Elective Caesarean Delivery Associated with Infant Hospitalisation for Intestinal But Not Respiratory Infection
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Elective Caesarean Delivery Associated with Infant Hospitalisation for Intestinal But Not Respiratory Infection Kim S. Betts1 · Ricardo J. Soares Magalhães2,3 · Rosa Alati1 Accepted: 7 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives We assessed the impact of caesarean delivery on offspring respiratory and intestinal infection. Methods Data were extracted from all live births (n = 429,058) occurring in the Australian state of Queensland between January 2009 and December 2015, and followed for 12 months. Births were categorised as either non-medically indicated caesarean or vaginal delivery and each offspring had a record (present/absent) of respiratory and intestinal infection hospitalisation for each month from birth to 12 months. Results Infants delivered by non-medically indicated caesarean were more likely to experience respiratory infection [OR = 1.51 (1.15, 1.99)] and intestinal infection [OR = 1.74 (1.19, 2.55)] than those born by vaginal delivery. In the propensity score weighted analyses the estimate for respiratory infection was similar but non-significant [OR = 1.52 (0.99, 2.31)], while the association with intestinal infection strengthened [OR = 2.21 (1.25, 3.89)]. Conclusions for Pratice Our findings provide strong evidence for a specific and clinically meaningful link between nonmedically indicated caesarean delivery and infant intestinal infection. Keywords Elective caesarean section · Intestinal infection · Respiratory infection · Epidemiology · Machine learning
Significance What is already known on the subject? Caesarean delivery has been shown to predict a range of negative health outcomes in neonates and infants, including suseptability to infections which may come from failure to prime the developing immune system. However, current research has been unable to control for important confounders. What this study adds? We use a machine learning big data approach to better control for confounding in a large sample Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10995-020-03065-4) contains supplementary material, which is available to authorized users. * Kim S. Betts [email protected] 1
School of Public Health, Curtin University, Perth, Australia
2
Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, Australia
3
Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia
of births taken from health administrative data. Using this method, we show caesarean delivery is associated with intentinal but not respiratory infections.
Introduction Recent studies and meta-analyses indicate caesarean delivery negatively affects a number of domains of offspring health, including respiratory infections, distress and wheeze, allergic rhinitis, asthma, diabetes, celiac disease and inflammatory bowel disorder (Bager et al. 2012, 2008; Cardwell et al. 2008; Karlström et al. 2013; Måri
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