Department of Environmental Health Sciences, School of Public Health, State University of New York, Albany, New York, USA.
Department of Epidemiology and Biostatistics, School of Public Health, State University of New York, Albany, New York, USA.
Am J Reprod Immunol. 2023 Apr;89(4):e13688. doi: 10.1111/aji.13688. Epub 2023 Feb 22.
Previous studies document an association between mode of delivery (MOD) and allergic conditions in children. Immunoglobulin (Ig) concentrations at birth may play a role. The goal of this study is to assess the impact of MOD on Ig concentrations at delivery from newborn dried blood spots (DBS).
The Upstate KIDS Study (2008-2010) is a prospective cohort of mother-child pairs recruited from New York State, excluding New York City. Ig subtypes IgA, IgE, IgG , IgG , IgG , IgG , and IgM were measured in residual NDBS from the Newborn Screening Program (N = 3274 infants). MOD was categorized as vaginal delivery (VD), emergency cesarean delivery (ECD) or planned cesarean delivery (PCD). Associations between MOD and Ig levels were assessed using ANOVA and multiple regression, with models adjusted for gestational age, birth weight, maternal race, plurality, and smoking status.
IgA, and the IgG subtypes IgG and IgG were found to be significantly lower in PCD neonates relative to VD neonates in adjusted regression models: 3.57 mg/ml, (95% CI: 3.51, 3.63) compared to 3.64 mg/ml (95% CI: 3.59, 3.69); 8.95 ng/ml (95% CI: 8.88,9.03) compared to 9.03 ng/ml (95% CI: 8.98, 9.08) and 8.05 ng/ml (95% CI: 7.91, 8.20) compared to 8.22 ng/ml (95% CI: 7.91,8.20), respectively.
MOD may thus be related to neonatal immune profile. Results were found to be robust to sensitivity testing based on maternal complications and indication for CD. Clinical implications are unclear given the small levels of association found in newborns, but the result suggests greater susceptibility to infection, and further study is warranted.
先前的研究记录了分娩方式（MOD）与儿童过敏状况之间的关联。出生时的免疫球蛋白（Ig）浓度可能起作用。本研究的目的是评估 MOD 对新生儿干血斑（DBS）中分娩时 Ig 浓度的影响。
2008-2010 年，Upstate KIDS 研究是一项前瞻性队列研究，从纽约州招募了母婴对，不包括纽约市。从新生儿筛查计划（N=3274 名婴儿）的剩余 NDBS 中测量 Ig 亚型 IgA、IgE、IgG、IgG、IgG、IgG 和 IgM。MOD 分为阴道分娩（VD）、紧急剖宫产（ECD）或计划性剖宫产（PCD）。使用方差分析和多元回归评估 MOD 与 Ig 水平之间的关联，调整模型包括胎龄、出生体重、产妇种族、多胎和吸烟状况。
在调整后的回归模型中，PCD 新生儿的 IgA 和 IgG 亚型 IgG 和 IgG 明显低于 VD 新生儿：3.57mg/ml（95%CI：3.51，3.63），而 3.64mg/ml（95%CI：3.59，3.69）；8.95ng/ml（95%CI：8.88，9.03），而 9.03ng/ml（95%CI：8.98，9.08）和 8.05ng/ml（95%CI：7.91，8.20），而 8.22ng/ml（95%CI：7.91，8.20）。
MOD 可能与新生儿免疫特征有关。基于产妇并发症和 CD 指征的敏感性测试结果稳健。鉴于在新生儿中发现的关联程度较小，临床意义尚不清楚，但结果表明对感染的易感性增加，需要进一步研究。
