Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta

S. Bellur, M. Jain, D. Cuthbertson, D. Krakow, Jay Shapiro, R. D. Steiner, P. A. Smith, M. B. Bober, T. Hart, J. Krischer, M. Mullins, P. H. Byers, M. Pepin, M. Durigova, F. H. Glorieux, F. Rauch, V. R. Sutton, B. Lee, S. C. Nagamani

Research output: Contribution to journalArticle

Abstract

Purpose: Osteogenesis imperfecta (OI) predisposes to recurrent fractures. Patients with the moderate to severe forms of OI present with antenatal fractures, and the mode of delivery that would be safest for the fetus is not known. Methods: We conducted systematic analyses of the largest cohort of individuals with OI (n = 540) enrolled to date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared among individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates, including method of delivery, on fracture-related outcomes. Results: When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean delivery (CD). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CD. Conclusion: Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI, shows that CD is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CD should be performed only for other maternal or fetal indications, not for the sole purpose of fracture prevention in OI.

Original languageEnglish (US)
Pages (from-to)570-576
Number of pages7
JournalGenetics in Medicine
Volume18
Issue number6
DOIs
StatePublished - Jun 1 2016

Fingerprint

Osteogenesis Imperfecta
Birth Rate
Logistic Models
Mothers
Breech Presentation
Birth Weight
Fetus
Cohort Studies
Multivariate Analysis

Keywords

  • at-birth fracture
  • cesarean delivery
  • in utero fracture
  • natural history study
  • osteogenesis imperfecta

ASJC Scopus subject areas

  • Genetics(clinical)

Cite this

Bellur, S., Jain, M., Cuthbertson, D., Krakow, D., Shapiro, J., Steiner, R. D., ... Nagamani, S. C. (2016). Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta. Genetics in Medicine, 18(6), 570-576. https://doi.org/10.1038/gim.2015.131

Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta. / Bellur, S.; Jain, M.; Cuthbertson, D.; Krakow, D.; Shapiro, Jay; Steiner, R. D.; Smith, P. A.; Bober, M. B.; Hart, T.; Krischer, J.; Mullins, M.; Byers, P. H.; Pepin, M.; Durigova, M.; Glorieux, F. H.; Rauch, F.; Sutton, V. R.; Lee, B.; Nagamani, S. C.

In: Genetics in Medicine, Vol. 18, No. 6, 01.06.2016, p. 570-576.

Research output: Contribution to journalArticle

Bellur, S, Jain, M, Cuthbertson, D, Krakow, D, Shapiro, J, Steiner, RD, Smith, PA, Bober, MB, Hart, T, Krischer, J, Mullins, M, Byers, PH, Pepin, M, Durigova, M, Glorieux, FH, Rauch, F, Sutton, VR, Lee, B & Nagamani, SC 2016, 'Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta', Genetics in Medicine, vol. 18, no. 6, pp. 570-576. https://doi.org/10.1038/gim.2015.131
Bellur, S. ; Jain, M. ; Cuthbertson, D. ; Krakow, D. ; Shapiro, Jay ; Steiner, R. D. ; Smith, P. A. ; Bober, M. B. ; Hart, T. ; Krischer, J. ; Mullins, M. ; Byers, P. H. ; Pepin, M. ; Durigova, M. ; Glorieux, F. H. ; Rauch, F. ; Sutton, V. R. ; Lee, B. ; Nagamani, S. C. / Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta. In: Genetics in Medicine. 2016 ; Vol. 18, No. 6. pp. 570-576.
@article{6a3c5e5c26284362bfc7a3f946857a9f,
title = "Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta",
abstract = "Purpose: Osteogenesis imperfecta (OI) predisposes to recurrent fractures. Patients with the moderate to severe forms of OI present with antenatal fractures, and the mode of delivery that would be safest for the fetus is not known. Methods: We conducted systematic analyses of the largest cohort of individuals with OI (n = 540) enrolled to date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared among individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates, including method of delivery, on fracture-related outcomes. Results: When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean delivery (CD). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CD. Conclusion: Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI, shows that CD is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CD should be performed only for other maternal or fetal indications, not for the sole purpose of fracture prevention in OI.",
keywords = "at-birth fracture, cesarean delivery, in utero fracture, natural history study, osteogenesis imperfecta",
author = "S. Bellur and M. Jain and D. Cuthbertson and D. Krakow and Jay Shapiro and Steiner, {R. D.} and Smith, {P. A.} and Bober, {M. B.} and T. Hart and J. Krischer and M. Mullins and Byers, {P. H.} and M. Pepin and M. Durigova and Glorieux, {F. H.} and F. Rauch and Sutton, {V. R.} and B. Lee and Nagamani, {S. C.}",
year = "2016",
month = "6",
day = "1",
doi = "10.1038/gim.2015.131",
language = "English (US)",
volume = "18",
pages = "570--576",
journal = "Genetics in Medicine",
issn = "1098-3600",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta

AU - Bellur, S.

AU - Jain, M.

AU - Cuthbertson, D.

AU - Krakow, D.

AU - Shapiro, Jay

AU - Steiner, R. D.

AU - Smith, P. A.

AU - Bober, M. B.

AU - Hart, T.

AU - Krischer, J.

AU - Mullins, M.

AU - Byers, P. H.

AU - Pepin, M.

AU - Durigova, M.

AU - Glorieux, F. H.

AU - Rauch, F.

AU - Sutton, V. R.

AU - Lee, B.

AU - Nagamani, S. C.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Purpose: Osteogenesis imperfecta (OI) predisposes to recurrent fractures. Patients with the moderate to severe forms of OI present with antenatal fractures, and the mode of delivery that would be safest for the fetus is not known. Methods: We conducted systematic analyses of the largest cohort of individuals with OI (n = 540) enrolled to date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared among individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates, including method of delivery, on fracture-related outcomes. Results: When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean delivery (CD). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CD. Conclusion: Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI, shows that CD is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CD should be performed only for other maternal or fetal indications, not for the sole purpose of fracture prevention in OI.

AB - Purpose: Osteogenesis imperfecta (OI) predisposes to recurrent fractures. Patients with the moderate to severe forms of OI present with antenatal fractures, and the mode of delivery that would be safest for the fetus is not known. Methods: We conducted systematic analyses of the largest cohort of individuals with OI (n = 540) enrolled to date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared among individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates, including method of delivery, on fracture-related outcomes. Results: When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean delivery (CD). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CD. Conclusion: Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI, shows that CD is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CD should be performed only for other maternal or fetal indications, not for the sole purpose of fracture prevention in OI.

KW - at-birth fracture

KW - cesarean delivery

KW - in utero fracture

KW - natural history study

KW - osteogenesis imperfecta

UR - http://www.scopus.com/inward/record.url?scp=84975076555&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975076555&partnerID=8YFLogxK

U2 - 10.1038/gim.2015.131

DO - 10.1038/gim.2015.131

M3 - Article

VL - 18

SP - 570

EP - 576

JO - Genetics in Medicine

JF - Genetics in Medicine

SN - 1098-3600

IS - 6

ER -