The grand multipara--still an obstetrical challenge?

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Perinatal Epidemiology

Background:

• Grand multiparity (parity of 6 or more) has historically been associated with increased obstetric risks.
• Changes in obstetric practices and maternal characteristics over time may influence these risks.

Purpose of the Study:

• To investigate whether grand multiparity continues to pose significant risks in contemporary birth cohorts.
• To compare obstetric outcomes between grand multiparous women and women of lower parity across different time periods.

Main Methods:

• A comparative study of two birth cohorts from northern Finland: 1966 and 1985/86.
• Analysis of maternal demographics, antenatal care utilization, delivery interventions, and perinatal outcomes.
• Statistical comparison of outcomes between grand multiparous women and women of lower parity.

Main Results:

• The prevalence of grand multiparity decreased from 7.7% to 4.0% between the cohorts.
• Grand multiparous women exhibited lower rates of cesarean sections and vacuum extractions but higher rates of labor induction.
• While low birth weight rates were lower in grand multiparous women, their stillbirth and neonatal death rates remained higher, linked to congenital anomalies.

Conclusions:

• Grand multiparity remains associated with elevated risks of stillbirth and neonatal death, particularly due to congenital anomalies.
• Despite a decrease in grand multiparity and improvements in perinatal outcomes for lower-parity women, these specific risks for grand multiparous women did not show similar improvement.
• Further research and targeted interventions may be necessary to mitigate the persistent risks associated with grand multiparity.