多胎妊娠和不良母婴结局的可能风险：一个有待破解的难题。
Grand multiparity and the possible risk of adverse maternal and neonatal outcomes: a dilemma to be deciphered.
机构信息
Obstetrics and Gynecology Department, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Department of Medical Biochemistry, Faculty of Medicine, Suez Canal University, Round Road, Ismailia, 41511, Egypt.
出版信息
BMC Pregnancy Childbirth. 2017 Sep 19;17(1):310. doi: 10.1186/s12884-017-1508-0.
BACKGROUND
The relation between grand multiparity (GMP) and the possible adverse pregnancy outcomes is not well identified. GMP (parity ≥5 births) frequently occurs in the Arab nations; therefore, this study aimed to identify the correlation between GMP and the different adverse maternal and neonatal outcomes in the Saudi population.
METHOD
This cohort study was conducted on a total of 3327 women from the labour ward in King Khaled University Hospital, Riyadh, Saudi Arabia. Primiparous, multiparous and grand multiparous females were included. Socio-demographic data and pregnancy complications like gestational diabetes or hypertension, preeclampsia and intrauterine growth restriction were retrieved from the participants' files. In addition, the labour ward records were used to extract information about delivery events (e.g. spontaneous preterm delivery, caesarean section [CS]) and neonatal outcomes including anthropometric measurements, APGAR score and neonatal admission to the intensive care.
RESULTS
Primiparas responses were more frequent in comparison to multiparas and GMP (56.8% and 33%, and 10.2% respectively). In general, history of miscarriage was elevated (27.2%), and was significantly higher in GMP (58.3%, p < 0.01). Caesarean delivery was also elevated (19.5%) and was significantly high in the GMP subgroup (p < 0.01). However, after adjustment for age, GMP were less likely to deliver by CS (odds ratio: 0.6, 95% CI: 0.4-0.8; p < 0.01). The two most frequent pregnancy-associated complications were gestational diabetes and spontaneous preterm delivery (12.6% and 9.1%, respectively). The former was significantly more frequent in the GMP (p < 0.01). The main neonatal complication was low birth weight (10.7%); nevertheless, neonatal admission to ICU was significantly higher in GMP (p = 0.04), and low birth weight was more common in primiparas (p < 0.01). Furthermore, logistic regression analysis revealed an insignificant increase in the maternal or neonatal risks in GMP compared to multiparas after adjustment for age.
CONCLUSION
Grand multiparous Saudi females have similar risks of maternal and neonatal complications compared to the other parity groups. Advanced age might play a major role on pregnancy outcomes in GMP. Nevertheless, grand multiparty might not be discouraged as long as women are provided with good perinatal care.
背景
多胎生育（GMP）与可能的不良妊娠结局之间的关系尚未明确。GMP（生育次数≥5 次）在阿拉伯国家中较为常见；因此，本研究旨在确定沙特人群中 GMP 与不同不良母婴结局之间的相关性。
方法
本队列研究纳入了沙特阿拉伯利雅得国王 Khaled 大学医院分娩病房的 3327 名女性。包括初产妇、多产妇和 GMP 产妇。从参与者的档案中检索社会人口统计学数据和妊娠并发症，如妊娠期糖尿病或高血压、子痫前期和宫内生长受限。此外，产房记录用于提取分娩事件（例如自发性早产、剖宫产 [CS]）和新生儿结局的信息，包括体格测量、APGAR 评分和新生儿入住重症监护病房。
结果
与多产妇和 GMP 相比，初产妇的比例更高（分别为 56.8%、33%和 10.2%）。一般来说，流产史较高（27.2%），在 GMP 中明显更高（58.3%，p<0.01）。剖宫产率也较高（19.5%），在 GMP 亚组中明显更高（p<0.01）。然而，调整年龄后，GMP 更不可能行 CS 分娩（优势比：0.6，95%CI：0.4-0.8；p<0.01）。最常见的两种与妊娠相关的并发症是妊娠期糖尿病和自发性早产（分别为 12.6%和 9.1%）。前者在 GMP 中明显更为常见（p<0.01）。新生儿主要并发症是低出生体重（10.7%）；然而，GMP 新生儿入住 ICU 的比例明显更高（p=0.04），而初产妇低出生体重更为常见（p<0.01）。此外，调整年龄后，与多产妇相比，GMP 产妇和新生儿的风险增加并不显著。
结论
与其他产次组相比，沙特的 GMP 产妇母婴并发症的风险相似。高龄可能在 GMP 产妇的妊娠结局中起主要作用。然而，只要为女性提供良好的围产期护理，就不应劝阻 GMP 生育。
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