Outcomes of Mothers and Children at Five Years After Cesarean Versus Vaginal Delivery [22E

Abstract

INTRODUCTION: The objective of this study was to determine whether outcomes of mothers and children at five years vary after cesarean versus vaginal delivery. METHODS: TRICARE (universal insurance coverage to all members of US Armed Services and their dependents) data was used to identify mother-infant pairs who delivered between 2007 and 2009 and had continuous enrollment for 5 years. Maternal complications (chronic pelvic pain, endometriosis, fistula, prolapse), and infant complications (asthma, acute respiratory illness (ARI) (>2/year), chronic respiratory illness (CRI), gastrointestinal allergies) within five years were compared between women delivered via cesarean as compared with those with a vaginal delivery using logistic regression adjusted for demographic, clinical and hospital characteristics. RESULTS: A total of 141,317 mother-infant pairs were identified:105,980 (74.9%) had a vaginal delivery and 35,337 (25.1%) had a cesarean delivery. Women with gestational diabetes (8.7%vs.4.9%) and pregnancy-related hypertension (17.3%vs.8.3%) were more likely to have had a cesarean delivery (p<0.001 for both). Mothers who had a cesarean delivery were more likely to have chronic pelvic pain (13.9%vs.4.6%, OR[CI]: 4.07[3.61-4.47]) and endometriosis (4.2%vs.2.9%, OR[CI]: 1.59[1.32-1.91]) within 5 years of delivery. Similarly, children born via a cesarean delivery were more likely to have asthma (OR[CI]:1.16[1.02-1.64]), ARI(OR[CI]: 1.19[1.13-1.37]) and CRI(OR[CI]: 1.16[1.04-1.29]) within 5 years of delivery. CONCLUSION: Cesarean delivery is associated an increased risk of maternal complications (chronic pain, endometriosis) and infant complications (asthma and acute/chronic respiratory illness) within the first 5 years of delivery. Such findings can inform decisions about mode of delivery, when cesarean delivery is not otherwise indicated.