Associations of cesarean sections with comorbidities within the Pregnancy Risk Assessment Monitoring System

Jordyn Austin; Alexis Wirtz; Morgan Garrett; Sydney C. Ferrell; Elise Stephenson; Swapnil Gajjar; Spenser Perloff; Micah Hartwell

doi:10.1515/jpm-2023-0005

Article

Associations of cesarean sections with comorbidities within the Pregnancy Risk Assessment Monitoring System

Jordyn Austin , Alexis Wirtz , Morgan Garrett , Sydney C. Ferrell , Elise Stephenson , Swapnil Gajjar , Spenser Perloff and Micah Hartwell

Published/Copyright: May 22, 2023

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From the journal Journal of Perinatal Medicine Volume 51 Issue 8

Abstract

Objectives

Cesarean delivery (CD) is a common obstetrical procedure aimed at reducing maternal and infant morbidity and mortality in complicated pregnancies and medical emergencies yet carries potential complications. CD rates in the USA have increased over the years – likely associated with increased comorbidities. Thus, to expand the literature, our objective was to identify the likelihood of a woman having a CD when comorbidities – diabetes, high blood pressure (HBP), or depression – are present.

Methods

We conducted a cross-sectional analysis of the 2019 Pregnancy Risk Assessment Monitoring System. Binary and multivariable logistic regression were used to calculate adjusted odds ratios (AORs) to determine associations between pre-existing and gestational comorbidities and CD among pregnant women.

Results

Compared to those without a diagnosis, women with pre-existing diabetes (AOR: 1.69; CI: 1.54–1.86), pre-existing HBP (AOR: 1.58; CI: 1.46–1.69), and pre-existing depression (AOR: 1.14; CI 1.08–1.20; Table 2) were more likely to have a CD. Additionally, participants with gestational diabetes (AOR 1.43; CI 1.34–1.52), HBP (AOR 1.86; CI 1.76–1.95) and depression (AOR 1.13; CI 1.07–1.19) were also more likely to have a CD than those without comorbidities.

Conclusions

Higher rates of CD were found among individuals with a pre-existing or gestational diagnosis of diabetes, HBP, or depression than those without these diagnoses. With increasing rates of these conditions, it is likely that CD rates will continue their trajectory in the USA. Thus, professional organizations can have more impact by popularizing and making effective evidence-based guidelines for management.

Keywords: cesarean delivery; comorbidities; maternal health; PRAMS; pregnancy

Corresponding author: Jordyn Austin, BS, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107, USA; and Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA, Phone: +1 (918) 561 1844, E-mail: Jordyn.S.Austin@okstate.edu

Acknowledgments

We thank the PRAMS Working Groups at Alabama: Tammie Yelldell, MPH; Alaska: Kathy Perham-Hester, MS, MPH; Arizona – Enid Quintana-Torres, MPH; Arkansas: Letitia de Graft-Johnson, DrPH, MHSA; Colorado: Ashley Juhl, MSPH; Connecticut: Jennifer Morin, MPH; Delaware: George Yocher, MS; District of Columbia – Fern Johnson-Clarke, PhD; Florida: Tara Hylton, MPH; Georgia: Fay Stephens; Hawaii: Matt Shim, PhD, MPH; Illinois: Julie Doetsch, MA; Indiana – Brittany Reynolds, MPH; Iowa: Jennifer Pham; Kansas – Lisa Williams; Kentucky: Tracey D. Jewell, MPH; Louisiana: Rosaria Trichilo, MPH; Maine: Virginia Buchanan, LMSW; Maryland: Laurie Kettinger, MS; Massachusetts: Hafsatou Diop, MD, MPH; Michigan: Peterson Haak; Minnesota: Mira Grice Sheff, PhD, MS; Mississippi: Brenda Hughes, MPPA; Missouri: Venkata Garikapaty, PhD; Montana: Miriam Naiman-Sessions, PhD, MPH; Nebraska: Jessica Seberger; Nevada: Tami M. Conn; New Hampshire: David J. Laflamme, PhD, MPH; New Jersey: Sharon Smith Cooley, MPH; New Mexico: Sarah Schrock, MPH; New York State: Anne Radigan; New York City: Lauren Birnie, MPH; North Carolina: Kathleen Jones-Vessey, MS; North Dakota: Grace Njau, MPH; Oklahoma: Ayesha Lampkins, MPH, CHES; Oregon: Cate Wilcox, MPH; Pennsylvania: Sara Thuma, MPH; Puerto Rico – Wanda Hernandez, MPH; Rhode Island: Karine Tolentino Monteiro, MPH; South Carolina: Harley T. Davis, PhD, MPSH; South Dakota – Maggie Minett; Texas: Tanya Guthrie, PhD; Tennessee: Ransom Wyse, MPH, CPH; Utah: Nicole Stone, MPH; Vermont: Peggy Brozicevic; Virginia: Kenesha Smith, PhD, MSPH; Washington: Linda Lohdefinck; West Virginia: Melissa Baker, MA; Wisconsin: Fiona Weeks, MSPH; Wyoming: Lorie Chesnut, PhD; and the CDC PRAMS Team, Women’s Health and Fertility Branch, Division of Reproductive Health.

Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Dr. Hartwell receives research support through the National Institutes for Justice and Health Resources and Services Administration unrelated to the present work.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This study was submitted to ethics review by the Oklahoma State University Institutional Review Board and was determined to be of exempt status. This study adhered to STROBE reporting guidelines.
Data availability: The datasets analyzed during the current study are available via the CDC PRAMS working group, https://www.cdc.gov/prams/prams-data/researchers.htm.

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Received: 2023-01-04

Accepted: 2023-05-02

Published Online: 2023-05-22

Published in Print: 2023-10-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0005

Keywords for this article

cesarean delivery; comorbidities; maternal health; PRAMS; pregnancy