Cesarean Section and Development of the Immune System in the Offspring

Abstract

C ancer and pregnancy are 2 conditions that rarely occur together. However, when a woman is pregnant and has cancer, her care during pregnancy may be complicated and will require a multidisciplinary approach for optimal treatment. Little published information of cases and reviews exist. Care for each patient should be individualized and must involve obstetric, oncology, anesthesiology, cardiology, and neonatology specialists. The above review by Tharmaratnam and Balki confirm that multidisciplinary care is required to optimize treatment in the pregnant patient.Pregnancy complicated by cancer may require a hastened delivery plan to optimize care and longevity for the mother and child. Anesthesia risk for these patients is increased because of the possibility of airway compromise. Lymphoma is the most common cancer seen in pregnant patients and in the study abstracted above, 12 of the 26 patients with lymphoma had either mediastinal or cervical lymphadenopathy, resulting in airway obstruction or cardiac compression. One case report of a patient with a large intrathoracic mass reported a successful cesarean delivery under continuous spinal anesthesia, with a cardiothoracic surgeon present if needed. Other case reports emphasized the need for total multidisciplinary care for these patients and their babies.Because the combination of cancer and pregnancy is rare but likely to increase as women delay childbirth, infertility therapies improve, and reproductive years are extended, a better means of documenting data on the management and outcomes of these women and their infants is necessary. A standardized national or international database would allow pertinent information to be readily available to physicians or to researchers who are developing strategies to improve care and outcomes for these women. Obstetric anesthesiologists must be prepared to evaluate these patients, obtain consults from surgeons, and develop appropriate and thorough anesthetic plans for labor analgesia or cesarean delivery.

Cesarean Section and Chronic Immune Disorders

“…3 Even though the World Health Organization recommends cesarean delivery as indicated choice of delivery mode in less than 15% of births, 4 many developed countries have a much higher prevalence, pointing toward a less strict medical indication for the procedure. 5,6 Cesarean delivery has been linked to the development of asthma and allergic rhinitis, [7][8][9][10] as well as other immune disorders [11][12][13][14][15][16] in the offspring.…”

Childhood Health and Developmental Outcomes After Cesarean Birth in an Australian Cohort

“…[3][4][5][6] For example, studies have reported that children born by cesarean delivery may have increased rates of respiratory illness in their first year of life 5,7,8 and beyond, 9,10 and relationships have also been described with diabetes 11 and child overweight and obesity. 12,13 Notwithstanding these potential adverse associations, children born by cesarean delivery are usually healthy, and it is important to recognize that many factors influence child health other than mode of birth.…”

Gut microbiota: a source of novel tools to reduce the risk of human disease?

“…These challenges are thought to result from lack of stress signals induced by labor in the fetus and the mother which is also reflected in immune markers measured from cord blood or in the neonatal period (43). Recently, more attention has been given to differences in early microbial contact related to the mode of birth.…”