themselves as healthy weight; (ii) the probability that healthy-weight adults misperceive themselves as underweight; and (iii) the probability that healthy-weight adults misperceive themselves as overweight. NHANES data are representative of the US civilian noninstitutionalized population. The analysis included 4,362 men and 4,057 women. BMI derived from measured weight and height was used to classify individuals as healthy weight or overweight. These classifications were compared with self-reported categorical weight status. We find that differences across sociodemographic characteristics in the propensity to underestimate or overestimate weight status were more pronounced for women than for men. Overweight female food stamp participants were more likely to underestimate weight status than income-eligible nonparticipants. Among healthy-weight and overweight women, non-Hispanic black and Mexican-American women, and women with less education were more likely to underestimate actual weight status. We found few differences across sociodemographic characteristics for men. Misperceptions of weight are common among both overweight and healthy-weight individuals and vary across socioeconomic and demographic groups. The nutrition education component of the Food Stamp Program could increase awareness of healthy body weight among participants.     

Self-Reported Substantial 1-Year Weight Change Among Men and Women in the United States

Population-based data have not been readily available on relatively short-term changes in weight. Therefore, we sought to determine the nature of self-reported substantial (> 10%) weight change over one year in a representative sample of the US population which participated in the 1989 National Health Interview Survey (NHIS). Across all ages, a larger proportion of women than men reported both weight loss as well as weight gain of any amount (18.9% vs. 16.1% for weight loss and 20.0% vs. 16.1% for weight gain). In sex-specific logistic regression analyses, significant risk factors common to both sexes for substantial weight loss included divorced/separated marital status, smoking, increased number of blood pressure checks, increased BMI (body mass index) and increased number of bed days. Black race reduced the risk of weight loss for both men and women. Sex-specific risk factors for weight loss in men only were widowhood or never married marital status, while increasing age was a protective factor in women only. Concerning weight gain > 10% over the past year, increased number of blood pressure checks and having one or more diabetic parents were significant risk factors among both men and women; while never being married, increased age, BMI, and education exerted a protective effect in both sexes. For women only, risk factors for weight gain included black race, increased number of contacts with a health professional, and being unemployed. Intention to lose weight was associated with both weight gain and weight loss in both sexes, although it did not serve as a confounder in any of these relationships. A greater likelihood of substantial weight loss among women relative to men was diminished for persons with higher BMI, higher number of blood pressure checks, being widowed, divorced or separated, and intention to lose weight. A greater likelihood of substantial weight gain among women relative to men was diminished for persons with low BMI. The results of this cross-sectional study of weight change, involving a one-year follow-up period, generally correspond with the results obtained by longitudinal studies involving a longer follow-up.     

Obesity and the likelihood of sexual behavioral risk factors for HPV and cervical cancer

Obesity is associated with higher cervical cancer mortality, but its relationship with sexual behavioral risk factors that predispose women to human papilloma virus (HPV) and cervical cancer is unclear. We used data from 3,329 women participants, aged 20-59 years, of the 1999-2004 National Health and Nutrition Examination Survey, to analyze the relationship between BMI and age at first intercourse, number of sexual partners, condom use during sexual activity, history of sexually transmitted disease (STD), herpes simplex virus 2 (HSV-2) seropositivity, and HPV prevalence. BMI was not associated with the prevalence of HPV. Mildly obese women (BMI 30.0-34.9 kg/m(2)) were least likely to report a STD history (9% vs. 13% in normal weight) and >or=2 sexual partners in the previous year (8% vs. 13%) while overweight women (BMI 25.0-29.9 kg/m(2)) were least likely to report >or=10 lifetime partners; among those with multiple partners, BMI was not associated with sexual activity without condoms in the past month. After adjustment for age, race/ethnicity, and education, women with higher BMI were less likely to report sexual behavioral risk factors than normal-weight women; however, odds ratios were only significant for mildly obese women for reporting a STD history (0.74, 95% confidence interval 0.55-0.99) and having >or=2 sexual partners in the last year (0.57, 0.39-0.85). Higher BMI was not associated with HSV-2 seropositivity after adjustment. HPV and sexual behavioral risk factors for HPV and cervical cancer are not more prevalent in obese than normal-weight women and unlikely to account for higher-observed cervical cancer mortality in obese women.     

