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Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

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  • Oonagh E Keag
  • Jane E Norman
  • Sarah J Stock

Abstract

Background: Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. Methods and findings: Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). Conclusions: When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery. In a systematic review and meta-analysis, Sarah Stock exmines the long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Oonagh E Keag & Jane E Norman & Sarah J Stock, 2018. "Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 15(1), pages 1-22, January.
    • Handle: RePEc:plo:pmed00:1002494
    DOI: 10.1371/journal.pmed.1002494
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    1. Taja Bracic & Isabella Pfniß & Nadja Taumberger & Kaltrina Kutllovci-Hasani & Daniela Ulrich & Wolfgang Schöll & Philipp Reif, 2020. "A 10 year comparative study of caesarean deliveries using the Robson 10 group classification system in a university hospital in Austria," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-11, October.
    2. Lenore Manderson & Fiona C. Ross, 2020. "Publics, technologies and interventions in reproduction and early life in South Africa," Palgrave Communications, Palgrave Macmillan, vol. 7(1), pages 1-9, December.
    3. Rubén Aragón-Martín & María del Mar Gómez-Sánchez & David Jiménez-Pavón & José Manuel Martínez-Nieto & Mónica Schwarz-Rodríguez & Carmen Segundo-Iglesias & José Pedro Novalbos-Ruiz & María José Santi-, 2021. "A Multimodal Intervention for Prevention of Overweight and Obesity in Schoolchildren. A Protocol Study “PREVIENE-CÁDIZ”," IJERPH, MDPI, vol. 18(4), pages 1-19, February.
    4. Shuqin Zeng & Dhrati Patangia & Alexandre Almeida & Zhemin Zhou & Dezhi Mu & R. Paul Ross & Catherine Stanton & Shaopu Wang, 2022. "A compendium of 32,277 metagenome-assembled genomes and over 80 million genes from the early-life human gut microbiome," Nature Communications, Nature, vol. 13(1), pages 1-15, December.
    5. Aneta Słabuszewska-Jóźwiak & Jacek Krzysztof Szymański & Michał Ciebiera & Beata Sarecka-Hujar & Grzegorz Jakiel, 2020. "Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 17(21), pages 1-17, October.
    6. Ana Costa-Ramón & Mika Kortelainen & Ana Rodríguez-González & Lauri Sääksvuori, 2022. "The Long-Run Effects of Cesarean Sections," Journal of Human Resources, University of Wisconsin Press, vol. 57(6), pages 2048-2085.
    7. Gwinyai Masukume & Ali S Khashan & Susan M B Morton & Philip N Baker & Louise C Kenny & Fergus P McCarthy, 2019. "Caesarean section delivery and childhood obesity in a British longitudinal cohort study," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-13, October.
    8. Shelly Jun & Kelsea Drall & Brittany Matenchuk & Cara McLean & Charlene Nielsen & Chinwe V. Obiakor & Aaron Van der Leek & Anita Kozyrskyj, 2018. "Sanitization of Early Life and Microbial Dysbiosis," Challenges, MDPI, vol. 9(2), pages 1-9, December.
    9. Maria Healy & Viola Nyman & Dale Spence & René H J Otten & Corine J Verhoeven, 2020. "How do midwives facilitate women to give birth during physiological second stage of labour? A systematic review," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-19, July.
    10. David Card & Alessandra Fenizia & David Silver, 2019. "The Health Impacts of Hospital Delivery Practices," NBER Working Papers 25986, National Bureau of Economic Research, Inc.
    11. Azahara María García-Serna & Elena Martín-Orozco & Trinidad Hernández-Caselles & Eva Morales, 2021. "Prenatal and Perinatal Environmental Influences Shaping the Neonatal Immune System: A Focus on Asthma and Allergy Origins," IJERPH, MDPI, vol. 18(8), pages 1-24, April.
    12. Monika Bączkowska & Katarzyna Kosińska-Kaczyńska & Magdalena Zgliczyńska & Robert Brawura-Biskupski-Samaha & Beata Rebizant & Michał Ciebiera, 2022. "Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption—Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center," IJERPH, MDPI, vol. 19(9), pages 1-14, April.

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