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Obstetrics & Gynecology 2008;111:659-666
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Timing of Planned Cesarean Delivery by Racial Group

Imelda Balchin, MB ChB, MSc1, John C. Whittaker, BSc (Hons), PhD2, Ronald F. Lamont, DM, FRCOG3 and Philip J. Steer, MD, FRCOG4

From the 1Department of Obstetrics and Gynaecology, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, United Kingdom; 2Department of Genetic Epidemiology and Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; 3Department of Obstetrics and Gynaecology, Imperial College Faculty of Medicine, Northwick Park Hospital, Middlesex, United Kingdom; and 4Academic Department of Obstetrics and Gynaecology, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, United Kingdom.

OBJECTIVE: To estimate the incidence of newborn respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in relation to gestational age and planned cesarean delivery in white, South Asian, and black women.

METHODS: Included in this study were 442,596 white, South Asian, and black women who delivered single live infants at 28 of weeks gestation onwards between 1988 and 2000. Using multiple logistic regression, the gestation-specific patterns of RDS for all deliveries and RDS plus TTN for deliveries by planned cesarean delivery were analyzed by racial group. The predictors of RDS from 37 weeks of gestation onwards were determined.

RESULTS: More South Asians (28.2%, 95% confidence interval [CI] 27.8–28.6) and blacks (24.6%, 95% CI 24.0–25.1) delivered spontaneously before 39 weeks than whites (16.9%, 95% CI 16.8–17.1). Respiratory distress syndrome patterns by gestation differed significantly (P<.001). Compared with whites, the gestation-specific crude RDS rate was lower in South Asians up until 40 weeks and after adjusting for confounders; South Asians were most protected against RDS (odds ratio [OR] 0.6, 95% CI 0.5–0.9). The gestation-specific patterns of RDS plus TTN after planned cesarean delivery also differed significantly (P<.001) between racial groups. The lowest rate of TTN plus RDS was at 40 weeks for whites, but in South Asians and blacks, it was lowest at 38 weeks.

CONCLUSION: The gestation-specific patterns of RDS differed significantly by racial group from 32 weeks of gestation onwards. Preterm black infants had a lower rate of RDS when compared with whites; also, South Asians had the lowest rate of transient tachypnea until 38 weeks and the lowest rate of RDS until 40 weeks of gestation. The advantages of waiting until 39 weeks to perform planned cesarean delivery for white women are not seen in South Asians or blacks.

LEVEL OF EVIDENCE: II






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