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Offspring Long-Term Respiratory Morbidity Following Cesarean Delivery at Different Stages of Labor
Gil Gutvirtz1, Hagar Brami1, Tamar Wainstock2
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva 84101, Israel.
Insights
Cesarean delivery (CD) for first-stage non-progressive labor (NPL1) increases offspring respiratory risks compared to vaginal birth (VD) or second-stage NPL (NPL2). Reduced exposure to vaginal flora during NPL1 CD is linked to higher long-term respiratory morbidity in children.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Pulmonology
- Epidemiology
Background:
- Cesarean delivery (CD) is linked to increased long-term respiratory issues in offspring.
- The impact of CD timing and partial vaginal flora exposure on respiratory health is not fully understood.
Purpose of the Study:
- To investigate if children born via CD at different labor stages, with varying vaginal flora exposure, exhibit different long-term respiratory morbidity.
- To compare respiratory outcomes between CD for first-stage non-progressive labor (CD-NPL1), CD for second-stage non-progressive labor (CD-NPL2), and vaginal delivery (VD).
Main Methods:
- Population-based study analyzing long-term respiratory morbidity in children up to 18 years.
- Comparison of offspring hospitalization rates for respiratory conditions based on delivery mode: VD, CD-NPL1, and CD-NPL2.
- Cox regression models were used to control for confounding variables.
Main Results:
- A graded association was observed between reduced fetal exposure to vaginal flora and increased respiratory hospitalization rates.
- Children born via CD-NPL1 showed significantly higher respiratory-related hospitalizations compared to VD (aHR 1.15).
- CD-NPL2 did not show a significantly increased risk for respiratory morbidity compared to VD.
Conclusions:
- First-stage non-progressive labor Cesarean deliveries (CD-NPL1) are associated with an elevated risk of long-term respiratory morbidity in offspring.
- The findings suggest a graded relationship between the extent of vaginal flora exposure during labor and the risk of childhood respiratory issues.
- Minimizing intrapartum exposure to vaginal flora may contribute to increased respiratory morbidity in offspring born via CD-NPL1.
Abstract:
Background/Objectives: Cesarean deliveries (CD) have been associated with an increased risk for offspring long-term respiratory morbidity. We sought to evaluate whether children born via CD in different stages of labor, and partially exposed to vaginal flora, would differ in their long-term respiratory morbidity. Methods: A population-based study comparing long-term respiratory morbidity of children according to their mode of delivery and CD indication was conducted. Children born via CD for first stage non-progressive labor (CD-NPL1) and children born via CD for non-progressive labor in the second stage (CD-NPL2) were compared with children born vaginally (VD) as a reference group. Offspring hospitalizations up to 18 years involving respiratory morbidities were evaluated. Results: 313,782 deliveries were included; 97.7% were VD, 1.6% were CD for NPL1 and 0.7% were CD for NPL2. The overall respiratory-related hospitalization rates as well as the cumulative incidence of respiratory hospitalizations were significantly higher in children born via CD, with a graded association, related to fetal exposure to vaginal flora, noted between VD, CD-NPL2 and CD-NPL1 with the highest incidence. In a Cox model, controlling for multiple confounding variables, NPL1 (vs. VD) was associated with an increased risk for offspring long-term respiratory morbidity (aHR 1.15), while NPL2 did not differ in risk. Conclusions: The risk for respiratory morbidity is increased for NPL1 offspring (with lower exposure to vaginal flora) as compared with NPL2 and VD offspring, with a graded association noted between exposure to vaginal flora during labor and the risk for offspring long-term respiratory morbidity.
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