Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE: Planned cesarean delivery comprises a significant proportion of births globally, with combined rates of planned and unscheduled cesarean delivery in a number of regions approaching 50%. Observational studies have shown that offspring born by cesarean delivery are at increased risk of ill health in childhood, but these studies have been unable to adjust for some key confounding variables. Additionally, risk of death beyond the neonatal period has not yet been reported for offspring born by planned cesarean delivery.

OBJECTIVE: To investigate the relationship between planned cesarean delivery and offspring health problems or death in childhood.

DESIGN, SETTING, AND PARTICIPANTS: Population-based data-linkage study of 321,287 term singleton first-born offspring born in Scotland, United Kingdom, between 1993 and 2007, with follow-up until February 2015.

EXPOSURES: Offspring born by planned cesarean delivery in a first pregnancy were compared with offspring born by unscheduled cesarean delivery and with offspring delivered vaginally.

MAIN OUTCOMES AND MEASURES: The primary outcome was asthma requiring hospital admission; secondary outcomes were salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, cancer, and death.

RESULTS: Compared with offspring born by unscheduled cesarean delivery (n = 56,015 [17.4%]), those born by planned cesarean delivery (12,355 [3.8%]) were at no significantly different risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, cancer, or death but were at increased risk of type 1 diabetes (0.66% vs 0.44%; difference, 0.22% [95% CI, 0.13%-0.31%]; adjusted hazard ratio [HR], 1.35 [95% CI, 1.05-1.75]). In comparison with children born vaginally (n = 252,917 [78.7%]), offspring born by planned cesarean delivery were at increased risk of asthma requiring hospital admission (3.73% vs 3.41%; difference, 0.32% [95% CI, 0.21%-0.42%]; adjusted HR, 1.22 [95% CI, 1.11-1.34]), salbutamol inhaler prescription at age 5 years (10.34% vs 9.62%; difference, 0.72% [95% CI, 0.36%-1.07%]; adjusted HR, 1.13 [95% CI, 1.01-1.26]), and death (0.40% vs 0.32%; difference, 0.08% [95% CI, 0.02%-1.00%]; adjusted HR, 1.41 [95% CI, 1.05-1.90]), whereas there were no significant differences in risk of obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, or cancer.

CONCLUSIONS AND RELEVANCE: Among offspring of women with first births in Scotland between 1993 and 2007, planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, and all-cause death by age 21 years. Further investigation is needed to understand whether the observed associations are causal.

Original languageEnglish
Pages (from-to)2271-2279
Number of pages9
JournalJAMA
Volume314
Issue number21
DOIs
Publication statusPublished - 1 Dec 2015

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Albuterol
Nebulizers and Vaporizers
Health
Prescriptions
Asthma
Type 1 Diabetes Mellitus
Obesity
Scotland
Crohn Disease
Neoplasms
Birth Order
Confounding Factors (Epidemiology)
Information Storage and Retrieval
Observational Studies
Cause of Death
Parturition
Pregnancy
Population

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Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health. / Black, Mairead; Bhattacharya, Siladitya; Philip, Sam; Norman, Jane E; McLernon, David J.

In: JAMA, Vol. 314, No. 21, 01.12.2015, p. 2271-2279.

Research output: Contribution to journalArticle

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abstract = "IMPORTANCE: Planned cesarean delivery comprises a significant proportion of births globally, with combined rates of planned and unscheduled cesarean delivery in a number of regions approaching 50{\%}. Observational studies have shown that offspring born by cesarean delivery are at increased risk of ill health in childhood, but these studies have been unable to adjust for some key confounding variables. Additionally, risk of death beyond the neonatal period has not yet been reported for offspring born by planned cesarean delivery.OBJECTIVE: To investigate the relationship between planned cesarean delivery and offspring health problems or death in childhood.DESIGN, SETTING, AND PARTICIPANTS: Population-based data-linkage study of 321,287 term singleton first-born offspring born in Scotland, United Kingdom, between 1993 and 2007, with follow-up until February 2015.EXPOSURES: Offspring born by planned cesarean delivery in a first pregnancy were compared with offspring born by unscheduled cesarean delivery and with offspring delivered vaginally.MAIN OUTCOMES AND MEASURES: The primary outcome was asthma requiring hospital admission; secondary outcomes were salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, cancer, and death.RESULTS: Compared with offspring born by unscheduled cesarean delivery (n = 56,015 [17.4{\%}]), those born by planned cesarean delivery (12,355 [3.8{\%}]) were at no significantly different risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, cancer, or death but were at increased risk of type 1 diabetes (0.66{\%} vs 0.44{\%}; difference, 0.22{\%} [95{\%} CI, 0.13{\%}-0.31{\%}]; adjusted hazard ratio [HR], 1.35 [95{\%} CI, 1.05-1.75]). In comparison with children born vaginally (n = 252,917 [78.7{\%}]), offspring born by planned cesarean delivery were at increased risk of asthma requiring hospital admission (3.73{\%} vs 3.41{\%}; difference, 0.32{\%} [95{\%} CI, 0.21{\%}-0.42{\%}]; adjusted HR, 1.22 [95{\%} CI, 1.11-1.34]), salbutamol inhaler prescription at age 5 years (10.34{\%} vs 9.62{\%}; difference, 0.72{\%} [95{\%} CI, 0.36{\%}-1.07{\%}]; adjusted HR, 1.13 [95{\%} CI, 1.01-1.26]), and death (0.40{\%} vs 0.32{\%}; difference, 0.08{\%} [95{\%} CI, 0.02{\%}-1.00{\%}]; adjusted HR, 1.41 [95{\%} CI, 1.05-1.90]), whereas there were no significant differences in risk of obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, or cancer.CONCLUSIONS AND RELEVANCE: Among offspring of women with first births in Scotland between 1993 and 2007, planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, and all-cause death by age 21 years. Further investigation is needed to understand whether the observed associations are causal.",
author = "Mairead Black and Siladitya Bhattacharya and Sam Philip and Norman, {Jane E} and McLernon, {David J}",
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T1 - Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health

