Abstract
BackgroundImproving and maintaining the health of mothers and newborns is indisputably a global priority, especially during a pandemic. This study intends to examine the factors associated with cesarean section (CS) during lockdown time.MethodsA total of 678 women who just gave birth within 7 days were enrolled from maternal and children hospitals in nine cities of China from April to May 2020. The delivery modes and potential influencing factors were investigated. The subgroup analysis and sensitivity analysis were used to examine the association of CS and risk factors among populations with different characteristics and to control for possible confounding, respectively.ResultsThe overall rate of cesarean delivery was 37.3%. In multi-variant model, maternal age > 30 years (OR, 95% CI = 1.71, 1.21–2.41), higher pre-gestational BMI (OR, 95% CI = 1.16, 1.10–1.23), living in regions with confirmed COVID-19 cases > 500 (OR, 95% CI = 2.45, 1.74–3.45), and excess gestational weight gain (OR, 95% CI = 1.73, 1.17–2.55) were associated with cesarean delivery. These trends of associations were not changes in sensitivity analysis and subgroup analysis. Cesarean delivery occurred more in women who got more nutrition instruction during the pandemic period in the univariant model; however, this association showed insignificance in the multiple-variant analysis.ConclusionA high cesarean delivery rate was found in uninfected women who experienced lockdown in their third trimester. During the COVID-19 pandemic, more medical support should be provided in severely affected regions to ensure and promote health in pregnancy.
Highlights
The 2019 novel coronavirus (COVID-19), a severe acute respiratory syndrome caused by a coronavirus, was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020 [1], due to its highly contagious nature, subsequently spreading around the world and infecting more than 13 million confirmed cases by July 15 [2]
Zhang et al Environmental Health and Preventive Medicine (2020) 25:60 extent to which pregnant or postpartum women and newborns are vulnerable to COVID-19 infection and the degree to which giving a healthy birth in the general pregnant population who are not infected with coronavirus is influenced by lockdown and quarantines
Factors with P < 0.05 in the univariate analysis were included in the multivariate model, including age (≤ 30 or > 30 years), pre-gestational body mass index (BMI), number of COVID-19 cases in the resident region (≤ 500 or > 500), history of metabolic disease, getting nutrition instruction during lockdown period, and gestational weight gain (GWG)
Summary
Participants This cross-sectional study was conducted in China during the COVID-19 outbreak between April and May 2020. Factors with P < 0.05 in the univariate analysis were included in the multivariate model, including age (≤ 30 or > 30 years), pre-gestational BMI (continuous), number of COVID-19 cases in the resident region (≤ 500 or > 500), history of metabolic disease (no or yes), getting nutrition instruction during lockdown period (no or yes), and GWG (optimal, low, or excess). Sensitivity analysis was conducted by including education level (middle school and below, or college and above) and getting regular prenatal check-ups during the lockdown period (no or yes) in the multivariate model. Subgroup analyses were conducted by excluding participants whose infants were preterm or post-term, whose infants had macrosomia and whose infant’s birth weight was missing, or who had metabolic diseases in pregnancy.
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