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Chu J, Keedle H, Sutcliffe K, Blumenthal N, Levett K. The outcomes for women planning a VBAC at a private hospital in Australia. Birth 2024; 51:571-580. [PMID: 38212947 DOI: 10.1111/birt.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Rates of cesarean birth (CBs) are steadily increasing and account for 36.7% of all births in New South Wales (NSW), with primary cesareans driving the increase. NSW Health guidelines recommend women attempt a vaginal birth after a previous CB (VBAC); however, rates of VBAC are decreasing, particularly within the private hospital setting. This study aimed to determine the rates of adverse outcomes for women who planned a VBAC (pVBAC) compared with women who planned an elective repeat CB (pERCB) at one private hospital in Sydney, Australia. METHOD This retrospective data review evaluated patient records over a 10-year period (2010-2019). Records (n = 2039) were divided into four groups: pVBAC, pVBAC + EMCB, labor + ERCB (lab + ERCB), and pERCB. The incidence of adverse maternal and neonatal outcomes is reported as counts and percentages. Regression and chi-squared tests were used to compare groups. Significance was determined at a p-value of <0.05. RESULTS Overall, very low rates (N = 148, 7.3%) of women had a VBAC compared with a repeat CB at this private hospital over the 10-year period. The incidence of adverse outcomes was low regardless of study group. Outcomes differed significantly between groups for postpartum hemorrhage (pERCB seven times less likely than VBAC group) and special care nursery admission (pVBAC + EMCB is 4.6 times more likely than in the VBAC group). CONCLUSION Overall, it is safe to attempt a VBAC at this private hospital, and labor after a cesarean should be recommended, yet very few women had a VBAC at the study site. The incidence of adverse outcomes was low compared with other published research.
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Affiliation(s)
- Julieanne Chu
- Westmead Hospital, University of Notre Dame Australia, Westmead, New South Wales, Australia
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Kerry Sutcliffe
- School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Norman Blumenthal
- Norwest Private Hospital, Bella Vista, New South Wales, Australia
- University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- Western Sydney University, Penrith, New South Wales, Australia
| | - Kate Levett
- School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NICM Health Research Institute, THRI Western Sydney University, Penrith, New South Wales, Australia
- Centre for Midwifery, Child and Family Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia
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2
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Zachariassen LF, Ebert MBB, Mentzel CMJ, Deng L, Krych L, Nielsen DS, Stokholm J, Hansen CHF. Cesarean section induced dysbiosis promotes type 2 immunity but not oxazolone-induced dermatitis in mice. Gut Microbes 2023; 15:2271151. [PMID: 37889696 PMCID: PMC10730161 DOI: 10.1080/19490976.2023.2271151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Delivery by cesarean section (CS) is associated with an altered gut microbiota (GM) colonization and a higher risk of later chronic inflammatory diseases. Studies investigating the association between CS and atopic dermatitis (AD) are contradictive and often biased by confounding factors. The aim of this study was therefore to provide experimental evidence for the association between CS and AD in a mouse model and clarify the role of the GM changes associated with CS. It was hypothesized that CS-delivered mice, and human CS-GM transplanted mice develop severe dermatitis due to early dysbiosis. BALB/c mice delivered by CS or vaginally (VD) as well as BALB/c mice transplanted with GM from CS or VD human donors were challenged with oxazolone on the ear. The severity of dermatitis was evaluated by ear thickness and clinical and histopathological assessment which were similar between all groups. The immune response was assessed by serum IgE concentration, local cytokine response, and presence of immune cells in the draining lymph node. Both CS-delivered mice and mice inoculated with human CS-GM had a higher IgE concentration. A higher proportion of Th2 cells were also found in the CS-GM inoculated mice, but no differences were seen in the cytokine levels in the affected ears. In support of the experimental findings, a human cohort analysis from where the GM samples were obtained found that delivery mode did not affect the children's risk of developing AD. In conclusion, CS-GM enhanced a Th2 biased immune response, but had no effect on oxazolone-induced dermatitis in mice.
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Affiliation(s)
- Line Fisker Zachariassen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Maria Bernadette Bergh Ebert
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Caroline Märta Junker Mentzel
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Ling Deng
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Lukasz Krych
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Dennis Sandris Nielsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Jakob Stokholm
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Camilla Hartmann Friis Hansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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3
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Pavlidou E, Antasouras G, Papadopoulou SK, Alexatou O, Papandreou D, Mentzelou M, Tsourouflis G, Louka A, Rodopaios NE, Chrysafi M, Sampani A, Giaginis C. Association of Maternal Risk Factors with the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study. Med Sci (Basel) 2023; 11:66. [PMID: 37873751 PMCID: PMC10594507 DOI: 10.3390/medsci11040066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
In the last few years, there has been a gradually increasing rate of caesarean section deliveries worldwide that negatively affects both mothers' and children's health. The present survey intended to explore the relations of common maternal risk factors with the prevalence of caesarean sections. This is a cross-sectional study including 5182 healthy mothers from geographically diverse regions of Greece, which has applied relevant inclusion and exclusion criteria. An elevated 56.4% incidence of caesarean sections was noted. The prevalence of caesarean section deliveries was estimated to be 51.5% in private hospitals and 48.5% in public hospitals. Maternal age, pre-pregnancy overweight/obesity, excess gestational weight gain, preterm birth, financial status, smoking habits, and private type of birth hospital were considerably associated with a high probability of caesarean section, regardless of several confounders. In conclusion, caesarean section rates are constantly increasing, and various maternal risk factors additively elevate its incidence, which additionally enhances the likelihood of postpartum complications for both the mothers and their infants. Public health procedures and approaches are strongly recommended to notify future mothers of the potential risk factors that may result in adverse pregnancy outcomes of caesarean section delivery, highlighting its use only for emergency medical reasons and also promoting healthier nutritional and lifestyle habits that may reduce the increasing prevalence of caesarean section deliveries.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Georgios Antasouras
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece;
| | - Olga Alexatou
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Dimitrios Papandreou
- Department of Clinical Nutrition & Dietetics, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
| | - Maria Mentzelou
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece;
| | - Aikaterini Louka
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Nikolaos E. Rodopaios
- Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Maria Chrysafi
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
| | - Anastasia Sampani
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece; (E.P.); (G.A.); (O.A.); (M.M.); (A.L.); (M.C.)
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Zhou L, Qiu W, Wang J, Zhao A, Zhou C, Sun T, Xiong Z, Cao P, Shen W, Chen J, Lai X, Zhao LH, Wu Y, Li M, Qiu F, Yu Y, Xu ZZ, Zhou H, Jia W, Liao Y, Retnakaran R, Krewski D, Wen SW, Clemente JC, Chen T, Xie RH, He Y. Effects of vaginal microbiota transfer on the neurodevelopment and microbiome of cesarean-born infants: A blinded randomized controlled trial. Cell Host Microbe 2023; 31:1232-1247.e5. [PMID: 37327780 DOI: 10.1016/j.chom.2023.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 06/18/2023]
Abstract
The microbiomes of cesarean-born infants differ from vaginally delivered infants and are associated with increased disease risks. Vaginal microbiota transfer (VMT) to newborns may reverse C-section-related microbiome disturbances. Here, we evaluated the effect of VMT by exposing newborns to maternal vaginal fluids and assessing neurodevelopment, as well as the fecal microbiota and metabolome. Sixty-eight cesarean-delivered infants were randomly assigned a VMT or saline gauze intervention immediately after delivery in a triple-blind manner (ChiCTR2000031326). Adverse events were not significantly different between the two groups. Infant neurodevelopment, as measured by the Ages and Stages Questionnaire (ASQ-3) score at 6 months, was significantly higher with VMT than saline. VMT significantly accelerated gut microbiota maturation and regulated levels of certain fecal metabolites and metabolic functions, including carbohydrate, energy, and amino acid metabolisms, within 42 days after birth. Overall, VMT is likely safe and may partially normalize neurodevelopment and the fecal microbiome in cesarean-delivered infants.
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Affiliation(s)
- Lepeng Zhou
- School of Nursing, Affiliated Foshan Maternity & Child Healthcare Hospital, Department of Laboratory Medicine in Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China; School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China; Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong 528244, China
| | - Wen Qiu
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Jie Wang
- School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China
| | - Aihua Zhao
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Chuhui Zhou
- School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China
| | - Tao Sun
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ziyu Xiong
- Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong 528244, China
| | - Peihua Cao
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China; Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wei Shen
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China; Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jingfen Chen
- School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China
| | - Xiaolu Lai
- School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China
| | - Liu-Hong Zhao
- School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China
| | - Yue Wu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Meng Li
- Department of Obstetrics, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong 528244, China
| | - Feng Qiu
- Department of Laboratory Medicine, The Seventh Affiliated Hospital, Southern Medical University, Foshan, Guangdong 528244, China
| | - Yanhong Yu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhenjiang Zech Xu
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China; State Key Laboratory of Food Science and Technology, Institute of Nutrition and College of Food Science and Technology, Nanchang University, Nanchang, Jiangxi 330047, China
| | - Hongwei Zhou
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China; State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wei Jia
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, ON K1H8L6, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada; Division of Endocrinology, University of Toronto, Toronto, ON M5S 2E8, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada; Risk Science International, Ottawa, ON K1P 5J6, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, ON K1H8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Jose C Clemente
- Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Tianlu Chen
- Center for Translational Medicine and Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Ri-Hua Xie
- School of Nursing; Department of Nursing, Foshan Fetal Medicine Research Institute, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong 528100, China.
| | - Yan He
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China; State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, Guangdong 510515, China; Guangdong Provincial Clinical Research Center for Laboratory Medicine, Guangzhou, Guangdong 510033, China.
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Rusch JA, Layden BT, Dugas LR. Signalling cognition: the gut microbiota and hypothalamic-pituitary-adrenal axis. Front Endocrinol (Lausanne) 2023; 14:1130689. [PMID: 37404311 PMCID: PMC10316519 DOI: 10.3389/fendo.2023.1130689] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Cognitive function in humans depends on the complex and interplay between multiple body systems, including the hypothalamic-pituitary-adrenal (HPA) axis. The gut microbiota, which vastly outnumbers human cells and has a genetic potential that exceeds that of the human genome, plays a crucial role in this interplay. The microbiota-gut-brain (MGB) axis is a bidirectional signalling pathway that operates through neural, endocrine, immune, and metabolic pathways. One of the major neuroendocrine systems responding to stress is the HPA axis which produces glucocorticoids such as cortisol in humans and corticosterone in rodents. Appropriate concentrations of cortisol are essential for normal neurodevelopment and function, as well as cognitive processes such as learning and memory, and studies have shown that microbes modulate the HPA axis throughout life. Stress can significantly impact the MGB axis via the HPA axis and other pathways. Animal research has advanced our understanding of these mechanisms and pathways, leading to a paradigm shift in conceptual thinking about the influence of the microbiota on human health and disease. Preclinical and human trials are currently underway to determine how these animal models translate to humans. In this review article, we summarize the current knowledge of the relationship between the gut microbiota, HPA axis, and cognition, and provide an overview of the main findings and conclusions in this broad field.
