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

O'Neill, Sinéad M.; Kearney, Patricia M.; Kenny, Louise C.; Henriksen, Tine B.; Lutomski, Jennifer E.; Greene, Richard A.; Khashan, Ali S.

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

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.contributor.funder	Health Research Board	en
dc.date.accessioned	2016-02-08T16:54:00Z
dc.date.available	2016-02-08T16:54:00Z
dc.date.issued	2013-08-27
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.description.status	Peer reviewed	en
dc.description.version	Published Version	en
dc.format.mimetype	application/pdf	en
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.doi	10.1186/1471-2393-13-165
dc.identifier.endpage	12	en
dc.identifier.issn	1471-2393
dc.identifier.journaltitle	BMC Pregnancy and Childbirth	en
dc.identifier.startpage	1	en
dc.identifier.uri	https://hdl.handle.net/10468/2268
dc.identifier.volume	13	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