Association Between Mode of Delivery of the Breech Fetus and Hospitalizations Due to Inflammatory Bowel Disease During Childhood

Abstract

Background and Goals: While evidence suggests short-term benefits in neonatal morbidity and mortality from cesarean delivery of the fetus in breech presentation, the long-term implications for the offspring are less clear. To assess the implications of the mode of delivery on offspring's health, we have evaluated the long-term gastrointestinal (GI) morbidity of offspring with a breech presentation delivered in either way. Materials and Methods:A population-based retrospective cohort study including singleton deliveries in breech presentation occurring between 1991 and 2014 at a tertiary referral hospital. Incidence of hospitalizations of the offspring up to the age of 18 years involving GI morbidity was compared between those delivered via cesarean section or vaginally. A Kaplan-Meier survival curve compared cumulative GI morbidity. A Weibull parametric survival model controlled for confounders while accounting for repeated occurrence of mothers and dependence among siblings.Results: Overall, 86.9% (n = 6376) of the 7337 fetuses in breech presentation, were delivered abdominally. Hospitalizations involving GI morbidity were higher in offspring delivered by cesarean section, specifically due to inflammatory bowel disease (IBD). Kaplan-Meier survival curve revealed the higher cumulative incidence of total GI morbidity and IBD specifically in the cesarean delivery group (P < 0.001 and P = 0.004, respectively). Using a Weibull parametric while controlling for relevant confounders, cesarean delivery emerged as an independent risk factor for long-term IBD-related morbidity of the offspring delivered in breech presentation (adjusted hazard ratio = 3.18, 95% confidence interval: 1.47-6.87, P = 0.003). Conclusion:Cesarean delivery is associated with higher rates of hospitalizations due to IBD and total GI morbidity during childhood in term singleton in breech presentation.

Respiratory morbidity among offspring misclassified as growth restricted

“…These interventions, though wellintentioned, carry inherent risks and raise concerns regarding the potential overtreatment of pregnant individuals. 36 In the context of the growth-restricted fetuses, several factors could be predictive of their respiratory health. First is the gestational age at birth, as extending beyond not only the late-preterm but also the early-term period (after 38 + 6 weeks) allows for a successful cardiorespiratory transition from fetal to neonatal life.…”

“…The initiation of labor under conditions of an unfavorable cervix (as opposed to elective inductions or spontaneous labor at full term 35 ), along with heightened concern for fetal distress, are factors that may contribute to the threefold increase in CD rates among those incorrectly categorized. These interventions, though well‐intentioned, carry inherent risks and raise concerns regarding the potential overtreatment of pregnant individuals 36 …”