Gender Differences in Shame in Patients with Binge‐Eating Disorder

Objective: To examine the relationship between shame and the behavioral and attitudinal features of eating disorders in men and women diagnosed with binge‐eating disorder (BED). Research Methods and Procedures: Participants were 188 consecutively evaluated adults (38 men and 150 women) who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for BED. Participants were interviewed and completed a battery of measures assessing shame, behavioral and attitudinal features of eating disorders, and general psychological functioning. Results: Shame did not differ significantly by gender and was not associated with BMI or binge‐eating frequency. Shame was significantly associated with the attitudinal features of eating disorders, even after controlling for levels of depression and self‐esteem. When considered separately by gender and controlling for depression and self‐esteem, shame was associated with body dissatisfaction in men and with weight concern in women. Discussion: Men and women with BED, who presented for treatment, reported similar levels of shame. Overall, while shame was related to attitudinal features, the specific associations differed by gender. For men, shame was related to how dissatisfied they felt with their bodies, whereas for women, shame was associated with concerns about weight. Interestingly, shame was not related to BMI or binge‐eating frequency in men or women. These results provide preliminary support for self‐conscious emotions playing different roles in men and women with BED.     

Gender Differences in Body Satisfaction

PINGITORE, REGINA, BONNIE SPRING, DAVID GARFIELD. Gender differences in body satisfaction. Although men and women show similar rates of obesity, women more frequently engage in weight loss efforts, with potentially adverse health consequences. We surveyed 320 college-aged men and women to examine gender differences in the determinants of body dissatisfaction and the degree of importance assigned to body-weight and shape. Results indicated that, for both genders, satisfaction with bodyweight and shape decreased as body mass index (BMI) increased. Women, however, showed significantly greater body and weight dissatisfaction than men at most weight categories. Only the underweight (BMI<20) women and men were similarly satisfied with their bodyweight and shape. As BMI increased, however, women became disproportionately more dissatisfied: both normal-weight and overweight women expressed greater dissatisfaction than comparable men. College-aged women also attributed progressively more importance to both weight and shape as BMI increased, unlike college-aged men, who considered body weight equally important to (or slightly less important than) self-esteem as BMI increased. We discuss implications for the self-esteem of obese women and men.     

Perceived Racial Discrimination in the Workplace and Body Weight among the Unemployed

This study investigates the association between body weight and the likelihood that people perceive that they have been the victims of racial discrimination in the workplace among the unemployed. I find that unemployed obese men and women are 8.4 percentage points and 7.7 percentage points, respectively, more likely to have experienced racial discrimination before becoming unemployed than their non-obese counterparts. For unemployed men, the relationship between body weight and perceived racial discrimination does not seem to be associated with race. For unemployed women, being black and obese significantly increases the likelihood of perceiving racial discrimination.     

Predictors of excessive and inadequate gestational weight gain in Hispanic women

Factors influencing gestational weight gain are incompletely understood, particularly among Hispanic women. We assessed medical, sociodemographic, behavioral, and psychosocial predictors of overall gestational weight gain, as well as gains below, within, or above the range recommended by the Institute of Medicine (IOM) within a prospective study of 770 Hispanic (predominantly Puerto Rican) prenatal care patients at a large tertiary care facility in Western Massachusetts. One third of women gained within the recommended range, 22% gained below, and 45% gained above the range. In multivariate analysis, women in the highest category of BMI (P(trend)<0.001) and parity (P(trend)<0.001) gained on average 9 lbs less than those in the lowest category. Increasing time in residence in the continental United States (P(trend)<0.01) as well as a number of prenatal care visits (P(trend)=0.03) were positively associated with weight gain. Overweight women (odds ratio (OR)=2.2, 95% confidence interval (CI) 1.3, 3.8) and those over age 30 years (OR=2.5, 95% CI 1.2, 5.0) were more likely to gain above the IOM range as compared to normal-weight women and those aged 20-24, respectively. Women with <10 years of residence in the United States were 50% less likely to gain above the IOM range as compared to third-generation women (95% CI 0.3, 0.9). Findings identify determinants of gestational weight gain which can form the basis of targeted interventions in this rapidly growing ethnic group.     

