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Late preterm birth and previous cesarean section: a population-based cohort study.

Abdool S Yasseen Iii1,2,3, Kate Bassil3,4, Ann Sprague1,2

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The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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Previous cesarean sections increase the risk of late preterm birth in subsequent pregnancies. This association is largely mediated by unplanned or emergency cesarean births in the current pregnancy.

Keywords:
Late preterm birthemergency cesarean sectionprevious cesarean section

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Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Epidemiology
  • Maternal-Fetal Medicine

Background:

  • Late preterm birth (LPB) is a growing concern, linked to increased infant morbidity and mortality.
  • The impact of previous cesarean section (PCS) on subsequent LPB risk remains understudied.
  • Understanding this relationship is crucial for optimizing pregnancy outcomes.

Purpose of the Study:

  • To investigate the association between previous cesarean section (PCS) and late preterm birth (LPB) in subsequent pregnancies.
  • To explore the potential mediating role of cesarean section in the current pregnancy on this association.

Main Methods:

  • Utilized population-based birth registry data from 2005-2012.
  • Included multiparous mothers with singleton births between 34-41 gestational weeks.
  • Employed propensity-weighted multivariable Poisson regression and the Baron-Kenny approach to analyze exposure, outcome, and mediation.

Main Results:

  • A cohort of 481,531 births was analyzed, with 4.5% resulting in LPB.
  • Mothers with a history of PCS had a significantly increased risk of LPB (aRR: 1.20).
  • Unplanned or emergency cesarean section in the current pregnancy acted as a strong mediator, explaining 97% of the association.

Conclusions:

  • Previous cesarean section is associated with a higher risk of late preterm birth in subsequent pregnancies.
  • This increased risk is substantially mediated by cesarean delivery during the current pregnancy.
  • Minimizing primary cesarean sections may help reduce the incidence of late preterm birth in future pregnancies.