Obstacles to reducing cesarean rates in a low-cesarean setting: the effect of maternal age, height, and weight

doi:10.1016/S0029-7844(98)00244-0

Obstetrics & Gynecology

Volume 92, Issue 4, Part 1, October 1998, Pages 501-506

https://doi.org/10.1016/S0029-7844(98)00244-0 Get rights and content

Abstract

Objective: To examine risk factors for elective and nonelective cesarean delivery in a population with a low cesarean rate.

Methods: Nulliparous women delivering singleton births in Sweden during 1992–93 were included (n = 92,623). Logistic regression analyses were performed to calculate adjusted odds ratios (ORs) and rates of cesarean delivery.

Results: The overall cesarean rate was 11.9%. Risks for cesarean increased consistently with increasing maternal age, decreasing maternal height, and increasing prepregnancy body mass index (BMI). Compared with teenagers, the OR of cesarean was 2.6 among women 30–34 years and 4.4 among women 35 years of age or older. Compared with tall women (greater than 174 cm), the OR of cesarean for women 155–164 cm was 2.0, and 4.5 for short women (less than 155 cm). Compared with lean women (BMI less than 20.0), the ORs of cesarean for overweight (BMI 25.0–29.9) and obese women (BMI of at least 30.0) were 1.8 and 2.4, respectively. Similar risks also were obtained when the analyses were restricted to elective or nonelective cesarean deliveries. The effect of prepregnancy BMI on cesarean rate was influenced by maternal height: among tall women, rates of cesarean increased from 5% among lean women to 11% among obese women, whereas corresponding rates among short women were 19% and 36%, respectively. The influence of mother’s education, type of hospital, and other factors was considerably less.

Conclusion: The increase in maternal age at first birth and the weight among young women present obstacles to the reduction of cesarean rates in developed countries.

Section snippets

Materials and methods

The Swedish Birth Register, maintained by the National Board of Health and Welfare, contains data on more than 99% of births in Sweden. Starting with the first antenatal visit, information is collected prospectively from all hospital births, including information about sociodemographic characteristics, previous reproductive history, pregnancy, and delivery. Such information is forwarded to the Birth Register through copies of standardized individual antenatal, obstetric, and pediatric records,

Results

Among the 92,623 single births were 11,037 cesarean deliveries (11.9%). In the univariate analyses presented in Table 1, maternal age, maternal height, and prepregnancy BMI had the strongest association with the risk of cesarean. Maternal education, mother’s place of birth, and type of hospital also influenced cesarean rates significantly, whereas smoking habits and family situation did not.

Adjusted ORs for the association between cesarean, maternal characteristics, and type of hospital are

Discussion

Maternal age, prepregnancy BMI, and maternal height were the primary influences on the risk for cesarean delivery in this large population-based cohort study. The importance of maternal anthropometric measures is emphasized by the synergistic effects of height and prepregnancy BMI on cesarean rates, which increased by BMI within each height category. Specifically, among tall (at least 175 cm) women, rates of cesarean increased from 5% among lean women to 11% among obese women, whereas the

References (25)

F.C Notzon et al.
Cesarean section delivery in the 1980sInternational comparison by indication
Am J Obstet Gynecol
(1994)
M Martel et al.
Maternal age and primary cesarean section ratesA multivariate analysis
Am J Obstet Gynecol
(1987)
F.R Witter et al.
Influence of maternal anthropometric status and birth weight on the risk of cesarean section delivery
Obstet Gynecol
(1995)
J Garbaciak et al.
Maternal weight and pregnancy complications
Am J Obstet Gynecol
(1985)
E Shearer
Cesarean sectionMedical benefits and costs
Soc Sci Med
(1993)
F.C Notzon et al.
Comparisons of national cesarean section rates
N Engl J Med
(1987)
F.C Notzon
International differences in the use of obstetric interventions
JAMA
(1990)
S.R Johnson et al.
Maternal obesity and pregnancy
Surg Gynecol Obstet
(1987)
S Mor-Yosef et al.
Ranking the risk factors for cesareanLogistic regression analysis of a nationwide study
Obstet Gynecol
(1990)
A.W Read et al.
Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia
Am J Public Health
(1994)

R.T Scott et al.

Maternal height and weight gain during pregnancy as a risk factor for cesarean section

Mil Med

(1989)

R Localio et al.

