Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis

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dc.contributor.author O'Neill, Sinéad M.
dc.contributor.author Kearney, Patricia M.
dc.contributor.author Kenny, Louise C.
dc.contributor.author Henriksen, Tine B.
dc.contributor.author Lutomski, Jennifer E.
dc.contributor.author Greene, Richard A.
dc.contributor.author Khashan, Ali S.
dc.date.accessioned 2016-02-08T16:54:00Z
dc.date.available 2016-02-08T16:54:00Z
dc.date.issued 2013-08-27
dc.identifier.citation O’NEILL, S. M., KEARNEY, P. M., KENNY, L. C., HENRIKSEN, T. B., LUTOMSKI, J. E., GREENE, R. A. & KHASHAN, A. S. 2013. Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis. BMC Pregnancy and Childbirth, 13:165, 1-12. http://dx.doi.org/10.1186/1471-2393-13-165 en
dc.identifier.volume 13 en
dc.identifier.startpage 1 en
dc.identifier.endpage 12 en
dc.identifier.issn 1471-2393
dc.identifier.uri http://hdl.handle.net/10468/2268
dc.identifier.doi 10.1186/1471-2393-13-165
dc.description.abstract Background: Caesarean delivery has increased worldwide, however, the effects on fertility are largely unknown. This systematic review aims to compare subsequent sub-fertility (time to next pregnancy or birth) among women with a Caesarean delivery to women with a vaginal delivery. Methods: Systematic review of the literature including seven databases: CINAHL; the Cochrane Library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge (1945 - October 2012), using detailed search-strategies and reference list cross-checking. Cohort, case–control and cross-sectional studies were included. Two assessors reviewed titles, abstracts, and full articles using standardised data abstraction forms and assessed study quality. Results: 11 articles were eligible for inclusion in the systematic review, of these five articles which adjusted for confounders were combined in a meta-analysis, totalling 750,407 women using fixed-effect models. Previous Caesarean delivery was associated with an increased risk of sub-fertility [pooled odds ratio (OR) 0.90; 95% CI 0.86, 0.93]. Subgroup analyses by parity [primiparous women: OR 0.91; 95% CI 0.87, 0.96; not limited to primiparous women: OR 0.81; 95% CI 0.73, 0.90]; by publication date (pre-2000: OR 0.80, 95% CI 0.68, 0.94; post-2000: OR 0.90, 95% CI 0.86, 0.94); by length of follow-up (<10 years: OR 0.81, 95% CI 0.73, 0.90; >10 years: OR 0.91, 95% CI 0.87, 0.96); by indication for mode of delivery (specified: 0.92, 95% CI 0.88, 0.97; not specified: OR 0.81, 95% CI 0.73, 0.90); by cohort size (<35,000: OR 0.79, 95% CI 0.67, 0.92; >35,000: OR 0.90, 95% CI 0.87, 0.95), by definition of sub-fertility used divided into (birth interval [BI]: OR 0.89, 95% CI 0.84, 0.94; inter-pregnancy interval [IPI]: OR 0.91, 95% CI 0.85, 0.97; and categorical measures: OR 0.81, 95% CI 0.73, 0.90); continuous measures: OR 0.91, 95% CI 0.87, 0.96) were performed. Results of the six studies not included in the meta-analysis (which did not adjust for confounders) are presented individually. Conclusions: The meta-analysis shows an increased waiting time to next pregnancy and risk of sub-fertility among women with a previous Caesarean delivery. However, included studies are limited by poor epidemiological methods such as variations in the definition of time to next pregnancy, lack of confounding adjustment, or details of the indication for Caesarean delivery. Further research of a more robust methodological quality to better explore any underlying causes of sub-fertility and maternal intent to delay childbearing is warranted. en
dc.description.sponsorship Health Research Board (PhD Scholars Programme in Health Services Research, Grant Number PhD/2007/16) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BioMed Central Ltd. en
dc.rights © O’Neill et al. licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en
dc.rights.uri creativecommons.​org/​licenses/​by/​2.​0 en
dc.subject Time-to-pregnancy en
dc.subject Selection bias en
dc.subject Primary-mode en
dc.subject Section en
dc.subject Fertility en
dc.subject Infertility en
dc.subject Birth en
dc.subject Subfertility en
dc.subject Childbirth en
dc.subject Options en
dc.title Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Patricia Kearney, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: patricia.kearney@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.rssid 234484220
dc.internal.rssid 269571371
dc.internal.rssid 269571371
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.identifier.journaltitle BMC Pregnancy and Childbirth en
dc.internal.IRISemailaddress patricia.kearney@ucc.ie en


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© O’Neill et al. licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as © O’Neill et al. licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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