Grand multiparity as a predictor of adverse pregnancy outcome among women who delivered at a tertiary hospital in Northern Tanzania

Zainab Muniro,Eusebious Maro,Michael J Mahande,Bariki Mchome,Clifford Silver Tarimo

doi:10.1186/s12884-019-2377-5

Abstract

BackgroundGrand multiparity has been associated with increased risks of adverse pregnancy outcomes such as post-partum hemorrhage,gestational hypertension, gestationaldiabetes mellitus and high perinatal mortality.There is limited information about the impact of high parity on pregnancy outcomes in Tanzania. This study aimed to determine prevalence, trend and associated adverse pregnancy outcomes of grand multiparity in a tertiary hospital in Northern Tanzania.MethodsA retrospective cross-sectional study was conducted at Kilimanjaro Christian Medical Centre (KCMC) using maternally linked data from medical birth registry. Women with singleton deliveries from 2006 to 2014 were analyzed. The prevalence of grand-multiparity was computed as proportion to estimate the trend over years. Adverse pregnancy outcomes associated with grand multiparity were estimated using multivariable logistic regression models. A p-value of < 0.05 was considered statistically significant.ResultsThe overall prevalence of grand multiparity was 9.44% ranging from 9.72% in 2006 to 8.49% in 2014. The grand multiparous women had increased odds of prelabour rupture of membranes (Adjusted odds ratio [AOR] 1.78: 95% CI:1.28–2.49), stillbirth (AOR 1.66: 95% CI:1.31–2.11) and preterm birth delivery (AOR 1.28; 95% CI: 1.05–1.56) as compared to women in the lower parity group.ConclusionsThe prevalence of grand multiparity among women in North-Tanzania was 9.44%. It was significantly associated with adverse pregnancy outcomes. This calls for a need to increase community awareness on its risks, encourage birth control among older women. Delivery-care facilities should prepare for emergency situation when attending deliveries of high parity group.

Highlights

Grand multiparity has been associated with increased risks of adverse pregnancy outcomes such as post-partum hemorrhage,gestational hypertension, gestationaldiabetes mellitus and high perinatal mortality.There is limited information about the impact of high parity on pregnancy outcomes in Tanzania
Half (52%) of the grand multiparous subjects had less than 4 antenatal care visits during their pregnancy while 60% delivered at term
After adjusting for maternal age, maternal education, mothers’ residence, body mass index (BMI), number of antenatal care visits and gestational age, prelabour rupture of membranes (PROM) (AOR 1.78; 95% confidence interval (CI): 1.28–2.49) remained significantly associated with grand multiparity

Summary

Introduction

Grand multiparity has been associated with increased risks of adverse pregnancy outcomes such as post-partum hemorrhage,gestational hypertension, gestationaldiabetes mellitus and high perinatal mortality.There is limited information about the impact of high parity on pregnancy outcomes in Tanzania. As Sustainable Development Goal’s (SDG) efforts to address promotion of maternal health and reduction of child mortality becomes intensified, regional specific investigation to inform the public health on potential effect of factors that presents a significant risk to the pregnant mother and the birth outcome are imperative. Low-and-middle income countries including Tanzania’s fertility rate have still relatively high annual fertility rate as compared to high income countries [1]. This trend may pose substantial risk to the pregnant mother and result in adverse birth outcome. Grand multiparity is hypothesized to play a significant role in adverse maternal outcomes especially in low-and-middle income countries like Tanzania.

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