Infant Infections Following Cesarean Delivery on Maternal Request: A Population-Based Cohort Study

Objectives Investigations about cesarean delivery (CD) on maternal request (CDMR) and infant infection risk frequently rely on administrative data with poorly defined indications for CD. We sought to determine the association between CDMR and infant infection using an intent-to-treat approach. Methods This was a population-based cohort study of low-risk singleton pregnancies with a term livebirth in Ontario, Canada between April 2012 and March 2018. Subjects with prior CD were excluded. Outcomes included upper and lower respiratory tract infections, gastrointestinal infections, otitis media, and a composite of these 4. Relative risks (RR) and 95% confidence intervals (CI) were calculated for component and composite outcomes up to 1 year following planned CDMR versus planned vaginal deliveries (VD). Sub-group and sensitivity analyses included age at infection (≤28 vs. >28 days), type of care (ambulatory vs. hospitalization), restricting the cohort to nulliparous pregnancies, and including individuals with previous CD. Last, we re-examined outcome risk on an as-treated basis (actual CD vs. actual VD). Results Of 422 134 pregnancies, 0.4% (1827) resulted in a planned CDMR. After adjusting for covariates, planned CDMR was not associated with a risk of composite infant infections (aRR 1.02, 95% CI 0.92–1.11). Findings for component infection outcomes, sub-group, and sensitivity analyses were similar. However, the as-treated analysis of the role of delivery mode on infant risk for infection demonstrated that actual CD (planned and unplanned) was associated with an increased risk for infant infections compared to actual VD. Conclusions Planned CDMR is not associated with increased risk for neonatal or infant infections compared with planned VD. Study design must be carefully considered when investigating the impact of CDMR on infant infection outcomes.