{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:43:52Z","timestamp":1791931432088,"version":"4.3.4"},"reference-count":54,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T00:00:00Z","timestamp":1696809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>In the last few years, there has been a gradually increasing rate of caesarean section deliveries worldwide that negatively affects both mothers\u2019 and children\u2019s health. The present survey intended to explore the relations of common maternal risk factors with the prevalence of caesarean sections. This is a cross-sectional study including 5182 healthy mothers from geographically diverse regions of Greece, which has applied relevant inclusion and exclusion criteria. An elevated 56.4% incidence of caesarean sections was noted. The prevalence of caesarean section deliveries was estimated to be 51.5% in private hospitals and 48.5% in public hospitals. Maternal age, pre-pregnancy overweight\/obesity, excess gestational weight gain, preterm birth, financial status, smoking habits, and private type of birth hospital were considerably associated with a high probability of caesarean section, regardless of several confounders. In conclusion, caesarean section rates are constantly increasing, and various maternal risk factors additively elevate its incidence, which additionally enhances the likelihood of postpartum complications for both the mothers and their infants. Public health procedures and approaches are strongly recommended to notify future mothers of the potential risk factors that may result in adverse pregnancy outcomes of caesarean section delivery, highlighting its use only for emergency medical reasons and also promoting healthier nutritional and lifestyle habits that may reduce the increasing prevalence of caesarean section deliveries.<\/jats:p>","DOI":"10.3390\/medsci11040066","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T12:51:04Z","timestamp":1696855864000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association of Maternal Risk Factors with the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-3544","authenticated-orcid":false,"given":"Eleni","family":"Pavlidou","sequence":"first","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Antasouras","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6408-6128","authenticated-orcid":false,"given":"Sousana K.","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57001 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Alexatou","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4923-484X","authenticated-orcid":false,"given":"Dimitrios","family":"Papandreou","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition & Dietetics, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Mentzelou","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Tsourouflis","sequence":"additional","affiliation":[{"name":"Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Louka","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7710-6231","authenticated-orcid":false,"given":"Nikolaos E.","family":"Rodopaios","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, Preventive Medicine and Nutrition, Medical School, University of Crete, 70013 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Chrysafi","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Sampani","sequence":"additional","affiliation":[{"name":"First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2878-4831","authenticated-orcid":false,"given":"Constantinos","family":"Giaginis","sequence":"additional","affiliation":[{"name":"Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/1471-0528.13526","article-title":"WHO statement on caesarean section rates","volume":"123","author":"Betran","year":"2016","journal-title":"BJOG"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Betr\u00e1n, A.P., Ye, J., Moller, A.B., Zhang, J., G\u00fclmezoglu, A.M., and Torloni, M.R. (2016). The increasing trend in caesarean section rates: Global, regional and national estimates: 1990\u20132014. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148343"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e005671","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: Global and regional estimates","volume":"6","author":"Betran","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/intqhc\/8.2.159","article-title":"Are operative delivery procedures in Greece socially conditioned?","volume":"8","author":"Skalkidis","year":"1996","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1093\/eurpub\/cki002","article-title":"An investigation of Caesarean sections in three Greek hospitals: The impact of financial incentives and convenience","volume":"15","author":"Mossialos","year":"2005","journal-title":"Eur. J. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"39","DOI":"10.18332\/ejm\/147993","article-title":"Which classification system could empower the understanding of caesarean section rates in Greece? A review of systematic reviews","volume":"6","author":"Giaxi","year":"2022","journal-title":"Eur. J. Midwifer."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e002789","DOI":"10.1136\/bmjopen-2013-002789","article-title":"Role of public and private funding in the rising caesarean section rate: A cohort study","volume":"3","author":"Haggar","year":"2013","journal-title":"BMJ Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1016\/S0140-6736(18)32113-5","article-title":"FIGO position paper: How to stop the caesarean section epidemic","volume":"392","author":"Visser","year":"2018","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/S0140-6736(18)31930-5","article-title":"Short-term and long-term effects of caesarean section on the health of women and children","volume":"392","author":"Sandall","year":"2018","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s00737-019-00968-2","article-title":"Delivery mode is associated with maternal mental health following childbirth","volume":"22","author":"Dekel","year":"2019","journal-title":"Archiv. Womens Ment. