Cesarean delivery

No association found between mode of birth, risk for food allergy

Posted by

0


Whether infants were born via vaginal or cesarean delivery did not lead to meaningful differences in likelihood of food allergy at age 12 months, according to a study published in The Journal of Allergy and Clinical Immunology.

The lack of likelihood persisted regardless of onset of labor or whether cesarean deliveries were elected or emergent, Anne Currell, MEpi, a researcher in population health at Murdoch Children’s Research Institute in Parkville, Victoria, Australia, and colleagues wrote.

13.2% of infants born via vaginal delivery and 12.7% of infants born via cesarean delivery had developed a food allergy by at 12 months.
Data were derived from Currell A, et al. J Allergy Clin Immunol. 2022;doi:10.1016/j.jaip.2022.03.031.

The researchers examined 2,045 infants born between September 2007 and August 2011 in the Melbourne area from the HealthNuts population-based longitudinal study, where parents completed questionnaires and infants underwent skin prick testing, oral food challenges and blood collection.

Of the included infants, 70% were delivered vaginally, 12.5% were born by cesarean section after the onset of labor and 17.5% were born by cesarean section before the onset of labor. Also, 14.9% of births were emergency cesarean sections, and 15.2% were elective cesarean sections.

Overall, 13% of infants were sensitized to food and 18.7% had food allergy.

Food allergy occurred among 12.7% of infants born via cesarean delivery and 13.2% of those born vaginally, indicating no evidence of an association between type of delivery and risk for any food allergy (adjusted OR = 0.95; 95% CI, 0.7-1.3), including to egg (aOR = 0.8; 95% CI, 0.57-1.13) or peanut (aOR = 1.11; 95% CI, 0.69-1.91).

However, food allergy occurred among more children born by cesarean section after labor had started (14.2%) than those born vaginally (13.3%) or via cesarean without labor (11%), but adjusted models showed no association between labor and risk for any food allergy, including egg or peanut allergy.

Fewer infants born via emergency cesarean section experienced food allergy (11.2%) than those born via elective cesarean section (13.4%) or vaginal delivery (13.3%), but adjusted models indicating no risk for any food allergy — egg or peanut included — based on these qualifications.

The researchers additionally found no evidence for increased risks for food allergy based on breastfeeding, older siblings, a pet dog or maternal history of allergy, with similar results for egg and peanut allergies.

Similarly, the researchers continued, there was no evidence of an association between mode of cesarean birth (with or without labor, or elective or emergency cesarean) and risk for food, egg or peanut sensitization compared with vaginal delivery.

The researchers noted the microbial exposure hypothesis, which proposes that altered exposure to microbes and infections early in life could predispose infants to allergic disease, with mode of delivery potentially influencing the microbiome.

However, the researchers wrote, their results suggest that gut colonization may begin in utero and have an impact on the infant’s microbiome and on risks for allergic disease, not just mode of delivery.

Caregivers can consider these findings, the researchers continued, in advising patients about the benefits and risks that come with cesarean delivery and in reassuring them that their infants are not likely to be at increased risk for food allergy.

Reference:

PERSPECTIVE

BACK TO TOP Tetsuhiro Sakihara, MD)

Tetsuhiro Sakihara, MD

The authors demonstrated that elective or emergency cesarean delivery with or without labor was not associated with the risk for food allergy development at age 12 months in HealthNuts cohort participants. One of the strengths of this study was its use of OFC tests to confirm food allergies.

Although there was no significant difference, infants born through vaginal delivery had a higher proportion of egg allergy development compared with those born through cesarean delivery in this study. On the other hand, the proportion of peanut allergy development was higher in those born through cesarean delivery compared with those born through vaginal delivery.

Our nested case-control trial of SPADE study participants also demonstrated that only a proportion of hen’s egg sensitization development at 6 months of age was higher among infants born through vaginal delivery compared with those born through cesarean delivery. The effect of delivery mode on the development of food allergy might differ between food allergens.

In addition, although there were no significant differences, the authors demonstrated that cesarean delivery with labor had higher proportions of egg allergy and peanut allergy development compared with cesarean delivery without labor. Our analysis revealed that participants who developed food sensitization had longer labor durations than those without food sensitization. Furthermore, longer labor durations were significantly associated with a higher proportion of participants with food sensitization.

Several reports have indicated that cesarean delivery can elevate the risk for food sensitization and food allergy compared with vaginal delivery. However, our study and Currell and colleagues showed that cesarean delivery might not elevate the risk for food sensitization and food allergy.

Several important potential confounders such as indication of cesarean delivery, labor duration, levels of stress hormone and microbiota should be considered in future research.

Antibiotic use before cesarean delivery does not increase asthma, eczema risks

Posted by

0


The administration of antibiotics before cesarean delivery did not increase the risks for asthma, eczema or other allergic conditions in early childhood, providing further support for their use, according to a study published in The BMJ.