Physical Activity in Relation to Long‐term Weight Maintenance After Intentional Weight Loss in Premenopausal Women

The type and amount of physical activity (PA) needed for prevention of weight regain are not well understood. We prospectively examined the associations between patterns of discretionary PA and 6‐year maintenance of intentional weight loss among 4,558 healthy premenopausal women who were 26–45 years old in 1991 and had lost >5% of their body weight in the previous 2 years. Participants reported their PA and weight in 1991 and 1997. The outcome was weight regain, defined as regaining in 1997 >30% of the lost weight between 1989 and 1991. Between 1991 and 1997, 80% of women regained >30% of their previous intentional weight loss. An increase of 30 min/day in total discretionary activity between 1991 and 1997 was associated with less weight regain (?1.36 kg, 95% confidence interval (CI) = ?1.61, ?1.12), particularly among overweight women (BMI ≥25) (?2.45 kg, ?3.12 to ?1.78). Increased jogging or running was associated with less weight regain (?3.26 kg; ?4.41 to ?2.10) than increased brisk walking (?1.69 kg; ?2.15 to ?1.22) or other activities (?1.26 kg; ?1.65 to ?0.87). Compared to women who remained sedentary, women were less likely to regain >30% of the lost weight if they maintained 30+ min/day of discretionary PA (odds ratio (OR) = 0.69, 0.53 to 0.89) or increased to this activity level (OR = 0.48, 0.39 to 0.60). Conversely, risk was elevated in women who decreased their activity. Increased PA, particularly high intensity activities, is associated with better maintenance of weight loss. The benefits of activity were greater among overweight/obese than normal weight women.     

Walking attenuates the relationships of high-meat, low-fruit dietary intake to total and regional adiposity in men and women

Vigorous physical activity (running) has been shown to attenuate the association between diet and body weight. Walking is the most popular physical activity, but is a moderate-intensity physical activity because it requires less than sixfold the energy expenditure of sitting at rest. We therefore examined whether reported distance walked per week affected the relationship of diet to BMI and circumferences of the waist, hip, and chest in 30,014 female and 7,133 male participants of the National Walkers' Health Study. Reported meat and fruit intakes served as indicators of high-risk diets for weight gain. The analyses showed that higher meat and lower fruit intake were significantly and consistently associated with greater BMI and waist circumference at all activity levels. Longer usual walking distance significantly attenuated the concordant relationships of diet with women's BMIs (P < 10(-8)), men's BMIs (P = 0.04), and women's waist (P < 10(-6)), hip (P = 0.0001), and chest circumferences (P < 10(-5)). Compared to walkers who averaged <1.5 km/day, the association of diet with adiposity in subjects who walked ≥1.5 km/day was reduced 21% in women and 31% in men for BMI; 20% in women and 27% in men for waist circumference; 19% for women's hip circumference; and 26% for women's chest circumference. Thus we conclude that diets characterized by high-meat/low-fruit intake were significantly associated with greater BMI, and this association was attenuated by moderate physical activity. The weaker results in men than women probably related to the smaller sample size, and reduced statistical power of the men.     

A prospective study of overweight, physical activity, and depressive symptoms in young women

This study examined the prospective associations of BMI, physical activity (PA), changes in BMI, and changes in PA, with depressive symptoms. Self-reported data on height, weight, PA, selected sociodemographic and health variables and depressive symptoms (CESD-10) were provided in 2000 and 2003 by 6,677 young adult women (22-27 years in 2000) participating in the Australian Longitudinal Study on Women's Health (ALSWH). Results of logistic regression analyses showed that the odds of developing depressive symptoms at follow-up (2003) were higher in women who were overweight or obese in 2000 than in healthy weight women, and lower in women who were active in 2000 than in sedentary women. Changes in BMI were significantly associated with increased odds of depressive symptoms at follow-up. Sedentary women who increased their activity had lower odds of depressive symptoms at follow-up than those who remained sedentary. Increases in activity among initially sedentary young women were protective against depressive symptoms even after adjusting for BMI changes. These findings indicate that overweight and obese young women are at risk of developing depressive symptoms. PA appears to be protective against the development of depressive symptoms, but does not attenuate the depressive symptoms associated with weight gain. However, among initially sedentary young women, even small increases in PA over time may reduce the odds of depressive symptoms, regardless of weight status.     

