ASTHMA

Asthma at 8 years of age in children born by caesarean section

C Roduit¹, S Scholtens², J C de Jongste³, A H Wijga¹, J Gerritsen⁴, D S Postma⁴, B Brunekreef^2,5, M O Hoekstra⁶, R Aalberse^7,8, H A Smit^1,5

¹ Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
² Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
³ Department of Pediatrics, Division of Respiratory Medicine, Erasmus MC – Sophia, Rotterdam, The Netherlands
⁴ Beatrix Children’s Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
⁵ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
⁶ Centre for Paediatric Allergology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
⁷ Sanquin Research, Amsterdam, The Netherlands
⁸ Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Dr H A Smit, National Institute for Public Health and the Environment (RIVM), Centre for Prevention and Health Services Research (pb 101), P O Box 1, 3720 BA Bilthoven, The Netherlands; jet.smit{at}rivm.nl

Background: Caesarean section might be a risk factor for asthma because of delayed microbial colonisation, but the association remains controversial. A study was undertaken to investigate prospectively whether children born by caesarean section are more at risk of having asthma in childhood and sensitisation at the age of 8 years, taking into account the allergic status of the parents.

Methods: 2917 children who participated in a birth cohort study were followed for 8 years. The definition of asthma included wheeze, dyspnoea and prescription of inhaled steroids. In a subgroup (n = 1454), serum IgE antibodies for inhalant and food allergens were measured at 8 years.

Results: In the total study population, 12.4% (n = 362) of the children had asthma at the age of 8 years. Caesarean section, with a total prevalence of 8.5%, was associated with an increased risk of asthma (OR 1.79; 95% CI 1.27 to 2.51). This association was stronger among predisposed children (with two allergic parents: OR 2.91; 95% CI 1.20 to 7.05; with only one: OR 1.86; 95% CI 1.12 to 3.09) than in children with non-allergic parents (OR 1.36; 95% CI 0.77 to 2.42). The association between caesarean section and sensitisation at the age of 8 years was significant only in children of non-allergic parents (OR 2.14; 95% CI 1.16 to 3.98).

Conclusions: Children born by caesarean section have a higher risk of asthma than those born by vaginal delivery, particularly children of allergic parents. Caesarean section increases the risk for sensitisation to common allergens in children with non-allergic parents only.

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