Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, POB 2007, 48810, Kfar-Qassim, Israel.
Department of Obstetrics and Gynecology, Haddasah Mt. Scopus Medical Center, The Hebrew University, Jerusalem, Israel.
Arch Gynecol Obstet. 2020 Nov;302(5):1135-1141. doi: 10.1007/s00404-020-05706-z. Epub 2020 Jul 31.
Cesarean delivery (CD) has been recently suggested to be associated with offspring's long-term health implications. We aimed to investigate the association between delivery mode and long-term infectious morbidity of the offspring while employing sibling matched analysis to maximize confounder control.
A retrospective population-based cohort study was performed, which included all sibling deliveries occurring between 1991 and 2014 at a regional tertiary medical center. Offsprings were followed up until the age of 18 years. The study included 13,516 individuals (6758 sibling pairs): the first born was via vaginal delivery and the second via CD. Each siblings pair was considered a matched set, with the aim to perform a within-family analysis. A Kaplan-Meier survival curve was used to compare the cumulative infectious morbidity incidence and a multivariable Cox survival hazards regression model to control for confounders.
Crude rates of total infectious hospitalizations were found to be significantly higher in the CD group (OR 1.25; 95% CI 1.12-1.40). Specifically, bronchiolitis (OR 2.02, 95% CI 1.56-2.63), otitis (OR 1.52, 95% CI 1.21-1.9), and gastroenteritis (OR 1.41, 95% CI 1.05-1.9) were all found to be significantly more common in the CD group. The survival curve demonstrated significantly higher cumulative infection-related hospitalization rates in the CD group (log-rank p < 0.001). The Cox model, adjusted for several confounders, confirmed the significant association between CD and offspring's infection-related morbidity (adjusted HR 1.25; 95% CI 1.02-1.53).
CD appears to be independently associated with later offspring infection-related morbidity, even while rigorously adjusting for confounders.
最近有研究表明，剖宫产（CD）与后代的长期健康影响有关。我们旨在通过同胞匹配分析来调查分娩方式与后代长期传染性发病率之间的关系，以最大限度地控制混杂因素。
进行了一项回顾性基于人群的队列研究，该研究包括 1991 年至 2014 年期间在一家地区性三级医疗中心发生的所有同胞分娩。对后代进行随访，直到 18 岁。该研究包括 13516 人（6758 对同胞）：第一胎是经阴道分娩，第二胎是经剖宫产分娩。每对同胞都被视为一个匹配组，旨在进行家庭内分析。使用 Kaplan-Meier 生存曲线比较累积传染性发病率，使用多变量 Cox 生存风险回归模型控制混杂因素。
发现 CD 组的总传染性住院率明显更高（OR 1.25；95%CI 1.12-1.40）。具体而言，支气管肺炎（OR 2.02，95%CI 1.56-2.63）、中耳炎（OR 1.52，95%CI 1.21-1.9）和肠胃炎（OR 1.41，95%CI 1.05-1.9）的发生率在 CD 组中均明显更高。生存曲线显示 CD 组累积感染相关住院率显著更高（对数秩 p<0.001）。在调整了几个混杂因素后，Cox 模型证实 CD 与后代感染相关发病率之间存在显著关联（调整后的 HR 1.25；95%CI 1.02-1.53）。
即使在严格调整混杂因素的情况下，剖宫产似乎与后代感染相关的发病率增加独立相关。
