Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T05:03:25.088Z Has data issue: false hasContentIssue false
  • English
  • Français

Elective cesarean delivery at term and the long-term risk for endocrine and metabolic morbidity of the offspring

Published online by Cambridge University Press:  27 December 2018

R. Moshkovsky Open the ORCID record for R. Moshkovsky [Opens in a new window] ,
T. Wainstock ,
E. Sheiner ,
D. Landau  and
A. Walfisch
R. Moshkovsky*
Affiliation:
The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
T. Wainstock
Affiliation:
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
E. Sheiner
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
D. Landau
Affiliation:
Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
A. Walfisch
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Address for correspondence: Ran Moshkovsky, The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Other than obesity, no definitive insights have been gained regarding the apparent association between mode of delivery and long-term endocrine and metabolic outcomes in the offspring. We aimed to determine whether elective cesarean delivery (CD) impacts on long-term endocrine and metabolic morbidity of the offspring. A population-based cohort analysis was performed including all singleton-term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via a non-emergent CD and those delivered vaginally (VD). Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated. A Kaplan–Meier survival curve was used to compare cumulative morbidity incidence. Cox and a Weibull regression models were used to control for confounders. During the study period 131,880 term deliveries met the inclusion criteria; 8.9% were elective non-urgent CDs (n=11,768) and 91.1% (n=120,112) were VDs. The survival curve demonstrated a significantly higher cumulative incidence of endo-metabolic morbidity in offspring born via CD (P=0.010). In the regression models, adjusted for maternal obesity, CD was not noted as an independent risk factor for long-term pediatric endocrine and metabolic morbidity of the offspring while maternal obesity emerged as a strong predictor. We therefore conclude that CD per-se does not appear to increase the risk for long-term pediatric endo-metabolic morbidity of the offspring.

Keywords

cesarean deliveryendocrinefollow-upmorbiditypediatric morbidity
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 10 , Issue 4 , August 2019 , pp. 429 - 435
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented in part at the 38th annual SMFM meeting, Dallas, Texas, USA, January 2017.

