Are children born by cesarean delivery at higher risk for respiratory sequelae?

Abstract

On behalf of the Bern Basel Infant Lung Development Study Group BACKGROUND: Globally, the number of children born by cesarean delivery is constantly increasing. However, hormonal and physiological changes associated with labor and vaginal delivery are considered necessary for lung maturation. OBJECTIVE: We aimed to assess whether the mode of delivery is associated with changes in respiratory and atopic outcomes during infancy and at school age. STUDY DESIGN: We included 578 children, born at !37 weeks of gestation, from a prospective birth cohort study. We compared weekly respiratory symptoms throughout the first year of life and infant lung function (tidal breathing and multiple-breath washout) at 5 weeks of age between children born by cesarean delivery (N¼114) and those born by vaginal delivery (N¼464) after term pregnancy in healthy women. At a follow-up visit conducted at 6 years of age (N¼371, of which 65 were delivered by cesarean delivery), we assessed respiratory, atopic, and lung function outcomes (spirometry, body plethysmography, and multiplebreath washout). We performed adjusted regression analyses to examine the association between cesarean delivery and respiratory and atopic outcomes. To account for multiple testing, we used the Bonferroni correction, which led to an adapted significance level of P<.002. RESULTS:During infancy, children born by cesarean delivery did not have more respiratory symptoms than those born by vaginal delivery (median, 4 weeks; interquartile range, 7 weeks vs median, 5 weeks; interquartile range, 7 weeks; adjusted incidence rate ratio, 0.8; 95% confidence interval, 0.6e1.0; P¼.02). Infant lung function was similar between the groups. Children born by cesarean delivery did not have a higher incidence of "ever wheezing" (adjusted odds ratio, 0.9; 95% confidence interval, 0.5e1.8; P¼.78) or current asthma (adjusted odds ratio, 0.4; 95% confidence interval, 0.0e3.5; P¼.42) at school age than those born by vaginal delivery. There was no difference in the lung function parameters between the groups. CONCLUSION: Cesarean delivery was not associated with respiratory symptoms in the first year of life, nor with different respiratory or atopic outcomes at school age, when compared with vaginal delivery. Our results indicate that there are no long-term consequences on the respiratory health of the child associated with cesarean delivery.

Preschool wheeze among a retrospective cohort of Egyptian children

“…Transient early wheezers represented 7.5%, persistent wheezers represented 4.1% and late-onset wheezers were 5.6% of participants. 20 Although the frequency rate of PSW in their series is lower than ours, distribution of phenotypes is almost comparable, taking in consideration the 20 years difference between the 2 studies, and the different ethnic, climate and environmental factors.…”

Birth mode is associated with development of atopic dermatitis in infancy and early childhood

“… 17 Also, no association between CS (not defined as elective or acute) and AD by 6 years was seen in a population-based prospective study of 371 Swiss children. 18 Finally, no certain association between CS overall and AD by age 4 was seen in a large register-based study from California. 15 These conflicting results may be due to differences in study design, population heterogeneity, and diagnostic approach.…”

“…Four prospective cohort studies and 1 retrospective register-based study found no evidence that CS increased the risk of AD in children aged between 3 months and 6 years. 13 , 15 , 16 , 17 , 18 …”

Association between caesarean section and childhood asthma development

“…Temat wpływu cięcia cesarskiego na ryzyko rozwoju astmy u dzieci budzi jednak kontrowersje w świecie naukowym i wiele prac zaprzecza istnieniu takiej zależności [5,[18][19][20][21]. Meta-analiza z 2020 roku poddała analizie 12 badań przeprowadzonych w Europie w latach 1967-2012 i wykazała, że nie można jednoznacznie stwierdzić czy poród przez cięcie cesarskie zwiększa ryzyko astmy oskrzelowej u dzieci ze względu na dużą niejednorodność wyników tych badań.…”

“…Inne badanie kohortowe analizujące grupę 578 dzieci urodzonych ≥ 37 tygodnia ciąży w Szwajcarii również nie znalazło powiązania CC z astmą u dzieci w wieku szkolnym. Ponadto nie wykazano różnic w funkcjonowaniu płuc w niemowlęctwie oraz wieku szkolnym w stosunku do dzieci urodzonych pochwowo [19]. Autorzy dwóch badań kohortowych przeprowadzonych w Wielkiej Brytanii uwzględniających ponad 24 000 dzieci oraz ponad 12 000 dzieci doszli do podobnych wniosków, także wykluczając związek porodu przez CC z późniejszym rozwojem astmy, jak również innych chorób alergicznych [20,21].…”