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The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis
Behzad Darabi1, Shoboo Rahmati2, Mohammad Reza HafeziAhmadi3
11Department of Pediatrics, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
Insights
Caesarean section delivery is linked to a higher risk of childhood asthma. This meta-analysis confirms that both elective and emergency caesarean sections increase asthma risk in children.
Area of Science:
- Pediatrics
- Public Health
- Obstetrics
Background:
- Conflicting findings exist regarding the association between caesarean section (SC) and childhood asthma.
- This study aimed to clarify this relationship through a comprehensive meta-analysis.
Purpose of the Study:
- To determine the association between caesarean section delivery and the risk of developing childhood asthma.
- To analyze the impact of both elective and emergency SC on asthma risk.
Main Methods:
- Systematic review and meta-analysis conducted following PRISMA guidelines.
- Searched multiple databases (Scopus, PubMed, Web of Science, etc.) for relevant studies up to February 1, 2019.
- Random effects model used for data synthesis, with heterogeneity assessed using I² index and Cochran's Q test.
Main Results:
- Analysis of 37 studies revealed a significant increase in childhood asthma risk associated with SC (RR = 1.20).
- Both emergency (RR = 1.18) and elective (RR = 1.23) SC were significantly linked to higher asthma risk.
- Subgroup analyses indicated no significant impact of study design, quality, continent, age of diagnosis, or publication year on heterogeneity.
Conclusions:
- Caesarean section, encompassing both elective and emergency procedures, is associated with an increased risk of childhood asthma.
- Recommendations include developing clinical guidelines and management plans to mitigate this risk.
Background:
Investigating the association between caesarean section (SC) and childhood asthma has shown contradictory results in different studies. The present study was conducted to determine the association between SC and childhood asthma.
Material And Method:
The present study was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. All the steps of the study were conducted independently by two reviewers from the inception until February 1, 2019. In case of disagreement, the third reviewer resolved it. We searched international online databases, including Scopus, Cochrane Library, PubMed/Medline, Embase, Web of Science (ISI), Science Direct, and Google scholar. The results of studies were combined using random effects model, and heterogeneity was measured through I2 index and Cochran's Q test. Comprehensive Meta-Analysis Software was used for meta-analysis. The significance level of all tests was considered to be P < 0.05.
Results:
The heterogeneity rate was high (I2 = 67.31%, P < 0.001) in 37 studies. The results showed that SC increased the risk of childhood asthma (RR (relative risk) = 1.20 [95% CI 1.15-1.25, P < 0.001]). The association between emergency and elective SC and childhood asthma was significant with RR of 1.18 (95% CI 1.07-1.29, P < 0.001) in 13 studies and 1.23 (95% CI 1.20-1.26, P < 0.001) in 13 studies, respectively. The subgroup analysis for RR of childhood asthma in SC indicated that study design (P = 0.306), prospective/retrospective studies (P = 0.470), quality of studies (P = 0.514), continent (P = 0.757), age of diagnosis (P = 0.283) and year of publication (P = 0.185) were not effective in the heterogeneity of studies. Sensitivity analysis by removing one study at a time indicated that the overall estimate is robust.
Conclusion:
According to the meta-analysis, SC (overall, elective, and emergency) increased the risk of childhood asthma. Therefore, it is hoped that developing clinical guidelines and implementing appropriate management plans would diminish the risk of asthma.
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