Gravidity and parity: Difference between revisions

{{Short description|Number of times a womanfemale has given birth to a baby}}

In [[biology]] and [[medicine|human medicine]], '''gravidity and parity''' are the number of times a female is or has been [[pregnant]] (gravidity) and carried the pregnancies to a viable gestational age (parity).<ref>{{Cite web |last1=Utterback |first1=Susan |last2=Cena |first2=Christianlly |title=Gravida & Parity: Definition & Examples |url=https://study.com/academy/lesson/gravida-definition-examples.html#:~:text=Gravida%20refers,pregnant |access-date=2023-09-13 |website=study.com}}</ref><ref name="Gravidity and Parity Definitions">{{cite web |firstfirst1 = Chloe|lastlast1 = Borton|last2 = Tidy|first2 = Colin|last3 = Payne|first3 = Jacqueline|date = November 12, 2009|url = http://patient.info/doctor/gravidity-and-parity-definitions-and-their-implications-in-risk-assessment|title = Gravidity and Parity Definitions (and their Implications in Risk Assessment)|publisher = Patient.info|access-date = June 26, 2013}}</ref> These two terms are usually coupled, sometimes with additional terms, to indicate more details of the womanfemale's obstetric history.<ref>{{cite journal|last=Creinin|first=MD|author2=Simhan, HN |title=Can we communicate gravidity and parity better?|journal=Obstetrics and Gynecology|date=Mar 2009|volume=113|issue=3|pages=709–11|pmid=19300338|doi=10.1097/AOG.0b013e3181988f8f}}</ref> When using these terms:

* Gravida indicates the number of times a womanfemale is or has been pregnant, regardless of the pregnancy outcome.<ref name="auto">{{cite book|last1=Cunningham|first1=Gary|title=William Obstetrics|date=2005|publisher=McGraw-Hill Companies|isbn=978-0-07-141315-2|page=121|edition=22|url=http://download.bioon.com.cn/upload/201111/23175321_1439.pdf|access-date=19 August 2016|archive-date=2 February 2017|archive-url=https://web.archive.org/web/20170202000954/http://download.bioon.com.cn/upload/201111/23175321_1439.pdf|url-status=dead}}</ref> A current pregnancy, if any, is included in this count. A multiple pregnancy (e.g., twins, triplets, etc.) is counted as 1.

In human medicine, "gravidity" refers to the number of times a womanfemale has been [[pregnant]],<ref name="Gravidity and Parity Definitions" /> regardless of whether the pregnancies were interrupted or resulted in a [[Live birth (human)|live birth]]. “Gravidity” is an important component of a patient’s reproductive history, as it provides insight into the risk factors that the patient has for pregnancy outcomes, such as risk for gestational diabetes, pre-ecclampsia, spontaneous abortion, preterm birth, fetal growth restriction, and more.<ref name="Stubblefield Coonrod Reddy et al 2006"/> The gravidity of the patient is associated with risk for other conditions as well, including risk for breast, ovarian, and endometrial cancer.<ref>{{cite journal |last1=Troisi |first1=R. |last2=Bjørge |first2=T. |last3=Gissler |first3=M. |last4=Grotmol |first4=T. |last5=Kitahara |first5=C. M. |last6=Myrtveit Sæther |first6=S. M. |last7=Ording |first7=A. G. |last8=Sköld |first8=C. |last9=Sørensen |first9=H. T. |last10=Trabert |first10=B. |last11=Glimelius |first11=I. |title=The role of pregnancy, perinatal factors and hormones in maternal cancer risk: a review of the evidence |journal=Journal of Internal Medicine |date=May 2018 |volume=283 |issue=5 |pages=430–445 |doi=10.1111/joim.12747 |pmid=29476569 |pmc=6688839 }}</ref> Knowing a patient’s obstetric history in a prenatal assessment or early in gestation allows the patient to receive early intervention to prevent these associated risks.<ref name="Stubblefield Coonrod Reddy et al 2006"/>

* The term "'''gravida'''" can be used to referrefers to a pregnant womanfemale.

* A "'''nulligravida'''" is a womanfemale who has never been pregnant.

* A "'''primigravida'''" is a womanfemale who is pregnant for the first time or has been pregnant once.

* A "'''multigravida'''" or "'''secundigravida'''" is a womanfemale who has been pregnant more than once.

