06 Jan Cesarean Delivery May Increase Risk of Childhood Inflammatory Diseases
MedicalResearch.com Interview with:
Professor of Pediatrics Hans Bisgaard, MD, DMSc
Copenhagen Prospective Studies on Asthma in Childhood
Herlev and Gentofte Hospital,
University of Copenhagen, Denmark
Medical Research: What is the background for this study? What are the main findings?
Prof. Bisgaard: The purpose of this study was to look for a shared risk factor for immunological diseases which make its debut in childhood. During the recent decades a parallel increase in prevalence of immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have been observed in westernized countries. The rate of cesarean delivery has increased in the same period and has previously been associated with the development of some of these diseases. This study takes advantage of the unique and valuable nationwide registry data in Denmark to establish a large population based cohort (2 million term children) with 35 years of follow up (in the period 1977-2012). We found cesarean delivery to be a common risk factor for a range of childhood immunological diseases: asthma, juvenile arthritis, inflammatory bowel diseases, connective tissue disorders, immune deficiencies and leukemia, but with no association to psoriasis, celiac disease, and diabetes type 1.
Medical Research: What should clinicians and patients take away from your report?
Prof. Bisgaard: Caesarean section is a very important procedure saving many lives of both mothers and children and preventing childhood disabilities from delivery complications. However, the study implies that caesarean section may be a risk factor for disease, which can be taken into account when planning the procedure in pregnancy for other than medical reasons. We need more research in the mechanisms behind this finding in order to be able to recommend clinicians and patients in the future. Understanding commonalities in the underlying mechanisms behind chronic diseases may give novel insight into disease origin and potential prevention.
Medical Research: What recommendations do you have for future research as a result of this study?
Prof. Bisgaard: First of all we hope to see replication in similar registry cohorts. Moreover, we hope that this study will direct future research in immunological diseases towards the commonalities of these and look into risk factors in early life or even prenatally. When it comes to the mechanisms behind our findings we know that the normal delivery canal exposes the child to a composite microbiome different from the one encountered during a cesarean delivery. It would therefore be interesting to investigate the composition of the microbiome in the newborns to see if there are any differences by mode of delivery and linking possible microbial differences to health and disease
Cesarean Section and Chronic Immune Disorders
Astrid Sevelsted, Jakob Stokholm, Klaus Bønnelykke, and Hans Bisgaard
Pediatrics peds.2014-0596; published ahead of print December 1, 2014, doi:10.1542/peds.2014-0596