References

Yuan, C, Gaskins, AJ, Blaine, AI, et al. Association between cesarean birth and risk of obesity in offspring in childhood, adolescence, and early adulthood. JAMA Pediatr. 2016; e162385–e162385.CrossRefGoogle ScholarPubMed
Martin, JA, Hamilton, BE, Osterman, MJ. Births in the United States, 2013. NCHS Data Brief. 2014; 175, 1–8.Google Scholar
Indicators, O. Health at a glance 2011. OECD Indicators; 2015. OECD Publishing: Paris. Retrieved 15 February 2016 from https://doi.org/10.1787/health_glance-2015-en CrossRefGoogle Scholar
Liu, S, Liston, RM, Joseph, KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007; 176, 455–460.CrossRefGoogle ScholarPubMed
Hansen, AK, Wisborg, K, Uldbjerg, N, Henriksen, TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: Cohort study. BMJ. 2008; 336, 85–87.CrossRefGoogle ScholarPubMed
Li, H, Zhou, Y, Liu, J. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. Int J Obes. 2013; 37, 893–899.CrossRefGoogle ScholarPubMed
Darmasseelane, K, Hyde, MJ, Santhakumaran, S, Gale, C, Modi, N. Mode of delivery and offspring body mass index, overweight and obesity in adult life: a systematic review and meta-analysis. PLoS One. 2014; 9, e87896.CrossRefGoogle ScholarPubMed
Hansen, S, Halldorsson, T, Olsen, S, et al. Birth by cesarean section in relation to adult offspring overweight and biomarkers of cardiometabolic risk. Int J Obes. 2018; 42, 15–19.CrossRefGoogle ScholarPubMed
Cani, PD. Crosstalk between the gut microbiota and the endocannabinoid system: impact on the gut barrier function and the adipose tissue. Clin Microbiol Infect. 2012; 18, 50–53.CrossRefGoogle ScholarPubMed
Azad, M, Konya, T, Persaud, R, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG. 2016; 123, 983–993.CrossRefGoogle ScholarPubMed
Adlerberth, I, Lindberg, E, Åberg, N, et al. Reduced enterobacterial and increased staphylococcal colonization of the infantile bowel: an effect of hygienic lifestyle? Pediatr Res. 2006; 59, 96–101.CrossRefGoogle ScholarPubMed
Dominguez-Bello, MG, Costello, EK, Contreras, M, 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, 11971–11975.CrossRefGoogle ScholarPubMed
Musso, G, Gambino, R, Cassader, M. Obesity, diabetes, and gut microbiota: the hygiene hypothesis expanded? Diabetes Care. 2010; 33, 2277–2284.CrossRefGoogle ScholarPubMed
Sevelsted, A, Stokholm, J, Bonnelykke, K, Bisgaard, H. Cesarean section and chronic immune disorders. Pediatrics. 2015; 135, e92–e98.CrossRefGoogle ScholarPubMed
Kulas, T, Bursac, D, Zegarac, Z, Planinic-Rados, G, Hrgovic, Z. New views on cesarean section, its possible complications and long-term consequences for children’s health. Med Arch. 2013; 67, 460–463.CrossRefGoogle ScholarPubMed
WHO multicentre growth reference study group. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. 2006. pp. 312. World Health Organization: Geneva.Google Scholar
Achoki, R, Opiyo, N, English, M. Mini-review: management of hypoglycaemia in children aged 0–59 months. J Trop Pediatr. 2009; 56, 227–234.CrossRefGoogle ScholarPubMed
Gavin, JR III, Alberti, K, Davidson, MB, DeFronzo, RA. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 1997; 20, 1183–1197.Google Scholar
American Academy of Pediatrics, Rose SR, Section on Endocrinology and Committee on Genetics, American Thyroid Association, et al . Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics. 2006; 117, 2290–2303.CrossRefGoogle Scholar
Lem, AJ, de Rijke, YB, van Toor, H, et al. Serum thyroid hormone levels in healthy children from birth to adulthood and in short children born small for gestational age. J Clin Endocrinol Metabol. 2012; 97, 3170–3178.CrossRefGoogle ScholarPubMed
Tun, HM, Bridgman, SL, Chari, R, et al. Roles of birth mode and infant gut microbiota in intergenerational transmission of overweight and obesity from mother to offspring. JAMA Pediatri. 2018; 172, 368–377.CrossRefGoogle ScholarPubMed
Li, HT, Zhou, YB, Liu, JM. Cesarean section might moderately increase offspring obesity risk. Am J Clin Nutr. 2012; 96, 215–216, author reply 216.CrossRefGoogle ScholarPubMed
Lynch, SV, Pedersen, O. The human intestinal microbiome in health and disease. N Engl J Med. 2016; 375, 2369–2379.CrossRefGoogle ScholarPubMed
Musso, G, Gambino, R, Cassader, M. Statements obesity, diabetes, and gut microbiota the hygiene hypothesis expanded? Diabetes Care. 2010; 33, 2277–2284.CrossRefGoogle Scholar
Neu, J, Rushing, J. Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011; 38, 321–331.CrossRefGoogle ScholarPubMed
Kumari, M, Kozyrskyj, A. Gut microbial metabolism defines host metabolism: an emerging perspective in obesity and allergic inflammation. Obes Rev. 2017; 18, 18–31.CrossRefGoogle ScholarPubMed
Cho, I, Yamanishi, S, Cox, L, et al. Antibiotics in early life alter the murine colonic microbiome and adiposity. Nature. 2012; 488, 621–626.CrossRefGoogle ScholarPubMed
Poroyko, VA, Carreras, A, Khalyfa, A, et al. Chronic sleep disruption alters gut microbiota, induces systemic and adipose tissue inflammation and insulin resistance in mice. Sci Rep. 2016; 6, 35405.CrossRefGoogle ScholarPubMed
Gitau, R, Menson, E, Pickles, V, et al. Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2001; 98, 14–17.CrossRefGoogle ScholarPubMed
Nikischin, W, Peter, M, Oldigs, HD. The influence of mode of delivery on hematologic values in the umbilical vein. Gynecol Obstet Invest. 1997; 43, 104–107.CrossRefGoogle ScholarPubMed
Dahlquist, G, Källén, B. Maternal-child blood group incompatibility and other perinatal events increase the risk for early-onset type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1992; 35, 671–675.CrossRefGoogle ScholarPubMed
GBD. 2015 obesity collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017; 377, 13–27.Google Scholar
Best, D, Bhattacharya, S. Obesity and fertility. Horm Mol Biol Clin Investig. 2015; 24, 5–10.Google ScholarPubMed
Zain, MM, Norman, RJ. Impact of obesity on female fertility and fertility treatment. Women’s Health. 2008; 4, 183–194.Google ScholarPubMed
Pantasri, T, Norman, RJ. The effects of being overweight and obese on female reproduction: a review. Gynecol Endocrinol. 2014; 30, 90–94.CrossRefGoogle ScholarPubMed
Bellver, J, Melo, MA, Bosch, E, et al. Obesity and poor reproductive outcome: the potential role of the endometrium. Fertil Steril. 2007; 88, 446–451.CrossRefGoogle ScholarPubMed
Lubchenco, LO, Bard, H. Incidence of hypoglycemia in newborn infants classified by birth weight and gestational age. Pediatrics. 1971; 47, 831–838.Google ScholarPubMed
Stanley, CA, Baker, L. The causes of neonatal hypoglycemia. N Engl J Med. 1999; 340, 1200–1201.CrossRefGoogle ScholarPubMed
Chu, DM, Ma, J, Prince, AL, et al. Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery. Nat Med. 2017; 23, 314–326.CrossRefGoogle ScholarPubMed
Azad, MB, Konya, T, Maughan, H, et al. Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. CMAJ. 2013; 185, 385–394.CrossRefGoogle ScholarPubMed
Guise, J, Denman, MA, Emeis, C, et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol. 2010; 115, 1267–1278.CrossRefGoogle ScholarPubMed
Koenig, JE, Spor, A, Scalfone, N, et al. Succession of microbial consortia in the developing infant gut microbiome. Proc Natl Acad Sci U S A. 2011; 108(Suppl. 1), 4578–4585.CrossRefGoogle ScholarPubMed
David, LA, Maurice, CF, Carmody, RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014; 505, 559–563.CrossRefGoogle ScholarPubMed
Jukes, TH. Antibiotics in animal feeds and animal production. Bioscience. 1972; 22, 526–534.CrossRefGoogle Scholar
Lin, J. Effect of antibiotic growth promoters on intestinal microbiota in food animals: a novel model for studying the relationship between gut microbiota and human obesity? Front Microbiol. 2011; 2, 53.CrossRefGoogle ScholarPubMed
Jost, T, Lacroix, C, Braegger, CP, Rochat, F, Chassard, C. Vertical mother–neonate transfer of maternal gut bacteria via breastfeeding. Environ Microbiol. 2014; 16, 2891–2904.CrossRefGoogle ScholarPubMed
Supplementary material: File

Moshkovsky et al. supplementary material

Table S1

Download Moshkovsky et al. supplementary material(File)
File 27.5 KB