The Health Effects of Cesarean Delivery for Low-Risk First Births
The Health Effects of Cesarean Delivery for Low-Risk First Births
复制标题
剖腹产对低风险第一胎的健康影响
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
D. Silver
中科院分区：
文献类型：
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作者：
David Card;Alessandra Fenizia;D. Silver
低风险妊娠的剖腹产通常与婴儿和母亲的健康状况较差有关。然而，对这种相关性的解释被出生模式选择中的潜在选择性所混淆。我们使用来自加州的出生记录，结合出生后一年婴儿和母亲的医院和急诊科（艾德）就诊，研究剖宫产对低风险初产婴儿的因果健康影响。在McClellan，McNeil和纽豪斯（1994）的基础上，我们使用母亲家到剖腹产率高和低的医院的相对距离作为剖腹产的工具。我们发现，相对距离是一个强有力的预测剖腹产，但正交许多观察到的风险因素，包括出生体重和产前护理指标。我们的IV估计表明，剖宫产导致婴儿艾德就诊率相对较大的增加，主要是由于急性呼吸道疾病。我们没有发现对母亲的住院治疗或出生后艾德的使用，或随后的生育能力有显着影响，但我们发现重复剖腹产的高可能性对第二次生育结果产生了涟漪反应。抵消这些发病率的影响，我们发现，在高剖腹产医院分娩导致婴儿死亡率显着降低，这是由于具有高风险因素的新生儿死亡率较低。
Cesarean delivery for low-risk pregnancies is generally associated with worse health outcomes for infants and mothers. The interpretation of this correlation, however, is confounded by potential selectivity in the choice of birth mode. We use birth records from California, merged with hospital and emergency department (ED) visits for infants and mothers in the year after birth, to study the causal health effects of cesarean delivery for low-risk first births. Building on McClellan, McNeil, and Newhouse (1994), we use the relative distance from a mother’s home to hospitals with high and low c-section rates as an instrument for c-section. We show that relative distance is a strong predictor of c-section but is orthogonal to many observed risk factors, including birth weight and indicators of prenatal care. Our IV estimates imply that cesarean delivery causes a relatively large increase in ED visits of the infant, mainly due to acute respiratory conditions. We find no significant effects on mothers’ hospitalizations or ED use after birth, or on subsequent fertility, but we find a ripple effect on second birth outcomes arising from the high likelihood of repeat c-section. Offsetting these morbidity effects, we find that delivery at a high c-section hospital leads to a significant reduction in infant mortality, driven by lower death rates for newborns with high rates of pre-determined risk factors.
影响因子：
5.6
作者：
Salam, Muhammad T.;Margolis, Helene G.;Gilliland, Frank D.
通讯作者：
Gilliland, Frank D.