Relationship between malpractice claims and cesarean delivery

JAMA

(1993)

Cited by (97)

Maternal factors associated with labor dystocia in low-risk nulliparous women. A systematic review and meta-analysis
2023, Sexual and Reproductive Healthcare
To identify maternal factors associated with labor dystocia in low-risk nulliparous women.
MEDLINE, Embase, ClinicalTrials.gov, Cochrane, and CINAHL were searched for intervention studies and observational studies published from January 2000 to January 2022. Low-risk was defined as nulliparous women with a singleton, cephalic birth in spontaneous labor at term. Labor dystocia was defined by national or international criteria or treatment. Countries were restricted to OECD members. Two authors independently screened 11,374 titles and abstracts, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Results were presented narratively and by meta-analysis when compatible.
Seven cohort studies were included. Overall, the certainty of the evidence was moderate. Three studies found that higher maternal age was associated with an increased frequency of labor dystocia (relative risk 1.68; 95% CI 1.43–1.98). Further three studies found that higher maternal BMI was associated with increased frequency of labor dystocia (relative risk 1.20; 95% CI 1.01–1.43). Maternal short stature, fear of childbirth, and high caffeine intake were also associated with an increased frequency of labor dystocia, while maternal physical activity was associated with a decreased frequency.
Maternal factors associated with an increased frequency of labor dystocia were mainly maternal age, physical characteristics, and fear of childbirth. Maternal physical activity was associated with a decreased frequency. Intervention studies targeting these maternal factors would need to be initiated before or early in pregnancy to test the causality of the identified factors and labor dystocia.
Pregnancy outcomes in a population with high prevalence of obesity: How bad is it?
2013, Clinical Epidemiology and Global Health
The prevalence of obesity and overweight in United Arab Emirates (UAE) reaches 39.9% among females and the WHO estimates that obesity prevalence will reach 44.6% among females by the year 2015.
To evaluate the effect of varying degrees of maternal obesity on perinatal outcomes.
Retrospective study of 1985 women grouped into 5 groups according to the body mass index (BMI) measurements in early pregnancy. Group 1 – BMI 18.5–24.9 (normal weight), Group 2 – BMI 25–29.9 (overweight), Group 3 – BMI 30–34.9 (obesity class I), Group 4 – BMI 35–39.9 (obesity class II), Group 5 – BMI 40 or more (obesity class III). The obstetric and perinatal outcomes were compared by creating multiple logistic regression models.
Morbidly obese women were about 5 times more likely to develop hypertensive disorders of pregnancy (OR = 4.97, 95% CI, 1.35–18.33, p = 0.016), 4 times more likely to develop gestational diabetes (OR 3.75, 95% CI, 1.83–7.69, p = 0.001), 3 times more likely to deliver post-term (OR 2.99, 95% CI1.35–6.65, p = 0.007), 3 times more at risk of delivering by caesarean section (OR 2.73, 95% CI, 1.61–4.65, p = 0.0001) and at a very high risk of delivering big babies, OR 17.30 (95% CI, 15.48–54.62, p = 0.001).
Maternal obesity especially morbid obesity in early pregnancy is strongly associated with a number of obstetrical and perinatal complications. Pregnancies in obese women should be managed as high risk pregnancies with strategies for prevention, early detection and management of complications arising from obesity.
Maternal Height Is an Independent Risk of Adverse Outcomes in Women with Gestational Diabetes Mellitus
2024, Diabetes Therapy
Substantial but Misunderstood Human Sexual Dimorphism Results Mainly From Sexual Selection on Males and Natural Selection on Females
2022, Frontiers in Psychology
The obstetrical dilemma hypothesis: there's life in the old dog yet
2021, Biological Reviews
Is routine X-ray pelvimetry of value to decide on mode of delivery for women with labor dystocia?
2021, Clinical and Experimental Obstetrics and Gynecology

View all citing articles on Scopus

View full text

Original ArticlesObstacles to reducing cesarean rates in a low-cesarean setting: the effect of maternal age, height, and weight

Abstract

Section snippets

Materials and methods

Results

Discussion

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Soc Sci Med

Comparisons of national cesarean section rates

N Engl J Med

International differences in the use of obstetric interventions

JAMA

Maternal obesity and pregnancy

Surg Gynecol Obstet

Ranking the risk factors for cesareanLogistic regression analysis of a nationwide study

Obstet Gynecol

Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia

Am J Public Health

Maternal height and weight gain during pregnancy as a risk factor for cesarean section

Mil Med

Relationship between malpractice claims and cesarean delivery

JAMA

Original Articles
Obstacles to reducing cesarean rates in a low-cesarean setting: the effect of maternal age, height, and weight