{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T06:40:02Z","timestamp":1765435202851,"version":"3.46.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cesarean section (C-section) rates have increased dramatically over the last few decades worldwide, and China's C-section rate has continuously remained much higher than the World Health Organization (WHO)'s suggested threshold. This study aimed to (1) estimate the temporal trends and factors for C-sections and (2) examine the association of a previous C-section with adverse outcomes in a subsequent pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a tertiary-level hospital-based retrospective cohort study in the Hubei Province, China between 2011 and 2019. A chi-squared test was used to estimate the baseline disparities between C-sections and normal delivery among singleton and twin pregnancies. A multiple binary logistic regression model was conducted to predict factors associated with C-sections and their impact on subsequent pregnancy outcomes. The secular trend of C-section was determined by using the joinpoint regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2013 and 2019, the trend of C-section was significantly increased among singleton women with a high education level (annual percentage change (APC), 9.8%; 95%CI: 5.3, 14.5) and professional services (APC, 7.9%; 95%CI: 2.9, 13.2). The leading five factors, including previous C-section followed by fetal breech presentation, abnormal placentation, oligohydramnios, and macrosomia, were associated with a higher risk of C-section among singleton pregnancies. Hypertensive disorders of pregnancy (HDP) increase the risk of C-section in women with twin gestations. Previous C-section associated with a higher likelihood of gestational diabetes mellitus (GDM) in the subsequent pregnancy of singleton (aOR, 1.30; 95%CI: 1.14, 1.49) and twin (aOR, 1.78; 95%CI: 1.05, 3.01) women. Moreover, previous C-sections increased the odds of C-sections (aOR, 3.41; 95%CI: 3.11, 3.75) in the subsequent pregnancy of singleton women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The secular trend of C-sections significantly increased among women with high socioeconomic status, and a previous C-section was associated with a higher likelihood of repeated C-sections in singleton women and GMD in the subsequent pregnancy of both singleton and twin women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1683485","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T06:37:56Z","timestamp":1765435076000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal trend and factors of C-section and its impact on subsequent pregnancy outcomes in Central China"],"prefix":"10.3389","volume":"12","author":[{"given":"Hui","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi","family":"Yuanmei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoli","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Nawsherwan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Xinhua","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e0148343","DOI":"10.1371\/journal.pone.0148343","article-title":"The 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