Delivery risks and outcomes associated with grand multiparity.

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Reproductive Epidemiology

Background:

• Limited recent US national data exists on risks associated with grand multiparity.
• Grand multiparity, defined as five or more previous births, requires updated risk assessment in contemporary obstetric practice.

Purpose of the Study:

• To investigate the association between grand multiparity and severe maternal morbidity (SMM) during delivery hospitalizations in the United States.
• To analyze trends and risks of specific adverse outcomes in women with grand multiparity.

Main Methods:

• A repeat cross-sectional study analyzed delivery hospitalizations from 2000-2015 using the National (Nationwide) Inpatient Sample database.
• Log linear regression models assessed the relationship between grand multiparity and SMM, with outcomes reported as risk ratios (RR) and adjusted risk ratios (aRR).
• Analysis included SMM, placental abruption, postpartum hemorrhage, hysterectomy, shock, and other complications.

Main Results:

• Deliveries with grand multiparity increased from 2000 to 2015, with these women being older and having more comorbidities.
• While univariable analysis showed an association with SMM, adjusted analyses revealed a lower risk (aRR 0.93).
• Grand multiparity was associated with increased risks for placental abruption, preterm delivery, postpartum hemorrhage, hysterectomy, and shock, but lower risks for hypertensive diseases and eclampsia.

Conclusions:

• Grand multiparity was not associated with an increased risk of severe maternal morbidity (SMM) in adjusted analyses.
• Despite a lower overall SMM risk, grand multiparity was linked to higher risks for specific complications like hysterectomy and shock.
• The absolute increase in risk for these specific complications remained small, suggesting careful but not prohibitive management.