Renata H Benjamin1, Adriana Lopez1, Laura E Mitchell1, KuoJen Tsao2, Anthony Johnson3, Peter H Langlois4, Michael D Swartz5, A J Agopian1. 1. Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas. 2. Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at UTHealth McGovern Medical School and Children's Memorial Hermann Hospital, Houston, Texas. 3. Department of Obstetrics, Gynecology and Reproductive Sciences, and Pediatric Surgery, UTHealth McGovern Medical School and The Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas. 4. Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas. 5. Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas.
Abstract
BACKGROUND: It is hypothesized that cesarean delivery may reduce mortality among infants with spina bifida (e.g., by reducing trauma to the open lesion); however, few studies have assessed this relationship. METHODS: We used the Texas Birth Defects Registry to identify neonates with spina bifida born between 1999 and 2014. The mode of delivery (main exposure) was abstracted from each subject's birth certificate. The vital status (main outcome) was determined based on the presence or absence of a death certificate. When a death certificate was present, survival time was calculated by subtracting the date of birth from the date of death. We then conducted multivariable Cox proportional hazards regression to estimate the adjusted hazard ratio between cesarean delivery and death prior to 29 days. We adjusted for maternal race/ethnicity, maternal education, gestational age/birthweight, and breech presentation. This analysis was repeated for death prior to 365 days. RESULTS: We analyzed 1,983 nonsyndromic, liveborn neonates with spina bifida, and 68% of these neonates were delivered by cesarean. After adjusting for potential confounders, the adjusted hazard ratio [aHR] for death prior to 29 days was 0.77 (95% confidence interval [CI] 0.49, 1.21) and the aHR for death prior to 365 days was 0.93 (95% CI 0.63, 1.38) comparing infants delivered by cesarean to those delivered vaginally. CONCLUSIONS: Despite a lack of strong prior epidemiologic evidence, cesarean rates for neonates with spina bifida were high. Further investigations of the relationship between mode of delivery and infant outcomes, including mortality, complications, and long-term prognosis, are warranted.
BACKGROUND: It is hypothesized that cesarean delivery may reduce mortality among infants with spina bifida (e.g., by reducing trauma to the open lesion); however, few studies have assessed this relationship. METHODS: We used the Texas Birth Defects Registry to identify neonates with spina bifida born between 1999 and 2014. The mode of delivery (main exposure) was abstracted from each subject's birth certificate. The vital status (main outcome) was determined based on the presence or absence of a death certificate. When a death certificate was present, survival time was calculated by subtracting the date of birth from the date of death. We then conducted multivariable Cox proportional hazards regression to estimate the adjusted hazard ratio between cesarean delivery and death prior to 29 days. We adjusted for maternal race/ethnicity, maternal education, gestational age/birthweight, and breech presentation. This analysis was repeated for death prior to 365 days. RESULTS: We analyzed 1,983 nonsyndromic, liveborn neonates with spina bifida, and 68% of these neonates were delivered by cesarean. After adjusting for potential confounders, the adjusted hazard ratio [aHR] for death prior to 29 days was 0.77 (95% confidence interval [CI] 0.49, 1.21) and the aHR for death prior to 365 days was 0.93 (95% CI 0.63, 1.38) comparing infants delivered by cesarean to those delivered vaginally. CONCLUSIONS: Despite a lack of strong prior epidemiologic evidence, cesarean rates for neonates with spina bifida were high. Further investigations of the relationship between mode of delivery and infant outcomes, including mortality, complications, and long-term prognosis, are warranted.
Authors: Mikyong Shin; James E Kucik; Csaba Siffel; Chengxing Lu; Gary M Shaw; Mark A Canfield; Adolfo Correa Journal: J Pediatr Date: 2012-06-23 Impact factor: 4.406
Authors: Inge Cuppen; Alex J Eggink; Fred K Lotgering; Jan J Rotteveel; Reinier A Mullaart; Nel Roeleveld Journal: Eur J Obstet Gynecol Reprod Biol Date: 2011-02-17 Impact factor: 2.435