Debley Jason S, Smith Jodi M, Redding Gregory J, Critchlow Cathy W
Division of Pulmonary Medicine, University of Washington, Seattle, Washington, USA.
Ann Allergy Asthma Immunol. 2005 Feb;94(2):228-33. doi: 10.1016/S1081-1206(10)61300-2.
Cesarean delivery modifies infant gut bacterial flora composition, which may result in hindered tolerance to allergenic substances, thereby increasing the risk of asthma in accordance with the hygiene hypothesis. Results of previous studies regarding an association between birth route and asthma are conflicting, and these studies have not evaluated some potential confounding effects, including prematurity and maternal asthma.
To determine whether cesarean delivery in full-term and premature infants increases the risk of subsequent childhood asthma hospitalization.
We conducted a case-control study using the Washington State Birth Events Record Database linked to statewide hospitalization data. The study included 2,028 children hospitalized for asthma (cases) and 8,292 age-matched controls.
Cesarean delivery was modestly associated with an increased risk of asthma hospitalization (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04-1.39). However, when analyzed separately, there was an association between cesarean delivery and asthma hospitalization in premature infants (OR, 1.90; 95% CI, 1.09-3.02) but not in full-term infants (OR, 1.15; 95% CI, 0.97-1.34).
Cesarean delivery was associated with subsequent asthma hospitalization only in premature infants. Because mothers with asthma are reported to have increased rates of cesarean delivery and premature delivery, other factors in addition to the hygiene hypothesis, including genetic and in utero influences associated with maternal asthma, may contribute to the increased risk of asthma in premature infants.
剖宫产会改变婴儿肠道细菌菌群的组成，这可能导致对过敏原物质的耐受性受到阻碍，从而根据卫生假说增加患哮喘的风险。先前关于分娩方式与哮喘之间关联的研究结果相互矛盾，并且这些研究没有评估一些潜在的混杂效应，包括早产和母亲哮喘。
确定足月和早产婴儿剖宫产是否会增加随后儿童期哮喘住院的风险。
我们使用与全州住院数据相关联的华盛顿州出生事件记录数据库进行了一项病例对照研究。该研究包括2028名因哮喘住院的儿童（病例）和8292名年龄匹配的对照。
剖宫产与哮喘住院风险增加存在适度关联（优势比[OR]，1.20；95%置信区间[CI]，1.04 - 1.39）。然而，当分别分析时，剖宫产与早产婴儿哮喘住院之间存在关联（OR，1.90；95%CI，1.09 - 3.02），但与足月婴儿无关（OR，1.15；95%CI，0.97 - 1.34）。
剖宫产仅与早产婴儿随后的哮喘住院有关。由于据报道患有哮喘的母亲剖宫产和早产的发生率增加，除了卫生假说之外的其他因素，包括与母亲哮喘相关的遗传和子宫内影响，可能导致早产婴儿患哮喘的风险增加。
