Thompson A L
Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Dev Orig Health Dis. 2019 Oct;10(5):555-562. doi: 10.1017/S2040174419000047. Epub 2019 Feb 7.
Caesarean delivery has been linked to a number of inflammatory conditions in childhood and adolescence. Yet the mechanisms underlying these associations and their generalizability across contexts with different postnatal feeding and pathogenic exposures remain unclear. This study tests the association between delivery type and three measures of immune function, inflammation, morbidity and leukocyte proportions, in Ecuadorian infants and children aged 6 months to 2 years. Data were collected from mother-child pairs participating in a nationally representative health and nutrition survey Encuesta Nacional de Salud y Nutricion (ENSANUT-ECU) conducted in 2012. The analytic sample includes 828 mothers and infants with delivery information and measured biomarkers. Poisson regression models were used to examine the association between delivery type and markers of immune function, controlling for maternal and infant characteristics, including age, sex, sociodemographic characteristics and medical indications. 40.8% (n=338) of sample infants and children were delivered by caesarean. Compared to those born vaginally, infants born by caesarean were less likely to have elevated C-reactive protein (CRP) [CRP>2 mg/l; risk ratio (RR): 0.76, 95% confidence interval (CI): 0.58-1.00] and more likely to have illness symptoms (RR: 1.22, 95% CI: 1.01-1.46) and elevated basophils (RR: 1.83, 95% CI: 1.03-3.25). No other immune cell proportions differed by delivery type. The results suggest that differences in the perinatal exposures accompanying caesarean delivery may alter immune development and function, particularly in the inflammatory response to infection and in cells involved in the allergic response, across infancy and early childhood. Understanding the pathways linking perinatal exposures to immune development is important for preventing the development of inflammatory conditions.
剖宫产与儿童期和青少年期的多种炎症性疾病有关。然而，这些关联背后的机制以及它们在不同产后喂养和病原体暴露背景下的普遍性仍不清楚。本研究检验了厄瓜多尔6个月至2岁婴幼儿的分娩方式与免疫功能、炎症、发病率和白细胞比例这三项指标之间的关联。数据收集自参与2012年全国代表性健康与营养调查“厄瓜多尔全国健康与营养调查（ENSANUT-ECU）”的母婴对。分析样本包括828名有分娩信息和测量生物标志物的母亲和婴儿。采用泊松回归模型来检验分娩方式与免疫功能标志物之间的关联，并对母亲和婴儿的特征进行控制，包括年龄、性别、社会人口学特征和医学指征。样本中的婴幼儿有40.8%（n = 338）通过剖宫产出生。与阴道分娩的婴儿相比，剖宫产出生的婴儿C反应蛋白（CRP）升高的可能性较小[CRP>2 mg/l；风险比（RR）：0.76，95%置信区间（CI）：0.58 - 1.00]，出现疾病症状的可能性较大（RR：1.22，95% CI：1.01 - 1.46），嗜碱性粒细胞升高的可能性较大（RR：1.83，95% CI：1.03 - 3.25）。其他免疫细胞比例在分娩方式上没有差异。结果表明，剖宫产分娩伴随的围产期暴露差异可能会改变婴儿期和幼儿期的免疫发育和功能，特别是在对感染的炎症反应以及参与过敏反应的细胞方面。了解围产期暴露与免疫发育之间的联系对于预防炎症性疾病的发生很重要。
