title: High parity and adverse birth outcomes: exploring the maze.
abstract: BACKGROUND
  Despite extensive literature on the topic, it is uncertain if grand (para > or = 5) and great grand (para > or = 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women.
  
  
  METHODS
  An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved.
  
  
  RESULTS
  Findings on the association between high parity and maternal-fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para > or = 10) were handicapped by inadequate power.
  
  
  CONCLUSIONS
  After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher-than-expected likelihood for occurrence of fetal macrosomia with advanced parity.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA.
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.forename: Pauline E
authors.initials: PE
authors.lastname: Jolly
authors.forename: John E
authors.initials: JE
authors.lastname: Ehiri
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
mesh_terms: D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors