Infant Infections Following Cesarean Delivery on Maternal Request: A Population-Based Cohort Study

Yanfang Guo; Malia S Q Murphy; Sheryll Dimanlig-Cruz; Alexie Leclerc; Michaela A Smith; Daniel J Corsi; Ruth Rennicks White; Alysha L J Dingwall-Harvey; JoAnn Harrold; Mark C Walker; Shi Wu Wen; Darine El-Chaâr

doi:10.1016/j.jogc.2024.102455

Infant Infections Following Cesarean Delivery on Maternal Request: A Population-Based Cohort Study

J Obstet Gynaecol Can. 2024 Apr 5;46(6):102455. doi: 10.1016/j.jogc.2024.102455. Online ahead of print.

Affiliations

¹ Better Outcomes Registry and Network (BORN), Ottawa, ON; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON.
³ Better Outcomes Registry and Network (BORN), Ottawa, ON.
⁴ Better Outcomes Registry and Network (BORN), Ottawa, ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON.
⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON.
⁷ Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON.
⁸ Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; International and Global Health Office, University of Ottawa, Ottawa, ON.
⁹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON. Electronic address: delchaar@toh.ca.

PMID: 38583665
DOI: 10.1016/j.jogc.2024.102455

Abstract

Objectives: Investigations about cesarean delivery (CD) on maternal request (CDMR) and infant infection risk frequently rely on administrative data with poorly defined indications for CD. We sought to determine the association between CDMR and infant infection using an intent-to-treat approach.

Methods: This was a population-based cohort study of low-risk singleton pregnancies with a term live birth in Ontario, Canada between April 2012 and March 2018. Subjects with prior CD were excluded. Outcomes included upper and lower respiratory tract infections, gastrointestinal infections, otitis media, and a composite of these 4. Relative risk and 95% CI were calculated for component and composite outcomes up to 1 year following planned CDMR versus planned vaginal deliveries (VDs). Subgroup and sensitivity analyses included age at infection (≤28 vs. >28 days), type of care (ambulatory vs. hospitalisation), restricting the cohort to nulliparous pregnancies, and including individuals with previous CD. Last, we re-examined outcome risk on an as-treated basis (actual CD vs. actual VD).

Results: Of 422 134 pregnancies, 0.4% (1827) resulted in a planned CDMR. After adjusting for covariates, planned CDMR was not associated with a risk of composite infant infections (adjusted relative risk 1.02; 95% CI 0.92-1.11). Findings for component infection outcomes, subgroup, and sensitivity analyses were similar. However, the as-treated analysis of the role of delivery mode on infant risk for infection demonstrated that actual CD (planned and unplanned) was associated with an increased risk for infant infections compared to actual VD.

Conclusions: Planned CDMR is not associated with increased risk for neonatal or infant infections compared with planned VD. Study design must be carefully considered when investigating the impact of CDMR on infant infection outcomes.

Keywords: cesarean delivery; cesarean section; infant; infant outcomes; infection; maternal request.