Association between maternal social vulnerability and cesarean delivery: A cohort study

Objective: Although social vulnerability has been correlated to adverse obstetrical outcomes, its definition as well as its correlation to mode of delivery vary between different studies. The aim of this study is to evaluate the association between maternal social vulnerabilities and cesarean section with the inclusion of a wide range of social vulnerability characteristics. Study design: The current study is a retrospective single center cohort study in a tertiary care maternity unit between January 2020 and December 2021. All women who delivered after 24 gestational weeks were included. Multiple component analysis (MCA) grouped vulnerability characteristics in three independent vulnerability axes, named after their clinical relevance as administrative, psychological, and dependency axis. Multiple logistic regression was performed, controlling for obstetrical, medical factors as well as the Robson classification. Results: In total, 7707 patients were identified. After adjustment for the aforementioned factors, a statistically significant association was shown between administrative vulnerability index and cesarean section before labor or during labor respectively (aOR 1.48 [1.23 - 1.78] and aOR 1.46 [OR 1.23 - 1.73]). In contrast, no significant correlation was found for the psychological vulnerability index (aOR 1.09 [0.86 - 1.38] and aOR 0.99 [0.78 - 1.25]) or the dependency vulnerability index (aOR 0.98 [0.76 - 1.26] and aOR 0.85 [0.64 - 1.12]). Conclusions: The current study provides new insight into the correlation between social vulnerabilities and the risk of cesarean section. It demonstrates that administrative vulnerability is an independent risk factor of cesarean delivery. These patients should be identified and offered an adapted pregnancy monitoring in order to reduce cesarean section rates.