546: Singletons delivered by elective cesarean delivery at term have an increased risk of long-term endocrine morbidity

Abstract

To determine whether elective cesarean delivery (CD) has an impact on the risk of long-term endocrine and metabolic morbidity of the offspring. A population-based cohort analysis was performed including all singleton term deliveries occurring between 1991-2014 at a single tertiary medical center. A comparison was performed between children delivered via a non-emergent (“elective”) CD and those delivered vaginally. Maternal thyroid disease, diabetes and hypertension, preterm deliveries, multiple gestation, and fetuses with congenital malformations were excluded. All cases of urgent CD were excluded from the analysis. Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. A Cox regression model was used to control for confounders. During the study period 131 880 term deliveries met the inclusion criteria; 8.9% were elective non-urgent CDs (n=11 768) and 91.0% (n=120 112) were vaginal deliveries. Selected pediatric endocrine and metabolic morbidities of the offspring according to mode of delivery are presented in the Table. Crude hospitalization rate due to hypoglycemia was significantly higher in the elective CD group (p=0.023). Total endocrine and metabolic hospitalization incidence per follow up years was higher as well (HR= 1.51, 95%CI 1.13-2.03). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of endocrine and metabolic morbidity in the offspring born via CD (Figure, log rank p=0.010). In the Cox proportional hazards model, while controlling for confounders such as maternal age and birth weight, CD was noted as an independent risk factor for long-term pediatric endocrine and metabolic morbidity of the offspring (adjusted HR=1.37, 95% CI 1. 01-1.86, p=0.041). Singletons delivered by an elective CD at term are at an increased risk of long-term pediatric endocrine and metabolic morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)