title: Is grandmultiparity an independent risk factor for adverse perinatal outcomes?
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes among grandmultiparous women to those of multiparous women 30 years or older.
  
  
  METHODS
  A database of the vast majority of maternal and newborn hospital discharge records linked to birth/death certificates was queried to obtain information on all multiparous women with a singleton delivery in the state of California from January 1, 1997 through December 31, 1998. Maternal and neonatal pregnancy outcomes of grandmultiparous women were compared to multiparous women who were 30 years or older at the time of their last birth.
  
  
  RESULTS
  The study population included 25,512 grandmultiparous and 265,060 multiparous women 30 years or older as controls. Grandmultiparous women were predominantly Hispanic (56%). After controlling for potential confounding factors, grandmultiparous women were at significantly higher risk for abruptio placentae (odds ratio OR: 1.3; 95% confidence intervals CI: 1.2-1.5), preterm delivery (OR: 1.3; 95% CI: 1.2-1.4), fetal macrosomia (OR: 1.5; 95% CI: 1.4-1.6), neonatal death (OR: 1.5; 95% CI: 1.3-1.8), postpartum hemorrhage (OR: 1.2; 95% CI: 1.1-1.3) and blood transfusion (OR: 1.5; 95% CI: 1.3-1.8).
  
  
  CONCLUSIONS
  Grandmultiparous women had increased maternal and neonatal morbidity, and neonatal mortality even after controlling for confounders, suggesting a need for closer observation than regular multiparous patients during labor and delivery.
authors.affiliation: Department of Obstetrics & Gynecology, University of California Davis, USA. shagufta.yasmeen@ucdmc.ucdavis.edu
authors.forename: Shagufta
authors.initials: S
authors.lastname: Yasmeen
authors.forename: Beate
authors.initials: B
authors.lastname: Danielsen
authors.forename: Malana
authors.initials: M
authors.lastname: Moshesh
authors.forename: William M
authors.initials: WM
authors.lastname: Gilbert
mesh_terms: D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors