A Counterfactual Analysis of Impact of Cesarean Birth in a First Birth on Severe Maternal Morbidity in the Subsequent Birth.

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Epidemiology Pub Date : 2024-11-01 Epub Date: 2024-07-26 DOI:10.1097/EDE.0000000000001775
Shalmali Bane, Jonathan M Snowden, Julia F Simard, Michelle Odden, Peiyi Kan, Elliott K Main, Suzan L Carmichael
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Abstract

Background: It is known that cesarean birth affects maternal outcomes in subsequent pregnancies, but specific effect estimates are lacking. We sought to quantify the effect of cesarean birth reduction among nulliparous, term, singleton, vertex (NTSV) births (i.e., preventable cesarean births) on severe maternal morbidity (SMM) in the second birth.

Methods: We examined birth certificates linked with maternal hospitalization data (2007-2019) from California for NTSV births with a second birth (N = 779,382). The exposure was cesarean delivery in the first birth and the outcome was SMM in the second birth. We used adjusted Poisson regression models to calculate risk ratios and population attributable fraction for SMM in the second birth and conducted a counterfactual impact analysis to estimate how lowering NTSV cesarean births could reduce SMM in the second birth.

Results: The adjusted risk ratio for SMM in the second birth given a prior cesarean birth was 1.7 (95% confidence interval: 1.5, 1.9); 15.5% (95% confidence interval: 15.3%, 15.7%) of this SMM may be attributable to prior cesarean birth. In a counterfactual analysis where 12% of the California population was least likely to get a cesarean birth instead delivered vaginally, we observed 174 fewer SMM events in a population of individuals with a low-risk first birth and subsequent birth.

Conclusion: In our counterfactual analysis, lowering primary cesarean birth among an NTSV population was associated with fewer downstream SMM events in subsequent births and overall. Additionally, our findings reflect the importance of considering the cumulative accrual of risks across the reproductive life course.

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首次分娩剖腹产对再次分娩严重产妇发病率影响的反事实分析。
背景:众所周知,剖宫产会影响产妇以后的妊娠结局,但缺乏具体的效果估计。我们试图量化减少无子宫、足月、单胎、顶点(NTSV)分娩(即可预防的剖宫产)中的剖宫产对第二胎严重孕产妇发病率(SMM)的影响:我们研究了加利福尼亚州与产妇住院数据相关联的出生证明(2007-19 年),其中包括有第二次分娩的 NTSV 新生儿(N=779,382)。第一胎为剖宫产,第二胎为SMM。我们使用调整后的泊松回归模型计算第二胎SMM的风险比和人口可归因分数,并进行了反事实影响分析,以估计降低NTSV剖宫产率可如何减少第二胎SMM:结果:如果产妇之前曾进行过剖宫产,则第二次分娩的SMM调整风险比为1.7(95% CI 1.5-1.9);其中15.5%(95% CI 15.3%-15.7%)的SMM可能归因于之前的剖宫产。在一项反事实分析中,加利福尼亚州最不可能进行剖宫产的人群中有12%经阴道分娩,我们观察到在低风险首次分娩和随后分娩的人群中,SMM事件减少了174例:在我们的反事实分析中,在 NTSV 人群中降低初次剖宫产率与后续分娩和总体分娩中减少下游 SMM 事件有关。此外,我们的研究结果还反映了考虑整个生育期风险累积的重要性。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
期刊最新文献
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