The association of mode of delivery and common childhood illnesses.
ABSTRACT Participants enrolled in a randomized control trial (RCT) were eligible for this cross-sectional study to determine if children born via cesarean (C)-section had higher rates of common infectious diseases and change in normal daily activities due to illness than children born vaginally. The RCT collected parent-reported health information and mode of delivery was assessed during follow-up calls. Parent-reported rates of infectious sequelae and changes in daily activities were compared between C-section and vaginally delivered children. In total, 72.4% of the 522 children were delivered vaginally. After accounting for age, siblings, breast-feeding as an infant, and clustering within families, C-section delivered children had significantly higher rates of cumulative infectious diseases, lower respiratory tract infections, and cough than vaginally born children. Mode of delivery appears to have some lasting effect on child health 3 to 6 years after birth, specifically respiratory health. Further research is imperative to elucidate the causative effect of mode of delivery on child health.
- SourceAvailable from: José Villar[show abstract] [hide abstract]
ABSTRACT: Caesarean delivery rates continue to increase worldwide. Our aim was to assess the association between caesarean delivery and pregnancy outcome at the institutional level, adjusting for the pregnant population and institutional characteristics. For the 2005 WHO global survey on maternal and perinatal health, we assessed a multistage stratified sample, comprising 24 geographic regions in eight countries in Latin America. We obtained individual data for all women admitted for delivery over 3 months to 120 institutions randomly selected from of 410 identified institutions. We also obtained institutional-level data. We obtained data for 97,095 of 106,546 deliveries (91% coverage). The median rate of caesarean delivery was 33% (quartile range 24-43), with the highest rates of caesarean delivery noted in private hospitals (51%, 43-57). Institution-specific rates of caesarean delivery were affected by primiparity, previous caesarean delivery, and institutional complexity. Rate of caesarean delivery was positively associated with postpartum antibiotic treatment and severe maternal morbidity and mortality, even after adjustment for risk factors. Increase in the rate of caesarean delivery was associated with an increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer even after adjustment for preterm delivery. Rates of preterm delivery and neonatal mortality both rose at rates of caesarean delivery of between 10% and 20%. High rates of caesarean delivery do not necessarily indicate better perinatal care and can be associated with harm.The Lancet 07/2006; 367(9525):1819-29. · 39.06 Impact Factor
- The Journal of pediatrics 06/2008; 152(5):607-11. · 4.02 Impact Factor
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ABSTRACT: The composition of the intestinal flora in young children, if unfavourable, may increase the susceptibility to allergic disorders. Beneficial intestinal microbes originate from the maternal vaginal tract and thus are more likely to be transferred during vaginal births than during Caesarean sections (C-sections). To determine whether children born by C-section have a different risk of allergic disorders compared with those delivered vaginally. We also tested the hypothesis that the risk of allergic disorders is highest for children born after 'repeat C-sections'. A retrospective cohort study of 8,953 children aged 3-10 years. Children diagnosed with allergic rhinoconjunctivitis (AR), asthma, atopic dermatitis (AD), or food allergies were identified from the Kaiser Permanente Northwest Region electronic records. The children's sex, birth weight, birth order, postnatal exposure to antibiotics as well as the mothers' age, ethnicity, education, marital status, smoking status during pregnancy, and use of asthma or hayfever medications were identified through the mothers' medical records or through the Oregon Birth Registry. The risk of being diagnosed with AR was significantly higher in the children born by C-section than in those delivered vaginally: adjusted odds ratio (OR)=1.37%, 95% confidence interval (CI)=1.14-1.63. Delivery by C-section was also associated with the subsequent diagnosis of asthma (OR=1.24%, 95% CI=1.01-1.53); this association was gender specific, with a positive association restricted to girls (OR for asthma in girls: OR=1.53%, 95% CI=1.11-2.10; in boys: OR=1.08%, 95% CI=0.81-1.43). There was no significant association between mode of delivery and AD. If children born in a 'repeat C-section' were considered separately the risk of being diagnosed with AR increased further (OR=1.78%, 95% CI=1.34-2.37). The same increase was noted for asthma in girls (OR=1.83%, 95% CI=1.13-2.97) but not in boys. Caesarean sections may be associated with an increased risk of developing AR in childhood.Clinical & Experimental Allergy 12/2005; 35(11):1466-72. · 4.79 Impact Factor