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Cesarean (associated with low Vitamin D) increased asthma, obesity, miscarriage and stillbirth – meta-analysis Jan 2018

Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

PLOS x Published: January 23, 2018 https://doi.org/10.1371/journal.pmed.1002494
Oonagh E. Keag, Jane E. Norman, Sarah J. Stock

VitaminDWiki
Health Problem Which birthIncreased Risk
Asthma Current 21 %
Obesity – age 5 Current59 %
MiscarriageFuture17 %
StillbirthFuture 27 %
Placenta previa - typically 3%Future 74 %
Placenta accreta- typically 1 in 3,000Future295 %


Noted by VitaminDWiki

See also VitaminDWiki

Healthy pregnancies need lots of vitamin D has the following summary

Problem
ReducesProof
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT*
3. Gestational Diabetes 3 times RCT*
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Premature birth 2 times RCT*
6. C-section - unplanned 1.6 timesObserve
7. Depression AFTER pregnancy 1.4 times RCT*
8. Small for Gestational Age 1.6 times meta-analysis
9. Infant height, weight, head size
     within normal limits
RCT*
10. Childhood Wheezing 1.3 times RCT*
11. Additional child is Autistic 4 times Intervention
12.Young adult Multiple Sclerosis 1.9 timesObserve
13. Preeclampsia in young adult 3.5 timesRCT*
14. Good motor skills @ age 31.4 times Observe
15. Childhood Mite allergy 5 times RCT*
16. Childhood Respiratory Tract visits 2.5 times RCT*

 Download the PDF from VitaminDWiki

Chart shows 60 % less likely to have future pregnancies/births
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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.

Lots of supporting data files and figures are online

  • S1 Protocol.
  • S1 Moose Checklist.
  • S1 Table. Search strategy.
  • S2 Table. Maternal outcomes—Study characteristics.
  • S3 Table. Childhood outcomes—Study characteristics.
  • S4 Table. Subsequent pregnancy outcomes—Study characteristics.
  • S5 Table. Risk of bias assessment tool for Non-randomized studies.
  • S6 Table. Non-prespecified childhood outcomes after cesarean delivery compared to vaginal delivery.
  • S7 Table. Summary of associations and numbers needed to treat for benefit or harm.
  • S1 Fig. Study flow diagram of maternal outcomes database search.
  • S2 Fig. Study flow diagram of childhood outcomes database search.
  • S3 Fig. Study flow diagram of subsequent pregnancy outcomes database search.
  • S4 Fig. A random effects meta-analysis of urinary incontinence after cesarean delivery compared to vaginal delivery.
  • S5 Fig. A random effects meta-analysis of pelvic organ prolapse after cesarean delivery compared to vaginal delivery.
  • S6 Fig. A random effects meta-analysis of fecal incontinence after cesarean delivery compared to vaginal delivery.
  • S7 Fig. A fixed effects meta-analysis of pelvic pain after cesarean delivery compared to vaginal delivery.
  • S8 Fig. A random effects meta-analysis of no further pregnancy up to 28 years after cesarean delivery compared with vaginal delivery.
  • S9 Fig. A random effects meta-analysis of asthma in children up to 12 years old after cesarean delivery compared to vaginal delivery.
  • S10 Fig. A random effects meta-analysis of asthma in adults after cesarean delivery compared to vaginal delivery.
  • S11 Fig. A random effects meta-analysis of wheeze in children up to 5 years old after cesarean delivery compared to vaginal delivery.
  • S12 Fig. A fixed effects meta-analysis of wheeze in children 6–15 years old after cesarean *delivery compared to vaginal delivery.
  • S13 Fig. A random effects meta-analysis of hypersensitivity or allergy or dermatitis or atopy in children after cesarean delivery compared to vaginal delivery.
  • S14 Fig. A random effects meta-analysis of children being overweight at 3–8 years old after cesarean delivery compared to vaginal delivery.
  • S15 Fig. A random effects meta-analysis of obesity in children up to 5 years old after cesarean delivery compared to vaginal delivery.
  • S16 Fig. A random effects meta-analysis of obesity in children 6–15 years old after cesarean delivery compared to vaginal delivery.
  • S17 Fig. A fixed effects meta-analysis of adulthood obesity after cesarean delivery compared to vaginal delivery.
  • S18 Fig. A fixed effects meta-analysis of inflammatory bowel disease in children and adults up to age 35 years after cesarean delivery compared to vaginal delivery.
  • S19 Fig. A fixed effects meta-analysis of perinatal death in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S20 Fig. A random effects meta-analysis of placenta previa in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S21 Fig. A random effects meta-analysis of placenta accreta in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S22 Fig. A random effects meta-analysis of placental abruption in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S23 Fig. A random effects meta-analysis of uterine rupture in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S24 Fig. A random effects meta-analysis of miscarriage in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S25 Fig. A fixed effects meta-analysis of ectopic pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S26 Fig. A fixed effects meta-analysis of stillbirth in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S27 Fig. A random effects meta-analysis of hysterectomy in pregnancy after caesarean delivery compared to pregnancy after vaginal delivery.
  • S28 Fig. A fixed effects meta-analysis of having antepartum haemorrhage in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S29 Fig. A random effects meta-analysis of postpartum haemorrhage in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S30 Fig. A random effects meta-analysis of preterm labour in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S31 Fig. A random effects meta-analysis of having a small for gestational age baby in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S32 Fig. A random effects meta-analysis of having a baby with low birthweight (<2,500 g) in pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.
  • S33 Fig. A fixed effects meta-analysis of neonatal death following a pregnancy after cesarean delivery compared to pregnancy after vaginal delivery.

Created by admin. Last Modification: Friday January 26, 2018 20:32:58 UTC by admin. (Version 11)

Attached files

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9268 C other.jpg admin 26 Jan, 2018 19:53 37.66 Kb 20
9267 C Child other.jpg admin 26 Jan, 2018 19:52 31.79 Kb 12
9266 C - subfertility.jpg admin 26 Jan, 2018 19:52 27.31 Kb 16
9265 cesarean meta-analysis.pdf PDF 2018 admin 26 Jan, 2018 19:46 2.23 Mb 15
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