Allergy Asthma Immunol Res.  2010 Jan;2(1):28-33. 10.4168/aair.2010.2.1.28.

Relationship between mode of delivery in childbirth and prevalence of allergic diseases in Korean children

Affiliations
  • 1Department of Pediatrics and Institute of Allergy, BK 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea. mhsohn@yuhs.ac

Abstract

PURPOSE
We tested the hypothesis that cesarean section might increase the risk for allergic diseases compared to vaginal delivery, by depriving the newborn of exposure to maternal microflora.
METHODS
We evaluated the prevalence of allergic diseases, allergic inflammation, and allergic sensitization according to mode of delivery for 279 Korean children aged < or =16 years. Data were extracted from medical records and a questionnaire filled out by parents. Logistic regression was used to determine the association between cesarean section and the outcomes of interest.
RESULTS
Of the 279 children, 179 (62.6%) were delivered vaginally and 100 (37.4%) by cesarean section. There were no differences in the prevalence of allergic diseases, allergic inflammation, or allergic sensitization according to mode of delivery. Children born by cesarean section had no higher risk of allergic disease than those delivered vaginally, regardless of a parental history for allergic disease. Adjusted odds ratios (95% confidence intervals) for cesarean section compared to vaginal delivery were not statistically significant for any outcome considered: asthma, 0.76 (0.37-1.57), allergic rhinitis, 1.14 (0.61-2.10), atopic dermatitis, 1.01 (0.59-1.71).
CONCLUSIONS
Delivery by cesarean section may not be associated with the subsequent development of asthma, allergic rhinitis, or atopic dermatitis in Korean children.

Keyword

Hypersensitivity; cesarean section; obstetric delivery, child

MeSH Terms

Aged
Asthma
Cesarean Section
Child
Dermatitis, Atopic
Female
Humans
Hypersensitivity
Infant, Newborn
Inflammation
Logistic Models
Medical Records
Odds Ratio
Parents
Parturition
Pregnancy
Prevalence
Rhinitis
Rhinitis, Allergic, Perennial
Surveys and Questionnaires

Cited by  5 articles

Intestinal Microflora and Atopy Development in Infants during the First Nine Months
Jae-Seok Kim, Tae-Jung Sung, Hong Kyu Park, Ji Young Park, Hyoun Chan Cho, Il Tae Hwang, Hae-Ran Lee
Ann Clin Microbiol. 2014;17(3):73-79.    doi: 10.5145/ACM.2014.17.3.73.

Prevalence of Allergic Diseases and Risk Factors in Preschool Children, 2009
Young Hui Kim, Sang-Hwa Urm, Woo Kyung Kim
Pediatr Allergy Respir Dis. 2011;21(3):165-175.    doi: 10.7581/pard.2011.21.3.165.

Prevalence of Allergic Diseases in Children according to Mode of Delivery
Yong Ju Lee, Hye Mi Jee, Byoung Ju Kim, Hyo Bin Kim, Jinho Yu, So Yeon Lee, Woo Kyung Kim, Myung Hyun Sohn, Kyu-Earn Kim, Soo-Jong Hong, Kyung Won Kim
Pediatr Allergy Respir Dis. 2011;21(3):197-206.    doi: 10.7581/pard.2011.21.3.197.

Is Mode of Delivery Associated with an Increased Risk for Childhood Asthma?
Bong-Seong Kim
Pediatr Allergy Respir Dis. 2011;21(4):250-260.    doi: 10.7581/pard.2011.21.4.250.

Perinatal Risk Factors for Asthma and Allergic Rhinitis in Children and Adolescents
Se Hwan Hwang, Hyesoo Shin, Gulnaz Stybayeva, Do Hyun Kim
Clin Exp Otorhinolaryngol. 2024;17(2):168-176.    doi: 10.21053/ceo.2024.00024.


