ACOG 2018—Cesarean delivery tied to increased maternal, child complications within 5 years

  • Emily Willingham, PhD
  • Conference Reports
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  • Compared with vaginal delivery, cesarean delivery (CD) is tied to increased risk within 5 years for chronic pelvic pain and endometriosis for women and greater risk for asthma and gastrointestinal (GI) allergy for children.

Why this matters

  • At the conference, 2 experts debated the merits of reducing the CD rate.
  • A real-time audience poll following the debate found that 73% agreed that "vaginal delivery is safer for mom and baby."
  • Baha M. Sibai, MD, from the University of Texas, Houston, argued against active reduction. "The increase in rate of cesarean is appropriate and necessary," he said, in part because of increases in pregnant women's ages, BMI, and comorbidities. 
  • Neel T. Shah, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts, argued for reducing CD rates where possible: "In 2018, what’s normal is that 1 in 3 Americans are getting major surgery to give birth, and 1 in 10 of those babies go into the [neonatal ICU]. I think we can absolutely do better than that." 

Key results

  • 144,039 mother-infant pairs (105,980 with vaginal delivery).
  • CD delivery group more likely to have had hypertension, diabetes, high-risk pregnancy.
  • With CD, for women, aOR (95% CI) values were as follows:
    • Chronic pelvic pain: 4.02 (3.61-4.47), P=.000;
    • Endometriosis: 1.59 (1.32-1.91), P=.000;
    • Severe acute maternal morbidity: 2.48 (2.27-2.71), P=.000;
    • Postpartum depression: 1.15 (1.08-1.21), P=.000;
    • Postpartum hemorrhage: 0.81 (0.76-0.87), P=.000; and
    • Incontinence: 0.37 (0.23-0.59), P=.000.
  • For children, CD delivery was tied to:
    • Asthma: 1.16 (1.02-1.64), P=.016; 
    • Acute respiratory illness
    • Chronic respiratory illness: 1.16 (1.04-1.29), P=.000; and
    • GI allergies: 1.40 (1.08-1.81), P=.000.
    • Pervasive disorder was not significant: 1.26 (0.96-1.64), P=.089. 

Study design

  • Tricare insurance cohort.
  • Funding: No conflicts of interest reported.  


  • Observational, no causation established.

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