TY - JOUR
T1 - Delivery mode and future infectious morbidity of the offspring
T2 - a sibling analysis
AU - Essa, Ahmad
AU - Walfisch, Asnat
AU - Sheiner, Eyal
AU - Sergienko, Ruslan
AU - Wainstock, Tamar
N1 - Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Purpose: Cesarean delivery (CD) has been recently suggested to be associated with offspring’s long-term health implications. We aimed to investigate the association between delivery mode and long-term infectious morbidity of the offspring while employing sibling matched analysis to maximize confounder control. Methods: A retrospective population-based cohort study was performed, which included all sibling deliveries occurring between 1991 and 2014 at a regional tertiary medical center. Offsprings were followed up until the age of 18 years. The study included 13,516 individuals (6758 sibling pairs): the first born was via vaginal delivery and the second via CD. Each siblings pair was considered a matched set, with the aim to perform a within-family analysis. A Kaplan–Meier survival curve was used to compare the cumulative infectious morbidity incidence and a multivariable Cox survival hazards regression model to control for confounders. Results: Crude rates of total infectious hospitalizations were found to be significantly higher in the CD group (OR 1.25; 95% CI 1.12–1.40). Specifically, bronchiolitis (OR 2.02, 95% CI 1.56–2.63), otitis (OR 1.52, 95% CI 1.21–1.9), and gastroenteritis (OR 1.41, 95% CI 1.05–1.9) were all found to be significantly more common in the CD group. The survival curve demonstrated significantly higher cumulative infection-related hospitalization rates in the CD group (log-rank p < 0.001). The Cox model, adjusted for several confounders, confirmed the significant association between CD and offspring’s infection-related morbidity (adjusted HR 1.25; 95% CI 1.02–1.53). Conclusion: CD appears to be independently associated with later offspring infection-related morbidity, even while rigorously adjusting for confounders.
AB - Purpose: Cesarean delivery (CD) has been recently suggested to be associated with offspring’s long-term health implications. We aimed to investigate the association between delivery mode and long-term infectious morbidity of the offspring while employing sibling matched analysis to maximize confounder control. Methods: A retrospective population-based cohort study was performed, which included all sibling deliveries occurring between 1991 and 2014 at a regional tertiary medical center. Offsprings were followed up until the age of 18 years. The study included 13,516 individuals (6758 sibling pairs): the first born was via vaginal delivery and the second via CD. Each siblings pair was considered a matched set, with the aim to perform a within-family analysis. A Kaplan–Meier survival curve was used to compare the cumulative infectious morbidity incidence and a multivariable Cox survival hazards regression model to control for confounders. Results: Crude rates of total infectious hospitalizations were found to be significantly higher in the CD group (OR 1.25; 95% CI 1.12–1.40). Specifically, bronchiolitis (OR 2.02, 95% CI 1.56–2.63), otitis (OR 1.52, 95% CI 1.21–1.9), and gastroenteritis (OR 1.41, 95% CI 1.05–1.9) were all found to be significantly more common in the CD group. The survival curve demonstrated significantly higher cumulative infection-related hospitalization rates in the CD group (log-rank p < 0.001). The Cox model, adjusted for several confounders, confirmed the significant association between CD and offspring’s infection-related morbidity (adjusted HR 1.25; 95% CI 1.02–1.53). Conclusion: CD appears to be independently associated with later offspring infection-related morbidity, even while rigorously adjusting for confounders.
KW - Cesarean delivery infectious morbidity
KW - Delivery mode
KW - Long-term health outcomes
KW - Sibling analysis
UR - http://www.scopus.com/inward/record.url?scp=85088815096&partnerID=8YFLogxK
U2 - 10.1007/s00404-020-05706-z
DO - 10.1007/s00404-020-05706-z
M3 - Article
C2 - 32737573
AN - SCOPUS:85088815096
SN - 0932-0067
VL - 302
SP - 1135
EP - 1141
JO - Archives of Gynecology and Obstetrics
JF - Archives of Gynecology and Obstetrics
IS - 5
ER -