The Second Department of Obstetrics, Cangzhou Central Hospital, NO.16 Xinhua Road, Yunhe District, Cangzhou City, 061000, Hebei Province, China.
Reprod Health. 2018 May 24;15(1):84. doi: 10.1186/s12978-018-0544-1.
The goal was to study whether higher physical activity can increase the success rate of Vaginal Birth after Cesarean Delivery (VBAC).
We enrolled 823 patients with previous cesarean section delivery history (between January 2015 and December 2017) and measured their physical activity during pregnancy. A final number of 519 patients were included for the trial of labor after cesarean delivery (TOLAC). All patients signed informed consent forms.
We conducted bivariate analyses and identified that several variables were associated with successful VBAC: Prior history of vaginal birth (odds ratio [OR] 2.4, 95% CI 1.8-3.9); previous indication for primary cesarean delivery (OR 2.2, 95% CI 1.5-3.0); age younger than 40 years (OR 2.1, 95% CI 1.3-3.4); Weight gain less than 20 kg (OR 1.5, 95% CI 1.3-2.4); high pelvic/birth weight score (OR 1.4, 95% CI 1.1-2.0); no induction of labor (OR 1.9, 95% CI 1.4-2.8); and estimated prenatal fetal weight (OR 1.4, 95% CI 1.2-1.5). We also found that the bivariate association between physical activity and VBAC was significant (p = 0.002). In addition, there was higher odds of VBAC in women who had active physical activity of more than 150 min/week (adjusted OR 1.86, 95% CI 1.69-2.07). Lower odds of VBAC was associated with older age, weight gain during pregnancy, induction of labor, and having estimated prenatal fetal weight more than 3500 g.
Physical activity during pregnancy may influence the success rate of VBAC in Chinese women. Future studies will be needed to prove the robustness of this association using more detailed exposure and outcome definitions.
本研究旨在探讨较高的身体活动水平是否能提高剖宫产后阴道分娩（VBAC）的成功率。
我们招募了 823 名有剖宫产史的患者（2015 年 1 月至 2017 年 12 月），并测量了她们在怀孕期间的身体活动量。共有 519 名患者符合剖宫产术后试产（TOLAC）的条件。所有患者均签署了知情同意书。
我们进行了双变量分析，并发现一些变量与 VBAC 成功相关：阴道分娩史（优势比[OR] 2.4，95%置信区间[CI] 1.8-3.9）；初次剖宫产指征（OR 2.2，95% CI 1.5-3.0）；年龄小于 40 岁（OR 2.1，95% CI 1.3-3.4）；体重增加小于 20kg（OR 1.5，95% CI 1.3-2.4）；骨盆/出生体重评分高（OR 1.4，95% CI 1.1-2.0）；未引产（OR 1.9，95% CI 1.4-2.8）；估计产前胎儿体重（OR 1.4，95% CI 1.2-1.5）。我们还发现，身体活动与 VBAC 的双变量关联具有统计学意义（p=0.002）。此外，每周进行超过 150 分钟的积极身体活动的女性 VBAC 成功率更高（调整后的 OR 1.86，95% CI 1.69-2.07）。VBAC 成功率较低与年龄较大、孕期体重增加、引产以及产前估计胎儿体重超过 3500g 有关。
孕期身体活动可能会影响中国女性 VBAC 的成功率。未来需要进一步研究，使用更详细的暴露和结局定义来证明这种关联的稳健性。
