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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 243-247    DOI: 10.31083/j.ceog.2020.02.5173
Original Research Previous articles | Next articles
Difference in pregnancy outcomes between primiparous and multiparous women older than 40 years
S. Y. Jung1, *, S. J. Chon1, R. S. Lee1, E. Y. Woo1, J. S. Lee1, S. Y. Kim1
1Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Abstract  Purpose of Investigation: This study aimed to compare pregnancy outcomes based on parity in women older than 40 years. Materials and Methods: This retrospective cohort study included women older than 40 years with singleton pregnancy, who delivered after 24 weeks of gestation. They were divided into two groups on the basis of parity, and maternal and perinatal outcomes were compared. Results: This study included 432 women, with primiparous women (n=111) comprising a quarter among them. The mean parity of multiparous women was 1.8, and the mean interval from the previous pregnancy was 9.5 years. On analyzing multivariable logistic regression-adjusted confounding factors, small for gestational age (SGA) neonates (OR, 2.525; 95% CI, 11.407-4.529) were associated with primiparous women. The occurrence of preterm birth before 37 weeks of gestation (OR, 1.783; 95% confidence CI, 1.080-2.942) was increased in multiparous women. Conclusion: There are different pregnancy outcomes between primiparous and multiparous women. Preterm birth is more frequent in multiparous women, with an extremely long interval to subsequent pregnancy. The incidence of SGA newborns was higher among primiparous women.
Key words:  Maternal and perinatal outcomes      Parity      Small for gestational age (SGA)     
Published:  15 April 2020     
*Corresponding Author(s):  S. Y. Jung   

Cite this article: 

S. Y. Jung, S. J. Chon, R. S. Lee, E. Y. Woo, J. S. Lee, S. Y. Kim. Difference in pregnancy outcomes between primiparous and multiparous women older than 40 years. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 243-247.

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https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.5173     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/243

Table 1  — Maternal clinical characteristics.
Total (n=432) Primiparity (n=111) Multiparas (N=321) p-value
Maternal age 41.5±1.7 41.2±1.6 41.6±1.7 0.076
Parity 1.8±0.8 <0.001
Body mass index 23.4±4.2 23.0±3.7 23.6±4.4 0.164
Marriage status 415 (96.1%) 109 (98.2%) 306 (95.3%) 0.259
Smoking 6 (1.4%) 0 6 (1.9%) 0.345
Assisted conception 13 (3.0%) 7 (6.3%) 6 (1.9%) 0.046
Interdelivery interval 9.5±5.6 <0.001
Prenatal care 410 (94.9%) 108 (97.3%) 302 (94.1%) 0.184
Preterm birth history 31 (9.7%) 0.001
Table 2  — Comparison of pregnancy outcomes.
Total (N=432) Primiparity (n=111) Multiparity (n=321) p-value
Gestational age at delivery 36.6±3.2 37.3±2.6 36.4±3.4 0.003
Preterm birth <37 weeks of gestation 152 (35.2%) 28(25.2%) 124 (38.6%) 0.011
Major fetal anomaly 11 (2.5%) 3 (2.7%) 8 (2.5%) 1.000
Intrauterine fetal death 6 (1.4%) 2 (1.8%) 4 (1.2%) 0.650
No maternal disease 302 (69.9%) 80 (72.1%) 222 (69.2%) 0.564
Maternal disease 130 (30.1%) 31 (27.9%) 99 (30.8%)
Preexisting hypertension 13 (3.0%) 5 (4.5%) 8 (2.5%) 0.333
Preeclampsia 59 (13.7%) 13 (11.7%) 46 (14.3%) 0.489
Pregestational diabetes mellitus 11 (2.5%) 3 (2.7%) 8 (2.5%) 1.000
Gestational diabetes mellitus 44 (10.2%) 14 (12.6%) 30 (9.3%) 0.327
Placenta previa 44 (10.2%) 11 (9.9%) 33 (10.3%) 0.911
Cesarean section 307 (71.1%) 84 (75.7%) 223 (69.5%) 0.214
Before labor 295 (96.1%) 79 (94.0%) 216 (96.9%) 0.320
In labor 12 (3.9%) 5 (6.0%) 7 (3.1%)
Neonatal sex (M) 233 (54.2%) 59 (53.2%) 174 (54.4%) 0.824
Birth weight 2789.9±781.2 2810.2±721.4 2782.9±782.0 0.743
Small for gestational age 68 (15.8%) 26 (23.4%) 42 (13.1%) 0.010
Large for gestational age 14 (3.2%) 5 (4.5%) 9 (2.8%) 0.365
Apgar score <7 at 5 min 18 (4.2%) 3 (2.7%) 15 (4.7%) 0.581
No postpartum complication 393 (91.0%) 104 (93.7%) 289 (90.0%) 0.246
Postpartum complication 39 (9.0%) 7 (6.3%) 32 (10.0%)
Transfusion 28 (6.5%) 6 (5.4%) 22 (6.9%) 0.593
Cardiovascular morbidity 5 (1.2%) 0 5 (1.6%) 0.334
Urogenital morbidity 3 (0.7%) 0 3 (0.9%) 0.573
Others 3 (0.7%) 1 (0.9%) 2 (0.6%) 1.000
Table 3  — Multivariate logistic regression analysis of pregnancy outcomes in primiparous women compared with multiparous women.
