{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:36:28Z","timestamp":1790998588535,"version":"4.1.0"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AJP Rep"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery.<\/jats:p><jats:p>\n          Objective\u2003To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery.<\/jats:p><jats:p>\n          Study Design\u2003In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery.<\/jats:p><jats:p>\n          Results\u2003There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78\u20131.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34\u20133.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN.<\/jats:p><jats:p>\n          Conclusion\u2003A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.<\/jats:p>","DOI":"10.1055\/s-0043-1777996","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T23:34:25Z","timestamp":1706052865000},"page":"e51-e56","source":"Crossref","is-referenced-by-count":11,"title":["The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1441-6627","authenticated-orcid":false,"given":"Robert","family":"Fresch","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendal","family":"Stephens","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0164-5703","authenticated-orcid":false,"given":"Emily","family":"DeFranco","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,1,23]]},"reference":[{"key":"ref1","volume-title":"Most Frequent Procedures Performed in U.S. Hospitals, 2010","author":"A Pfuntner"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/01.AOG.0000255668.20639.40","article-title":"Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births","volume":"109","author":"E Declercq","year":"2007","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref3","first-page":"1","article-title":"Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006-2012","volume":"63","author":"M J Osterman","year":"2014","journal-title":"Natl Vital Stat Rep"},{"issue":"08","key":"ref4","first-page":"1","article-title":"Births: final data for 2017","volume":"67","author":"J A Martin","year":"2018","journal-title":"Natl Vital Stat Rep"},{"key":"ref7","first-page":"i","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ijgo.2004.03.006","article-title":"Chronic hypertension and the risk for adverse pregnancy outcome after superimposed pre-eclampsia","volume":"86","author":"M Vanek","year":"2004","journal-title":"Int J Gynaecol Obstet"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1097\/AOG.0000000000003020","article-title":"ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy","volume":"133","author":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Obstetrics","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1067\/mob.2001.117314","article-title":"Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension","volume":"185","author":"E N Gofton","year":"2001","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref11","doi-asserted-by":"crossref","first-page":"812","DOI":"10.3109\/14767058.2013.842551","article-title":"The effect of cigarette smoking during pregnancy on mode of delivery in uncomplicated term singleton pregnancies","volume":"27","author":"S Lurie","year":"2014","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/AOG.0000000000002501","article-title":"ACOG Practice Bulletin No. 190: gestational diabetes mellitus","volume":"131","author":"Committee on Practice","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"e228","DOI":"10.1097\/AOG.0000000000002960","article-title":"ACOG Practice Bulletin No. 201: pregestational diabetes mellitus","volume":"132","author":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Obstetrics","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/j.1523-536X.2010.00409.x","article-title":"Advanced maternal age and the risk of cesarean birth: a systematic review","volume":"37","author":"H Bayrampour","year":"2010","journal-title":"Birth"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1097\/AOG.0000000000001807","article-title":"Practice Bulletin No. 156: obesity in pregnancy correction","volume":"128","year":"2016","journal-title":"Obstet Gynecol"},{"key":"ref16","first-page":"263","volume-title":"Guidelines for Perinatal Care. 8th ed","author":"American College of Obstetrics and Gynecology (ACOG) and American Academy of Pediatrics (AAoP).","year":"2017"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"32.e1","DOI":"10.1016\/j.ajog.2007.02.026","article-title":"Accuracy of birth certificate data by risk factors and outcomes: analysis of data from New Jersey","volume":"197","author":"N E Reichman","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1097\/AOG.0000000000002516","article-title":"Statewide quality improvement initiative to reduce early elective deliveries and improve birth registry accuracy","volume":"131","author":"H C Kaplan","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1055\/s-0037-1600898","article-title":"Using a state birth registry as a quality improvement tool","volume":"34","author":"C Lannon","year":"2017","journal-title":"Am J Perinatol"}],"container-title":["American Journal of Perinatology Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1777996.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T11:06:28Z","timestamp":1730804788000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1777996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":17,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,1,23]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1777996","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2157-6998","2157-7005"],"issn-type":[{"value":"2157-6998","type":"print"},{"value":"2157-7005","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}