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

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.

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Survey of factors influencing women’s selection of the delivery method of their second child in Shanxi Province, China

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.3.2634 ◽

2021 ◽

Vol 37 (3) ◽

Author(s):

Jin-qiong Li

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Shanxi Province ◽

Delivery Mode ◽

Delivery Method ◽

Childbearing Age ◽

Second Child ◽

Factors Influencing ◽

Selection Of

Objective: To explore the factors influencing women’s selection of the delivery method of their second child. Methods: A questionnaire survey was administered among 431 women in the age range of interest from January 2015 to January 2017, and the survey results were evaluated and analyzed statistically. The experts evaluating the questionnaire are professionals in the Department of Obstetrics and Gynecology, Heji Hospital Affiliated to Changzhi Medical College. Results: A total of 70.99% of subjects were 28-35 years old. Approximately 82.35% wished to undergo vaginal delivery, and the remaining 17.65% expressed to undergo cesarean delivery. The reasons for cesarean delivery included the following: fetal factors: worry about fetal health (33.33%), birth trauma (12.90%), and fetal macrosomia (38.17%); maternal factors: advanced age (36.56%), inability to bear uterine contraction pains (21.51%), worry about uracratia after vaginal delivery (10.75%), worry about perineum laceration (8.60%) and the impacts on sexual gratification after delivery (5.38%); social factors: faster delivery mode (54.84%), selection of birth time (27.96%), and better planning of maternity leave (17.20%). Conclusion: Most women tend to undergo vaginal delivery. However, due to the influence of age, educational level and other factors, an increasing number of women prefer cesarean delivery. Medical institutions have the responsibility for providing overall and fair medical information to women of childbearing age to help them make informed choices regarding mode of delivery. doi: https://doi.org/10.12669/pjms.37.3.2634 How to cite this:Li JQ. Survey of factors influencing women’s selection of the delivery method of their second child in Shanxi Province, China. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.2634 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A Multistate Decomposition Analysis of Cesarean Rate Variations, Associated Health Outcomes, and Financial Implications in the United States

American Journal of Perinatology ◽

10.1055/s-0041-1736538 ◽

2021 ◽

Author(s):

Hasan Symum ◽

José L. Zayas-Castro

Keyword(s):

Risk Factors ◽

New York ◽

Cesarean Delivery ◽

Hospital Costs ◽

Decomposition Analysis ◽

The United States ◽

Emergency Department Visits ◽

Multivariable Logistic Regression Analysis ◽

Lengths Of Stay ◽

The Difference

Objectives Cesarean rates vary widely across the U.S. states; however, little is known about the causes and implications associated with these variations. The objectives of this study were to quantify the contribution of the clinical and nonclinical factors in explaining the difference in cesarean rates across states and to investigate the associated health outcome of cesarean variations. Study Design Using the Hospital Cost and Utilization Project State Inpatient Databases, this retrospective study included all nonfederal hospital births from Wisconsin, Florida, and New York. A nonlinear extension of the Oaxaca–Blinder method was used to decompose the contributions of differences in characteristics to cesarean variations between these states. The risk factors for cesarean delivery were identified using separate multivariable logistic regression analysis for each State. Results The difference in clinical and nonclinical factors explained a substantial (∼46.57–65.45%) proportion of cesarean variations between U.S. states. The major contributors of variation were patient demographics, previous cesareans, hospital markup ratios, and social determinants of health. Cesarean delivery was significantly associated with higher postpartum readmissions and unplanned emergency department visits, greater lengths of stay, and hospital costs across all states. Conclusion Although a proportion of variations in cesarean rates can be explained by the differences in risk factors, the remaining unexplained variations suggest differences in practice patterns and imply potential quality concerns. Since nonclinical factors are likely to play an important role in cesarean variation, we recommend targeted initiatives increasing access to maternal care and improving maternal health literacy. Key Points

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Plasma Concentrations of Per- and Polyfluoroalkyl Substances and Body Composition from Mid-childhood to Early Adolescence

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab187 ◽

2021 ◽

Author(s):

Jaclyn A Janis ◽

Sheryl L Rifas-Shiman ◽

Shravanthi M Seshasayee ◽

Sharon Sagiv ◽

Antonia M Calafat ◽

...

