Changes in maternal risk factors and their association with changes in cesarean sections in Norway between 1999 and 2016: A descriptive population-based registry study

Autor: Erik Eik Anda, Finn Egil Skjeldestad, Kajsa Møllersen, Emanuelle Pessa Valente, Ingvild Hersoug Nedberg, Ilaria Mariani, Marzia Lazzerini
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Time Factors
Epidemiology
medicine.medical_treatment
Maternal Health
Cardiovascular Medicine
Geographical Locations
Labor and Delivery
Medical Conditions
Endocrinology
Obstetrics and gynaecology
Pregnancy
Risk Factors
Medicine and Health Sciences
Registries
education.field_of_study
VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin
sosialmedisin: 801
Norway
Obstetrics and Gynecology
General Medicine
Gestational diabetes
Europe
Parity
Obstetric Procedures
Cardiovascular Diseases
language
Medicine
Female
Research Article
Maternal Age
Adult
Maternal risk factors
Reproductive Techniques
Assisted
Endocrine Disorders
Population
Cardiology
Surgical and Invasive Medical Procedures
Norwegian
Risk Assessment
Young Adult
medicine
Diabetes Mellitus
Humans
Risk factor
Gestational Diabetes
education
Assisted reproductive technology
business.industry
Cesarean Section
Cardiovascular Disease Risk
medicine.disease
language.human_language
Pregnancy Complications
Medical Risk Factors
Metabolic Disorders
People and Places
Birth
Women's Health
VDP::Medical disciplines: 700::Health sciences: 800::Community medicine
Social medicine: 801
business
Demography
Zdroj: PLoS Medicine
PLoS Medicine, Vol 18, Iss 9, p e1003764 (2021)
Popis: Background Increases in the proportion of the population with increased likelihood of cesarean section (CS) have been postulated as a driving force behind the rise in CS rates worldwide. The aim of the study was to assess if changes in selected maternal risk factors for CS are associated with changes in CS births from 1999 to 2016 in Norway. Methods and findings This national population-based registry study utilizes data from 1,055,006 births registered in the Norwegian Medical Birth Registry from 1999 to 2016. The following maternal risk factors for CS were included: nulliparous/≥35 years, multiparous/≥35 years, pregestational diabetes, gestational diabetes, hypertensive disorders, previous CS, assisted reproductive technology, and multiple births. The proportion of CS births in 1999 was used to predict the number of CS births in 2016. The observed and predicted numbers of CS births were compared to determine the number of excess CS births, before and after considering the selected risk factors, for all births, and for births stratified by 0, 1, or >1 of the selected risk factors. The proportion of CS births increased from 12.9% to 16.1% (+24.8%) during the study period. The proportion of births with 1 selected risk factor increased from 21.3% to 26.3% (+23.5%), while the proportion with >1 risk factor increased from 4.5% to 8.8% (+95.6%). Stratification by the presence of selected risk factors reduced the number of excess CS births observed in 2016 compared to 1999 by 67.9%. Study limitations include lack of access to other important maternal risk factors and only comparing the first and the last year of the study period. Conclusions In this study, we observed that after an initial increase, proportions of CS births remained stable from 2005 to 2016. Instead, both the size of the risk population and the mean number of risk factors per birth continued to increase. We observed a possible association between the increase in size of risk population and the additional CS births observed in 2016 compared to 1999. The increase in size of risk population and the stable CS rate from 2005 and onward may indicate consistent adherence to obstetric evidence-based practice in Norway.
In a population-based study, Ingvild Nedberg and colleagues investigate the relationship between maternal risk factors and changes in rates of cesarean section births in Norway.
Author summary Why was this study done? A general increase in maternal risk factors is thought to be an important part of the explanation for increasing cesarean section (CS) worldwide. Few studies examine a combination of maternal risk factors. What did the researchers do and find? We studied the relationship between CS and 8 maternal risk factors over time in Norway. We found that most of maternal risk factors increased continuously, proportions of CS births also increased initially, then remained stable from 2005 till 2016. We found that most of the increase in proportions of CS was associated with an increase in maternal risk factors. What do these findings mean? Norway is one of the few high-resource countries that has managed to keep CS rates low and stable. The stable proportions of CS births from 2005 onward, while the size of the risk population continued to increase, may indicate that Norwegian obstetrical providers have not been influenced by possible factors driving CS rates in other parts of the world.
Databáze: OpenAIRE
Externí odkaz: