Cesarean birth and childhood health
Real associations. Weak evidence that the cesarean caused them.
Many studies report associations between cesarean birth and later childhood asthma, obesity, type 1 diabetes and immune conditions. The important question is whether the operation causes them, or whether the same underlying factors that led to the cesarean also affect the child.
The studies designed to answer that question mostly say confounding.
- Asthma. In 87,500 Swedish sibling pairs, the association between planned cesarean and asthma disappeared entirely when siblings were compared with each other.
- Autism. In 2.7 million Swedish births, planned cesarean showed a 21% higher population-level hazard. Within 13,411 sibling pairs discordant for delivery mode, the association vanished completely.
- Comparing planned with unscheduled cesarean. In 321,287 Scottish children, planned and unscheduled cesarean did not differ in asthma, obesity, inflammatory bowel disease, cancer or death. Only type 1 diabetes differed, and by 0.22 percentage points.
- Type 1 diabetes and celiac disease. A Danish cohort of about two million children found no association with either.
The honest conclusionThe population-level associations are real and reproducible. The best-designed studies, which compare children within the same family, consistently find that the associations disappear. Anxiety about a cesarean permanently damaging your child's health is not supported by the strongest available evidence.
Where this comes from:
335. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995;102(2):101-106.
337. Almqvist C, Cnattingius S, Lichtenstein P, Lundholm C. The impact of birth mode of delivery on childhood asthma and allergic diseases: a sibling study. Clin Exp Allergy. 2012;42(9):1369-1376.
338. Black M, Bhattacharya S, Philip S, Norman JE, McLernon DJ. Planned cesarean delivery at term and adverse outcomes in childhood health. JAMA. 2015;314(21):2271-2279.
339. Curran EA, Dalman C, Kearney PM, Kenny LC, Cryan JF, Dinan TG, et al. Association between obstetric mode of delivery and autism spectrum disorder: a population-based sibling design study. JAMA Psychiatry. 2015;72(9):935-942.
340. Sevelsted A, Stokholm J, Bønnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Pediatrics. 2015;135(1):e92-e98.
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