Journal of Clinical Epidemiology
Volume 56, Issue 11 , Pages 1100-1110, November 2003

Explaining the association of maternal age with cesarean delivery for nulliparous and parous women

  • Ilana F Gareen

      Affiliations

    • Center for Statistical Sciences and the Department of Community Health, Brown University School of Medicine, Box G-H, Providence, RI 02912, USA
    • Corresponding Author InformationCorresponding author. Tel.: 401-863-1758; fax: 401-863-9182.
    • ,
  • Hal Morgenstern

      Affiliations

    • Department of Epidemiology, UCLA School of Public Health, 250 Young Drive South, Los Angeles, CA 90095, USA
    • ,
  • Sander Greenland

      Affiliations

    • Department of Epidemiology, UCLA School of Public Health, 250 Young Drive South, Los Angeles, CA 90095, USA
    • Department of Statistics, UCLA College of Letters and Science, 250 Young Drive South, Los Angeles, CA 90095, USA
    • ,
  • Deidre Spelliscy Gifford

      Affiliations

    • Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, RI 02912, USA

Accepted 16 June 2003.

Abstract 

Method

We used data on 6,805 live births from the National Maternal and Infant Health Survey to examine the positive association between maternal age and Cesarean delivery.

Results

For parous women, the unadjusted risk ratio [RR] for Cesarean, comparing 35 year olds with 20 year olds, was estimated to be 1.40 [95% confidence limits (CL)=1.18, 1.65]; this association disappeared upon adjustment for obstetrical predictors and other factors (adjusted RR=1.04; 95% CL=0.80, 1.35). In contrast, for nulliparous women, the unadjusted risk ratio was 2.16 (95% CL=1.78, 2.63) and remained substantial upon adjustment (RR=1.74; 95% CL=1.25, 2.43).

Conclusion

These results, along with baseline risk information, suggest that older nulliparous women and their obstetricians should be the target of future efforts to control Cesarean rates.

Keywords:  Cesarean delivery, Maternal age, Epidemiology

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PII: S0895-4356(03)00199-9

doi:10.1016/S0895-4356(03)00199-9

Journal of Clinical Epidemiology
Volume 56, Issue 11 , Pages 1100-1110, November 2003

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