Maternal and neonatal outcomes of grand multiparas over two decades in Mali.
OBJECTIVE
To analyze the association between grand multiparity and maternal and neonatal morbidity and mortality.


METHODS
Retrospective cross-sectional study.


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


METHODS
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.


METHODS
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.
Gabriel Touré Teaching Hospital, Department of Obstetrics and Gynecology, Bamako, Mali.
Ibrahima
I
Teguete
Amelia W
AW
Maiga
Phyllis C
PC
Leppert
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008302:Mali / Q000453:epidemiology; D008423:Maternal Age; D008428:Maternal Mortality / Q000639:trends; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care; D012189:Retrospective Studies; D055815:Young Adult