Pediatr Allergy Respir Dis.  2011 Dec;21(4):250-260.

Is Mode of Delivery Associated with an Increased Risk for Childhood Asthma?

Affiliations
  • 1Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. bskim@gnah.co.kr

Abstract

Under the hygiene hypothesis, children born by cesarean section (CS) may consequently have an increased risk of asthma and other allergic diseases. CS has been shown to have a delayed and altered development in establishment of gut flora and altered cytokine production. Concerns about the relations between CS and the risk of children's asthma are rising due to the growing number of CS performed in many countries. However, finding the concrete evidence to correlate CS with higher risk of asthma is still controversial. There were significant covariate imbalance between groups of children born by CS vs. vaginal delivery that include the number of maternal age, gestational age, birth weight, complication during pregnancy, complication during labor, socioeconomic status, a parental history of atopy, and maternal smoking history. And there were considerable heterogeneity in methods and study subjects between the studies of delivery by CS and the offspring's risk of asthma and other allergic diseases. Therefore, as we proceed into the further study, researchers must refer to the literatures and look for the best way proving their hypothesis that are based on the methodological subject group. Of which should be accordance with the research purposes. Also, researchers have to search for identifying the core biological mechanism in order to know whether there is a causal relationship exists between the CS and asthma.

Keyword

Mode of delivery; Cesarean section; Vaginal delivery; Asthma; Allergic disease; Risk factors

MeSH Terms

Asthma
Birth Weight
Cesarean Section
Child
Female
Gestational Age
Humans
Hygiene Hypothesis
Maternal Age
Parents
Population Characteristics
Pregnancy
Risk Factors
Smoke
Smoking
Social Class
Smoke

