Abstract
Objective
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.
Results
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).
Conclusion
Children delivered by an elective Cesarean are at an increased risk for pediatric GI morbidity, as compared with children delivered vaginally.
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.
Results
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).
Conclusion
Children delivered by an elective Cesarean are at an increased risk for pediatric GI morbidity, as compared with children delivered vaginally.
| Original language | English |
|---|---|
| Pages (from-to) | S327-S327 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 216 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2017 |