1193: The combined influence of multiple maternal medical conditions on incidence of primary cesarean section

Abstract

Common maternal medical co-morbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, BMI, and gestational weight gain, are known individually to have impact on the rate of cesarean delivery. Numerous prior studies have estimated the risk of individual risk factors on cesarean delivery, but many parturients have more than one condition that may compound cesarean risk. We aim to examine the risk for cesarean delivery in women with multiple maternal medical co-morbidities to determine the cumulative risk they pose on pregnancy. In this retrospective cohort study we analyzed data from the Ohio live birth records from 2006-2015 with the goal to estimate the influence of individual and combinations of maternal co-morbidities on rates of primary cesarean delivery. The exposures were individual and combined maternal morbidities (chronic hypertension, gestational hypertension, pre-gestational diabetes, tobacco use, advanced maternal age, obesity, and insufficient gestational weight gain) and outcomes were rates and adjusted relative risk (aRR) of Cesarean. There were 1,463,506 live births in Ohio during the study period, of which 1,044,570 (71.3%) had one or more risk factor. The rate and aRR range of Cesarean delivery were 19.9-36.2% (aRR 1.15-1.96) in pregnancies with a single risk factor and this increased to 29.8-45.8% (aRR1.54-2.70) in pregnancies complicated by multiple medical co-morbidities, see figures. A greater number of maternal medical co-morbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data provide specific estimates of risk with a variety of combinations of medical co-morbidities, which may be used for patient counseling, risk stratification and pregnancy management planning.View Large Image Figure ViewerDownload Hi-res image Download (PPT)