Elective cesarean delivery and pediatric infectious morbidity of the offspring - results of a population based cohort of up to 18 years

Tamar Wainstock, Asnat Walfisch, Ilana Shoham-Vardi, Idit Segal, Ruslan Sergienko, Eyal Sheiner

Research output: Contribution to journalMeeting Abstractpeer-review


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.

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).

Children delivered by Cesarean are at an increased risk for pediatric infectious morbidity, as compared with children delivered vaginally.
Original languageEnglish
Pages (from-to)S326-S326
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2017


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