Reference

1. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, Williams H. ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006. 368:733–743.
2. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy. 2008. 38:634–642.
3. Menacker F. Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990-2003. Natl Vital Stat Rep. 2005. 54:1–8.
4. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2006. National vital statstics reports. 2007. Hyattsville (MD): National Center for Health Statistics.
5. Bennet R, Nord CE. Development of the faecal anaerobic microflora after caesarean section and treatment with antibiotics in newborn infants. Infection. 1987. 15:332–336.
6. Gronlund MM, Lehtonen OP, Eerola E, Kero P. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr. 1999. 28:19–25.
7. Grönlund MM, Arvilommi H, Kero P, Lehtonen OP, Isolauri E. Importance of intestinal colonisation in the maturation of humoral immunity in early infancy: a prospective follow up study of healthy infants aged 0-6 months. Arch Dis Child Fetal Neonatal Ed. 2000. 83:F186–F192.
8. Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989. 299:1259–1260.
9. Xu B, Pekkanen J, Jarvelin MR. Obstetric complications and asthma in childhood. J Asthma. 2000. 37:589–594.
10. Kero J, Gissler M, Grönlund MM, Kero P, Koskinen P, Hemminki E, Isolauri E. Mode of delivery and asthma - is there a connection? Pediatr Res. 2002. 52:6–11.
11. Renz-Polster H, David MR, Buist AS, Vollmer WM, O'Connor EA, Frazier EA, Wall MA. Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005. 35:1466–1472.
12. Bager P, Melbye M, Rostgaard K, Benn CS, Westergaard T. Mode of delivery and risk of allergic rhinitis and asthma. J Allergy Clin Immunol. 2003. 111:51–56.
13. Bernsen RM, de Jongste JC, Koes BW, Aardoom HA, van der Wouden JC. Perinatal characteristics and obstetric complications as risk factors for asthma, allergy and eczema at the age of 6 years. Clin Exp Allergy. 2005. 35:1135–1140.
14. Juhn YJ, Weaver A, Katusic S, Yunginger J. Mode of delivery at birth and development of asthma: a population-based cohort study. J Allergy Clin Immunol. 2005. 116:510–516.
15. Nafstad P, Magnus P, Jaakkola JJ. Risk of childhood asthma and allergic rhinitis in relation to pregnancy complications. J Allergy Clin Immunol. 2000. 106:867–873.
16. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, MacIntyre NR, McKay RT, Wanger JS, Anderson SD, Cockcroft DW, Fish JE, Sterk PJ. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000. 161:309–329.
17. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FE, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D; World Health Organization; GA(2)LEN; AllerGen. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008. 63:Suppl 86. 8–160.
18. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980. 92:44–47.
19. Maitra A, Sherriff A, Strachan D, Henderson J. Mode of delivery is not associated with asthma or atopy in childhood. Clin Exp Allergy. 2004. 34:1349–1355.
20. Hong SJ, Ahn KM, Lee SY, Kim KE. The Prevalences of Asthma and Allergic Diseases in Korean Children. Pediatr Allergy Respir Dis. 2008. 18:15–25.
21. Wylie BJ, Mirza FG. Cesarean delivery in the developing world. Clin Perinatol. 2008. 35:571–582. xii.
22. Hansen G, McIntire JJ, Yeung VP, Berry G, Thorbecke GJ, Chen L, DeKruyff RH, Umetsu DT. CD4(+) T helper cells engineered to produce latent TGF-beta1 reverse allergen-induced airway hyperreactivity and inflammation. J Clin Invest. 2000. 105:61–70.
23. Pessi T, Sutas Y, Hurme M, Isolauri E. Interleukin-10 generation in atopic children following oral Lactobacillus rhamnosus GG. Clin Exp Allergy. 2000. 30:1804–1808.
24. Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy. 2008. 38:629–633.
25. Pistiner M, Gold DR, Abdulkerim H, Hoffman E, Celedon JC. Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. J Allergy Clin Immunol. 2008. 122:274–279.
26. Koplin J, Allen K, Gurrin L, Osborne N, Tang ML, Dharmage S. Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review. Pediatr Allergy Immunol. 2008. 19:682–687.
27. McKeever TM, Lewis SA, Smith C, Hubbard R. Mode of delivery and risk of developing allergic disease. J Allergy Clin Immunol. 2002. 109:800–802.
Full Text Links
  • AAIR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr