16 Mar Study Examines Adverse Childhood Health After Planned Repeat C-Section
MedicalResearch.com Interview with:
Dr. Mairead Black
Dr Mairead Black MBChB, MRCOG, MSc
Clinical Lecturer, Obstetrics and Gynaecology
School of Medicine and Dentistry, Division of Applied Health Sciences
University of Aberdeen
Aberdeen Maternity Hospital, Cornhill Road
Aberdeen
MedicalResearch.com: What is the background for this study?
Dr. Black: The commonest reason for performing a planned Cesarean Section (CS) in high-income countries is a history of a previous CS. However, there is very little information available on childhood health outcomes of birth after a previous .
MedicalResearch.com: Why might vaginal birth be beneficial?
Dr. Black: If a baby is born naturally, it is exposed to various processes of labour and birth which may help their immunity and ability to avoid or fight future illness.
MedicalResearch.com: Why might Cesarean Section be beneficial?
Dr. Black: If a woman aims for a vaginal birth in the pregnancy after a Cesarean Section, there is a small risk of scar rupture which can, very rarely, lead to a lack of oxygen to the baby with potential for lasting problems if the brain is affected. By performing a pre-labour caesarean section, the risk of scar rupture is essentially avoided.
MedicalResearch.com: What did the study do?
Dr. Black: This study set out to compare health outcomes in children after planned repeat C-section (where there was no exposure to labour), and those following emergency repeat C-section, with outcomes following vaginal birth after Cesarean Section.
The study analysed data from over 40,000 second births in Scotland between 1993 and 2007 using 8 linked databases. Smaller populations, using more recent birth years and restricted geographical areas, were used to study some outcomes, including learning disability and cerebral palsy, where data availability was limited.
MedicalResearch.com: What are the main findings in the study?
Dr. Black: The study shows a slight increase in risk of asthma in children born by both planned repeat C-section (36 per 1000 children vs 33 per 1000) and emergency repeat Cesarean Section (37 per 1000 children vs 33 per 1000) compared to vaginal birth, and that obesity levels at age five are similar across these delivery groups.
The study also noted a slight increase in risk of learning disability (37 per 1000 versus 23 per 1000) and death (5 per 1000 versus 4 per 1000) following unscheduled repeat Cesarean Section compared with vaginal birth after a CS.
MedicalResearch.com: Why would an unplanned C-section lead to an increased risk of learning disability or death?
Dr. Black: It is important to note that the precise reason for performing the unscheduled Cesarean Section was not known in this study. The reason for performing the unscheduled CS may relate to a problem (with mother or unborn baby) detected before or during labour, which could in itself explain the increased risk of learning disability or death. It is therefore important that further studies are conducted to investigate this possible link further. Such studies would collect data on planned mode of birth and reasons for performing unscheduled Cesarean Section.
MedicalResearch.com: What are the implications?
Dr. Black: This study further suggests that C-section may contribute to global increases in asthma. The absolute increase in risk of asthma to children delivered by C-section was very low, so it is unlikely to be important enough to influence individual delivery decisions, where other factors should take priority. If the link with asthma is causal, 298 successful vaginal births would be required to avoid one case of hospitalisation with asthma.
Overall, this study provides some reassurance that offspring delivered by planned repeat C-section are not at substantially higher risk of childhood illness, and our findings regarding learning disability and death following an unscheduled Cesarean Section require further research to establish causation.
MedicalResearch.com: What is the take-home message?
Dr. Black: C-section may play a part in explaining global increases in asthma, but overall, this study provides some reassurance that children delivered by planned repeat C-section are not at substantially higher risk, and our findings regarding learning disability and death risk following unscheduled Cesarean Section require further research.
The findings regarding asthma remind us that widespread medical interventions such as C-section may not be without some negative public health impact.
The study findings regarding risk of learning disability and death are important, but before these should impact upon clinical practice, further research is required. Our study cannot confirm what the childhood health outcomes of a specific planned mode of birth are. Instead we report outcomes following the actual birth type.
MedicalResearch.com: Should women be worried?
Dr. Black: This study supports existing data suggesting asthma risk may be slightly increased following birth by caesarean section. However, the increase in risk is so small that we do not consider it to be important enough to influence delivery decisions where indications for caesarean birth exist.
The findings regarding increased learning disability and death risk following unscheduled C-section compared to vaginal birth require further investigation. This study is unable to confirm whether these risks relate to scar rupture or other complications resulting in unscheduled caesarean section.
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Citation:
Planned Repeat Cesarean Section at Term and Adverse Childhood Health Outcomes: A Record-Linkage Study
Mairead Black ,Siladitya Bhattacharya ,Sam Philip ,Jane E. Norman ,David J. McLernon
Published: March 15, 2016
DOI: 10.1371/journal.pmed.1001973
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Last Updated on March 16, 2016 by Marie Benz MD FAAD