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. 2021 Dec 14:12:793762.
doi: 10.3389/fimmu.2021.793762. eCollection 2021.

The Associations of Caesarean Delivery With Risk of Wheezing Diseases and Changes of T Cells in Children

Jilei Lin  1 , Shuhua Yuan  1 , Bin Dong  2   3 , Jing Zhang  1 , Lei Zhang  1 , Jinhong Wu  1 , Jiande Chen  1 , Mingyu Tang  1 , Bin Zhang  2   3 , Hansong Wang  2   3 , Yuanyuan Dai  4 , Shijian Liu  5 , Yabin Hu  5 , Xinyi Qi  1 , Liangye Xu  6 , Liebin Zhao  3 , Yong Yin  1   2   3
Affiliations

The Associations of Caesarean Delivery With Risk of Wheezing Diseases and Changes of T Cells in Children

Jilei Lin et al. Front Immunol. .

Abstract

Objectives: This study aimed to assess the associations of caesarean delivery (CD) with risk of wheezing diseases and changes of immune cells in children.

Design: The cross-sectional study was conducted between May, 2020 and April, 2021.

Setting and participants: The study was conducted in Shanghai Children's Medical Center, Shanghai, China. A total of 2079 children with a mean age of 36.97 ± 40.27 months and their guardians were included in the present study via face-to-face inquiry and physical examination by clinicians.

Methods: Logistic regression was applied to estimate odds ratio (ORs) and 95% confidence intervals (CIs) for the association between CD and first episode of wheezing (FEW) or asthma. Models were adjusted for premature or full-term delivery, exclusive breastfeeding (at least 4 months) or not.

Results: Among the 2079 children, 987 children (47.47%) were born by CD and 1092 (52.53%) by vaginal delivery (VD). Children delivered by caesarean had significantly lower gestational age (P<0.01) compared with those who delivered vaginally. Our results also showed that CD was related to increased risk of FEW by the age of 3(adjusted OR 1.50, 95%CI 1.06, 2.12) and increased tendency to develop asthma by the age of 4 (adjusted OR 3.16, 95%CI 1.25, 9.01). The subgroup analysis revealed that the negative effects of CD on asthma were more obvious in children without exclusive breastfeeding (adjusted OR 4.93, 95%CI 1.53, 21.96) or without postnatal smoking exposure (adjusted OR 3.58, 95%CI 1.20, 13.13). Furthermore, compared with children born through VD, a significant change of the T cells (increased proportion of CD4+ T cells and decreased number and proportion of CD8+ T cells) were observed before the age of one in the CD group. However, the changes were insignificant in children over 1 year old.

Conclusions: This study showed age-dependent associations of CD with asthma and FEW in offspring. Moreover, CD appeared to have an effect on the cellular immunity in infants, the disorder of which may contribute to the development of asthma in children.

Keywords: Caesarean delivery; age-dependent associations; asthma; children; first episode of wheezing; immune cells.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The odds ratio (ORs) and 95% confidence intervals (CIs) for the association between CD and FEW or asthma. Models were adjusted for premature or full-term delivery, breastfeeding status. The age-dependent association between CD and FEW or asthma was assessed by hazard ratios (HRs), with time of development of FEW and asthma as the underlying time metric. (A) the crude ORs and HRs for FEW; (B) the adjusted ORs and adjusted HRs for FEW; (C) the crude ORs and HRs for asthma; (D) the adjusted ORs and adjusted HRs for asthma.
Figure 2
Figure 2
The mean difference of LOS of wheezing diseases between CD and VD groups.
See this image and copyright information in PMC

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