Sociodemographic Factors Associated With Successful TOLAC in the U.S. Population [ID 1345]

INTRODUCTION: We aim to assess the contemporary sociodemographic factors associated with successful trials of labor after cesarean delivery (TOLACs). METHODS: A retrospective analysis of the Centers for Disease Control and Prevention’s Natality live birth database (2016–2022) was performed. The inclusion criteria were term (37 0/7 to 40 6/7 weeks), singleton pregnancies with prior cesarean deliveries who attempted TOLAC. The study group included individuals with successful TOLAC. The comparison group included those who had repeat cesarean births after failed TOLAC. Sociodemographic factors were compared between the two groups using Pearson’s chi-squared test. Results were presented as odds ratios (ORs) with 95% CIs. A value of P <.05 was considered significant. RESULTS: Of the 2,313,494 individuals who attempted TOLAC, 469,020 (20.3%) were successful. Trial of labor after cesarean delivery is associated with higher odds of success for the following groups: age 30–34 (OR 2.44; CI, 2.41–2.47), age 35–39 (OR 2.73; CI, 2.70–2.76), Native American or Alaskan race (OR 1.24; CI, 1.19–1.29), Hispanic ethnicity (OR 1.28; CI, 1.28–1.30), education less than high school (OR 1.61; CI, 1.59–1.63), self-pay (OR 1.34; CI, 1.31–1.37), and third-trimester start of prenatal care (OR 1.35; CI, 1.33–1.37). Trial of labor after cesarean delivery is associated with lower odds of success with higher body mass indexes, for example, 35–39.9 kg/m 2 (OR 0.57; CI, 0.57–0.58) and 40+ kg/m 2 (OR 0.40; CI, 0.39–0.41). CONCLUSIONS/IMPLICATIONS: Based on this large database, we characterize maternal and sociodemographic factors that are associated with successful TOLAC. These findings may assist providers in considering the likelihood of success in those patients desiring TOLAC.