Association of cesarean section with asthma in children/adolescents: a systematic review and meta-analysis based on cohort studies

Abstract

Background Whether cesarean section (CS) is a risk factor for asthma in offspring is controversial. The purpose of this study was to investigate the association between CS and asthma in children/adolescents. Methods Pubmed, Embase, Web of Science, and Cochrane Library electronic databases were searched for cohort studies on the relationship between mode of delivery and asthma in children/adolescents up to February 2023. Birth via CS was considered an exposure factor. Asthma incidence was taken as a result. Results Thirty-five cohort studies (thirteen prospective and twenty-two retrospective cohort studies) were included. The results showed that the incidence of asthma was higher in CS offspring (odds ratio (OR) = 1.18, P < 0.001) than in the vaginal delivery (VD) group. Partial subgroup analyses showed a higher incidence of asthma in female offspring born via CS (OR = 1.26, P < 0.001) compared with the VD group, while there was no difference in males (OR = 1.07, P = 0.325). Asthma incidence was higher in CS offspring than in the VD group in Europe (OR = 1.20, P < 0.001), North America (OR = 1.15, P < 0.001), and Oceania (OR = 1.06, P = 0.008). This trend was not found in the Asian population (OR = 1.17, P = 0.102). The incidence of atopic asthma was higher in offspring born via CS (OR = 1.14, P < 0.001) compared to the VD group. The CS group had a higher incidence of persistent asthma, but the difference did not reach statistical significance (OR = 1.15, P = 0.063). Conclusion In this meta-analysis, CS may be a risk factor for asthma in offspring children/adolescents compared with VD. The relationship between CS and asthma was influenced by sex and region.

Diverging patterns in innate immunity against respiratory viruses during a lifetime: lessons from the young and the old

“…Results from a longitudinal study of 100 children during the first 3 months of life [ 8 ], employing mass cytometry and proteomics on peripheral blood, suggested stereotypical immune maturation driven by the development of the gut microbiome. The relevance of early-life microbial exposure is further underlined in children born via caesarean section [ 9 , 10 ] or those who received antibiotics in early life [ 11 , 12 ], which were associated with an increased susceptibility to respiratory viruses and a heightened risk of developing childhood asthma. To protect the vulnerable mucosal surfaces in vital organs such as lungs and gut, maintaining immune balance and a state of tonic noninflammatory immune readiness is essential.…”