Estimating the effect of cesarean delivery on long-term childhood health across two countries

Ayya Keshet, Hagai Rossman, Smadar Shilo, Shiri Barbash-Hazan, Guy Amit, Maytal Bivas-Benita, Chen Yanover, Irena Girshovitz, Pinchas Akiva, Avi Ben-Haroush, Eran Hadar, Arnon Wiznitzer*, Eran Segal*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Assessing the impact of cesarean delivery (CD) on long-term childhood outcomes is challenging as conducting a randomized controlled trial is rarely feasible and inferring it from observational data may be confounded. Utilizing data from electronic health records of 737,904 births, we defined and emulated a target trial to estimate the effect of CD on predefined long-term pediatric outcomes. Causal effects were estimated using pooled logistic regression and standardized survival curves, leveraging data breadth to account for potential confounders. Diverse sensitivity analyses were performed including replication of results in an external validation set from the UK including 625,044 births. Children born in CD had an increased risk to develop asthma (10-year risk differences (95% CI) 0.64% (0.31, 0.98)), an average treatment effect of 0.10 (0.07–0.12) on body mass index (BMI) z-scores at age 5 years old and 0.92 (0.68–1.14) on the number of respiratory infection events until 5 years of age. A positive 10-year risk difference was also observed for atopy (10-year risk differences (95% CI) 0.74% (-0.06, 1.52)) and allergy 0.47% (-0.32, 1.28)). Increased risk for these outcomes was also observed in the UK cohort. Our findings add to a growing body of evidence on the long-term effects of CD on pediatric morbidity, may assist in the decision to perform CD when not medically indicated and paves the way to future research on the mechanisms underlying these effects and intervention strategies targeting them.

Original languageEnglish
Article numbere0268103
JournalPLoS ONE
Volume17
Issue number10 October
DOIs
StatePublished - Oct 2022

Funding

FundersFunder number
Federal German Ministry for Education and Research
Weizmann Data Science Research Center
White Rose International Foundation
Masonic Charitable Foundation
European Research Council
Minerva Foundation
Else Kröner-Fresenius-Stiftung
Israel Science Foundation
Council for Higher Education
Crown Human Genome Center

    Fingerprint

    Dive into the research topics of 'Estimating the effect of cesarean delivery on long-term childhood health across two countries'. Together they form a unique fingerprint.

    Cite this