OBJECTIVES: The rate of cesarean deliveries in the United States is 22 to 38%. Patients who undergo cesarean procedures are at greater risk for excessive blood loss, higher birth costs, maternal mortality, and morbidity. This study aims to evaluate the risk of cesareans, overall survival, and postpartum depression within low-risk pregnant patients with labor induction compared to those without labor induction over 8 years.

METHODS: Low-risk pregnancy patients within the TriNetX federated network of de-identified electronic health record data from 2014-2022 were identified. Data collected included patients with at least one full-term pregnancy between 18-34 years of age while excluding those with comorbidities or potential complications. Patients were categorized by those who had induced labor (N=192,171) and those who did not (N=127,311). Cohorts were 1:1 propensity score-matched to adjust for confounding variables. The risk of cesarian delivery and postpartum depression were evaluated using risk ratios, while overall survival was calculated using a Kaplan-Meier analysis. All criteria were defined using ICD9/10, CPT, and RxNorm terminology.

RESULTS: In the matched analysis (N=127,058), the risk of cesarean delivery was 24.1% in the induced cohort and 12.1% in the non-induced cohort (RR=1.995) within 90 days. The risk of postpartum depression was 8.03% in the induced cohort and 4.65% in the non-induced cohort (RR=1.726). Overall survival probability at 90 days was 99.98% in the induced cohort and 99.98% in the non-induced cohort.

CONCLUSIONS: Among patients with low-risk pregnancies, there were significantly higher risks of cesarean deliveries and postpartum depression in those who underwent labor induction than those who did not. Overall survival probability at 90 days was comparable among the two cohorts. Our study suggests that further research is needed to assess why low-risk pregnancy patients undergo labor induction and the risks associated with the intervention.