Cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse compared with vaginal delivery, but it is adversely associated with fertility, future pregnancy, and long-term childhood outcome, according to a study published in PLoS Medicine.
Oonagh E. Keag, from the NHS Lothian Department of Obstetrics and Gynecology, Simpson’s Centre for Reproductive Health, at the Royal Infirmary of Edinburgh, United Kingdom, and colleagues, conducted a systematic literature review from March 23, 2014, to May 25, 2017.
A total of 80 studies were included (1 randomized control trial and 79 observational studies). All studies were from high-income countries; 13 were hospital studies, and 67 were population studies. A total of 29,928,274 participants were included.
Compared with vaginal delivery, cesarean delivery was associated with a decreased risk of urinary incontinence (odds ratio [OR], 0.56; n = 58,900; 8 studies) and pelvic organ prolapse (OR, 0.29; n = 39,208; 2 studies). Children delivered by cesarean delivery had an increased risk of asthma up to the age of 12 years (OR, 1.21; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR, 1.59; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with an increased risk of miscarriage (OR, 1.17; n = 151,412; 4 studies) and stillbirth (OR, 1.27; n = 703,562; 8 studies), but not perinatal mortality (OR, 1.11; n = 91,429; 2 studies). Pregnancy following cesarean delivery was associated with an increased risk of placenta previa (OR, 1.74; n = 7,101,692; 10 studies), placenta accreta (OR, 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR, 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies).
“This systematic review and meta-analysis has highlighted the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies when compared to vaginal delivery in term (>37 weeks gestation) pregnancies,” the authors stated. “We found that cesarean delivery is associated with reduced rates of urinary incontinence and pelvic organ prolapse but has adverse associations with fertility, future pregnancy outcome, future pregnancy complications, and long-term childhood outcomes.”
Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med. 2018 Jan 23;15(1). doi: 10.1371/journal.pmed.1002494