Previous Cesarean Section and the Risk of Preeclampsia: A Meta-analysis

Preeclampsia is a common pregnancy complication with the multisystem variable disorder. Yet, the literature has not been systematically reviewed for the relationship between previous cesarean section and the risk of preeclampsia.

This study aimed to identify the relationship between previous cesarean delivery and the risk of preeclampsia.

This study was a systematic review and meta-analysis. PubMed, Scopus, ProQuest, and Web of Sciences were searched to identify eligible observational studies until May 25, 2019. The odds ratio (OR) and 95% confidence intervals (CI) were calculated as random effect estimates of association among studies. The quality of the included studies was examined based on the Newcastle-Ottawa scale.

This study included 7 eligible articles (2 studies with a case-control design, 4 with a cohort design, and 1 with a cross-sectional design). The meta-analysis results showed an increased risk of preeclampsia in the women with previous cesarean section compared to women without cesarean section (OR=1.28, 95% CI, 1.15%-1.41%, P=0.001), I2=37.2%. The quality of all studies except one study was high based on the Newcastle-Ottawa scale. The subgroup analysis was conducted based on the adjusted form of studies. The crude and adjusted studies were 1.29 (95% CI, 0.13%-2.46%, P=0.2) and 1.29 (95% CI, 1.22%-1.36%, P=0.001), respectively.

These findings showed that previous cesarean section is a risk factor for preeclampsia. Therefore, education programs and interventions should be considered to reduce elective cesarean section on maternal requests.