School of Nutrition, Federal University of Bahia (UFBA), Araújo Pinho - No. 32, Canela, Salvador, Bahia, Brazil.
Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil.
BMC Pregnancy Childbirth. 2023 Aug 3;23(1):562. doi: 10.1186/s12884-023-05807-y.
Cesarean section (CS) rates are increasing worldwide and are associated with negative maternal and child health outcomes when performed without medical indication. However, there is still limited knowledge about the association between high CS rates and early-term births. This study explored the association between CSs and early-term births according to the Robson classification.
A population-based, cross-sectional study was performed with routine registration data of live births in Brazil between 2012 and 2019. We used the Robson classification system to compare groups with expected high and low CS rates. We used propensity scores to compare CSs to vaginal deliveries (1:1) and estimated associations with early-term births using logistic regression.
A total of 17,081,685 live births were included. Births via CS had higher odds of early-term birth (OR 1.32; 95% CI 1.32-1.32) compared to vaginal deliveries. Births by CS to women in Group 2 (OR 1.50; 95% CI 1.49-1.51) and 4 (OR 1.57; 95% CI 1.56-1.58) showed the highest odds of early-term birth, compared to vaginal deliveries. Increased odds of an early-term birth were also observed among births by CS to women in Group 3 (OR 1.30, 95% CI 1.29-1.31), compared to vaginal deliveries. In addition, live births by CS to women with a previous CS (Group 5 - OR 1.36, 95% CI 1.35-1.37), a single breech pregnancy (Group 6 - OR 1.16; 95% CI 1.11-1.21, and Group 7 - OR 1.19; 95% CI 1.16-1.23), and multiple pregnancies (Group 8 - OR 1.46; 95% CI 1.40-1.52) had high odds of an early-term birth, compared to live births by vaginal delivery.
CSs were associated with increased odds of early-term births. The highest odds of early-term birth were observed among those births by CS in Robson Groups 2 and 4.
剖宫产率在全球范围内呈上升趋势，当无医学指征时进行剖宫产会对母婴健康产生负面影响。然而，对于高剖宫产率与早产之间的关系，我们的了解仍然有限。本研究根据罗伯逊分类法探讨了剖宫产与早产之间的关系。
这是一项基于人群的横断面研究，使用了 2012 年至 2019 年巴西活产儿的常规登记数据。我们使用罗伯逊分类系统比较了预期剖宫产率高和低的组。我们使用倾向评分将剖宫产与阴道分娩（1:1）进行比较，并使用逻辑回归估计与早产的关联。
共纳入 17081685 例活产儿。与阴道分娩相比，剖宫产的早产几率更高（OR 1.32；95%CI 1.32-1.32）。与阴道分娩相比，罗伯逊分类法第 2 组（OR 1.50；95%CI 1.49-1.51）和第 4 组（OR 1.57；95%CI 1.56-1.58）的产妇剖宫产分娩的早产几率最高。与阴道分娩相比，罗伯逊分类法第 3 组（OR 1.30；95%CI 1.29-1.31）的产妇剖宫产分娩的早产几率也有所增加。此外，与阴道分娩相比，有剖宫产史的产妇（第 5 组-OR 1.36；95%CI 1.35-1.37）、单臀位妊娠（第 6 组-OR 1.16；95%CI 1.11-1.21）、多胎妊娠（第 8 组-OR 1.46；95%CI 1.40-1.52）的产妇剖宫产分娩的早产几率也较高。
剖宫产与早产几率增加有关。在罗伯逊分类法第 2 组和第 4 组中，剖宫产分娩的早产几率最高。
