Elective cesarean delivery and pediatric gastrointestinal morbidity of the offspring - results from a population based cohort of up to 18 years follow up

Tamar Wainstock, Asnat Walfisch, Ilana Shoham-Vardi, Idit Segal, Ruslan Sergienko, Eyal Sheiner

Research output: Contribution to journalMeeting Abstractpeer-review


Cesarean delivery (CD) has been shown to affect the newborn’s microbiome. We aimed to study a possible association between mode of delivery and the risk for gastro intestinal (GI) diseases of the offspring, during a follow- up period of up to 18 years.

Study Design
A population based cohort analysis was performed comparing different subtypes of GI morbidity leading to hospitalization among children (up to the age of 18 years) based on mode delivery: vaginal (VD) or CD. Data on pregnancy course and outcome, mode of delivery, and later offspring hospitalization causes were collected from two different databases of a single tertiary center. All singleton deliveries between the years 1991-2013 were included in the analysis. Exclusion criteria were congenital malformations, perinatal deaths, instrumental deliveries, and all pregnancy, delivery, and fetal complications (including: maternal hypertensive disorders and gestational diabetes, labor dystocia, fetal distress, labor induction, and fetal growth restriction). Kaplan-Meier survival curve was constructed to compare cumulative GI related hospitalization incidence based on mode of delivery, and a Cox proportional hazard model was used to control for confounders.

During the study period, 138 910 newborns met the inclusion criteria: 13 206 (9.5%) were delivered by CD, and 125 704 (91.5%) were delivered vaginally. During the follow up period (0-18 years, median 10.5), 6925 (5.0%) were hospitalized (at least once) due to GI morbidity: 5.9% among the CD children, and 4.9% of the VD (RR=1.23; 95% CI 1.13-1.32; incidence density rates for first hospitalization: CD 7.2/1000 person years (py); VD 4.7/1000 py; incidence density ratio: 1.53, 95%CI 1.45-1.60, Kaplan-Meier Log rank p<0.001, figure). Selected categories of GI morbidity are presented in the table. The association between CD and long-term pediatric GI morbidity remained significant in a Cox proportional hazards model, controlling for maternal age, preterm births, and birth weight (adjusted HR 1.41; 95% CI 1.31-1.52; p<0.001).

Children delivered by an elective Cesarean are at an increased risk for pediatric GI morbidity, as compared with children delivered vaginally.
Original languageEnglish GB
Pages (from-to)S327-S327
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2017


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