title: Grand multiparity: is it still a risk in pregnancy?
abstract: BACKGROUND
  The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Classifying grand multiparous women as a high-risk group without clear evidence of a consistent association with adverse outcomes can lead to socioeconomic burdens to the mother, family and health systems. We compared the maternal and perinatal complications among grand multiparous and other multiparous women in Dar es Salaam in Tanzania.
  
  
  METHODS
  A cross-sectional study was undertaken at Muhimbili National Hospital (MNH). A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk factors. Predictors of adverse outcomes in relation to grand multiparous women were assessed at p = 0.05.
  
  
  RESULTS
  Grand multiparas had twice the likelihood of malpresentation and a threefold higher prevalence of meconium-stained liquor and placenta previa compared with lower-parity women even when adjusted for age. Neonates delivered by grand multiparous women (12.1%) were at three-time greater risk of a low Apgar score compared with lower-parity women (5.4%) (odds ratio (OR), 2.9; 95% confidence interval (CI), 1.5-5.0). Grand multiparity and low birth weight were independently associated with a low Apgar score (OR, 2.4; 95%, CI 1.4-4.2 for GM; OR, 4.2; 95% CI, 2.3-7.8) for low birth weight.
  
  
  CONCLUSIONS
  Grand multiparity remains a risk in pregnancy and is associated with an increased prevalence of maternal and neonatal complications (malpresentation, meconium-stained liquor, placenta previa and a low Apgar score) compared with other multiparous women who delivered at Muhimbili National Hospital.
authors.affiliation: Department of Obstetrics and Gynaecology, Muhimbili National Hospital, PO Box 65000, Dar es Salaam, Tanzania. mgaya4@yahoo.com.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Mgaya
authors.forename: Siriel N
authors.initials: SN
authors.lastname: Massawe
authors.forename: Hussein L
authors.initials: HL
authors.lastname: Kidanto
authors.forename: Hans N
authors.initials: HN
authors.lastname: Mgaya
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D001034:Apgar Score; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007746:Labor Presentation; D008423:Maternal Age; D008470:Meconium; D010298:Parity; D010923:Placenta Previa / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult