Sitarik Alexandra R, Johnson Christine C, Levin Albert M, Lynch Susan V, Ownby Dennis R, Rundle Andrew G, Straughen Jennifer K, Wegienka Ganesa, Woodcroft Kimberley J, Cassidy-Bushrow Andrea E
Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States.
Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, United States.
Front Pediatr. 2023 Jun 14;11:1155852. doi: 10.3389/fped.2023.1155852. eCollection 2023.
Delivery via caesarean section (C-section) has been associated with an increased risk of childhood chronic diseases such as obesity and asthma, which may be due to underlying systemic inflammation. However, the impact of specific C-section types may be differential, as emergency C-sections typically involve partial labor and/or membrane rupture. Our objectives were to determine if mode of delivery associates with longitudinal profiles of high sensitivity CRP (hs-CRP) -a marker of systemic inflammation-from birth through preadolescence, and to examine if CRP mediates the association between mode of delivery and preadolescent body mass index (BMI).
Data from the WHEALS birth cohort ( = 1,258) were analyzed; 564 of the 1,258 children in the cohort had data available for analysis. Longitudinal plasma samples (birth through 10-years of age) from 564 children from were assayed for hs-CRP levels. Maternal medical records were abstracted to obtain mode of delivery. Growth mixture models (GMMs) were used to determine classes of hs-CRP trajectories. Poisson regression with robust error variance was used to calculate risk ratios (RRs).
Two hs-CRP trajectory classes were identified: class 1 (76% of children) was characterized by low hs-CRP, while class 2 (24% of children) was characterized by high and steadily increasing hs-CRP. In multivariable models, children delivered via planned C-section had 1.15 times higher risk of being in hs-CRP class 2, compared to vaginal deliveries ( = 0.028), while no association was found for unplanned C-section deliveries [RR (95% CI) = 0.96 (0.84, 1.09); = 0.49]. Further, the effect of planned C-section on BMI z-score at age 10 was significantly mediated by hs-CRP class (percent mediated = 43.4%).
These findings suggest potentially beneficial effects of experiencing partial or full labor, leading to a lower trajectory of systemic inflammation throughout childhood and decreased BMI during preadolescence. These findings may have implications for chronic disease development later in life.
剖宫产与儿童肥胖和哮喘等慢性疾病风险增加有关，这可能归因于潜在的全身炎症。然而，特定剖宫产类型的影响可能存在差异，因为急诊剖宫产通常涉及部分产程和/或胎膜破裂。我们的目标是确定分娩方式是否与从出生到青春期前高敏C反应蛋白（hs-CRP，一种全身炎症标志物）的纵向变化情况相关，并研究CRP是否介导分娩方式与青春期前体重指数（BMI）之间的关联。
分析了 WHEALS 出生队列（n = 1,258）的数据；该队列中的 1,258 名儿童中有 564 名儿童的数据可供分析。对 564 名儿童从出生到 10 岁的纵向血浆样本进行 hs-CRP 水平检测。提取产妇病历以获取分娩方式。使用生长混合模型（GMMs）确定 hs-CRP 轨迹类别。采用稳健误差方差的泊松回归计算风险比（RRs）。
确定了两个 hs-CRP 轨迹类别：第 1 类（76%的儿童）的特征是 hs-CRP 水平低，而第 2 类（24%的儿童）的特征是 hs-CRP 水平高且持续升高。在多变量模型中，与阴道分娩相比，计划剖宫产分娩的儿童处于 hs-CRP 第 2 类的风险高 1.15 倍（P = 0.028），而未计划剖宫产分娩未发现关联[RR（95%CI）= 0.96（0.84, 1.09）；P = 0.49]。此外，计划剖宫产对 10 岁时 BMI z 评分的影响有 43.4%由 hs-CRP 类别显著介导。
这些发现表明经历部分或全部产程可能具有有益影响，可导致整个儿童期全身炎症水平较低，并在青春期前降低 BMI。这些发现可能对生命后期的慢性病发展具有启示意义。