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Affiliation(s)
- Jody A. Rusch
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- C17 Chemical Pathology Laboratory, Groote Schuur Hospital, National Health Laboratory Service, Cape Town, South Africa
| | - Brian T. Layden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
- Department of Medicine, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United States
| | - Lara R. Dugas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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Sayed G, Salama H, Abumhara S, Al Obaidly S, Al-Qubaisi M, Al-Rifai H. Review of socioeconomic risk factors for cesarean births: a population-based study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023082. [PMID: 37326277 PMCID: PMC10308481 DOI: 10.23750/abm.v94i3.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/09/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The reasons for increased cesarean section (CS) rates are complex and multifactorial. The goal of this study was to look at different social and economic factors that might be causing more cases of CS in the population. STUDY DESIGN A retrospective population-based cohort study. Data was taken from the Perinatal Neonatal Outcomes Research study in the Arabian Gulf (PEARL study) registry. Data from 60,728 live births ≥ 24 weeks of gestation were analyzed. In this study, various socioeconomic factors, such as maternal nationality, religion, educational level, employment status, parental income, consanguinity, housing, preterm birth, and tall stature, were examined for women undergoing cesarean section (CS) and their economic outcomes. Women who underwent vaginal delivery (VD) were compared. There are risks associated with pregnancy, smoking, assisted conception, and prenatal care. RESULTS 60,728 births ≥ 24 weeks gestation were included in the analysis. 17,535 women delivered by CS (28.9%). Women with university-level -education and above were more likely to deliver by CS (61%), as compared to illiterate women or women with basic education at elementary or secondary levels (OR 0.73, CI 95%: P: <0.0001). Working women were more likely to deliver by CS (OR 1.40, CI 95%, P value <0.0001). Women living in rented houses were less likely to achieve a normal delivery (71.8%) (OR 1.40, CI 95%; P: <0.0001) as compared to women living in owned houses (74.7%). Women over 20 years old tended to achieve more VD compared to women less than 20 years old. P value <0.0001. Smoking was associated with lower chances of VD, with 42.4% of smokers delivered by CS compared to 28.3% of non-smokers (OR 1.87, CI 95%; P: <0.0001). Assisted conception was associated with higher CS rates as compared to spontaneous conceptions (OR 0.39; P: <0.0001). We found no statistically significant differences in how babies were born based on the mother's nationality, the father's job, or the mother's income. CONCLUSIONS Higher education, employed mothers, smoking, and living in rented houses were socioeconomic factors associated with a higher rate of CS in our population. Furthermore, women who had regular antenatal care were more at risk for delivery by cesarean section, which could be related to other comorbidities increasing the likelihood of cesarean birth rather than antenatal care itself. In our population, assisted reproduction was associated with a higher probability of cesarean delivery.
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Affiliation(s)
- Gamal Sayed
- Department of Obstetrics and Gynecology. women's wellness and research center. Hamad Medical City Hamad Medical corporation WWRC.
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Tesfahun TD, Awoke AM, Kefale MM, Balcha WF, Nega AT, Gezahegn TW, Alemayehu BA, Dabalo ML, Bogale TW, Azene Z, Nigatu S, Beyene A. Factors associated with successful vaginal birth after one lower uterine transverse cesarean section delivery. Sci Rep 2023; 13:8871. [PMID: 37258595 DOI: 10.1038/s41598-023-36027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/27/2023] [Indexed: 06/02/2023] Open
Abstract
A Trial of labor after cesarean section is an attempt to deliver vaginally by a woman who had a previous cesarean delivery and when achieved by a vaginal delivery it is called successful vaginal birth after cesarean section. Vaginal birth after a caesarian section is a preferred method to decrease complications associated with repeated caesarian section delivery for both mother and fetus. It has a higher success rate when the right women are selected for a trial of labor. This study aimed to assess factors associated with successful vaginal birth after one lower uterine transverse cesarean section and to validate the Flamm and Geiger score at the public hospitals of Bahir Dar City, Northwest, Ethiopia, 2021. A health facility-based retrospective cross-sectional study was conducted from March 1 to 15/2021. A medical record review of 408 women charts with a trial of labor after one lower uterine transverse cesarean section from January 1/2020 to December 31/2020 was done and 345 women charts with complete maternal and fetal information were included in the study with a response rate of 84.6%. The data were collected using a structured checklist, entered into Epi data 3.1, and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. This study identified that the trial of labor after cesarean section rate was 69.5%, and the success rate of vaginal birth after one lower uterine transverse cesarean section was 35.07%. Of the failed trial of labor, fetal distress (38.9%) and failed progress of labor (32.1%) were the main indications for an emergency cesarean section. The maternal age group of 21-30 years, prior vaginal birth after or before cesarean section, non-recurring indication (fetal distress and malpresentation), ruptured membrane, cervical dilatation ≥ 4 cm, cervical effacement ≥ 50%, and low station (≥ 0) at admission were associated with successful vaginal birth after one lower uterine transverse cesarean section. For the Flamm and Geiger score at a cut point of 5, the sensitivity and specificity were 73.6% and 86.6% respectively. In this study area, the trial of labor after cesarean section rate is encouraging, however, the success rate of vaginal birth after one lower uterine transverse caesarian section was lower. The maternal socio-demographic and obstetric-related factors were significantly associated with successful vaginal birth after one lower transverse caesarian section delivery. This study indicated that when the Flamm and Geiger score increases, the chance of successful vaginal birth after one lower uterine transverse caesarian section also increases. We suggest emphasizing counselling and encouraging the women, as their chance of successful vaginal delivery will be high in the subsequent pregnancy, especially if the indications of primary caesarian section delivery were non-recurring.
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Affiliation(s)
- Tigist Derebe Tesfahun
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amlaku Mulat Awoke
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mezgebu Mihiret Kefale
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondu Feyisa Balcha
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Amanuel Tebabal Nega
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tigist Wubet Gezahegn
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bezawit Abeje Alemayehu
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Magarsa Lami Dabalo
- Department of Midwifery, College of Medicine and Health Sciences, Haramaya University, Haramaya, Ethiopia
| | - Tewodros Worku Bogale
- Department of Midwifery, School of Health Sciences, Injibara University, Injibara, Ethiopia
| | - Zigijit Azene
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Selamawit Nigatu
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Aberash Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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8
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Bui T. Compulsory education reform and child mortality in Peru. HEALTH ECONOMICS 2023. [PMID: 37182225 DOI: 10.1002/hec.4696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
The government of Peru amended its constitution to increase compulsory education from six to 11 years in 1993. This constitutional amendment provides a natural experiment to investigate the impact of maternal education on child mortality. Exploiting differences in the reform exposure by age, I find that mothers who were exposed to the reform were less likely to experience the death of a child. There is also evidence that the reform caused a decline in infant mortality. These results are not driven by the age difference between mothers who were treated by the reform and those who were not treated. Additional analyses reveal that the reform increased age at first birth, decreased desired fertility, reduced smoking, and improved economic opportunities for women. The results demonstrate that compulsory schooling may be a useful policy tool to improve women's education, which can, in turn, enhance the survival of their children.
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Affiliation(s)
- Thao Bui
- Department of Economics, Louisiana State University, Baton Rouge, Louisiana, USA
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Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: A call to action. Health Sci Rep 2023; 6:e1274. [PMID: 37216058 PMCID: PMC10196217 DOI: 10.1002/hsr2.1274] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Over the years; global caesarian section (CS) rates have significantly increased from around 7% in 1990 to 21% today surpassing the ideal acceptable CS rate which is around 10%-15% according to the WHO. However, currently, not all CS are done for medical reasons with rapidly increasing rate of nonmedically indicated CS and the so-called "caesarian on maternal request." These trends are projected to continue increasing over this current decade where both unmet needs and overuse are expected to coexist with the projected global rate of 29% by 2030. CS reduces both maternal and neonatal morbidity and mortality significantly when it is done under proper indications while at the same time, it can be of harm to the mother and the child when performed contrary. The later exposes both the mother and the baby to a number of unnecessary short and long-term complications and increase the chances of developing different noncommunicable diseases and immune-related conditions among babies later in life. The implications of lowering SC rate will ultimately lower healthcare expenditures. This challenge can be addressed by several ways including provision of intensive public health education regarding public health implications of increased CS rate. Assisted vaginal delivery approaches like the use of vacuum and forceps and other methods should be considered and encouraged during delivery as long as their indications for implementation are met. Conducting frequent external review and audits to the health facilities and providing feedback regarding the rates of CS deliveries can help to keep in check the rising CS trends as well as identifying the settings with unmet surgical needs. Moreover, the public especially expectant mothers during clinic visits and clinicians should be educated and be informed on the WHO recommendations on nonclinical interventions towards reduction of unnecessary CS procedures.
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Affiliation(s)
- Cornel M. Angolile
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Medicine, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Obstetrics and GynaecologyKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Baraka L. Max
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Justice Mushemba
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Medicine, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Obstetrics and GynaecologyKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Harold L. Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Medicine, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Obstetrics and GynaecologyKilimanjaro Christian Medical University CollegeMoshiTanzania
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10
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Chauhan BG, Radkar A. Trends and inequalities in caesarean section delivery in India, 1992–2021. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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11
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Papadopoulou SK, Mentzelou M, Pavlidou E, Vasios GK, Spanoudaki M, Antasouras G, Sampani A, Psara E, Voulgaridou G, Tsourouflis G, Mantzorou M, Giaginis C. Caesarean Section Delivery Is Associated with Childhood Overweight and Obesity, Low Childbirth Weight and Postnatal Complications: A Cross-Sectional Study. Medicina (B Aires) 2023; 59:medicina59040664. [PMID: 37109623 PMCID: PMC10146198 DOI: 10.3390/medicina59040664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Background and Objectives: In the last decades, simultaneously increasing trends have been recorded for both caesarean section delivery and childhood overweight/obesity around the world, which are considered serious public health concerns, negatively affecting child health. Aim: The present study aims to investigate whether caesarean section is associated with the increased rates of childhood overweight/obesity, low childbirth anthropometric indices and postnatal complications in pre-school age. Materials and Methods: This is a cross-sectional study in which 5215 pre-school children aged 2–5 years old were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Non-adjusted and adjusted statistical analysis was performed to assess the impact of caesarean section in comparison to vaginal delivery. Results: Children delivered by caesarean section were significantly more frequently overweight or obese at the age of 2–5 years, also presenting a higher prevalence of low birth weight, length and head circumference. Caesarean section was also associated with higher incidence of asthma and diabetes type I at the age of 2–5 years. In a multivariate analysis, caesarean section increased the risk of childhood overweight/obesity and low childbirth anthropometric indices even if adjusting for several childhood and maternal confounding factors. Conclusions: Increasing trends were recorded for both caesarean section delivery and childhood overweight/obesity, which are considered serious public health concerns. Caesarean section independently increased childhood overweight/obesity in pre-school age, highlighting the emergent need to promote health policies and strategies to inform future mothers about its short and long-term risks and that this mode of delivery should preferably be performed only when there are strong medical recommendations in emergency obstetric conditions.
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Affiliation(s)
- Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Correspondence: (S.K.P.); (C.G.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Anastasia Sampani
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
- Correspondence: (S.K.P.); (C.G.)
