Department of General Pediatrics and Neonatology, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Giessen, Germany.
Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), INSERM, Université de Paris, Paris, France.
Neonatology. 2022;119(4):464-473. doi: 10.1159/000524337. Epub 2022 May 6.
Bronchopulmonary dysplasia (BPD) represents a tremendous disease burden following preterm birth. The strong association between compromised gas exchange after birth and BPD demands particular focus on the perinatal period. The mode of delivery can impact on lung fluid clearance and microbial colonization, but its impact on BPD and potential trade-off effects between death and BPD are not established.
A total of 7,435 live births (24+0 to 31+6 weeks postmenstrual age) in 19 regions of 11 European countries were included. Principal outcomes were death and BPD at 36 weeks. We estimated unadjusted and adjusted associations with mode of delivery using multilevel logistic regression to account for clustering within units and regions. Sensitivity analyses examined effects, taking into consideration regional variations in C-section rates.
Compared to vaginal delivery, delivery by C-section was not associated with the incidence of BPD (OR 0.92, 95% CI: 0.68-1.25) or the composite outcome of death or BPD (OR 0.94, 95% CI: 0.74-1.19) after adjustment for perinatal and neonatal risk factors in the total cohort and in pregnancies for whom a vaginal delivery could be considered. Sensitivity analyses among singletons, infants in cephalic presentation, and infants of ≥26+0 weeks of gestation did not alter the results for BPD, severe BPD, and death or BPD, even in regions with a high C-section rate.
In our population-based cohort study, the mode of delivery was not associated with the incidence of BPD. The intention to reduce BPD does not justify a C-section in pregnancies where a vaginal delivery can be considered.
支气管肺发育不良（BPD）是早产儿出生后面临的巨大疾病负担。出生后气体交换受损与 BPD 之间的强烈关联要求特别关注围产期。分娩方式会影响肺液清除和微生物定植，但它对 BPD 的影响以及死亡和 BPD 之间的潜在权衡效应尚不确定。
共纳入来自 11 个欧洲国家 19 个地区的 7435 例活产儿（24+0 至 31+6 周龄）。主要结局为 36 周时的死亡和 BPD。我们使用多水平逻辑回归估计了未调整和调整后的分娩方式与 BPD 之间的关联，以考虑到单位和地区内的聚类。敏感性分析考虑了区域剖宫产率差异对 BPD 发生的影响。
与阴道分娩相比，剖宫产与 BPD 的发生率无关（OR 0.92，95%CI：0.68-1.25）或死亡或 BPD 的复合结局无关（OR 0.94，95%CI：0.74-1.19）在调整了围产期和新生儿危险因素后，在整个队列和可以考虑阴道分娩的妊娠中。在单胎、头位分娩和胎龄≥26+0 周的婴儿中进行的敏感性分析并未改变 BPD、重度 BPD 和死亡或 BPD 的结果，即使在剖宫产率较高的地区也是如此。
在我们的基于人群的队列研究中，分娩方式与 BPD 的发生率无关。在可以考虑阴道分娩的情况下，为了降低 BPD 而进行剖宫产并不合理。
