title: Risk factors for cesarean delivery among Puerto Rican women.
abstract: OBJECTIVE
  The rate of primary cesarean delivery in Puerto Rico in 2002 was 52% higher than in 1996 and 85% higher than among Puerto Rican women delivering on the U.S. mainland. Reasons for these differences were explored using birth certificate data.
  
  
  METHODS
  Distributions of mothers' age, education, parity, level of prenatal care, pregnancy weight gain, medical risk factors, labor induction, labor or delivery complications, and infant birth weight among births in Puerto Rico in 2002 (n=40,489) were compared with births in Puerto Rico in 1996 (n=51,357) and births to Puerto Rican women delivering on the mainland in 2002 (n=47,800). Multivariable log-linear regression models were used to estimate relative risks for primary cesarean delivery by year, place of delivery, and selected risk factors.
  
  
  RESULTS
  Risk for cesarean delivery was higher in Puerto Rico in 2002 than in both 1996 (relative risk 2.1, 95% confidence interval 2.0, 2.3) and on the mainland in 2002 (relative risk 2.4, 95% confidence interval 2.2, 2.6). This translates into one additional cesarean delivery in Puerto Rico in 2002 for every 4.2 live births, controlled for examined risk factors. Higher rates of cesarean delivery in Puerto Rico in 2002 could not be explained by examined risk factors.
  
  
  CONCLUSIONS
  Until further research reveals ways to safely reduce the rate of cesarean delivery in Puerto Rico, physicians, public health practitioners, and other stakeholders may want to focus their efforts on reducing rates among low-risk women and those with no labor complications.
  
  
  METHODS
  II.
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. sfarr@cdc.gov
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Farr
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Hirmice Vásquez
authors.initials: HV
authors.lastname: Rivera
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ahmed
authors.forename: Charles M
authors.initials: CM
authors.lastname: Heilig
mesh_terms: D000328:Adult; D001719:Birth Certificates; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data; D011647:Puerto Rico / Q000453:epidemiology / Q000208:ethnology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D015430:Weight Gain