Sociodemographic profiles and maternal comorbidities associated with caesarean delivery: a comparison between nulliparous and multiparous mothers in Malaysia

INTRODUCTION: Caesarean section (CS) rates have been rising globally, with maternal comorbidities such as obesity, diabetes mellitus, and hypertensive disorders playing significant roles. Sociodemographic factors also critically influence delivery outcomes. However, limited data exist on the prevalence and determinants of CS in Malaysia. This study aimed to determine the prevalence of CS and its associated factors among nulliparous and multiparous mothers, focusing on sociodemographic profiles and maternal comorbidities. METHODOLOGY: A nationwide cross-sectional survey was conducted in Malaysia using multistage random sampling to select mothers who had delivered within the past two years. Data on delivery methods, sociodemographic factors, and maternal comorbidities were analyzed using descriptive statistics and multiple logistic regression in IBM SPSS version 25.0. RESULTS: Among the 6,326 mothers surveyed, 29.1% (1,843) were nulliparous, and 70.9% were multiparous. The overall prevalence of CS was 26.2%, with nulliparous mothers having a significantly higher prevalence (31.1% vs. 24.4%, p < 0.001). Obesity (nulliparous: aOR: 2.51, 95% CI: 1.71, 3.69; multiparous: aOR: 2.00, 95% CI: 1.59, 2.53), diabetes mellitus (nulliparous: aOR: 1.74, 95% CI: 1.26, 2.40; multiparous: aOR: 1.37, 95% CI: 1.13, 1.67), overweight, and advanced maternal age were significant factors associated with CS in both groups. Hypertensive disorders were significant only among multiparous mothers who underwent CS (aOR: 1.78, 95% CI: 1.32, 2.40). Nulliparous mothers were additionally influenced by Indian ethnicity (aOR: 3.85, 95% CI: 1.28, 11.55), Chinese ethnicity (aOR: 3.07, 95% CI: 1.25, 7.55), tertiary education, and self-employment. CONCLUSION: This study found that obesity, overweight, diabetes mellitus, and advanced maternal age were associated with CS in both nulliparous and multiparous mothers, while hypertensive disorders were significant only among multiparous mothers. In addition, sociodemographic disparities were observed in both groups, highlighting the need for targeted interventions to reduce non-medically indicated CS in Malaysia.