The Effect of Pelvic Size on Cesarean Delivery Rates: Using Adolescent Maternal Age as an Unbiased Proxy for Pelvic Size

AbstractThe relevance of pregestational body mass index (BMI) on adverse pregnancy outcomes remained unclear in Southwest China. This study aimed to investigate the overall and age-category specific association between pre-gestational BMI and gestational diabetes mellitus (GDM), preeclampsia, cesarean delivery, preterm delivery, stillbirth, macrosomia, and small-for-gestational age (SGA) or large-for-gestational age (LGA) neonates in Southwest China. Furthermore, it explores the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. 51,125 Chinese singleton pregnant women were recruited as study subjects. Multiple logistic regression models were used to examine the influence of pre-pregnancy BMI on adverse pregnancy outcomes. Gradient boosting machine was used to evaluate the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. It is found that women who were overweight or obese before pregnancy are at higher risk of adverse pregnancy outcomes except for SGA neonates, while pre-pregnancy underweight is a protective factor for GDM, preeclampsia, cesarean delivery, macrosomia and LGA, but not SGA. Younger mothers are more susceptible to GDM and macrosomia neonates, while older mothers are more prone to preeclampsia. Pre-pregnancy BMI has more influence on various pregnancy outcomes than maternal age. To improve pregnancy outcomes, normal BMI weight as well as relatively young maternal ages are recommended for women in child-bearing age.

Download Full-text

Maternal age at first cesarean delivery related to adverse pregnancy outcomes in a second cesarean delivery: a multicenter, historical, cross-sectional cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03608-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shilei Bi ◽

Lizi Zhang ◽

Jingsi Chen ◽

Minshan Huang ◽

Lijun Huang ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Cesarean Delivery ◽

Maternal Age ◽

Reference Group ◽

Multivariate Logistic Regression Analysis ◽

Advanced Maternal Age ◽

Adverse Outcomes ◽

Cross Sectional ◽

Singleton Pregnancies

Abstract Background To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean. Methods This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis. Results The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years). Conclusions Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.

Download Full-text

Maternal age as an independent risk factor for cesarean delivery

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(99)00112-5 ◽

1999 ◽

Vol 67 (3) ◽

pp. 187-188 ◽

Cited By ~ 7

Author(s):

G. Lialios ◽

A. Kaponis ◽

G. Adonakis

Keyword(s):

Risk Factor ◽

Cesarean Delivery ◽

Maternal Age ◽

Independent Risk Factor

Download Full-text

Choice of scheduled cesarean delivery versus trial of labor for advanced maternal age primiparous women

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2017.1397121 ◽

2017 ◽

Vol 32 (6) ◽

pp. 979-984 ◽

Cited By ~ 2

Author(s):

Lina Salman ◽

Anat Shmueli ◽

Rony Chen ◽

Eran Ashwal ◽

Liran Hiersch ◽

...

Keyword(s):

Cesarean Delivery ◽

Maternal Age ◽

Advanced Maternal Age ◽

Trial Of Labor ◽

Versus Trial ◽

Primiparous Women

Download Full-text

Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae

Medicine ◽

10.1097/md.0000000000027063 ◽

2021 ◽

Vol 100 (34) ◽

pp. e27063

Author(s):

Yeonseong Jeong ◽

Sung Pil Choo ◽

Jisun Yun ◽

Eui Hyeok Kim

Keyword(s):

Cesarean Delivery ◽

Maternal Age ◽

Perinatal Outcomes ◽

Induction Of Labor

Download Full-text

Gambaran Kejadian Ketuban Pecah Dini (KPD) di RSUP Prof. Dr. R.D. Kandou Manado Tahun 2018

Medical Scope Journal ◽

10.35790/msj.1.2.2020.27462 ◽

2020 ◽

Vol 1 (2) ◽

Author(s):

Teuku I. Syarwani ◽

Hermie M. M. Tendean ◽

John J. E. Wantania

Keyword(s):

