Analysis

Time to consider the risks of caesarean delivery for long term child health

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h2410 (Published 10 June 2015) Cite this as: BMJ 2015;350:h2410
  1. Jan Blustein, professor 1,
  2. Jianmeng Liu, professor2
  1. 1New York University Wagner Graduate School and Departments of Population Health and Medicine, School of Medicine, New York, USA
  2. 2Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
  1. Correspondence to: J Blustein jan.blustein{at}wagner.nyu.edu, J Liu liujm{at}pku.edu.cn
  • Accepted 25 March 2015

Jan Blustein and Jianmeng Liu examine the evidence linking caesarean delivery with childhood chronic disease and say that guidelines on delivery should be reviewed with these risks in mind

Caesarean delivery can improve maternal and child health, and even save lives. But the past two decades have brought a sharp growth in caesareans in many nations, raising concerns about unnecessarily high rates. Caesarean delivery on maternal request is relatively rare in the UK (1-2% of births) and US (3% of births). But in some middle income countries the rate is high and growing (20% of births in southeastern China in 2006), making it an emerging global public health concern. Another contributor to the rising rates is repeat caesarean. Although this is not necessarily medically indicated in women with otherwise low obstetrical risk, among US births to women with prior caesarean in 2006, over 90% were caesarean deliveries.

Prospective parents want a delivery that is safe for the baby.1 In emergencies, or when a fetal or maternal indication is present, the choice is clear. But in cooler moments, such as repeat or maternal choice of caesarean, it makes sense to consider the risks and benefits of caesarean versus vaginal delivery, just as we would for other medical treatments. Both modes of delivery are associated with well known acute risks. For the neonate, for example, a caesarean is associated with increased risk of admission to a neonatal intensive care unit and vaginal delivery with a greater likelihood of cephalohaematoma. To date, concerns around long term child health have largely focused on neurological impairment. But recent research points to latent risks for chronic disease: children delivered by caesarean have a higher incidence of type 1 diabetes, obesity, and asthma. We argue that a detailed assessment of these risks should be taken into …

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