The role of parity in the mode of delivery in advanced maternal age women

Martinelli, Katrini Guidolini; Gama, Silvana Granado Nogueira da; Santos Neto, Edson Theodoro dos

doi:10.1590/1806-93042021000100004

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 21 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1806-93042021000100004 copy

The role of parity in the mode of delivery in advanced maternal age women

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to describe the profile of Brazilian Advanced Maternal Age (AMA) women (> 35 years) according to parity, as well as to analyze the role of parity in the relationship between AMA and mode of delivery.

Methods:

this is a cross-sectional study, based on the “Nascer no Brasil” (Born in Brazil) survey. The data were collected in 2011/2012. The chi-square test was performed to verify the association between parity and maternal, prenatal and delivery characteristics, maternal habits, pre-pregnancy diseases, maternal complications and obstetric history.

Results:

of the 2,510 puerperal AMA women, 20.2% were nulliparous, 54.4% had one or two previous births and 25.4% had three or more previous births. The nulliparous women had higher schooling, higher economic class and adequate BMI, were white; and had better maternal habits when compared to multiparous. However, they were also more submitted to cesarean section, although without reported complications.

Conclusions:

one cannot speak of AMA pregnant women as a homogeneous group in Brazil. There are inequalities that can be revealed via parity, since nulliparous women have maternal characteristics, habits and access to prenatal care and childbirth that are more advantageous than multiparous women.

Key words:
Maternal and child health; Maternal age; Complications at pregnancy; Delivery

Variables	Total (N = 2,510)		Nulliparous (N = 507)		1 or 2 previous births (N=1,365)		≥ 3 previous births (N = 638)		p#
Variables	n	%	n	%	n	%	n	%	p#
Mother's characteristics
Mother's schooling (years)									<0.001
≤ 7	750	30.1	32	6.3	294	21.7	424	67.2
8 - 10	343	13.8	41	8.1	211	15.6	91	14.4
≥11	1,399	56.1	432	85.5	851	62.8	116	18.4
Socioeconomic classification									<0.001
Class D+E (low)	436	17.6	24	4.8	157	11.6	255	41.1
Class C (middle)	1,050	42.5	197	39.2	573	42.5	280	45.1
Class A+B (high)	986	39.9	281	56.0	619	45.9	86	13.8
Race / skin color									<0.001
White	1,021	40.7	262	51.8	588	43.1	171	26.8
Black	213	8.5	21	4.2	120	8.8	72	11.3
Mixed	1,250	49.8	218	43.1	645	47.3	387	60.8
Yellow	18	0.7	5	1.0	10	0.7	3	0.5
Indigenous	6	0.2	0	-	2	0.1	4	0.6
Pre-pregnancy BMI (Kg/m²)
< 18.5	79	3.1	11	2.2	48	3.5	20	3.1	0.002
18.5 - 24.9	1,258	50.1	307	60.6	673	49.3	278	43.6
25.0 - 29.9	812	32.4	131	25.8	460	33.7	221	34.7
≥ 30.0	360	14.3	58	11.4	184	13.5	118	18.5
Residence region									<0.001
North	140	5.6	11	2.2	57	4.2	72	11.3
Northeast	724	28.8	148	29.2	395	28.9	181	28.4
Sutheast	1,127	44.9	250	49.4	626	45.8	251	39.3
South	375	14.9	72	14.2	205	15.0	98	15.4
Midwest	144	5.7	25	4.9	83	6.1	36	5.6
Marital status									0.007
Without partner	323	12.9	79	15.6	142	10.4	102	16.0
With partner	2,185	87.1	428	84.4	1,223	89.6	534	84.0
Paying job									<0.001
Yes	1,514	60.3	396	78.1	856	62.7	262	41.1
No	995	39.7	111	21.9	509	37.3	375	58.9
Mother's habits
Smoking during pregnancy									<0.001
Yes	246	9.8	14	2.8	107	7.9	125	19.7
No	2,260	90.2	493	97.2	1,256	92.1	511	80.3
≥3 cigarettes/day or ≥15 cigarettes other than every day									<0.001
Yes	183	7.3	10	2.0	69	5.1	104	16.4
No	2,325	92.7	498	98.0	1,295	94.9	532	83.6
Suspected misuse of alcohol during pregnancy
3 or + doses to feel high (2 points)	114		19		44		51
Partner/parents complain when drinks (2 points)	116		9		47		60
Usually drinks in the morning (1 point)	12		0		3		9
Awoke without memory of the night before (1 point)	14		1		7		6
Felt she should decrease/stop drinking (1 point)	133		11		56		66
Measure of alcohol use suspicion:									<0.001
Did not drink alcohol or a point	2,308	93.5	483	95.8	1,277	95.2	548	88.1
Two or more points	160	6.5	21	4.2	65	4.8	74	11.9
Characteristics of prenatal and birth
Place of Prenatal									<0.001
Only public sector	1,335	53.9	145	28.6	656	48.2	534	88.0
Some at private sector	1,140	46.1	362	71.4	705	51.8	73	12.0
Professional in charge of prenatal									<0.001
Physician	2,059	82.6	461	90.9	1.170	86.0	428	68.6
Nurse	395	15.9	45	8.9	181	13.3	169	27.1
Other	11	0.4	1	0.2	6	0.4	4	0.6
Did not have prenatal	27	1.1	0	-	4	0.3	23	3.7
Minimum global adequacy of prenatal									0.038
Inadequate	2,139	85.3	416	81.9	1,159	85.0	564	88.5
Adequate	370	14.7	92	18.1	205	15.0	73	11.5
Type of birth financing									<0.001
Public	1,632	65.0	212	41.8	817	59.9	603	94,7
Private	877	35.0	295	58.2	548	40.1	34	5,3
Pilgrimage for childbirth care									<0.001
Yes	354	14.1	40	7.9	198	14.5	116	18,2
No	2,155	85.9	467	92.1	1.166	85.5	522	81,8
Mode of delivery									<0.001
Vaginal / Forceps	850	34.6	63	12.7	401	30.2	386	61.0
Cesarean section without labor	1,496	60.8	414	83.3	860	64.7	222	35.1
Cesarean section with labor	113	4.6	20	4.0	68	5.1	25	3.9