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12
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De A, Tripathi R, Gupta N, Nigam A, Anwar A. Leadership Driven Persistent Reduction in Cesarean Trends: An Interventional Study for Quality Improvement. J Obstet Gynaecol India 2023; 73:36-43. [PMID: 36879945 PMCID: PMC9984660 DOI: 10.1007/s13224-022-01710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022] Open
Abstract
Background This is a quality improvement study in North India undertaken to observe the efficacy and safety of a proposed set of interventions along Quality Improvement guidelines to reduce cesarean rates. Materials and Methods It was a retrospective cross-sectional study conducted in New Delhi. Measures were iteratively introduced from 2017 and improved using multiple PDSA (Plan, Do, Study, Act) cycles to note the overall reduction in cesarean rates. Chi square tests were done with subanalysis based on the Robsons classification. Results There was a significant reduction of annual cesarean rates from 36.35 to 22.87% over four years (p < 0.01) and in neonatal nursery admissions (p < 0.01). Covid outbreak saw a comparatively increased cesarean rate in 2020, for which it was excluded from the detailed study. The relative risk of cesarean delivery in the postintervention period was 0.62. Maximum reductions were seen in Robsons II, VI &VII. Conclusion Devising multipronged interventions and their implementation through PDSA cycles are essential. Such measures in moderate resources are replicable elsewhere as well.
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Affiliation(s)
- Arpita De
- Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, Hamdard Nagar, New Delhi, India
- New Delhi, India
| | - Reva Tripathi
- Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - Neha Gupta
- Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - Arifa Anwar
- Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), Jamia Hamdard, Hamdard Nagar, New Delhi, India
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13
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Fitzpatrick KE, Quigley MA, Kurinczuk JJ. Planned mode of birth after previous cesarean section: A structured review of the evidence on the associated outcomes for women and their children in high-income setting. Front Med (Lausanne) 2022; 9:920647. [PMID: 36148449 PMCID: PMC9486480 DOI: 10.3389/fmed.2022.920647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/08/2022] [Indexed: 12/05/2022] Open
Abstract
In many high-income settings policy consensus supports giving pregnant women who have had a previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or planning a vaginal birth after previous cesarean (VBAC), provided they have no contraindications to VBAC. To help women make an informed decision regarding this choice, clinical guidelines advise women should be counseled on the associated risks and benefits. The most recent and comprehensive review of the associated risks and benefits of planned VBAC compared to ERCS in high-income settings was published in 2010 by the US Agency for Healthcare Research and Quality (AHRQ). This paper describes a structured review of the evidence in high-income settings that has been published since the AHRQ review and the literature in high-income settings that has been published since 1980 on outcomes not included in the AHRQ review. Three databases (MEDLINE, EMBASE, and PsycINFO) were searched for relevant studies meeting pre-specified eligible criteria, supplemented by searching of reference lists. Forty-seven studies were identified as meeting the eligibility criteria and included in the structured review. The review suggests that while planned VBAC compared to ERCS is associated with an increased risk of various serious birth-related complications for both the mother and her baby, the absolute risk of these complications is small for either birth approach. The review also found some evidence that planned VBAC compared to ERCS is associated with benefits such as a shorter length of hospital stay and a higher likelihood of breastfeeding. The limited evidence available also suggests that planned mode of birth after previous cesarean section is not associated with the child’s subsequent risk of experiencing adverse neurodevelopmental or health problems in childhood. This information can be used to manage and counsel women with previous cesarean section about their subsequent birth choices. Collectively, the evidence supports existing consensus that there are risks and benefits associated with both planned VBAC and ERCS, and therefore women without contraindications to VBAC should be given an informed choice about planned mode of birth after previous cesarean section. However, further studies into the longer-term effects of planned mode of birth after previous cesarean section are needed along with more research to address the other key limitations and gaps that have been highlighted with the existing evidence.
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14
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Hou R, Liu C, Li N, Yang T. Obstetric complications and outcomes of singleton pregnancy with previous caesarean section according to maternal age. Placenta 2022; 128:62-68. [PMID: 36087450 DOI: 10.1016/j.placenta.2022.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION To delineate obstetric complications and neonatal outcomes by maternal age in singleton pregnancies with previous caesarean section (CS). METHODS A retrospective study involved 7715 singleton gestations with previous CS was conducted in a single centre. Statistical methods were used to describe and analyse the incidence of various complications and adverse outcomes classified by maternal ages. After selecting the reference group (30-34 years), multivariate logistic-binomial regression model was used to investigate the outcomes using SPSS. RESULTS From 2013 to 2017, the proportion of advanced maternal age (AMA, ≥35 years) women with a history of CS increased yearly, especially in the 35-39 years age group. AMA women accounted for 39.4% of all pregnancies and has a high incidence of in vitro fertilization(IVF), progesterone therapy in early pregnancy, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), placenta previa, premature rupture of membranes (PROM) and postpartum haemorrhage (PPH). Compared to the 30-34 years group, the risks of PIH, GDM, placenta previa, PROM and PPH increased in AMA pregnancies. Very advanced age (≥40 years) may be associated with placenta accreta while young mothers (20-24 years) have a higher prevalence of premature birth. Vaginal bleeding during pregnancy is a risk factor for maternal complications, maternal and neonatal morbidity. DISCUSSION AMA is associated with increased risk of PIH, GDM, placenta previa, PROM and PPH. Vaginal bleeding may be a predictor during pregnancy.
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Affiliation(s)
- Rui Hou
- Department of Obstetrics and Gynecology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian Province, China
| | - Caixia Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China; Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Benxi, China
| | - Na Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China; Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, Benxi, China
| | - Tian Yang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetric, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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15
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Giaxi P, Gourounti K, Vivilaki VG, Lykeridoy K. Which classification system could empower the understanding of caesarean section rates in Greece? A review of systematic reviews. Eur J Midwifery 2022; 6:39. [PMID: 35801228 PMCID: PMC9201784 DOI: 10.18332/ejm/147993] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 03/12/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Worldwide there is an alarming increase in the caesarean delivery rate which has become a controversial topic. However, the reasons for this tendency are not clear. For example, in Greece alone, rates increased by almost 50% from 1983 to 1996. In order to better understand the causes of this phenomenon, we need to examine closely what groups of women undergo caesarean section (CS). To achieve this, it is essential to use a system that will enable us to monitor and compare caesarean delivery rates. Such a classification system should be easily adopted by obstetricians, midwives, and public health services. METHODS A review search of electronic databases concerning medical care was held from December 2020 to January 2021 in order to find systematic reviews which describe either theoretical or practical CS classification systems. RESULTS The most common classification systems fall into three main categories based on indication, urgency and maternal-based characteristics. According to users the highest rated classification system was women-based classifications in general. In particular the Robson Ten Group Classification System was considered to be the most valid to meet current local and international standards. The Robson classification system is praised for its robustness, simplicity, flexibility, and reproducibility. CONCLUSIONS The right implementation of the Robson Ten Group Classification System can facilitate an in-depth analysis of the main groups that increase CS rates and can be used to both review and monitor delivery practices both in Greece and abroad.
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Affiliation(s)
- Paraskevi Giaxi
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Kleanthi Gourounti
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria G. Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Katerina Lykeridoy
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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16
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Cruz N, Abernathy GA, Dichosa AEK, Kumar A. The Age of Next-Generation Therapeutic-Microbe Discovery: Exploiting Microbe-Microbe and Host-Microbe Interactions for Disease Prevention. Infect Immun 2022; 90:e0058921. [PMID: 35384688 PMCID: PMC9119102 DOI: 10.1128/iai.00589-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Humans are considered "superorganisms," harboring a diverse microbial collective that outnumbers human cells 10 to 1. Complex and gravely understudied host- and microbe-microbe interactions-the product of millions of years of host-microbe coevolution-govern the superorganism in almost every aspect of life functions and overall well-being. Abruptly disrupting these interactions via extrinsic factors has undesirable consequences for the host. On the other hand, supplementing commensal or beneficial microbes may mitigate perturbed interactions or enhance the interactive relationships that ultimately benefit all parties. Hence, immense efforts have focused on dissecting the innumerable host- and microbe-microbe relationships to characterize if a "positive" or "negative" interaction is at play and to exploit such behavior for broader implications. For example, microbiome research has worked to identify and isolate naturally antipathogenic microbes that may offer therapeutic potential either in a direct, one-on-one application or by leveraging its unique metabolic properties. However, the discovery and isolation of such desired therapeutic microbes from complex microbiota have proven challenging. Currently, there is no conventional technique to universally and functionally screen for these microbes. With this said, we first describe in this review the historical (probiotics) and current (fecal microbiota or defined consortia) perspectives on therapeutic microbes, present the discoveries of therapeutic microbes through exploiting microbe-microbe and host-microbe interactions, and detail our team's efforts in discovering therapeutic microbes via our novel microbiome screening platform. We conclude this minireview by briefly discussing challenges and possible solutions with therapeutic microbes' applications and paths ahead for discovery.
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Affiliation(s)
- Nathan Cruz
- B-10: Biosecurity and Public Health Group, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - George A. Abernathy
- B-10: Biosecurity and Public Health Group, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Armand E. K. Dichosa
- B-10: Biosecurity and Public Health Group, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Anand Kumar
- B-10: Biosecurity and Public Health Group, Bioscience Division, Los Alamos National Laboratory, Los Alamos, New Mexico, USA
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Kanellopoulos D, Gourounti K. Tocophobia and Women's Desire for a Caesarean Section: a Systematic Review. MAEDICA 2022; 17:186-193. [PMID: 35733734 PMCID: PMC9168579 DOI: 10.26574/maedica.2022.17.1.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction:The rate of cesarean sections has been continuously increasing in most industrialized countries in recent years. It has been observed that the rate of cesarean sections has increased in the last thirty years and is now between 0.4 and 65%. A significant percentage of women, ranging from 1-20%, request a caesarean section without a medical indication. Aim:The aim of this study is to systematically review the available international literature concerning the phenomenon of tocophobia leading to woman`s desire for a caesarean section. Methods: The methodology followed, included an advanced search in various scientific databases and retrieval of the relevant quantitative studies. Results:We found a total of seven papers, all in English, which examined the correlation between tocophobia and women's desire for a caesarean section. Conclusions:One of the primary reasons behind women's desire to give birth through a caesarean delivery is the pathological fear associated with the labor process, known under the scientific term "tocophobia". According to the findings of this review, the prevalence of tocophobia ranged between 7-25% among primiparous women and 7.7-16.25% among multiparous ones. Approximately 7-18.6% of women with tocophobia asked for an elective cesarean section without any medical indication. Clinical treatment of tocophobia is required when the condition has a negative impact on the pregnant woman's quality of life and her bond with the embryo, as well as when it affects her decision regarding the method of childbirth.
