Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis.
Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis.
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DOI：
10.1016/j.clp.2011.03.008
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发表时间：
2011-06
影响因子：
2.1
通讯作者：
Rushing J
中科院分区：
文献类型：
--
作者：
Neu J;Rushing J
在美国，剖腹产率自1996年以来上升了48%，在2007年达到31.8%的水平。1这一趋势反映在世界许多地方，世界上人口最多的国家中国的人口接近50%2，巴西的一些私人诊所接近80%3。虽然相当多的CD是为产科指征而准备的，但有些CD只是由于母亲的要求，可能会给孩子带来几个风险。众所周知，这些风险包括全身麻醉引起的新生儿抑郁、剖宫产和/或分娩过程中胎儿受伤、即使是足月呼吸窘迫的可能性增加，以及母乳喂养并发症。在CD增加的同时，自身免疫性疾病如1型糖尿病、克罗恩病和多发性硬化症以及过敏性疾病如哮喘、过敏性鼻炎和特应性皮炎4，5的流行。这些疾病的发生率在更富裕的西方工业化国家更高。已经出现了几种理论，表明环境影响是导致这种现象的原因。最值得注意的是，“卫生假说”表明，过度清洁的环境，特别是在儿童早期，可能会导致几种儿童疾病的发生。它最早是由Strachan提出的，他观察到花粉热与兄弟姐妹的数量呈负相关。6这随后被其他人从过敏症扩展到自身免疫性疾病，如1型糖尿病。5本审查将讨论CD发病率的增加是否也有因果关系。
In the United States the rate of cesarean delivery (CD) has risen 48% since 1996, reaching a level of 31.8% in 2007. 1 This trend is reflected in many parts of the world, with the most populous country in the world, China, approaching 50% 2 and some private clinics in Brazil approaching 80% 3. While a significant number of CD are preformed for obstetrical indications, some are simply due to maternal request and may incur several risks for the child. Well known among these risks are neonatal depression due to general anesthesia, fetal injury during hysterotomy and/or delivery, increased likelihood of respiratory distress even at term, and breastfeeding complications. Concurrent with the trend of increasing CD, there has been an epidemic of both autoimmune diseases such as type 1 diabetes, Crohn's disease, and multiple sclerosis and allergic diseases, such as asthma, allergic rhinitis, and atopic dermatitis4, 5. The occurrence of these diseases is higher in more affluent, Western, industrialized countries. Several theories have emerged that suggest environmental influences are contributing to this phenomenon. Most notably, the “hygiene hypothesis” suggests that an overly clean environment, especially in early childhood, may contribute to the development of several childhood diseases. It was first proposed by Strachan, who observed an inverse correlation between hay fever and the number of older siblings. 6 This was subsequently extended by others from the allergies to autoimmune diseases such as type 1 diabetes. 5 Whether the increase in CD incidence is also causally related will be addressed in this review.
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DOI：
10.1073/pnas.1002601107
发表时间：
2010-06-29
影响因子：
11.1
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影响因子：
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