Predictors of Caesarian section in a population of high risk minority pregnant women in Washington, DC

The rate of Caesarian sections is continuing to rise in the US despite efforts to limit it. C-sections confer additional risks for both the mother and her infant. It is important to understand factors predicting C-sections in an already high risk population. We followed 1,044 African American women during pregnancy if they were >17 years, spoke English, were <28 weeks pregnant and screened positive for smoking, environmental tobacco smoke exposure, depression or intimate partner violence. Mode of delivery was known for 837 live births, 29% of which were C-sections. In bivariate analysis, women with preconception or gestational diabetes were more likely to have a C-section (p<0.001 and p=0.092). Women with a multiple pregnancy and women who were primiparous were more likely to have a C-section (p=0.003 and p=0.033, respectively). Women with less than a high school diploma or some college were more likely to have a C-section compared to those with a high school degree (p=0.073). In a logistic regression model, adjusting for demographic and medical factors, women with preconception diabetes were more likely to have a C-section (OR=3.55, 95% CI=1.43-8.78). Women delivering a singleton were less likely to have a C-section (OR=0.22, 95% CI=0.06-0.78) and women of higher gravidity were less likely to have a C-section (OR=0.90, 95% CI=0.82-1.00). Older women were more likely to have a C-section (OR=1.04, 95% CI=1.00-1.08). Health providers need to be aware of these factors such as maternal age, gravidity, multiple pregnancy and preconception diabetes when caring for pregnant women.