Elective cesarean delivery at term and the long-term risk for respiratory morbidity of the offspring
Maternal morbidity is associated with cesarean deliveries. However, new evidence suggests that short- and long-term neonatal morbidity is also associated. This includes respiratory morbidity with conflicting results. To determine whether mode of delivery has an impact on the long-term risk for respiratory morbidity in the offspring, a population-based cohort analysis was conducted including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via elective cesarean delivery (CD) and those delivered vaginally. Multiple gestations and fetuses with congenital malformations were excluded from the analysis as were all cases of urgent CDs. Pediatric hospitalizations involving respiratory morbidity of offspring up to the age of 18 years were evaluated. A Kaplan-Meier survival curve was used to compare cumulative respiratory morbidity incidence and a Cox regression model to control for confounders. During the study period, 132,054 term deliveries met the inclusion criteria; 8.9% were via elective CDs (n = 11,746) and 91.1% (n = 120,308) were vaginal deliveries. Hospitalizations of the offspring involving respiratory morbidity were significantly more common in offspring delivered by CDs (5.2 vs. 4.3% in vaginal deliveries, p < 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the elective CD group (log rank p < 0.001). In a Cox proportional hazards model, while controlling for maternal age, gestational age, and birthweight, CD exhibited a significant and independent association with long-term respiratory morbidity of the offspring (adjusted hazard ratio = 1.22 (CI, 1.12–1.33), p < 0.001).
What is Known:
• Cesarean delivery is a major surgery with known possible complications.
• Cesarean delivery has possible immediate complications for the newborn including respiratory complications.
What is New:
• Our study shows more long term respiratory morbidity in the CD group including asthma and obstructive sleep apnea.
• Different possible explanations have been proposed including exposure to maternal flora during vaginal delivery and the stress hormones secreted during contractions and delivery.
KeywordsAsthma Mode of delivery Obstructive sleep apnea (OSA) Respiratory morbidity
All authors contributed to the study, including study design (Walfisch, Sheiner, Landau Baumfeld), data acquisition (Sheiner, Segal, Baumfeld, Wainstock), data analysis (Wainstock, Sergienko), data interpretation (Baumfeld, Walfisch, Landau, Sheiner) and writing the paper (Baumfeld, Walfisch, Sheiner).
The authors state that they do not have a financial relationship and that this research was not funded.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 14.Miller JM Jr (1988) Maternal and neonatal morbidity and mortality in cesarean section. Obstet Gynecol Clin N Am 15(4):629–638Google Scholar
- 20.Sonnenschein-van der Voort AM, Arends LR, de Jongste JC et al (2014) Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children. J Allergy Clin Immunol 133(5):1317–1329. https://doi.org/10.1016/j.jaci.2013.12.1082 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Stutchfield P, Whitaker R, Russell I, Antenatal Steroids for Term Elective Cesarean section (ASTECS) Research team (2005) Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomized trial. BMJ 331(7518):662CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Tun HM, Bridgman SL, Chari R, Field CJ, Guttman DS, Becker AB, Mandhane PJ, Turvey SE, Subbarao P, Sears MR, Scott JA, Kozyrskyj AL, for the Canadian Healthy Infant Longitudinal Development (CHILD) Study Investigators (2018) Roles of birth mode and infant gut microbiota in intergenerational transmission of overweight and obesity from mother to offspring. JAMA Pediatr 172:368–377. https://doi.org/10.1001/jamapediatrics.2017.5535 CrossRefPubMedGoogle Scholar
- 29.Zainal N, Rahardja A, Faris Irfan CY, Nasir A, Wan Pauzi WI, Mohamad Ikram I, Van Rostenberghe H (2016) Prevalence of asthma-like symptoms and assessment of lung function in schoolchildren born with low birth weight. Singap Med J 57(12):690–693. https://doi.org/10.11622/smedj.2016019 CrossRefGoogle Scholar