Parity and Body Weight in the United States: Differences by Race and Size of Place of Residence

Objective: In women, parity has been studied in relation to body weights. This study examined whether and how relationships between parity and body weight differ by race and size of place of residence, adjusting for sociodemographic factors (age, income, education, working status, and marital status) and health behaviors (alcohol consumption, birth control pills, diet, physical activity, and smoking). Research Methods and Procedures: A U.S. national sample of 3398 white and black women from the Third National Health and Nutrition Examination Survey was used to study the relationships using multiple linear regression analysis. Results: The parity—weight relationships varied by race and size of place of residence. After adjusting for the covariates, significant relationships between parity and body weight were found only in black women in metropolitan areas and white women in non‐metropolitan areas. Compared with women with no children, white women with two children living in non‐metropolitan areas tended to have lower BMIs, whereas black women in metropolitan areas with one or two children showed higher BMIs. Discussion: Overall, the parity—weight relationships in these groups of women were not strong or linear. The parity—weight relationships of black women in non‐metropolitan areas warrant further examination.     

Associations of Body Mass and Body Fat Distribution with Parity Among African-American and Caucasian Women: The CARDIA Study

Associations of parity with body fat and its distribution are poorly understood; therefore, we examined the relationships between parity and obesity in young adult women. Body mass index (BMI), skin folds, and waist-hip ratio were compared in 1452 African-American and 1268 Caucasian nonpregnant women aged 18 to 30, adjusting for age (where no age-parity interactions were present), education, physical activity (assessed by questionnaire) and fitness (assessed by graded exercise test), dietary fat intake, alcohol and smoking. Adjusted mean BMI was significantly higher in African-American women aged 25–30 years with three or more children (28.5 kg/m²) than in those with two (27.0 kg/m²), one (26.2 kg/m²), or no children (26.3 kg/m²). Similar trends were found in Caucasians (BMI = 23.3, 23.4, 23.7, 25.0 kg/m² for parity = 0,1, 2, ≥ 3, respectively), but the mean BMI was significantly higher in African Americans in each parity group. The association between BMI and parity was not present among women 18–24 years of age. Skinfolds were directly associated with parity in African Americans only. Waist-hip ratios were generally lower among nulliparous than parous women in both ethnic groups; race differences were present only among nulliparas. In conclusion, parity was associated with BMI in women aged 25 to 30 years but did not explain ethnicity-related differences in body mass.     

Body Size Perceptions and Eating Attitudes in Elderly Men

The majority of studies on eating attitudes, dieting and body size perceptions have focused on young adults and women. This study examined these attitudes in 334 black and white men, ages 55 to 98 years, who were members of the Charleston Heart Study cohort. Associations of the eating attitude variable with race, education and weight status were examined. Eighty-two percent of the overweight white men studied had dieted to lose weight, whereas only 49% of slimmer white men had dieted. In contrast, overweight black men did not diet more than slimmer black men. Overall black men dieted less than white men (37% reported dieting). Black men who were high school graduates were 1.3 times more likely to have dieted than were less educated black men. Overweight white men were over twice as likely as slimmer white men to feel guilty after overeating. This difference was not found in overweight versus slimmer black men. Education was not associated with measured body mass index (BMI) or perceived or ideal body size. However, there were some racial differences in these variables. White men preferred to be slightly thinner than black men (ideal BMI 25.6 vs. 26.1 kg/m²), and the difference between actual and desired BMI was 0.6 kg/m² greater in white than in black men. These results indicate that effects of race and weight status on eating restraint and body size perceptions seen in younger subjects and in women are also present, at least to some degree, in elderly men.     

