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Elective cesarean delivery at term and the long-term risk for respiratory morbidity of the offspring

  • Yael Baumfeld
  • Asnat Walfisch
  • Tamar Wainstock
  • Idit Segal
  • Ruslan Sergienko
  • Daniella Landau
  • Eyal Sheiner
Original Article

Abstract

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).

Conclusion: Elective cesarean delivery at term is a significant risk factor for long-term pediatric respiratory morbidity of the offspring.

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.

Keywords

Asthma Mode of delivery Obstructive sleep apnea (OSA) Respiratory morbidity 

Notes

Authors’ contributions

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).

Funding

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.

Supplementary material

431_2018_3225_MOESM1_ESM.xlsx (11 kb)
ESM 1 (XLSX 10 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Soroka University Medical CenterBen-Gurion University of the NegevBeer ShevaIsrael
  2. 2.The Clinical Research Center, Soroka University Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael
  3. 3.Department of Public Health, Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael
  4. 4.Ministry of HealthJerusalemIsrael
  5. 5.Department of Neonatology, Soroka University Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael

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