Terms such as "gravida 0", referring to a nulligravida, "gravida 1" for a primigravida, and so on, can also be used. The term "elderly primigravida" has also been used to refer to a womanfemale in their first pregnancy who is at least 35 years old.<ref name="pmid3609426">{{cite journal |vauthors=Brassil MJ, Turner MJ, Egan DM, MacDonald DW|title=Obstetric outcome in first-time mothers aged 40 years and over|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology |volume=25 |issue=2 |pages=115–20 |date=June 1987 |pmid=3609426 |doi=10.1016/0028-2243(87)90114-6|doi-access=free }}</ref> [[Advanced maternal age]] can be a risk factor for some birth defects.

In human medicine, ''parity'' is the number of pregnancies carried by a womanfemale for at least 20 weeks (duration varies from region to region, 20 – 28 weeks, depending upon age of viability). If a womanfemale carries the fetus to viable age, even if ultimately the fetus is born deceased, this still counts as an instance of parity, as parity is based on the time of gestation prior to a birth, and not the status of the offspring once born.<ref>{{Cite web|url=https://www.merriam-webster.com/dictionary/parity|title = Definition of PARITY}}</ref><ref>https://demo.oppia-mobile.org/media/courses/ldc-all/02_12181_en.html{{full|date=September 2022}}</ref>

A womanfemale who has never carried a pregnancy beyond 20 weeks is ''nulliparous'' and is called a ''nullipara'' or ''para 0''.<ref name="Cunningham">F. Gary Cunningham, 2005. Williams Obstetrics, 22nd Edition, McGraw-Hill Companies.{{pn|date=September 2022}}</ref> A womanfemale who has given birth once is ''primiparous'' and is referred to as a ''primipara'' or ''primip''. A womanfemale who has given birth two, three, or four times is '''multiparous''' and is called a ''multip''. ''Grand multipara'' describes the condition of having given birth five or more times.<ref>{{cite web|url=https://www.medicinenet.com/script/main/art.asp?articlekey=9750|title=Definition of Grand multipara|website=medicinenet.com}}</ref>

Like gravidity, parity may also be counted. A womanfemale who has given birth one or more times can also be referred to as para 1, para 2, para 3, and so on.

A ''nulliparous'' ({{IPAc-en|n|ʌ|l|ˈ|ɪ|p|ə|r|ə|s}}) womanfemale (a ''nullipara'' or ''para 0'') has never given birth. It includes womenfemales who have experienced [[Miscarriage|spontaneous miscarriages]] and [[induced abortions]] before the mid-point of pregnancy, but not womenfemales who have experienced [[Stillbirth|pregnancy loss after 20 weeks]]. Nulliparity has been implicated in the development of various complications during pregnancy including preeclampsia, gestational diabetes and pre-term labor.<ref name="Stubblefield Coonrod Reddy et al 2006">{{cite journal |last1=Stubblefield |first1=Phillip G. |last2=Coonrod |first2=Dean V. |last3=Reddy |first3=Uma M. |last4=Sayegh |first4=Raja |last5=Nicholson |first5=Wanda |last6=Rychlik |first6=Daniel F. |last7=Jack |first7=Brian W. |title=The clinical content of preconception care: reproductive history |journal=American Journal of Obstetrics and Gynecology |date=1 December 2008 |volume=199 |issue=6, Supplement B |pages=S373–S383 |doi=10.1016/j.ajog.2008.10.048 |pmid=19081433 }}</ref>

Long-term and permanent nulliparity ({{IPAc-en|ˌ|n|ʌ|l|ᵻ|ˈ|p|ær|ᵻ|t|i}}) are [[risk factor for breast cancer|risk factors for breast cancer]]. For instance, a meta-analysis, published in 1990, of 8 population-based studies in the Nordic countries found that never giving birth was associated with a 30% increase in the risk of breast cancer compared with womenfemales who have given birth, and for every 2 births, the risk was reduced by about 16%. WomenFemales having their first birth after the age of 35 years had a 40% increased risk compared to those with a first birth before the age of 20 years.<ref>{{cite journal |pmid=2145231 |year=1990 |vauthors=Ewertz M, Duffy SW, Adami HO |title=Age at first birth, parity and risk of breast cancer: A meta-analysis of 8 studies from the Nordic countries |volume=46 |issue=4 |pages=597–603 |journal=International Journal of Cancer |doi=10.1002/ijc.2910460408 |s2cid=32387496 |display-authors=etal }}</ref>