Pregnancy outcome Primiparity Multiparity
aOR1 (95% CI) aOR1 (95% CI)
Assisted conception 4.228 (1.285-13.906) 0.239 (0.073-0.787)
Small for gestational age 2.525 (1.407-4.529) 0.405 (0.226-0.726)
Fetal major anomaly 0.896 (0.2023-3.959) 1.125 (0.256-4.934)
No maternal disease 1.037 (0.613-1.757) 0.937 (0.554-1.584)
Intrauterine fetal death 3.851 (0.467-31.767) 0.272 (0.033-2.234)
Preterm birth <37 weeks of gestation 0.535 (0.322-0.887) 1.783 (1.080-2.942)
No postpartum complication 1.415 (0.562-3.565) 0.689 (0.274-1.732)
[1] Khalil A., Syngelaki A., Maiz N., Zinevich Y., Nicolaides K.H.: “Maternal age and adverse pregnancy outcome: a cohort study”. Ultrasound Obstet. Gynecol. 2013, 42, 634.
doi: 10.1002/uog.12494 pmid: 23630102
[2] Kenny L.C., Lavender T., McNamee R., O’Neill S.M., Mills T., Khashan A.S.: “Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort”. PLoS One, 2013, 8, e56583.
doi: 10.1371/journal.pone.0056583 pmid: 23437176
[3] Cleary-Goldman J., Malone F.D., Vidaver J., Ball R.H., Nyberg D.A., Comstock C.H., et al.: “Impact of maternal age on obstetric outcome”. Obstet. Gynecol., 2005, 105, 983.
doi: 10.1097/01.AOG.0000158118.75532.51 pmid: 15863534
[4] Callaway L.K., Lust K., McIntyre H.D.: “Pregnancy outcomes in women of very advanced maternal age”. Aust. N. Z. J. Obstet. Gynaecol., 2005, 45, 12.
doi: 10.1111/j.1479-828X.2005.00333.x pmid: 15730358
[5] Dulitzki M., Soriano D., Schiff E., Chetrit A., Mashiach S., Seidman D.S.: “Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery”. Obstet. Gynecol., 1998, 92, 935.
doi: 10.1016/s0029-7844(98)00335-4 pmid: 9840553
[6] Finer L.B., Henshaw S.K.: “Disparities in rates of unintended pregnancy in the United States, 1994 and 2001”. Perspect. Sex. Reprod. Health, 2006, 38, 90.
doi: 10.1363/psrh.38.090.06 pmid: 16772190
[7] Ananth C.V., Wilcox A.J., Savitz D.A., Bowes W.A., Jr., Luther E.R.: “Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy”. Obstet. Gynecol., 1996, 88, 511.
doi: 10.1016/0029-7844(96)00236-0 pmid: 8841208
[8] Behbehani S., Patenaude V., Abenhaim H.A.: “Maternal Risk Factors and Outcomes of Umbilical Cord Prolapse: A Population-Based Study”. J. Obstet. Gynaecol. Can., 2016, 38, 23.
doi: 10.1016/j.jogc.2015.10.008 pmid: 26872752
[9] Bai J., Wong F.W., Bauman A., Mohsin M.: “Parity and pregnancy outcomes”. Am. J. Obstet. Gynecol., 2002, 186, 274.
doi: 10.1067/mob.2002.119639 pmid: 11854649
[10] Seidman D.S., Armon Y., Roll D., Stevenson D.K., Gale R.: “Grand multiparity: an obstetric or neonatal risk factor?” Am. J. Obstet. Gynecol., 1988, 158, 1034.
