Giuliana Grossi

An association was identified between emergency cesarean section and childhood 

, according to recent data. This relationship has been investigated before, however, previous results have yielded conflicting evidence.

While some studies showed the absence of a connection, others have indicated the disruption of infant intestinal flora that occurs during cesarean section can facilitate the development of allergens.

The aim of this study was to explore how the mode of delivery related to asthma development at 7, 11, or 14 years. Additionally, investigators examined persistent asthma and adolescent onset asthma by analyzing data acquired from the UK Millennium Cohort Study.

Does the Mode of Delivery Determine Asthma Risk?

In a research letter regarding the UK Millennium Cohort Study, Amy O’Connor, School of Public Health, University College Cork, Cork, Ireland, and a team of investigators hypothesized that if the disruption of infant intestinal microflora was responsible for the link between cesarean section and asthma, an association would be observed between planned cesarean section and asthma in this study.

The mode of delivery was categorized as one of the following: ‘spontaneous vaginal delivery’, ‘assisted vaginal delivery’, ‘induced vaginal delivery’, ‘emergency cesarean section’, ‘planned cesarean section’, and cesarean section after induction of labor.’ Investigators defined the variable as the effect of any intervention during labor, as opposed to no intervention.

One of the principal findings was the link between emergency cesarean section and asthma at ages 7, 11, and 14 years. According to the results, few associations were observed between assisted and induced vaginal delivery and asthma at the age of 11 and induced vaginal delivery and wheezing at 7 years.

The other principal finding came from assessing the relationship between planned cesarean section and asthma–after crude and adjusted model analyses, investigators observed no associations.

In the research letter, it was speculated that the positive associations could potentially include a disruption in the infant intestinal microflora following cesarean section. However, investigators emphasized that in that case, the expectation was related to planned cesarean section.

Some limitations noted by investigators included the possible role of recall bias for self-reported potential confounders, and that the data was collected before asthma status of the child was known. In instances of any misclassification, the letter stated this could bias results toward the null due to the likelihood of it being non-differential.

By confounding by indication, investigators didn’t have any information regarding the reasoning for planned or emergency C-section scenarios, which they explained could have influenced results.

The large, population-based cohort nationally represented children born in the UK between 2000-2002, which strengthened this research. Additionally, the outcome measure was determined by a validated questionnaire that exhibited a specificity of 93%, and is widely used to measure childhood asthma.

Unlike previous investigations, this one categorically distinguished planned C-section, and emergency C-section. Complications of pregnancy, maternal asthma, and several maternal and socio-economic factors were considered when controlling for potential confounders.

“In conclusion, children born by emergency CS, but not planned CS had an increased likelihood of asthma diagnosis,” investigators wrote. “These results suggest that the association may be due to confounding by indication or other residual confounding factors, and unlikely to be causal based on the microbiome theory.”

Mode of delivery and asthma in childhood and adolescence: Findings from the Millennium Cohort Study

This article was published by our sister publication HCP Live.

Articles

The relationship between cesarean sections and childhood asthma has been investigated before, however, previous results have yielded conflicting evidence.

From cesarean section to childhood asthma: New evidence sheds light on the relationship

American College of Gastroenterolgy 2021 conference

, Rawan Aljaras, MD, Indiana University School of Medicine, discussed the various ways in which diet can influence a patient’s 

Aljaras explained how important it is to continuously monitor trends in diet because of how closely related diet is to the gastrointestinal system. Certain diets have been proven to affect bowel movements and multiple gastrointestinal disorders.

When asked about an optimal diet for irritable bowel syndrome patients, Aljaras stressed the importance of fiber.

She reflected on how making dietary lifestyle changes can be a difficult process for a patient. Working with the patient to take baby steps and view the goal as a moving target is her focus.

“I feel like it’s always very easy for us as physicians to talk to patients about committing to lifestyle changes,” Aljaras said. “It's never easy in real life.”

As for the effect that the pandemic has had on patients’ diets, Aljaras said the impact was negative for everyone. She emphasized the amount of stress that came with the pandemic.

Many people were trying to keep up with life as usual even through the stress of quarantine. The impact of this could potentially be seen by doctors as a result of the poor dietary habits developed throughout this time and the effect they could have on the gastrointestinal system.

