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Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section
Nis Brix1, Lonny Stokholm, Fjola Jonsdottir
1nis.brix@gmail.com.
Insights
Emergency caesarean section does not increase the risk of childhood asthma. This twin study found no association between birth by emergency C-section and asthma development in children.
Area of Science:
- Pediatrics
- Obstetrics
- Epidemiology
Background:
- Caesarean section is a potential risk factor for childhood asthma.
- Familial factors may confound the association between caesarean section and asthma.
- Twin studies can minimize residual confounding to assess this relationship.
Purpose of the Study:
- To investigate the association between emergency caesarean section and childhood asthma risk.
- To minimize confounding factors by utilizing twin pairs.
Main Methods:
- Register-based, nation-wide matched cohort study.
- Inclusion of twin pairs where one twin was delivered vaginally and the other via emergency caesarean section.
- Study period: January 1997 to December 2012.
Main Results:
- 464 twin pairs (928 twins) were analyzed.
- Emergency caesarean section showed no significant association with childhood asthma in unadjusted analysis (OR = 0.67).
- Adjusted analysis, controlling for birth weight, gender, umbilical cord pH, Apgar score, and neonatal respiratory morbidity, also found no association.
Conclusions:
- Emergency caesarean section is not associated with an increased risk of childhood asthma.
- The study design effectively minimized confounding factors.
- Findings suggest that other factors may explain the previously observed association.
Introduction:
Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section.
Methods:
The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012.
Results:
In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged.
Conclusion:
Emergency caesarean section was not associated with childhood asthma.
Funding:
none.
Trial Registration:
not relevant.
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