Jessica Miller PhD Postdoc Fellow Murdoch Childrens Research Institute

Greater Rate of Infection-Related Hospitalizations in Cesarean Section-Born Children Interview with:

Jessica Miller PhD Postdoc Fellow Murdoch Childrens Research Institute

Dr. Miller

Jessica Miller PhD
Postdoc Fellow
Murdoch Childrens Research Institute What is the background for this study?

Response: Cesarean section (CS) may be a lifesaving intervention for women and babies. However, the global proportion of CS births is rapidly increasing and may not be medically justified. As CS has implications for both mother and child, the increasing rates warrant population-level analyses of potential risks. Many suggested long-term outcomes in CS-born children relate to altered immune development. It is possible that differences in the newborn microbiome by mode of birth contribute to the development of early immune responses which may influence the risk of immune-related outcomes, including infection. CS has been associated with an increased risk for specific infection-related hospitalisations, mainly lower respiratory tract and gastrointestinal infections, but it remains unclear whether CS is associated with increased risk of overall infection-related hospitalisation or only certain infection types, and whether risk differs for emergency versus elective/pre-labour CS. What are the main findings?

Response: Among 7.17 million births from 4 high-income countries, compared to vaginally born children, Cesarean section -born children had a 10% increased risk of infection-related hospitalisation. The risk was higher following both emergency and elective Cesarean section and risk lasted until 5 years of age. If the associations are causal, 2-3% of children with infection-related hospitalisation could attribute their infection to being born by CS. What should readers take away from your report? 

Response: We observed a consistent association between CS births and infection-related hospitalisation in early childhood. Regardless of underlying indication for Cesarean section , our findings suggest that there may be causal determinants of susceptibility to infection among CS-born children. If our findings are confirmed, they could inform efforts to reduce elective/pre-labour Cesarean section rates that are not medically indicated. What recommendations do you have for future research as a result of this work?

Response: Future studies should consider the underlying mechanism, including the effects of birth mode on immune development. Additionally, further studies in other settings, particularly low- and middle-income countries, are needed and should include data on modifiable postnatal exposures, such as infant feeding and postnatal smoking exposure. Is there anything else you would like to add?

Response: The findings should not discourage women from having cesareans when medically indicated and despite the small increased risk of childhood infections, cesarean births may be the safest option for some women and babies.


Miller JE, Goldacre R, Moore HC, Zeltzer J, Knight M, Morris C, et al. (2020) Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries. PLoS Med 17(11): e1003429. 


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Last Updated on November 26, 2020 by Marie Benz MD FAAD