Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis
PLOS x Published: January 23, 2018 https://doi.org/10.1371/journal.pmed.1002494
Oonagh E. Keag, Jane E. Norman, Sarah J. Stock
| Health Problem | Which birth | Increased Risk |
| Asthma | Current | 21 % |
| Obesity – age 5 | Current | 59 % |
| Miscarriage | Future | 17 % |
| Stillbirth | Future | 27 % |
| Placenta previa - typically 3% | Future | 74 % |
| Placenta accreta- typically 1 in 3,000 | Future | 295 % |
Noted by VitaminDWiki
- The first 4 items above, as well as Caesarean, are each strongly related to low vitamin D
- Suspect the women at high risk for Vitamin D deficiencyy have more Caesareans and the associated health problems
Dark Skin, Obese, little access to sun, etc.
see Dark skin pregnancies and Vitamin D - many studies - The word VITAMIN does not occur once in the PDF
See also VitaminDWiki
- Risk of Cesarean 2X higher if low vitamin D – April 2012
- Caesarean birth much more likely if low Vitamin D - many studies
- Unplanned c-section birth 40 percent less often if sufficient vitamin D – Sept 2014
- Caesarean emergency risk 2 X higher for Indian women with low Vitamin D – Nov 2015
- c-section OR "caesarean section" (various spellings) 340 items as of Jan 2018
- Miscarriage 2 times more likely if low vitamin D – meta-analysis May 2017
- Overweight children associated with low vitamin D during pregnancy – 2015, 2018
- Overview Asthma and Vitamin D
- Risk of infant Asthma cut in half if mother supplemented Vitamin D to get more than 30 ng – RCT Oct 2017
Healthy pregnancies need lots of vitamin D has the following summary
Most were taking 2,000 to 7,000 IU daily for >50% of pregnancy
Click on hyperlinks for details
Problem | Vit. D Reduces | Evidence |
| 0. Chance of not conceiving | 3.4 times | Observe |
| 1. Miscarriage | 2.5 times | Observe |
| 2. Pre-eclampsia | 3.6 times | RCT |
| 3. Gestational Diabetes | 3 times | RCT |
| 4. Good 2nd trimester sleep quality | 3.5 times | Observe |
| 5. Premature birth | 2 times | RCT |
| 6. C-section - unplanned | 1.6 times | Observe |
| Stillbirth - OMEGA-3 | 4 times | RCT - Omega-3 |
| 7. Depression AFTER pregnancy | 1.4 times | RCT |
| 8. Small for Gestational Age | 1.6 times | meta-analysis |
| 9. Infant height, weight, head size within normal limits | RCT | |
| 10. Childhood Wheezing | 1.3 times | RCT |
| 11. Additional child is Autistic | 4 times | Intervention |
| 12.Young adult Multiple Sclerosis | 1.9 times | Observe |
| 13. Preeclampsia in young adult | 3.5 times | RCT |
| 14. Good motor skills @ age 3 | 1.4 times | Observe |
| 15. Childhood Mite allergy | 5 times | RCT |
| 16. Childhood Respiratory Tract visits | 2.5 times | RCT |
RCT = Randomized Controlled Trial
Download the PDF from VitaminDWiki
Chart shows 60 % less likely to have future pregnancies/births
Background
Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death.
Methods and findings
Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%).
One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies).
- Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and
- obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies).
Pregnancy after cesarean delivery was associated with increased risk of
- miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and
- stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies), but
- not perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies).
Pregnancy following cesarean delivery was associated with increased risk of
- placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies),
- placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and
- placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies).
This is a comprehensive review adhering to a registered protocol, and guidelines for the Meta-analysis of Observational Studies in Epidemiology were followed, but it is based on predominantly observational data, and in some meta-analyses, between-study heterogeneity is high; therefore, causation cannot be inferred and the results should be interpreted with caution.
Conclusions
When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery.