In [[agriculture]], parity in biology is a factor in [[Milk#Production yields|productivity]] in domestic animals kept for [[Dairy farming|milk production]]. Animals that have given birth once are described as "primiparous"; those that have given birth more than once are described as "pluriparous".<ref name = mehrzad>{{cite journal |last1=Mehrzad |first1=Jalil |last2=Duchateau |first2=Luc |last3=Pyörälä |first3=Satu |last4=Burvenich |first4=Christian |title=Blood and Milk Neutrophil Chemiluminescence and Viability in Primiparous and Pluriparous Dairy Cows During Late Pregnancy, Around Parturition and Early Lactation |journal=Journal of Dairy Science |date=December 2002 |volume=85 |issue=12 |pages=3268–3276 |doi=10.3168/jds.S0022-0302(02)74415-9 |pmid=12512600 |doi-access=free |hdl=1854/LU-149282 |hdl-access=free }}</ref><ref name = vecchio>{{cite journal |last1=Vecchio |first1=D. |last2=Neglia |first2=G. |last3=Rendina |first3=M. |last4=Marchiello |first4=M. |last5=Balestrieri |first5=A. |last6=Di Palo |first6=R. |title=Dietary influence on primiparous and pluriparous buffalo fertility |journal=Italian Journal of Animal Science |date=January 2007 |volume=6 |issue=sup1 |pages=512–514 |doi=10.4081/ijas.2007.1s.512 |s2cid=85810948 |doi-access=free }}</ref> Those that have given birth twice may also be described as "secondiparous", in which case "pluriparous" is applied to those that have given birth three times or more.

A number of systems are incorporated into a womanfemale's obstetric history to record the number of past pregnancies and pregnancies carried to viable age. These include:

* The '''gravida/para/abortus''' (GPA) system, or sometimes just ''gravida/para'' (GP), is one such shorthand.{{citation needed|date=April 2014}} For example, the obstetric history of a womanfemale who has had two pregnancies (both of which resulted in live births) would be noted as G₂P₂. The obstetric history of a womanfemale who has had four pregnancies, one of which was a miscarriage before 20 weeks, would be noted in the GPA system as G₄P₃A₁ and in the GP system as G₄P₃. The obstetric history of a womanfemale who has had one pregnancy of twins with successful outcomes would be noted as G₁P₁₊₁.<ref name="isbn0-7817-3690-0 p 142">{{Cite book |author1=Hatfield, Nancy |author2=N. Jayne Klossner |title=Introductory maternity & pediatric nursing |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2006 |page=[https://archive.org/details/introductorymate00klos/page/142 142] |isbn=978-0-7817-3690-9 |url=https://archive.org/details/introductorymate00klos/page/142 }}</ref>

* '''TPAL''' is one of the methods to provide a quick overview of a person's obstetric history.<ref>{{cite web |title=The OB-GYN Clerkship: Your Guide to Success |publisher=Loyola University Chicago |url=https://www.meddean.luc.edu/lumen/MedEd/obgyne/tools.pdf }}</ref> In TPAL, the '''T''' refers to term births (after 37 weeks' gestation), the '''P''' refers to [[premature births]], the '''A''' refers to [[abortions]], and the '''L''' refers to living children.<ref name="isbn1-58255-939-2 p 385">{{cite book |title=Lippincott Manual of Nursing Practice Series: Assessment |series=Lippincott Manual of Nursing Practice |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2006 |page=385 |isbn=978-1-58255-939-1}}</ref> When reported, the "abortions" number refers to the total number of spontaneous or induced abortions and [[miscarriage]]s, including [[ectopic pregnancies]], prior to 20 weeks. If a fetus is aborted after 20 weeks, spontaneously or electively, then it is counted as a premature birth and P will increase but L will not.{{citation needed|date=May 2014}} The TPAL is described by numbers separated by hyphens. [[Multiple births]] ([[twins]], triplets and higher multiples) count as one pregnancy (gravidity) and as one birth. For example, a pregnant womanfemale who carried one pregnancy to term with a surviving infant; carried one pregnancy to 35 weeks with surviving twins; carried one pregnancy to 9 weeks as an ectopic (tubal) pregnancy; and has three living children would have a TPAL annotation of T1, P1, A1, L3. This could also be written as 1-1-1-3.

* The term '''GTPAL''' is used when the TPAL is prefixed with gravidity, and '''GTPALM''' when GTPAL is followed by number of multiple pregnancies.<ref name="isbn1-58255-939-2 p 385"/> For example, the gravidity and parity of a womanfemale who has given birth at term once and has had one miscarriage at 12 weeks would be recorded as G2 T1 P0 A1 L1. This notation is not standardized and can lead to misinterpretations.<ref name="Cunningham" />