Recent trends in cesarean delivery among women with obesity by race and ethnicity

Abstract

Cesarean deliveries have been decreasing in the United States over recent years; however, this may not be true among all patient populations. We sought to determine if cesarean deliveries are decreasing among women with obesity (body mass index (BMI) ≥30 kg/m2) and if there are disparities by race and ethnicity. This was a retrospective cohort study of deliveries in the United States between 2014-2018. Inclusion criteria were non-anomalous, singleton deliveries with gestational age ≥20 weeks and maternal BMI ≥30 kg/m2. Analyses were stratified by maternal race/ethnicity, including the following categories: non-Hispanic white, non-Hispanic Black, non-Hispanic American Indian or Alaska Native (AI/AN), non-Hispanic Asian or Native Hawaiian and Pacific Islander (NHPI), non-Hispanic multiracial and Hispanic. The confounders assessed included age, parity, cigarette use, educational attainment, insurance type, prior cesarean delivery and diabetes status. We used multivariable logistic regression and predicted probabilities to estimate the adjusted proportion of deliveries delivered via cesarean delivery. All analyses were conducted using STATA 17. There were 5,251,703 deliveries included in this analysis. The predicted probability of cesarean delivery was highest among non-Hispanic Black women and lowest among non-Hispanic AI/AN and Asian/NHPI women. The predicted probability of cesarean delivery was lower in 2018 than in 2014 for women of all races and ethnicities except for non-Hispanic Asian/NHPI and was lower but not significantly different for non-Hispanic AI/AN. The largest decline in the predicted probability of cesarean delivery over the specified period was among Hispanic women from 39.5% to 37.8%. While cesarean deliveries are decreasing among most women with obesity, there are disparities in this outcome when accounting for maternal race and ethnicity.