Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing

Sui-Ling Liao,Ming-Han Tsai,Jing-Long Huang,Chuan-Chi Kao,Man-Chin Hua,Chih-Yung Chiu,Kuan-Wen Su,Kuo-Wei Yeh,Tsung-Chieh Yao,Shih-Yin Huang,Shen-Hao Lai

doi:10.1038/s41598-017-07894-2

Sui-Ling Liao, Ming-Han Tsai + Show 9 more

Open Access

https://doi.org/10.1038/s41598-017-07894-2

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Abstract

The relationship between cesarean section (CS) and allergic disorders such as asthma and wheezing has been inconsistent, and the mechanisms for their connection remained largely unknown. We aimed to investigate whether CS is associated with infantile wheeze and to explore the connection between CS and several risk factors known to correlate with allergy development. Mononuclear cells were isolated from cord blood and assessed for cytokine responses by ELISA. Bacteria from nasopharyngeal specimens were identified with traditional culture methods. Infant lung function tests were performed at 6 and 12 months of age. IgE levels and clinical outcomes were assessed at 12 months. The result showed that children delivered by CS were associated with increased risk of wheezing (aHR 1.63; 95% CI: 1.01–2.62) and decreased compliance of the respiratory system at 12 months (p = 0.045). In addition, CS was associated with reduced TLR1–2- triggered TNF-α and IL-6 responses at birth. By12 months of age, children delivered by CS had significantly less airway bacterial clearance. Our findings suggested that CS was associated with decreased pro-inflammatory cytokine response to TLR1–2 stimulation, followed by higher abundance of bacterial colonization in the airway during late infancy, thus increasing the risk of infantile wheezing.

Highlights

The rate of cesarean deliveries has increased considerably in the last decade; the impact of delivery mode on the offspring’s’ future health deserves in-depth investigation
Given the apparent importance of these factors that might have critical influence on the ultimate pattern of allergy development, we aimed to investigate whether delivery by cesarean section (CS) has potential effects on these important elements known to associate with infantile allergic disorder
There were no significant differences in the maternal or neonatal characteristics between children born by CS or vaginal delivery, except that children delivered by CS had slightly lower gestational age; mean birth body weight remained similar between these 2 groups

Summary

Introduction

The rate of cesarean deliveries has increased considerably in the last decade; the impact of delivery mode on the offspring’s’ future health deserves in-depth investigation. Numerous studies have shown cesarean section (CS) to be associated with increased risk of developing future asthma and other wheezing disorder[1,2,3,4,5,6], several reports found no significant correlation[7,8,9]. The first aim of this study was to investigate whether CS is associated with increased risk of infantile wheezing and/or other allergic disorders in a prospective birth cohort study. Given the apparent importance of these factors that might have critical influence on the ultimate pattern of allergy development, we aimed to investigate whether delivery by CS has potential effects on these important elements known to associate with infantile allergic disorder

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