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18
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Mínguez-Alarcón L, Rifas-Shiman SL, Mitchell C, Sordillo J, Aris IM, Hivert MF, Oken E, Chavarro JE. Cesarean delivery and metabolic health and inflammation biomarkers during mid-childhood and early adolescence. Pediatr Res 2022; 91:672-680. [PMID: 33824455 PMCID: PMC8492770 DOI: 10.1038/s41390-021-01503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND We assessed differences in plasma levels of metabolic health and inflammation biomarkers during mid-childhood and early adolescence between children born by cesarean section vs. vaginal delivery. METHODS Mother-child pairs (N = 942) enrolled during pregnancy in obstetric practices and child follow-up started at birth. Risk biomarkers were assessed in blood samples collected at the mild-childhood (median = 7 years) and early adolescence (median = 13 years) in-person visits. RESULTS Two hundred and six children (22%) were born by cesarean section. There were no significant differences in biomarker levels between children born by cesarean and children born vaginally in mid-childhood. However, adolescents born by cesarean section had significantly lower adiponectin [% difference (95% confidence interval (CI)) = -11.3 (-18.1, -4.0) µg/mL] compared to vaginal delivery. We also found some suggestion of higher insulin resistance [insulin levels % difference (95% CI) = 11.5 (-0.40, 25.0) µU/mL and HOMA-IR (homeostatic model assessment of insulin resistance) % difference (95% CI) = 9.1 (-2.30, 21.8) U] in adolescents born by cesarean section compared to those born vaginally. CONCLUSIONS We found suggestive evidence that adolescents born by cesarean section show differences in certain metabolic health biomarkers relative to adolescents born by vaginal delivery. Further studies are needed to reevaluate these associations since the clinical significance of these differences is unclear. IMPACT Multiple studies show that children born by cesarean section are at higher risk of obesity compared to those born vaginally. It is unclear yet to what extent this elevated risk may extend to a more adverse profile of biomarkers of metabolic health and inflammation. Adolescents born by cesarean section show small differences in adiponectin and insulin relative to adolescents born by vaginal delivery. Adolescents born by cesarean section may be at higher risk to a more adverse profile of biomarkers of metabolic health and inflammation, but the clinical significance of these differences is uncertain.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. .,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Sheryl L. Rifas-Shiman
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Caroline Mitchell
- grid.32224.350000 0004 0386 9924Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA USA
| | - Joanne Sordillo
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Izzuddin M. Aris
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Marie-France Hivert
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA ,grid.32224.350000 0004 0386 9924Diabetes Unit, Massachusetts General Hospital, Boston, MA USA
| | - Emily Oken
- grid.38142.3c000000041936754XDepartment of Nutrition, Harvard School of Public Health, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Jorge E. Chavarro
- grid.38142.3c000000041936754XDepartment of Nutrition, Harvard School of Public Health, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard School of Public Health, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA USA
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Recio Alcaide A, Arranz JM. An impact evaluation of the strategy for normal birth care on caesarean section rates and perinatal mortality in Spain. Health Policy 2022; 126:24-34. [PMID: 34848110 DOI: 10.1016/j.healthpol.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022]
Abstract
The objectives of this research are to evaluate the impact of a health policy (the Strategy for Normal Birth Care, EAPN) on caesarean rates and perinatal mortality in Spanish public hospitals belonging to the National Health System (NHS) and to assess the related cost savings. Data from the Spanish Ministry of Health for the period 2002-2011 and quantitative impact evaluation techniques (double difference method) are used to compare the effects of this policy in a treatment group composed of the NHS hospitals and a control group made up of private for-profit hospitals outside the scope of the EAPN. Both groups are compared some years before and after the health policy initiated in 2006 and approved in October 2007. The estimation results show that the EAPN had a significant effect in reducing caesarean rates of approximately 2 percentage points between 2007 and 2011, with increasing cost savings over the years ranging from 24 to 44 million euros depending on the year. Furthermore, EAPN reduced perinatal mortality levels by 0.08% in years 2008-2009.
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Affiliation(s)
- Adela Recio Alcaide
- Instituto de Estudios Fiscales. Avda. Cardenal Herrera Oria, 378 Ed. B 1.59 28035 Madrid (Spain); Public Health Unit, School of Medicine, Universidad de Alcalá, Alcalá de Henares 28871 Madrid-España.
| | - José M Arranz
- Departamento de Economía. Facultad de CCEE y Turismo. Universidad de Alcalá. Plaza de la Victoria 2. Alcalá de Henares 28802 Madrid-España.
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Ji YJ, Wang HB, Bai Z, Long DJ, Ma K, Yan J, Li YX, Wu YF, Yang H. Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital. Front Med (Lausanne) 2021; 8:774487. [PMID: 34881268 PMCID: PMC8645788 DOI: 10.3389/fmed.2021.774487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10-15%. Whether it is achievable remains unknown. Methods: We collected the data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between the two hospitals the 10 years trend in annual rate of CS, standardized by age, education level, parity, and CS history, against the time of issuing relevant national, local, and hospital policies. Results: In 10 years, 42,441 women in Longhua and 36,935 women in Dongguan have given birth. China's first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was issued in 2015-2016. In Longhua, the standardized annual CS rate was around 35% in 2008-2009, which declined sharply since 2010 down to 13.1% in 2016 (p < 0.001) and then leveled off. In contrast, in Dongguan, the rate stayed around 25% at the beginning, increased to 36% in 2011, decreased sharply to 27% in 2012, and leveled off until 2015 (p < 0.001), and then bounced back to 35% in 2017. The proportion of women with the history of CS increased significantly in the two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital. Conclusion: With vigorously implementing national policies at micro levels, the WHO-recommended CS rate could be achieved without increase in major complications.
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Affiliation(s)
- Yan-Jie Ji
- The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Zhi Bai
- The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Da-Jian Long
- The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China
| | - Kaidong Ma
- Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yun-Xiu Li
- Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yang-Feng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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21
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Mínguez-Alarcón L, Rifas-Shiman SL, Sordillo JE, Aris IM, Wu AJ, Hivert MF, Oken E, Chavarro JE. Association of Mode of Obstetric Delivery With Child and Adolescent Body Composition. JAMA Netw Open 2021; 4:e2125161. [PMID: 34623410 PMCID: PMC8501392 DOI: 10.1001/jamanetworkopen.2021.25161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Although the literature on the association between birth by cesarean delivery and children's anthropometry has continued to increase, only a few studies have examined the association of cesarean delivery with measures of body composition assessed using dual-energy x-ray absorptiometry (DXA), which allows the differentiation of fat and lean mass overall and in specific regions of the body. OBJECTIVE To investigate whether differences exist in DXA-measured body composition between children and adolescents born by cesarean delivery and those born by vaginal delivery. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included singleton children of mothers enrolled between April 1999 and July 2002 in Project Viva, a longitudinal prebirth cohort of mother-child pairs in Massachusetts. The children had at least 1 DXA scan at a follow-up visit during middle childhood (2007-2010) and/or early adolescence (2013-2016). Data analysis was performed from October 16, 2020, to May 9, 2021. EXPOSURES Mode of delivery (cesarean vs vaginal). MAIN OUTCOMES AND MEASURES Total lean mass index, total and truncal fat mass indexes, visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue, and total abdominal adipose tissue (TAAT) were estimated using DXA. Multivariable linear regression models were used to estimate the association between mode of delivery and DXA-derived outcomes with adjustment for confounders. Stabilized inverse probability weights were used to control for potential selection bias owing to loss to follow-up. RESULTS A total of 975 mother-child pairs were included in the study. The mean (SD) maternal age at study entry was 32.0 (5.5) years, and the mean (SD) self-reported prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 25.0 (5.4). Of the children included in the study, 491 (50%) were female; 212 (22%) were born by cesarean delivery and 763 (78%) by vaginal delivery. Body composition in middle childhood as measured by DXA did not differ by mode of delivery. In early adolescence, participants born by cesarean delivery had a significantly greater total lean mass index (β, 0.4; 95% CI, 0.0-0.7), total fat mass index (β, 0.6; 95% CI, 0.1-1.1), truncal fat mass index (β, 0.3; 95% CI, 0.0-0.5), VAT area (β, 4.7; 95% CI, 0.9-8.6), and TAAT area (β, 23.8; 95% CI, 0.8-46.8) in a model adjusted for child sex and age at the time of DXA measurements; maternal age, educational level, race and ethnicity, total gestational weight gain, and smoking status during pregnancy; birth-weight-per-gestational-age z score; and paternal BMI. Associations between mode of delivery and measures of adiposity were found for cesarean deliveries performed in the absence of labor (total fat mass index: β, 1.3; 95% CI, 0.3-2.3; truncal fat mass index: β, 0.6; 95% CI, 0.1-1.0; VAT area: β, 10.7; 95% CI, 3.1-18.3; TAAT area: β, 47.3; 95% CI, 2.3-92.2). There were no associations after adjustment for maternal self-reported prepregnancy BMI (total lean mass index: β, 0.2; 95% CI, -0.1 to 0.6; total fat mass index: β, 0.4; 95% CI, -0.1 to 0.9; truncal fat mass index: β, 0.2; 95% CI, -0.1 to 0.4; VAT area: β, 3.0; 95% CI, -0.6 to 6.7; TAAT area: β, 13.6; 95% CI, -8.2 to 35.3). CONCLUSIONS AND RELEVANCE In this cohort study, adolescents born by cesarean delivery had significantly higher measures of lean mass, fat mass, and central adiposity compared with those born by vaginal delivery, but associations did not remain after adjustment for the mothers' self-reported prepregnancy BMI. The findings suggest that the association between birth by cesarean delivery and adolescent adiposity may partly be explained by maternal self-reported prepregnancy BMI.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Sheryl L. Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Joanne E. Sordillo
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Allison J. Wu
- Department of Obstetrics and Gynecology and Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston
| | - Emily Oken
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jorge E. Chavarro
- Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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22
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Cho NA, Sales KM, Sampsell K, Wang W, Noye Tuplin EW, Lowry DE, Reimer RA. C-section birth increases offspring obesity risk dependent on maternal diet and obesity status in rats. Obesity (Silver Spring) 2021; 29:1664-1675. [PMID: 34464518 DOI: 10.1002/oby.23258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The gut microbiota is a complex ecosystem that shapes host metabolism, especially in early life. Maternal vaginal and gut microbiota is vertically transmitted to offspring during natural birth. Offspring born by cesarean section (CS) do not receive these bacteria and exhibit higher obesity risk later in life. The objective of this study was to examine differences in obesity risk between offspring born naturally (NB) or by CS to lean/obese dams. METHODS Lean and obese rat dams gave birth to offspring naturally or by CS. Offspring obesity risk was analyzed via body weight/composition, food intake, sucrose preference, gut microbiota, and gene expression in gut and brain tissues. RESULTS Obese (O)+CS offspring showed greater weight gain and caloric intake but a reduction in hypothalamic agouti related neuropeptide, neuropeptide Y, and interleukin 1β expression compared with O+NB offspring. Lean (L)+CS offspring had higher serum corticosterone concentration and reduced liver peroxisome proliferator-activated receptor γ expression compared with L+NB. O+CS offspring had long-term alterations to gut microbiota, including increased relative abundance of Faecalibaculum and reduced Muribaculaceae. CONCLUSIONS Overall, CS alters obesity risk differentially based on maternal obesity status. Further studies looking at the risks of obesity associated with CS are needed, with special attention paid to maternal obesity status and gut microbiota.
