Number of children and cognitive function among Chinese menopausal women: The mediating role of depressive symptoms and social participation

This study examined the association between number of children and cognitive function and its possible hormone and psychosocial pathways in Chinese menopausal women.We analyzed data from the China Health and Retirement Longitudinal Study (CHALRS), including 4803 menopausal women. Ordinary least squares (OLS) regression modeling and structural equation modeling (SEM) were applied to explore the association between number of children and cognitive function and the potential mechanisms.Overall, the median number of biological children was three among participants. The cognitive function score decreased significantly with increasing numbers of children [β = -0.547, 95 % confidence interval (CI): -0.677, -0.416]. There was a significant interaction between number of children and residence (P = 0.003). Compared with older women with three or less children, women with more than three children had worse cognitive function (β = -0.798, 95 % CI: -1.081, -0.514). Mediation analysis verified that depressive symptoms and social participation partially mediate the associations between the number of children and cognitive function.First, because of the cross-sectional design, our study was unable to make causal inferences. Second, information about endogenous estrogen exposure was not collected in CHARLS. Third, recall bias may exist due to the use of self-reported data.Our results indicated that a higher number of children is associated with an increased risk for cognitive impairment. We suggest paying special attention to mental and social health among women with multiple children (>3).