Delivery mode and maternal health conditions before and after childbirth: A population-based cohort study from Estonia.

INTRODUCTION: Cesarean section (CS) is the most common gynecological surgery globally, with rates increasing in many developed countries. In Estonia, the CS rate rose from 6.4% in 1992 to 20.6% in 2021. While CS can be lifesaving when medically necessary, its rising use without clear medical indication does not have benefits for the mother but is associated with a broad spectrum of long-term complications, including uterine rupture, abnormal placentation, ectopic pregnancy, abnormal uterine bleeding, and chronic pelvic pain. The Estonian Biobank (EstBB) is a population-based biobank that links genetic data with health records from national registries. Between 2007 and 2023, over 200 000 individuals were recruited, providing a valuable dataset for health and genetics research. This study examines maternal health conditions occurring both before and after childbirth, including short- and long-term outcomes associated with CS and vaginal delivery (VD). MATERIAL AND METHODS: We analyzed EstBB health data using International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes to compare short- and long-term maternal health conditions occurring before and after childbirth between women with one or more VD (ICD-10 O80, n = 30 898) and women with one or more CS (ICD-10 O82, n = 8285). Women with a history of both VD and CS were excluded. Logistic regression assessed associations between delivery mode and health conditions, adjusting for maternal birth year and body mass index. RESULTS: As expected, the CS group had higher rates of comorbidities and pregnancy complications like gestational diabetes, hypertensive disorders, mental health issues, and possible postsurgical morbidities such as infections, incisional hernia, and chronic pain. In the VD group, conditions like perineal trauma, pelvic organ prolapse, and stress urinary incontinence were more prevalent. Interestingly, cervical inflammatory conditions and cervical dysplasia were also more common in the VD group. CONCLUSION: CS is related to more complications and health problems compared with VD, but the relationship may not be causative. CS risks should be weighed against clinical indications for its use. It is important for healthcare providers to recognize and openly discuss both the immediate and long-term risks associated with the procedure with women requiring or considering CS.