AU - Black, Mairead

AU - Bhattacharya, Siladitya

AU - Philip, Sam

AU - Norman, Jane E

AU - McLernon, David J

N1 - Dr Black was funded by the Wellcome Trust as part of a personal research training fellowship.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - IMPORTANCE: Planned cesarean delivery comprises a significant proportion of births globally, with combined rates of planned and unscheduled cesarean delivery in a number of regions approaching 50%. Observational studies have shown that offspring born by cesarean delivery are at increased risk of ill health in childhood, but these studies have been unable to adjust for some key confounding variables. Additionally, risk of death beyond the neonatal period has not yet been reported for offspring born by planned cesarean delivery.OBJECTIVE: To investigate the relationship between planned cesarean delivery and offspring health problems or death in childhood.DESIGN, SETTING, AND PARTICIPANTS: Population-based data-linkage study of 321,287 term singleton first-born offspring born in Scotland, United Kingdom, between 1993 and 2007, with follow-up until February 2015.EXPOSURES: Offspring born by planned cesarean delivery in a first pregnancy were compared with offspring born by unscheduled cesarean delivery and with offspring delivered vaginally.MAIN OUTCOMES AND MEASURES: The primary outcome was asthma requiring hospital admission; secondary outcomes were salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, cancer, and death.RESULTS: Compared with offspring born by unscheduled cesarean delivery (n = 56,015 [17.4%]), those born by planned cesarean delivery (12,355 [3.8%]) were at no significantly different risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, cancer, or death but were at increased risk of type 1 diabetes (0.66% vs 0.44%; difference, 0.22% [95% CI, 0.13%-0.31%]; adjusted hazard ratio [HR], 1.35 [95% CI, 1.05-1.75]). In comparison with children born vaginally (n = 252,917 [78.7%]), offspring born by planned cesarean delivery were at increased risk of asthma requiring hospital admission (3.73% vs 3.41%; difference, 0.32% [95% CI, 0.21%-0.42%]; adjusted HR, 1.22 [95% CI, 1.11-1.34]), salbutamol inhaler prescription at age 5 years (10.34% vs 9.62%; difference, 0.72% [95% CI, 0.36%-1.07%]; adjusted HR, 1.13 [95% CI, 1.01-1.26]), and death (0.40% vs 0.32%; difference, 0.08% [95% CI, 0.02%-1.00%]; adjusted HR, 1.41 [95% CI, 1.05-1.90]), whereas there were no significant differences in risk of obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, or cancer.CONCLUSIONS AND RELEVANCE: Among offspring of women with first births in Scotland between 1993 and 2007, planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, and all-cause death by age 21 years. Further investigation is needed to understand whether the observed associations are causal.

AB - IMPORTANCE: Planned cesarean delivery comprises a significant proportion of births globally, with combined rates of planned and unscheduled cesarean delivery in a number of regions approaching 50%. Observational studies have shown that offspring born by cesarean delivery are at increased risk of ill health in childhood, but these studies have been unable to adjust for some key confounding variables. Additionally, risk of death beyond the neonatal period has not yet been reported for offspring born by planned cesarean delivery.OBJECTIVE: To investigate the relationship between planned cesarean delivery and offspring health problems or death in childhood.DESIGN, SETTING, AND PARTICIPANTS: Population-based data-linkage study of 321,287 term singleton first-born offspring born in Scotland, United Kingdom, between 1993 and 2007, with follow-up until February 2015.EXPOSURES: Offspring born by planned cesarean delivery in a first pregnancy were compared with offspring born by unscheduled cesarean delivery and with offspring delivered vaginally.MAIN OUTCOMES AND MEASURES: The primary outcome was asthma requiring hospital admission; secondary outcomes were salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, cancer, and death.RESULTS: Compared with offspring born by unscheduled cesarean delivery (n = 56,015 [17.4%]), those born by planned cesarean delivery (12,355 [3.8%]) were at no significantly different risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, cancer, or death but were at increased risk of type 1 diabetes (0.66% vs 0.44%; difference, 0.22% [95% CI, 0.13%-0.31%]; adjusted hazard ratio [HR], 1.35 [95% CI, 1.05-1.75]). In comparison with children born vaginally (n = 252,917 [78.7%]), offspring born by planned cesarean delivery were at increased risk of asthma requiring hospital admission (3.73% vs 3.41%; difference, 0.32% [95% CI, 0.21%-0.42%]; adjusted HR, 1.22 [95% CI, 1.11-1.34]), salbutamol inhaler prescription at age 5 years (10.34% vs 9.62%; difference, 0.72% [95% CI, 0.36%-1.07%]; adjusted HR, 1.13 [95% CI, 1.01-1.26]), and death (0.40% vs 0.32%; difference, 0.08% [95% CI, 0.02%-1.00%]; adjusted HR, 1.41 [95% CI, 1.05-1.90]), whereas there were no significant differences in risk of obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, or cancer.CONCLUSIONS AND RELEVANCE: Among offspring of women with first births in Scotland between 1993 and 2007, planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, and all-cause death by age 21 years. Further investigation is needed to understand whether the observed associations are causal.

U2 - 10.1001/jama.2015.16176

DO - 10.1001/jama.2015.16176

M3 - Article

VL - 314

SP - 2271

EP - 2279

JO - JAMA

JF - JAMA

SN - 0098-7484

IS - 21

ER -