Maternal height associated with cesarean section. A cross-sectional study using the 2014–2015 national maternal-child health survey in Guatemala

Abstract

Background: Socioeconomic status is associated with cesarean section (CS). Maternal height, however, may be another related factor to CS. In Guatemala, a quarter of women between 15 and 49 years of age are shorter than 145 cm. Therefore, this study aims to examine the association of maternal height with cesarean section in Guatemala. Methods: We carried out a secondary analysis study using data from the 2014-15 Guatemalan national maternal and child health survey-9542 mothers aged 15-49 and 12,426 live births were analyzed. We obtained the prevalence ratio of the association between maternal height and CS based on three Poisson regression models. One model included all live births, another the first live birth, and a third model the last live birth. For each model, we accounted for covariates and sampling design. Results: The national prevalence of CS was 26.3% (95%CI: 25.0, 27.7). The adjusted prevalence ratio of CS, including all live births, was 1.63 (95%CI: 1.37, 1.94) more likely in mothers shorter than 145 cm compared with those equal or greater than 170 cm. This figure was 1.45 (95%CI: 1.19, 1.76) in the model with the first live birth. In the model with the last birth, maternal height was not associated with CS after accounting for previous CS as one of the covariates. Conclusions: Prevalence of CS in this setting was high and above international recommendations. Further, very short mothers were more likely to experience CS compared to taller mothers after accounting for covariates, except when a previous CS was present. Maternal height should be included in clinical assessments during prenatal care.

Effect of maternal height on the risk of caesarean section in singleton births: evidence from a large-scale survey in India

“…Another important factor that contributes to the association between short maternal height and CS is nutritional status. Shorter women were more likely to be overweight or obese than taller women, 21 40 and obesity has been linked to increase in CS. 21 41 Furthermore, our study found that higher odds of CS among mothers who were overweight/obese before pregnancy and had a higher risk related to height and pregnancy related complications than those among mothers' with normal weight.…”

“…Shorter women were more likely to be overweight or obese than taller women, 21 40 and obesity has been linked to increase in CS. 21 41 Furthermore, our study found that higher odds of CS among mothers who were overweight/obese before pregnancy and had a higher risk related to height and pregnancy related complications than those among mothers' with normal weight. 21 Therefore, obesity prior to or during pregnancy in short or very short mothers may cause labour to be prolonged, and triggers a need for CS.…”

“…21 41 Furthermore, our study found that higher odds of CS among mothers who were overweight/obese before pregnancy and had a higher risk related to height and pregnancy related complications than those among mothers' with normal weight. 21 Therefore, obesity prior to or during pregnancy in short or very short mothers may cause labour to be prolonged, and triggers a need for CS. 42 A combination of maternal height and birth weight, with shorter women has been more vulnerable to the effect of neonatal weight on CS risk (contrary to previous research [43][44][45] ).…”

“…Only a few studies in Europe, Latin America and Africa have analysed the association between maternal height and the risk of CS. [20][21][22] However, to our knowledge, no previous study in India has investigated the association between maternal height and CS using a large-scale data that represents a larger population. Although past studies in India have assess the association of socioeconomic factors, 23 maternal malnutrition, 24 place of childbirth 25 and healthcare accessibility 26 with the risk of CS, the likely effect of maternal height on the risk of CS is still poorly understood.…”

Understanding inequities in health and health systems in Latin America and the Caribbean: a thematic series

“…Actively addressing exclusion requires going beyond health system financing to develop policies aimed at including afro-descendants, indigenous peoples, and others who live in poverty and/or are geographically excluded from accessing health facilities, while addressing health worker capacities and provider incentives. Obstetric violence continues to be a central issue in the region: Roldán, Grajeda & Pérez found that Cesarean section rates in Guatemala were high and above international recommendations, with the bulk of these procedures being performed in shorter women [ 12 ]. In the country, indigenous and poor women tend to be much shorter than their non-indigenous counterparts, which points towards the overuse of a medical procedure in a traditionally marginalized population group that already faces compounding factors that limit the use of their agency when it comes to deciding how and when to give birth.…”