168: Does elective cesarean delivery affect long-term cardiovascular morbidity of the offspring?

Abstract

To determine whether cesarean delivery (CD) has an impact on the risk of long-term cardiovascular morbidity of the offspring. A population-based cohort analysis was performed including all singleton deliveries occurring between 1991-2013 at a single tertiary medical center. A comparison was performed between children delivered via CD and those delivered vaginally. Multiple gestation and fetuses with cardiac as well as other congenital malformations were excluded. All cases of urgent CD due to non-reassuring fetal status, non-progressive labor, prolapse of cord, preeclampsia, placenta previa, placental abruption, gestational diabetes, labor induction and failed induction, fetal growth restriction, preterm PROM, and instrumental deliveries, were excluded from the analysis. Hospitalizations of the offspring up to the age of 18 years involving cardiovascular morbidity, including hypertensive disorders, arrhythmia, ischemia, valvular disorders, rheumatic fever, pulmonary heart disease, endocarditis etc. were evaluated. A Kaplan-Meier survival curve was used to compare cumulative cardiovascular morbidity incidence. A Cox regression model was used to control for confounders. During the study period 138 910 deliveries met the inclusion criteria; 9.5% were CDs (n=13 206) and 90.5% (n=125 704) were vaginal deliveries. Hospitalizations up to the age of 18 years involving cardiovascular disorders were comparable between offspring delivered by CD (0.6%, n=81) and those delivered vaginally (0.6%, n=733; p=0.665). However, the Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of cardiovascular morbidity following CD (Figure, log rank p=0.018). Using the Cox proportional hazards model, controlling for confounders such as maternal age, preterm delivery and birth weight, CD was noted as an independent risk factor for long-term pediatric cardiovascular morbidity (adjusted HR=1.3, CI 1.01-1.6, p=0.049). Singletons delivered by CD have an increased risk of long-term cardiovascular morbidity.