Watch the full interview originally published on HCP Live®. 

Dr. Aljaras talks about the importance of focusing on diet when examining irritable bowel syndrome.

The impact of diet on IBS

A team of investigators led by Katarina Remaeus, PhD, Karolinska Institutet, Department of medicine Solna, Clinical Epidemiology Division, conducted a cohort study in order to evaluate the impact that antirheumatic treatment had on pregnancy outcomes in women with psoriatic arthritis (PsA).

Investigators found that the risk of adverse outcomes increased the most in pregnancies with antirheumatic treatment, especially those treated with biologic disease modifying antirheumatic drugs (bDMARDs), during pregnancy, compared with non-psoriatic arthritis.

Of the few previous studies that describe maternal and neonatal pregnancy outcomes in women with psoriatic arthritis, some indicated an increased risk of preterm birth and cesarean delivery.

Investigators conducted a nationwide Swedish register-based cohort study of births from July 2007-December 2017 to compare pregnancy outcomes, with a focus on presence and timing of antirheumatic treatment in pregnancies with exposure to psoriatic arthritis compared with pregnancies without exposure to PsA.

Exposure to psoriatic arthritis was defined by women with a diagnosis of psoriatic arthritis in the NPR according to International Classification of Diseases (ICD)-10 codes L405, M070-1, and M073. First and subsequent pregnancies of these women were identified by linkage to the medical birth registry (MBR).

Unexposed pregnancies or non-psoriatic arthritis pregnancies were identified from the NPR and by the medical birth registry, the first and subsequent singleton pregnancies to women without diagnosis of inflammatory joint disease sampled from a pre-existing linkage.

In total, 921 psoriatic arthritis pregnancies and 9210 non-psoriatic arthritis pregnancies were identified by investigators. There were 10 unexposed pregnancies sampled matched on year of birth, maternal age, and parity.

Investigators used the prescribed drug register (PDR) to gather information on dispensed prescriptions for antirheumatic treatment. Antirheumatic treatment was defined as oral corticosteroids, conventional (cs) or biological (b) disease modifying antirheumatic drugs (DMARDs).

Of the 921 psoriatic arthritis pregnancies, 495 were pregnancies without any prior treatment for PsA in the year before pregnancy up until delivery and 426 were pregnancies with presence of any antirheumatic treatment within the same time frame.

The pregnancies were then further stratified, all based on presence and timing of maternal antirheumatic treatment and compared to the matched 9210 non-psoriatic pregnancies.

Results demonstrated that pregnancy outcomes varied with timing, presence and type of antirheumatic treatment.

The risk of adverse outcomes were found to be most increased in pregnancies with antirheumatic treatment, especially biologic disease modifying antirheumatic drugs, during pregnancy, compared with non-psoriatic arthritis.

Overall, the risk of preterm birth was increased for the main analysis of the 921 psoriatic arthritis pregnancies (aOR of 1.69, 95%CI 1.27-2.24).

The increased risks for spontaneous onset and medically indicated preterm birth were statistically significant, as well as for moderately, but not for very preterm birth. Elective (aOR 1.77, 95%CI 1.43-2.20) and emergency (aOR 1.42 95%CI 1.10-1.84) cesarean delivery showed an increased risk also.

The results displayed no differences in risk of pre-eclampsia, gestational diabetes or hypertension, small for gestational age, or large for gestational age in psoriatic arthritis pregnancies compared to non-psoriatic arthritis pregnancies.

Investigators recommended that all women with psoriatic arthritis should be counseled about pregnancy outcomes and receive individualized monitoring during pregnancy, regardless of antirheumatic treatment.

Pregnancy outcomes in women with psoriatic arthritis with respect to presence and timing of antirheumatic treatment

This article was initially published by our sister publication HCP Live.

The study examines the impact of antirheumatic treatment on pregnancy outcomes in women with psoriatic arthritis.

Giuliana Grossi

Articles

From cesarean section to childhood asthma: New evidence sheds light on the relationship

The impact of diet on IBS

Pregnancy outcomes vary in women with psoriatic arthritis