Predictors of cesarean delivery in South Carolina births 2006-2008

Background From 1996 to 2007, cesarean-section (CSEC) delivery rates in the United States increased by 53%. Previous studies have suggested that factors such as race, diabetes, and obesity are associated with CSEC. South Carolina (SC) has the ninth highest obesity rate in the nation. We examined the association between CSEC and race, as well as secondary variables such as ethnicity, obesity, smoking status (mother), low birth weight (LBW), high birth weight (HBW), prepregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), prepregnancy hypertension (HTN), and gestational hypertension (GHTN) in SC. Methods This retrospective, cross-sectional, observational study examined birth records for years 2006-2008 from the SC Department of Health & Environmental Control (SCDHEC). This IRB-exempt study used only de-identified data. Chi-square tests of association were used to analyze the primary and secondary categorical variables. Predictors found to be significantly associated with CSEC (p<0.05) were further analyzed using multivariate logistic regression. Results 56,537 women were included (68% white, 32% non-white). Non-whites were more likely to have a CSEC than whites (OR 1.1, 95% CI 1.05-1.13). CSEC was also found to be associated with Hispanic ethnicity, obesity, HBW, DM, GDM, HTN, and GHTN (p<0.05). All of these variables remained significantly associated with CSEC in the multivariate analysis. Discussion Race and ethnicity were significantly associated with CSEC. Diabetes, hypertension, obesity, and HBW were also independent risk factors for CSEC. These findings are consistent with prior studies. Future health efforts could potentially focus on these high-risk populations to reduce their risk for CSEC.