Keyword(s):

Body Composition ◽

Linear Regression ◽

Fat Mass ◽

Early Adolescence ◽

Plasma Concentrations ◽

Subcutaneous Fat ◽

Linear Regression Models ◽

Early Life Exposure ◽

Polyfluoroalkyl Substances ◽

Total Fat

Abstract Context Per- and polyfluoroalkyl substances (PFAS) may alter body composition by lowering anabolic hormones and increasing inflammation, but data are limited, particularly in adolescence when body composition is rapidly changing. Objective To evaluate associations of PFAS plasma concentrations in childhood with change in body composition through early adolescence. Design, Setting, and Participants 537 children in the Boston-area Project Viva cohort. Methods We used multivariable linear regression and Bayesian kernel machine regression (BKMR) to examine associations of plasma concentrations of six PFAS, quantified by mass spectrometry, in mid-childhood (mean age 7.9 years; 2007-2010) with change in body composition measured by dual-energy X-ray absorptiometry from mid-childhood to early adolescence (mean age 13.1 years). Results In single PFAS linear regression models, children with higher concentrations of perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorodecanoate (PFDA), and perfluorohexane sulfonate (PFHxS) had less accrual of lean mass (e.g., -0.33 [95% CI: -0.52, -0.13] kg/m 2 per doubling of PFOA). Children with higher PFOS and PFHxS had less accrual of total and truncal fat mass (e.g., -0.32 [95% CI: -0.54, -0.11] kg/m 2 total fat mass per doubling of PFOS), particularly subcutaneous fat mass (e.g., -17.26 [95% CI -32.25, -2.27] g/m 2 per doubling of PFOS). Children with higher PFDA and perfluorononanoate (PFNA) had greater accrual of visceral fat mass (e.g., 0.44 [95% CI: 0.13, 0.75] g/m 2 per doubling of PFDA). Results from BKMR mixture models were consistent with linear regression analyses. Conclusions Early life exposure to some but not all PFAS may be associated with adverse changes in body composition.

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Recovery after Nulliparous Birth

Anesthesiology ◽

10.1097/aln.0000000000001789 ◽

2017 ◽

Vol 127 (4) ◽

pp. 684-694 ◽

Cited By ~ 26

Author(s):

Ryu Komatsu ◽

Brendan Carvalho ◽

Pamela D. Flood

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Functional Recovery ◽

Rating Scale ◽

Area Under The Curve ◽

The United States ◽

Opioid Use ◽

Pain Experience ◽

Nulliparous Women ◽

Time Required

Abstract Background The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients. Methods A total of 213 nulliparous women were enrolled and assessed daily until they completed 3 outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery from delivery. The primary endpoint, pain- and opioid-free functional recovery, was the time required to reach all three of the endpoints. Pain burden was assessed as the area under the curve created by plotting the daily numerical pain rating scale against the days required to attain pain resolution. Times to attain study endpoints after cesarean delivery and vaginal delivery were compared using survival analysis. Results After vaginal delivery, days required for pain and opioid-free functional recovery (median [interquartile range (IQR)]) were 19 [11 to 26], for opioid cessation 0 [0 to 2], termination of all analgesic (including nonsteroidal antiinflammatories and acetaminophen) 11 [5 to 17], and pain resolution 14 [7 to 24]. Achievement of these endpoints after cesarean delivery required 27 [19 to 40], 9 [5 to 12], 16 [11 to 24], and 21 [14 to 27] days, respectively. Conclusions There is clinically significant variability between healthy nulliparous parturients in the pain experience, opioid use, and functional recovery after childbirth following vaginal and cesarean delivery. Recovery to predelivery function is similar after vaginal and cesarean delivery, and approximately half of the variance was explained by pain burden.