Reference

References

1. Magnus MC, Håberg SE, Stigum H, Nafstad P, London SJ, Vangen S, et al. Delivery by cesarean section and early childhood respiratory symptoms and disorders: the norwegian mother and child cohort study. Am J Epidemiol. 2011; 174:1275–85.
Article
2. Tollånes MC, Moster D, Daltveit AK, Irgens LM. Cesarean section and risk of severe childhood asthma: a population-based cohort study. J Pediatr. 2008; 153:112–6.
Article
3. Eggesb M, Botten G, Stigum H, Nafstad P, ⊘ Magnus P. Is delivery by cesarean section a risk factor for food allergy? J Allergy Clin Immunol. 2003; 112:420–6.
4. Annesi-Maesano I, Moreau D, Strachan D. In utero and perinatal complications preceding asthma. Allergy. 2001; 56:491–7.
Article
5. Magnus P, Jaakkola JJ. Secular trend in the occurrence of asthma among children and young adults: critical appraisal of repeated cross sectional surveys. BMJ. 1997; 314:1795–9.
Article
6. Hamilton BE, Martin JA, Sutton PD. Centers for Disease Control and Prevention, National Center for Health Statistics. Births: preliminary data for 2003. Natl Vital Stat Rep. 2004; 53:1–17.
7. Arias E, MacDorman MF, Strobino DM, Guyer B. Annual summary of vital statistics–2002. Pediatrics. 2003; 112(6 Pt 1):1215–30.
Article
8. Porreco RP, Thorp JA. The cesarean birth epidemic: trends, causes, and solutions. Am J Obstet Gynecol. 1996; 175:369–74.
Article
9. Hamilton BE, Martin JC, Ventura SJ. Birth: preliminary data for 2006. Natl Vital Stat Rep. 2007; 56:1–18.
10. Health Insurance Review & Assessment Service. 2007 Annual report on the appropriacy of the caesarean section delivery. Reston: Health Insurance Review & Assessment Service;2008.
11. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989; 299:1259–60.
Article
12. Malamitsi-Puchner A, Protonotariou E, Boutsi-kou T, Makrakis E, Sarandakou A, Creatsas G. The influence of the mode of delivery on circulating cytokine concentrations in the perinatal period. Early Hum Dev. 2005; 81:387–92.
Article
13. Al-Kubaisy W, Ali SH, Al-Thamiri D. Risk factors for asthma among primary school children in Baghdad, Iraq. Saudi Med J. 2005; 26:460–6.
14. Bager P, Melbye M, Rostgaard K, Benn CS, Westergaard T. Mode of delivery and risk of allergic rhinitis and asthma. J Allergy Clin Immunol. 2003; 111:51–6.
Article
15. Calvani M, Alessandri C, Sopo SM, Panetta V, Tripodi S, Torre A, et al. Infectious and uterus related complications during pregnancy and development of atopic and nonatopic asthma in children. Allergy. 2004; 59:99–106.
Article
16. Debley JS, Smith JM, Redding GJ, Critchlow CW. Childhood asthma hospitalization risk after cesarean delivery in former term and premature infants. Ann Allergy Asthma Immunol. 2005; 94:228–33.
Article
17. Gessner BD, Chimonas MA. Asthma is associated with preterm birth but not with small for gestational age status among a population-based cohort of Medicaid-enrolled children 10 ˂ years of age. Thorax. 2007; 62:231–6.
18. Hagendorens MM, Bridts CH, Lauwers K, van Nuijs S, Ebo DG, Vellinga A, et al. Perinatal risk factors for sensitization, atopic dermatitis and wheezing during the first year of life (PIPO study). Clin Exp Allergy. 2005; 35:733–40.
Article
19. Håkansson S, Källén K. Caesarean section increases the risk of hospital care in childhood for asthma and gastroenteritis. Clin Exp Allergy. 2003; 33:757–64.
Article
20. Juhn YJ, Weaver A, Katusic S, Yunginger J. Mode of delivery at birth and development of asthma: a population-based cohort study. J Allergy Clin Immunol. 2005; 116:510–6.
Article
21. Kero J, Gissler M, Grönlund MM, Kero P, Koskinen P, Hemminki E, et al. Mode of delivery and asthma – is there a connection? Pediatr Res. 2002; 52:6–11.
Article
22. Kim BS, Qin R, Katusic S, Juhn YJ. The influence of cesarean section on the incidence of childhood asthma: a propensity score approach [abstract]. J Allergy Clin Immunol. 2011; 127:AB80.
23. Maitra A, Sherriff A, Strachan D, Henderson J. ALSPAC Study Team. Mode of delivery is not associated with asthma or atopy in childhood. Clin Exp Allergy. 2004; 34:1349–55.
Article
24. McKeever TM, Lewis SA, Smith C, Hubbard R. Mode of delivery and risk of developing allergic disease. J Allergy Clin Immunol. 2002; 109:800–2.
Article
25. Menezes AM, Hallal PC, Matijasevich AM, Barros AJ, Horta BL, Araujo CL, et al. Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clin Exp Allergy. 2011; 41:218–23.
Article
26. Montgomery SM, Wakefield AJ, Morris DL, Pounder RE, Murch SH. The initial care of newborn infants and subsequent hay fever. Allergy. 2000; 55:916–22.
Article
27. Nafstad P, Magnus P, Jaakkola JJ. Risk of childhood asthma and allergic rhinitis in relation to pregnancy complications. J Allergy Clin Immunol. 2000; 106:867–73.
Article
28. Negele K, Heinrich J, Borte M, von Berg A, Schaaf B, Lehmann I, et al. Mode of delivery and development of atopic disease during the first 2 years of life. Pediatr Allergy Immunol. 2004; 15:48–54.
Article
29. Oliveti JF, Kercsmar CM, Redline S. Pre-and perinatal risk factors for asthma in inner city African-American children. Am J Epidemiol. 1996; 143:570–7.
30. Park YH, Kim KW, Choi BS, Jee HM, Sohn MH, Kim KE. Relationship between mode of delivery in childbirth and prevalence of allergic diseases in Korean children. Allergy Asthma Immunol Res. 2010; 2:28–33.
Article
31. Renz-Polster H, David MR, Buist AS, Vollmer WM, O'Connor EA, Frazier EA, et al. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005; 35:1466–72.
Article
32. Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, et al. Asthma at 8 years of age in children born by caesarean section. Thorax. 2009; 64:107–13.
Article
33. Rusconi F, Galassi C, Forastiere F, Bellasio M, De Sario M, Ciccone G, et al. Maternal complications and procedures in pregnancy and at birth and wheezing phenotypes in children. Am J Respir Crit Care Med. 2007; 175:16–21.
Article
34. Salam MT, Margolis HG, McConnell R, McGregor JA, Avol EL, Gilliland FD. Mode of delivery is associated with asthma and allergy occurrences in children. Ann Epidemiol. 2006; 16:341–6.
