Background
Methods
Study population and settings
Clinical measurements and data collection of potential confounders
Assessment of physical activity and sleep status
Definition of caesarean delivery
Statistical analyses
Results
Characteristics of the study population
Variables | Vaginal delivery | CD for medical reasons | CD for non-medical reasons | P-value |
---|---|---|---|---|
n | 4682 | 5692 | 2641 | |
Variables at registration for pregnancy | ||||
Age, year | 28.07 ± 2.60†,‡ | 28.72 ± 3.04† | 28.66 ± 3.11‡ | < 0.001* |
Pre-pregnancy BMI, kg/m2 | 21.56 ± 2.97†,‡ | 22.81 ± 3.54† | 22.62 ± 3.48‡ | < 0.001* |
Han-nationality | 4481 (95.7%) | 5404 (94.9%) | 2516 (95.3%) | 0.186** |
Weight, kg | 57.82 ± 8.68†,‡ | 60.67 ± 10.20†,§ | 60.09 ± 10.04‡,§ | < 0.001* |
Height, cm | 163.68 ± 4.55†,‡ | 162.99 ± 4.82† | 162.88 ± 4.74‡ | < 0.001* |
Systolic blood pressure, mmHg | 104.80 ± 10.38†,‡ | 106.24 ± 10.82† | 106.22 ± 11.10‡ | < 0.001* |
Diastolic blood pressure, mmHg | 67.73 ± 7.50†,‡ | 68.95 ± 7.83† | 69.00 ± 8.05‡ | < 0.001* |
Parity ≥1 | 138 (2.9%) | 249 (4.4%) | 97 (3.7%) | 0.001** |
Family history of diabetes in first degree relatives | 364 (8.3%) | 538 (10.0%) | 223(9.1%) | 0.014** |
Gestational age at registration, weeks | 10.45 ± 2.40† | 10.32 ± 2.31† | 10.39 ± 2.27 | 0.008* |
History of caesarean delivery ≥1 | 5 (0.1%) | 193 (3.4%) | 64 (2.4%) | < 0.001** |
Variables at Glucose challenge test | ||||
Smoke before or during pregnancy | 119 (2.5%) | 326 (5.7%) | 162 (6.1%) | < 0.001** |
Drink before or during pregnancy | 1462 (31.2%) | 1818 (31.9%) | 846 (32.0%) | 0.680** |
Gestational diabetes mellitus | 261 (5.9%) | 453(8.4%) | 183 (7.4%) | < 0.001** |
Glucose challenge test, mmol/L | 6.49 ± 1.50†,‡ | 6.72 ± 1.60† | 6.71 ± 1.56‡ | < 0.001* |
Weight gain from registration to GCT, kg | 7.41 ± 3.02†,‡ | 7.81 ± 3.58† | 7.72 ± 3.18‡ | < 0.001* |
Occupational physical activity | 0.347** | |||
Low | 4022 (86.0%) | 4946 (86.9%) | 2289 (86.7%) | |
Moderate-to-high | 656 (14.0%) | 743 (13.1%) | 351 (13.3%) | |
Commuting physical activity(min/day) a | 0.003** | |||
low | 4374 (93.6%) | 5386 (94.7%) | 2513 (95.4%) | |
Moderate-to-high | 301 (6.4%) | 302 (5.3%) | 122(4.6%) | |
Leisure-time physical activity(min/week) | 0.123** | |||
0 | 2477(53.1%) | 3074(54.3%) | 1474(56.0%) | |
0–150 | 1391 (29.8%) | 1657 (29.2%) | 716 (27.2%) | |
≥ 150 | 797 (17.1%) | 935 (16.5%) | 441 (16.8%) | |
Housework physical activity(h/day) | 0.007** | |||
≤ 1 | 3544 (77.6%) | 4432 (79.9%) | 2008 (77.6%) | |
> 1 | 1022 (22.4%) | 1114 (20.1%) | 579(22.4%) | |
Physical activity during pregnancy b | ||||
Low | 2454 (52.4%) | 3147(55.3%) | 1427 (54.0%) | 0.014** |
Moderate-to-high | 2228 (47.6%) | 2545 (44.7%) | 1214 (46.0%) | |
Sleep duration during pregnancy(h/day) | 0.025** | |||
< 7 | 88 (1.9%) | 98 (1.7%) | 65(2.5%) | |
≥ 7 to < 9 | 2067 (44.1%) | 2410 (42.3%) | 1091 (41.3%) | |
≥ 9 | 2527 (54.0%) | 3184 (55.9%) | 1485 (56.2%) | |
Sleep quality during pregnancy | 0.872** | |||
