Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing

Abstract

The relationship between cesarean section (CS) and allergic disorders such as asthma and wheezing has been inconsistent, and the mechanisms for their connection remained largely unknown. We aimed to investigate whether CS is associated with infantile wheeze and to explore the connection between CS and several risk factors known to correlate with allergy development. Mononuclear cells were isolated from cord blood and assessed for cytokine responses by ELISA. Bacteria from nasopharyngeal specimens were identified with traditional culture methods. Infant lung function tests were performed at 6 and 12 months of age. IgE levels and clinical outcomes were assessed at 12 months. The result showed that children delivered by CS were associated with increased risk of wheezing (aHR 1.63; 95% CI: 1.01–2.62) and decreased compliance of the respiratory system at 12 months (p = 0.045). In addition, CS was associated with reduced TLR1–2- triggered TNF-α and IL-6 responses at birth. By12 months of age, children delivered by CS had significantly less airway bacterial clearance. Our findings suggested that CS was associated with decreased pro-inflammatory cytokine response to TLR1–2 stimulation, followed by higher abundance of bacterial colonization in the airway during late infancy, thus increasing the risk of infantile wheezing.

Parturition and the perinatal period: can mode of delivery impact on the future health of the neonate?

“…The Prediction of Allergy in Taiwanese Children (PATCH) study, a prospective birth cohort of 579 children, reported that CS was associated with an increased incidence of ‘wheeze’ and reduced lung function at 12 months of age (Liao et al . ). Furthermore, these infants had impaired neonatal production of pro‐inflammatory cytokines in isolated mononuclear cells linking mode of delivery with development of the neonatal immune system (Liao et al .…”

“…Furthermore, these infants had impaired neonatal production of pro‐inflammatory cytokines in isolated mononuclear cells linking mode of delivery with development of the neonatal immune system (Liao et al . ; Chu et al . ).…”

Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis

“…According to an increasing number of epidemiologic studies, children delivered by cesarean section more commonly developed respiratory and neurological disorders (e.g., autism spectrum disorders [11], schizophrenia [12]) and immune-related diseases, such as asthma [13,14], skin atopy [15], juvenile arthritis, coeliac disease [16], type 1 diabetes (T1D) [17] or obesity [1,[18][19][20][21][22][23]. It is worth noting differences between the occurrence of the above-mentioned conditions in cases when the surgical procedure was performed after delivery had started.…”

Cesarean section. Is the choice justified? Risks to children’s health

“…Родовой стресс является пусковым механизмом активации различных цитокинов, способствует активации иммунной системы новорожденного, что доказано как для вагинальных родов, так и родов путем кесарева сечения, проводимого в периоде начавшейся родовой деятельности [8]. Изменение естественного родового процесса может привести к отрицательному воздействию на активацию системы иммунитета младенца [9]. Перед родами и во время родов в условиях гипоксии и ацидоза происходит образование большого числа биоактивных веществ в организме матери и плода, способствующих физиологической перестройке всех органов и систем к адаптационному периоду [10].…”

“…Механизмы, в полной мере объясняющие влияние способа родоразрешения на развитие бронхиальной астмы у детей, ясны не до конца. Предполагают, что оперативное родоразрешение приводит к изменению врожденных иммунных реакций (снижение продукции ФНО-α и ИЛ-6 для стимуляции TLR 1-2) в раннем возрасте и к обильной бактериальной колонизации дыхательных путей у детей в старшем возрасте с нарушением равновесия Th1/Th2 лимфоцитарного ответа [15]. TLR-рецепторы занимают центральное место среди наследственно-закодированных рецепторов PRRs (паттерн-распознающих рецепторов), которые регулируют адаптивный иммунный ответ и влияют на дифференцировку Th1/Th2 так же, как и биомаркер аллергической сенсибилизации (IgE) [16].…”