TY - JOUR
T1 - Mode of Delivery and Asthma at School Age in 9 European Birth Cohorts
AU - Rusconi, Franca
AU - Zugna, Daniela
AU - Annesi-Maesano, Isabella
AU - Baiz, Nour
AU - Barros, Henrique
AU - Correia, Sofia
AU - Duijts, Liesbeth
AU - Forastiere, Francesco
AU - Inskip, Hazel
AU - Kelleher, Cecily C.
AU - Larsen, Pernille S.
AU - Mommers, Monique
AU - Andersen, Anne-Marie Nybo
AU - Penders, John
AU - Pike, Katharine
AU - Porta, Daniela
AU - Sonnenschein-van der Voort, Agnes
AU - Sunyer, Jordi
AU - Torrent, Maties
AU - Viljoen, Karien
AU - Vrijheid, Martine
AU - Richiardi, Lorenzo
AU - Galassi, Claudia
PY - 2017/3/15
Y1 - 2017/3/15
N2 - Evidence on the association between mode of delivery and asthma at school age is inconclusive. We assessed the associations between specific modes of delivery and asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted risk ratios for asthma at ages 5-9 years were calculated using Poisson regression models and pooled. A sensitivity analysis was carried out in children born at term to reduce confounding due to perinatal factors. The study included 67,613 participants. Cohort-specific rates of cesarean delivery varied from 9.4% to 37.5%. Cesarean delivery, as opposed to vaginal delivery, was associated with an increased risk of asthma (adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.02, 1.46). Compared with spontaneous vaginal delivery, the adjusted risk ratio was 1.33 (95% CI: 1.02, 1.75) for elective cesarean delivery, 1.07 (95% CI: 0.94, 1.22) for emergency cesarean delivery, and 0.97 (95% CI: 0.84, 1.12) for operative vaginal delivery. In children born at term, the associations were strengthened only for elective cesarean delivery (aRR = 1.49, 95% CI: 1.13, 1.97). The large sample size allowed analysis of the associations between specific modes of delivery and asthma at school age. The increased risk of asthma associated with elective cesarean delivery, especially among children born at term, is relevant in counteracting the increasing use of this procedure, which is often performed without a clear medical indication.
AB - Evidence on the association between mode of delivery and asthma at school age is inconclusive. We assessed the associations between specific modes of delivery and asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted risk ratios for asthma at ages 5-9 years were calculated using Poisson regression models and pooled. A sensitivity analysis was carried out in children born at term to reduce confounding due to perinatal factors. The study included 67,613 participants. Cohort-specific rates of cesarean delivery varied from 9.4% to 37.5%. Cesarean delivery, as opposed to vaginal delivery, was associated with an increased risk of asthma (adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.02, 1.46). Compared with spontaneous vaginal delivery, the adjusted risk ratio was 1.33 (95% CI: 1.02, 1.75) for elective cesarean delivery, 1.07 (95% CI: 0.94, 1.22) for emergency cesarean delivery, and 0.97 (95% CI: 0.84, 1.12) for operative vaginal delivery. In children born at term, the associations were strengthened only for elective cesarean delivery (aRR = 1.49, 95% CI: 1.13, 1.97). The large sample size allowed analysis of the associations between specific modes of delivery and asthma at school age. The increased risk of asthma associated with elective cesarean delivery, especially among children born at term, is relevant in counteracting the increasing use of this procedure, which is often performed without a clear medical indication.
KW - asthma
KW - cesarean delivery
KW - child
KW - cohort studies
KW - ELECTIVE CESAREAN-SECTION
KW - POPULATION-BASED COHORT
KW - CHILDHOOD ASTHMA
KW - ALLERGIC SENSITIZATION
KW - VAGINAL DELIVERY
KW - HEALTH RESEARCH
KW - GUT MICROBIOTA
KW - ASSOCIATION
KW - RISK
KW - METAANALYSIS
U2 - 10.1093/aje/kwx021
DO - 10.1093/aje/kwx021
M3 - Article
C2 - 28399567
SN - 0002-9262
VL - 185
SP - 465
EP - 473
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
IS - 6
ER -