Witt Whitney P, Wisk Lauren E, Cheng Erika R, Mandell Kara, Chatterjee Debanjana, Wakeel Fathima, Godecker Amy L, Zarak Dakota
Maternal and Child Health Research, Truven Health Analytics, 7700 Old Georgetown Road, 6th Floor, Bethesda, MD, 20814, USA,
Matern Child Health J. 2015 Jan;19(1):84-93. doi: 10.1007/s10995-014-1498-8.
This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the US by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated cesarean section (C-section) deliveries. Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n = 9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-sections. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-sections, compared to vaginal delivery. 74.2 % of women had a vaginal delivery, 11.6 % had a non-medically indicated C-section, and 14.2 % had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we found salient differences between the risk factors for indicated and non-indicated C-sections. Surgical deliveries continue to occur at a high rate in the US despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short- and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.
本研究采用生命历程方法，通过确定医学指征性和非医学指征性剖宫产分娩的孕前及孕期相关决定因素，来理解影响美国分娩方式的因素。数据来自《儿童早期纵向研究——出生队列》，这是一项对2001年分娩活产婴儿的女性进行的具有全国代表性的基于人群的调查（n = 9350）。研究考察了三种分娩方式：（1）阴道分娩（参照组）；（2）医学指征性剖宫产；（3）非医学指征性剖宫产。我们使用多项逻辑回归分析，研究了社会人口统计学、健康状况、医疗保健、压力性生活事件、妊娠并发症以及剖宫产史对医学指征性和非医学指征性剖宫产几率的影响，并与阴道分娩进行比较。74.2%的女性进行了阴道分娩，11.6%的女性进行了非医学指征性剖宫产，14.2%的女性进行了医学指征性剖宫产。多变量分析显示，既往剖宫产是医学指征性和非医学指征性剖宫产的最强预测因素。然而，我们发现指征性和非指征性剖宫产的危险因素存在显著差异。尽管有证据表明手术分娩会增加女性及其子女发病和死亡的风险，但在美国，手术分娩的发生率仍然很高。有必要减少非医学指征性剖宫产的数量，以降低女性及其婴儿在整个生命历程中出现有害健康后果的短期和长期风险。医疗保健提供者应关注医学指征性剖宫产的危险因素，以优化低风险分娩方式，提高儿童及其母亲的生存率、健康水平和幸福感。
