Cesareans increase risk for offspring complications, decrease risk for maternal complications
Children delivered by cesarean were at higher risk for obesity and asthma, but cesarean deliveries were linked to a lower risk of pelvic prolapse and urinary incontinence among mothers, according to a systematic review and meta-analysis recently published in PLOS Medicine.
Researchers said this lower risk for pelvic organ relapse and urinary incontinence should be weighed against a higher risk for infertility. “Although previous systematic reviews have assessed individual outcomes, we have found no other published reviews synthesizing the evidence for all long-term risks and benefits of cesarean delivery relating to mother, baby, and subsequent pregnancies,” Oonagh E. Keag, MBchB, of the department of obstetrics and gynecology at the Royal Infirmary of Edinburgh, United Kingdom, and colleagues wrote. “There is a lack of documented evidence about medium- to long-term outcomes in women and their babies after a planned cesarean delivery or a planned vaginal birth.”
According to the authors, nearly one in three pregnancies in North America results in a cesarean delivery.
Researchers looked at 79 cohort studies and one randomized controlled trial containing more than 29.9 million participants. According to Keag and colleagues, these studies were performed in high-income countries and had follow-up data of 1 year or more from index delivery date.
They found offspring delivered via cesarean delivery had higher risk for:
- asthma before turning 12 years old (OR = 1.21; 95% CI, 1.11-1.32); and
- obesity before turning 5 years old (OR = 1.59; 1.33-1.9).
Researchers also found that compared with vaginal delivery at 37 or more weeks, cesarean delivery was associated with lower risk for:
- pelvic organ prolapse (OR = 0.29; 95% CI, 0.17-0.51) in the mother; and
- urinary incontinence (OR = 0.56; 95% CI, 0.47-0.66) in the mother.
However, pregnancy after cesarean delivery was linked to higher risk for:
- miscarriage (OR = 1.17; 95% CI, 1.03-1.32);
- stillbirth (OR = 1.27; 95% CI, 1.15-1.4);
- placenta previa (OR = 1.74; 95% CI, 1.62-1.87);
- placenta accreta (OR = 2.95; 95% CI, 1.32-6.6); and
- placental abruption (OR = 1.38, 95% CI, 1.27-1.49).
“We chose our outcomes a priori. Whilst this minimized bias, we have been unable to include some data from well-conducted prospective randomized trials,” Kaeg and colleagues wrote. “Examples include [two studies] both of which looked at neurodevelopmental outcomes at two years of age in children delivered by planned cesarean delivery vs. planned vaginal delivery. Neither study demonstrated statistically significant differences in the two delivery groups; therefore, including these would not have substantially altered the conclusions of our review.”
Researchers said their findings are “valuable” to doctors and expectant mothers alike.
“These findings might help enhance discussions between clinicians and patients regarding mode of delivery, meaning that patients will be better informed of the potential long-term risks and benefits of cesarean delivery for themselves, their offspring, and any future pregnancies,” Kaeg and colleagues wrote. - by Janel Miller
Disclosure: The authors did not declare any relevant financial disclosures.