Salem, Yasmin; Oestreich, Marc-Alexander Heinz; Fuchs, Oliver; Usemann, Jakob; Frey, Urs; Surbek, Daniel; Amylidi-Mohr, Sofia; Latzin, Philipp; Ramsey, Kathryn A.; Yammine, Sophie (2022). Are children born by cesarean section at higher risk for respiratory sequelae? American journal of obstetrics and gynecology, 226(2), 257.e1-257.e11. Elsevier 10.1016/j.ajog.2021.07.027
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BACKGROUND
Globally, the number of children born by cesarean section (CS) is constantly increasing. However, hormonal and physiological changes associated with labor and vaginal delivery (VD) are considered necessary for lung maturation.
OBJECTIVE
We aimed to assess if the mode of delivery is associated with changes in respiratory and atopic outcomes in infancy and at school-age.
STUDY DESIGN
We included 578 children born ≥37 weeks of gestational age from a prospective birth cohort study. We compared weekly respiratory symptoms throughout the first year of life, and infant lung function (tidal breathing, multiple-breath washout (MBW)) at five weeks between children born by CS (N=114) and VD (N=464) after term pregnancy in healthy women. For follow-up at six years (N=371, of which 65 CS) we assessed respiratory, atopic, and lung function outcomes (spirometry, body plethysmography, MBW). We performed adjusted regression analyses to examine the association between CS, respiratory, and atopic outcomes. To account for multiple testing, we used bonferroni correction resulting in an adapted significance level at P<0.002.
RESULTS
In infancy, children born by CS did not have more respiratory symptoms compared to VD (median (IQR) weeks with respiratory symptoms 4 (7) versus 5 (7); adjusted incidence rate ratio 0.8 (95% CI 0.6 to 1.0, P=0.02). Infant lung function was similar between groups. Children born by CS did not have more "ever wheezing" (adjusted Odds ratio 0.9 (95% CI 0.5 to 1.8, P=0.78)) or current asthma (0.4 (0.0 to 3.5, P=0.42)) at school-age compared to VD. Lung function parameters were not different between groups.
CONCLUSION
CS was not associated with respiratory symptoms in the first year of life, nor with different respiratory or atopic outcomes at school-age compared to VD. Our results indicate that there are no long-term consequences of CS on the respiratory health of the child.
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