A cohort study of maternal cardiometabolic risk factors and primary cesarean delivery in an integrated health system

Autor: Charles P. Quesenberry, Monique M. Hedderson, Emily S. Han, Sneha B. Sridhar, Yvonne Crites, Fei Xu
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Physiology
Maternal Health
lcsh:Medicine
Blood Pressure
Overweight
Vascular Medicine
Cohort Studies
Labor and Delivery
0302 clinical medicine
Endocrinology
Pregnancy
Risk Factors
Medicine and Health Sciences
030212 general & internal medicine
lcsh:Science
030219 obstetrics & reproductive medicine
Multidisciplinary
Obstetrics
Delivery of Health Care
Integrated
Gestational age
Obstetrics and Gynecology
Middle Aged
Gestational diabetes
Physiological Parameters
Obstetric Procedures
Cardiovascular Diseases
Hypertension
medicine.symptom
Cohort study
Research Article
Primary Hypertension
Adult
medicine.medical_specialty
Adolescent
Endocrine Disorders
Mothers
Surgical and Invasive Medical Procedures
03 medical and health sciences
Young Adult
Hypertensive Disorders in Pregnancy
Diabetes mellitus
medicine
Diabetes Mellitus
Humans
Obesity
Gestational Diabetes
business.industry
Cesarean Section
lcsh:R
Body Weight
Biology and Life Sciences
medicine.disease
Relative risk
Metabolic Disorders
Birth
Women's Health
lcsh:Q
business
Zdroj: PLoS ONE
PLoS ONE, Vol 13, Iss 7, p e0199932 (2018)
ISSN: 1932-6203
Popis: Background Maternal cardiometabolic risk factors (i.e., hyperglycemia, pre-existing hypertension and high body mass index) impact fetal growth and risk of having a cesarean delivery. However, the independent and joint contribution of maternal cardiometabolic risk factors to primary cesarean section is unclear. We aimed to elucidate the degree to which maternal cardiometabolic risk factors contribute to primary cesarean deliveries and whether associations vary by infant size at birth in an integrated health system. Methods A cohort study of 185,045 singleton livebirths from 2001 to 2010. Poisson regression with robust standard errors provided crude and adjusted relative risks (RR) and 95% confidence intervals (CIs) for cesarean delivery risk associated with risk factors. We then estimated the proportion of cesarean sections that could be prevented if the cardiometabolic risk factor in pregnant women were eliminated (the population-attributable risk [PAR]). Results In a single multivariable model, maternal cardiometabolic risk factors were independently associated with cesarean delivery: RR (95% CI) abnormal glucose screening 1.04 (1.01–1.08); gestational diabetes 1.18 (1.11–1.18) and pre-existing diabetes 1.60 (1.49–1.71); pre-existing hypertension 1.16 (1.10–1.23); overweight 1.27 (1.24–1.30); obese class I 1.46 (1.42–1.51); obese class II 1.73 (1.67–1.80); and obese class III 1.97 (1.88–2.07); adjusting for established risk factors, medical facility and year. The associations between maternal cardiometabolic risk factors and primary cesarean delivery remained among infants with appropriate weights for gestational age. The PARs were 17.4% for overweight/obesity, 7.0% for maternal hyperglycemia, 2.0% for pre-existing hypertension and 20.5% for any cardiometabolic risk factor. Conclusions Maternal cardiometabolic risk factors were independently associated with risk of primary cesarean delivery, even among women delivering infants born at an appropriate size for gestational age. Effective strategies to increase the proportion of women entering pregnancy at an optimal weight with normal blood pressure and glucose before pregnancy could potentially eliminate up to 20% of cesarean deliveries.
Databáze: OpenAIRE
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