Caesarean delivery, immune function and inflammation in early life among Ecuadorian infants and young children

Abstract

Caesarean delivery has been linked to a number of inflammatory conditions in childhood and adolescence. Yet the mechanisms underlying these associations and their generalizability across contexts with different postnatal feeding and pathogenic exposures remain unclear. This study tests the association between delivery type and three measures of immune function, inflammation, morbidity and leukocyte proportions, in Ecuadorian infants and children aged 6 months to 2 years. Data were collected from mother–child pairs participating in a nationally representative health and nutrition survey Encuesta Nacional de Salud y Nutricion (ENSANUT-ECU) conducted in 2012. The analytic sample includes 828 mothers and infants with delivery information and measured biomarkers. Poisson regression models were used to examine the association between delivery type and markers of immune function, controlling for maternal and infant characteristics, including age, sex, sociodemographic characteristics and medical indications. 40.8% (n=338) of sample infants and children were delivered by caesarean. Compared to those born vaginally, infants born by caesarean were less likely to have elevated C-reactive protein (CRP) [CRP>2 mg/l; risk ratio (RR): 0.76, 95% confidence interval (CI): 0.58–1.00] and more likely to have illness symptoms (RR: 1.22, 95% CI: 1.01–1.46) and elevated basophils (RR: 1.83, 95% CI: 1.03–3.25). No other immune cell proportions differed by delivery type. The results suggest that differences in the perinatal exposures accompanying caesarean delivery may alter immune development and function, particularly in the inflammatory response to infection and in cells involved in the allergic response, across infancy and early childhood. Understanding the pathways linking perinatal exposures to immune development is important for preventing the development of inflammatory conditions.

Cesarean section and risk of allergies in Ecuadorian children: A cross‐sectional study

“…In a recent study, Davoodi et al 42 observed a positive correlation between asthma and socioeconomic status. In two studies conducted in Ecuador by Jahnke et al, 15 the authors noted an increased rate of CS in Ecuadorian women with higher income and suggested that the mode of delivery may be associated with an altered inflammatory response to infection and changes in the proportion of cells involved in the allergic response 23 . Our study substantiates these conclusions since we were also able to delineate an increased occurrence of allergic diseases in higher social strata.…”

“…In two studies conducted in Ecuador by Jahnke et al, 15 the authors noted an increased rate of CS in Ecuadorian women with higher income and suggested that the mode of delivery may be associated with an altered inflammatory response to infection and changes in the proportion of cells involved in the allergic response. 23 Our study substantiates these conclusions since we were also able to delineate an increased occurrence of allergic diseases in higher social strata. Regarding sex, age, and mode of delivery, socioeconomic status appeared to be a significant predictor of asthma, physician-diagnosed rhinitis, the occurrence of rhinitis symptoms (such as itching of the nasal tract, nasal secretion, and blocked nose), and food allergies.…”

“…The relationship between the current "allergy epidemic" and key environmental factors such as environmental pollution, lifestyle, nutrition, and bacterial contact in early childhood, has been investigated in the Latin American population, [12][13][14]25 but limited evidence exists on how the prevalence of allergic diseases is associated with the high rate of CS and the impact of socioeconomic background. 15,23 We found that delivery via CS strongly increased the risk of developing asthma and wheezing (OR = 20.2 and 3.76, respectively), independently of industrialization, which was also evident after adjusting for confounding factors such as sex, premature birth exclusive breastfeeding, nursery attendance, parents' allergic status, and exposure to tobacco smoke (OR = 24.1 and 4.12, respectively).…”

“…Pilot studies in Ecuador have demonstrated a relationship between CS and inflammatory diseases, which may predispose to future infections. 23,24 Therefore, it was appropriate to study the association between the delivery mode and allergic diseases in a nonindustrialized country in this setting by conducting a cross-sectional study of children aged 3-12 years living in Ecuador. The relationship between the current "allergy epidemic" and key environmental factors such as environmental pollution, lifestyle, nutrition, and bacterial contact in early childhood, has been investigated in the Latin American population, [12][13][14]25 but limited evidence exists on how the prevalence of allergic diseases is associated with the high rate of CS and the impact of socioeconomic background.…”

“…Ortiz‐Prado et al 22 investigated CS rates in Ecuador and found that the overall national CS rate in the private healthcare system was double that of the public healthcare system. Pilot studies in Ecuador have demonstrated a relationship between CS and inflammatory diseases, which may predispose to future infections 23,24 …”