title: Uterine leiomyomata and cesarean birth risk: a prospective cohort with standardized imaging.
abstract: OBJECTIVE
  To determine if women with leiomyomata detected using uniform ultrasound methods are at increased risk of cesarean birth, without regard to indication.
  
  
  METHODS
  Women were enrolled in Right from the Start (2000-2010), a prospective pregnancy cohort. Leiomyomata were counted, categorized, and measured during first trimester ultrasounds. Women provided information about demographics and reproductive history during first trimester interviews. Route of delivery was extracted from medical records or vital records, if the former were unavailable. Generalized estimating equations were used to calculate risk ratios (RR) and 95% confidence intervals (CIs) for the risk of cesarean birth by leiomyoma presence and characteristics.
  
  
  RESULTS
  Among 2635 women, the prevalences of leiomyomata and cesarean birth were 11.2% and 29.8%, respectively. Women with leiomyomata, compared with those without, had a 27% increase in cesarean risk (RR, 1.27; CI, 1.17-1.37). The association was weaker following adjustment for maternal body mass index and age (adjusted risk ratio [ARR], 1.11; CI, 1.02-1.20). The adjusted risk was elevated for women with a single leiomyoma 3 cm or more in diameter (ARR, 1.22; CI, 1.14-1.32) and women with the largest total leiomyoma volumes (ARR, 1.59; CI, 1.44-1.76).
  
  
  CONCLUSIONS
  Women with leiomyomata were at increased risk for cesarean birth particularly, those with larger tumor volumes.
authors: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
authors: Kara A
authors: KA
authors: Michels
authors: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Center for Human Genetics Research, Vanderbilt University, Nashville, TN. Electronic address: digna.r.velez.edwards@vanderbilt.edu.
authors: Digna R
authors: DR
authors: Velez Edwards
authors: Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
authors: Donna D
authors: DD
authors: Baird
authors: Department of Epidemiology, Brown University, Providence, RI; Department of Obstetrics and Gynecology, Brown University, Providence, RI.
authors: David A
authors: DA
authors: Savitz
authors: Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
authors: Katherine E
authors: KE
authors: Hartmann
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D007889:Leiomyoma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009657:North Carolina / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology; D016216:Ultrasonography, Prenatal; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Cesarean section; Epidemiology; Leiomyoma; Prospective studies