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The impact of previous cesarean section on the success of future fetal programming pattern

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to examine whether cesarean section in the first pregnancy is associated with the success or failure of programmed fetal growth phenotypes or patterns in the subsequent pregnancy.

Methods

We analyzed data from a population-based retrospective cohort of singleton deliveries that occurred in the state of Missouri from 1978 to 2005 (n = 1,224,133). The main outcome was neonatal mortality, which was used as an index of the success of fetal programming. Cox proportional hazard and logistic regression models were used to generate point estimates and 95% confidence intervals.

Results

Mothers delivering by cesarean section in the first pregnancy were less likely to deliver subsequent appropriate-for-gestational-age (AGA) neonates (OR 0.91, 95% CI 0.89–0.92) when compared with mothers delivering vaginally. Of the 1,457 neonatal deaths in the second pregnancy, 383 early neonatal and 95 late neonatal deaths were to mothers with cesarean section deliveries in the first pregnancy. When compared with women with a previous vaginal delivery, AGA neonates of women with a primary cesarean section had 20% increased risk of both neonatal (OR 1.20, 95% CI 1.05–1.37) and early neonatal (OR 1.23, 95% CI 1.05–1.43) death.

Conclusion

Our study suggests that previous cesarean section is a risk factor for neonatal mortality among AGA infants of subsequent pregnancy. Future prospective studies are needed to confirm these findings.

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Acknowledgments

This study was funded by a Grant from the Flight Attendant Medical Research Institute (FAMRI: 024008) to the first author (Hamisu Salihu, MD, PhD). The funding agency did not play any role in any aspect of the study. We thank the Missouri Department of Health and Senior Services for providing the data files used in this study.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Center for Research and Evaluation, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA

    Hamisu M. Salihu & Phillip J. Marty

  2. Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA

    Hamisu M. Salihu

  3. Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA

    Hamisu M. Salihu, Chelsea M. Bowen & Ronee E. Wilson

Authors
  1. Hamisu M. Salihu
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  2. Chelsea M. Bowen
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  3. Ronee E. Wilson
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  4. Phillip J. Marty
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Corresponding author

Correspondence to Hamisu M. Salihu.

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Salihu, H.M., Bowen, C.M., Wilson, R.E. et al. The impact of previous cesarean section on the success of future fetal programming pattern. Arch Gynecol Obstet 284, 319–326 (2011). https://doi.org/10.1007/s00404-010-1665-0

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  • DOI: https://doi.org/10.1007/s00404-010-1665-0

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