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Affiliation(s)
- Nicole A Cho
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kate M Sales
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kara Sampsell
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Weilan Wang
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Dana E Lowry
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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23
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Poncet L, Panjo H, Andro A, Ringa V. Caesarean delivery in a migration context: the role of prior delivery in the host country. Sex Reprod Health Matters 2021; 28:1763576. [PMID: 32544031 PMCID: PMC7888083 DOI: 10.1080/26410397.2020.1763576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.
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Affiliation(s)
- Lorraine Poncet
- PhD Candidate in Public Health, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France; French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- Research Engineer, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
| | - Armelle Andro
- Professor, Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France; French Collaborative Institute on Migration, Paris, France
| | - Virginie Ringa
- Researcher (INSERM), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
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Shen M, Wu Y, Xiang X. Hukou-based rural-urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province. Int J Equity Health 2021; 20:145. [PMID: 34158068 PMCID: PMC8218440 DOI: 10.1186/s12939-021-01485-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most existing research on rural-urban health inequalities focuses on disparities in service access and health outcomes based on region. This paper examines rural-urban disparities in maternal healthcare utilization and delivery modes based on household registration (hukou) status to understand the role of state institutions in producing healthcare disparities in China. METHODS Utilizing administrative data from the Public Maternal Health Insurance scheme, we analyzed 54,733 live births in City A (2015-2019) and 25,849 live births in City B (2018-2019) in Guangdong Province in China. We constructed regression models using hukou status (rural versus urban) as the explanatory variable. RESULTS While there is no statistically significant difference in rural and urban mothers' probability of obtaining the minimum recommended number of prenatal care checkups in City A (OR = 0.990 [0.950, 1.032]), mothers with rural hukou status have a lower probability of obtaining the minimum recommended number of visits in City B than their counterparts with urban hukou (OR = 0.781 [0.740, 0.825]). The probability of delivering in tertiary hospital is lower among mothers with rural hukou than among those with urban hukou in both cities (City A: OR = 0.734 [0.701, 0.769]; City B: OR = 0.336 [0.319, 0.354]). Mothers with rural hukou are more likely to have a Cesarean section than those with urban hukou in both cities (City A: OR = 1.065 [1.027, 1.104]; City B: OR = 1.127 [1.069, 1.189]). Compared with mothers with urban hukou, mothers with rural hukou incurred 4 % (95 % CI [-0.046, -0.033]) and 9.4 % (95 % CI [-0.120, -0.068]) less in total medical costs for those who delivered via Cesarean section and 7.8 % (95 % CI [-0.085, -0.071]) and 19.9 % (95 % CI [-0.221, -0.177]) less for those who delivered via natural delivery in City A and City B, respectively. CONCLUSIONS Rural hukou status is associated with younger age, no difference or lower probability of having a minimum number of prenatal checkups, higher likelihood of delivering in nontertiary hospitals, increased Cesarean delivery rates, and lower medical cost for delivery in these two Chinese cities. Evaluating how hukou status influences maternal healthcare in Chinese cities is important for devising targeted public policies to promote more equitable maternal health services.
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Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, China
| | - Yushan Wu
- The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N. T. HKSAR, China
| | - Xin Xiang
- Graduate School of Education, Harvard University, 14 Appian Way, MA, 02139, Cambridge, USA.
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25
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Davidesko S, Alioshin A, Walfisch A, Wainstock T, Yerushalmi B, Sheiner E. Mode of delivery and long-term gastrointestinal-related hospitalization of the offspring. J Matern Fetal Neonatal Med 2021; 35:5775-5782. [PMID: 33645391 DOI: 10.1080/14767058.2021.1892636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We set out to ascertain a possible association between mode of delivery (cesarean vs. vaginal delivery) and gastrointestinal hospitalization of the offspring. STUDY DESIGN A population based cohort analysis including all uncomplicated singleton deliveries occurring between the years 1991-2014 at a tertiary medical center was performed, comparing long-term gastrointestinal hospitalization of offspring, according to mode of delivery. Multiple gestations, fetuses with congenital malformations and perinatal deaths were excluded, as were cases of urgent cesarean delivery and pregnancy complications. Gastrointestinal hospitalizations (up to age 18 years) were defined using predefined ICD9 codes, as recorded in hospital records. A Kaplan Meier survival curve was constructed to compare cumulative incidence of first gastrointestinal hospitalizations. A Cox proportional hazard model was used to control for confounders. RESULTS During the study period 139,232 deliveries met the inclusion criteria; 13,242 (9.5%) of which were elective cesarean deliveries, and the remaining 125,990 (90.5%) were delivered vaginally. Cesarean delivery was associated with more offspring hospitalizations for gastrointestinal morbidity (p < .001). The Kaplan Meier survival curve demonstrated higher cumulative incidence of gastrointestinal hospitalizations in the cesarean delivery group (log rank test p < .001). Utilizing a Cox proportional hazards model to control for confounders, cesarean delivery was found to be an independent risk factor for long-term gastrointestinal hospitalization of the offspring (adjusted HR 1.409, 95%CI 1.306-1.521, p < .001). Specifically, inflammatory bowel disease was more common among offspring following cesarean delivery aHR 1.386 95% CI 1.215-1.582 p < .001. CONCLUSION Elective cesarean delivery is an independent risk factor for long-term gastrointestinal-related hospitalization of the offspring.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Alioshin
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Mt, Scopus University Medical Center, The Hebrew University, Jerusalem, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Baruch Yerushalmi
- Pediatric Gastroenterology Unit, Saban Pediatric Medical Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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26
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Coelho S, Simões V, Batista R, Ribeiro C, Lamy Z, Lamy-Filho F, Carvalho C, Viola P, Queiroz R, Ferraro A, Bettiol H. Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil. Braz J Med Biol Res 2021; 54:e10285. [PMID: 33503158 PMCID: PMC7822467 DOI: 10.1590/1414-431x202010285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022] Open
Abstract
The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.
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Affiliation(s)
- S.J.D.C. Coelho
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - V.M.F. Simões
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R.F.L. Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - C.C.C. Ribeiro
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - Z.C. Lamy
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - F. Lamy-Filho
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - C.A. Carvalho
- Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - P.C.A.F. Viola
- Departamento de Nutrição, Universidade Federal do Piauí, Teresina, PI, Brasil
| | - R.C.S. Queiroz
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A.A. Ferraro
- Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - H. Bettiol
- Departamento de Puericultura e Pediatria, Faculdade de Medicina, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Lubkowska A, Szymański S, Chudecka M. Neonatal thermal response to childbirth: Vaginal delivery vs. caesarean section. PLoS One 2020; 15:e0243453. [PMID: 33296407 PMCID: PMC7725314 DOI: 10.1371/journal.pone.0243453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/22/2020] [Indexed: 11/24/2022] Open
Abstract
Newborns, regardless of the method of termination of pregnancy, are exposed to the first exogenous stress factors during delivery. The purpose of the study was to evaluate the differences in newborns' thermal response to vaginal (VD) vs caesarean section (CS) delivery. The temperature was measured during the first minutes of life within 122 healthy full-term newborns, on the forehead, chest and upper-back by infrared camera (FLIR T1030sc HD). The lowest temperatures were recorded in the forehead of VD newborns (significantly difference with CS; p < 0.001), the warmest was the chest. A significant correlation was found between the duration of the second stage of natural childbirth and surface temperature and pO2 in the newborn blood. The temperatures of selected body surface areas correlate highly positively, regardless of the mode of delivery. In the case of healthy neonates, with normal birth weight and full-term, VD creates more favourable conditions stimulating the mechanisms of adaptation for a newborn than CS.
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Affiliation(s)
- Anna Lubkowska
- Chair and Department of Functional Diagnostics and Physical Medicine, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Sławomir Szymański
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Chudecka
- Institute of Physical Culture Sciences, Faculty of Physical Education and Health, University of Szczecin, Szczecin, Poland
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Yu H, Guo Y, Zeng X, Gao M, Yang BY, Hu LW, Yu Y, Dong GH. Modification of caesarean section on the associations between air pollution and childhood asthma in seven Chinese cities. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 267:115443. [PMID: 32892008 DOI: 10.1016/j.envpol.2020.115443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
It is unknown whether giving birth via caesarean section (c-section) is a modifier for the association between air pollution and asthma. From 2012 to 2013, 59,754 children between the ages of 2 and 17 were randomly selected from 94 middle schools, elementary schools and kindergartens in seven Chinese cities for a cross-sectional study. The children's parents or guardians completed questionnaires, from which data on asthma as well as asthma-related symptoms were obtained. Participants' exposure to particles with an aerodynamic diameter ≤1.0 μm (PM1), ≤2.5 μm (PM2.5), and ≤10 μm (PM10) and exposure to nitrogen dioxide (NO2) were estimated using random forest models. We used mixed effects logistic regression models and added an interaction term between mode of delivery and ambient air pollution into the model to estimate effect modification from c-sections after appropriate adjustments for potential confounding variables. Among children delivered by c-section, the adjusted ORs for asthma and its symptoms per interquartile range (IQR) increase of PM1, PM2.5, PM10 and NO2 (1.20 95% CI: 1.07-1.34 to 2.04 95% CI: 1.87-2.24) were significantly higher than those of children delivered vaginally (1.05 95% CI: 0.92-1.19 to 1.33 95%CI: 1.21-1.47). The interactions between c-sections and ambient air pollution were statistically significant for all studied respiratory disorders, except current wheeze. Delivery via c-section may increase the risks of air pollution on asthma and its symptoms in Chinese children.
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Affiliation(s)
- Hongyao Yu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Meng Gao
- Department of Geography, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, 510655, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Leow HW, Tan EL, Black M. Reported outcomes for planned caesarean section versus planned vaginal delivery: A systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 256:101-108. [PMID: 33197678 DOI: 10.1016/j.ejogrb.2020.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is currently no consensus regarding the outcomes and outcome measures that should be reported in studies assessing planned mode of birth. OBJECTIVE To develop an inventory for reported outcomes for studies comparing planned caesarean section (CS) and planned vaginal delivery (VD) for women age 18-45. METHODS A systematic review of outcomes reported in prospective studies investigating planned CS and planned VD was conducted. Three online databases, Ovid SP version of MEDLINE and EMBASE and the Cochrane Pregnancy and Childbirth Group's Trials Register, were searched from 2011 to June 2019. The inclusion criteria were: prospective studies evaluating planned mode of birth, age 18-45, singleton pregnancy, gestational age 37-40 weeks, >100 participants, middle or high income countries. No language restrictions were applied. Two researchers independently screened titles and abstracts, and subsequently reviewed the full text of each selected study to assess for eligibility. Discrepancies were resolved by discussion with a third author. The selected studies were evaluated using the MOMENT criteria. Outcomes and outcome measures were systematically extracted and organised into an inventory. RESULTS 63 prospective studies comparing planned CS versus planned VD including data from 6,397,310 women were included. 37 studies (59%) investigating planned CS versus planned VD fulfilled four or more MOMENT criteria. In total, 43 different primary outcomes and 79 different primary outcome measures, and 12 different secondary outcomes and 31 secondary outcome measures were identified from studies investigating planned CS versus planned VD. CONCLUSION The findings of this study will contribute to the development of a core outcome set for planned mode of birth in the future. Standardising outcomes will aid comparison and interpretation of data pertaining to planned CS versus planned VD. PROSPERO registration: CRD42019133104.
