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.
Conclusion: 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.
