Gestational Weight Gain during Pregnancy as an Important Factor Influencing a Successful Trial of Labor following Two Previous Cesareans

James A. Sargent, Leah M. Savitsky, Mekhala V. Dissanayake, Jamie Lo, Yvonne W. Cheng, Aaron Caughey

Research output: Contribution to journalArticle

Abstract

Objective We sought to identify factors associated with a successful trial of labor (TOL) following two cesarean deliveries (CDs) in a contemporary North American cohort. Study Design This is a retrospective cohort study of term, nonanomalous, singleton, vertex pregnancies attempting a vaginal birth after cesarean (VBAC) following a history of two previous CDs in the United States from 2012 to 2014. Maternal and intrapartum factors were analyzed using chi-square tests and multivariable logistic regression. Results A total of 22,762 women met the inclusion criteria and underwent TOL. Of these, 12,192 (53.6%) had a VBAC. Using multivariate logistic regression, previous vaginal delivery and delivery at 40 to 41 weeks' gestation were associated with VBAC; maternal age, education, Medicaid insurance, non-Caucasian race/ethnicity, weight (overweight or obese), and gestational weight gain above the Institute of Medicine guidelines (adjusted odds ratio: 0.88; 95% confidence interval: 0.81-0.95) were associated with CD. Induction of labor did not affect the VBAC rate. Conclusion For those desiring a TOL after two previous CDs, prospective studies are needed to assess interventions that limit gestational weight gain as well as the safety and optimal timing of an induction of labor. The decision to attempt a TOL should be guided by counseling regarding the risks, benefits, and chances of a successful TOL.

Original languageEnglish (US)
Pages (from-to)588-593
Number of pages6
JournalAmerican Journal of Perinatology
Volume36
Issue number6
DOIs
StatePublished - Jan 1 2019

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Trial of Labor
Vaginal Birth after Cesarean
Weight Gain
Pregnancy
Induced Labor
Logistic Models
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Maternal Age
Medicaid
Chi-Square Distribution
Insurance
Counseling
Cohort Studies
Retrospective Studies
Odds Ratio
Mothers
Prospective Studies
Guidelines
Confidence Intervals
Safety

Keywords

  • maternal and fetal morbidity
  • TOLAC
  • trial of labor after two cesareans
  • vaginal birth after cesarean
  • VBAC

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Gestational Weight Gain during Pregnancy as an Important Factor Influencing a Successful Trial of Labor following Two Previous Cesareans. / Sargent, James A.; Savitsky, Leah M.; Dissanayake, Mekhala V.; Lo, Jamie; Cheng, Yvonne W.; Caughey, Aaron.

In: American Journal of Perinatology, Vol. 36, No. 6, 01.01.2019, p. 588-593.

Research output: Contribution to journalArticle

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