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Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: a Cohort Analysis from C hina
Author(s) -
Zhou Yubo,
Blustein Jan,
Li Hongtian,
Ye Rongwei,
Zhu Liping,
Liu Jianmeng
Publication year - 2015
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12191
Subject(s) - medicine , overweight , underweight , caesarean section , obstetrics , obesity , body mass index , confidence interval , pregnancy , caesarean delivery , biology , genetics
Background To quantify the association between maternal obesity and caesarean delivery, particularly caesarean delivery on maternal request ( CDMR ), a fast‐growing component of caesarean delivery in many nations. Methods We followed 1 019 576 nulliparous women registered in the P erinatal H ealthcare S urveillance S ystem during 1993–2010. Maternal body mass index ( BMI , kg/m 2 ), before pregnancy or during early pregnancy, was classified as underweight (<18.5), normal (18.5 to <23; reference), overweight (23 to <27.5), or obese (≥27.5), consistent with W orld H ealth O rganization guidelines for A sian people. The association between maternal obesity and overall caesarean and its subtypes was modelled using log‐binomial regression. Results During the 18‐year period, 404 971 (39.7%) caesareans and 93 927 (9.2%) CDMRs were identified. Maternal obesity was positively associated with overall caesarean and CDMR . Adjusted risk ratios for overall caesarean in the four ascending BMI categories were 0.96 [95% confidence interval (CI) 0.94, 0.97], 1.00 (Reference), 1.16 [95% CI 1.14, 1.18], 1.39 [95% CI 1.43, 1.54], and for CDMR were 0.95 [95% CI 0.94, 0.96], 1.00 (Reference), 1.20 [95% CI 1.18, 1.22], 1.48 [95% CI 1.433, 1.54]. Positive associations were consistently found in women residing in southern and northern provinces and in subgroups stratified by year of delivery, urban or rural residence, maternal age, education, level of delivering hospital, and birthweight. Conclusions In a large C hinese cohort study, maternal obesity was associated with an increased risk of caesarean delivery and its subtypes, including CDMR . Given the rising global prevalence of obesity, and in view of the growth of CDMR , it seems likely that caesarean births will increase, unless there are changes in obstetrical practice.