Obstetric and Neonatal Outcomes in Grand Multiparity Horace Roman, MD, Pierre-Yves Robillard, MD, Eric Verspyck, MD, PhD, Thomas C. Hulsey, PhD, MSPH, Loı ¨c Marpeau, MD, PhD, and Georges Barau, MD OBJECTIVE: To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among grand multiparas with age-matched multiparas. METHODS: Six hundred twenty-one grand multiparas (para more than 4) women were prospectively compared with 621 age-matched multiparous (para 2– 4) controls. RESULTS: Grand multiparity was associated with low socio- economic status and education (odds ratio [OR]6.4; 95% confidence interval [CI] 4.5, 9.0), poorer prenatal care (OR 3.1; 95% CI 1.5, 6.1), smoking (OR 2.2; 95% CI 1.5, 3.2), and alcohol consumption (OR 9.0; 95% CI 2.1, 39.3). Grand multiparas had a higher body mass index (OR 1.5; 95% CI 1.2, 1.9) and rate of insulin-dependent gestational diabetes (OR 1.7; 95% CI 1.02, 3.1). They had more previous intra- uterine (OR 4.2; 95% CI 1.5, 11.3) and perinatal deaths (OR 3.2; 95% CI 2.0, 5.0). They had fewer intrapartum complications (arrests of cervical dilatation [OR 0.19; 95% CI 0.06, 0.66], instrumental deliveries [OR 0.31; 95% CI 0.16, 0.59], and fever during labor [OR 0.47; 95% CI 0.26, 0.86]). Conditional logistic regression models found that grand multiparity was the most closely correlated factor to a previous history of fetal death (OR 4.3; 95% CI 1.6, 11.6), but it was not an independent predictor of insulin-depen- dent gestational diabetes mellitus (OR 1.3; 95% CI 0.75, 2.2). CONCLUSION: Grand multiparas, when compared with same-age multiparous controls, appear to have fewer intra- partum complications. However, they present several pre- natal risk factors that require special antenatal care. (Obstet Gynecol 2004;103:1294 –9. © 2004 by The Amer- ican College of Obstetricians and Gynecologists.) LEVEL OF EVIDENCE: II-3 For many decades pregnancies in grand multiparas have been considered risky. 1 Grand multiparity is defined as parity greater than or equal to 5 (including the last delivery). 2–5 As a matter of fact, several retrospective studies have reported increased complication rates, such as diabetes, 2,4,6 threatened premature labor, 2 perinatal mortality, 2,7,8 hypertension, 4 and intrauterine fetal death. 9 However, in all these studies, the authors argued that the grand multiparas’ advanced maternal age might distort these findings. Currently, in developed countries, grand multiparity is becoming rare (3– 4% of all births 2 ), and therefore many studies have had a limited sample size. 5 We are reporting on a prospective cross age– matched study of 621 grand-multiparous and 621 mul- tiparous pregnancies in Reunion Island, a French De- partment situated in the Indian Ocean, where grand multiparity is still highly prevalent at relatively young ages. The objective of this study was to compare the incidence of antenatal and intrapartum complications and neonatal outcomes among grand multiparas versus age-matched multiparas with the control for several con- founding variables. MATERIALS AND METHODS Reunion is an island located in the Indian Ocean (be- tween Madagascar and Mauritius) with 850,000 inhab- itants and 14,500 births per year. The current infant and perinatal mortality rates are 6 and 13 per 1,000, respec- tively. The Sud-Reunion Hospital’s maternity depart- ment performs 4,200 deliveries per year (75% of births in the southern area). Patients benefit from free medical care through the French National Social Security Sys- tem. During a 20-month period (January 2001 to August 2002) all grand multiparas (parity more than 4, including the last birth) delivering after 22 weeks of gestation were included in the study. The control group was composed of the next age-matched multiparas (parity 2 to 4) deliv- ering after the index case. Agreement was obtained from the departmental research ethics committee. Prenatal risk factors have been defined by the stan- dards of Williams Obstetrics, 21st edition. 10 Chronic hyper- tension was defined as a diastolic blood pressure of at least 90 mm Hg before 20 weeks of gestation or a preexisting history of essential hypertension or anti- From the Department of Gynecology et Obstetrics, Groupe Hospitalier Sud Re ´union, St Pierre, France; Department of Gynecology et Obstetrics, University Hospital of Rouen, Rouen, France; Department of Pediatrics, Groupe Hospitalier Sud Re ´union, St Pierre, France; Pediatric Epidemiology, Medical University of South Carolina, Charleston, South Carolina. VOL. 103, NO. 6, JUNE 2004 1294 © 2004 by The American College of Obstetricians and Gynecologists. 0029-7844/04/$30.00 Published by Lippincott Williams & Wilkins. doi:10.1097/01.AOG.0000127426.95464.85