Underappreciated risks of the elderly multipara

American Journal of Obstetrics and Gynecology
R A Bobrowski, S F Bottoms

Abstract

Our purpose was to identify the age-related increased risks of the elderly gravida by clarifying the effects of age and parity, their combination, and their interaction. We studied 9556 singleton pregnancies in women aged 20 to 29 years or > or = 35 years delivered over an 8-year period. Data were analyzed by stepwise multiway contingency table analysis, with p < 0.002 considered significant. Many of the previously reported risks of the elderly gravida are expected on the basis of age and parity. Significant associations (primarily related to advanced age) included higher frequencies of obesity, chronic hypertension, gestational diabetes, and large-for-gestational-age and macrosomic infants. These elderly gravidas, on the other hand, had fewer postdates pregnancies. Although often overlooked, the greatest age-related increases in risk for induction (1.8 times), preeclampsia (2.7 times), gestational diabetes (4.5 times), clinical diabetes (3.2 times), oxytocin use (1.7 times), and macrosomia (1.6 times) occur in multiparas, not nulliparas. The risk for preeclampsia in the elderly multipara is significantly higher than expected on the basis of age and parity. The increased risks of the elderly multipara may have been overshadowed...Continue Reading

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