title: Obstetric and neonatal outcomes in grand multiparity.
abstract: OBJECTIVE
  To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among grand multiparas with age-matched multiparas.
  
  
  METHODS
  Six hundred twenty-one grand multiparas (para more than 4) women were prospectively compared with 621 age-matched multiparous (para 2-4) controls.
  
  
  RESULTS
  Grand multiparity was associated with low socioeconomic status and education (odds ratio [OR]6.4; 95% confidence interval [CI] 4.5, 9.0), poorer prenatal care (OR 3.1; 95% CI 1.5, 6.1), smoking (OR 2.2; 95% CI 1.5, 3.2), and alcohol consumption (OR 9.0; 95% CI 2.1, 39.3). Grand multiparas had a higher body mass index (OR 1.5; 95% CI 1.2, 1.9) and rate of insulin-dependent gestational diabetes (OR 1.7; 95% CI 1.02, 3.1). They had more previous intrauterine (OR 4.2; 95% CI 1.5, 11.3) and perinatal deaths (OR 3.2; 95% CI 2.0, 5.0). They had fewer intrapartum complications (arrests of cervical dilatation [OR 0.19; 95% CI 0.06, 0.66], instrumental deliveries [OR 0.31; 95% CI 0.16, 0.59], and fever during labor [OR 0.47; 95% CI 0.26, 0.86]). Conditional logistic regression models found that grand multiparity was the most closely correlated factor to a previous history of fetal death (OR 4.3; 95% CI 1.6, 11.6), but it was not an independent predictor of insulin-dependent gestational diabetes mellitus (OR 1.3; 95% CI 0.75, 2.2).
  
  
  CONCLUSIONS
  Grand multiparas, when compared with same-age multiparous controls, appear to have fewer intrapartum complications. However, they present several prenatal risk factors that require special antenatal care.
  
  
  METHODS
  II-3
authors.affiliation: Department of Gynecology et Obstetrics, Groupe Hospitalier Sud Réunion, St Pierre, France. horace.roman@libertysurf.fr
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Robillard
authors.forename: Eric
authors.initials: E
authors.lastname: Verspyck
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Hulsey
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
authors.forename: Georges
authors.initials: G
authors.lastname: Barau
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D017508:Reunion / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors