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BMC Pediatrics
Published in: BMC Pediatrics 1/2012

Open Access 01-12-2012 | Research article

Asthma and atopy in children born by caesarean section: effect modification by family history of allergies – a population based cross-sectional study

Authors: Ourania Kolokotroni, Nicos Middleton, Marina Gavatha, Demetris Lamnisos, Kostas N Priftis, Panayiotis K Yiallouros

Published in: BMC Pediatrics | Issue 1/2012

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Abstract

Background

Studies on the association of birth by caesarean section (C/S) and allergies have produced conflicting findings. Furthermore, evidence on whether this association may differ in those at risk of atopy is limited. This study aims to investigate the association of mode of delivery with asthma and atopic sensitization and the extent to which any effect is modified by family history of allergies.

Methods

Asthma outcomes were assessed cross-sectionally in 2216 children at age 8 on the basis of parents’ responses to the ISAAC questionnaire whilst skin prick tests to eleven aeroallergens were also performed in a subgroup of 746 children. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models while evidence of effect modification was examined by introducing interaction terms in the models.

Results

After adjusting for potential confounders, children born by C/S appeared significantly more likely than those born vaginally to report ever wheezing (OR 1.36, 95% CI 1.07-1.71), asthma diagnosis (OR 1.41, 95% CI 1.09-1.83) and be atopic (OR 1.67, 95% CI 1.08-2.60). There was modest evidence that family history of allergies may modify the effect of C/S delivery on atopy (p for effect modification=0.06) but this was not the case for the asthma outcomes. Specifically, while more than a two-fold increase in the odds of being a topic was observed in children with a family history of allergies if born by C/S (OR 2.62, 95% CI 1.38-5.00), no association was observed in children without a family history of allergies (OR 1.16, 95% CI 0.64-2.11).

