Short birth intervals and early menopause in sub-Saharan Africa: a multicountry analysis of physiological and psychosocial pathways in reproductive aging

Short birth intervals and early menopause in sub-Saharan Africa: a multicountry analysis of physiological and psychosocial pathways in reproductive aging | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Short birth intervals and early menopause in sub-Saharan Africa: a multicountry analysis of physiological and psychosocial pathways in reproductive aging Kun TANG, Shuangyue Shangguan, Yuqing Wang, Beiran Qian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7964408/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract Background Early menopause (before age 45) significantly elevates risks for cardiovascular disease, osteoporosis, diabetes, cognitive decline, and overall mortality. While previous research predominantly focused on genetic and socioeconomic determinants in high-income countries, reproductive factors such as birth spacing remain understudied, especially in resource-limited regions like sub-Saharan Africa (SSA), where short birth intervals (SBIs) are prevalent. Methods This study utilized pooled data from Demographic and Health Surveys (DHS) across 26 SSA countries (2015–2022), involving 120,912 women aged 30–49 years. Multilevel logistic regression models assessed associations between birth intervals and early menopause. Country-specific analyses and quantile regressions further evaluated the dose-response relationship and effects on age at menopause, respectively. Mediation analysis using the Karlson–Holm–Breen (KHB) method explored pathological, metabolic, nutritional, and psychological pathways. Findings Compared to intervals of ≥ 60 months, birth intervals ≤ 17 months and 18–23 months increased early menopause odds by 33% (AOR = 1·33, 95% CI: 1·18–1·49) and 22% (AOR = 1·22, 95% CI: 1·09–1·37), respectively. A dose-response relationship emerged: multiple very short intervals (< 18 months) substantially heightened risk. Quantile regression confirmed SBIs significantly lowered menopause age, particularly at lower quantiles. Pathological (pregnancy loss), metabolic (obesity), nutritional (underweight), and psychological (Mental Disease) factors significantly mediated this association. Interpretation Our findings identify SBIs as a modifiable reproductive risk factor for early menopause in SSA, underscoring the necessity of integrating optimal birth spacing into lifelong women’s health strategies. Enhancing access to family planning, nutritional support, and psychosocial interventions could mitigate associated chronic disease risks and safeguard women’s long-term well-being. Funding None Health sciences/Risk factors Scientific community and society/Developing world Early menopause Birth intervals Reproductive aging Sub-Saharan Africa Mediation analysis Full Text Additional Declarations There is NO Competing Interest. Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7964408","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":546064559,"identity":"4b307d87-7aa2-4095-a10e-3f5ac32d120f","order_by":0,"name":"Kun 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aging","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nature-portfolio","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"Nature Portfolio","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"ejp","reportingPortfolio":"","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Early menopause, Birth intervals, Reproductive aging, Sub-Saharan Africa, Mediation analysis","lastPublishedDoi":"10.21203/rs.3.rs-7964408/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7964408/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly menopause (before age 45) significantly elevates risks for cardiovascular disease, osteoporosis, diabetes, cognitive decline, and overall mortality. While previous research predominantly focused on genetic and socioeconomic determinants in high-income countries, reproductive factors such as birth spacing remain understudied, especially in resource-limited regions like sub-Saharan Africa (SSA), where short birth intervals (SBIs) are prevalent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized pooled data from Demographic and Health Surveys (DHS) across 26 SSA countries (2015–2022), involving 120,912 women aged 30–49 years. Multilevel logistic regression models assessed associations between birth intervals and early menopause. Country-specific analyses and quantile regressions further evaluated the dose-response relationship and effects on age at menopause, respectively. Mediation analysis using the Karlson–Holm–Breen (KHB) method explored pathological, metabolic, nutritional, and psychological pathways.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared to intervals of ≥ 60 months, birth intervals ≤ 17 months and 18–23 months increased early menopause odds by 33% (AOR = 1·33, 95% CI: 1·18–1·49) and 22% (AOR = 1·22, 95% CI: 1·09–1·37), respectively. A dose-response relationship emerged: multiple very short intervals (\u0026lt; 18 months) substantially heightened risk. Quantile regression confirmed SBIs significantly lowered menopause age, particularly at lower quantiles. Pathological (pregnancy loss), metabolic (obesity), nutritional (underweight), and psychological (Mental Disease) factors significantly mediated this association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings identify SBIs as a modifiable reproductive risk factor for early menopause in SSA, underscoring the necessity of integrating optimal birth spacing into lifelong women’s health strategies. Enhancing access to family planning, nutritional support, and psychosocial interventions could mitigate associated chronic disease risks and safeguard women’s long-term well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e","manuscriptTitle":"Short birth intervals and early menopause in sub-Saharan Africa: a multicountry analysis of physiological and psychosocial pathways in reproductive aging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-18 09:55:40","doi":"10.21203/rs.3.rs-7964408/v1","editorialEvents":[],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nature-communications","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"NCOMMS","sideBox":"Learn more about [Nature Communications](http://www.nature.com/ncomms/)","snPcode":"","submissionUrl":"https://mts-ncomms.nature.com/","title":"Nature Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature Communications","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"59111c20-91dc-4bb0-be99-26c0c7443588","owner":[],"postedDate":"November 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":58087457,"name":"Health sciences/Risk factors"},{"id":58087458,"name":"Scientific community and society/Developing world"}],"tags":[],"updatedAt":"2026-03-23T21:45:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-18 09:55:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7964408","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7964408","identity":"rs-7964408","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}