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Are children born by cesarean delivery at higher risk for respiratory sequelae?
Yasmin Salem1, Marc-Alexander Oestreich1, Oliver Fuchs2
1Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Insights
Cesarean delivery is not linked to increased respiratory symptoms or conditions like asthma in children. This study found no long-term respiratory health effects in children born via cesarean compared to vaginal delivery.
Area of Science:
- Pediatric Health
- Obstetrics
- Respiratory Medicine
Background:
- Cesarean delivery rates are rising globally.
- Labor and vaginal delivery involve hormonal and physiological changes crucial for infant lung maturation.
Purpose of the Study:
- To investigate the association between cesarean delivery and respiratory/atopic outcomes in infancy and school age.
- To determine if delivery mode impacts infant lung function and long-term respiratory health.
Main Methods:
- Prospective birth cohort study of 578 children (≥37 weeks gestation).
- Compared respiratory symptoms and infant lung function (5 weeks) between cesarean (N=114) and vaginal (N=464) delivery groups.
- Assessed respiratory, atopic, and lung function outcomes at 6 years (N=371).
Main Results:
- No significant difference in respiratory symptoms during infancy between cesarean and vaginal delivery groups (P=.02).
- Infant lung function was similar between groups.
- No increased incidence of wheezing or asthma at school age in children born via cesarean delivery (P=.78 and P=.42, respectively).
Conclusions:
- Cesarean delivery showed no association with respiratory symptoms in the first year of life.
- No different respiratory or atopic outcomes were observed at school age compared to vaginal delivery.
- Results suggest no long-term respiratory health consequences associated with cesarean delivery.
Background:
Globally, the number of children born by cesarean delivery is constantly increasing. However, hormonal and physiological changes associated with labor and vaginal delivery are considered necessary for lung maturation.
Objective:
We aimed to assess whether the mode of delivery is associated with changes in respiratory and atopic outcomes during infancy and at school age.
Study Design:
We included 578 children, born at ≥37 weeks of gestation, from a prospective birth cohort study. We compared weekly respiratory symptoms throughout the first year of life and infant lung function (tidal breathing and multiple-breath washout) at 5 weeks of age between children born by cesarean delivery (N=114) and those born by vaginal delivery (N=464) after term pregnancy in healthy women. At a follow-up visit conducted at 6 years of age (N=371, of which 65 were delivered by cesarean delivery), we assessed respiratory, atopic, and lung function outcomes (spirometry, body plethysmography, and multiple-breath washout). We performed adjusted regression analyses to examine the association between cesarean delivery and respiratory and atopic outcomes. To account for multiple testing, we used the Bonferroni correction, which led to an adapted significance level of P<.002.
Results:
During infancy, children born by cesarean delivery did not have more respiratory symptoms than those born by vaginal delivery (median, 4 weeks; interquartile range, 7 weeks vs median, 5 weeks; interquartile range, 7 weeks; adjusted incidence rate ratio, 0.8; 95% confidence interval, 0.6-1.0; P=.02). Infant lung function was similar between the groups. Children born by cesarean delivery did not have a higher incidence of "ever wheezing" (adjusted odds ratio, 0.9; 95% confidence interval, 0.5-1.8; P=.78) or current asthma (adjusted odds ratio, 0.4; 95% confidence interval, 0.0-3.5; P=.42) at school age than those born by vaginal delivery. There was no difference in the lung function parameters between the groups.
Conclusion:
Cesarean delivery was not associated with respiratory symptoms in the first year of life, nor with different respiratory or atopic outcomes at school age, when compared with vaginal delivery. Our results indicate that there are no long-term consequences on the respiratory health of the child associated with cesarean delivery.
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