The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis

Darabi, Behzad; Rahmati, Shoboo; Hafezi-Ahmadi, Mohammad Reza; Badfar, Gholamreza; Azami, Milad

doi:10.1186/s13223-019-0367-9

Cited by 66 publications

(55 citation statements)

References 46 publications

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“…Similar results were obtained in a meta-analysis conducted in 2018, which revealed a significantly higher risk of developing asthma up to the age of 12 years (OR 1.21, 13 studies, n = 887,960) and obesity up to the age of 5 years (OR 1.59, 95%CI 1.33-1.90; n = 64,113; 6 studies) in children delivered by cesarean section [23]. Comparable results concerning asthma were revealed by a meta-analysis conducted by Darabi et al [104]. It needs to be emphasized that the above mentioned studies included the analyses of cesarean sections without considering the clinical indications for performing the procedure.…”

Section: Discussionmentioning

confidence: 92%

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

Słabuszewska-Jóźwiak

Szymański

Ciebiera

et al. 2020

IJERPH

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Background: Cesarean section is a surgical procedure, which is the most frequently performed in gynecology and obstetrics. It is commonly believed that an operative delivery is a less painful and safer mode of delivery, which translates into an increasing number of the procedures performed without medical indications. The maternal sequelae of cesarean sections are well elucidated and widely discussed in the literature, while long-term neonatal consequences still remain the issue of research and scientific dispute. The aim of the present paper was to perform a systematic review of current literature regarding pediatrics consequences of cesarean section. Methods: We reviewed available data from PubMed, Science Direct as well as Google Scholar bases concerning early and long-term neonatal sequelae of operative deliveries. The following key words were used: “cesarean section”, “caesarean section”, “neonatal outcomes”, “respiratory disorders”, “asthma”, “obesity”, “overweight”, and “neurological disorders”. A total of 1636 papers were retrieved out of which 27 were selected for the final systematic review whereas 16 articles provided data for meta-analysis. Statistical analyses were performed using RevMan 5.4. To determine the strength of association between the caesarean section and respiratory tract infections, asthma, diabetes type 1 as well as obesity the pooled odds ratios (OR) with the 95% confidence intervals (CI) were calculated. Results: Conducted meta-analyses revealed that caesarean section is a risk factor for respiratory tract infections (pooled OR = 1.30 95%CI 1.06–1.60, p = 0.001), asthma (pooled OR = 1.23 95%CI 1.14–1.33, p < 0.00001) as well as obesity (pooled OR = 1.35 95%CI 1.29–1.41, p < 0.00001) in offspring. Conclusions: The results of the studies included indicated that children delivered by cesarean section more commonly developed respiratory tract infections, obesity and the manifestations of asthma than children delivered vaginally. The risk of developing diabetes mellitus type 1 or neurological disorders in offspring after caesarean section is still under discussion.

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Section: Discussionmentioning

confidence: 92%

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

Słabuszewska-Jóźwiak

Szymański

Ciebiera

et al. 2020

IJERPH

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“…Although women with asthma are more likely to have a caesarean section [ 1 ], no previous studies have reported on the association between maternal asthma exacerbations and mode of delivery. Being born via caesarean section has also been associated with long-term risks for the child, including increased risk of asthma and allergy [ 23 , 24 ]. In our study, the increased risk of having an elective caesarean section was a risk for all women who had exacerbations, but was even higher amongst women who experienced multiple exacerbations during pregnancy compared to women who exacerbated only once.…”

Section: Discussionmentioning

confidence: 99%

Effect of maternal asthma exacerbations on perinatal outcomes: a population-based study