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"h2410","DOI":"10.1136\/bmj.h2410","article-title":"Time to consider the risks of caesarean delivery for long term child health","volume":"350","author":"Blustein","year":"2015","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000365164","article-title":"Women are designed to deliver vaginally and not by cesarean section: An obstetrician\u2019s view","volume":"107","author":"Visser","year":"2015","journal-title":"Neonatology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Brizan, J.B., and Amabebe, E. (2022). Maternal obesity as a risk factor for caesarean delivery in Sub-Saharan Africa: A systematic review. Life, 12.","DOI":"10.3390\/life12060906"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1111\/birt.12644","article-title":"Cesarean birth and risk of obesity from birth to adolescence: A cohort study","volume":"49","author":"Rodrigues","year":"2022","journal-title":"Birth"},{"key":"ref_15","first-page":"e20326","article-title":"Prevalence and factors associated with caesarean delivery in Nepal: Evidence from a nationally representative sample","volume":"13","author":"Das","year":"2021","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bhandari, A.K., Dhungel, B., and Rahman, M. (2020). Trends and correlates of cesarean section rates over two decades in Nepal. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-03453-2"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dzakpasu, S., Fahey, J., Kirby, R.S., Tough, S.C., Chalmers, B., Heaman, M.I., Bartholomew, S., Biringer, A., Darling, E.K., and Lee, L.S. (2014). Contribution of prepregnancy body mass index and gestational weight gain to caesarean birth in Canada. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-106"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e0162506","DOI":"10.1371\/journal.pone.0162506","article-title":"Cross-country individual participant analysis of 4.1 million singleton births in 5 countries with very high human development index confirms known associations but provides no biologic explanation for 2\/3 of all preterm births","volume":"11","author":"Ferrero","year":"2016","journal-title":"PLoS ONE"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/1471-0528.16566","article-title":"Caesarean birth and risk of subsequent preterm birth: A retrospective cohort study","volume":"128","author":"Williams","year":"2021","journal-title":"BJOG"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1002\/uog.20173","article-title":"Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor","volume":"53","author":"Fiolna","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_21","first-page":"E885","article-title":"Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery: A national prevalence study of 11 provinces in Iran","volume":"62","author":"Darbandi","year":"2022","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mantzorou, M., Papandreou, D., Vasios, G.K., Pavlidou, E., Antasouras, G., Psara, E., Taha, Z., Poulios, E., and Giaginis, C. (2022). Exclusive breastfeeding for at least four months is associated with a higher prevalence of overweight and obesity in mothers and their children after 2\u20135 years from delivery. Nutrients, 14.","DOI":"10.3390\/nu14173599"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.wombi.2019.06.011","article-title":"Indications for, and timing of, planned caesarean section: A systematic analysis of clinical guidelines","volume":"33","author":"Coates","year":"2020","journal-title":"Women Birth"},{"key":"ref_24","unstructured":"WHO (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part I: Diagnosis and Classification of Diabetes Mellitus WHO\/MCD\/MCS\/99.2 ed Geneva WHO 1999, World Health Organization."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s41043-017-0115-z","article-title":"Association of dietary patterns with diabetes complications among type 2 diabetes patients in gaza strip. Palestine: A cross sectional study","volume":"36","author":"Hosseini","year":"2017","journal-title":"J. Health Popul. Nutr."},{"key":"ref_26","unstructured":"Na-Than, L., Laufer, N., Roman, A., and Education, M. (2019). Current Diagnosis & Treatment: Obstetrics & Gynecology, McGraw-Hill Education."},{"key":"ref_27","first-page":"181","article-title":"Diagnosis and management of gestational hypertension and preeclampsia","volume":"102","author":"Sibai","year":"2003","journal-title":"Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1001\/jama.2015.15553","article-title":"Relationship between caesarean delivery rate and maternal and neonatal mortality","volume":"314","author":"Molina","year":"2015","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/ajo.13085","article-title":"Rates of stillbirth by maternal region of birth and gestational age in New South Wales, Australia 2004\u20132015","volume":"60","author":"Berman","year":"2020","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.1523-536X.2006.00147.x","article-title":"Elective caesarean section and decision making: A critical review of the literature","volume":"34","author":"McCourt","year":"2007","journal-title":"Birth"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1023\/A:1021730318217","article-title":"Beyond the simple economics of cesarean section birthing: Women\u2019s resistance to social inequality","volume":"26","year":"2002","journal-title":"Cult. Med. