{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T07:15:17Z","timestamp":1763968517928,"version":"3.37.3"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003Dichorionic twins have increased risk of preterm birth and hypertensive disorders of pregnancy. Grand multiparity may be associated with adverse perinatal outcomes in singleton pregnancies, although the effect of increasing parity in twins is unclear. This study aimed to elucidate whether grand multiparity leads to adverse outcomes in dichorionic twins compared with multiparity and nulliparity.<\/jats:p><jats:p>\n            Study Design\u2003This was a retrospective review of dichorionic twins at a single institution between January 2008 and December 2019 comparing pregnancy outcomes among grand multiparity, multiparity, and nulliparity. Primary outcome was preterm birth less than 37 weeks. Multivariable regression controlled for differing demographics, prior preterm birth, use of reproductive technologies, and hypertensive disorders of pregnancy. Chi square and Fisher's exact were used for categorical variables and Kruskal\u2013Wallis was used for continuous variables.<\/jats:p><jats:p>\n            Results\u2003A total of 843 (60.3%) pregnancies were nulliparous, 499 (35.7%) multiparous, and 57(4.1%) grand multiparous. Univariate analysis indicated that multiparous women had lower incidence of preterm birth less than 37, 34, and 32 weeks (57 vs. 51%, p\u2009=\u20090.04; 19.2 vs. 14.0%, p\u2009=\u20090.02; 9.6 vs. 5.6%, p\u2009=\u20090.01) and that grand multiparous women had lower incidence of preterm birth less than 34 weeks (19.2 vs. 5.3%, p\u2009=\u20090.008) compared with nulliparous women. Multivariable regression confirmed multiparous women had lower odds of preterm birth less than 34 and 32 weeks compared with nulliparous women (&lt;34 wk: odds ratio [OR]\u2009=\u20090.69, 95% confidence interval [CI]\u2009=\u20090.49\u20130.97, p\u2009=\u20090.03; &lt;32 wk: OR\u2009=\u20090.48, 95% CI\u2009=\u20090.29\u20130.79, p\u2009=\u20090.004) and that multiparous women (OR\u2009=\u20090.57, 95% CI\u2009=\u20090.42\u20130.77, p\u2009=\u20090.0002) and grand multiparous women (OR\u2009=\u20090.23, 95% CI\u2009=\u20090.08\u20130.68, p\u2009=\u20090.0074) had lower incidence of hypertensive disorders of pregnancy when compared with nulliparous women.<\/jats:p><jats:p>\n            Conclusion\u2003Grand multiparity is not associated with adverse perinatal outcomes compared with nulliparity or multiparity in dichorionic twins. Increasing parity may protect against incidence of preterm birth and hypertensive disorders of pregnancy even among grand multiparous women.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2107-1755","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T23:25:31Z","timestamp":1686180331000},"page":"e2238-e2247","source":"Crossref","is-referenced-by-count":2,"special_numbering":"S","title":["Is Increasing Parity Associated with Adverse Perinatal Outcomes in Dichorionic Twin Gestations?"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6105-6249","authenticated-orcid":false,"given":"Manasa G.","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-4109","authenticated-orcid":false,"given":"Chelsea A.","family":"Debolt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Center for Biostatistics, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia G.","family":"Khurana","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra N.","family":"Mills","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisha","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrei","family":"Rebarber","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan S.","family":"Fox","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/AOG.0000000000001338","article-title":"Twin pregnancy and severe maternal outcomes: the World Health Organization multicountry survey on maternal and newborn health","volume":"127","author":"D S Santana","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1097\/AOG.0000000000004397","article-title":"Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies: ACOG practice bulletin, number 231","volume":"137","author":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Obstetrics, Society for Maternal-Fetal Medicine","year":"2021","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S0002-9378(00)70350-4","article-title":"Hypertensive disorders in twin versus singleton gestations","volume":"182","author":"B M Sibai","year":"2000","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0002-9378(99)70324-8","article-title":"Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies","volume":"181","author":"D B Schwartz","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref5","first-page":"91","article-title":"Impact of fetal reduction on the incidence of gestational diabetes","volume":"99","author":"E Sivan","year":"2002","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1097\/00006250-200006000-00022","article-title":"Maternal morbidity and mortality associated with multiple gestations","volume":"95","author":"A Conde-Agudelo","year":"2000","journal-title":"Obstet Gynecol"},{"issue":"17","key":"ref7","first-page":"1","article-title":"Births: final data for 2020","volume":"70","author":"M Osterman","year":"2021","journal-title":"Natl Vital Stat Rep"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5455\/msm.2015.27.244-247","article-title":"Grand multiparity: risk factors and outcome in a tertiary hospital: a comparative study","volume":"27","author":"M A Alsammani","year":"2015","journal-title":"Mater Sociomed"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/S0002-9378(99)70511-9","article-title":"Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric risk factors","volume":"181","author":"A Babinszki","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1186\/s12884-017-1508-0","article-title":"Grand multiparity and the possible risk of adverse maternal and neonatal outcomes: a dilemma to be deciphered","volume":"17","author":"G K Al-Shaikh","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1055\/s-2006-947158","article-title":"Grandmultiparas