Lots of supporting data files and figures are online
- S1 Protocol.
- S1 Moose Checklist.
- S1 Table. Search strategy.
- S2 Table. Maternal outcomes—Study characteristics.
- S3 Table. Childhood outcomes—Study characteristics.
- S4 Table. Subsequent pregnancy outcomes—Study characteristics.
- S5 Table. Risk of bias assessment tool for Non-randomized studies.
- S6 Table. Non-prespecified childhood outcomes after cesarean delivery compared to vaginal delivery.
- S7 Table. Summary of associations and numbers needed to treat for benefit or harm.
- S1 Fig. Study flow diagram of maternal outcomes database search.
- S2 Fig. Study flow diagram of childhood outcomes database search.
- S3 Fig. Study flow diagram of subsequent pregnancy outcomes database search.
- S4 Fig. A random effects meta-analysis of urinary incontinence after cesarean delivery compared to vaginal delivery.
- S5 Fig. A random effects meta-analysis of pelvic organ prolapse after cesarean delivery compared to vaginal delivery.
- S6 Fig. A random effects meta-analysis of fecal incontinence after cesarean delivery compared to vaginal delivery.
- S7 Fig. A fixed effects meta-analysis of pelvic pain after cesarean delivery compared to vaginal delivery.
- S8 Fig. A random effects meta-analysis of no further pregnancy up to 28 years after cesarean delivery compared with vaginal delivery.
- S9 Fig. A random effects meta-analysis of asthma in children up to 12 years old after cesarean delivery compared to vaginal delivery.
- S10 Fig. A random effects meta-analysis of asthma in adults after cesarean delivery compared to vaginal delivery.
- S11 Fig. A random effects meta-analysis of wheeze in children up to 5 years old after cesarean delivery compared to vaginal delivery.
- S12 Fig. A fixed effects meta-analysis of wheeze in children 6–15 years old after cesarean *delivery compared to vaginal delivery.
- S13 Fig. A random effects meta-analysis of hypersensitivity or allergy or dermatitis or atopy in children after cesarean delivery compared to vaginal delivery.
- S14 Fig. A random effects meta-analysis of children being overweight at 3–8 years old after cesarean delivery compared to vaginal delivery.
- S15 Fig. A random effects meta-analysis of obesity in children up to 5 years old after cesarean delivery compared to vaginal delivery.
- S16 Fig. A random effects meta-analysis of obesity in children 6–15 years old after cesarean delivery compared to vaginal delivery.
- S17 Fig. A fixed effects meta-analysis of adulthood obesity after cesarean delivery compared to vaginal delivery.
- S18 Fig. A fixed effects meta-analysis of inflammatory bowel disease in children and adults up to age 35 years after cesarean delivery compared to vaginal delivery.
- S19 Fig. A fixed effects meta-analysis of perinatal death in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S20 Fig. A random effects meta-analysis of placenta previa in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S21 Fig. A random effects meta-analysis of placenta accreta in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S22 Fig. A random effects meta-analysis of placental abruption in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S23 Fig. A random effects meta-analysis of uterine rupture in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S24 Fig. A random effects meta-analysis of miscarriage in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S25 Fig. A fixed effects meta-analysis of ectopic pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S26 Fig. A fixed effects meta-analysis of stillbirth in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S27 Fig. A random effects meta-analysis of hysterectomy in pregnancy after caesarean delivery compared to pregnancy after vaginal delivery.
- S28 Fig. A fixed effects meta-analysis of having antepartum haemorrhage in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S29 Fig. A random effects meta-analysis of postpartum haemorrhage in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S30 Fig. A random effects meta-analysis of preterm labour in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S31 Fig. A random effects meta-analysis of having a small for gestational age baby in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S32 Fig. A random effects meta-analysis of having a baby with low birthweight (<2,500 g) in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
- S33 Fig. A fixed effects meta-analysis of neonatal death following a pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.