高龄孕妇分娩新生儿出生体重及出院转归的影响因素分析

摘要 目的：探讨高龄孕妇分娩新生儿出生体重及出院转归的影响因素。方法：选择2021年01月到2022年01月与我院就诊的198例产妇作为研究对象,根据孕妇分娩时的年龄分为观察组和对照组,分娩时年龄满35周岁为高龄产妇组（98例）,分娩时年龄为20~34周岁为适龄组（100例）。比较适龄孕妇和高龄孕妇新生儿出生体重情况和新生儿住院时间,对高龄孕妇新生儿体重和新生儿出院转归影响因素进行Logistic单因素分析和多因素分析。结果：与适龄孕妇相比,高龄孕妇新生儿低出生体重儿、巨大儿发生率更高（P<0.05）,新生儿住院时间明显更长（P<0.05）。对高龄孕妇新生儿体重进行单因素分析结果显示,妊娠糖尿病、产检检查、分娩方式、是否使用催产素、分娩时麻醉方式和脐带情况与高龄孕妇新生儿体重无关（P>0.05）,孕妇年龄、孕前BMI、孕期体重增加情况、妊娠高血压、合并其他疾病状况、孕次、产次、羊水情况与高龄孕妇新生儿体重相关（P<0.05）。进行Logistic多因素回归分析结果显示,孕妇年龄、孕前BMI、孕期体重增加情况、孕次、产次、羊水情况是影响高龄孕妇新生儿出生体重的独立危险因素（P<0.05）。对新生儿出院转归情况进行单因素分析结果显示,胎次、开奶时间、喂养方式和有无接受治疗与新生儿出院转归无相关性（P>0.05）,胎龄、出生体重、Apgar评分、出生窒息史、有无伴发疾病与新生儿转归相关（P<0.05）。进行Logistic多因素分析结果显示,胎龄、出生体重、Apgar评分、出生窒息史、有无伴发病是影响新生儿出院转归的独立危险因素（P<0.05）。结论：孕妇年龄、孕前BMI、孕期体重增加情况、孕次、产次、羊水情况是影响高龄孕妇新生儿出生体重的独立危险因素。新生儿出院转归受到胎龄、出生体重、Apgar评分、出生窒息史、有无伴发病影响。     

The Relationship of Body Mass Index to Reproductive Factors in Pre- and Postmenopausal African-American Women With and Without Breast Cancer

To date, there are virtually no existing data on the relationship between obesity, menopausal status, and breast cancer in African-Americans. Therefore, the present study was designed to test the following hypotheses in an African-American population: (1) there exists a positive association between BMI and breast cancer among postmenopausal women; (2) there exists an inverse association between BMI and breast cancer among premenopausal women; and (3) similar associations between BMI and reproductive factors exist for both pre- and postmenopausal breast cancer cases. The study population comprised 357 African-American women (n=193 breast cancer cases; n=164 controls). No significant differences were observed between premenopausal cases and controls for BMI, obesity categories, and reproductive factors. Among the postmenopausal women, the cases had significantly lower weight and BMI levels than the controls. Age at first pregnancy and parity were significantly lower among postmenopausal cases than their controls. No significant associations were revealed between body mass index and breast cancer for pre- and postmenopausal women. In the present study, early age at menarche was the only reproductive factor that was an independent predictor of BMI for both pre- and postmenopausal women, irrespective of breast cancer status. Also, these findings strongly suggest the need to consider reproductive factors, particularly age at menarche, as a covariate of BMI and other obesity-related diseases.     

Weight gain prevention among women

Objective: Women 25 to 45 years old are at risk for weight gain and future obesity. This trial was designed to evaluate the efficacy of two interventions relative to a control group in preventing weight gain among normal or overweight women and to identify demographic, behavioral, and psychosocial factors related to weight gain prevention. Research Methods and Procedures: Healthy women (N = 284), ages 25 to 44, with BMI < 30 were randomized to one of three intervention conditions: a clinic‐based group, a correspondence course, or an information‐only control. Intervention was provided over 2 years, with a follow‐up at Year 3. BMI and factors related to eating and weight were assessed yearly. Results: Over the 3‐year study period, 40% (n = 114) of the women remained at or below baseline body weight (±2 lbs), and 60% gained weight (>2 lbs). Intervention had no effect on weight over time. Independently of intervention, women who were older, not actively dieting to lose weight, and who reported less perceived hunger at baseline were more likely to be successful at weight maintenance. Weight maintenance also was associated with increasing dietary restraint (conscious thoughts and purposeful behaviors to control calorie intake) and decreasing dietary disinhibition (the tendency to lose control over eating) over time. Discussion: This study raises concern about the feasibility and efficacy of weight gain prevention interventions because most women were interested in weight loss, rather than weight gain prevention, and the interventions had no effect on weight stability. Novel approaches to the prevention of weight gain are needed.     

