Delivery mode and future respiratory morbidity of the offspring - a sibling analysis

Ahmad S. Essa, Asnat Walfisch, Eyal Sheiner, Tamar Wainstock

Research output: Contribution to journalMeeting Abstract


Cesarean delivery was recently suggested to be associated with several long-term health implications in offspring including higher respiratory morbidity rates. Previous studies have, however, been hindered by limited control for confounders. In this study we aimed to investigate the association between delivery mode and long-term respiratory morbidity of the offspring while employing sibling analysis theme in order to maximize confounder control.

Study Design
A prospectively analyzed population-based cohort study was performed, which included all sibling deliveries occurring between 1991 and 2014 at a regional tertiary medical center. The study included 13,516 individuals (6758 siblings pairs): the first born was via vaginal delivery (VD) and the second via caesarean delivery (CD). Each siblings pair was considered a matched set, with the aim to perform a within-family analysis and minimize confounding effects. CD was considered the exposure and VD, the comparison. The risk for long-term respiratory morbidity in offspring was based on the hospital’s pediatric database and a pre-defined set of respiratory ICD-9 code list associated with offspring hospitalizations. Only the first respiratory related hospitalization for each child up to the age of 18 years was included in the analysis. A Kaplan–Meier survival curve was used to compare the cumulative respiratory morbidity incidence while Cox hazards models were employed to control for potential confounders.

Crude rates of total respiratory hospitalizations were found to be significantly higher in the CD as compared to the VD group (OR=1.238; 95%CI, 1.06-1.43, p=0.006; Table). The Kaplan-Meier survival curve showed significantly higher cumulative hospitalization rates in the CD group as compared to the VD group (log rank p ≤ 0.001; Figure). Using a Cox proportional hazards model, adjusted for birthweight, preeclampsia, diabetes, smoking, induction of labor and obesity, the association remained significant (Adjusted HR= 1.212, 95%CI 1.401-1.048, p=0.009).

Cesarean delivery appears to significantly impact future respiratory health of the offspring in a sibling analysis. Mode of delivery appears to play a major role in the future respiratory health of a child.
Original languageEnglish
Pages (from-to)S609-S610
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2019


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