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Mode of delivery and childhood fractional exhaled nitric oxide, interrupter resistance and asthma: the Generation R study
Author(s) -
Berkel Annemaria C.,
Dekker Herman T.,
Jaddoe Vincent W. V.,
Reiss Irwin K.,
Gaillard Romy,
Hofman Albert,
Jongste Johan C.,
Duijts Liesbeth
Publication year - 2015
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12385
Subject(s) - medicine , asthma , exhaled nitric oxide , caesarean section , vaginal delivery , odds ratio , confidence interval , pediatrics , population , obstetrics , pregnancy , spirometry , genetics , environmental health , biology
Background Previous studies suggest that caesarean section may influence the risk of childhood asthma. We examined the associations of different modes of delivery with childhood wheezing patterns, asthma, fractional exhaled nitric oxide (Fe NO ) and airway interrupter resistance (Rint) up to school age. Methods This study among 6,128 children was embedded in a population‐based prospective cohort study. Information on mode of delivery was obtained from midwives and hospital registries. Wheezing patterns from birth onwards and ever physician‐diagnosed asthma at age 6 yr were assessed by questionnaires. Fe NO and Rint were measured at age 6 yr. We used multivariate polynomial, logistic and linear regression models. Results Compared with vaginal delivery, caesarean section was associated with increased risks of early and persistent wheezing up to school age [odds ratios (95% confidence interval): 1.36 (1.06, 1.75) and 1.73 (1.24, 2.40), respectively]. The effect sizes of elective and emergency caesarean section with wheezing outcomes were similar. Only elective caesarean section was associated with a higher Fe NO level [sympercent (95% CI ): 12.7 (0.6, 24.8)]. We did not observe associations of mode of delivery with asthma or Rint. Also, vacuum‐ or forceps‐assisted vaginal delivery was not associated with any asthma or related outcome. Conclusions Both elective and emergency caesarean sections are associated with increased risks of early and persistent wheezing up to school age. This might be explained by increased airway inflammation reflected by higher Fe NO levels.