Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e51-e56
DOI: 10.1055/s-0043-1777996
Original Article

The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery

Robert Fresch 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Kendal Stephens
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Emily DeFranco 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery.

Objective To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery.

Study Design In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery.

Results There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78–1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34–3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN.

Conclusion A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.

Keywords

advanced maternal age - chronic hypertension - gestational hypertension - obesity - multiple - pregestational diabetes - primary cesarean delivery - vaginal delivery - tobacco use

Note

This study was presented as a poster presentation at the Society of Maternal-Fetal Medicine 40th Annual Pregnancy Meeting, between February 3 and 8, 2020, in Grapevine, TX.




Publication History

Received: 08 September 2020

Accepted: 22 October 2023

Article published online:
23 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Pfuntner A, Wier LM, Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2010. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. Statistical Brief #149. PMID: 23596641
    Google Scholar
  • 2 Declercq E, Barger M, Cabral HJ. et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol 2007; 109 (03) 669-677
    CrossrefPubMedGoogle Scholar
  • 3 Osterman MJ, Martin JA. Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006-2012. Natl Vital Stat Rep 2014; 63 (01) 1-11
    PubMedGoogle Scholar
  • 4 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
    PubMedGoogle Scholar
  • 5 National Center for Health Statistics. 2003 Revisions of the U.S. Standard Certificates of Live Birth. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention. Accessed in March 2020, at: http://www.cdc.gov nchs/data/dvs/birth11–03final-ACC.pdf
    PubMedGoogle Scholar
  • 6 National Center for Health Statistics. Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death (2003 Revision). Accessed in March 2020, at: https://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf
    PubMedGoogle Scholar
  • 7 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii , 1–253
    PubMedGoogle Scholar
  • 8 Vanek M, Sheiner E, Levy A, Mazor M. Chronic hypertension and the risk for adverse pregnancy outcome after superimposed pre-eclampsia. Int J Gynaecol Obstet 2004; 86 (01) 7-11
    CrossrefPubMedGoogle Scholar
  • 9 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019; 133 (01) e26-e50
    CrossrefPubMedGoogle Scholar
  • 10 Gofton EN, Capewell V, Natale R, Gratton RJ. Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension. Am J Obstet Gynecol 2001; 185 (04) 798-803
    CrossrefPubMedGoogle Scholar
  • 11 Lurie S, Ribenzaft S, Boaz M, Golan A, Sadan O. The effect of cigarette smoking during pregnancy on mode of delivery in uncomplicated term singleton pregnancies. J Matern Fetal Neonatal Med 2014; 27 (08) 812-815
    CrossrefPubMedGoogle Scholar
  • 12 Committee on Practice. ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
    CrossrefPubMedGoogle Scholar
  • 13 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 201: pregestational diabetes mellitus. Obstet Gynecol 2018; 132 (06) e228-e248
    CrossrefPubMedGoogle Scholar
  • 14 Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth 2010; 37 (03) 219-226
    CrossrefPubMedGoogle Scholar
  • 15 Practice Bulletin No. 156: obesity in pregnancy correction. Obstet Gynecol 2016; 128 (06) 1450
    CrossrefPubMedGoogle Scholar
  • 16 American College of Obstetrics and Gynecology (ACOG) and American Academy of Pediatrics (AAoP).. Guidelines for Perinatal Care. 8th ed. Washington, DC: ACOG and AAoP; 2017: 263-267
    Google Scholar
  • 17 Reichman NE, Schwartz-Soicher O. Accuracy of birth certificate data by risk factors and outcomes: analysis of data from New Jersey. Am J Obstet Gynecol 2007; 197 (01) 32.e1-32.e8
    CrossrefPubMedGoogle Scholar
  • 18 Ohio Perinatal Quality Collaborative. Birth Registry Accuracy. Accessed March 11, 2020, at: https://opqc.net/node/169
    PubMedGoogle Scholar
  • 19 Kaplan HC, King E, White BE. et al. Statewide quality improvement initiative to reduce early elective deliveries and improve birth registry accuracy. Obstet Gynecol 2018; 131 (04) 688-695
    CrossrefPubMedGoogle Scholar
  • 20 Lannon C, Kaplan HC, Friar K. et al. Using a state birth registry as a quality improvement tool. Am J Perinatol 2017; 34 (10) 958-965
    Article in Thieme ConnectPubMedGoogle Scholar