Enmeier Mackenzie, Stephenson Elise, Prince Jordyn, Markey Caroline, Phung Binh, Hartwell Micah
Department of Obstetrics and Gynecology, 8586 University of Kansas School of Medicine-Wichita , Wichita, KS, USA.
Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
J Osteopath Med. 2025 May 22. doi: 10.1515/jom-2024-0060.
Cesarean sections (CSs) can reduce maternal and fetal risk in medically necessary cases. However, studies show that CSs are associated with negative fetal outcomes, including birth defects, low birth weight, delayed fetal resuscitation, neonatal acidosis, and even infant mortality. Maternal comorbidities play a role in determining if a CS is necessary and may contribute to negative fetal outcomes following a CS.
The primary objective of this study was to determine the prevalence of negative fetal outcomes such as low birth weight, birth defects, prolonged hospital stay, and infant mortality in CS deliveries and their increased risk of occurrence among mothers with comorbidities.
We conducted a cross-sectional study of the Phase 8 (2016-2019) Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the associations of the aforementioned birth outcomes with pre-existing conditions such as high blood pressure (HBP), depression, and type II diabetes mellitus, as well as demographic factors in the United States (US).
Our findings showed that mothers who delivered via CS with pre-existing or gestational HBP, or gestational diabetes, were less likely to experience infant mortality (adjusted odds ratio [AOR]: 0.4; confidence interval [CI]: 0.17-0.92, AOR: 0.2; CI: 0.09-0.44, and AOR: 0.09; CI: 0.03-0.33, respectively). However, mothers who delivered via CS with pre-existing or gestational diabetes, pre-existing or gestational HBP, or pre-existing or gestational depression had higher rates of prolonged infant hospital stay (AOR: 1.73; CI: 1.41-2.11, AOR: 1.21; CI: 1.05-1.39, AOR: 1.77; CI: 1.5-2.09, AOR: 2.58; CI: 2.31-2.88, AOR: 1.25; CI: 1.09-1.43 and AOR: 1.33; CI: 1.16-1.52, respectively). Likewise, mothers who delivered via CS with pre-existing or gestational HBP, or pre-existing or gestational depression, were more likely to deliver an infant with low birth weight (AOR: 1.88; CI: 1.62-2.19, AOR: 2.7; CI: 2.45-2.98, AOR: 1.24; CI: 1.09-1.41, and OR: 1.28; CI: 1.14-1.42, respectively).
Our study revealed a lower incidence of infant mortality following CS deliveries among mothers with pre-existing or gestational HBP, or gestational diabetes. This suggests a potential benefit in antenatal testing in mothers experiencing depression or those with no comorbidities. Additionally, infants born to mothers with these comorbidities experienced longer hospital stays, and infants of mothers with pre-existing or gestational HBP and depression had a higher incidence of low birth weight. Given the increasing rates of diabetes, HBP, and depression in the US, it is crucial to provide healthcare professionals with the necessary guidance to prevent and manage these comorbidities and improve fetal outcomes following CS deliveries.
剖宫产在医疗必要的情况下可以降低母婴风险。然而，研究表明，剖宫产与不良胎儿结局相关，包括出生缺陷、低出生体重、胎儿复苏延迟、新生儿酸中毒，甚至婴儿死亡。孕产妇合并症在决定是否有必要进行剖宫产时起作用，并且可能导致剖宫产术后出现不良胎儿结局。
本研究的主要目的是确定剖宫产分娩中低出生体重、出生缺陷、住院时间延长和婴儿死亡等不良胎儿结局的发生率，以及这些结局在合并症母亲中的发生风险增加情况。
我们对第8阶段（2016 - 2019年）妊娠风险评估监测系统（PRAMS）进行了横断面研究，以评估上述出生结局与美国高血压（HBP）、抑郁症和II型糖尿病等既往疾病以及人口统计学因素之间的关联。
我们的研究结果表明，患有既往或妊娠期高血压或妊娠期糖尿病且通过剖宫产分娩的母亲，婴儿死亡的可能性较小（调整后的优势比[AOR]：0.4；置信区间[CI]：0.17 - 0.92，AOR：0.2；CI：0.09 - 0.44，以及AOR：0.09；CI：0.03 - 0.33）。然而，患有既往或妊娠期糖尿病、既往或妊娠期高血压或既往或妊娠期抑郁症且通过剖宫产分娩的母亲，婴儿住院时间延长的发生率较高（AOR：1.73；CI：1.41 - 2.11，AOR：1.21；CI：1.05 - 1.39，AOR：1.77；CI：1.5 - 2.09，AOR：2.58；CI：2.31 - 2.88，AOR：1.25；CI：1.09 - 1.43和AOR：1.33；CI：1.16 - 1.52）。同样，患有既往或妊娠期高血压或既往或妊娠期抑郁症且通过剖宫产分娩的母亲，分娩低出生体重婴儿的可能性更大（AOR：1.88；CI：1.62 - 2.19，AOR：2.7；CI：2.45 - 2.98，AOR：1.24；CI：1.09 - 1.41，以及OR：1.28；CI：1.14 - 1.42）。
我们的研究显示，患有既往或妊娠期高血压或妊娠期糖尿病的母亲剖宫产分娩后婴儿死亡率较低。这表明对患有抑郁症或无合并症的母亲进行产前检查可能有益。此外，患有这些合并症的母亲所生婴儿住院时间更长，患有既往或妊娠期高血压及抑郁症的母亲所生婴儿低出生体重的发生率更高。鉴于美国糖尿病、高血压和抑郁症的发病率不断上升，为医护人员提供必要的指导以预防和管理这些合并症并改善剖宫产分娩后的胎儿结局至关重要。