“Women who give birth by cesarean section are at increased risk of infections, such as wound infections, in the period after giving birth, and prophylactic antibiotics are used to reduce this risk,” Dana Sumilo, DPhil (Oxon), MFPH, honorary clinical research fellow at the Institute of Applied Health Research and fellow of the faculty of public health at University of Birmingham in the United Kingdom, told Healio.

mother and newborn baby
Source: Adobe Stock

Providing antibiotics to the mother before skin incision instead of after the cord has been clamped can reduce these risks even further, Sumilo continued, prompting the National Institute for Health and Care Excellence to update its guidance in 2011.

“Preventative antibiotics, if given before cord clamping, can cross the placenta and affect microbes that colonize the baby’s gut. Gut microbiota include bacteria that are thought to play a role in the development of the immune system,” Sumilo said.

Previous studies have implicated disruptions in gut microbiota and antibiotic use in susceptibility to conditions related to allergy such as asthma and eczema, Sumilo said.

“Although there are no known health harms from pre-incision antibiotics for cesarean section to newborns, until now there have been no studies looking at longer term outcomes,” she said.

The researchers conducted an observational controlled interrupted time series study of linked health care records of mothers and their babies born between 2006 and 2018 in the U.K. covering a period before and after the change in policy.

Records included 515,945 mother-baby pairs from the Health Improvement Network and Clinical Practice Research Datalink databases, where 28.1% of births were cesarean, and 3,945,351 mother-baby pairs in the Hospital Episode Statistics (HES) dataset, where 25.4% of births were cesarean.

Children who were exposed to pre-incision prophylactic antibiotics experienced a 9% decrease in asthma diagnosis (incidence rate ratio [IRR] = 0.91; 95% CI, 0.78-1.05) and a 2% decrease in eczema diagnosis (IRR = 0.98; 95% CI, 0.94-1.03) compared with those who were not exposed, although these differences did not reach statistical significance. Sensitivity analyses for asthma and eczema produced fairly similar results to the primary analyses, the researchers added.

Also, the researchers found no evidence of a significant difference in risks for other allergic or allergy-related conditions, autoimmune health conditions, infections or less specific child health measures.

Children exposed to pre-incision prophylactic antibiotics in the HES dataset experienced a 5% increase in first-time hospital admissions for asthma (IRR = 1.05; 95% CI, 0.99-1.11) and a 4% decrease in admissions for eczema (IRR = 0.96; 95% CI, 0.71-1.29) compared with those who were not exposed, but again these differences were not statistically significant.

There were no significant differential effects based on whether caesarean deliveries were elective or emergencies, nor was there any evidence that different antibiotic regimens had a differential effect on risk for asthma hospital admissions or necrotizing enterocolitis.

“Our study found no evidence of a link between the policy change to offer prophylactic antibiotics before skin incision for caesarean section and asthma, eczema and other allergic and allergy-related health conditions in early childhood,” Sumilo said.

“Our findings provide further evidence for the current policy in the U.K. to administer prophylactic antibiotics for cesarean section before skin incision and discussion regarding the timing of prophylactic antibiotics for cesarean section,” she continued.

However, the researchers cautioned that their results may not be generalizable to settings with different prophylactic antibiotic regimens or to babies who were delivered vaginally.

“Further studies are needed to confirm our findings in older children and in other populations and settings using different prophylactic antibiotic regimens for cesarean section,” Sumilo said.

Cesarean delivery linked with offspring BMI.

Posted by

0


  • Researchers from the Imperial College London identified 15 studies published before March 31, 2012 that included a combined population of 163,753 people and information about birth characteristics and long-term follow-up into adulthood. The goals of the study were to determine whether mode of delivery correlated with offspring BMI or overweight or obesity in adulthood, and whether offspring age, gender or type of cesarean section affected outcomes.

Data for all pooled-gender, unadjusted analyses (n=12) demonstrated a difference in mean BMI of 0.44 kg/m-2 (95% CI, 0.17-0.72; P=.002)for cesarean delivery vs. vaginal delivery. The ORs for overweight (BMI >25) and obesity (BMI>30) were 1.26 (95% CI, 1.16-1.38; P<.00001)   and 1.22 (95% CI, 1.05-1.42; P=.01) for cesarean delivery vs. vaginal delivery. According to data from subgroup analyses, gender and type of cesarean section had no significant effect on the results.

“There are plausible mechanisms by which cesarean delivery might influence later body weight. The types of healthy bacteria in the gut differ in babies born by cesarean and vaginal delivery, which can have broad effects on health. Also, the compression of the baby during vaginal birth appears to influence which genes are switched on, and this could have a long-term effect on metabolism,” researcher Matthew Hyde, PhD, said in a press release.

According to the authors, while the association in the data is strong, they cannot state with certainty that cesarean delivery causes higher body weight later in life.

“We now need to determine whether this is the result of the c-section or if other reasons explain the association,” Neena Modi, MD, also an author of the report, said in the press release.“There are good reasons why c-section may be the best option for many mothers and their babies, and c-sections on occasion can be life-saving. However, we need to understand the long-term outcomes in order to provide the best advice to women who are considering cesarean delivery.”