Maternal obesity and risk of cesarean delivery: A meta-analysis
Tufts University, Бостон, Georgia, United States Obesity Reviews
(Impact Factor: 8).
10/2007; 8(5):385-94. DOI: 10.1111/j.1467-789X.2007.00397.x
Despite numerous studies reporting an increased risk of cesarean delivery among overweight or obese compared with normal weight women, the magnitude of the association remains uncertain. Therefore, we conducted a meta-analysis of the current literature to provide a quantitative estimate of this association. We identified studies from three sources: (i) a PubMed search of relevant articles published between January 1980 and September 2005; (ii) reference lists of publications selected from the search; and (iii) reference lists of review articles published between 2000 and 2005. We included cohort designed studies that reported obesity measures reflecting pregnancy body mass, had a normal weight comparison group, and presented data allowing a quantitative measurement of risk. We used a Bayesian random effects model to perform the meta-analysis and meta-regression. Thirty-three studies were included. The unadjusted odd ratios of a cesarean delivery were 1.46 [95% confidence interval (CI): 1.34-1.60], 2.05 (95% CI: 1.86-2.27) and 2.89 (95% CI: 2.28-3.79) among overweight, obese and severely obese women, respectively, compared with normal weight pregnant women. The meta-regression found no evidence that these estimates were affected by selected study characteristics. Our findings provide a quantitative estimate of the risk of cesarean delivery associated with high maternal body mass.
Available from: Frans J M E Roumen
- "Using a previously published design for clinical decision-making, we created 16 hypothetical cases of women with a twin pregnancy (Kok et al. 2008; Vellekoop et al. 2009). Th e cases diff ered in nine clinical factors, each divided in 2 or 3 or 4 relevant options, based on current literature: age (23 or 39 years), vaginal parity (nulliparous or multiparous), mode of conception (spontaneously or aft er in vitro fertilisation), gestational age (32, 35 or 38 weeks), chorionicity (monochorionic/diamniotic or dichorionic/diamniotic ), BMI (24 or 39 kg/m 2 ), estimated foetal weight (concordant growth, foetus A 25% heavier than foetus B and foetus A 25% lighter than foetus B), twin presentation (non-vertex – non-vertex, non-vertex – vertex, vertex – vertex or vertex – non-vertex) and the wish of the mother to have more children in the future (yes or no) (Amaru et al. 2004; Barrett et al. 2013; Chu et al. 2007; Hack et al. 2008; Hoff mann et al. 2012; Little et al. 2008; Park et al. 2009; Vellekoop et al. 2009). "
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ABSTRACT: Using orthogonal design, we created a questionnaire containing 16 cases of twin pregnancies. For each case, respondents indicated whether they would plan a vaginal delivery (VD) or a caesarean section (CS). We assessed the association between each variable (maternal age, parity, mode of conception, gestational age, chorionicity, body mass index, foetal growth, foetal presentation and wish for additional children) and the planned mode of delivery. A VD was planned mostly for vertex presentation of twin A (vertex-vertex vs. non-vertex-vertex, odds ratio [OR]: 0.002, 95% confidence interval [CI]: 0.001-0.003, p < 0.001). For vertex- non-vertex (vs. vertex-vertex) presentation, chances on planning a VD decreased threefold (OR: 0.29, 95% CI: 0.018-0.46, p < 0.001), although the majority of respondents would still plan a VD. In multiparous (vs. nulliparous) women, VD was chosen more often (OR: 3.24, 95% CI: 2.50-4.18, p < 0.001).Vertex presentation of twin A and multiparity were the main reasons for planning a VD.
Available from: Scott A Adler
- "Although maternal age was assessed relative to whether infants were born by caesarean section or vaginally and was found not to differ, additional factors other than differences in brain development could have contributed to the poorer attentional responding in caesarean-section infants. Some of the other factors that might distinguish infants born by caesarean section from those born vaginally include, but are not limited to, maternal weight (Chu et al., 2007; Galtier-Dereure, Montpeyroux, Boulot, Bringer, & Jaffiol, 1995), fetal status and weight (Barber et al., 2011), and position of the fetus in the uterus (Akmal, Kametas, Tsoi, Howard, & Nicolaides, 2004). Each of these factors has been associated with an increased probability of caesarean-section delivery, and consequently , each factor might contribute to the attentional deficit of caesarean-section delivery revealed in the present study. "
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ABSTRACT: Little is known about the role that the birth experience plays in brain and cognitive development. Recent research has suggested that birth experience influences the development of the somatosensory cortex, an area involved in spatial attention to sensory information. In this study, we explored whether differences in spatial attention would occur in infants who had different birth experiences, as occurs for caesarean versus vaginal delivery. Three-month-old infants performed either a spatial cueing task or a visual expectation task. We showed that caesarean-delivered infants' stimulus-driven, reflexive attention was slowed relative to vaginally delivered infants', whereas their cognitively driven, voluntary attention was unaffected. Thus, types of birth experience influence at least one form of infants' attention, and possibly any cognitive process that relies on spatial attention. This study also suggests that birth experience influences the initial state of brain functioning and, consequently, should be considered in our understanding of brain development.
Available from: Jerel Ezell
- "Maternal and fetal factors associated with C-section include older maternal age, greater parity, prior C-section delivery, increased maternal or fetal weight, and breech presentation   . Racial dimensions also exist: populationbased evidence consistently demonstrates that rates of Csections are disproportionately higher among women in racial/ethnic minority populations, in comparison to White women   . "
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We examined the association between 1-hour glucose challenge test (GCT) values and risk of caesarean section.
A prospective cohort study recruited 203 pregnant Black women to participate. At ~28 weeks of gestation, participants underwent a routine 1-hour 50 g GCT to screen for gestational diabetes mellitus. Logistic regression was used to examine the association between 1-hour GCT value and delivery mode.
Of the 158 participants included, 53 (33.5%) delivered via C-section; the majority (n = 29; 54.7%) were nulliparous. Mean 1-hour GCT values were slightly, but not significantly, higher among women delivering via C-section; versus vaginally (107.8 ± 20.7 versus 102.4 ± 21.5 mg/dL, resp.; P = 0.13). After stratifying by parity and adjusting for maternal age, previous C-section, and prepregnancy body mass index, 1-hour GCT value was significantly associated with increased risk of C-section among parous women (OR per 1 mg/dL increase in GCT value = 1.05; 95% CI OR: 1.00, 1.05; P = 0.045).
Even slightly elevated 1-hour 50 g GCT values may be associated with delivery mode among parous Black women.
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