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Affiliation(s)
- Hui Wei Leow
- University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom.
| | - Elizabeth Lilinn Tan
- University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - Mairead Black
- University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
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Giles EM, Couper J. Microbiome in health and disease. J Paediatr Child Health 2020; 56:1735-1738. [PMID: 32502314 DOI: 10.1111/jpc.14939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
There has been an exponential rise in research into the microbiota of the human gastrointestinal tract, particularly of the genomic content (the microbiome). The vast number of micro-organisms residing in our gut has an integral role in essential processes, including growth and development. Probiotics, live micro-organisms with putative benefits on health have become ubiquitous as treatments for many conditions, despite often limited robust clinical trial data. However, the resurgence of faecal microbial transplantation as an effective treatment modality provides further promise that manipulation of our microbiome can have clinical benefits. This review will present the recent evidence for the role of the microbiome in development and growth, and focus on the evidence for its manipulation in paediatric diseases. We will show that while there is promising data in specific diseases, there remain many unanswered questions. Only through a deeper understanding of our complex internal ecosystem will we be able to move to the next stage of targeted microbial therapy.
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Affiliation(s)
- Edward M Giles
- Centre for Innate Immunity and Infectious Disease, Hudson Institute for Medical Research, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jenny Couper
- Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia
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Levett KM, Lord SJ, Dahlen HG, Smith CA, Girosi F, Downe S, Finlayson KW, Fleet J, Steen M, Davey MA, Newnham E, Werner A, Arnott L, Sutcliffe K, Seidler AL, Hunter KE, Askie L. The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis. BMJ Open 2020; 10:e037175. [PMID: 32967876 PMCID: PMC7513601 DOI: 10.1136/bmjopen-2020-037175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? METHODS AND ANALYSIS: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural.Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women's confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting.Comparator: standard care alone in hospital-based maternity units. OUTCOMES Primary: CS.Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being.Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components. STUDY DESIGN An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees. ETHICS AND DISSEMINATION Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group. TRIAL REGISTRATION NUMBER CRD42020103857.
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Affiliation(s)
- Kate M Levett
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
| | - Caroline A Smith
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
- Graduate Research School, University of Western Sydney, Kingswood, New South Wales, Australia
| | - Federico Girosi
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Capital Markets CRC, New South Wales, Australia, Sydney, New South Wales, Australia
| | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Julie Fleet
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary Steen
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary-Ann Davey
- Obstetrics & Gynaecology, Monash Health, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Elizabeth Newnham
- School of Nursing & Midwifery, Griffith University, Medowbrook, Queensland, Australia
| | - Anette Werner
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Leslie Arnott
- The B.E.A.R. Program, Lamaze Australia, Melbourne, Victoria, Australia
| | - Kerry Sutcliffe
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie Elizabeth Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Yan J, Wang L, Yang Y, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Wang Q, Shen H, Zhang Y, Yan D, Ma X, Yang H. The trend of caesarean birth rate changes in China after 'universal two-child policy' era: a population-based study in 2013-2018. BMC Med 2020; 18:249. [PMID: 32928217 PMCID: PMC7491061 DOI: 10.1186/s12916-020-01714-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The universal two-child policy in China which was announced in October 2015 might affect the caesarean birth rate. Few studies reported the caesarean birth rate affected by the policy especially after the universal two-child policy period. This study aimed to demonstrate the caesarean birth rate changes before and after the universal two-child policy and further elaborate the underlying influencing factors. METHODS This nationwide, retrospective, population-based study was based on National Free Pre-Pregnancy Check-ups Project (NFPCP). Couples planning to conceive in next 6 months were encouraged to participate in NFPCP. Baseline information was collected using a standardized questionnaire with a face-to-face interview, and medical examinations were conducted. Two rounds of follow-up interviews were then conducted by trained nurses to update pregnancy status and outcomes. NFPCP participants who completed deliveries before December 31, 2018, were included in the current study. We used marginal effect of year to examine the trend of caesarean birth rate over time and interrupted time series (ITS) analysis to determine impacts of the universal two-child policy on the trend of caesarean birth rate. RESULTS A total of 9,398,045 participants were included in the final analysis. High-risk factors to increase caesarean birth rate were identified. In the current study, the standardized caesarean birth rate declined from 34.1% in 2013 to 31.8% in 2015 and increased to 35.6% in 2018. ITS analysis showed the caesarean birth rate decreased by 0.1% (95% CI 0.1-0.1) per month before the release of universal two-child policy, 1.3% (95% CI 0.6-2.1%) absolute drop during the policy release month, and increased by 0.2% (95% CI 0.1-0.2%) per month after the policy implementation. For the period after the policy release, the increasing trends were observed in rural participants and urban primiparas. The prevalence of caesarean birth rates within China varied regionally. CONCLUSIONS The decreasing trend of caesarean birth rate was reported after immediate release of the universal two-child policy. An increasing trend of caesarean birth rate was observed 2-3 years after the policy. It reminds us that the caesarean birth rate control is a long-lasting process and all the strategies need to be continually reinforced.
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Affiliation(s)
- Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, 100034, China.,China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Long Wang
- China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China.,National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China.,School of Public Health, Lanzhou University, No. 199 Donggang Road (West), Chengguang District, Lanzhou, 730000, China
| | - Ying Yang
- China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. .,National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. .,Graduate School of Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100005, China.
| | - Ya Zhang
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Yuan He
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the PRC, No. 1 Xizhimenwai Road (South), Xicheng District, Beijing, 100044, China
| | - Xu Ma
- China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. .,National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China. .,Graduate School of Peking Union Medical College, No. 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100005, China.
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, 100034, China. .,China DOHaD Research Centre, China DOHaD Research Centre, National Human Genetic Resources Centre, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China.
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Wang JG, Sun JL, Shen J. Factors affecting failed trial of labor and countermeasures: A retrospective analysis. World J Clin Cases 2020; 8:3483-3492. [PMID: 32913855 PMCID: PMC7457101 DOI: 10.12998/wjcc.v8.i16.3483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy. However, the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.
AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion, explore how to promote the trial of labor success rate, and determine the feasibility of reducing the rate of conversion to cesarean section.
METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital. Among them, 8164 pregnant women who had a successful trial of labor were used as a control group, and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group. The patients’ clinical data during hospitalization were collected for comparative analysis, the related factors of the failed trial of labor were discussed, and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.
RESULTS The analysis revealed that advanced age (≥ 35 years old), macrosomia (≥ 4000 g), delayed pregnancy (≥ 41 wk), use of uterine contraction drugs, primipara, and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor. Multivariate regression analysis showed that age, gestational age, primipara, use of uterine contraction drugs, fever during birth, and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor. The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor: Fetal distress (44.3%), social factors (12.8%), malpresentation (face presentation, persistent occipitoposterior position, and persistent occipitotransverse position) (9.4%), and cephalopelvic disproportion (8.9%).
CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors. Medical staff should take appropriate preventive measures for the main factors, increase the trial of labor success rate, improve the quality of delivery, ensure the safety of mother and child during the perinatal period, and improve the relationship between doctors and patients.
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Affiliation(s)
- Jin-Guang Wang
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
| | - Jing-Li Sun
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
| | - Jian Shen
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
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Kumar R, Lakhtakia S. Rising cesarean deliveries in India: medical compulsions or convenience of the affluent? Health Care Women Int 2020; 42:611-635. [PMID: 32779972 DOI: 10.1080/07399332.2020.1798963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
From 2005-06 to 2015-16, proportion of cesarean deliveries in total deliveries has almost doubled in India. In this paper, we study changes in prevalence of cesarean deliveries across different social-economic groups and study factors affecting odds of undergoing cesarean delivery. The present paper was based on National Family Health Surveys and employs logistic regression. We find that rise in cesarean deliveries has been across social groups, religions, urban/rural India, wealth groups, though increase has not been uniform. Further, many economically affluent states have high proportion of cesarean deliveries. We find that women delivering at private hospitals had significantly higher odds of opting for cesarean delivery. Further, women belonging to rich households were more likely to go through surgery for birth. In case of earlier terminated pregnancies, odds were higher too. The higher odds of cesarean sections in the relatively affluent geographic regions, richer households and private institutions indicate that these procedures may be driven by non-medical reasons in many cases, pointing toward the use of surgical procedures for the convenience.
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Affiliation(s)
- Rishi Kumar
- Department of Economics and Finance, Birla Institute of Technology and Science,Telangana, India
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Chavarro JE, Martín-Calvo N, Yuan C, Arvizu M, Rich-Edwards JW, Michels KB, Sun Q. Association of Birth by Cesarean Delivery With Obesity and Type 2 Diabetes Among Adult Women. JAMA Netw Open 2020; 3:e202605. [PMID: 32282045 PMCID: PMC7154804 DOI: 10.1001/jamanetworkopen.2020.2605] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/12/2020] [Indexed: 01/18/2023] Open
Abstract
Importance Cesarean delivery is associated with an increased risk of childhood obesity in offspring. However, whether this increased risk also includes obesity-associated conditions remains unclear. Objective To evaluate the association of birth by cesarean delivery with offspring's risks of obesity and type 2 diabetes in adulthood. Design, Setting, and Participants This prospective cohort study compared the incidence of obesity and type 2 diabetes between birth by cesarean delivery and vaginal delivery among 33 226 women participating in the Nurses' Health Study II who were born between 1946 and 1964, with follow-up through the end of the 2013-2015 follow-up cycle. Participants' mothers provided information on mode of delivery and pregnancy characteristics. Participants provided information every 2 years on weight and diagnosis of type 2 diabetes. Relative risks of obesity and type 2 diabetes were estimated using log-binomial and proportional hazards regression accounting for maternal body mass index and other confounding factors. Statistical analysis was performed from June 2017 to December 2019. Exposure Birth by cesarean delivery compared with birth by vaginal delivery. Main Outcomes and Measures Risk of obesity and incidence of type 2 diabetes. Results At baseline, the participants' mean (SD) age was 33.8 (4.6) years (range, 24.0-44.0 years). A total of 1089 of the 33 226 participants (3.3%) were born by cesarean delivery. After 1 913 978 person-years of follow-up, 12 156 (36.6%) women were obese and 2014 (6.1%) had received a diagnosis of type 2 diabetes. Women born by cesarean delivery were more likely to be classified as obese and to have received a diagnosis of type 2 diabetes during follow-up. The multivariable-adjusted relative risk of obesity among women born by cesarean vs vaginal delivery was 1.11 (95% CI, 1.03-1.19). The multivariable-adjusted hazard ratio for type 2 diabetes among women born by cesarean vs vaginal delivery was 1.46 (95% CI, 1.18-1.81); this association remained significant after additional adjustment for participant's own body mass index (relative risk, 1.34 [95% CI, 1.08-1.67]). These associations persisted when analyses were restricted to women at low risk of cesarean delivery based on maternal characteristics. Conclusions and Relevance This study suggests that women born by cesarean delivery may have a higher risk than women born by vaginal delivery of being obese and developing type 2 diabetes during adult life.
