Maternal and neonatal outcomes of grand multiparas over two decades in Mali

Acta Obstet Gynecol Scand. 2012 May;91(5):580-6. doi: 10.1111/j.1600-0412.2012.01372.x.


Objective: To analyze the association between grand multiparity and maternal and neonatal morbidity and mortality.

Design: Retrospective cross-sectional study.

Setting: Point G National Hospital, a tertiary care hospital in Bamako, Mali.

Population: All singleton births from 1985 to 2003.

Methods: Cross-sectional study of 13 340 singleton births at a tertiary care hospital in Mali (1985-2003) compared outcomes between 3617 grand multiparas (para ≥5) and 9723 pauciparas (para 1-4). Odds ratios (OR) were adjusted for maternal age, prenatal care utilization, socioeconomic status, and region of origin.

Main outcome measures: Maternal mortality, perinatal mortality, placental abnormalities (previa and abruption), uterine rupture, postpartum infection, postpartum hemorrhage, eclampsia, cesarean delivery, mean birthweight, low birthweight, high birthweight.

Results: Grand multiparas were older, poorer, and less likely to have accessed prenatal care. Grand multiparas had a lower adjusted odds of maternal death (adjusted OR, 0.66; 95%CI, 0.45-0.97), but higher adjusted odds of perinatal death (adjusted OR, 1.33; 95%CI, 1.12-1.59), placental abnormalities (adjusted OR, 1.57; 95%CI, 1.21-2.05), and high birthweight (adjusted OR, 1.42; 95%CI, 1.05-1.92).

Conclusions: The healthy person effect may explain grand multiparas' lower odds of maternal death. Reducing grand multiparity and improving grand multiparas' access to prenatal care may improve population-level perinatal outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Infant Mortality / trends
  • Infant, Newborn
  • Mali / epidemiology
  • Maternal Age
  • Maternal Mortality / trends
  • Middle Aged
  • Parity*
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Pregnancy Outcome / epidemiology*
  • Prenatal Care
  • Retrospective Studies
  • Young Adult