Delivery Mode and Future Infectious Morbidity of the Offspring – a Sibling Analysis

Objective:

Cesarean delivery (CD) has been shown to affect the newborn’s microbiome and was recently suggested to be associated with several long-term health implications in offspring. We aimed to investigate the association between delivery mode and long-term infectious morbidity of the offspring while employing sibling analysis theme in order to maximize confounder control.

Study design:

A retrospective population-based cohort study was performed, which included all sibling deliveries occurring between 1991 and 2014 at a regional tertiary medical center. Offspring were followed-up until the age of 18 years. The study included 13,516 individuals (6758 siblings pairs): the first born was via vaginal delivery (VD) and the second via CD. Each siblings pair was considered a matched set, with the aim to perform a within-family analysis. A Kaplan–Meier survival curve was used to compare the cumulative infectious morbidity incidence and a multivariable Cox survival hazards regression model to control for confounders.

Results:

Crude rates of total infectious hospitalizations were found to be significantly higher in the CD group (OR=1.25; 95%CI, 1.12-1.40, p<0.001). Specifically, bronchiolitis (OR=2.02, 95%CI 1.56-2.63, p<0.001), otitis (OR=1.52, 95%CI 1.21-1.9, p<0.001), respiratory syncytial virus (OR=4.33, 95%CI 1.23-15.21, p=0.021) and gastroenteritis (OR=1.41, 95%CI 1.05-1.9, p=0.025) were all found to be significantly more common in the CD group. The survival curve demonstrated significantly higher cumulative infectious related hospitalization rates in the CD group (log rank p<0.001). The Cox model, adjusted for maternal age, birthweight, gestational age, preeclampsia, diabetes, smoking, and obesity confirmed the significant association between CD and offspring infectious related morbidity (adjusted HR= 1.28; 95%CI 1.04-1.57, p=0.018).

Conclusions:

CD appears to be independently associated with later offspring infectious related morbidity, even while rigorously adjusting for confounders. Physicians should consider potential implications on offspring’s future health when considering delivery mode.