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Retention, Progression and the Taking of Online Courses

Online Learning ◽

10.24059/olj.v20i2.780 ◽

2015 ◽

Vol 20 (2) ◽

Cited By ~ 4

Author(s):

Scott James ◽

Karen Swan ◽

Cassandra Daston

Keyword(s):

Community Colleges ◽

Online Courses ◽

Predictive Analytics ◽

The United States ◽

Retention Rates ◽

Pell Grant ◽

Delivery Mode ◽

The Difference ◽

Media Reports ◽

Onground Courses

Online learning continues to grow at post-secondary institutions across the United States, but many question its efficacy, especially for students most at-risk for failure. This paper engages that issue. It examines recent research on the success of community college students who take online classes and explores similar comparisons using 656,258 student records collected through the Predictive Analytics Reporting (PAR) Framework. In particular, the research investigated retention rates for students in three delivery mode groups — students taking only onground courses, students taking only online courses, and students taking some courses onground and some courses online at five primarily onground community colleges, five primarily onground four-year universities, and four primarily online institutions. Results revealed that taking some online courses did not result in lower retention rates for students enrolled in primarily onground community colleges participating in the PAR Framework. Moreover, although retention rates were lower for such students taking only online courses than for similar students taking only onground or blending their courses, much of the difference could be explained by extraneous factors. Essentially no differences in retention between delivery mode groups were found for students enrolled in primarily onground four-year universities participating in the PAR Framework, while at participating primarily online institutions, students blending their courses had slightly better odds of being retained than students taking exclusively onground or exclusively online courses. No differences between the latter groups were found at these institutions. Patterns of retention were similar regardless of gender across institutional categories, and were mostly similar regardless of Pell grant status with the exception of fully online students at traditional community colleges. Age, however, did differentially affect delivery mode effects. Older students taking only online courses were retained at higher rates than younger students taking only online courses at both primarily onground community colleges and primarily online institutions. The results suggest that, despite media reports to the contrary, taking online courses is not necessarily harmful to students’ chances of being retained, and may provide course-taking opportunities that otherwise might not be available, especially for nontraditional students.

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The effectiveness of delivery ball use versus conventional nursing care during delivery of primiparae

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.3.1440 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Jianfang Wang ◽

Xuemei Lu ◽

Chunhong Wang ◽

Xuemei Li

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Nursing Care ◽

Statistical Significance ◽

Control Group ◽

Delivery Mode ◽

Observation Group ◽

Gynecology And Obstetrics ◽

Significant Difference ◽

Free Position

Objective: To analyze the clinical effect of delivery ball and free position delivery nursing in primipara delivery. Methods: Total 110 primipara who were admitted to the department of gynecology and obstetrics of our hospital from August 2017 to August 2018 were included in the study. They were randomly divided into an observation group and a control group, 55 each group. The control group adopted conventional nursing measures, while the observation group adopted delivery ball combined with free position midwifery nursing on the basis of conventional nursing. The pain degree, comfort degree, pregnancy outcome and sense of delivery control were compared between the two groups. Results: The number of puerperae with grade 0 and 3 labor pain in the two groups had no statistically significant difference (P>0.05). The number of puerperae with grade 1 and 2 had significant difference (P<0.05). As to the comparison of the delivery mode between the two groups, there were 9 cases of cesarean delivery and 46 cases of vaginal delivery in the observation group; there were 19 cases of cesarean delivery and 36 cases of vaginal delivery in the control group; the differences had statistical significance (P<0.05). In the comparison of the birth process time of the vaginal delivery puerperae, the time of the first and second stages of labor in the observation group was shorter than that in the control group, and the differences were statistically significant (P<0.05); there was no difference in the time of the third stage of labor between the two groups (P>0.05). The amount of hemorrhage of the observation group 2 hours after labor was 172.50±40.60 mL and that of the control group was 224.45±32.80 mL; the difference between the two groups was statistically significant (P<0.05). The sense of delivery control of the puerperae who suffered vaginal delivery was compared between the two groups using Labor Agentry Scale (LAS); the sense of delivery control of the observation group was stronger than that of the control group, and the differences had statistical significance (P<0.05). Conclusion: In the delivery of primipara, delivery ball combined with free position delivery can help the primipara relieve pain, improve comfort degree, reduce the amount of postpartum hemorrhage, shorten the duration of various stages of labor, and improve the delivery outcome. It has a high clinical promotion value. doi: https://doi.org/10.12669/pjms.36.3.1440 How to cite this:Wang J, Lu X, Wang C, Li X. The effectiveness of delivery ball use versus conventional nursing care during delivery of primiparae. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1440 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Local Anesthetic Requirements Are Greater in Dystocia Than in Normal Labor

