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Mode of delivery and childhood blood pressure
Insights
Cesarean delivery may lower childhood blood pressure in preterm infants, but this effect was not observed in full-term births. This suggests a sensitive developmental period for blood pressure programming related to delivery mode.
Area of Science:
- Pediatrics
- Obstetrics
- Cardiovascular Health
Background:
- Neonatal studies indicate lower blood pressure in infants born via cesarean section.
- Understanding long-term cardiovascular implications of delivery mode is crucial.
Purpose of the Study:
- To investigate the influence of delivery mode on childhood blood pressure at ages 7-9 years.
- To determine if delivery mode impacts blood pressure differently in preterm versus term infants.
Main Methods:
- Analysis of three cohorts: preterm infants (n=756), UK term infants (n=166), and Tasmanian term infants (n=650).
- Comparison of systolic blood pressure between cesarean and vaginal deliveries at childhood follow-up.
Main Results:
- Preterm infants born via cesarean section had significantly lower systolic blood pressure (99.3 vs. 101.4 mm Hg) compared to vaginally born infants.
- A trend of increasing blood pressure was observed from cesarean to spontaneous vaginal, forceps, and breech deliveries in preterm infants.
- These associations were not found in the term infant cohorts.
Conclusions:
- Mode of delivery may influence blood pressure programming in preterm infants.
- The findings suggest a sensitive developmental window for delivery mode's impact on blood pressure that may not extend to full-term gestation.
Abstract:
A number of studies have shown that children born by cesarean section have lower blood pressure during the neonatal period. The aim of this study was to investigate whether mode of delivery influenced childhood blood pressure: at age 7.5 to 8 y in a cohort of 756 children born preterm, at 7 to 9 y in a pilot study of 166 children born at term in the United Kingdom, and in a cohort of 650 Tasmanian children born at term. In the preterm cohort, systolic blood pressure was significantly lower in children born by cesarean section rather than delivered vaginally (99.3+/-10.0 versus 101.4+/-9.4 mm Hg; 95% confidence interval, -0.69 to -3.46; p = 0.003), with a significant trend to having a higher pressure in those born by breech versus forceps versus spontaneous vaginal delivery versus cesarean section. These findings were not replicated in the term cohorts. This raises the hypothesis that there is a sensitive period for programming later blood pressure by factors associated with mode of delivery and that this period does not extend to full-term.