[11] Lisonkova S., Janssen P.A., Sheps S.B., Lee S.K., Dahlgren L.: “The effect of maternal age on adverse birth outcomes: does parity matter?” J. Obstet. Gynaecol. Can., 2010, 32, 541.
[12] Schimmel M.S., Bromiker R., Hammerman C., Chertman L., Ioscovich A., Granovsky-Grisaru S., et al.: “The effects of maternal age and parity on maternal and neonatal outcome”. Arch. Gynecol. Obstet., 2015, 291, 793.
doi: 10.1007/s00404-014-3469-0 pmid: 25227657
[13] Ben-David A., Glasser S., Schiff E., Zahav A.S., Boyko V., Lerner-Geva L.: “Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?”. Matern. Child Health J., 2016, 20, 833.
doi: 10.1007/s10995-015-1914-8 pmid: 26686195
[14] Bayrampour H., Heaman M.: “Comparison of demographic and obstetric characteristics of Canadian primiparous women of advanced maternal age and younger age”. J. Obstet. Gynaecol. Can., 2011, 33, 820.
doi: 10.1016/S1701-2163(16)34985-4 pmid: 21846437
[15] Waldenstrom U., Cnattingius S., Vixner L., Norman M.: “Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study”. BJOG, 2017, 124, 1235.
doi: 10.1111/1471-0528.14368 pmid: 27770495
[16] Korea S.: “Preliminary Results of Birth and Death Statistics in 2017”. Republic of Korea: Statistics Korea, 2018.
[17] Guedes M., Canavarro M.C.: “Characteristics of primiparous women of advanced age and their partners: a homogenous or heterogenous group?” Birth, 2014, 41, 46.
[18] Chan B.C., Lao T.T.: “Effect of parity and advanced maternal age on obstetric outcome”. Int. J. Gynaecol. Obstet., 2008, 102, 237.
doi: 10.1016/j.ijgo.2008.05.004 pmid: 18606410
[19] Chan B.C., Lao T.T.: “Influence of parity on the obstetric performance of mothers aged 40 years and above”. Hum. Reprod., 1999, 14, 833.
doi: 10.1093/humrep/14.3.833 pmid: 10221722
[20] Shah P.S.: “Knowledge Synthesis Group on Determinants of LBWPTb. “Parity and low birth weight and preterm birth: a systematic review and meta-analyses”. Acta Obstet. Gynecol. Scand., 2010, 89, 862.
doi: 10.3109/00016349.2010.486827 pmid: 20583931
[21] Camilleri A.P., Cremona V.: “The effect of parity on birthweight”. J. Obstet. Gynaecol. Br. Commonw., 1970, 77, 145.
doi: 10.1111/j.1471-0528.1970.tb03493.x pmid: 5419878
[22] Hafner E., Schuchter K., Metzenbauer M., Philipp K.: “Uterine artery Doppler perfusion in the first and second pregnancies”. Ultrasound Obstet. Gynecol. , 2000, 16, 625.
doi: 10.1046/j.1469-0705.2000.00290.x pmid: 11169368
[23] Prefumo F., Bhide A., Sairam S., Penna L., Hollis B., Thilaganathan B.: “Effect of parity on second-trimester uterine artery Doppler flow velocity and waveforms”. Ultrasound Obstet. Gynecol., 2004, 23, 46.
doi: 10.1002/uog.908 pmid: 14970999
[24] Krulewitch C.J., Herman A.A., Yu K.F., Johnson Y.R.: “Does changing paternity contribute to the risk of intrauterine growth retardation?”. Paediatr. Perinat. Epidemiol., 1997, 11, 41.
doi: 10.1046/j.1365-3016.11.s1.7.x pmid: 9018714
[25] Woessner J.F., Brewer T.H., : “Formation and Breakdown of Collagen and Elastin in the Human Uterus during Pregnancy and Post-Partum Involution”. Biochem J., 1963, 89, 75.
doi: 10.1042/bj0890075 pmid: 14097370
[26] Sornes T., Bakke T.: “Uterine size, parity and umbilical cord length”. Acta Obstet. Gynecol. Scand., 1989, 68, 439.
doi: 10.3109/00016348909021017 pmid: 2520789
[27] Helmerhorst F.M., Perquin D.A., Donker D., Keirse M.J.: “Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies”. BMJ, 2004, 328, 261.