Good | 1762 (37.7%) | 2161 (38.1%) | 990 (37.6%) | |
Moderate | 2792 (59.8%) | 3390 (59.8%) | 1583 (60.1%) | |
Poor | 114 (2.4%) | 122(2.2%) | 63 (2.4%) | |
Variables at delivery | ||||
Gestational age at delivery, weeks | 39.09 ± 1.60† | 39.06 ± 1.40†,§ | 39.13 ± 1.52§ | < 0.001* |
Birth weight, kg | 3.28 ± 0.42†,‡ | 3.46 ± 0.49†,§ | 3.40 ± 0.45‡,§ | < 0.001* |
Neonatal height, cm | 50.03 ± 1.67†,‡ | 50.21 ± 1.63† | 50.22 ± 1.60‡ | < 0.001* |
Physical activity and sleep status for caesarean delivery risk
Variables | n (%) | OR (95% CI) | ||
---|---|---|---|---|
Model 1 | Model 2 | Model 3 | ||
Physical activity | ||||
Low | 4574 (35.1%) | 1.10 (1.03–1.19) | 1.12 (1.03–1.21) | 1.12 (1.04–1.22) |
Moderate-to-high | 3759 (28.9%) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Sleep duration (h/day) | ||||
< 7 | 163 (1.3%) | 1.09 (0.84–1.43) | 1.05 (0.79–1.41) | 1.04 (0.78–1.39) |
≥ 7 to < 9 | 3501 (26.9%) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
≥ 9 | 4669 (35.9%) | 1.09 (1.01–1.17) | 1.13 (1.04–1.22) | 1.13 (1.04–1.22) |
Sleep quality | ||||
Good | 3151 (24.2%) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Moderate | 4973 (38.2%) | 1.00 (0.92–1.07) | 0.99 (0.91–1.07) | 1.00 (0.92–1.09) |
Poor | 185 (1.4%) | 0.91 (0.71–1.16) | 0.88 (0.68–1.14) | 0.91 (0.70–1.19) |
Additive interaction between physical activity and sleep duration for caesarean delivery
Variables | OR (95% CI) | ||
---|---|---|---|
Model 1 | Model 2 | Model 3 | |
Subgroup analyses | |||
Among sleep time < 9 h/day | |||
Low V.S Moderate-to-high PA | 1.04 (0.94–1.16) | 1.04 (0.92–1.17) | 1.03 (0.91–1.16) |
Among sleep time ≥ 9 h/day | |||
Low V.S Moderate-to-high PA | 1.16 (1.06–1.28) | 1.20 (1.08–1.34) | 1.22 (1.09–1.36) |
Among low PA | |||
≥9 h/day V.S < 9 h/day sleep time | 1.15 (1.04–1.27) | 1.21 (1.09–1.35) | 1.22 (1.10–1.37) |
Among moderate-to-high PA | |||
≥9 h/day V.S < 9 h/day sleep time | 1.03 (0.92–1.14) | 1.03 (0.92–1.16) | 1.02 (0.90–1.15) |
Additive interaction models | |||
Moderate-to-high PA and sleep time < 9 h/day | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
Low PA and sleep time < 9 h/day | 1.04 (0.94–1.16) | 1.04 (0.92–1.16) | 1.03 (0.91–1.16) |
Moderate-to-high PA and sleep time ≥ 9/day | 1.03 (0.92–1.14) | 1.04 (0.93–1.17) | 1.03 (0.92–1.16) |
Low PA and sleep time ≥ 9 h/day | 1.20 (1.08–1.33) | 1.25 (1.12–1.41) | 1.25 (1.12–1.41) |
Additive interaction indications | |||
RERI | 0.13 (−0.02–0.28) | 0.17 (0.01–0.34) | 0.20 (0.03–0.36) |
AP | 0.11 (− 0.02–0.23) | 0.14 (0.01–0.27) | 0.16 (0.02–0.29) |
S | 2.85 (0.24–33.50) | 3.20 (0.30–34.42) | 4.40 (0.15–130.67) |
Physical activity and sleep status for risk of caesarean delivery for medical reasons and non-medical reasons
Variables | OR (95% confidence interval) | ||
---|---|---|---|
CD for medical reasons | CD for non-medical ressons rereasons | ||
Model 1 | Physical activity | ||
Low V.S Moderate-to-high | 1.12 (1.04–1.21) | 1.07 (0.97–1.17) | |
Sleep duration (h/day) | |||
