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Bedolla-Barajas M, Morales-Romero J, Contreras-Aceves IE, Gaxiola-de Alba G, Estrada-Bedolla MDR, Bedolla-Pulido TR. Nonelective cesarean section is associated with the prevalence of asthma among Mexican children who attended childcare centers. Asia Pac Allergy 2024; 14:63-69. [PMID: 38827257 PMCID: PMC11142758 DOI: 10.5415/apallergy.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/13/2024] [Indexed: 06/04/2024] Open
Abstract
Background The cesarean section (CS) mode of delivery can influence the prevalence of bronchial asthma (BA), allergic rhinitis (AR), or atopic dermatitis (AD) by promoting modifications in the infantile microbiome. Objective To analyze the prevalence of asthma in children who were born through CS and attended childcare centers. Methods The data were obtained through an online survey that was answered anonymously by one of the parents; the survey inquired about the route of delivery of the child and the prevalence of BA, AR, and AD. Results A total of 525 children were included. The frequency of births by vaginal, elective CS, or nonelective CS was 34.1%, 37.9%, and 28.0%, respectively, and the prevalence of BA, AR, and AD was 4.8%, 19.8%, and 12.4%, respectively. Multivariate analyses identified nonelective CS as a factor associated with the prevalence of BA (odds ratio: 3.51, P = 0.026). Conclusion Our study shows that being born through nonelective CS can increase the probability of BA in children who attended daycare centers.
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Affiliation(s)
- Martín Bedolla-Barajas
- Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, Servicio de Alergia e Inmunología Clínica,” Guadalajara, Jalisco, Mexico
| | | | - Ilce Estefanía Contreras-Aceves
- Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, Servicio de Alergia e Inmunología Clínica,” Guadalajara, Jalisco, Mexico
| | - Gabriela Gaxiola-de Alba
- Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, Servicio de Alergia e Inmunología Clínica,” Guadalajara, Jalisco, Mexico
| | | | - Tonatiuh Ramses Bedolla-Pulido
- Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca, Servicio de Alergia e Inmunología Clínica,” Guadalajara, Jalisco, Mexico
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Hwang SH, Shin H, Stybayeva G, Kim DH. Perinatal Risk Factors for Asthma and Allergic Rhinitis in Children and Adolescents. Clin Exp Otorhinolaryngol 2024; 17:168-176. [PMID: 38584131 DOI: 10.21053/ceo.2024.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES In this study, we evaluated the associations between birth-related exposures, postnatal factors, and the risk of allergic rhinitis and asthma in children and adolescents. METHODS We performed a comprehensive search of five literature databases up to May 2023. To quantify the associations of birth-related exposures (birth weight, delivery mode, prematurity, sex, maternal age, and parental allergy history) and postnatal factors (birth order, number of siblings, breastfeeding exclusivity, and breastfeeding duration) with allergic disease, we calculated pooled odds ratios and 95% confidence intervals. We conducted subgroup analyses for allergic disease type, birth order, number of siblings, and parental allergy history. The methodological quality of the identified studies was evaluated using the Newcastle-Ottawa Scale. RESULTS This meta-analysis included 31 studies, encompassing 218,899 patients in total. The birth-related exposures of low birth weight, maternal age, and prematurity (less than 37 weeks gestation) were not significantly associated with the risk of asthma or allergic rhinitis during childhood or adolescence. Male sex, family history of allergy, and cesarean delivery were linked to an elevated risk of asthma or allergic rhinitis. Among postnatal factors, exclusive breastfeeding, breastfeeding for longer than 6 months, second or later birth order, and having siblings exhibited protective effects against allergic diseases in offspring. CONCLUSION The risks of allergic rhinitis and asthma were elevated in male patients, those delivered by cesarean section, and those with a family history of allergy. Conversely, exclusive breastfeeding, breastfeeding for longer than 6 months, and having siblings corresponded to a reduced risk of respiratory allergic diseases.
