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 |
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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 |
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