FROM PLOS MEDICINE
Cesarean deliveries may reduce a woman’s risk for urinary incontinence and pelvic organ prolapse but may raise her risk of complications with future pregnancies, based on data from a literature review including nearly 30,000,000 women.
Rates of cesarean delivery in 2016, often without medical indication, were approximately 25%, 32%, and 41% in Western Europe, North America, and South America, respectively, wrote Oonagh E. Keag, MD, of the Royal Infirmary of Edinburgh and colleagues in a study published in PLOS Medicine .
However, they wrote, “at present, evidence of longer-term complications of cesarean delivery has not been adequately synthesized to allow fully informed decisions about mode of delivery to be made.”
The researchers reviewed data from 79 observational studies and 1 randomized, controlled trial for a study population of 29,928,274 individuals.
Overall, women who had cesarean deliveries had a significantly lower risk of urinary incontinence (odds ratio, 0.56) and pelvic organ prolapse (OR, 0.29), compared with women who had vaginal deliveries.
No significant association appeared between type of delivery and risk of perinatal death, but women with a history of cesarean delivery were significantly more likely to experience miscarriage or stillbirth on a subsequent pregnancy, as well as placenta previa, placenta accreta, and placental abruption.
In addition, children born via cesarean delivery were significantly more likely than those born via vaginal delivery to have asthma at age 12 years (OR, 1.21) and to be obese up to age 5 years (OR, 1.59).
The findings were limited by the observational nature of most of the data, which does not imply causation, the researchers said. In addition, the study was not designed for subanalysis of elective vs. emergency cesarean delivery.
Although women will attach varying degrees of significance to the risks and benefits associated with cesarean delivery, “it is imperative that clinicians take care to ensure that women are made aware of any risk that they are likely to attach significance to,” the researchers said. “Women and clinicians thus should be aware of both the short- and long-term risks and benefits of cesarean delivery and discuss these when deciding on mode of delivery,” they noted.
The researchers had no financial conflicts to disclose.
SOURCE: Keag OE et al. PLoS Med. 2018 Jan 23. 15(1):e1002494 .