Eating Frequency is Associated With Energy Intake but Not Obesity in Midlife Women

Midlife women tend to gain weight with age, thus increasing risk of chronic disease. The purpose of this study was to examine associations between overweight/obesity and behavioral factors, including eating frequency, in a cross‐sectional national sample of midlife women (n = 1,099) (mean age = 49.7 years, and BMI = 27.7 kg/m²). Eating behaviors and food and nutrient intakes were based on a mailed 1‐day food record. BMI was calculated from self‐reported height and weight, and level of physical activity was assessed by self‐reported questionnaire. After exclusion of low‐energy reporters (32% of sample), eating frequency was not associated with overweight/obesity (P > 0.05) and was not different between BMI groups (normal, 5.21 ± 1.79; overweight, 5.16 ± 1.74; obese, 5.12 ± 1.68, P = 0.769). Adjusted logistic regression showed that eating frequency, snacking frequency, breakfast consumption, eating after 10 pm and consuming meals with children or other adults were not significantly associated with overweight/obesity. Total energy intake increased as eating frequency increased in all BMI groups, however, obese women had greater energy intake compared to normal weight women who consumed the same number of meals and snacks. Intake of fruit and vegetables, whole grains, dietary fiber, dairy, and added sugars also increased as eating frequency increased. While eating frequency was not associated with overweight/obesity, it was associated with energy intake. Thus, addressing total energy intake rather than eating frequency may be more appropriate to prevent weight gain among midlife women.     

Accuracy of self-reported weight among bariatric surgery candidates: the influence of race and weight cycling

Objective: Research on the accuracy of self‐reported weight has indicated that the degree of misreporting (underestimating) weight is associated with increasing weight but is variable across patient groups. We examined the degree of discrepancy between actual and self‐reported BMI in severely obese bariatric surgery candidates, and whether the degree of accuracy varied by race and by eating‐related and psychological factors. Research Methods and Procedures: Participants were 179 obese female gastric bypass surgery candidates (31 black, 22 Hispanic, 126 white) who were asked to self‐report height and weight as part of a larger assessment battery. Actual height and weight were then measured and a discrepancy score was generated (actual BMI ? reported BMI). Results: In this group of severely obese patients, degree of misreporting was unrelated to BMI. The race groups did not differ in actual or self‐reported BMI but differed significantly in the degree of misestimation between self‐reported and actual BMI. Post hoc tests indicated that black women underestimated their BMI significantly more than white women; Hispanic women did not differ from the other race groups. No eating‐related or psychological variables assessed predicted percentage discrepancy; however, the accuracy in self‐reported weight was related to history of weight cycling. Discussion: Overall, obese bariatric surgery candidates were accurate in self‐report of weight, although the degree of accuracy differed by race and weight cycling history.     

The impact of reproduction on gambian women: Does controlling for phenotypic quality reveal costs of reproduction?

Life history theory predicts that where resources are limited, investment in reproduction will cause a decline in body condition and ultimately may lower survival rates. We investigate the relationship between reproduction and mortality in women in rural Gambia. We use a number of different measures of reproductive investment: the timing of reproduction, intensity of reproduction, and cumulative reproductive investment (parity). Though giving birth is clearly a risk factor for increased mortality, we find limited evidence that the timing, intensity, or cumulative effects of reproduction have a survival cost. Instead, there is some evidence that women who have invested heavily in reproduction have higher survival than women with lower reproductive investment: both high parity and late age at last reproduction are associated with high survival. The only evidence for any cost of reproduction is that women who have given birth to twins (considered a marker of heavy investment in reproduction) have higher mortality rates than other women, after the age of 50 years. A potential confounding factor may be differences in health between women: particularly healthy women may be able to invest substantially in both reproduction and their own survival, leading to the positive correlations between survival and both parity and age at last birth we observe. To control for differences in health between women, we reanalyze the relationship between reproduction and mortality but include variables correlating with health in our models (height, BMI, and hemoglobin). Even when controlling for health, the positive correlation between investment in reproduction and survival remains unchanged.