Cesarean Section and Development of Childhood Bronchial Asthma: Is There A Risk?
BACKGROUND: Asthma is a chronic inflammatory disease of the airways that results from complex interactions between multiple environmental and genetic influences. In recent years, studies have observed an increase in caesarean section rates, and have suggested a strong association with the rapid increase in the incidence of childhood asthma that cannot be explained by genetic factors alone. In this case-control study, we investigate the association between the developments of childhood asthma with the mode of delivery. We also explored the relationship between mode of delivery and control of asthma.
METHODS: Two groups (509 pediatric patients in total) were assessed between January 1, 2017, and January 1, 2018. Part of these patients, 257 (50.4%) were asthmatic children visiting specialised clinics, and 252 (49.6%) controlled cases selected from a primary health care clinic from the same institution (control group).
RESULTS: The Chi-square test revealed a significant association between cesarean sections and bronchial asthma (OR, 1.483 [95% CI, 1.013â€“21.71]; P =â€‰0.042). However, the adjusted OR from our binary logistic regression model revealed this association to be insignificant (adjusted OR, 1.417 [95% CI, 0.885â€“2.269]; P =â€‰0.804). The value of the chi-square of the model shows that the overall model is statistically significant at 1%. The Nagelkerke R square indicates that 34.9% of the variation in having asthma is explained by the risk factors included in the model.
CONCLUSION: We do not believe that the rise in cesarean sections explains the increase in childhood bronchial asthma â€“ at least not in our population. We also found no association between the mode of delivery and asthma control. We encourage further research into this topic, namely to recruit a larger number of patients, and to adjust for the significant risk factors found in our study.
Plum Analytics Artifact Widget Block
Arbes SJ, Gergen PJ, Vaughn B, Zeldin DC. Asthma cases attributable to atopy: results from the Third National Health and Nutrition Examination Survey. Journal of Allergy and Clinical Immunology. 2007; 120(5):1139-45. https://doi.org/10.1016/j.jaci.2007.07.056 PMid:17889931 PMCid:PMC2291202
Kero J, Gissler M, GrÃ¶nlund M-M, Kero P, Koskinen P, Hemminki E, et al. Mode of delivery and asthmaâ€“is there a connection? Pediatric research. 2002; 52(1):6-11. PMid:12084840
TollÃ¥nes MC, Moster D, Daltveit AK, Irgens LM. Cesarean section and risk of severe childhood asthma: a population-based cohort study. The Journal of paediatrics. 2008; 153(1):112-6.e1. https://doi.org/10.1016/j.jpeds.2008.01.029 PMid:18571547
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(2):107-13. https://doi.org/10.1136/thx.2008.100875 PMid:19052046
Ramzan M, Yadav SP, Bhalla S, Jamwal P, Grover A, Sachdeva A. Eyelid nodule: a rare presentation of langerhans cell histiocytosis. Journal of pediatric hematology/oncology. 2012; 34(4):e158-e60. https://doi.org/10.1097/MPH.0b013e3182332281 PMid:22246150
Crevel R, Pickup MJ. The Hygiene Hypothesis and its implications for home hygiene, lifestyle and public health, 2012.
Decker E, Hornef M, Stockinger S. Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Gut microbes. 2011; 2(2):91-8. https://doi.org/10.4161/gmic.2.2.15414 PMid:21637025
Sevelsted A, Stokholm J, BÃ¸nnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Pediatrics. 2015; 135(1):e92-e8. https://doi.org/10.1542/peds.2014-0596 PMid:25452656
MÃ¥rild K, Stephansson O, Montgomery S, Murray JA, Ludvigsson JF. Pregnancy outcome and risk of celiac disease in offspring: a nationwide case-control study. Gastroenterology. 2012; 142(1):39-45. e3.
Pistiner M, Gold DR, Abdulkerim H, Hoffman E, CeledÃ³n JC. Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. Journal of Allergy and Clinical Immunology. 2008; 122(2):274-9. https://doi.org/10.1016/j.jaci.2008.05.007 PMid:18571710 PMCid:PMC4762591
Menezes A, Hallal P, Matijasevich A, Barros A, Horta B, Araujo C, et al. Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clinical & Experimental Allergy. 2011; 41(2):218-23. https://doi.org/10.1111/j.1365-2222.2010.03611.x PMid:20840395 PMCid:PMC3505367
Nathan AM, de Bruyne J, Farah K, Arumugam K. Caesarean section and asthma in Malaysian children: a case-control study. Asian Pacific journal of allergy and immunology. 2012; 30(3):204.
Maitra A, Sherriff A, Strachan D, Team AS, Henderson J. Mode of delivery is not associated with asthma or atopy in childhood. Clinical & Experimental Allergy. 2004; 34(9):1349-55. https://doi.org/10.1111/j.1365-2222.2004.02048.x PMid:15347366
McKeever TM, Lewis SA, Smith C, Hubbard R. Mode of delivery and risk of developing allergic disease. Journal of Allergy and Clinical Immunology. 2002; 109(5):800-2. https://doi.org/10.1067/mai.2002.124046 PMid:11994703
Bager P, Melbye M, Rostgaard K, Benn CS, Westergaard T. Mode of delivery and risk of allergic rhinitis and asthma. Journal of Allergy and Clinical Immunology. 2003; 111(1):51-6. https://doi.org/10.1067/mai.2003.34 PMid:12532096
Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell C. A metaâ€analysis of the association between Caesarean section and childhood asthma. Clinical & Experimental Allergy. 2008; 38(4):629-33. https://doi.org/10.1111/j.1365-2222.2007.02780.x PMid:18352976
Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disesase: metaâ€analyses. Clinical & Experimental Allergy. 2008; 38(4):634-42. https://doi.org/10.1111/j.1365-2222.2008.02939.x PMid:18266879
Gina Guideline, Global Iniative For Asthma. Diagnosis and Management of Asthma for Adult and Children older than 5 years 2015 [cited 2016 16/3].
Gina Guideline, Global Iniative For Asthma. Diagnosis and Management of Asthma for Children 5 years and younger 2015 [cited 2016 16/3].
Copyright (c) 2019 Faisal Boker, Abdullah Alzahrani, Abdulaziz Alsaeed, Meshari Alzhrani, Rawia Albar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.