TY - JOUR
T1 - Estimating the effect of cesarean delivery on long-term childhood health across two countries
AU - Keshet, Ayya
AU - Rossman, Hagai
AU - Shilo, Smadar
AU - Barbash-Hazan, Shiri
AU - Amit, Guy
AU - Bivas-Benita, Maytal
AU - Yanover, Chen
AU - Girshovitz, Irena
AU - Akiva, Pinchas
AU - Ben-Haroush, Avi
AU - Hadar, Eran
AU - Wiznitzer, Arnon
AU - Segal, Eran
N1 - Publisher Copyright:
© 2022 Public Library of Science. All rights reserved.
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85140188805&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0268103
DO - 10.1371/journal.pone.0268103
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C2 - 36256630
AN - SCOPUS:85140188805
SN - 1932-6203
VL - 17
JO - PLoS ONE
JF - PLoS ONE
IS - 10 October
M1 - e0268103
ER -