Relation of Parity to Pregnancy Outcome in a Rural Community in Zimbabwe

F Majoko, L Nyström, SP Munjanja, E Mason, G Lindmark


This population-based cohort study was conducted to compare pregnancy complications and outcome among nulliparous, low (1-5) and high (> 6) parity women. Women who registered for antenatal care and gave birth in Gutu District, Zimbabwe, between January 1995 and June 1998 were classified into groups by parity. The women were compared for baseline characteristics, utilisation of health facilities and occurrence of pregnancy complications such as hypertensive disorders of pregnancy, haemorrhage, pre-term delivery, operative delivery, low birth weight and perinatal death. In estimating risk, primiparous (parity = 1) women were used as referents. Pregnancy records for 10,569 women were analysed. Mean ages of nulliparous and high parity (> 6) women were 20.1 and 37.7 years respectively (p < 0.001). Prevalence of anaemia at booking (haemoglobin <10.5 g/dl) was reduced in nulliparous compared to multiparous women (11.7% vs 16.8%; p > 0.001). Nulliparous women were likely to book early (< 20 weeks) for antenatal care, have a higher number of visits (> 6) and fewer home births. Nulliparous women had higher risk for low birth weight (RR 1.70; 95% CI 1.36 - 2.13). Compared to low parity women, nulliparous and high parity women had an elevated risk of hypertensive complications RR 1.62 (95% CI 1.37-1.92) and RR 1.64 (95% CI 1.29 - 2.07) respectively. The risk of developing any pregnancy complications was highest in nulliparous women (RR 1.48; 95% 1.31- 1.67). In conclusion, nulliparous women had an increased risk of pregnancy complications. High parity women with no previous complicated pregnancy were at low risk of complications. (Afr J Reprod Health 2004; 8[3] 198-206)


Keywords: Nulliparity, grand multiparity, pregnancy complications, risk factors

Full Text:



Ounsted M, Moar VA and Scott A. Risk factors associated with small for dates and large for dates infants. Br J Obstet Gynaecol 1985; 92: 226-232.

Eidelman AI, Kamar R, Schimmel MS and Bar-on E. The grandmultipara: is she still a risk? Am J ObstetGynecol 1988; 158:


Babinszki A, Kerenyi T, Torok O, Grazi V, Lapinski RH and Berkowitz RL. Perinatal outcome in grand and great-grand multiparity: Effects of parity on obstetric risk factors. Am J ObstetGynecol 1999; 181: 669-674.

Bai JB, Wong FWS, Bauman A and Mohsin M. Parity and pregnancy outcomes. Am J ObstetGynecol 2002; 186: 274-278.

Bugg GJ, Atwal GS and Maresh M. Grandmultiparae in a modern setting. Br J ObstetGynaecol 2002; 109: 249-253.

Rooney C. Antenatal care and maternal health: how effective is it? A review of the evidence. World Health Organization, Geneva, MSM/92.4, 1992.

James DK, Steer PJ, Weiner CP and Gonik B (Eds.). High-Risk Pregnancy. Management Options. WB Saunders Co Ltd., 1997, pp 40-42.

Samueloff A, Schimmel MS and Eidelman AI. Grandmultiparity. Is it a perinatal risk? ClinPerinatol 1998; 25: 529-538.

Van den Heuvel OA, de Mey WG, Buddingh H and Bots ML. Use of maternal care in a rural area of Zimbabwe: a population-based study. ActaObstetGynecolScand 1999; 78: 838-846.

Nhindiri P, Munjanja S, Zhanda I, Lindmark G and Nystrom L. A community-based study on utilisation of maternity services in rural Zimbabwe. Afr J Health Sci 1996; 3: 120-125.

Nilses C, Nystrom L, Munjanja S and Lindmark G. Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe. ActaObstetGynecolScand 2002; 81: 508-515.

Irvine LM, Otigbah C, Crawford A and Setchell ME. Grand multiparity an obstetric problem in Great Britain in the 90s? J ObstetGynaecol 1996; 16: 2172-23.

Toohey JS, Keegan KA, Morgan MA, Francis J, Task S and deVeciana M. The ”dangerous multipara”: fact or fiction? Am J ObstetGynecol 1995; 172: 683-686.

Chan BCP and Lao TT. Influence of parity on the obstetric performance of mothers aged 40 years and above. Human Reprod 1999; 14: 833-837.

Rizk DEE, Khalfan M and Ezimokhai M. Obstetric outcome in grand multipara in the United Arab Emirates: a case control study. Arch GynecolObstet 2001; 264: 194-198.

Seoud MA-F, Nassar AH, Usta IM, Melhem Z, Kazma A and Khalil AM. Impact of advanced maternal age on pregnancy outcome. Am J Perinatol 2002; 19: 17.


  • There are currently no refbacks.