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Affiliation(s)
- Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Hyesoo Shin
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Zachariassen LF, Ebert MBB, Mentzel CMJ, Deng L, Krych L, Nielsen DS, Stokholm J, Hansen CHF. Cesarean section induced dysbiosis promotes type 2 immunity but not oxazolone-induced dermatitis in mice. Gut Microbes 2023; 15:2271151. [PMID: 37889696 PMCID: PMC10730161 DOI: 10.1080/19490976.2023.2271151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Delivery by cesarean section (CS) is associated with an altered gut microbiota (GM) colonization and a higher risk of later chronic inflammatory diseases. Studies investigating the association between CS and atopic dermatitis (AD) are contradictive and often biased by confounding factors. The aim of this study was therefore to provide experimental evidence for the association between CS and AD in a mouse model and clarify the role of the GM changes associated with CS. It was hypothesized that CS-delivered mice, and human CS-GM transplanted mice develop severe dermatitis due to early dysbiosis. BALB/c mice delivered by CS or vaginally (VD) as well as BALB/c mice transplanted with GM from CS or VD human donors were challenged with oxazolone on the ear. The severity of dermatitis was evaluated by ear thickness and clinical and histopathological assessment which were similar between all groups. The immune response was assessed by serum IgE concentration, local cytokine response, and presence of immune cells in the draining lymph node. Both CS-delivered mice and mice inoculated with human CS-GM had a higher IgE concentration. A higher proportion of Th2 cells were also found in the CS-GM inoculated mice, but no differences were seen in the cytokine levels in the affected ears. In support of the experimental findings, a human cohort analysis from where the GM samples were obtained found that delivery mode did not affect the children's risk of developing AD. In conclusion, CS-GM enhanced a Th2 biased immune response, but had no effect on oxazolone-induced dermatitis in mice.
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Affiliation(s)
- Line Fisker Zachariassen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Maria Bernadette Bergh Ebert
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Caroline Märta Junker Mentzel
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Ling Deng
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Lukasz Krych
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Dennis Sandris Nielsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Jakob Stokholm
- Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, Gentofte, Denmark
| | - Camilla Hartmann Friis Hansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Liu Z, Xie L, Liu X, Chen J, Zhou Y, Zhang J, Su H, Yang Y, Tian M, Li J, Dong Y. Cesarean section and the risk of allergic rhinitis in children: a systematic review and meta-analysis. Sci Rep 2023; 13:18361. [PMID: 37884557 PMCID: PMC10603136 DOI: 10.1038/s41598-023-44932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Multiple evidence indicates that perinatal factors make impact on immune development and affect offspring allergic rhinitis (AR) risk. In this systematic review and meta-analysis, we examined available published studies to clarify the relationship between cesarean section (C-section) and offspring AR in children. To explore the relationship between C-section, especially the special attention was paid to different cesarean delivery mode, and the risk of AR in children. Articles were searched using PubMed, Web of Science, EMBASE, Cochrane Library, China knowledge Network, Wanfang, and China Science and Technology Journal databases. A meta-analysis of 22 studies published before August 1, 2022, which included 1,464,868 participants, was conducted for statistical analysis with RevMan5.4. The correlation strength between C-section and offspring AR was determined by combining odds ratio (OR) and 95% confidence interval (95% CI). Meta-regression and subgroup analyses were used to explore potential sources of heterogeneity. Publication bias was detected using the funnel chart and Egger tests. Meta-analysis revealed that there was a significant correlation between C-section and children AR (OR = 1.19, 95% CI: 1.12-1.27, P < 0.001), especially C-section with a family history of allergy (OR = 1.82, 95% CI: 1.36-2.43, P < 0.001). Moreover, elective C-section (without genital tract microbe exposure) had the higher risk of offspring AR (OR = 1.24, 95% CI: 1.05-1.46, P = 0.010) compared with the whole study. Meta-regression demonstrated that sample size explained 38.0% of the variability between studies, and year of publication explained 18.8%. Delivery by C-section, particularly elective C-section and C-section with a family history of allergy can increase the risk of AR in children.
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Affiliation(s)
- Zixin Liu
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
- Third Xiangya Hospital, Central South University, 138 Tongzipo Road, 410013, Changsha, Hunan, China
| | - Li Xie
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Xiaohua Liu
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, 410013, Changsha, Hunan, China
| | - JunRong Chen
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Yaqian Zhou
- Second Xiangya Hospital, Central South University, 139 Renmin Road, 410011, Changsha, Hunan, China
| | - Jialin Zhang
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Honghui Su
- Third Xiangya Hospital, Central South University, 138 Tongzipo Road, 410013, Changsha, Hunan, China
| | - Yide Yang
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Mei Tian
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China
| | - Jian Li
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, 410013, Hunan, China.
