TOPLINE:

Women who had a first child by cesarean delivery had an 11% lower chance of having a second child over 12 years and were 28% more likely to use in vitro fertilization (IVF) or other fertility treatments to have a second child.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to evaluate whether having a first childbirth by cesarean delivery affected subsequent reproductive outcomes.
• They used data from a perinatal registry and three IVF units to include women who gave birth to their first spontaneously conceived singleton in Victoria, Australia, between 2005 and 2015.
• Of 298,241 women (mean age, 29 years), 68.8% delivered vaginally and 31.2% had cesarean deliveries.
• The two primary outcomes were having a second live birth and conception via IVF or other assisted reproductive technologies among those who had a second birth.
• Data on second birth were included through December 2017.

TAKEAWAY:

• Overall, 61.7% of women had a second live birth within the 12-year period.
• Women who delivered their first child by cesarean were 11% less likely to have a second live birth than those who delivered vaginally (adjusted hazard ratio, 0.89; 95% CI, 0.88-0.90).
• Among women who had a second live birth, a prior cesarean delivery was linked to a 28% increased risk of using IVF (adjusted risk ratio [aRR], 1.28; 95% CI, 1.15-1.43) or any assisted reproductive technology for conception (aRR, 1.28; 95% CI, 1.18-1.40).
• These associations were observed for both elective and emergency cesarean deliveries. The risk for miscarriage did not differ by the mode of the first childbirth.

IN PRACTICE:

“Given what is known about the benefits and potential risks of cesarean delivery, any counselling regarding fertility implications should form part of nuanced shared decision-making conversations for each individual woman,” the researchers of the study wrote.

SOURCE:

The study was led by N.L. Pritchard, PhD, of the University of Melbourne in Melbourne, Australia. It was published online on March 18 in American Journal of Obstetrics and Gynecology.

LIMITATIONS:

Researchers lacked information on personal choice of size of family, which may have influenced the findings. Information on preexisting health or fertility problems was limited. The study excluded women who experienced stillbirths.

DISCLOSURES:

Three authors reported receiving salary support from the National Health and Medical Research Council of Australia. One author reported receiving an unrelated grant. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.