Anesthesiology ◽

10.1097/00000542-200304000-00024 ◽

2003 ◽

Vol 98 (4) ◽

pp. 957-963 ◽

Cited By ~ 54

Author(s):

Moeen K. Panni ◽

Scott Segal

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Local Anesthetic ◽

The United States ◽

Labor Analgesia ◽

Delivery Mode ◽

Clinical Model ◽

Clinically Normal ◽

Considerable Controversy ◽

A Prospective Study

Background Dystocia is characterized by abnormal progress of labor and is a common contemporary indication for cesarean delivery in the United States. There has been considerable controversy as to whether epidural analgesia causes dysfunctional labor leading to cesarean delivery for dystocia. The minimum local analgesic concentration (MLAC) is a clinical model used to determine the relative potencies of local anesthetics in the first stage of labor. In this article, the authors report a prospective study determining the MLAC of bupivacaine in early labor of parturients who eventually delivered either vaginally or via cesarean section. Methods An up-down sequential allocation technique was used to determine the MLAC of bupivacaine in 57 nulliparous parturients assigned to either vaginal delivery or cesarean section arms. In addition, patients were assigned to groups receiving or not receiving intravenous oxytocin at the time of epidural placement. Only patients who delivered by the assigned delivery mode were included in the MLAC analyses. Results Parturients who later delivered vaginally had 25% and 31% lower MLAC values (0.078% and 0.085% wt/vol bupivacaine, receiving or not receiving intravenous oxytocin, respectively) than those who later delivered by cesarean section (0.102% and 0.106% wt/vol bupivacaine, receiving or not receiving intravenous oxytocin, respectively). Conclusions These data suggest that an increased local anesthetic requirement for epidural labor analgesia is associated with more intense pain related to dystocia. Women in early, clinically normal labor but who later develop dystocia require more local anesthetic and, by inference, are experiencing more severe pain than women who deliver vaginally. This association should be considered when studying the relation between the method of labor analgesia and the course of labor.

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Disparities in Trial of Labor among Women with Twin Gestations in the United States

American Journal of Perinatology ◽

10.1055/s-0041-1727228 ◽

2021 ◽

Author(s):

Gina N. Mo ◽

Yvonne W. Cheng ◽

Aaron B. Caughey ◽

Lynn M. Yee

Keyword(s):

