无医学指征剖宫产与儿童哮喘风险以及母乳喂养的缓解作用
Cesarean section without medical indication and risk of childhood asthma, and attenuation by breastfeeding.
作者信息
Chu Shuyuan, Chen Qian, Chen Yan, Bao Yixiao, Wu Min, Zhang Jun
机构信息
The Laboratory of Respiratory Disease, Affiliated Hospital of Guilin Medical University, Guilin, China.
MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
出版信息
PLoS One. 2017 Sep 18;12(9):e0184920. doi: 10.1371/journal.pone.0184920. eCollection 2017.
BACKGROUND
Previous studies suggest that caesarean section (CS) may increase the risk of asthma in children, but none of them could preclude potential confounding effects of underlying medical indications for CS. We aim to assess the association between CS itself (without medical indications) and risk of childhood asthma.
METHODS
We conducted a hospital-based case-control study on childhood asthma with 573 cases and 812 controls in Shanghai. Unconditional logistic regression models in SAS were employed to control for potential confounders.
RESULTS
Our study found that CS without medical indication was significantly associated with elevated asthma risk (adjusted OR = 1.58 [95% CI 1.17-2.13]). However, this risk was attenuated in children fed by exclusive breastfeeding in the first six months after birth (adjusted OR = 1.39 [95% CI 0.92-2.10]). In contrast, the risk was more prominent in children with non-exclusive breastfeeding or bottle feeding (adjusted OR = 1.91 [95% CI 1.22-2.99]).
CONCLUSIONS
CS without medical indication was associated with an increased risk of childhood asthma. Exclusive breastfeeding in infancy may attenuate this risk.
背景
先前的研究表明剖宫产可能会增加儿童患哮喘的风险，但这些研究均无法排除剖宫产潜在的医学指征所带来的混杂效应。我们旨在评估剖宫产本身（无医学指征）与儿童哮喘风险之间的关联。
方法
我们在上海开展了一项基于医院的儿童哮喘病例对照研究，病例573例，对照812例。使用SAS中的无条件逻辑回归模型来控制潜在的混杂因素。
结果
我们的研究发现，无医学指征的剖宫产与哮喘风险升高显著相关（校正比值比=1.58[95%置信区间1.17 - 2.13]）。然而，在出生后头六个月纯母乳喂养的儿童中，这种风险有所减弱（校正比值比=1.39[95%置信区间0.92 - 2.10]）。相比之下，非纯母乳喂养或奶瓶喂养的儿童中，这种风险更为突出（校正比值比=1.91[95%置信区间1.22 - 2.99]）。
结论
无医学指征的剖宫产与儿童哮喘风险增加有关。婴儿期纯母乳喂养可能会减弱这种风险。
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