Variables	Total (N = 2,510)		Nulliparous (N = 507)		1 or 2 previous births (N=1,365)		≥ 3 previous births (N=638)		p#
Variables	n	%	n	%	n	%	n	%	p#
Pre-pregnancy diseases
Diabetes	67	2.8	8	1.6	41	3.0	20	3.1	0.243
Cardiac disease	29	1.2	7	1.4	13	1.0	9	1.4	0.782
Maternal complications
Urine infection	300	12.0	53	10.4	155	11.4	92	14.4	0.146
Hypertensive disease^* * Hypertensive disease = chronic hypertension, pre-eclampsia, eclampsia and HEELP syndrome.	521	20.8	108	21.3	261	19.1	152	23.8	0.280
Gestational diabetes	374	14.9	67	13.2	215	15.8	92	14.4	0.403
Multiple gestation	52	2.1	16	3.2	20	1.5	16	2.5	0.212
Previous obstetric history
Previous abortion/miscarriage	755	30.1	114	22.4	402	29.5	239	37.5	<0.001
Low weigth history	274	13.7	-		130	9.5	144	22.6	<0.001
Prematury history	252	12.6	-		141	10.3	111	17.4	<0.001
Previous C-sections
None	1,067	53.3	-		605	44.3	462	72.5	<0.001
One	678	33.9	-		593	43.4	85	13.3
Two or more	257	12.8	-		167	12.2	90	14.1

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[1] Authors' contribution

Study design and planning: Martinelli KG, Gama SGN, Santos Neto ET. Analysis and interpretation of data, preparation and writing of the manuscript: Martinelli KG, Gama SGN. Critical review of the manuscript: Gama SGN, Santos Neto ET. All authors approved the final version of the article.