United States ◽

Vaginal Delivery ◽

Maternal Age ◽

Demographic Factors ◽

The United States ◽

Clinical Factors ◽

Factors Associated ◽

Trial Of Labor ◽

Hispanic White ◽

Second Twin

Objective The aim of the study is to examine clinical and demographic factors associated with trial of labor (TOL) among women with twin gestations eligible for a vaginal delivery. Study Design This was a population-based cohort study of women giving birth to twin gestations in the United States (2012–2014). Inclusion criteria for the analysis included live births greater than 23 weeks' gestation and a cephalic presenting twin. Women with prior cesarean delivery were excluded. Women were categorized by whether they underwent a TOL. Clinical and demographic characteristics associated with TOL status were evaluated using multivariable logistic regression analyses. Secondary analyses with stratification by parity and by second twin presentation were performed. Results Of 90,000 women eligible for inclusion, a minority (39.3%) underwent TOL. Women who had a greater gestational age at delivery were more likely to have a TOL. In contrast, several demographic factors were associated with decreased likelihood of TOL, including maternal age >35 years and identifying as Hispanic or Asian compared with non-Hispanic White. No differences in odds of TOL were observed for women who were identified as non-Hispanic Black versus non-Hispanic White, nor were other demographic factors such as marital status, insurance status, or educational attainment associated with undergoing TOL. Clinical factors associated with decreased odds of TOL included nulliparity, obesity, and hypertensive disorders of pregnancy. Results did not substantively change when stratified by parity or second twin presentation, nor did findings differ in the subgroup who delivered at 32 weeks of gestation or greater. Conclusion In this large population of women with twins who were eligible for a TOL, a minority of individuals attempted a vaginal delivery. Demographic and clinical factors such as older maternal age, Asian or Hispanic racial or ethnic identification, nulliparity, and obesity are associated with decreased odds of undergoing TOL. Key Points

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Term Labor Induction and Cesarean Delivery Risk among Obese Women with and without Comorbidities

American Journal of Perinatology ◽

10.1055/s-0040-1714422 ◽

2020 ◽

Author(s):

Kimberly B. Glazer ◽

Valery A. Danilack ◽

Alison E. Field ◽

Erika F. Werner ◽

David A. Savitz

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Maternal Age ◽

Expectant Management ◽

Labor Induction ◽

Induction Of Labor ◽

Low Risk ◽

Obese Women ◽

Adjusted Risk ◽

Nulliparous Women

Objective Findings of the recent ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, showing reduced cesarean risk with elective labor induction among low-risk nulliparous women at 39 weeks' gestation, have the potential to change interventional delivery practices but require examination in wider populations. The aim of this study was to identify whether term induction of labor was associated with reduced cesarean delivery risk among women with obesity, evaluating several maternal characteristics associated with obesity, induction, and cesarean risk. Study Design We studied administrative records for 66,280 singleton, term births to women with a body mass index ≥30, without a prior cesarean delivery, in New York City from 2008 to 2013. We examined elective inductions in 39 and 40 weeks' gestation and calculated adjusted risk ratios for cesarean delivery risk, stratified by parity and maternal age. We additionally evaluated medically indicated inductions at 37 to 40 weeks among women with obesity and diabetic or hypertensive disorders, comorbidities that are strongly associated with obesity. Results Elective induction of labor was associated with a 25% (95% confidence interval: 19–30%) lower adjusted risk of cesarean delivery as compared with expectant management at 39 weeks of gestation and no change in risk at 40 weeks. Patterns were similar when stratified by parity and maternal age. Risk reductions in week 39 were largest among women with a prior vaginal delivery. Women with comorbidities had reduced cesarean risk with early term induction and in 39 weeks. Conclusion Labor induction at 39 weeks was consistently associated with reduced risk of cesarean delivery among women with obesity regardless of parity, age, or comorbidity status. Cesarean delivery findings from induction trials at 39 weeks among low-risk nulliparous women may generalize more broadly across the U.S. obstetric population, with potentially larger benefit among women with a prior vaginal delivery. Key Points

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1367-P: Risk and Indications for Cesarean Delivery among Women with Diabetes in the United States

Diabetes ◽

10.2337/db20-1367-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1367-P

Author(s):

JENNIFER GRASCH ◽

KATHERINE MILLER ◽

DAVID HAAS ◽

METHODIUS TUULI ◽

CHRISTINA M. SCIFRES

Keyword(s):

United States ◽

Cesarean Delivery ◽

The United States

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