Download PDF
Am J Perinatol 2019; 36(04): 335-340
DOI: 10.1055/s-0038-1672170
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk of Cesarean Delivery among Nulliparous Asian-Indian Women with Term Singleton Pregnancies

Malavika Prabhu
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
,
Alexander Melamed
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
,
Allison S. Bryant
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations Funding None.
Further Information

Publication History

24 April 2018

18 August 2018

Publication Date:
03 October 2018 (online)

    Permissions and Reprints

Abstract

Objective Asian-Indian women are a growing population in the United States, but little data exist about their risk of cesarean delivery (CD). We characterize the odds of CD among Asian-Indian women and determine whether neonatal birth weight modifies this relationship.

Study Design This is a retrospective cohort study using an administrative perinatal database from California. We identified 1,029,940 nulliparous women with live, singleton, nonanomalous deliveries between 37 and 42 completed weeks of gestation. We performed multivariable logistic regression analyses to determine if Asian-Indian women were more likely to deliver by CD, compared with white non-Hispanic women, adjusting for sociodemographic and clinical variables. We explored if birth weight was an effect modifier, testing the interaction term's significance using Wald's test, and performed multivariable logistic regressions stratified by birth weight category.

Results Asian-Indian women comprised 2.0% of the cohort. Compared with white non-Hispanic women, Asian-Indian women had an adjusted odds of 1.41 (95% confidence interval: 1.36–1.46) for CD. However, we noted effect modification of birth weight on the odds of CD by race/ethnicity (p < 0.001). Among all birth weight categories exceeding 3,000 g, Asian-Indian women had higher odds of CD than white non-Hispanic women.

Conclusion Asian-Indian women are at greater risk of CD than white non-Hispanic women when birthweight exceeds 3,000 g.

Keywords

cesarean delivery - race - ethnicity - Asian-Indian - pregnancy - birth weight - disparities
 

  • References

  • 1 Min CJ, Ehrenthal DB, Strobino DM. Investigating racial differences in risk factors for primary cesarean delivery. Am J Obstet Gynecol 2015; 212 (06) 814.e1-814.e14
    CrossrefPubMedGoogle Scholar
  • 2 Huesch M, Doctor JN. Factors associated with increased cesarean risk among African American women: evidence from California, 2010. Am J Public Health 2015; 105 (05) 956-962
    CrossrefPubMedGoogle Scholar
  • 3 Osterman MJ, Martin JA. Trends in low-risk cesarean delivery in the United States, 1990-2013. Natl Vital Stat Rep 2014; 63 (06) 1-16
    PubMedGoogle Scholar
  • 4 Hoeffel EM, Rastogi S, Kim MO, Shahid H. The Asian population: 2010. 2010 Census Briefs. Available at: https://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf . Accessed August 15, 2016
    PubMedGoogle Scholar
  • 5 Wong LF, Caughey AB, Nakagawa S, Kaimal AJ, Tran SH, Cheng YW. Perinatal outcomes among different Asian-American subgroups. Am J Obstet Gynecol 2008; 199 (04) 382.e1-382.e6
    CrossrefPubMedGoogle Scholar
  • 6 Cheng H-R, Walker LO, Brown A, Lee JY. Gestational weight gain and perinatal outcomes of subgroups of Asian-American women, Texas, 2009. Womens Health Issues 2015; 25 (03) 303-311
    CrossrefPubMedGoogle Scholar
  • 7 Rao AK, Daniels K, El-Sayed YY, Moshesh MK, Caughey AB. Perinatal outcomes among Asian American and Pacific Islander women. Am J Obstet Gynecol 2006; 195 (03) 834-838
    CrossrefPubMedGoogle Scholar
  • 8 Morisaki N, Kawachi I, Oken E, Fujiwara T. Social and anthropometric factors explaining racial/ethnical differences in birth weight in the United States. Sci Rep 2017; 7: 46657
    CrossrefPubMedGoogle Scholar
  • 9 Kiserud T, Piaggio G, Carroli G. , et al. The World Health Organization fetal growth charts: A multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med 2017; 14 (03) e1002284
    CrossrefPubMedGoogle Scholar
  • 10 Herrchen B, Gould JB, Nesbitt TS. Vital statistics linked birth/infant death and hospital discharge record linkage for epidemiological studies. Comput Biomed Res 1997; 30 (04) 290-305
    CrossrefPubMedGoogle Scholar
  • 11 Baumeister L, Marchi K, Pearl M, Williams R, Braveman P. The validity of information on “race” and “Hispanic ethnicity” in California birth certificate data. Health Serv Res 2000; 35 (04) 869-883
    PubMedGoogle Scholar
  • 12 Talegawkar SA, Kandula NR, Gadgil MD, Desai D, Kanaya AM. Dietary intakes among South Asian adults differ by length of residence in the USA. Public Health Nutr 2016; 19 (02) 348-355
    CrossrefPubMedGoogle Scholar
  • 13 American College of Obstetricians and Gynecologists. Practice Bulletin 173. Macrosomia. November 2016. Available at: http://www.acog.org/Resources%20And%20Publications/Practice%20Bulletins/Committee%20on%20Practice%20Bulletins%20Obstetrics/Fetal%20Macrosomia.aspx . Accessed March 27, 2017
    PubMedGoogle Scholar
  • 14 Yasmeen S, Romano PS, Schembri ME, Keyzer JM, Gilbert WM. Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am J Obstet Gynecol 2006; 194 (04) 992-1001
    CrossrefPubMedGoogle Scholar
  • 15 Getahun D, Strickland D, Lawrence JM, Fassett MJ, Koebnick C, Jacobsen SJ. Racial and ethnic disparities in the trends in primary cesarean delivery based on indications. Am J Obstet Gynecol 2009; 201 (04) 422.e1-422.e7
    CrossrefPubMedGoogle Scholar
  • 16 Bryant AS, Washington S, Kuppermann M, Cheng YW, Caughey AB. Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates. Paediatr Perinat Epidemiol 2009; 23 (05) 454-462
    CrossrefPubMedGoogle Scholar