et al. 2020

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BackgroundAlthough there is a growing body of literature about the impact of asthma exacerbations during pregnancy on adverse perinatal outcomes, it is still unclear whether asthma exacerbations themselves or asthma severity are the driving factor for negative outcomes. This study aimed to estimate the associations between maternal asthma exacerbations and perinatal outcomes; and whether this differed by asthma treatment regime as a proxy for severity.MethodsWe included births of women with asthma in Sweden from July 2006-November 2013 (N=33 829). Asthma exacerbations were defined as unplanned emergency visits/hospitalisations, or a short course of oral corticosteroids. Adjusted odds ratios (aOR) were estimated for the associations between exacerbations during pregnancy and perinatal outcomes (small for gestational age (SGA), preterm birth, birth weight and mode of delivery), stratified by pre-conception treatment regime.ResultsExacerbations occurred in 1430 (4.2%) pregnancies. Exacerbations were associated with reduced birth weight (aOR 1.45, 95%CI 1.24–1.70), and elective (aOR 1.50, 95%CI 1.25–1.79) and emergency caesarean section (aOR 1.35, 95%CI 1.13–1.61). Multiple exacerbations were associated with a 2.6-fold increased odds of SGA (95%CI 1.38–4.82). Amongst women treated pre-pregnancy with combination therapy (proxy for moderate-severe asthma), exacerbators were at increased odds of elective (aOR 1.69, 95%CI 1.30–2.2) and emergency (aOR 1.62, 95%CI 1.26–2.08) caesarean section; and SGA (aOR 1.74, 95%CI 1.18–2.57) versus non-exacerbators.ConclusionMaternal asthma exacerbations increase the risk of SGA and caesarean sections, particularly in women with multiple exacerbations or moderate-severe asthma. Adequate antenatal asthma care is needed to reduce exacerbations and reduce risks of poor outcomes.

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“…Third, as missing data were a historical issue with the English data (1998 to 2003), we compared the full English results (1998 to 2010) with restricted English results (2003 to 2012, when the issue of missing data improved). Fourth, to consider if asthma, which may be associated with CS birth [ 26 ], was an underlying cause for the observed associations, we estimated the association between mode of birth and the separate outcomes of infection-related hospitalisation with and without a concurrent diagnosis for asthma and/or wheeze using the Western Australia data. Fifth, to examine whether the association between mode of birth and infection-related hospitalisations was similar by birth year, we estimated the overall risk stratified by birth year in 4-year intervals in the Western Australia data.…”

Section: Methodsmentioning

confidence: 99%

Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries

et al. 2020

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Background The proportion of births via cesarean section (CS) varies worldwide and in many countries exceeds WHO-recommended rates. Long-term health outcomes for children born by CS are poorly understood, but limited data suggest that CS is associated with increased infection-related hospitalisation. We investigated the relationship between mode of birth and childhood infection-related hospitalisation in high-income countries with varying CS rates. Methods and findings We conducted a multicountry population-based cohort study of all recorded singleton live births from January 1, 1996 to December 31, 2015 using record-linked birth and hospitalisation data from Denmark, Scotland, England, and Australia (New South Wales and Western Australia). Birth years within the date range varied by site, but data were available from at least 2001 to 2010 for each site. Mode of birth was categorised as vaginal or CS (emergency/elective). Infection-related hospitalisations (overall and by clinical type) occurring after the birth-related discharge date were identified in children until 5 years of age by primary/secondary International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes. Analysis used Cox regression models, adjusting for maternal factors, birth parameters, and socioeconomic status, with results pooled using meta-analysis. In total, 7,174,787 live recorded births were included. Of these, 1,681,966 (23%, range by jurisdiction 17%–29%) were by CS, of which 727,755 (43%, range 38%–57%) were elective. A total of 1,502,537 offspring (21%) had at least 1 infection-related hospitalisation. Compared to vaginally born children, risk of infection was greater among CS-born children (hazard ratio (HR) from random effects model, HR 1.10, 95% confidence interval (CI) 1.09–1.12, p < 0.001). The risk was higher following both elective (HR 1.13, 95% CI 1.12–1.13, p < 0.001) and emergency CS (HR 1.09, 95% CI 1.06–1.12, p < 0.001). Increased risks persisted to 5 years and were highest for respiratory, gastrointestinal, and viral infections. Findings were comparable in prespecified subanalyses of children born to mothers at low obstetric risk and unchanged in sensitivity analyses. Limitations include site-specific and longitudinal variations in clinical practice and in the definition and availability of some data. Data on postnatal factors were not available. Conclusions In this study, we observed a consistent association between birth by CS and infection-related hospitalisation in early childhood. Notwithstanding the limitations of observational data, the associations may reflect differences in early microbial exposure by mode of birth, which should be investigated by mechanistic studies. If our findings are confirmed, they could inform efforts to reduce elective CS rates that are not clinically indicated.

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The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis

Cited by 66 publications

References 46 publications

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

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

Effect of maternal asthma exacerbations on perinatal outcomes: a population-based study

Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries

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