Conclusions

Birth by C/S is associated with asthma and atopic sensitization in childhood. The association of C/S and atopy appears more pronounced in children with family history of allergies.
Literature
1.
Flamm BL: Caesarean delivery in the United States: A summary of the past twenty years. Caesarean section: Guidelines for appropriate utilization. Edited by: Flamm BL, Quilligan EJ. 1995, New York: Springer VerlagCrossRef
2.
Black C, Kaye JA, Jick H: Caesarean delivery in the United Kingdom: time trends in the general practice research database. Obstet Gynecol. 2005, 106: 151-155.CrossRefPubMed
3.
Tranquilli AL, Giannubilo SR: Cesarean delivery on maternal request in Italy. Int J Gynaecol Obstet. 2004, 84: 169-170.CrossRefPubMed
4.
Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, van der Meulen JH: Variation in the rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010, 341: 5065-5072.CrossRef
5.
Statistical Service of the Republic of Cyprus: Perinatal Health Survey. 2007
6.
Kero J, Gissler M, Gronlund MM, Kero P, Koskinen P, Hemminki E, Isolauri E: Mode of delivery and asthma – is there a connection?. Pediatr Res. 2002, 52 (1): 6-11.PubMed
7.
Xu B, Pekkanen J, Hartikainen AL, Jarvelin MR: Caesarean section and risk of asthma and allergy in adulthood. J Allergy Clin Immunol. 2001, 107 (4): 732-733.CrossRefPubMed
8.
Maitra A, Sherriff A, Strachan D, Henderson J, ALSPAC Study Team: Mode of delivery is not associated with asthma or atopy in childhood. Clin Exp Allergy. 2004, 34 (9): 1349-1355.CrossRefPubMed
9.
Negele K, Heinrich J, Borte M, von Berg A, Schaaf B, Lehmann I, Wichmann HE, Bolte G, For the LISA Study Group: Mode of delivery and development of atopic disease during the first 2 years of life. Pediatr Allergy Immunol. 2004, 15 (1): 48-54.CrossRefPubMed
10.
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 (11): 1466-1472.CrossRefPubMed
11.
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.CrossRefPubMed
12.
Werner A, Ramlau-Hansen CH, Jeppesen SK, Thulstrup AM, Olsen J: Caesarean delivery and risk of developing asthma in the offspring. Acta Paediatr. 2007, 96: 595-596.CrossRefPubMed
13.
Menezes AM, Hallal PC, Matijasevich AM, Barros AJ, Horta BL, Araujo CL, Gigante DP, Santos IS, Minten G, Domingues MR, Dumith SC, Barros FC: Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clin Exp Allergy. 2011, 41: 218-223.CrossRefPubMedPubMedCentral
14.
Adlerberth I, Strachan DP, Matricardi PM, Ahrné S, Orfei L, Aberg N, Perkin MR, Tripodi S, Hesselmar B, Saalman R, Coates AR, Bonanno CL, Panetta V, Wold AE: Gut microbiota and development of atopic eczema in 3 European birth cohorts. J Allergy Clin Immunol. 2007, 120 (2): 343-350.CrossRefPubMed
15.
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 (1): 19-25.CrossRefPubMed
16.
Ly NP, Ruiz-Pérez B, Onderdonk AB, Tzianabos AO, Litonjua AA, Liang C, Laskey D, Delaney ML, DuBois AM, Levy H, Gold DR, Ryan LM, Weiss ST, Celedón JC: Mode of delivery and cord blood cytokines: a birth cohort study. Clin Mol Allergy. 2006, 4: 13-CrossRefPubMedPubMedCentral
17.
Neaville WA, Tisler C, Bhattacharya A, Anklam K, Gilbertson-White S, Hamilton R, Adler K, Dasilva DF, Roberg KA, Carlson-Dakes KT, Anderson E, Yoshihara D, Gangnon R, Mikus LD, Rosenthal LA, Gern JE, Lemanske RF: Developmental cytokine response profiles and the clinical and immunologic expression of atopy during the first year of life. J Allergy Clin Immunol. 2003, 33: 1537-1543.
18.
Abrahamsson TR, Sandberg Abelius M, Forsberg A, Bjorksten B, Jenmalm MC: A Th1/Th2 - associated chemokine imbalance during infancy in children developing eczema, wheeze and sensitization. Clin Exp Allergy. 2011, Epub ahead of print
19.
Matricardi PM: The role of early infections, hygiene and intestinal microflora. Pediatr Pulmonol. 2004, 37: 211-212.CrossRef
20.
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 (4): 629-633.CrossRefPubMed
21.
Bager P, Wohlfahrt J, Westergaard T: Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy. 2008, 38 (4): 634-642.CrossRefPubMed
22.
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 (2): 274-279.CrossRefPubMedPubMedCentral
23.
Roduit C, Scholtens S, de Jongste JC, Wijga AH, Gerritsen J, Postma DS, Brunekreef B, Hoekstra MO, Aalberse R, Smit HA: Asthma at 8 years of age in children born by caesarean section. Thorax. 2009, 64: 107-113.CrossRefPubMed
24.
Birnkrant DJ, Picone C, Markowitz W, El Khwad M, Shen WH, Tafari N: Association of transient tachypnea of the newborn and childhood asthma. Pediatr Pulmonol. 2006, 41: 978-984.CrossRefPubMed
25.
Mavalankar DV, Gray RH, Trivedi DR: Risk Factors for Preterm and Term Low Birthweight in Ahmedabad, India. Int J Epidemio. 1992, 21 (2): 263-272.CrossRef
26.
Victorino CC, Gauthier AH: The social determinants of child health: variations across health outcomes- a population based cross-sectional study. BMC Pediatr. 2009, 9: 53-64.CrossRefPubMedPubMedCentral
27.
Liem JJ, Kozyrskyj AL, Huq SI, Becker AB: The risk of developing food allergy in premature or low birth weight children. J Allergy Clin Immunol. 2007, 119 (5): 1203-1209.CrossRefPubMed
28.
Eggesbo M, Botten G, Stigum H, Nafstad P, Magnus P: Is delivery by cesarean section a risk factor for food allergy?. J Allergy Clin Immunol. 2003, 112 (2): 420-426.CrossRefPubMed
29.
Laubereau B, Filipiak-Pittroff B, von Berg A, Grübl A, Reinhardt D, Wichmann HE, Koletzko S, GINI Study Group: Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life. Arch Dis Child. 2004, 89 (11): 993-997.CrossRefPubMedPubMedCentral
30.
Vonk JM, Boezen HM, Postma DS, Schouten JP, van Aalderen WM, Boersma ER: Perinatal risk factors for bronchial hyperresponsiveness and atopy after a follow-up of 20 years. J Allergy Clin Immunol. 2004, 114 (2): 270-276.CrossRefPubMed
31.
Xu B, Pekkanen J, Jarvelin MR: Obstetric complications and asthma in childhood. J Asthma. 2000, 37 (7): 589-594.CrossRefPubMed
32.
Civelek E, Cakir B, Orhan F, Yuksel H, Boz AB, Uner A, Sekerel BE: Risk factors for current wheezing and its phenotypes among elementary school children. Pediatr Pulmonol. 2011, 46: 166-174.CrossRefPubMed
33.
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 (8): 682-687.CrossRefPubMed
34.
Scholtens S, Wijga AH, Brunekreef B, Kerkhof M, Postma DS, Oldenwening M, de Jongste JC, Smit HA: Maternal overweight before pregnancy and asthma in offspring followed for 8 years. Int J Obes. 2010, 34: 606-613.CrossRef
35.
Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Holt PG: Development of allergen specific T-cell memory in atopic and normal children. Lancet. 1999, 353: 196-200.CrossRefPubMed
36.
Hoffjan S, Nicolae D, Ostrovnaya I, Roberg K, Evans M, Mirel DB, Steiner L, Walker K, Shult P, Gangnon RE, Gern JE, Martinez FD, Lemanske RF, Ober C: Gene-Environment Interaction Effects on the Development of Immune Responses in the 1st Year of Life. Am J Hum Genet. 2005, 76: 696-704.CrossRefPubMedPubMedCentral
37.
Tan THT, Ellis JA, Saffery R, Allen KJ: The role of genetics and environment in the rise of childhood food allergy. Clin Exp Allergy. 2011, Epub ahead of print
Metadata
Title
Asthma and atopy in children born by caesarean section: effect modification by family history of allergies – a population based cross-sectional study
Authors
Ourania Kolokotroni
Nicos Middleton
Marina Gavatha
Demetris Lamnisos
Kostas N Priftis
Panayiotis K Yiallouros
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2012
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/1471-2431-12-179

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