Article
35. Sugiyama M, Arakawa H, Ozawa K, Mizuno T, Mochizuki H, Tokuyama K, et al. Early-life risk factors for occurrence of atopic dermatitis during the first year. Pediatrics. 2007; 119:e716–23.
Article
36. Xu B, Pekkanen J, Hartikainen AL, Järvelin MR. Caesarean section and risk of asthma and allergy in adulthood. J Allergy Clin Immunol. 2001; 107:732–3.
Article
37. Xu B, Pekkanen J, Järvelin MR. Obstetric complications and asthma in childhood. J Asthma. 2000; 37:589–94.
Article
38. Metsälä J, Kilkkinen A, Kaila M, Tapanainen H, Klaukka T, Gissler M, et al. Perinatal factors and the risk of asthma in childhood–a population-based register study in Finland. Am J Epidemiol. 2008; 168:170–8.
39. van Beijsterveldt TC, Boomsma DI. Asthma and mode of birth delivery: a study in 5-year-old Dutch twins. Twin Res Hum Genet. 2008; 11:156–60.
Article
40. Vonk JM, Boezen HM, Postma DS, Schouten JP, van Aalderen WM, Boersma ER. Perinatal risk factors for bronchial hyperresponsiveness and atopy after a follow-up of 20 years. J Allergy Clin Immunol. 2004; 114:270–6.
Article
41. Bernsen RM, de Jongste JC, Koes BW, Aar-doom HA, van der Wouden JC. Perinatal characteristics and obstetric complications as risk factors for asthma, allergy and eczema at the age of 6 years. Clin Exp Allergy. 2005; 35:1135–40.
Article
42. Werner A, Ramlau-Hansen CH, Jeppesen SK, Thulstrup AM, Olsen J. Caesarean delivery and risk of developing asthma in the offspring. Acta Paediatr. 2007; 96:595–6.
Article
43. Smith GC, Wood AM, White IR, Pell JP, Cameron AD, Dobbie R. Neonatal respiratory morbidity at term and the risk of childhood asthma. Arch Dis Child. 2004; 89:956–60.
Article
44. Benn CS, Thorsen P, Jensen JS, Kjaer BB, Bisgaard H, Andersen M, et al. Maternal vaginal microflora during pregnancy and the risk of asthma hospitalization and use of antiasthma medication in early childhood. J Allergy Clin Immunol. 2002; 110:72–7.
Article
45. Lee YJ, Jee HM, Kim BJ, Kim HB, Yu JH, Lee SY, et al. Prevalence of allergic diseases in children according to mode of delivery. Pediatr Allergy Respir Dis(Korea). 2011; 21:197–206.
Article
46. Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A metaanalysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy. 2008; 38:629–33.
Article
47. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: metaanalyses. Clin Exp Allergy. 2008; 38:634–42.
48. Bergholt T, stberg B, Legarth J, Weber T. Ø Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nationwide postal survey. Acta Obstet Gynecol Scand. 2004; 83:262–6.
49. van den Berg A, van Elburg RM, van Geijn HP, Fetter WP. Neonatal respiratory morbidity following elective caesarean section in term infants. A 5-year retrospective study and a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2001; 98:9–13.
50. Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009; 360:111–20.
Article
51. Cardwell CR, Stene LC, Joner G, Cinek O, Svensson J, Goldacre MJ, et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a metaanalysis of observational studies. Diabetologia. 2008; 51:726–35.
Article
52. Bluhm E, McNeil DE, Cnattingius S, Gridley G, El Ghormli L, Fraumeni JF Jr. Prenatal and perinatal risk factors for neuroblastoma. Int J Cancer. 2008; 123:2885–90.
Article
53. Kaye SA, Robison LL, Smithson WA, Gunderson P, King FL, Neglia JP. Maternal reproductive history and birth characteristics in childhood acute lymphoblastic leukemia. Cancer. 1991; 68:1351–5.
Article
54. Cnattingius S, Zack M, Ekbom A, Gunnarskog J, Linet M, Adami HO. Prenatal and neonatal risk factors for childhood myeloid leukemia. Cancer Epidemiol Biomarkers Prev. 1995; 4:441–5.
55. Neu J, Rushing J. Cesarean versus vaginal delivery: longterm infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011; 38:321–31.
Article
56. Birnkrant DJ, Picone C, Markowitz W, El Kh-wad M, Shen WH, Tafari N. Association of transient tachypnea of the newborn and childhood asthma. Pediatr Pulmonol. 2006; 41:978–84.
Article
57. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001; 97:439–42.
Article
58. Björkstén B. Effects of intestinal microflora and the environment on the development of asthma and allergy. Springer Semin Immunopathol. 2004; 25:257–70.
59. Grönlund MM, Lehtonen OP, Eerola E, Kero P. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr. 1999; 28:19–25.
60. Salminen S, Gibson GR, McCartney AL, Isolauri E. Influence of mode of delivery on gut microbiota composition in seven year old children. Gut. 2004; 53:1388–9.
Article
61. Hällström M, Eerola E, Vuento R, Janas M, Tammela O. Effects of mode of delivery and necrotising enterocolitis on the intestinal microflora in preterm infants. Eur J Clin Microbiol Infect Dis. 2004; 23:463–70.
62. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003; 112(3 Pt 1):607–19.
Article
63. Evans KC, Evans RG, Royal R, Esterman AJ, James SL. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Arch Dis Child Fetal Neonatal Ed. 2003; 88:F380–2.
Article
64. Welberg LA, Seckl JR. Prenatal stress, glucocorticoids and the programming of the brain. J Neuroendocrinol. 2001; 13:113–28.
Article
65. Schlinzig T, Johansson S, Gunnar A, Ekström TJ, Norman M. Epigenetic modulation at birth – altered DNA-methylation in white blood cells after Caesarean section. Acta Paediatr. 2009; 98:1096–9.
Article
66. Gdalevich M, Mimouni D, Mimouni M. Breastfeeding and the risk of bronchial asthma in childhood: a systematic review with metaanalysis of prospective studies. J Pediatr. 2001; 139:261–6.
Article
67. Joad JP. Smoking and pediatric respiratory health. Clin Chest Med. 2000; 21:37–46. vii-viii.
Article
68. Rebelo F, da Rocha CM, Cortes TR, Dutra CL, Kac G. High cesarean prevalence in a national population-based study in Brazil: the role of private practice. Acta Obstet Gynecol Scand. 2010; 89:903–8.
Article
69. Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010; 107:11971–5.
Article
Full Text Links
  • PARD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr