Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health

• Published in: JAMA : the journal of the American Medical Association 2015-12, Vol.314 (21), p.2271-2279
• Main Authors: Black, Mairead, Bhattacharya, Siladitya, Philip, Sam, Norman, Jane E, McLernon, David J
• Format: Article
• Language: English
• Subjects: Adult; Asthma; Asthma - epidemiology; Cesarean section; Cesarean Section - adverse effects; Child, Preschool; Diabetes; Diabetes Mellitus, Type 1 - epidemiology; Elective Surgical Procedures; Female; Follow-Up Studies; Hospitalization; Humans; Incidence; Inflammatory bowel disease; Inflammatory Bowel Diseases - epidemiology; Mortality - trends; Neoplasms - epidemiology; Obesity; Pediatric Obesity - epidemiology; Pregnancy; Risk; Risk factors; Scotland; United Kingdom - epidemiology
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2015.16176

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: A