Adverse Pregnancy Outcomes Among Advanced-maternal-age Grand-multipara Compared to Young-low-parity Women at Kajiado County Referral and Loitokitok Subcounty Hospitals in Kenya

Abstract

Grand-multipara are women who have delivered at least 5 fetuses that have attained the gestational age of fetal viability. Maternal age of at least 35 years is known as advanced maternal age. Women with advanced maternal age as well as grand-multipara are considered a high-risk category as each of the two conditions is associated with diverse undesirable outcomes of pregnancy. The situation is further worsened by coexistence of the two conditions in one woman where they impact negatively on the feto-maternal outcomes of pregnancy in a synergistic manner. Pregnancy outcomes in advanced-maternal-age grand-multipara has not been evaluated in Kajiado County despite having mothers with this duo-characteristic precipitated by the prevailing socio-cultural norms. Local advocacy programs have concentrated on issues surrounding teenage pregnancies and no special focus is given to pregnancies of women with advanced maternal age intertwined with grand multiparity. The latter are deemed experts in matters related to pregnancy and childbirth, hence less expected to develop adverse pregnancy outcomes. Additionally, there is low utilization of skilled delivery services and low uptake of modern family planning methods in this group. Broad Objective To compare pregnancy outcomes between advanced-maternal age grand-multipara and low-parity women aged 20 to 34 years at Kajiado County Referral Hospital and Loitokitok Sub- County Hospital between 2018 and 2022 Methodology Study design: Comparative cross-sectional study in which medical records of advanced- maternal age grand-multipara and young-low parity women were used in the study to compare pregnancy outcomes Study site and setting: Kajiado County Referral Hospital and Loitokitok Sub- County Hospital, Kajiado County Study population: Advanced-maternal age grand-multipara Comparison groups: Low parity women aged 20-34 years Sample size: Study Population-119 Comparison group-130 Data Collection: Consecutive sampling was done to select the study participants. Using a data abstraction tool, variables on socio-demographic characteristics, maternal and perinatal outcomes were collected. The data was entered into an excel sheet and exported to R version 4.3 for analysis. Data Analysis: Continuous data was summarized using mean and standard deviation and while categorical data was summarized using frequencies and percentages. Odds ratio (OR) was calculated by comparing the incidence of adverse pregnancy outcomes in advanced-maternal age grand-multipara versus low-parity women aged 20-34 years using bi-variate analysis. Where variables were found to be statistically significant, multi-variable logistic regression models were used to compare the pregnancy outcomes of the two groups. Chi-square test was used for statistical hypothesis testing. Statistical significance was set at 95% and a p- value of <0.05 was considered statistically significant. Results: Advanced-maternal-age coexisting with grand-multiparity had a significant association with the following adverse maternal outcomes: postpartum haemorrhage aOR 3.2 (2.23-7.92) p=0.01, malpresentations aOR 2.69(1.99-4.51) p=0.02 and perineal tears aOR 0.42(0.42-0.58) p<0.001. Similarly, coexistence of advanced maternal age with grand-multiparity had a significant association with the following adverse perinatal outcomes: still births aOR 2.81(1.74-4.92) p=0.02, preterm births aOR 3.27(2.33-5.21) p<0.001, birth weight > 4000g aOR 2.99(1.62-3.71) p=0.01, Apgar score<7 at 5 minutes aOR 0.87(0.51-0.99) p=0.04. Conclusion: Compared to young low parity women, advanced maternal age grand-multipara are associated with increased odds of postpartum hemorrhage, malpresentation, fetal macrosomia, still births, preterm births and NICU admissions.