Grand multiparity: is it still a risk in pregnancy?

Andrew H Mgaya,Hussein L Kidanto,Hans N Mgaya,Siriel N Massawe

doi:10.1186/1471-2393-13-241

Abstract

BackgroundThe association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Classifying grand multiparous women as a high-risk group without clear evidence of a consistent association with adverse outcomes can lead to socioeconomic burdens to the mother, family and health systems. We compared the maternal and perinatal complications among grand multiparous and other multiparous women in Dar es Salaam in Tanzania.MethodsA cross-sectional study was undertaken at Muhimbili National Hospital (MNH). A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk factors. Predictors of adverse outcomes in relation to grand multiparous women were assessed at p = 0.05.ResultsGrand multiparas had twice the likelihood of malpresentation and a threefold higher prevalence of meconium-stained liquor and placenta previa compared with lower-parity women even when adjusted for age. Neonates delivered by grand multiparous women (12.1%) were at three-time greater risk of a low Apgar score compared with lower-parity women (5.4%) (odds ratio (OR), 2.9; 95% confidence interval (CI), 1.5–5.0). Grand multiparity and low birth weight were independently associated with a low Apgar score (OR, 2.4; 95%, CI 1.4–4.2 for GM; OR, 4.2; 95% CI, 2.3–7.8) for low birth weight.ConclusionGrand multiparity remains a risk in pregnancy and is associated with an increased prevalence of maternal and neonatal complications (malpresentation, meconium-stained liquor, placenta previa and a low Apgar score) compared with other multiparous women who delivered at Muhimbili National Hospital.

Highlights

The association of grand multiparity and poor pregnancy outcome has not been consistent for decades
grand multiparity” (GM) and low birth weight were independently associated with a low Apgar score (p = 0.001, odds ratio (OR), 2.4; 95% confidence interval (CI), 1.4–4.2 for GM; p = 0.002, OR, 4.2; 95% CI, 2.3– 7.8 for low birth weight)
This study demonstrated that GM remains a risk in pregnancy and is associated with an increased prevalence of maternal and neonatal complications as compared with other multiparous women who delivered at Muhimbili National Hospital (MNH)

Summary

Introduction

The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Classifying grand multiparous women as a high-risk group without clear evidence of a consistent association with adverse outcomes can lead to socioeconomic burdens to the mother, family and health systems. High parity has been deemed a burden to the family and health systems [13]. The Tanzania Demographic Health Survey (TDHS) for 2005 revealed a total fertility rate (TFR) of 5.7, which is statistically at the same level as rates estimated by the TDHS in 1996 (5.8 births) and 1999 (5.6 births). These data implied that, on average, a Tanzanian woman will bear 6 children [14]. A study completed in rural Tanzania revealed that ≤60% of health workers were unaware of the definition of GM [15]

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Conclusion