Thomas Bergholt1, Finn E Skjeldestad2, Aura Pyykönen3, Steen C Rasmussen1, Anna-Maija Tapper4,5, Ragnheiður I Bjarnadóttir6,7,8, Alexander Smárason7, Birna B Másdóttir8, Kari Klungsøyr9,10, Susanne Albrechtsen10,11, Karin Källén12,13, Mika Gissler14,15, Ellen C L Løkkegaard1. 1. Clinical Research Unit, Department of Obstetrics and Gynecology, North Zeeland Hospital, University of Copenhagen, Hillerød, Denmark. 2. Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway. 3. Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland. 4. Hyvinkää Hospital, Hyvinkää, Finland. 5. University of Helsinki, Helsinki, Finland. 6. The Icelandic Birth Registry, Akureyri, Iceland. 7. Institute of Health Science Research, University of Akureyri, Akureyri, Iceland. 8. Landspitali University Hospital, Reykjavik, Iceland. 9. Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway. 10. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 11. Haukeland University Hospital, Bergen, Norway. 12. Swedish National Board of Health and Welfare, Stockholm, Sweden. 13. University of Lund, Lund, Sweden. 14. Finnish Institute for Health and Welfare THL, Helsinki, Finland. 15. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
Abstract
INTRODUCTION: Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on cesarean section at term among nulliparous and multiparous women without previous cesarean section. MATERIAL AND METHODS: We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway, and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on cesarean section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term, and no previous cesarean section. Confounders comprised country, time-period, and gestational age. RESULTS: In nulliparous women with induced labor the rate of cesarean section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared with women aged 25-29 years, the corresponding relative risks were 0.60 (95% confidence interval [95% CI] 0.57 to 0.64) and 1.72 (95% CI 1.66 to 1.79). In multiparous induced women the risk of cesarean section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared with women aged 25-29 years, the relative risks were 0.86 (95% CI 0.54 to 1.37) and 1.98 (95% CI 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period, and gestational age on risk for cesarean section. CONCLUSIONS: Advanced maternal age is associated with increased risk of cesarean section in women undergoing labor induction with a single cephalic presentation at term without a previous cesarean section. The absolute risk of cesarean section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor.
INTRODUCTION: Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on cesarean section at term among nulliparous and multiparous women without previous cesarean section. MATERIAL AND METHODS: We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway, and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on cesarean section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term, and no previous cesarean section. Confounders comprised country, time-period, and gestational age. RESULTS: In nulliparous women with induced labor the rate of cesarean section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared with women aged 25-29 years, the corresponding relative risks were 0.60 (95% confidence interval [95% CI] 0.57 to 0.64) and 1.72 (95% CI 1.66 to 1.79). In multiparous induced women the risk of cesarean section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared with women aged 25-29 years, the relative risks were 0.86 (95% CI 0.54 to 1.37) and 1.98 (95% CI 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period, and gestational age on risk for cesarean section. CONCLUSIONS: Advanced maternal age is associated with increased risk of cesarean section in women undergoing labor induction with a single cephalic presentation at term without a previous cesarean section. The absolute risk of cesarean section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor.
Authors: Grażyna Bączek; Ewa Rzońca; Patryk Rzońca; Sylwia Rychlewicz; Margareta Budner; Agnieszka Bień Journal: Int J Environ Res Public Health Date: 2022-08-03 Impact factor: 4.614