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Meta-Analysis
. 2023 Nov 16;23(1):571.
doi: 10.1186/s12887-023-04396-1.

Association of cesarean section with asthma in children/adolescents: a systematic review and meta-analysis based on cohort studies

Ziwei Zhong #  1 , Meiling Chen #  2 , Senjie Dai #  3 , Yu Wang  4 , Jie Yao  2 , Haojie Shentu  5 , Jianing Huang  2 , Chiyuan Yu  3 , Hongrui Zhang  6 , Tianyue Wang  3 , Wei Ren  7
Affiliations
Meta-Analysis

Association of cesarean section with asthma in children/adolescents: a systematic review and meta-analysis based on cohort studies

Ziwei Zhong et al. BMC Pediatr. .

Abstract

Background: Whether cesarean section (CS) is a risk factor for asthma in offspring is controversial. The purpose of this study was to investigate the association between CS and asthma in children/adolescents.

Methods: Pubmed, Embase, Web of Science, and Cochrane Library electronic databases were searched for cohort studies on the relationship between mode of delivery and asthma in children/adolescents up to February 2023. Birth via CS was considered an exposure factor. Asthma incidence was taken as a result.

Results: Thirty-five cohort studies (thirteen prospective and twenty-two retrospective cohort studies) were included. The results showed that the incidence of asthma was higher in CS offspring (odds ratio (OR) = 1.18, P < 0.001) than in the vaginal delivery (VD) group. Partial subgroup analyses showed a higher incidence of asthma in female offspring born via CS (OR = 1.26, P < 0.001) compared with the VD group, while there was no difference in males (OR = 1.07, P = 0.325). Asthma incidence was higher in CS offspring than in the VD group in Europe (OR = 1.20, P < 0.001), North America (OR = 1.15, P < 0.001), and Oceania (OR = 1.06, P = 0.008). This trend was not found in the Asian population (OR = 1.17, P = 0.102). The incidence of atopic asthma was higher in offspring born via CS (OR = 1.14, P < 0.001) compared to the VD group. The CS group had a higher incidence of persistent asthma, but the difference did not reach statistical significance (OR = 1.15, P = 0.063).

Conclusion: In this meta-analysis, CS may be a risk factor for asthma in offspring children/adolescents compared with VD. The relationship between CS and asthma was influenced by sex and region.

Keywords: Adolescent; Asthma; Cesarean section; Child; Meta-analysis; Offspring.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
PRISMA retrieval procedures flow chart
Fig. 2.
Fig. 2.
Forest plot of the association between cesarean section and asthma (P < 0.001)
See this image and copyright information in PMC

References

    1. Labaki WW, Han MK. Chronic respiratory diseases: a global view. Lancet Respir Med. 2020;8(6):531–533. doi: 10.1016/S2213-2600(20)30157-0. - DOI - PMC - PubMed
    1. Stern J, Pier J, Litonjua AA. Asthma epidemiology and risk factors. Semin Immunopathol. 2020;42(1):5–15. doi: 10.1007/s00281-020-00785-1. - DOI - PubMed
    1. García-Marcos L, Asher MI, Pearce N, Ellwood E, Bissell K, Chiang CY, El Sony A, Ellwood P, Marks GB, Mortimer K, et al. The burden of asthma, hay fever and eczema in children in 25 countries: GAN Phase I study. Eur Respir J. 2022;60(3):2102866. doi: 10.1183/13993003.02866-2021. - DOI - PMC - PubMed
    1. Bisgaard H, Szefler S. Prevalence of asthma-like symptoms in young children. Pediatr Pulmonol. 2007;42(8):723–728. doi: 10.1002/ppul.20644. - DOI - PubMed
    1. Jartti T, Gern JE. Role of viral infections in the development and exacerbation of asthma in children. J Allergy Clin Immunol. 2017;140(4):895–906. doi: 10.1016/j.jaci.2017.08.003. - DOI - PMC - PubMed