Department of Anthropology, University of Vienna, A-1090 Vienna, Austria.
Clinic for Gynaecology and Obstetrics, Danube Hospital, A-1220 Vienna, Austria.
Int J Environ Res Public Health. 2018 Dec 21;16(1):14. doi: 10.3390/ijerph16010014.
Caesarean section (CS) rates are increasing in many parts of the world, recently reaching about 20% worldwide. The postmodern lifestyle characteristics, obesity and delayed childbirth, have been put forward as the main reasons for high CS rates. The present study tests the association patterns between lifestyle parameters and delivery mode on a data set of 3786 births in Vienna between 2005 and 2013. The focus is exclusively on singleton term births. As well as maternal age, prepregnancy weight status, maternal body height and gestational weight gain, newborn size (birth weight, birth length, and head circumference), Apgar scores and child presentation were recorded. Planned as well as emergency CS rates increased significantly ( < 0.0001) with increasing maternal age and decreasing maternal body height. Emergency CS rates, however, increased significantly with increasing maternal prepregnancy weight status and gestational weight gain. An especially high risk of emergency CS occurred among four groups of mothers: those older than 40 years (OR = 2.68; 95% CI 1.87⁻3.86), those who were obese (OR = 1.44; 95% 1.15⁻1.81), those experiencing a gestational weight gain above 15 kg (OR = 1.32; 95% CI 1.13⁻1.54), and those shorter than 160 cm (OR = 1.216; 95% CI 1.02⁻1.45). Emergency CS rates were significantly higher among low-weight newborns (<2500 g) and macrosome newborns (>4000 g) than among normal-weight newborns. Furthermore, breech presentation was associated with an increased risk of caesarean delivery (OR 6.97; 95% CI 6.09⁻7.96). Logistic regression analyses reveal that maternal age, maternal body height, prepregnancy weight status, gestational weight gain, birth weight, newborn head circumference and child presentation show an independent, highly significant association with caesarean delivery. We conclude that maternal and newborn characteristics typical of recent lifestyle patterns, such as advanced maternal age, obesity, increased gestational weight gain and increased newborn size, are highly significantly associated with increased emergency CS rates. Moreover, maternal shortness and breech presentation are risk factors for emergency CS.
剖宫产率在世界许多地区呈上升趋势，最近全球已达到约 20%。后现代生活方式的特点、肥胖和分娩推迟被认为是剖宫产率高的主要原因。本研究在 2005 年至 2013 年期间对维也纳的 3786 例分娩数据进行了生活方式参数与分娩方式之间关联模式的检验。研究仅关注单胎足月分娩。除了产妇年龄、孕前体重状况、产妇身高和孕期体重增加外，还记录了新生儿大小（出生体重、出生体长和头围）、阿普加评分和分娩方式。计划剖宫产率和紧急剖宫产率随着产妇年龄的增加和产妇身高的降低显著增加（<0.0001）。然而，紧急剖宫产率随着产妇孕前体重状况和孕期体重增加的增加而显著增加。紧急剖宫产的高风险尤其发生在四组产妇中：年龄大于 40 岁的产妇（OR=2.68；95%CI 1.87⁻3.86）、肥胖的产妇（OR=1.44；95%CI 1.15⁻1.81）、孕期体重增加超过 15kg 的产妇（OR=1.32；95%CI 1.13⁻1.54）和身高低于 160cm 的产妇（OR=1.216；95%CI 1.02⁻1.45）。新生儿体重较轻（<2500g）和巨大儿（>4000g）的紧急剖宫产率明显高于体重正常的新生儿。此外，臀位分娩与剖宫产风险增加相关（OR 6.97；95%CI 6.09⁻7.96）。Logistic 回归分析显示，产妇年龄、产妇身高、孕前体重状况、孕期体重增加、新生儿体重、新生儿头围和分娩方式与剖宫产独立显著相关。我们得出结论，近期生活方式特点的产妇和新生儿特征，如高龄产妇、肥胖、孕期体重增加和新生儿大小增加，与紧急剖宫产率的增加高度相关。此外，产妇身材矮小和臀位分娩是紧急剖宫产的危险因素。
