Occupation and risk of cesarean section: study based on the perinatal survey of Baden-Württemberg, Germany

Simoes, Elisabeth; Kunz, S; Bosing-Schwenkglenks, M.; Schmahl, F. W.

doi:10.1007/s00404-004-0616-z

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…Regarding the generalizability of our results, we found similar prevalence rates of preterm births and cesarean sections as in national comparisons 49 , 50 . However, the study population consisted primarily of white European women living in Southern Germany, which limits the generalizability of our results for other ethnic groups.…”

Section: Discussionsupporting

confidence: 81%

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

Goetz

Müller

Gutsfeld

et al. 2021

Sci Rep

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Women with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.

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Section: Discussionsupporting

confidence: 81%

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

Goetz

Müller

Gutsfeld

et al. 2021

Sci Rep

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“…Many studies have examined the effect of socioeconomic status on childbirth intervention, cesarean section in particular (18–24). No direct measure of socioeconomic status exists, however, and different studies have used different indicators, such as education, occupation, household income, and neighborhood affluence.…”

Section: Discussionmentioning

confidence: 99%

“…Across the border, in Canada, the highest cesarean section rates in 1988 to 1995 were in women of low‐income rather than high‐income categories (21). In Germany, in 1998 to 2001, cesarean section rates were highest among unskilled workers (20). France showed no relationship between cesarean section rates and maternal education in 1981; by 1995, the least educated had the highest rates (31).…”

Section: Discussionmentioning

confidence: 99%

Mothers’ Level of Education and Childbirth Interventions: A Population-based Study in Flanders, Northern Belgium

Cammu¹,

Martens²,

Keirse

2011

Birth

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“…In France, Guihard and Blondel [ 24 ] report that women with a low level of education have a higher risk of cesarean deliveries. German studies point out high rates of surgical deliveries for low-income women [ 25 , 26 ]. Accordingly, Italian mothers with low education levels consistently give birth by a cesarean delivery more often than highly educated women [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Prenatal care and socioeconomic status: effect on cesarean delivery

Milcent¹,

Zbiri

2018

Health Econ Rev

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Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008–2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.

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Occupation and risk of cesarean section: study based on the perinatal survey of Baden-Württemberg, Germany

Cited by 6 publications

References 15 publications

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

Mothers’ Level of Education and Childbirth Interventions: A Population-based Study in Flanders, Northern Belgium

Prenatal care and socioeconomic status: effect on cesarean delivery

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