UNDERAPPRECIATED RISKS OF THE ELDERLY MULTIPARA

OBJECTIVE: Our purpose was to identify the ago-related increased risks of the elderly gravida by clarifying the effects of age and parity, t heir combination, and their interaction. STUDY DESIGN: We studied 9556 singleton pregnancies in women aged 20 to 29 years or greater than or equal to 35 years delivered over an 8-year period. Data were analyzed by stepwise multiway contingency table analysis, with p < 0.002 consi dered significant. RESULTS: Many of the previously reported risks of t he elderly gravida are expected on the basis of age and parity, Signif icant associations (primarily related to advanced age) included higher frequencies of obesity, chronic hypertension, gestational diabetes, a nd large-for-gestational-age and macrosomic infants. These elderly gra vidas, on the other hand, had fewer postdates pregnancies. Although of ten overlooked, the greatest age-related increases in risk for inducti on (1.8 times), preeclampsia (2.7 times), gestational diabetes (4.5 ti mes), clinical diabetes 3.2 times), oxytocin use (1.7 times), acid mac rosomia (1.6 times) occur in multiparas, not nulliparas. The risk for preeclampsia in the elderly multipara is significantly higher than exp ected on the basis of age and parity. CONCLUSION: The increased risks of the elderly multipara may have been overshadowed by the previous fo cus on the elderly nullipara. It is important to recognize the increas es in age-related risks of the elderly multipara to appropriately coun sel and manage this group of patients.