Abstract
Objective
Cesarean delivery (CD) has been shown to affect the newborn’s microbiome. We aimed to study a possible association between mode of delivery and the risk for infectious diseases of the offspring, during a follow- up period of up to 18 years.
Study Design
A population based cohort analysis was performed comparing different subtypes of infectious morbidity leading to hospitalization among children (up to the age of 18 years) based on mode delivery: vaginal (VD) or CD. Data on pregnancy course and outcome, mode of delivery, and later offspring hospitalization were collected from the same database of a single tertiary center in the region. All singleton deliveries between the years 1991-2013 were included in the analysis. Exclusion criteria were congenital malformations, perinatal deaths, instrumental deliveries, pregnancy, delivery, and fetal complications (including: maternal hypertensive disorders and gestational diabetes, labor dystocia, fetal distress, labor induction, and fetal growth restriction). Kaplan-Meier survival curve was constructed to compare cumulative infectious disease hospitalization incidence based on mode of delivery, and a Cox proportional hazard model was used to control for confounders including gestational age and maternal factors.
Results
During the study period, 138 910 newborns met the inclusion criteria: 13 206 (9.5%) were delivered by CD, and 125 704 (91.5%) were delivered vaginally. During the follow up period (0-18 years, median 10.22), 13 054 (9.4%) were hospitalized (at least once) due to infectious morbidity: 12.0% among the CD children, and 9.1% of the VD (RR=1.36; 95%CI 1.28-1.43; incidence density rates for first hospitalization: CD 15.22/1000 person years; VD 9.06/1000 person years; Kaplan-Meier Log rank p<0.001, figure). Selected categories of infections morbidity are presented in the table. The association between CD and long-term pediatric infectious morbidity remained significant in a Cox proportional hazards model, controlling for maternal age, preterm births, and birth weight (aHR 1.45; 95% CI 1.37-1.53).
Conclusion
Children delivered by Cesarean are at an increased risk for pediatric infectious morbidity, as compared with children delivered vaginally.
Cesarean delivery (CD) has been shown to affect the newborn’s microbiome. We aimed to study a possible association between mode of delivery and the risk for infectious diseases of the offspring, during a follow- up period of up to 18 years.
Study Design
A population based cohort analysis was performed comparing different subtypes of infectious morbidity leading to hospitalization among children (up to the age of 18 years) based on mode delivery: vaginal (VD) or CD. Data on pregnancy course and outcome, mode of delivery, and later offspring hospitalization were collected from the same database of a single tertiary center in the region. All singleton deliveries between the years 1991-2013 were included in the analysis. Exclusion criteria were congenital malformations, perinatal deaths, instrumental deliveries, pregnancy, delivery, and fetal complications (including: maternal hypertensive disorders and gestational diabetes, labor dystocia, fetal distress, labor induction, and fetal growth restriction). Kaplan-Meier survival curve was constructed to compare cumulative infectious disease hospitalization incidence based on mode of delivery, and a Cox proportional hazard model was used to control for confounders including gestational age and maternal factors.
Results
During the study period, 138 910 newborns met the inclusion criteria: 13 206 (9.5%) were delivered by CD, and 125 704 (91.5%) were delivered vaginally. During the follow up period (0-18 years, median 10.22), 13 054 (9.4%) were hospitalized (at least once) due to infectious morbidity: 12.0% among the CD children, and 9.1% of the VD (RR=1.36; 95%CI 1.28-1.43; incidence density rates for first hospitalization: CD 15.22/1000 person years; VD 9.06/1000 person years; Kaplan-Meier Log rank p<0.001, figure). Selected categories of infections morbidity are presented in the table. The association between CD and long-term pediatric infectious morbidity remained significant in a Cox proportional hazards model, controlling for maternal age, preterm births, and birth weight (aHR 1.45; 95% CI 1.37-1.53).
Conclusion
Children delivered by Cesarean are at an increased risk for pediatric infectious morbidity, as compared with children delivered vaginally.
| Original language | American English |
|---|---|
| Pages (from-to) | S326-S326 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 216 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2017 |