{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T12:02:58Z","timestamp":1774526578185,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2012,4,19]],"date-time":"2012-04-19T00:00:00Z","timestamp":1334793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:title>Abstract\u2002<\/jats:title><jats:p><jats:italic>Objective.<\/jats:italic> To analyze the association between grand multiparity and maternal and neonatal morbidity and mortality. <jats:italic>Design.<\/jats:italic> Retrospective cross\u2010sectional study. <jats:italic>Setting.<\/jats:italic> Point G National Hospital, a tertiary care hospital in Bamako, Mali. <jats:italic>Population.<\/jats:italic> All singleton births from 1985 to 2003. <jats:italic>Methods.<\/jats:italic> Cross\u2010sectional study of 13 340 singleton births at a tertiary care hospital in Mali (1985\u20132003) compared outcomes between 3617 grand multiparas (para \u22655) and 9723 pauciparas (para 1\u20134). Odds ratios (OR) were adjusted for maternal age, prenatal care utilization, socioeconomic status, and region of origin. <jats:italic>Main outcome measures.<\/jats:italic> Maternal mortality, perinatal mortality, placental abnormalities (previa and abruption), uterine rupture, postpartum infection, postpartum hemorrhage, eclampsia, cesarean delivery, mean birthweight, low birthweight, high birthweight. <jats:italic>Results.<\/jats:italic> Grand multiparas were older, poorer, and less likely to have accessed prenatal care. Grand multiparas had a lower adjusted odds of maternal death (adjusted OR, 0.66; 95%CI, 0.45\u20130.97), but higher adjusted odds of perinatal death (adjusted OR, 1.33; 95%CI, 1.12\u20131.59), placental abnormalities (adjusted OR, 1.57; 95%CI, 1.21\u20132.05), and high birthweight (adjusted OR, 1.42; 95%CI, 1.05\u20131.92). <jats:italic>Conclusions.<\/jats:italic> The healthy person effect may explain grand multiparas\u2019 lower odds of maternal death. Reducing grand multiparity and improving grand multiparas\u2019 access to prenatal care may improve population\u2010level perinatal outcomes.<\/jats:p>","DOI":"10.1111\/j.1600-0412.2012.01372.x","type":"journal-article","created":{"date-parts":[[2012,2,7]],"date-time":"2012-02-07T19:43:13Z","timestamp":1328643793000},"page":"580-586","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Maternal and neonatal outcomes of grand multiparas over two decades in Mali"],"prefix":"10.1111","volume":"91","author":[{"given":"IBRAHIMA","family":"TEGUETE","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AMELIA W.","family":"MAIGA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PHYLLIS C.","family":"LEPPERT","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,4,19]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70511-9"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0730-7659.2005.00344.x"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767050500123798"},{"key":"e_1_2_9_5_2","first-page":"825","article-title":"Risk factors for antepartum fetal death","volume":"46","author":"Oron T","year":"2001","journal-title":"J Reprod Med."},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)90086-2"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(65)90246-2"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0028-2243(92)90152-O"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(96)00236-0"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000165825.65203.69"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.119639"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-1809.1968.tb00060.x"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000157444.74674.75"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00269-X"},{"key":"e_1_2_9_15_2","unstructured":"HoganMC ForemanKJ NaghaviM AhnSY WangM MakelaSM et al.Maternal mortality for 181 countries 1980\u20132008: a systematic analysis of progress towards Millennium Development Goal 5.Lancet.2010."},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016349709024342"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(01)00498-5"},{"key":"e_1_2_9_18_2","unstructured":"World Health Organization.WHO Statistical Information System. 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