Martin Melanie A, Veile Amanda J, Valeggia Claudia R
Department of Anthropology, University of Washington, Seattle, Washington.
Department of Anthropology, Yale University, New Haven, Connecticut.
Am J Hum Biol. 2019 Mar;31(2):e23200. doi: 10.1002/ajhb.23200. Epub 2018 Dec 19.
Cesarean delivery may increase childhood infectious morbidity risks via altered birth exposures and subsequent immune, microbial, and epigenetic development. Many Latin American indigenous populations experience dual burdens of infectious and chronic diseases, and are particularly vulnerable to rising rates of cesarean delivery and associated adverse outcomes. The Qom/Toba are an indigenous population in Argentina experiencing rapid lifestyle transitions. We hypothesized that cesarean delivery would be associated with increased risk of infectious symptoms in Qom children after adjusting for gestational and nutritional factors.
We conducted a secondary analysis of birth records and monthly anthropometric and illness data collected previously from 90 Qom children (aged 1-55 months). We tested for additive effects of birth mode on risk of gastrointestinal (GI) and respiratory illness (RI) in mixed-effects logistic regression models adjusting for child weight-for-age (WAZ), weaning, and gestational and maternal age.
Cesarean deliveries accounted for 46% of births and were associated with maternal age < 20 and ≥ 30 years, gestational age < 39 weeks, and prenatal complications. GI and RI risks were reduced in association with cesarean delivery, greater WAZ, weaning, maternal age ≥ 30 years, and gestational age < 39 weeks.
The relationship between cesarean delivery and reduced infectious risks may reflect statistical confounding with relatively rapid postnatal growth and greater adiposity. Postnatal growth trajectories may be important mediators of long-term morbidity risks associated with cesarean delivery. The frequency of cesarean deliveries among the Qom remains concerning given traditionally high rates of fertility and adolescent pregnancy.
剖宫产可能会通过改变出生暴露以及随后的免疫、微生物和表观遗传发育增加儿童期感染性疾病的发病风险。许多拉丁美洲土著人口同时面临感染性疾病和慢性疾病的双重负担，尤其容易受到剖宫产率上升及其相关不良后果的影响。科姆/托巴族是阿根廷的一个土著群体，他们正在经历快速的生活方式转变。我们假设，在调整了孕周和营养因素后，剖宫产与科姆族儿童感染症状风险增加有关。
我们对先前收集的90名科姆族儿童（年龄在1 - 55个月）的出生记录、每月人体测量数据和疾病数据进行了二次分析。在调整了儿童年龄别体重（WAZ）、断奶情况、孕周和母亲年龄的混合效应逻辑回归模型中，我们测试了分娩方式对胃肠道（GI）和呼吸道疾病（RI）风险的相加效应。
剖宫产占分娩总数的46%，与母亲年龄<20岁和≥30岁、孕周<39周以及产前并发症有关。剖宫产、较高的WAZ、断奶、母亲年龄≥30岁和孕周<39周与胃肠道和呼吸道疾病风险降低有关。
剖宫产与感染风险降低之间的关系可能反映了与出生后相对快速的生长和更高的肥胖程度相关的统计混杂因素。出生后生长轨迹可能是与剖宫产相关的长期发病风险的重要中介因素。鉴于传统上较高的生育率和青少年怀孕率，科姆族的剖宫产频率仍然令人担忧。
