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Meta-Analysis
. 2020 Oct 31;17(21):8031.
doi: 10.3390/ijerph17218031.

Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis

Aneta Słabuszewska-Jóźwiak  1 , Jacek Krzysztof Szymański  1 , Michał Ciebiera  2 , Beata Sarecka-Hujar  3 , Grzegorz Jakiel  1
Affiliations
Meta-Analysis

Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis

Aneta Słabuszewska-Jóźwiak et al. Int J Environ Res Public Health. .

Abstract

Background: Cesarean section is a surgical procedure, which is the most frequently performed in gynecology and obstetrics. It is commonly believed that an operative delivery is a less painful and safer mode of delivery, which translates into an increasing number of the procedures performed without medical indications. The maternal sequelae of cesarean sections are well elucidated and widely discussed in the literature, while long-term neonatal consequences still remain the issue of research and scientific dispute. The aim of the present paper was to perform a systematic review of current literature regarding pediatrics consequences of cesarean section.

Methods: We reviewed available data from PubMed, Science Direct as well as Google Scholar bases concerning early and long-term neonatal sequelae of operative deliveries. The following key words were used: "cesarean section", "caesarean section", "neonatal outcomes", "respiratory disorders", "asthma", "obesity", "overweight", and "neurological disorders". A total of 1636 papers were retrieved out of which 27 were selected for the final systematic review whereas 16 articles provided data for meta-analysis. Statistical analyses were performed using RevMan 5.4. To determine the strength of association between the caesarean section and respiratory tract infections, asthma, diabetes type 1 as well as obesity the pooled odds ratios (OR) with the 95% confidence intervals (CI) were calculated.

Results: Conducted meta-analyses revealed that caesarean section is a risk factor for respiratory tract infections (pooled OR = 1.30 95%CI 1.06-1.60, p = 0.001), asthma (pooled OR = 1.23 95%CI 1.14-1.33, p < 0.00001) as well as obesity (pooled OR = 1.35 95%CI 1.29-1.41, p < 0.00001) in offspring.

Conclusions: The results of the studies included indicated that children delivered by cesarean section more commonly developed respiratory tract infections, obesity and the manifestations of asthma than children delivered vaginally. The risk of developing diabetes mellitus type 1 or neurological disorders in offspring after caesarean section is still under discussion.

Keywords: asthma; caesarean section; neonatal outcomes; neurological disorders; obesity; overweight; respiratory disorders.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Factors influence on fetus, depend on mode of delivery.
Figure 2
Figure 2
Flow chart presenting the process of searching for the eligible articles according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [90].
Figure 3
Figure 3
Forest plot for respiratory tract infections in the caesarean section (CS) and vaginally delivered (VD) offspring. M.-H.-Mantel-Haenszel; CI-confidence interval; I2-heterogeneity; df-degrees of freedom.
Figure 4
Figure 4
Forest plot for asthma in the caesarean section (CS) and vaginally delivered (VD) offspring. M.-H.-Mantel-Haenszel; CI-confidence interval; I2-heterogeneity; df-degrees of freedom.
Figure 5
Figure 5
Forest plot for diabetes mellitus type 1 in the caesarean section (CS) and vaginally delivered (VD) offspring. M.-H.-Mantel-Haenszel; CI-confidence interval; I2-heterogeneity; df-degrees of freedom.
Figure 6
Figure 6
Forest plot for obesity in the caesarean section (CS) and vaginally delivered (VD) offspring. M.-H.-Mantel-Haenszel; CI-confidence interval; I2-heterogeneity; df-degrees of freedom; *-analysis for group of children at three years of age.
See this image and copyright information in PMC

References

    1. Betrán A.P., Ye J., Moller A.-B., Zhang J., Gülmezoglu A.M., Torloni M.R. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990–2014. PLoS ONE. 2016;11:e0148343. doi: 10.1371/journal.pone.0148343. - DOI - PMC - PubMed
    1. Molina G., Weiser T.G., Lipsitz S.R., Esquivel M.M., Uribe-Leitz T., Azad T., Shah N., Semrau K., Berry W.R., Gawande A.A., et al. Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality. JAMA. 2015;314:2263–2270. doi: 10.1001/jama.2015.15553. - DOI - PubMed
    1. Betran A.P., Torloni M.R., Zhang J.J., Gulmezoglu A.M. WHO Working Group on Caesarean Section WHO Statement on Caesarean Section Rates. BJOG Int. J. Obstet. Gynaecol. 2015;123:667–670. doi: 10.1111/1471-0528.13526. - DOI - PMC - PubMed
    1. Ye J., Betran A.P., Vela M.G., Souza J.P., Zhang J. Searching for the Optimal Rate of Medically Necessary Cesarean Delivery. Birth. 2014;41:237–244. doi: 10.1111/birt.12104. - DOI - PubMed
    1. Betran A.P., Torloni M.R., Zhang J., Ye J., Mikolajczyk R., Deneux-Tharaux C., Oladapo O.T., Souza J.P., Tunçalp Ö., Vogel J.P., et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod. Health. 2015;12:1–10. doi: 10.1186/s12978-015-0043-6. - DOI - PMC - PubMed