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, 410013, Changsha, Hunan, China.
- The Engineering Research Center of Reproduction and Translational Medicine of Hunan Province, Hunan Normal University, 410013, Changsha, Hunan, China.
| | - Yunpeng Dong
- Department of Otolatyngoloty-Head and Neck Surgery, Yichang Central People's Hospital, Three Gorges University, 443000, Hubei, China.
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He X, Zhang S, Wu J, Fu Q, Zhang Q, Peng W. The global/local (limited to some regions) effect of cesarean delivery on the risk of pediatric allergic rhinitis: a systematic review and meta-analysis. Front Pediatr 2023; 11:1228737. [PMID: 37601128 PMCID: PMC10435734 DOI: 10.3389/fped.2023.1228737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Allergic rhinitis is a chronic and refractory disease that can be affected by a variety of factors. Studies have shown an association between cesarean section and the risk of pediatric allergic rhinitis. Methods The PubMed, Springer, Embase, Cochrane Library, and Web of Science databases were searched to retrieve all studies published from January 2000 to November 2022, focusing on the relationship between cesarean section and the risk of pediatric allergic rhinitis. A meta-analysis was conducted to find a correlation between cesarean section and the risk of pediatric allergic rhinitis. A subgroup analysis was performed, considering the region and family history of allergy, after adjusting for confounding factors. Pooled odds ratios (ORs) were calculated, publication bias was assessed using a funnel plot, and heterogeneity between study-specific relative risks was taken into account. Results The results showed that cesarean section was significantly associated with an increased risk of pediatric allergic rhinitis (OR: 1.27, 95% CI: 1.20-1.35). Subgroup analysis stratified by region indicated that cesarean section increased the risk of pediatric allergic rhinitis, with the highest increase in South America (OR: 1.67, 95% CI: 1.10-2.52) and the lowest in Europe (OR: 1.13, 95% CI: 1.02-1.25). The results of the subgroup analysis stratified by family history of allergy indicate that family history of allergy was not associated with the risk of pediatric allergic rhinitis. Conclusion An association exists between cesarean section as the mode of delivery and the increased risk of pediatric allergic rhinitis, and cesarean section is a risk factor for allergic rhinitis.
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Affiliation(s)
- Xingyi He
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shipeng Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiamin Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinwei Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinxiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- World Health Organization Collaborating Centre (WHOCC), Chengdu, China
| | - Wenyu Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Liang Y, Zhang J, Bai S, Du S, Yang X, Wang Z. Short-term and long-term effects of cesarean section on asthma and wheezing: A cohort study and meta-analysis. Respir Med 2023:107300. [PMID: 37257787 DOI: 10.1016/j.rmed.2023.107300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/21/2023] [Accepted: 05/27/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the short-term and long-term effects of cesarean section on childhood asthma and wheezing. METHOD Firstly, in the cohort study, 6640 infants were included in the cohort baseline from January 2018 to December 2019, in which 6501 children completed the follow-up study for respiratory diseases at age 2 years. The effect of cesarean section on asthma and wheezing was estimated by the logistic regression model. Secondly, we conducted a meta-analysis of studies with outcomes of childhood asthma and wheezing under 2 years of age and over 2 years of age, respectively, to investigate the short-term and long-term effects of cesarean section on asthma and wheezing. RESULTS In our cohort study, the cumulative incidence of asthma and wheezing was 1.3% (84/6501). 45.5% of children (2961/6501) were born by cesarean section. The adjusted odds ratio for the effect of cesarean section on asthma and wheezing in children under 2 years of age was 1.14 (95%CI 0.73-1.78). Combining previous studies (outcomes of asthma and wheezing under 2 years of age) with our results for a meta-analysis, the odds ratio was 1.15 (95%CI 1.05-1.25, I2 = 46.82%). Meanwhile, cesarean section had a long-term effect on asthma and wheezing in the child population over 2 years of age (OR = 1.17, 95%CI 1.11-1.24, P < 0.001, I2 = 79.38%). CONCLUSION Cesarean section had a short-term effect on asthma and wheezing before the age of 2, in addition, the long-term effect of cesarean section on asthma and wheezing persisted in the child population (under 18).
