New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children's Health

Abstract

Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of ‘modern’ diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the ‘good’ maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the ‘bad’ bacteria that may endanger the child’s immune system are frequently present. In children born by vaginal delivery, the ‘good’ maternal bacteria stimulate the newborn’s white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section.

Association of objectively measured physical fitness during pregnancy with maternal and neonatal outcomes. The GESTAFIT Project

“…However, while it is well-established that physical activity improves birth outcomes [9][10][11], studies looking at the relationships between objective assessments of fitness and delivery type, gestational age, duration of labour stages, birth weight and values of umbilical cord blood gas are limited. The causes of caesarean sections and how to reduce caesarean section rates are now a spotlight of research as this type of delivery has been associated with an increased risk of infection compared with vaginal deliveries, higher wound dehiscence, haemorrhage and reduced fertility [12][13][14], as well as an increased risk of allergies, type 1 diabetes or respiratory problems [15] in infants, among other complications. Furthermore, it is noteworthy that in 2016 in Spain there were 22% caesarean sections in public hospitals [16], higher than the 15% rate recommended by the World Health Organization [17].…”

The Microbiome and the Epigenetics of Diabetes Mellitus

“…Acetate, butyrate, and propionate (SCFA) modulate the gene expression in host, modifying the infant microbiome and stimulating white blood cells [65]. Some studies suggested that infants born by cesarean section are at greater risk of developing obesity and/ or diabetes than those born vaginally [66]. Other studies with preschool children showed overweight or obesity in children born by cesarean [67], while in other showed the opposite [68].…”

Erhöhte Prävalenz konnataler Tränenwegsstenosen nach Sectio caesarea

“…Grundlage hierfür ist die Programmierung der Hypothalamus-Hypophysen-Nebennierenrinden-Achse, die zu einer vermutlich lebenslangen Modulation des metabolisch endokrinen Systems führt. Zusätzlich konnten einige Metaanalysen belegen, dass das Risiko für frühkindliches Asthma und für einen frühkindlichen insulinpflichtigen Diabetes mellitus Typ 1 nach Schnittentbindung jeweils um 20 % erhöht ist [19]. Prinzipiell müssen somit auch unterschiedliche fetale Hormonkonzentrationen und Zusammensetzungen zum Zeitpunkt der Geburt und in den ersten Lebenswochen oder die Exposition des Säuglings gegenüber bestimmten Bakterienstämmen während der vaginalen Entbindung als mögliche Einflussfaktoren für eine spontane Eröffnung der bei etwa 90 % aller Kinder zum Zeitpunkt der Geburt vorhandenen Hasner-Membran diskutiert werden.…”