Association between parity and adverse maternal and neonatal outcomes: a population-based cross-sectional study

This study aimed to comprehensively assess the association between parity and adverse maternal and neonatal outcomes among Chinese women, particularly across different age and educational strata, in the context of recent changes in China's birth policy.

This population-based cross-sectional study analyzed data from 451,002 women who delivered at 22 hospitals in 10 cities of Hebei Province, China, between 2013 and 2022. Participants were categorized into three parity groups: the nulliparous (parity = 0) group, primiparous (parity = 1) group, and multiparous (parity ≥ 2) group. Temporal trends in parity composition and maternal age were analyzed using a joinpoint regression analysis to identify significant transition points. Multivariable logistic regression models were used to assess the independent associations between parity and adverse outcomes, adjusting for potential confounders. Subgroup analyses were conducted by maternal age and educational level to examine effect modifications.

From 2013 to 2022, the proportion of multiparous (parity ≥ 2) women and the average maternal age at delivery increased significantly. The joinpoint analysis revealed notable transitions approximately in 2017 in parity composition and in 2019 for maternal age trends among multiparous women, coinciding with major policy changes. After adjusting for confounders, higher parity (compared to nulliparity) was associated with increased risks of anemia, gestational diabetes mellitus (GDM), placenta previa, preterm delivery, macrosomia, stillbirth, and neonatal death (p-trend < 0.001). In contrast, higher parity (compared to nulliparity) was associated with lower adjusted odds of hypertension during pregnancy, malpresentation, cesarean delivery, and low birth weight (p < 0.001). Subgroup analyses indicated that advanced maternal age (≥35 years) was associated with a heightened risk of perineal laceration among multiparous (parity ≥ 2) women, while lower educational attainment (primary school or below) attenuated the associations between parity and several adverse outcomes, including gestational diabetes, malpresentation, postpartum hemorrhage (PPH), and stillbirth.

The risk of adverse pregnancy outcomes varies significantly by parity, and these relationships are further modified by maternal age and educational level. Tailored prenatal strategies considering parity, age, and education are essential to mitigate risks and improve maternal and neonatal health.