doi: 10.1136/bmj.37957.560278.EE pmid: 14742347
[28] Clapp J.F., Capeless E.: “Cardiovascular function before, during, and after the first and subsequent pregnancies”. Am. J. Cardiol., 1997, 80, 1469.
doi: 10.1016/s0002-9149(97)00738-8 pmid: 9399724
[29] Hinkle S.N., Albert P.S., Mendola P., Sjaarda L.A., Yeung E., Boghossian N.S. et al.: “The Association between Parity and Birthweight in a Longitudinal Consecutive Pregnancy Cohort”. Paediatr. Perinat. Epidemiol., 2014, 28, 106.
doi: 10.1111/ppe.12099 pmid: 24320682
[30] Organization W.H.: “Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13-15 June 2005”. Geneva: World Health Organization, 2007.
[31] Zhu B.P.: “Effect of interpregnancy interval on birth outcomes: findings from three recent US studies”. Int. J. Gynaecol. Obstet., 2005, 89, S25.
doi: 10.1016/j.ijgo.2004.08.002 pmid: 15820365
[32] Zhu B.P., Rolfs R.T., Nangle B.E., Horan J.M.: “Effect of the interval between pregnancies on perinatal outcomes”. N. Engl. J. Med., 1999, 340, 589.
doi: 10.1056/NEJM199902253400801 pmid: 10029642
[33] Henriksen T.B., Baird D.D., Olsen J., Hedegaard M., Secher N.J., Wilcox A.J.: “Time to pregnancy and preterm delivery”. Obstet. Gynecol., 1997, 89, 594.
doi: 10.1016/s0029-7844(97)00045-8 pmid: 9083319
[34] Panidis D.K., Rousso D.H., Matalliotakis I.M., Kourtis A.I., Vlassis G.D., Koumantakis E.E.: “Hyperinsulinemia does not influence androgens/estrogens ratio in patients with polycystic ovarian syndrome”. Int. J. Fertil. Womens Med., 1999, 44, 301.
pmid: 10617252
[35] Shachar B.Z., Mayo J.A., Lyell D.J., Baer R.J., Jeliffe-Pawlowski L.L., Stevenson D.K., et al.: “Interpregnancy interval after live birth or pregnancy termination and estimated risk of preterm birth: a retrospective cohort study”. BJOG, 2016, 123, 2009.
doi: 10.1111/1471-0528.14165 pmid: 27405702
[36] Rousso D., Panidis D., Gkoutzioulis F., Kourtis A., Mavromatidis G., Kalahanis I.: “Effect of the interval between pregnancies on the health of mother and child”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2002, 105, 4.
doi: 10.1016/S0301-2115(02)00077-5 pmid: 12270555
[37] Bitto A., Gray R.H., Simpson J.L., Queenan J.T., Kambic R.T., Perez A., et al.: “Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study”. Am. J. Public Health, 1997, 87, 338.
doi: 10.2105/ajph.87.3.338 pmid: 9096531
[38] National Research Council(US) Committee on Population: “Contraception and Reproduction: Health Consequences for Women and Children in the Developing World”. Washington (DC), National Academies Press(US), 1989.
[39] Ecker J.L., Chen K.T., Cohen A.P., Riley L.E., Lieberman E.S.:“Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women”. Am. J. Obstet. Gynecol., 2001, 185, 883.
doi: 10.1067/mob.2001.117364 pmid: 11641671
[40] Wang C., Wang X.Y., Yang H.X.:“Effect of maternal age on pregnancy outcomes in Beijing”. Zhonghua Fu Chan Ke Za Zhi, 2017, 52, 514.
doi: 10.3760/cma.j.issn.0529-567X.2017.08.003 pmid: 28851167
[41] Pasupathy D., Wood A.M., Pell J.P., Fleming M., Smith G.C.S.:“Advanced maternal age and the risk of perinatal death due to intrapartum anoxia at term”. J. Epidemiol. Community Health, 2011, 65, 241.
doi: 10.1136/jech.2009.097170 pmid: 20719805
[42] Shan D., Qiu P.Y., Wu Y.X., Chen Q., Li A.L., Ramadoss S., et al.: “Pregnancy Outcomes in Women of Advanced Maternal Age: a Retrospective Cohort Study from China”. Sci. Rep., 2018, 8, 12239.
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