in modern obstetrics","volume":"23","author":"A H Nassar","year":"2006","journal-title":"Am J Perinatol"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1067\/mob.2002.119639","article-title":"Parity and pregnancy outcomes","volume":"186","author":"J Bai","year":"2002","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/0020-7292(85)90027-X","article-title":"The \u201cgrand multipara\u201d\u2013is it a problem? A review of 5785 cases","volume":"23","author":"K Fuchs","year":"1985","journal-title":"Int J Gynaecol Obstet"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/0002-9378(65)90246-2","article-title":"Obstetric behavior of the grand multipara","volume":"91","author":"S L Israel","year":"1965","journal-title":"Am J Obstet Gynecol"},{"issue":"25","key":"ref15","doi-asserted-by":"crossref","first-page":"7708","DOI":"10.1080\/14767058.2021.1960972","article-title":"Delivery risks and outcomes associated with grand multiparity","volume":"35","author":"K E Lee","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"03","key":"ref16","first-page":"381","article-title":"Maternal outcome of grand multipara","volume":"20","author":"S M Shahida","year":"2011","journal-title":"Mymensingh Med J"},{"issue":"11","key":"ref17","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1016\/S0002-9378(16)35787-8","article-title":"Grand multiparity\u2013its obstetric implications","volume":"84","author":"H A Ziel Jr","year":"1962","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"ref18","first-page":"625","article-title":"Grand multiparity\u2013a nationwide survey","volume":"25","author":"A Samueloff","year":"1989","journal-title":"Isr J Med Sci"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3109\/00016348709092954","article-title":"The grand multipara\u2013maternal and neonatal complications","volume":"66","author":"T G Tanbo","year":"1987","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"862","DOI":"10.3109\/00016349.2010.486827","article-title":"Parity and low birth weight and preterm birth: a systematic review and meta-analyses","volume":"89","author":"P S Shah","year":"2010","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/0002-9378(95)90593-6","article-title":"The \u201cdangerous multipara\u201d: fact or fiction?","volume":"172","author":"J S Toohey","year":"1995","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref22","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1097\/01.AOG.0000127426.95464.85","article-title":"Obstetric and neonatal outcomes in grand multiparity","volume":"103","author":"H Roman","year":"2004","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1067\/mob.2002.123989","article-title":"Demographic and obstetric factors influencing pregnancy outcome in twin gestations","volume":"186","author":"J G Tarter","year":"2002","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/01.AOG.0000128905.37143.47","article-title":"Nulliparity and duration of pregnancy in multiple gestation","volume":"104","author":"A J Aina-Mumuney","year":"2004","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/j.1600-0412.2011.01192.x","article-title":"Effect of parity on maternal and neonatal outcomes in twin gestations","volume":"91","author":"A Hannoun","year":"2012","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/uog.18930","article-title":"Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF\/ICSI treatment: meta-analysis of cohort studies","volume":"51","author":"P Cavoretto","year":"2018","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1093\/humrep\/deaa380","article-title":"Preterm delivery risk in infertile women who conceived after reproductive surgery: natural conception versus IVF\/ICSI","volume":"36","author":"T Premru-Srsen","year":"2021","journal-title":"Hum Reprod"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/0029-7844(95)00049-W","article-title":"Risk factors for preeclampsia in twin pregnancies: a population-based cohort study","volume":"85","author":"D V Coonrod","year":"1995","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/0002-9378(86)90747-7","article-title":"Hypertensive diseases of pregnancy and parity","volume":"154","author":"N Gleicher","year":"1986","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1159\/000009948","article-title":"Comparative changes in uterine artery blood flow waveforms in singleton and twin pregnancies","volume":"45","author":"Q Chen","year":"1998","journal-title":"Gynecol Obstet Invest"},{"issue":"03","key":"ref31","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1080\/14767050600587850","article-title":"Influence of parity on second-trimester uterine artery Doppler waveforms in twin pregnancy","volume":"19","author":"S Suzuki","year":"2006","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/bmj.327.7410.313","article-title":"Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study","volume":"327","author":"G CS Smith","year":"2003","journal-title":"BMJ"},{"issue":"15","key":"ref33","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1001\/jama.295.15.1809","article-title":"Birth spacing and risk of adverse perinatal outcomes: a meta-analysis","volume":"295","author":"A Conde-Agudelo","year":"2006","journal-title":"JAMA"},{"issue":"05","key":"ref34","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1002\/ajhb.22708","article-title":"Short interpregnancy interval and low birth weight: a role of parity","volume":"27","author":"A Merklinger-Gruchala","year":"2015","journal-title":"Am J Hum Biol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2107-1755.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:36:26Z","timestamp":1730813786000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2107-1755"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,7]]},"references-count":34,"journal-issue":{"issue":"S 01","published-online":{"date-parts":[[2024,5,13]]},"published-print":{"date-parts":[[2024,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2107-1755","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published-other":{"date-parts":[[2023,6,7]]},"published":{"date-parts":[[2023,6,7]]}}}