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Affiliation(s)
- Yuxiu Liang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Jiatao Zhang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Shuoxin Bai
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Shang Du
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Xiwei Yang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China.
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China.
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Ai T, Wu Y, Zhang L, Luo R, Liao H, Fan Y, Xia W, Xie C, Zhang L. Evaluation of the factors affecting lung function in pediatric patients with asthma. J Asthma 2023; 60:682-690. [PMID: 35674402 DOI: 10.1080/02770903.2022.2087670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to analyze the risk factors affecting lung function in children with asthma based on clinical data to advice on clinical treatment and prognosis. METHODS This study included newly diagnosed patients with asthma admitted to the Respiratory Department of Chengdu Women's and Children's Central Hospital in Sichuan from July 2020 to June 2021. The factors associated with lung function were analyzed using univariate and multivariate linear regression with the forward method, while factors affecting lung ventilation function were analyzed using multivariate logistic regression. RESULTS Sixty percent of the patients had normal lung function. Age was significantly negatively correlated with forced vital capacity (FVC)/FVCpredicted (B = -1.385, p = 0.001), FEV1/FEV1predicted (B = -2.092, p < 0.001), and FEV1%/FEV1%predicted (B = -0.834, p = 0.001). Body mass index (BMI) for age Z score (B = 1.661, p = 0.045) and cesarean delivery (B = 4.471, p = 0.013) were significantly positively correlated with FVC/FVCpredicted. Birth weight was significantly positively correlated with FEV1/FEV1predicted (B = 4.593, p = 0.027). Multivariate logistic regression analysis revealed that age ≥6 years and cough variant asthma (CVA) were risk factors for abnormal lung function. CONCLUSIONS Age, BMI for age Z score, mode of delivery, and birth weight were significantly correlated with lung function in children with asthma. Furthermore, children with asthma and normal lung function were more likely to be overlooked. More attention should be given to children with asthma and normal lung function, and CVA.
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Affiliation(s)
- Tao Ai
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Wu
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Zhang
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ronghua Luo
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Huling Liao
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yinghong Fan
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wanmin Xia
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Cheng Xie
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Libing Zhang
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Mubanga M, Lundholm C, Rohlin ES, Rejnö G, Brew BK, Almqvist C. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol 2023; 34:e13904. [PMID: 36705040 PMCID: PMC10107099 DOI: 10.1111/pai.13904] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Atopic dermatitis is a common chronic childhood disease associated with significant morbidity and healthcare costs. There is a known association between caesarean section and asthma, but the relationship between caesarean section and offspring atopic dermatitis remains uncertain. METHODS We conducted a register-based nationwide cohort study including children born in Sweden between January 2006 and December 2018. Data on health and socioeconomic variables were extracted from the national registers for children aged ≤5 years. Time-to-event analyses were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) adjusting for confounders and familial factors. RESULTS 1,399,406 children were included (6,029,542 person-years at risk). Atopic dermatitis was observed in 17.2% of the 1,150,896 children born by vaginal delivery and 18.3% of the 248,510 born by caesarean section. The mean age of onset of atopic dermatitis was 2.72 years (SD 1.8). Birth by caesarean section was associated with a higher risk of atopic dermatitis (adj-HR 1.12, 95% CI: 1.10-1.14). A higher risk of atopic dermatitis was found in children born by instrumental vaginal delivery (adj-HR 1.10, 1.07-1.13); emergency caesarean section (adj-HR 1.12, 1.10-1.15), and elective caesarean section (adj-HR 1.13, 1.10-1.16) than uncomplicated vaginal delivery in children <1 year of age. Similar hazards were observed in those ≥1 year of age. In sibling control analysis, greater risks remained in children aged <1 year but not in age ≥1 year. CONCLUSIONS In our study population, it was observed that children born by caesarean section or instrumental vaginal delivery were at higher risk of early childhood atopic dermatitis. Although familial confounding attenuates the risk in children aged ≥1 year, this was not observed in the first year of life.