< 7 | 0.96 (0.71–1.28) | 1.40 (1.01–1.95) | |
≥7 to < 9 | 1.00 (Reference) | 1.00 (Reference) | |
≥9 | 1.08 (0.99–1.17) | 1.11 (1.01–1.23) | |
Sleep quality | |||
Good | 1.00 (Reference) | 1.00 (Reference) | |
Moderate | 0.99 (0.91–1.07) | 1.01 (0.91–1.11) | |
Poor | 0.87 (0.67–1.14) | 0.98 (0.72–1.35) | |
Model 2 | Physical activity | ||
Low V.S Moderate-to-high | 1.13 (1.04–1.23) | 1.10 (0.99–1.22) | |
Sleep duration (h/day) | |||
< 7 | 0.90 (0.65–1.24) | 1.37 (0.96–1.94) | |
≥7 to < 9 | 1.00 (Reference) | 1.00 (Reference) | |
≥9 | 1.12 (1.02–1.22) | 1.16 (1.05–1.29) | |
Sleep quality | |||
Good | 1.00 (Reference) | 1.00 (Reference) | |
Moderate | 0.98 (0.90–1.07) | 0.99 (0.89–1.11) | |
Poor | 0.85 (0.64–1.13) | 0.93 (0.66–1.31) | |
Model 3 | Physical activity | ||
Low V.S Moderate-to-high | 1.13(1.04–1.24) | 1.11 (0.99–1.23) | |
Sleep duration (h/day) | |||
< 7 | 0.88 (0.64–1.22) | 1.37 (0.96–1.95) | |
≥7 to < 9 | 1.00 (Reference) | 1.00 (Reference) | |
≥9 | 1.12 (1.02–1.22) | 1.16 (1.04–1.29) | |
Sleep quality | |||
Good | 1.00 (Reference) | 1.00 (Reference) | |
Moderate | 0.99 (0.91–1.09) | 1.01 (0.91–1.13) | |
Poor | 0.88 (0.66–1.18) | 0.98 (0.69–1.38) |
Additive interaction between physical activity and sleep duration for risk of caesarean delivery for medical reasons and non-medical reasons
Variables | OR (95% CI) | ||
---|---|---|---|
CD for medical reasons | CD for non-medical reasons | ||
Model 1 | Additive interaction | ||
Moderate-to-high PA and sleep time < 9 h/day | 1.00(Reference) | 1.00(Reference) | |
Low PA and sleep time < 9 h/day | 1.07(0.96–1.19) | 1.07(0.93–1.22) | |
Moderate-to-high PA and sleep time ≥ 9/day | 1.00(0.89–1.12) | 1.08(0.94–1.25) | |
Low PA and sleep time ≥ 9 h/day | 1.27(1.12–1.44) | 1.24(1.05–1.45) | |
Additive interaction indications | |||
RERI | 0.20(0.03–0.37) | 0.09(−0.13–0.31) | |
AP | 0.16(0.03–0.29) | 0.07(−0.10–0.25) | |
S | 3.98(0.26–61.04) | 1.60(0.37–6.99) | |
Model 2 | Additive interaction | ||
Moderate-to-high PA and sleep time < 9 h/day | 1.00(Reference) | 1.00(Reference) | |
Low PA and sleep time < 9 h/day | 1.06(0.95–1.20) | 1.09(0.95–1.26) | |
Moderate-to-high PA and sleep time ≥ 9/day | 1.02(0.90–1.15) | 1.11(0.95–1.29) | |
Low PA and sleep time ≥ 9 h/day | 1.34(1.16–1.54) | 1.36(1.14–1.61) | |
Additive interaction indications | |||
RERI | 0.26(0.06–0.45) | 0.15(−0.09–0.40) | |
AP | 0.19(0.05–0.33) | 0.11(−0.06–0.29) | |
S | 4.13(0.35–48.48) | 1.75(0.54–5.67) | |
Model 3 | Additive interaction | ||
Moderate-to-high PA and sleep time < 9 h/day | 1.00(Reference) | 1.00(Reference) | |
Low PA and sleep time < 9 h/day | 1.07(0.95–1.20) | 1.07(0.93–1.24) | |
Moderate-to-high PA and sleep time ≥ 9/day | 1.01(0.89–1.15) | 1.08(0.92–1.26) | |
Low PA and sleep time ≥ 9 h/day | 1.34(1.16–1.54) | 1.36(1.14–1.62) | |
Additive interaction indications | |||
RERI | 0.26(0.06–0.45) | 0.21(−0.04–0.45) | |
AP | 0.19(0.05–0.33) | 0.15(−0.02–0.33) | |
S | 4.21(0.32–56.28) | 2.36(0.47–11.79) |