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Affiliation(s)
- Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Physiopathology of Obesity and Nutrition, Carlos III Institute of Health, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Changzheng Yuan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mariel Arvizu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W. Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karin B. Michels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Kang L, Ye S, Jing K, Fan Y, Chen Q, Zhang N, Zhang B. A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016. Risk Manag Healthc Policy 2020; 13:245-253. [PMID: 32256135 PMCID: PMC7092689 DOI: 10.2147/rmhp.s230923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022] Open
Abstract
Objective This study evaluated change in caesarean section rate with reform of birth planning policy in China from one-child to two-child policy. Methods Study data were collected from patient-level hospital records of 59,668 pregnant women who visited three major urban hospitals in Jiangsu Province and Inner Mongolia Autonomous Region of China between January 2012 and December 2016. A segmented logistic regression approach was developed to evaluate the changes in caesarean section rate in these regions with the launch of China's new partial and universal two-child policies in January 2014 and January 2016, respectively. Results Jiangsu Province had a significantly lower non-emergency caesarean rate (Jiangsu 8.15% vs Inner Mongolia 34.03%, p < 0.001) and a much lower percentage of minority population (Jiangsu 6.99% vs Inner Mongolia 21.76%, p < 0.001) than Inner Mongolia Autonomous Region. In Jiangsu Province, no change in caesarean section rate was detected with the two-child policies (all p-values > 0.05), although the unadjusted trend change (0.038, 95% confidence interval or CI: [0.016, 0.060], p < 0.001) in log odds after the implementation of the partial two-child policy was statistically significant. In Inner Mongolia Autonomous Region, an immediate jump in caesarean section rate was discovered by the segmented logistic regression with the implementation of both the partial (unadjusted level change 0.297, CI: [0.105, 0.489], p = 0.002) and universal two-child policies (unadjusted level change 1.945, CI: [1.277, 2.614], p < 0.001); but the rate reverted to the previous level thereafter. Ethnicity, maternal age, maternal reproduction history, insurance coverage type, infant weight, and infant gender were the significant factors associated with caesarean section rate (for odds ratios, all p-values < 0.05). However, the significance of infant gender may stem from the large sample size of the study and is not clinically meaningful. Conclusion Change in caesarean section rate was not observed with the launch of two-child policy in China.
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Affiliation(s)
- Lili Kang
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu, People's Republic of China.,School of Health Management, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Shangyuan Ye
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Kangzhen Jing
- Department of Medical Affair, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Qihui Chen
- Center for Food and Health Economic Research, College of Economics and Management, China Agricultural University, Beijing, People's Republic of China
| | - Ning Zhang
- Department of Health Policy and Management, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.,Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Jabri L, Rosenthal DM, Benton L, Lakhanpaul M. Complementary feeding practices and nutrient intakes of children aged 6-24 months from Bangladeshi background living in Tower Hamlets, East London: a feasibility study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2020; 39:4. [PMID: 32111257 PMCID: PMC7048146 DOI: 10.1186/s41043-020-0213-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 02/05/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim of this study was to assess dietary intakes and complementary feeding practices of children aged 6-24 months who are from Bangladeshi ancestry and living in Tower Hamlets, London, and determine the feasibility of a larger, population-representative study. METHODS Questionnaires for demographic variables and feeding practices, and 24-h dietary recalls were administered to 25 mothers to determine whether it would be feasible to conduct a similar study on a representative sample size of the same population. Data from both tools were used to determine adequacy of complementary feeding practices through the WHO indicators and an infant and child feeding index score as well as overall macronutrient and micronutrient intake. RESULTS Four children had varying suboptimal complementary feeding practices: two children failed to achieve the minimum dietary diversity, one child was being fed cow's milk before the age of 1 year, and one scored 'poor' on the infant and child feeding index. Most notably, the mean protein intake (39.7 g/day, SD 18.2) was higher than RNIs for all age groups (P = 0.001). Vitamin D intake was below recommendations (P = 0.006) for the 12-24-month age group. For the 10-12-month age group, zinc intake fell below recommendations (P = 0.028). For the 6-9-month combined age group, iron and zinc intakes were below recommendations (P = 0.021 and P = 0.002, respectively). CONCLUSIONS Given the feasibility of this study, the results obtained require a large-scale study to be conducted to confirm findings. Our initial results indicated that children from Bangladeshi heritage may not be meeting nutritional requirements; thus, a future intervention tailored to the needs of the Bangladeshi population may be required to improve aspects of complementary feeding practices and nutrient intakes of those children.
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Affiliation(s)
- Laura Jabri
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH UK
- University College London, London, WC1E 6BT UK
| | - Diana Margot Rosenthal
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH UK
- University College London, London, WC1E 6BT UK
- UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, London, WC1E 7HB UK
| | - Lorna Benton
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH UK
- University College London, London, WC1E 6BT UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH UK
- University College London, London, WC1E 6BT UK
- UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, London, WC1E 7HB UK
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Tang D, Gao X, Rebeira M, Coyte PC. Effects of Migration on Infant and Maternal Health in China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019884189. [PMID: 31646919 PMCID: PMC6820187 DOI: 10.1177/0046958019884189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
We assess the association between maternal migrant status and health outcomes in China, which has one of the world’s largest migrant populations. Health records from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to June 30, 2017, were used to analyze 104 681 live births for Shanghai native-born and migrant women based on International Classification of Diseases, Tenth Revision diagnosis codes and demographic data. Regression analysis including propensity score matching was conducted to investigate the association between maternal migrant status and adverse infant birth outcomes (fetal disease, congenital malformation, neonatal disease) and maternal health after controlling for pregnancy status and socioeconomic factors. The results demonstrate that migrant women had statistically significant increased odds (9.1%-10%, P < .001) of having infants with adverse health outcomes compared with their urban counterparts and that migrant mothers have less likelihood of pregnancy complications and gestational diabetes mellitus. Our results show the mixed effects of migration on infant and maternal health may be a possible outcome of China’s Hukou system that often represents an important barrier in accessing prenatal health care by migrant women. Current reforms that improve access to prenatal health care services for migrant women may enhance the health outcomes of their infants.
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Affiliation(s)
- Di Tang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.,School of Public Administration, East China Normal University, Shanghai, China.,Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Xiangdong Gao
- School of Public Administration, East China Normal University, Shanghai, China
| | - Mayvis Rebeira
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Shen M, Li L. Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role? ECONOMICS AND HUMAN BIOLOGY 2020; 36:100824. [PMID: 31675612 DOI: 10.1016/j.ehb.2019.100824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/28/2019] [Accepted: 10/12/2019] [Indexed: 06/10/2023]
Abstract
To investigate whether elements of Chinese culture, such as son preference, influence women's mode of child delivery, this paper analyzes how fetal sex affects C-section rates among Chinese mothers compared with Japanese mothers in the United States. It uses birth certificate data from 1990 to 2000, a period when women were routinely able to learn the sex of the fetus during pregnancy. Compared with Japanese mothers, Chinese mothers were 1 percentage point more likely to undergo C-section when giving birth to boys than when giving birth to girls. This result is robust to the addition of a rich set of controls and the restriction of the sample to infants without congenital diseases or anomalies at birth. The effects are concentrated in subgroups that are more likely to prefer sons-specifically, where both parents are Asian or where mothers are first-generation immigrants. The findings offer valuable insights for health professionals into culturally driven pregnancy behaviors among Chinese women, potentially enabling them to offer more culturally appropriate healthcare as they support women in making a healthy transition to motherhood.
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Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, No. 135 Xin Gang Xi Road, Guangzhou, 510275, China.
| | - Linyan Li
- Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA.
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Kang L, Gu H, Ye S, Xu B, Jing K, Zhang N, Zhang B. Rural-urban disparities in caesarean section rates in minority areas in China: evidence from electronic health records. J Int Med Res 2019; 48:300060519877996. [PMID: 31566034 PMCID: PMC7607187 DOI: 10.1177/0300060519877996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the rural-urban disparity in caesarean section rates using electronic health records from hospitals located in the Province of Inner Mongolia, which is a minority area in Northeastern China. METHODS The study examined the electronic health records of women that gave birth in three major public hospitals between January 2012 and December 2016. Multinomial regression analyses were used to estimate rural-urban disparities in caesarean section rates. RESULTS Data from 61 903 women were examined. Caesarean section rates increased slightly over the study period and the rate was significantly higher in rural compared with urban hospitals (48% versus 38%). This disparity consistently increased over time. Multinomial regression analyses showed that maternal age, ethnicity, health insurance type, employment status, reproductive history and the newborn's sex were significant risk factors associated with caesarean section rate. Furthermore, stratified analysis of first-time pregnancies, minorities and different age groups showed that the odds of undergoing an emergency caesarean section was lower in the rural hospital, but the odds of undergoing a planned caesarean section was higher in the rural hospital. CONCLUSIONS Caesarean section rates have increased in rural areas and the disparity in rural-urban areas has increased substantially over the years.
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Affiliation(s)
- Lili Kang
- Centre for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu Province, China.,School of Health Management, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Hai Gu
- Centre for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu Province, China
| | - Shangyuan Ye
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Biao Xu
- Centre for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu Province, China
| | - Kangzhen Jing
- Department of Medical Affairs, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Ning Zhang
- Department of Health Policy and Management, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.,Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Bo Zhang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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No. 384-Management of Breech Presentation at Term. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1193-1205. [DOI: 10.1016/j.jogc.2018.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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No 384 - Prise en charge de la présentation du siège du fœtus à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1206-1220. [DOI: 10.1016/j.jogc.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Xia X, Zhou Z, Shen S, Lu J, Zhang L, Huang P, Yu J, Yang L, Wang P, Lam KBH, Jacobsson B, Mol BW, Xia H, Qiu X. Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: A before-and-after study. PLoS Med 2019; 16:e1002846. [PMID: 31283770 PMCID: PMC6613675 DOI: 10.1371/journal.pmed.1002846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The cesarean section (CS) rate has risen globally during the last two decades. Effective and feasible strategies are needed to reduce it. The aim of this study was to assess the CS rate change after a two-stage intervention package that was designed to reduce the overall CS rate in Guangzhou, China. METHODS AND FINDINGS This intervention package was implemented by the Health Commission of Guangzhou Municipality in 2 stages (October 2010-September 2014 and October 2014-December 2016) and included programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system. A retrospective repeated cross-sectional study was conducted to evaluate influences of the intervention on CS rates. A pre-intervention period from January 2008 to September 2010 served as the baseline. The primary outcome was the CS rate, and the secondary outcomes included maternal mortality ratio (MMR) and perinatal mortality rate (PMR), all obtained from the Guangzhou Perinatal Health Care and Delivery Surveillance System (GPHCDSS). The Cochran-Armitage test was used to examine the trends of the overall CS rate, MMR, and PMR across different stages. Segmented linear regression analysis was used to assess the change of the CS rate over the intervention period. A total of 1,921,932 records of births and 108 monthly CS rates from 2008 to 2016 were analyzed. The monthly CS rate declined across the intervention stages (Z = 75.067, p < 0.001), with an average rate of 42.4% at baseline, 39.8% at Stage 1, and 35.0% at Stage 2. The CS rate declined substantially among nulliparous women who delivered term singletons, with an accelerating decreasing trend observed across Stage 1 and Stage 2 (the difference in slopes: -0.09 [95% CI -0.16 to -0.02] between Stage 1 and baseline, p = 0.014; -0.11 [95% CI -0.20 to -0.02] between Stage 1 and Stage 2, p = 0.017). The CS rate in the remaining population increased during baseline and Stage 1 and subsequently decreased during Stage 2. The sensitivity analysis suggested no immediate impact of the universal two-child policy on the trend of the CS rate. The MMR (Z = -4.368, p < 0.001) and PMR (Z = -13.142, p < 0.001) declined by stage over the intervention period. One of the main limitations of the study is the lack of a parallel control group. Moreover, the influence of temporal changes in the study population on the CS rate was unknown. Given the observational nature of the present study, causality cannot be confirmed. CONCLUSIONS Apparent decline in the overall CS rate was observed in Guangzhou, China, after the implementation of a two-stage intervention package. The decline was most evident among nulliparous women who delivered term singletons. Despite some limitations for causal inference, Guangzhou's experience in controlling the CS rate by implementing composite interventions with public health education and perinatal healthcare service improvement could have implications for other similar areas with high rates of CS.
