Epidemiology Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Mitro, Mills, Qiao, Cifuentes, and Grantz); Kaiser Permanente Northern California Division of Research, Oakland, CA (Mitro).
Biostatistics and Bioinformatics Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Sundaram).
Am J Obstet Gynecol MFM. 2024 Nov;6(11):101498. doi: 10.1016/j.ajogmf.2024.101498. Epub 2024 Sep 19.
Pregnancy complications have been recognized as a window to future health. Though cesarean delivery is common, it is unknown whether labor duration and mode of delivery are associated with maternal long-term mortality.
To examine whether labor duration and mode of delivery were associated with all-cause and cause-specific mortality.
Participants were mothers from the multisite Collaborative Perinatal Project (CPP) cohort (1959-1966; n=43,646, limited to last CPP delivery). We ascertained all-cause and specific causes of death as of 2016 via linkage to the National Death Index and Social Security Death Master File. Hazard ratios (HR) testing mode of delivery and labor duration were estimated using Cox proportional hazards models adjusted for demographic and clinical characteristics. We further stratified analyses by parity.
Among participants with a recorded delivery mode, 5.9% (2486/42,335) had a cesarean delivery. Participants who had a cesarean were older (26.9 vs 24.3 years), with higher body mass index (24.0 vs 22.7 kg/m), were less likely to be nulliparous (21% vs 30%), and more likely to have a household income of at least $6000 (22% vs 17%), to smoke ≥1 pack/d (18% vs 15%), to have diabetes mellitus (12% vs 1%) and to have a prior medical condition (47% vs 34%), compared to participants with a vaginal delivery. Delivery mode was similar by race/ethnicity, marital status, and education. Median labor duration was 395 minutes among participants who had an intrapartum cesarean delivery and 350 minutes among participants delivered vaginally. By 2016, 52.2% of participants with a cesarean delivery and 38.5% of participants with a vaginal delivery had died. Cesarean vs vaginal delivery was significantly associated with increased risk for all-cause mortality (HR=1.16 (95% confidence interval [CI]: 1.09, 1.23); in nulliparas, HR=1.27 (95% CI: 1.09, 1.47); in multiparas, HR=1.13 (95% CI: 1.06, 1.21) as well as increased risk of death from cardiovascular disease, diabetes, respiratory disease, infection, and kidney disease. Associations with death from cardiovascular disease, infection, and kidney disease were stronger for multiparas than nulliparas, though the association with death from diabetes was stronger among nulliparas. Labor duration was not significantly related to overall mortality.
In a historic United States cohort with a low cesarean delivery rate, cesarean delivery was an indicator for subsequent increased mortality risk, particularly related to cardiovascular disease and diabetes. Future studies with long-term follow-up are warranted given the current high prevalence of cesarean delivery.
妊娠并发症已被认为是未来健康的一个窗口。虽然剖宫产很常见，但尚不清楚分娩持续时间和分娩方式是否与产妇的长期死亡率有关。
研究分娩持续时间和分娩方式是否与全因死亡率和死因特异性死亡率有关。
参与者为多地点协作围产期项目（CPP）队列（1959-1966 年；n=43646，仅限于最后一次 CPP 分娩）中的母亲。我们通过与国家死亡指数和社会保障死亡主文件链接，确定截至 2016 年的全因和特定死因死亡。使用 Cox 比例风险模型估计风险比（HR）检测分娩方式和分娩持续时间，该模型根据人口统计学和临床特征进行了调整。我们进一步按产次进行分层分析。
在有记录的分娩方式的参与者中，5.9%（2486/42335）行剖宫产。行剖宫产的参与者年龄更大（26.9 岁 vs 24.3 岁），体重指数更高（24.0 千克/平方米 vs 22.7 千克/平方米），初产妇比例较低（21% vs 30%），家庭收入至少为 6000 美元的比例较高（22% vs 17%），吸烟≥1 包/天的比例较高（18% vs 15%），糖尿病的比例较高（12% vs 1%），既往病史的比例较高（47% vs 34%），与阴道分娩的参与者相比。种族/民族、婚姻状况和教育程度对分娩方式的影响相似。行产时剖宫产的参与者的中位分娩持续时间为 395 分钟，行阴道分娩的参与者的中位分娩持续时间为 350 分钟。截至 2016 年，52.2%行剖宫产的参与者和 38.5%行阴道分娩的参与者已经死亡。与阴道分娩相比，剖宫产与全因死亡率增加显著相关（HR=1.16（95%置信区间[CI]：1.09，1.23）；在初产妇中，HR=1.27（95% CI：1.09，1.47）；在经产妇中，HR=1.13（95% CI：1.06，1.21）；与心血管疾病、糖尿病、呼吸道疾病、感染和肾脏疾病导致的死亡率增加也相关。与心血管疾病、感染和肾脏疾病相关的死亡风险在经产妇中比初产妇中更强，尽管糖尿病相关死亡的风险在初产妇中更强。分娩持续时间与总体死亡率无显著相关性。
在一个美国历史队列中，剖宫产率较低，剖宫产是随后增加死亡率风险的一个指标，特别是与心血管疾病和糖尿病有关。鉴于目前剖宫产的高流行率，需要进行长期随访的未来研究。
