Offspring Long-Term Respiratory Morbidity Following Cesarean Delivery at Different Stages of Labor.

Background/

Objectives

Cesarean deliveries (CD) have been associated with an increased risk for offspring long-term respiratory morbidity. We sought to evaluate whether children born via CD in different stages of labor, and partially exposed to vaginal flora, would differ in their long-term respiratory morbidity.

Methods

A population-based study comparing long-term respiratory morbidity of children according to their mode of delivery and CD indication was conducted. Children born via CD for first stage non-progressive labor (CD-NPL1) and children born via CD for non-progressive labor in the second stage (CD-NPL2) were compared with children born vaginally (VD) as a reference group. Offspring hospitalizations up to 18 years involving respiratory morbidities were evaluated.

Results

313,782 deliveries were included; 97.7% were VD, 1.6% were CD for NPL1 and 0.7% were CD for NPL2. The overall respiratory-related hospitalization rates as well as the cumulative incidence of respiratory hospitalizations were significantly higher in children born via CD, with a graded association, related to fetal exposure to vaginal flora, noted between VD, CD-NPL2 and CD-NPL1 with the highest incidence. In a Cox model, controlling for multiple confounding variables, NPL1 (vs. VD) was associated with an increased risk for offspring long-term respiratory morbidity (aHR 1.15), while NPL2 did not differ in risk.

Conclusions

The risk for respiratory morbidity is increased for NPL1 offspring (with lower exposure to vaginal flora) as compared with NPL2 and VD offspring, with a graded association noted between exposure to vaginal flora during labor and the risk for offspring long-term respiratory morbidity.