High School ◽

Cesarean Delivery ◽

Gestational Age ◽

Apgar Score ◽

Perinatal Outcome ◽

Maternal Age ◽

Perinatal Outcomes ◽

Senior High School ◽

Premature Rupture ◽

Type Of Delivery

Abstract: Premature rupture of membrane (PROM) is the rupture of the membrane before delivery. This study was aimed to determine the profile of PROM based on maternal age, parity, occupation, duration of PROM, type of delivery, gestational age, and perinatal outcomes. This was a descriptive and retrospective study. Samples were delivery women who had PROM at gestational age≥ 37 weeks and <37 weeks at Prof. Dr. R. D. Kandou Manado form January 1 to December 31, 2018. The results showed a total of 78 patients of PROM. Most patients were 20-34 years (65.39%), senior high school educated (71.80%), housewifery (69.23%), multiparity (58.87%), PROM ≥24 hours (65.38%), gestational age ≥37 weeks (85.90%), cesarean delivery (85.90%), and Apgar score of 7-10 (79.48%). In conclusion, PROM patients in 2018 were more common in age 20-34 years, senior high school educated, housewifery, multiparity, PROM ≥24 hours, gestational age ≥37 weeks, cesarean delivery, and a perinatal outcome of Apgar score of 7-10 (79.48%)Keywords: premature rupture of membrane Abstrak: Ketuban pecah dini (KPD) adalah keadaan pecahnya selaput ketuban sebelum persalinan. Penelitian ini bertujuan untuk mengetahui gambaran kejadian KPD berdasarkan usia ibu, paritas, pekerjaan, lamanya ketuban pecah, jenis persalinan, usia kehamilan, dan luaran perinatal. Jenis penelitian ialah deskriptif retrospektif. Sampelpenelitian ini ialah ibu bersalin yang mengalami KPD pada usia kehamilan ≥37 minggu dan <7 minggu di RSUP Prof. Dr. R. D. Kandou Manado periode 1 Januari -31 Desember 2018. Hasil penelitian mendapatkan total 78 kasus KPD yang terdiri dari ibu berusia 20-34 tahun (65,39%), pendidikan SMA (71,80%), IRT (69,23%), multipara (58,87%), ketuban pecah ≥24 jam (65,38%), usia kehamilan ≥37 minggu (85,90%), persalinan seksio sesarea (85,90%), dan Apgar score 7-10 (79,48%). Simpulan penelitian ini ialah kasus KPD pada tahun 2018 yang paling sering pada usia ibu 20-34 tahun, pendidikan SMA, IRT, multipara, ketuban pecah ≥24 jam, usia kehamilan ≥37 minggu, persalinan seksio sesarea, dan luaran perinatal Apgar score 7-10.Kata kunci: ketuban pecah dini

Download Full-text

A Prospective Investigation of Cesarean Birth with Total and Truncal Fat Mass in Early Adolescence

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_111 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1039-1039

Author(s):

Lidia Minguez Alarcon ◽

Sheryl Rifas-Shiman ◽

Joanne Sordillo ◽

Izzuddin Aris ◽

Marie-France Hivert ◽

...

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Fat Mass ◽

Early Adolescence ◽

Maternal Age ◽

The United States ◽

Delivery Mode ◽

Linear Regression Models ◽

Funding Sources ◽

The Difference

Abstract Objectives Nearly 1.3 million cesarean deliveries are performed each year in the United States, resulting in the birth of one third of all children nationwide. A higher risk of childhood obesity has been observed among children born by cesarean, but this literature is inconsistent. We investigated differences in total and truncal fat mass during early adolescence among offspring born by cesarean compared to those born by vaginal delivery. Methods This prospective study includes adolescents (median age 12.8 years) whose mothers enrolled in while pregnant in Project Viva between 1999 and 2002, and who have been followed since birth. A total of 740 adolescents had available total and truncal fat mass measured using Dual Energy X-Ray Absorptiometry (DXA) at the early adolescent in-person visit. We abstracted delivery mode from electronic medical records. We used multivariable linear regression models to estimate the difference in total and truncal fat mass indices (FMI, kg/m,2) among adolescents born by cesarean compared to those born by vaginal delivery while adjusting for confounders. We used stabilized inverse probability weights to account for censoring. Results Mean (SD) maternal age was 32.2 (5.4) years and pre-pregnancy BMI was 25.0 (5.3) kg/m,2. A total of 157 (21%) of the adolescents were born by cesarean delivery and 51%were female; mean (SD) total and truncal FMI were 6.3 (3.1) and 2.4 (1.5) kg/m,2 respectively. Adolescents born by cesarean vs. vaginal delivery had significantly higher total [β (95% CI) = 0.78 (0.23, 1.33) kg/m,2] and truncal [β (95% CI) = 0.35 (0.08, 0.61) kg/m,2] FMI than those born by vaginal delivery in models adjusted for child age and sex, and maternal age, education and race/ethnicity. These associations were attenuated and no longer statistically significant after further adjusting for maternal pre-pregnancy BMI [β (95% CI) = 0.45 (−0.06, 0.96) kg/m,2 for total and 0.19 (−0.05, 0.44) kg/m,2 for truncal FMI]. Additional adjustment for gestational weight gain, smoking and paternal BMI did not substantially change the results. Conclusions These data suggest that the association between birth by cesarean delivery and adolescent adiposity is largely explained by maternal pre-pregnancy BMI. Funding Sources NIH grants R01HD093761, R01HD034568, R01ES024765, and UH3 OD023286.

Download Full-text