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Elective cesarean delivery and long-term cardiovascular morbidity in the offspring - a population-based cohort
Shaked Galin1, Tamar Wainstock2, Eyal Sheiner1
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Cesarean delivery (CD) is linked to a higher risk of long-term cardiovascular issues in children. This study found that babies born via CD had increased cardiovascular hospitalizations compared to those born vaginally.
Area of Science:
- Reproductive Health
- Pediatric Cardiology
- Epidemiology
Background:
- Cesarean delivery (CD) rates have increased globally.
- The long-term health implications of CD on offspring cardiovascular health require further investigation.
Purpose of the Study:
- To evaluate the impact of cesarean delivery (CD) on the risk of long-term cardiovascular morbidity in offspring.
- To identify potential associations between mode of delivery and pediatric cardiovascular health outcomes.
Main Methods:
- Population-based cohort analysis of singleton term deliveries from 1991-2014.
- Exclusion of pregnancies with congenital malformations, preeclampsia, gestational diabetes, and other high-risk conditions.
- Comparison of cardiovascular hospitalization rates up to age 18 between CD and vaginal delivery groups using Kaplan-Meier curves and Cox regression analysis.
Main Results:
- The study included 132,054 term deliveries; 8.9% were CD.
- Cesarean delivery was associated with a significantly higher incidence of cardiovascular hospitalizations (HR = 1.3, p=0.018).
- CD was identified as an independent risk factor for long-term pediatric cardiovascular morbidity (aHR = 1.295, p=0.04).
Conclusions:
- Singletons delivered by cesarean delivery at term face an elevated risk of developing long-term cardiovascular morbidity.
- These findings highlight the importance of considering the potential long-term health consequences of delivery mode.
- Further research may explore underlying mechanisms linking cesarean delivery to cardiovascular outcomes.
Objective:
To evaluate the impact of cesarean delivery (CD) on offspring risk for long-term cardiovascular morbidity.
Study Design:
A population-based cohort analysis was performed, including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via CD and those delivered vaginally. Fetuses with cardiac or other congenital malformations were excluded, as were cases of urgent CD and pregnancies involving preeclampsia, gestational diabetes, placenta previa, labor induction, fetal growth restriction, preterm PROM, and instrumental deliveries. Hospitalizations of the offspring up to 18 years of age involving cardiovascular morbidity were compared between the two study groups. A Kaplan-Meier survival curve compared cumulative cardiovascular morbidity incidence and a Cox regression model controlled for confounders.
Results:
Of the 132,054 term deliveries who met the inclusion criteria; 8.9% were CDs (n = 11,746) and 91.1% (n = 120,308) were vaginal deliveries. Cardiovascular hospitalization incidence per 1000 person follow up years was 0.742 in the CD group and 0.054 in the comparison group (HR = 1.3, 95%CI 1.051-1.710, p = .018). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of cardiovascular morbidity following CD (log rank p = .018). In the Cox proportional hazards model, CD was noted as an independent risk factor for offspring long-term pediatric cardiovascular morbidity (adjusted HR = 1.295, CI 1.005-1.668, p = .04) when controlling for maternal age, obesity, ethnicity, gestational age, newborn gender, low birthweight, maternal preexisting cardiovascular disease, and deliveries occurring after 2008.
Conclusion:
Singletons delivered by CD at term have an increased risk of long-term cardiovascular morbidity.
