Associations of cesarean sections with comorbidities within the Pregnancy Risk Assessment Monitoring System

Cesarean delivery (CD) is a common obstetrical procedure aimed at reducing maternal and infant morbidity and mortality in complicated pregnancies and medical emergencies yet carries potential complications. CD rates in the USA have increased over the years - likely associated with increased comorbidities. Thus, to expand the literature, our objective was to identify the likelihood of a woman having a CD when comorbidities - diabetes, high blood pressure (HBP), or depression - are present.

We conducted a cross-sectional analysis of the 2019 Pregnancy Risk Assessment Monitoring System. Binary and multivariable logistic regression were used to calculate adjusted odds ratios (AORs) to determine associations between pre-existing and gestational comorbidities and CD among pregnant women.

Compared to those without a diagnosis, women with pre-existing diabetes (AOR: 1.69; CI: 1.54-1.86), pre-existing HBP (AOR: 1.58; CI: 1.46-1.69), and pre-existing depression (AOR: 1.14; CI 1.08-1.20; Table 2) were more likely to have a CD. Additionally, participants with gestational diabetes (AOR 1.43; CI 1.34-1.52), HBP (AOR 1.86; CI 1.76-1.95) and depression (AOR 1.13; CI 1.07-1.19) were also more likely to have a CD than those without comorbidities.

Higher rates of CD were found among individuals with a pre-existing or gestational diagnosis of diabetes, HBP, or depression than those without these diagnoses. With increasing rates of these conditions, it is likely that CD rates will continue their trajectory in the USA. Thus, professional organizations can have more impact by popularizing and making effective evidence-based guidelines for management.