Elective cesarean delivery at term and the long-term risk for respiratory morbidity of the offspring

Abstract

Maternal morbidity is associated with cesarean deliveries. However, new evidence suggests that short- and long-term neonatal morbidity is also associated. This includes respiratory morbidity with conflicting results. To determine whether mode of delivery has an impact on the long-term risk for respiratory morbidity in the offspring, a population-based cohort analysis was conducted including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via elective cesarean delivery (CD) and those delivered vaginally. Multiple gestations and fetuses with congenital malformations were excluded from the analysis as were all cases of urgent CDs. Pediatric hospitalizations involving respiratory morbidity of offspring up to the age of 18 years were evaluated. A Kaplan-Meier survival curve was used to compare cumulative respiratory morbidity incidence and a Cox regression model to control for confounders. During the study period, 132,054 term deliveries met the inclusion criteria; 8.9% were via elective CDs (n = 11,746) and 91.1% (n = 120,308) were vaginal deliveries. Hospitalizations of the offspring involving respiratory morbidity were significantly more common in offspring delivered by CDs (5.2 vs. 4.3% in vaginal deliveries, p < 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the elective CD group (log rank p < 0.001). In a Cox proportional hazards model, while controlling for maternal age, gestational age, and birthweight, CD exhibited a significant and independent association with long-term respiratory morbidity of the offspring (adjusted hazard ratio = 1.22 (CI, 1.12-1.33), p < 0.001).Conclusion: Elective cesarean delivery at term is a significant risk factor for long-term pediatric respiratory morbidity of the offspring. What is Known: • Cesarean delivery is a major surgery with known possible complications. • Cesarean delivery has possible immediate complications for the newborn including respiratory complications. What is New: • Our study shows more long term respiratory morbidity in the CD group including asthma and obstructive sleep apnea. • Different possible explanations have been proposed including exposure to maternal flora during vaginal delivery and the stress hormones secreted during contractions and delivery.

Impact of delivery mode-associated gut microbiota dynamics on health in the first year of life

“…Delivery mode-induced microbiota changes and infant health. Since delivery mode is reported to be associated with infant and childhood health, especially regarding respiratory illness 16 , we defined a secondary research question, namely whether gut microbiota development is associated with health outcome. Although it was not our aim to study differences in health outcomes between the delivery mode groups in our cohort, we did find a trend toward differences in infectious disease and treatment parameters, specifically parent-reported RI events and antibiotic courses over the first year of life ( Table 1, chi-square test, p = 0.119 and p = 0.100, respectively).…”

Meconium‐stained amniotic fluid as a protective factor against childhood dermatitis and skin rash‐related hospitalization in the offspring – a population‐based cohort analysis

“…Gut microflora was shown to affect the maturation of the host's immune system and protect against pathogens. [24][25][26][27][28][29][30] MSAF ingestion during the prenatal period may potentially increase early infant diversity of gut microbiome, thus stimulating and directing the newborn's gut immune system development. Microflora is also involved in salvage of energy from carbohydrates, vitamin synthesis, and transformation and degradation of xenobiotics.…”

“…22,23 Further support to the importance of early exposure and the increase diversity of gut microbiota to the reduced risk of inflammatory diseases late in life is gained by the fact that children born via caesarean delivery, as compared with vaginally delivered ones, exhibit increased rates of asthma, obesity, coeliac disease and type 1 diabetes. [24][25][26][27][28][29][30] MSAF ingestion during the prenatal period may potentially increase early infant diversity of gut microbiome, thus stimulating and directing the newborn's gut immune system development. This process may have a positive effect on the host's immunity and, in turn, decrease vulnerability to skin inflammation later in life.…”

Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section

“…Birth by caesarean section (CS) has been linked to an increased risk of several neonatal respiratory morbidities, including respiratory distress syndrome (RDS) and transient tachypnoea of the newborn (TTN). Recent data also suggest that the negative effects of CS on respiratory function might extend beyond the neonatal period, leading to respiratory morbidities in the long term, such as obstructive sleep apnoea [1] and asthma [2]. Active labour before delivery enhances lung liquid clearance soon after birth [3].…”