Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America.
The Kaiser Permanente Northern California Medical Group, Oakland, California, United States of America.
PLoS One. 2018 Jul 3;13(7):e0199932. doi: 10.1371/journal.pone.0199932. eCollection 2018.
Maternal cardiometabolic risk factors (i.e., hyperglycemia, pre-existing hypertension and high body mass index) impact fetal growth and risk of having a cesarean delivery. However, the independent and joint contribution of maternal cardiometabolic risk factors to primary cesarean section is unclear. We aimed to elucidate the degree to which maternal cardiometabolic risk factors contribute to primary cesarean deliveries and whether associations vary by infant size at birth in an integrated health system.
A cohort study of 185,045 singleton livebirths from 2001 to 2010. Poisson regression with robust standard errors provided crude and adjusted relative risks (RR) and 95% confidence intervals (CIs) for cesarean delivery risk associated with risk factors. We then estimated the proportion of cesarean sections that could be prevented if the cardiometabolic risk factor in pregnant women were eliminated (the population-attributable risk [PAR]).
In a single multivariable model, maternal cardiometabolic risk factors were independently associated with cesarean delivery: RR (95% CI) abnormal glucose screening 1.04 (1.01-1.08); gestational diabetes 1.18 (1.11-1.18) and pre-existing diabetes 1.60 (1.49-1.71); pre-existing hypertension 1.16 (1.10-1.23); overweight 1.27 (1.24-1.30); obese class I 1.46 (1.42-1.51); obese class II 1.73 (1.67-1.80); and obese class III 1.97 (1.88-2.07); adjusting for established risk factors, medical facility and year. The associations between maternal cardiometabolic risk factors and primary cesarean delivery remained among infants with appropriate weights for gestational age. The PARs were 17.4% for overweight/obesity, 7.0% for maternal hyperglycemia, 2.0% for pre-existing hypertension and 20.5% for any cardiometabolic risk factor.
Maternal cardiometabolic risk factors were independently associated with risk of primary cesarean delivery, even among women delivering infants born at an appropriate size for gestational age. Effective strategies to increase the proportion of women entering pregnancy at an optimal weight with normal blood pressure and glucose before pregnancy could potentially eliminate up to 20% of cesarean deliveries.
母体心脏代谢危险因素（如高血糖、孕前高血压和高身体质量指数）会影响胎儿生长和剖宫产的风险。然而，母体心脏代谢危险因素对初次剖宫产的独立和联合贡献尚不清楚。我们旨在阐明母体心脏代谢危险因素在综合医疗体系中对初次剖宫产的贡献程度，以及这些关联是否因出生时婴儿大小而异。
这是一项对 2001 年至 2010 年间 185045 例单胎活产儿的队列研究。应用泊松回归和稳健标准误差，提供了与危险因素相关的剖宫产风险的粗相对风险（RR）和 95%置信区间（CI）。然后，我们估计如果消除孕妇心脏代谢危险因素，可预防多少比例的剖宫产（人群归因风险[PAR]）。
在单一多变量模型中，母体心脏代谢危险因素与剖宫产独立相关：RR（95%CI）异常葡萄糖筛查 1.04（1.01-1.08）；妊娠期糖尿病 1.18（1.11-1.18）和孕前糖尿病 1.60（1.49-1.71）；孕前高血压 1.16（1.10-1.23）；超重 1.27（1.24-1.30）；肥胖 I 级 1.46（1.42-1.51）；肥胖 II 级 1.73（1.67-1.80）；肥胖 III 级 1.97（1.88-2.07）；调整了已确立的危险因素、医疗机构和年份。母体心脏代谢危险因素与初次剖宫产之间的关联在出生时体重与胎龄相称的婴儿中仍然存在。超重/肥胖的 PAR 为 17.4%，母体高血糖为 7.0%，孕前高血压为 2.0%，任何心脏代谢危险因素为 20.5%。
母体心脏代谢危险因素与初次剖宫产风险独立相关，即使在出生时婴儿体重与胎龄相称的女性中也是如此。制定有效的策略，增加更多女性在怀孕前体重处于理想状态、血压和血糖正常的比例，可能会使高达 20%的剖宫产得以避免。
