According to the results of a new study published this week in the journal PLOS Medicine, children born via cesarean section may be at an increased risk of hospitalization due to infection in their first years.
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Given that infection is the leading cause of hospitalization in children worldwide, this research has the potential to significantly impact the overall health of global populations by deepening our knowledge on childhood infection and developing effective preventative strategies.
The link between mode of birth and childhood infections not well understood
Previously, the link between the mode of birth and childhood infections had not been well researched. While the proportion of births by cesarean section continues to grow each year, having almost doubled since 2000, its impact on childhood infections, the leading cause of childhood hospitalization, is not well understood.
We spoke to Dr. Jessica Miller, the study’s author, to ask why the global proportion of cesarean section births has nearly doubled since 2000. Her response was the following;
The increase in cesarean sections is multifaceted and a single cause is not driving it. Factors related to the decision to perform cesarean sections include, but are not limited to, medical indications for mother or baby, social and cultural, and differences in health systems and facilities. However, it is important to stress that despite the small increased risk of childhood infections, cesarean births may be the safest option for some women and babies."
Dr. Jessica Miller
Researchers at the Murdoch Children's Research Institute, Australia, conducted a large-scale study to uncover the nature of the relationship between mode of birth and childhood infection. The team analyzed data from hospitals in Australia, Denmark, England, and Scotland relating to singleton children (single childbirth).
The data was collected between January 1st, 1996, and December 31st, 2015. During this period, children were followed until they were admitted to hospital for an infection-related reason. Children who did not face infection-related hospitalizations were followed until the end of the study until they turned five. In some cases, children were omitted from the study due to death or emigration.
An analysis was made to reveal the link between mode of birth and risk of infection. However, the study's authors recognize that they were not able to control for confounding variables that may have impacted the results, such as postnatal smoke exposure or vaccination status.
In comparison to children who are delivered vaginally, those born via cesarean section, according to the study's data, are at a 10% increased risk of being hospitalized as a result of infection by the age of five.
Preventing childhood infections
The study's findings are important for highlighting the need for further research into the nature of infectious diseases in children. One suggestion is that vaginal birth may expose children to microbes that may help children fight off infection in their early years.
However, extensive further research is required to explore this theory thoroughly and to use this evidence to develop strategies that may protect children born via cesarean section from infection.
Importantly, the paper's authors emphasize that the takeaway from their findings should not be that women should avoid having cesarean sections.
Often, a cesarean section is the safest option for a mother and baby, and, therefore, discouraging women from this option may cause unnecessary medical complications and even death.
Women should not be discouraged to have cesarean sections
The key takeaway from the study, the authors believe, is to highlight the link between cesarean section and childhood infection and inspire further research into the science underpinning this connection...
infection is the leading cause of early childhood hospitalization, and these findings should lead to studies to understand the mechanisms, including the effects of birth mode on immune development, and whether simple interventions, such as increasing breastfeeding rates, can onset any increased risks."
Further to explore the underlying mechanisms of this relationship, the authors also suggest that it would be valuable to conduct further research to understand whether the relationship between cesarean section and infection rates is the same in low and middle-income countries.
Data from these regions would be particularly impactful given that childhood infection is likely to be an increased burden in these locations.
- Miller JE, Goldacre R, Moore HC, Zeltzer J, Knight M, Morris C, et al. (2020) Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries. PLoS Med 17(11): e1003429. https://doi.org/10.1371/journal.pmed.1003429