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      The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population‐based cohort study

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          Abstract

          Background

          Spontaneous vaginal birth rates are decreasing worldwide, while cesarean delivery, instrumental births, and medical birth interventions are increasing. Emerging evidence suggests that birth interventions may have an effect on children's health. Therefore, the aim of our study was to examine the association between operative and medical birth interventions on the child's health during the first 28 days and up to 5 years of age.

          Methods

          In New South Wales (Australia), population‐linked data sets were analyzed, including data on maternal characteristics, child characteristics, mode of birth, interventions during labor and birth, and adverse health outcomes of the children (ie, jaundice, feeding problems, hypothermia, asthma, respiratory infections, gastrointestinal disorders, other infections, metabolic disorder, and eczema) registered with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification codes. Logistic regression analyses were performed for each adverse health outcome.

          Results

          Our analyses included 491 590 women and their children; of those 38% experienced a spontaneous vaginal birth. Infants who experienced an instrumental birth after induction or augmentation had the highest risk of jaundice, adjusted odds ratio (aOR) 2.75 (95% confidence interval [CI] 2.61‐2.91) compared with spontaneous vaginal birth. Children born by cesarean delivery were particularly at statistically significantly increased risk for infections, eczema, and metabolic disorder, compared with spontaneous vaginal birth. Children born by emergency cesarean delivery showed the highest association for metabolic disorder, aOR 2.63 (95% CI 2.26‐3.07).

          Conclusion

          Children born by spontaneous vaginal birth had fewer short‐ and longer‐term health problems, compared with those born after birth interventions.

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          Most cited references23

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          Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.

          Suellen Miller, Edgardo Abalos, Monica Chamillard … (2016)
          On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
          Article 0 comments Cited 417 times – based on 0 reviews     Review now
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            Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

            Oonagh E. Keag, Jane E. Norman, Sarah Stock (2018)
            Background Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. Methods and findings Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with increased risk of miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies), but not perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies). Pregnancy following cesarean delivery was associated with increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies). This is a comprehensive review adhering to a registered protocol, and guidelines for the Meta-analysis of Observational Studies in Epidemiology were followed, but it is based on predominantly observational data, and in some meta-analyses, between-study heterogeneity is high; therefore, causation cannot be inferred and the results should be interpreted with caution. Conclusions When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery.
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              Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies.

              C Cardwell, L. Stene, G. Joner … (2008)
              The aim of this study was to investigate the evidence of an increased risk of childhood-onset type 1 diabetes in children born by Caesarean section by systematically reviewing the published literature and performing a meta-analysis with adjustment for recognised confounders. After MEDLINE, Web of Science and EMBASE searches, crude ORs and 95% CIs for type 1 diabetes in children born by Caesarean section were calculated from the data reported in each study. Authors were contacted to facilitate adjustments for potential confounders, either by supplying raw data or calculating adjusted estimates. Meta-analysis techniques were then used to derive combined ORs and to investigate heterogeneity between studies. Twenty studies were identified. Overall, there was a significant increase in the risk of type 1 diabetes in children born by Caesarean section (OR 1.23, 95% CI 1.15-1.32, p < 0.001). There was little evidence of heterogeneity between studies (p = 0.54). Seventeen authors provided raw data or adjusted estimates to facilitate adjustments for potential confounders. In these studies, there was evidence of an increase in diabetes risk with greater birthweight, shorter gestation and greater maternal age. The increased risk of type 1 diabetes after Caesarean section was little altered after adjustment for gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes (adjusted OR 1.19, 95% CI 1.04-1.36, p = 0.01). This analysis demonstrates a 20% increase in the risk of childhood-onset type 1 diabetes after Caesarean section delivery that cannot be explained by known confounders.
              Article 0 comments Cited 168 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Lilian L. Peters:
                ORCID: http://orcid.org/0000-0003-2342-0799
                L.L.Peters@umcg.nl
                Journal
                Journal ID (nlm-ta): Birth
                Journal ID (iso-abbrev): Birth
                Journal ID (doi): 10.1111/(ISSN)1523-536X
                Journal ID (publisher-id): BIRT
                Title: Birth (Berkeley, Calif.)
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0730-7659
                ISSN (Electronic): 1523-536X
                Publication date (Electronic): 25 March 2018
                Publication date (Print): December 2018
                Volume: 45
                Issue: 4 ( doiID: 10.1111/birt.2018.45.issue-4 )
                Pages: 347-357
                Affiliations
                [ 1 ] Department of Midwifery Science VU University Medical Center Amsterdam Amsterdam Public Health Research Institute Amsterdam The Netherlands
                [ 2 ] Department of General Practice & Elderly Care Medicine University Medical Center Groningen University of Groningen Groningen The Netherlands
                [ 3 ] AVAG Midwifery Academy Amsterdam Groningen Amsterdam/Groningen The Netherlands
                [ 4 ] College of Nursing and Health Sciences Adelaide Flinders University Adelaide SA Australia
                [ 5 ] School of Public Health University College Cork Cork Ireland
                [ 6 ] The Irish Centre for Fetal and Neonatal Translational Research University College Cork (INFANT) Cork Ireland
                [ 7 ] Westmead Newborn Intensive Care Unit Westmead Hospital University of Sydney Sydney NSW Australia
                [ 8 ] University of Central Lancashire Preston Lancashire UK
                [ 9 ] School of Nursing and Midwifery Sydney Western Sydney University Sydney NSW Australia
                [ 10 ] Affiliate of the Ingham Institute Liverpool NSW Australia
                [ 11 ] National Institute of Complementary Medicine Western Sydney University Sydney NSW Australia
                Author notes
                [*] [* ] Correspondence

                Lilian L. Peters, VU University Medical Center Amsterdam, Department of Midwifery Science/University Medical Center Groningen, The Netherlands.

                Email: L.L.Peters@ 123456umcg.nl

                Author information
                http://orcid.org/0000-0003-2342-0799
                http://orcid.org/0000-0003-4457-1799
                http://orcid.org/0000-0002-5384-3744
                http://orcid.org/0000-0001-5766-296X
                http://orcid.org/0000-0002-4450-3078
                Article
                Publisher ID: BIRT12348
                DOI: 10.1111/birt.12348
                PMC ID: 6282837
                PubMed ID: 29577380
                SO-VID: e4e32edb-e031-4907-b592-50ae8ecf9ee9
                Copyright © © 2018 the Authors. Birth published by Wiley Periodicals, Inc.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 December 2017
                Date revision received : 19 February 2018
                Date accepted : 19 February 2018
                Page count
                Figures: 0, Tables: 3, Pages: 11, Words: 8582
                Funding
                Funded by: Midwifery Academy Amsterdam Groningen
                Funded by: EU Cost Action IS1405
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id birt12348
                cover-date December 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.3 mode:remove_FC converted:06.12.2018

                Keywords: birth interventions,child's health,epidemiology
                Data availability:
                Keywords: birth interventions, child's health, epidemiology

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