剖宫产分娩与儿童期过敏性疾病风险
Caesarean section delivery and the risk of allergic disorders in childhood.
作者信息
Renz-Polster H, David M R, Buist A S, Vollmer W M, O'Connor E A, Frazier E A, Wall M A
机构信息
Oregon Health & Science University, Portland OR, USA.
出版信息
Clin Exp Allergy. 2005 Nov;35(11):1466-72. doi: 10.1111/j.1365-2222.2005.02356.x.
BACKGROUND
The composition of the intestinal flora in young children, if unfavourable, may increase the susceptibility to allergic disorders. Beneficial intestinal microbes originate from the maternal vaginal tract and thus are more likely to be transferred during vaginal births than during Caesarean sections (C-sections).
OBJECTIVE
To determine whether children born by C-section have a different risk of allergic disorders compared with those delivered vaginally. We also tested the hypothesis that the risk of allergic disorders is highest for children born after 'repeat C-sections'.
METHODS
A retrospective cohort study of 8,953 children aged 3-10 years. Children diagnosed with allergic rhinoconjunctivitis (AR), asthma, atopic dermatitis (AD), or food allergies were identified from the Kaiser Permanente Northwest Region electronic records. The children's sex, birth weight, birth order, postnatal exposure to antibiotics as well as the mothers' age, ethnicity, education, marital status, smoking status during pregnancy, and use of asthma or hayfever medications were identified through the mothers' medical records or through the Oregon Birth Registry.
RESULTS
The risk of being diagnosed with AR was significantly higher in the children born by C-section than in those delivered vaginally: adjusted odds ratio (OR)=1.37%, 95% confidence interval (CI)=1.14-1.63. Delivery by C-section was also associated with the subsequent diagnosis of asthma (OR=1.24%, 95% CI=1.01-1.53); this association was gender specific, with a positive association restricted to girls (OR for asthma in girls: OR=1.53%, 95% CI=1.11-2.10; in boys: OR=1.08%, 95% CI=0.81-1.43). There was no significant association between mode of delivery and AD. If children born in a 'repeat C-section' were considered separately the risk of being diagnosed with AR increased further (OR=1.78%, 95% CI=1.34-2.37). The same increase was noted for asthma in girls (OR=1.83%, 95% CI=1.13-2.97) but not in boys.
CONCLUSION
Caesarean sections may be associated with an increased risk of developing AR in childhood.
背景
幼儿肠道菌群的组成若不理想，可能会增加患过敏性疾病的易感性。有益的肠道微生物源自母体阴道，因此相较于剖宫产，顺产时更有可能发生菌群转移。
目的
确定剖宫产出生的儿童与顺产儿童相比，患过敏性疾病的风险是否不同。我们还检验了“再次剖宫产”出生的儿童患过敏性疾病风险最高这一假设。
方法
对8953名3至10岁儿童进行回顾性队列研究。从凯撒医疗西北区电子记录中识别出被诊断患有过敏性鼻结膜炎（AR）、哮喘、特应性皮炎（AD）或食物过敏的儿童。通过母亲的病历或俄勒冈州出生登记处确定儿童的性别、出生体重、出生顺序、产后抗生素暴露情况以及母亲的年龄、种族、教育程度、婚姻状况、孕期吸烟状况和哮喘或花粉热药物使用情况。
结果
剖宫产出生的儿童被诊断患有AR的风险显著高于顺产儿童：校正比值比（OR）=1.37%，95%置信区间（CI）=1.14 - 1.63。剖宫产分娩还与随后哮喘的诊断相关（OR = 1.24%，95% CI = 1.01 - 1.53）；这种关联具有性别特异性，正相关仅限于女孩（女孩哮喘的OR：OR = 1.53%，95% CI = 1.ll - 2.10；男孩：OR = 1.08%，95% CI = 0.81 - 1.43）。分娩方式与AD之间无显著关联。如果单独考虑“再次剖宫产”出生的儿童，被诊断患有AR的风险进一步增加（OR = 1.78%，95% CI = 1.34 - 2.37）。女孩哮喘也有同样的增加（OR = 1.83%，95% CI = 1.13 - 2.97），但男孩没有。
结论
剖宫产可能与儿童期患AR的风险增加有关。
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