Abstract
Objective
This study aimed to provide contemporary data on maternal and infant outcomes after
delivery to better understand risks of cesarean section (CS).
Study Design
Data for deliveries in 2019 and 2020 were obtained from a large U.S. commercial health
care claims database. Maternal morbidity measures included 20 severe maternal morbidity
(SMM) outcomes and seven additional obstetric and mental health outcomes. Infant morbidity
measures included eight outcomes related to respiratory health, digestive health,
atopic dermatitis, and birth trauma. Outcome prevalence was ascertained at 42 days
(maternal only) and 360 days after delivery. Logistic regression was used to estimate
the odds ratio (OR) and 95% confidence interval (CI) for prevalence adjusted for risk
factors for delivery mode and each outcome. Analyses were conducted for 2019 and 2020
to assess the influence of the coronavirus disease 2019 pandemic.
Results
A total of 436,991 deliveries were identified (145,061 CS; 291,930 vaginal). The prevalence
of SMM was 3.3% at 42 days and 4.1% at 360 days. The covariate-adjusted odds of SMM
were higher among CS than vaginal deliveries at 42 days (OR: 2.0, 95% CI: 1.9, 2.1)
and 360 days (OR: 1.7, 95% CI: 1.7, 1.8). There were 226,983 infants available for
analysis of outcomes at 360 days. Most adverse infant outcomes were more prevalent
at 360 days among CS than vaginal deliveries, and the covariate-adjusted odds of any
adverse infant outcome at 360 days were higher among CS than vaginal deliveries (OR:
1.2; 95% CI: 1.1, 1.3). Respiratory morbidity was most affected by delivery mode.
Maternal and infant mortality up to 360 days was rare. Similar trends were observed
in the 2019 and 2020 cohorts.
Conclusion
This observational study, performed using recent data obtained from a large U.S. commercial
claims database, provides contemporary evidence of risks to mothers and infants of
CS relative to vaginal delivery.
Key Points
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In a large commercially insured population, one-third of deliveries were by CS.
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Most maternal and infant outcomes were more prevalent among CS deliveries than vaginal
deliveries.
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Respiratory conditions were most strongly related to delivery mode among infants.
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Maternal and infant mortality up to 360 days was rare in this population.
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Results were similar in 2019 and 2020, indicating a small impact of the COVID-19 pandemic.
Keywords
delivery mode - cesarean section - SMM - mortality - maternal - infant - COVID-19
- real-world data
