ArticleFrontiers in medicine2025
Temporal trend and factors of C-section and its impact on subsequent pregnancy outcomes in Central China.
Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cesarean section (C-section) rates have increased dramatically over the last few decades worldwide, and China's C-section rate has continuously remained much higher than the World Health Organization (WHO)'s suggested threshold. This study aimed to (1) estimate the temporal trends and factors for C-sections and (2) examine the association of a previous C-section with adverse outcomes in a subsequent pregnancy. Methods: We conducted a tertiary-level hospital-based retrospective cohort study in the Hubei Province, China between 2011 and 2019. A chi-squared test was used to estimate the baseline disparities between C-sections and normal delivery among singleton and twin pregnancies. A multiple binary logistic regression model was conducted to predict factors associated with C-sections and their impact on subsequent pregnancy outcomes. The secular trend of C-section was determined by using the joinpoint regression model. Results: Between 2013 and 2019, the trend of C-section was significantly increased among singleton women with a high education level (annual percentage change (APC), 9.8%; 95%CI: 5.3, 14.5) and professional services (APC, 7.9%; 95%CI: 2.9, 13.2). The leading five factors, including previous C-section followed by fetal breech presentation, abnormal placentation, oligohydramnios, and macrosomia, were associated with a higher risk of C-section among singleton pregnancies. Hypertensive disorders of pregnancy (HDP) increase the risk of C-section in women with twin gestations. Previous C-section associated with a higher likelihood of gestational diabetes mellitus (GDM) in the subsequent pregnancy of singleton (aOR, 1.30; 95%CI: 1.14, 1.49) and twin (aOR, 1.78; 95%CI: 1.05, 3.01) women. Moreover, previous C-sections increased the odds of C-sections (aOR, 3.41; 95%CI: 3.11, 3.75) in the subsequent pregnancy of singleton women. Conclusion: The secular trend of C-sections significantly increased among women with high socioeconomic status, and a previous C-section was associated with a higher likelihood of repeated C-sections in singleton women and GMD in the subsequent pregnancy of both singleton and twin women.
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