Abstract
BackgroundCesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery.MethodsWe used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally.ResultsWe found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy.ConclusionsAfter accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.
Highlights
Cesarean delivery accounts for nearly one-third of all births in the U.S and contributes to an additional $38 billion in healthcare costs each year
Our study contributes to the literature by relying on the conditional randomness of fetal malpresentation to isolate the causal impact of Cesarean delivery on maternal postpartum weight
As we point out above, in order for fetal malpresentation to serve as a natural experiment for measuring the effect of Cesarean delivery on postpartum weight, occurrence of fetal malplresentation must be uncorrelated with the mother’s weight prior to pregnancy and gestational weight gain, as well as with any other obesity risk factors and maternal characteristics that might have a direct influence on maternal post-pregnancy weight
Summary
Cesarean delivery accounts for nearly one-third of all births in the U.S and contributes to an additional $38 billion in healthcare costs each year. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Evidence suggests Cesarean delivery when not medically indicated leads to negative health outcomes - longer postpartum recovery [6], higher rates of re-hospitalization [7], longer hospital stays [8] and greater risk of maternal morbidity [9]. Beyond the impact on the Several observational studies have documented evidence of an association between Cesarean delivery and subsequent maternal weight. One study using US vital statistics records reported a nearly 40% increase in the adjusted odds of Cesarean delivery for women who gained more than 40 lb during pregnancy [13]
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