Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health

Bo Ri Kim, Mercer University College of Pharmacy

The National Institute for Health and Clinical Excellence (NICE) caesarean section clinical guidelines recommend that the risks and benefits of caesarean section (CS) and vaginal birth should be discussed with health care providers, including the risks of placental problems and postsurgical wound infection (9-10%). It is also stated that short-term offspring risks include respiratory compromise, but data beyond the neonatal stage are not regularly collected. [1]

Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health [2]
Design Retrospective cohort study; N= 321,287
Objective To investigate the relationship between planned cesarean delivery and offspring health problems or death in childhood
Study Groups First-born offspring born in Scotland, United Kingdom, between 1993 and 2007
Methods Offspring born by planned cesarean delivery in a first pregnancy were compared with offspring born by unscheduled cesarean delivery and with offspring delivered vaginally.
Duration 22 years
Primary Outcome Measure Asthma requiring hospital admission
Baseline Characteristics  

Characteristic

Cesarean Delivery Vaginal Birth

(n= 252,917)

Planned

(n= 12,355)

Unscheduled

(n = 56,015)

Maternal age, median 29 29 26
Maternal BMI, median 24.8 25.8 23.9
Gestation, mean 38.6 39.99 39.8
Maternal Smoker 2,261 9,413 59,058
Maternal type 1 diabetes 2,073 501 39,757
Birth weight, mean 3,301 3531.9 3,379.4
Year of delivery, median 2000 2001 1999
Male offspring 5,963 31,439 126,991
Breastfeeding at age 6 week 3,055 13,056 54,006
Results ·      Compared with offspring born by unscheduled cesarean delivery, those born by planned cesarean delivery were at no significantly different risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, cancer, or death but were at increased risk of type 1 diabetes (0.66% vs 0.44%; difference, 0.22% [95% CI, 0.13%-0.31%]; adjusted hazard ratio [HR], 1.35 [95% CI, 1.05-1.75]).

·      In comparison with children born vaginally, offspring born by planned cesarean delivery were at increased risk of asthma requiring hospital admission (3.73% vs 3.41%; difference, 0.32% [95% CI, 0.21%-0.42%]; adjusted HR, 1.22 [95% CI, 1.11-1.34]), salbutamol inhaler prescription at age 5 years (10.34% vs 9.62%; difference, 0.72% [95% CI, 0.36%-1.07%]; adjusted HR, 1.13 [95% CI, 1.01-1.26]), and death (0.40% vs 0.32%; difference, 0.08% [95% CI, 0.02%-1.00%]; adjusted HR, 1.41 [95% CI, 1.05-1.90]), whereas there were no significant differences in risk of obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, or cancer.

Adverse Events Common Adverse Events: Asthma (3.73%)
Serious Adverse Events: Death (0.40%)
Study Author Conclusions Among offspring of women with first births in Scotland between 1993 and 2007, planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, and all-cause death by age 21 years. Further investigation is needed to understand whether the observed associations are causal.

This study suggests that vaginal birth offers some protection from asthma. Vaginal birth decreases exposure to maternal bowel flora, which may develop T-cell-mediated asthma.

This study has a few limitations: maternal educations, ethnicity and indication for cesarean delivery could have confounded the results. Also, administration of intravenous antibiotics for planned cesarean delivery can affect the outcomes measured. Even with the study limitations, this study implies that a vaginal birth can be an important early-life factor in the development of asthma in childhood, which healthcare providers and women contemplating cesarean delivery should consider.

  1. National Institute for Health and Clinical Excellence (NICE). Caesarean Section: Clinical Guideline No. NICE website. http://www.nice.org.uk/guidance/cg132. November 2011. Accessed November 4, 2015
  2. Black M, Bhattacharya S, Phillip S, et al. Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health. 2015 Dec 1;314(21):2271-2279.
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