- Sara Ellis Simonsen, CNM, MSPH, PhD
Sara Ellis Simonsen, CNM, MSPH, PhD
- Visiting Instructor, Department of Family and Preventive Medicine
- Division of Public Health
- University of Utah Health Sciences Center
- Michael W Varner, MD
Michael W Varner, MD
- Professor, Maternal-Fetal Medicine
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
A commonly used clinical definition of parity is the number of births (both live births and stillbirths) ≥20 weeks of gestation that a woman has experienced. Nulliparas have experienced no such births, primiparas have experienced one such birth, and multiparas have experienced more than one such birth. (Pregnancy losses under 20 weeks of gestation are considered abortions, which may be spontaneous or induced. Abortions are not counted toward parity, but are counted toward gravidity, which is the number of times a woman has been pregnant, including her current pregnancy).
A 1934 study suggested that increasing parity increased the risk of pregnancy complications, and first introduced the term "grand multipara." The author concluded that grand multiparity was dangerous because, in his study, maternal mortality increased steadily from the 5th to the 10th pregnancy . After a number of subsequent studies on grand multiparity, the clinically accepted definition evolved to the currently used definition of parity ≥5 births, while great grand multiparas are defined as women of parity ≥10 . In the United States in 2011, nearly 190,000 women gave birth to a child that was at least their fifth birth, which represented about 4.8 percent of all births .
FACTORS AFFECTING THE RELATIONSHIP BETWEEN PARITY AND PREGNANCY OUTCOME
The relationship between obstetric complications and parity has been studied extensively, with inconsistent findings. In addition to the usual limitations of observational data, there are several reasons for the discordancy:
Variability in the definition of parity — There are discrepancies in the way clinicians define parity. A study that evaluated the definition of parity among obstetricians and midwives in London noted that 62 percent defined parity as pregnancies of ≥24 weeks of gestation irrespective of outcome, 25 percent defined parity as pregnancies of ≥24 weeks ending in live birth, and 13 percent defined parity by the number of pregnancies irrespective of outcome . Only 21 percent of those surveyed described twin pregnancies as a single parous experience.
In addition, there is a discrepancy between the clinical definition of parity and the definition used by the United States National Center for Health Statistics (NCHS), an organization within the Centers for Disease Control and Prevention (CDC). The NCHS defines parity as the number of prior live births, excluding stillbirths and fetal deaths , while most clinical investigators in the United States have defined parity as the number of births (live births and stillbirths) ≥20 weeks of gestation. Other gestational age cut-offs to define a parous event (eg, birth after 28 weeks of gestation) are used in other parts of the world.
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- FACTORS AFFECTING THE RELATIONSHIP BETWEEN PARITY AND PREGNANCY OUTCOME
- Variability in the definition of parity
- Variability in the definition of controls
- Nonlinear relationship between parity and pregnancy outcome
- Inadequate adjustment for maternal age
- Healthy person effect
- RISK OF PREGNANCY COMPLICATIONS
- LONG-TERM RISKS
- PATIENT COUNSELING
- PREGNANCY MANAGEMENT
- SUMMARY AND RECOMMENDATIONS