ArticleAJOG global reports2026
Disparities in planned and successful vaginal delivery after a cesarean delivery by body mass index: a population-based cohort study.
Article in AJOG global reports, 2026. 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: Previous literature suggests that pregnant individuals with obesity have fewer planned and successful vaginal births following a previous cesarean delivery. Concern is growing that discrimination based on body mass index (BMI) and comorbidities associated with BMI, rather than BMI itself, are primarily responsible for these findings. Objective: To describe disparities in planning and having a successful vaginal delivery after a previous cesarean delivery by BMI status. Study Design: This population-based cohort study included all singleton pregnancies ≥37 weeks' gestation from 2003 to 2021 in Nova Scotia, Canada, with one previous cesarean and without contraindications for a trial of labor. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression, incorporating inverse probability weighting to account for confounding by demographic characteristics and co-morbidities. Results: Among 12 646 deliveries, approximately 31% experienced pre-pregnancy obesity. Of those with obesity, 34% planned a vaginal birth compared to 44% of those without obesity (aRR: 0.82, 95% CI: 0.78, 0.86). Higher BMI classification was associated with a reduced likelihood of planned vaginal delivery: class I: 37%, aRR: 0.88 (95% CI: 0.82, 0.94); class II: 32%, aRR: 0.81 (95% CI: 0.74, 0.89); class III: 26%, aRR 0.65 (95% CI: 0.56, 0.75). Among those planning a vaginal delivery, those with obesity were less likely to have a vaginal birth compared to those without obesity (57% vs 69%; aRR: 0.87, 95% CI: 0.82, 0.92); successful vaginal birth was less likely as BMI increased. Conclusion: Obesity was associated with reduced planned and successful vaginal delivery after a previous cesarean delivery and the association was most pronounced at higher BMI after accounting for demographic characteristics and co-morbidities. While discrimination based on BMI was unmeasured, notable disparities in planning and having a vaginal delivery by BMI suggest that training for health care providers and the availability of appropriate infrastructure may help optimize care for this population.
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