High parity and fetal morbidity outcomes
ABSTRACT We investigated the association between high parity and fetal morbidity outcomes.
We analyzed 22,463,141 singleton deliveries at 20 weeks or more of gestation in the United States from 1989 through 2000. Adjusted odds ratios generated from logistic regression models were used to approximate relative risk for neonatal morbidity in women with 1-4 (moderate parity or type I; referent group), 5-9 (high parity or type II), 10-14 (very high parity or type III) and 15 or more (extremely high parity or type IV) prior live births. Main outcome measures included low and very low birth weight, preterm and very preterm birth, and small and large for gestational age delivery.
The overall crude rates for low birth weight, very low birth weight, preterm birth, very preterm birth, and small and large for gestational age were 55, 11, 97, 19, 83, and 129 per 1,000 live births, respectively. The adjusted odds ratios for low birth weight, very low birth weight, preterm, and very preterm delivery increased consistently and in a dose-effect fashion with ascending parity (P for trend < .001). In the case of large for gestational age delivery, the adjusted odds ratio showed an inverted-U pattern, being highest among women in the type III parity cluster. The findings with respect to small for gestational age were inconclusive.
High parity is a risk factor for adverse fetal outcomes. However, the impact of heightened parity is more manifest as shortened gestation rather than physical size restriction. These findings could prove beneficial for counseling women of high parity.
- SourceAvailable from: Christine M. Demont‐Heinrich[Show abstract] [Hide abstract]
ABSTRACT: Objective To determine the risk factors associated with having a very low birth weight (VLBW) infant as a follow-up to the first phase of a Perinatal Periods of Risk approach.Design and SampleRetrospective cohort analysis of birth certificates. Population-based sample of 53,427 birth certificates for the city under study during the years 1999–2006.MeasuresThe relationship of selected maternal characteristics as predictors of VLBW using multivariate logistic regression analysis.ResultsThe maternal characteristics associated with VLBW were as follows: no prenatal care (OR = 4.04), inadequate weight gain (OR = 3.97), Black, non-Hispanic race (OR = 1.50), less than 20 years old (OR = 1.42) and more than 35 years old (OR = 1.43). After analyzing age and race/ethnicity together, Black non-Hispanic women less than 20 years of age (OR = 2.70) or over 35 years of age (OR = 2.45) still had an increased odds for having a VLBW infant whereas Black non-Hispanic women between the ages of 20 and 35 did not.Conclusions The findings of this study suggest educating women on the importance of preconception care, prenatal care, and adequate pregnancy weight gain to reduce the odds of having a VLBW infant.Public Health Nursing 05/2014; 31(3). DOI:10.1111/phn.12062 · 0.89 Impact Factor
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ABSTRACT: Background : There is disagreement about the association between cleft lip with or without cleft palate and multigravidity, which could be explained by differences of adjusting for maternal age, Amerindian ancestry, and socioeconomic status. Objective : The aim was to evaluate gravidity 4+ (more than four gestations) as a risk factor for cleft lip with or without cleft palate in South America. Design : We used a matched (1:1) case-control study with structural equation modeling for related causes. Data were obtained from 1,371,575 consecutive newborn infants weighing ≥500 g who were born in the hospitals of the Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC) network between 1982 and 1999. There were a total of 1,271 cases with cleft lip with or without cleft palate (excluding midline and atypical cleft lip with or without cleft palate). A total of 1,227 case-control pairs were obtained, matched by maternal age, newborn gender, and year and place of birth. Potential confounders and intermediary variables were analyzed with structural equation modeling. Results : The crude risk of gravidity 4+ was 1.41 and the 95% confidence interval was 1.14 to 1.61. When applying structural equation modeling, the effect of multigravidity on the risk of cleft lip with or without cleft palate was 1.22 and the 95% confidence interval was 0.91 to 1.39. Conclusions : Multigravid mothers (more than four gestations) showed no greater risk of bearing children who had cleft lip with or without cleft palate than mothers with two or three births. Therefore, the often observed and reported association between multigravidity and oral clefts likely reflects the effect of other risk factors related to low socioeconomic status in South American populations.The Cleft Palate-Craniofacial Journal 04/2013; 50(5). DOI:10.1597/11-320 · 1.11 Impact Factor
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ABSTRACT: The objective of this retrospective cohort study was to explore the potential causal relation between parity and fetal growth indices, including low birth weight (LBW), macrosomia, and prematurity. The study was nested on a community trial in a city in Oman. The study analyzed 1939 pregnancies among 479 participants. Of these, 944 pregnancies (48.7%) were high parity (≥5). Obtained newborns with outcomes of interest were as follows: 191 LBW, 34 macrosomic, and 69 premature. Associations were measured using multilevel logistic regression modeling. Compared to low parity (LP, defined as <5), high parity was found to be associated with less risk of LBW (relative risk [RR] = 0.76; 95% confidence interval [CI]: 0.44-1.1) and prematurity (RR = 0.82; 95% CI: 0.54-1.27), but greater risk of macrosomia (RR = 1.8; 95% CI: 1.2-2.4). This study provides evidence that with increasing parity, risks of LBW and prematurity decrease, while risk of macrosomia increases.International Journal of Women's Health 07/2012; 4:289-93. DOI:10.2147/IJWH.S32190