Abstract
Objective
To determine whether the mode of delivery at term has an impact on the risk of long-term neurological morbidity of the offspring.
Study Design
A population-based cohort analysis was performed including all singleton term deliveries occurring between 1991-2013 at a tertiary medical center. A comparison was performed between children delivered via elective cesarean delivery (CD) and those delivered vaginally. Multiple gestations and fetuses with congenital malformations were excluded. All cases of urgent CD due to non-reassuring fetal status, non-progressive labor, prolapse of cord, preeclampsia, placenta previa, placental abruption, gestational diabetes, labor induction and failed induction, fetal growth restriction, as well as instrumental deliveries, were excluded from the analysis. Pediatric hospitalizations of the offspring up to the age of 18 years involving neurological morbidity were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. A Cox regression model was used to control for confounders.
Results
During the study period 132 054 term deliveries met the inclusion criteria; 8.9% were via elective CD (n=11 746) and 91.1% (n=120 308) were vaginal deliveries. Hospitalizations up to the age of 18 years involving neurological morbidity were significantly more common in offspring delivered by CD as compared with those delivered vaginally (Table). Specifically, autism and movement disorders were more common in the CD group (p<0.001 in both). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neurological morbidity in the CD group (Figure, log rank p<0.001). Using a Cox proportional hazards model while controlling for maternal age, gestational age, and birth weight, elective CD at term exhibited an independent association with long-term neurological morbidity of the offspring (adjusted HR=1.32, CI 1.18-1.47, p<0.001).
Conclusion
Elective CD at term is a significant risk factor for long-term pediatric neurological morbidity of the offspring.
To determine whether the mode of delivery at term has an impact on the risk of long-term neurological morbidity of the offspring.
Study Design
A population-based cohort analysis was performed including all singleton term deliveries occurring between 1991-2013 at a tertiary medical center. A comparison was performed between children delivered via elective cesarean delivery (CD) and those delivered vaginally. Multiple gestations and fetuses with congenital malformations were excluded. All cases of urgent CD due to non-reassuring fetal status, non-progressive labor, prolapse of cord, preeclampsia, placenta previa, placental abruption, gestational diabetes, labor induction and failed induction, fetal growth restriction, as well as instrumental deliveries, were excluded from the analysis. Pediatric hospitalizations of the offspring up to the age of 18 years involving neurological morbidity were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. A Cox regression model was used to control for confounders.
Results
During the study period 132 054 term deliveries met the inclusion criteria; 8.9% were via elective CD (n=11 746) and 91.1% (n=120 308) were vaginal deliveries. Hospitalizations up to the age of 18 years involving neurological morbidity were significantly more common in offspring delivered by CD as compared with those delivered vaginally (Table). Specifically, autism and movement disorders were more common in the CD group (p<0.001 in both). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neurological morbidity in the CD group (Figure, log rank p<0.001). Using a Cox proportional hazards model while controlling for maternal age, gestational age, and birth weight, elective CD at term exhibited an independent association with long-term neurological morbidity of the offspring (adjusted HR=1.32, CI 1.18-1.47, p<0.001).
Conclusion
Elective CD at term is a significant risk factor for long-term pediatric neurological morbidity of the offspring.
| Original language | English GB |
|---|---|
| Pages (from-to) | S97 |
| Number of pages | 1 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 216 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2017 |