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Affiliation(s)
- Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elin S Rohlin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Rejnö
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Obstetrics and Gynaecology Unit, Stockholm, Sweden
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Sakihara T, Yasuki D, Otsuji K, Arakaki Y, Hamada K, Sugiura S, Ito K. Effects of delivery mode and labor duration on the development of food sensitization in infancy. Ann Allergy Asthma Immunol 2022; 129:212-219.e2. [PMID: 35460868 DOI: 10.1016/j.anai.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effects of delivery mode and labor duration on the development of food sensitization (FS) in infancy remain unclear. OBJECTIVE To elucidate the potential effects of delivery mode and labor duration on FS development by 6 months of age. METHODS Using data from a randomized controlled trial of a birth cohort from 4 Japanese hospitals that assessed cow's milk allergy development by 6 months of age, we performed a nested case-control trial of 462 participants who had undergone the final assessment at 6 months of age. FS was defined as positive skin prick test reactions to hen's egg, cow's milk, wheat, or soy. For the primary outcome, we calculated the adjusted odds ratio of vaginal delivery (VD) relative to cesarean delivery for FS development by 6 months of age using a multivariable logistic regression analysis. For the secondary outcome, we compared labor durations between participants with and without FS using the Mann-Whitney U test. RESULTS The adjusted odds ratio of VD for FS development was 2.54 (95% confidence interval, 1.32-4.87; P = .005). The median labor duration was significantly longer in participants with FS (5.7 hours, interquartile range, 2.7-10.1) than in participants without FS (4.5 hours, 1.1-8.2) (P = .01). CONCLUSION VD was considerably associated with an increased risk of FS in infancy, and longer labor durations may promote FS development.
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Affiliation(s)
| | - Daichi Yasuki
- Department of Pediatrics, Heartlife Hospital, Okinawa, Japan
| | - Kenta Otsuji
- Department of Pediatrics, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Yohei Arakaki
- Department of Pediatrics, Naha City Hospital, Okinawa, Japan
| | - Kazuya Hamada
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shiro Sugiura
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
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Gorris A, Bustamante G, Mayer KA, Kinaciyan T, Zlabinger GJ. Cesarean section and risk of allergies in Ecuadorian children: A cross-sectional study. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:763-773. [PMID: 33128350 PMCID: PMC7654393 DOI: 10.1002/iid3.368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/15/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies have shown an association between cesarean section (CS) and increased prevalence of childhood allergic diseases. While these observations have been consistent in industrialized countries, evidence from developing countries is limited. OBJECTIVE To assess the association between the mode of delivery and allergic diseases in children aged 3-12 years in Quito, Ecuador. METHODS In this cross-sectional study, parents were surveyed using an anonymous, standardized questionnaire from the International Study of Asthma and Allergies in Childhood project to assess the presence of asthma, allergic rhinitis, atopic dermatitis, and food allergies in their children. The children's age, sex, birthplace, delivery mode (CS/vaginal), socioeconomic status, and ethnicity were recorded. Other parameters included gestational age, breastfeeding, smoking status during pregnancy, and parental allergic diseases. RESULTS After adjusting for confounding factors, children delivered via CS were found to have a higher risk of wheezing (odds ratio [OR] = 4.12, 95% confidence interval [CI]: 1.43-11.89), physician-diagnosed asthma (OR = 24.06; 95% CI: 1.98-292.3), and pimples, or eczema with the itching for 6 months (OR = 2.65; 95% CI: 1.06-6.61) than children delivered vaginally. No association was found between the delivery mode and rhinitis or food allergies. After stratifying by socioeconomic status, CS was only associated with allergic disorders in children of medium/high socioeconomic backgrounds. CONCLUSIONS As seen in industrialized settings, children born by CS in nonindustrialized countries have an increased risk of developing allergic disorders including asthma and dermatitis, compared to those delivered vaginally.
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Affiliation(s)
- Amélie Gorris
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.,Institute of Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Bustamante
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador.,Program in Health Disparities Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katharina A Mayer
- Institute of Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Tamar Kinaciyan
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Gerhard J Zlabinger
- Institute of Immunology, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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