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/birt.12421","article-title":"Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades","volume":"46","author":"Jahnke","year":"2019","journal-title":"Birth"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.bpobgyn.2020.06.006","article-title":"The impact of advanced maternal age on pregnancy outcome","volume":"70","author":"Attali","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3325\/cmj.2021.62.130","article-title":"The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: A retrospective study","volume":"62","author":"Genc","year":"2021","journal-title":"Croat. Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S1701-2163(15)30228-0","article-title":"Factors associated with increased rates of caesarean section in women of advanced maternal age","volume":"37","author":"Janoud","year":"2015","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/0959353516639615","article-title":"\u201cFor some people it isn\u2019t a choice, it\u2019s just how it happens\u201d: Accounts of \u2018delayed\u2019 motherhood among middle-class women in the UK","volume":"26","author":"Budds","year":"2016","journal-title":"Fem. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Muhammad, T., Srivastava, S., Kumar, P., and Rashmi, R. (2022). Prevalence and predictors of elective and emergency caesarean delivery among reproductive-aged women in Bangladesh: Evidence from demographic and health survey, 2017\u201318. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04833-6"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"848","DOI":"10.31729\/jnma.7532","article-title":"Primary Caesarean Section among Multiparous Pregnant Women Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study","volume":"60","author":"Shah","year":"2022","journal-title":"JNMA J. Nepal. Med. Assoc."},{"key":"ref_39","first-page":"38","article-title":"Effect of age and parity on primary caesarean section rates","volume":"25","author":"Rasheed","year":"1998","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Jatta, F., Sundby, J., Vangen, S., Lindskog, B.V., S\u00f8rbye, I.K., and Owe, K.M. (2021). Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18115938"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1111\/1471-0528.15661","article-title":"Impact of maternal body mass index and gestational weight gain on pregnancy complications: An individual participant data meta-analysis of European, North American, and Australian cohorts","volume":"126","author":"Santos","year":"2019","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ajog.2011.05.039","article-title":"Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy","volume":"205","author":"McDonald","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S1701-2163(16)32758-X","article-title":"The Canadian maternity experiences survey: An overview of findings","volume":"30","author":"Chalmers","year":"2008","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e021538","DOI":"10.1136\/bmjopen-2018-021538","article-title":"Caesarean sections and the prevalence of preterm and early-term births in Brazil: Secondary analyses of national birth registration","volume":"8","author":"Barros","year":"2018","journal-title":"BMJ Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/S2214-109X(18)30451-0","article-title":"Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis","volume":"7","author":"Chawanpaiboon","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Lackovic, M., Milicic, B., Mihajlovic, S., Filimonovic, D., Jurisic, A., Filipovic, I., Rovcanin, M., Prodanovic, M., and Nikolic, D. (2021). Gestational Diabetes and Risk Assessment of Adverse Perinatal Outcomes and Newborns Early Motoric Development. Medicina, 57.","DOI":"10.3390\/medicina57080741"},{"key":"ref_47","first-page":"1","article-title":"Predictors of caesarean section\u2014A cross-sectional study in Hungary","volume":"31","author":"Renes","year":"2017","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1111\/birt.12654","article-title":"Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study","volume":"49","author":"Panda","year":"2022","journal-title":"Birth"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1038\/s41430-018-0127-9","article-title":"The association between caesarean delivery and the initiation and duration of breastfeeding: A prospective cohort study in China","volume":"72","author":"Wu","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1080\/01443615.2019.1647519","article-title":"Caesarean delivery associated with adverse breastfeeding practices: A prospective cohort study","volume":"40","author":"Binns","year":"2020","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"931","DOI":"10.26719\/emhj.21.027","article-title":"Associations between caesarean births and breastfeeding in the Middle East: A scoping review","volume":"27","author":"Sodeno","year":"2021","journal-title":"East. Mediterr. Health J."},{"key":"ref_52","first-page":"e37026","article-title":"Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study","volume":"15","author":"Reddy","year":"2023","journal-title":"Cureus"},{"key":"ref_53","first-page":"CD005528","article-title":"Non-clinical interventions for reducing unnecessary caesarean section","volume":"9","author":"Chen","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"186","DOI":"10.26574\/maedica.2022.17.1.186","article-title":"Tocophobia and Women\u2019s Desire for a Caesarean Section: A Systematic Review","volume":"17","author":"Kanellopoulos","year":"2022","journal-title":"Maedica"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/11\/4\/66\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:03:42Z","timestamp":1760130222000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/11\/4\/66"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,9]]},"references-count":54,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["medsci11040066"],"URL":"https:\/\/doi.org\/10.3390\/medsci11040066","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,9]]}}}