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Affiliation(s)
- Xiaoyan Xia
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zehong Zhou
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinhua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lifang Zhang
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peiyuan Huang
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jia Yu
- Department of Woman and Child Health Care, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Yang
- Guangzhou Women and Children’s Health Information Center, Guangzhou, China
| | - Ping Wang
- Guangzhou Women and Children’s Health Information Center, Guangzhou, China
| | - Kin-bong Hubert Lam
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Ben Willem Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Birmingham, Birmingham, United Kingdom
| | - Huimin Xia
- Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- * E-mail: , (HX); , (XQ)
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Woman and Child Health Care, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Obstetrics and Gynecology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- * E-mail: , (HX); , (XQ)
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Dominguez-Bello MG, Godoy-Vitorino F, Knight R, Blaser MJ. Role of the microbiome in human development. Gut 2019; 68:1108-1114. [PMID: 30670574 PMCID: PMC6580755 DOI: 10.1136/gutjnl-2018-317503] [Citation(s) in RCA: 413] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/15/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022]
Abstract
The host-microbiome supraorganism appears to have coevolved and the unperturbed microbial component of the dyad renders host health sustainable. This coevolution has likely shaped evolving phenotypes in all life forms on this predominantly microbial planet. The microbiota seems to exert effects on the next generation from gestation, via maternal microbiota and immune responses. The microbiota ecosystems develop, restricted to their epithelial niches by the host immune system, concomitantly with the host chronological development, providing early modulation of physiological host development and functions for nutrition, immunity and resistance to pathogens at all ages. Here, we review the role of the microbiome in human development, including evolutionary considerations, and the maternal/fetal relationships, contributions to nutrition and growth. We also discuss what constitutes a healthy microbiota, how antimicrobial modern practices are impacting the human microbiota, the associations between microbiota perturbations, host responses and diseases rocketing in urban societies and potential for future restoration.
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Affiliation(s)
- Maria Gloria Dominguez-Bello
- Department of Biochemistry and Microbiology, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA
| | - Filipa Godoy-Vitorino
- Department of Microbiology and Medical Zoology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico, USA
| | - Rob Knight
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - Martin J Blaser
- Department of Medicine, New York University Langone Medical Center, New York City, New York, USA
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Liao Z, Zhou Y, Li H, Wang C, Chen D, Liu J. The Rates and Medical Necessity of Cesarean Delivery in the Era of the Two-Child Policy in Hubei and Gansu Provinces, China. Am J Public Health 2019; 109:476-482. [PMID: 30676790 DOI: 10.2105/ajph.2018.304868] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the cesarean rates in different child policy periods and assess the medical necessity of cesareans during the 2-child policy period. METHODS We collected hospital-level aggregate data on 93 745 deliveries and individual-level data on 27 977 deliveries from 6 hospitals in the Hubei and Gansu provinces of China from 2013 to 2016. Experts in gynecology and obstetrics assessed the medical necessity of 1024 randomly selected cesareans in 2016. RESULTS The overall cesarean rate decreased significantly from 45.1% in the 1-child policy period (January 2013-September 2014) to 40.4% in the selective 2-child policy period (October 2014-July 2016) and further to 38.9% in the universal 2-child policy period (August 2016-December 2016). The rate of cesarean delivery on maternal request decreased by 46.3%, whereas the rate of cesarean delivery indicated by a previous cesarean delivery increased by 118.8% (P < .001). The experts assessed 222 (21.6%) cesareans as lacking medical necessity. CONCLUSIONS The overall cesarean rate in Hubei and Gansu provinces decreased after the implementation of the 2-child policy, and one fifth of cesareans might be nonessential.
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Affiliation(s)
- Zijun Liao
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yubo Zhou
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hongtian Li
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dunjin Chen
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jianmeng Liu
- Zijun Liao, Yubo Zhou, Hongtian Li, and Jianmeng Liu are with the Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, and the Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China. Cheng Wang is with the Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, Gansu, China. Dunjin Chen is with the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Zachariassen LF, Krych L, Rasmussen SH, Nielsen DS, Kot W, Holm TL, Hansen AK, Hansen CHF. Cesarean Section Induces Microbiota-Regulated Immune Disturbances in C57BL/6 Mice. THE JOURNAL OF IMMUNOLOGY 2018; 202:142-150. [DOI: 10.4049/jimmunol.1800666] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/23/2018] [Indexed: 12/12/2022]
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Baumfeld Y, Walfisch A, Wainstock T, Segal I, Sergienko R, Landau D, Sheiner E. Elective cesarean delivery at term and the long-term risk for respiratory morbidity of the offspring. Eur J Pediatr 2018; 177:1653-1659. [PMID: 30091110 DOI: 10.1007/s00431-018-3225-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/25/2018] [Accepted: 07/29/2018] [Indexed: 02/04/2023]
Abstract
Maternal morbidity is associated with cesarean deliveries. However, new evidence suggests that short- and long-term neonatal morbidity is also associated. This includes respiratory morbidity with conflicting results. To determine whether mode of delivery has an impact on the long-term risk for respiratory morbidity in the offspring, a population-based cohort analysis was conducted including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via elective cesarean delivery (CD) and those delivered vaginally. Multiple gestations and fetuses with congenital malformations were excluded from the analysis as were all cases of urgent CDs. Pediatric hospitalizations involving respiratory morbidity of offspring up to the age of 18 years were evaluated. A Kaplan-Meier survival curve was used to compare cumulative respiratory morbidity incidence and a Cox regression model to control for confounders. During the study period, 132,054 term deliveries met the inclusion criteria; 8.9% were via elective CDs (n = 11,746) and 91.1% (n = 120,308) were vaginal deliveries. Hospitalizations of the offspring involving respiratory morbidity were significantly more common in offspring delivered by CDs (5.2 vs. 4.3% in vaginal deliveries, p < 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the elective CD group (log rank p < 0.001). In a Cox proportional hazards model, while controlling for maternal age, gestational age, and birthweight, CD exhibited a significant and independent association with long-term respiratory morbidity of the offspring (adjusted hazard ratio = 1.22 (CI, 1.12-1.33), p < 0.001).Conclusion: Elective cesarean delivery at term is a significant risk factor for long-term pediatric respiratory morbidity of the offspring. What is Known: • Cesarean delivery is a major surgery with known possible complications. • Cesarean delivery has possible immediate complications for the newborn including respiratory complications. What is New: • Our study shows more long term respiratory morbidity in the CD group including asthma and obstructive sleep apnea. • Different possible explanations have been proposed including exposure to maternal flora during vaginal delivery and the stress hormones secreted during contractions and delivery.
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Affiliation(s)
- Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel. .,The Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, 84101, Beer Sheva, Israel
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Visser GHA, Ayres-de-Campos D, Barnea ER, de Bernis L, Di Renzo GC, Vidarte MFE, Lloyd I, Nassar AH, Nicholson W, Shah PK, Stones W, Sun L, Theron GB, Walani S. FIGO position paper: how to stop the caesarean section epidemic. Lancet 2018; 392:1286-1287. [PMID: 30322563 DOI: 10.1016/s0140-6736(18)32113-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/29/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, Netherlands.
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Medical School-University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | - Eytan R Barnea
- Society for the Investigation of Early Pregnancy, New York, NY, USA; BioIncept, LLC, New York, NY, USA
| | | | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | | | - Isabel Lloyd
- Ginecólogo Obstetra, Clinica Hospital San Fernando, Consultorio 6-8, Panama
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill School of Medicine, NC, USA
| | - P K Shah
- Department of Obstetrics and Gynecology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - William Stones
- Departments of Public Health and Obstetrics and Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Luming Sun
- Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - Gerhard B Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salimah Walani
- Global Health Programs, March of Dimes Foundation, White Plains, NY, USA
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Jargin SV. Cesarean combined with tubal sterilization: some medical and demographic aspects. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mu Y, Li X, Zhu J, Liu Z, Li M, Deng K, Deng C, Li Q, Kang L, Wang Y, Liang J. Prior caesarean section and likelihood of vaginal birth, 2012-2016, China. Bull World Health Organ 2018; 96:548-557. [PMID: 30104795 PMCID: PMC6083396 DOI: 10.2471/blt.17.206433] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/14/2018] [Accepted: 06/08/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To examine the trends and safety of vaginal birth after caesarean section around the period of the one-child policy relaxation in China. METHODS We used data from China's National Maternal Near Miss Surveillance System between 2012 and 2016. To examine trends in vaginal birth after caesarean section, we used Poisson regression with a robust variance estimator. We also assessed the association between vaginal birth after caesarean section and maternal and perinatal outcomes. FINDINGS We analysed 871 636 deliveries by women with a previous caesarean section. Both in 2012 and 2016, the rate of vaginal birth after caesarean section was 9.8%. After adjusting for institutional, sociodemographic and obstetric characteristics, the rate increased by 14% between 2012 and 2016 (adjusted relative risk, aRR: 1.14; 95% confidence interval, CI: 1.07-1.21). Compared to women with a repeat caesarean section, women with a vaginal birth after caesarean section experienced lower incidence of uterine rupture (aRR: 0.26, 95% CI: 0.16-0.42), blood transfusion (aRR: 0.68, 95% CI: 0.53-0.87) and admission to the intensive care unit (aRR: 0.36, 95% CI: 0.25-0.52), but higher incidence of intrapartum stillbirths, (aRR: 7.20, 95% CI: 6.09-8.51), newborns with a 5-minute Apgar score less than 7 (aRR: 1.75, 95% CI: 1.54-1.99) and neonatal death before discharge (aRR: 1.90, 95% CI: 1.61-2.24). CONCLUSION Promotion of vaginal birth after caesarean section could increase the rate even further in China. To ensure the safety of mothers and their newborns, national policies and guidelines on vaginal birth after caesarean section are needed.
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Affiliation(s)
- Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jun Zhu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Changfei Deng
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance of China, Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
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