The impact of birth mode of delivery on childhood asthma and allergic diseases--a sibling study.
The impact of birth mode of delivery on childhood asthma and allergic diseases--a sibling study.
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DOI：
10.1111/j.1365-2222.2012.04021.x
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Lundholm C
中科院分区：
文献类型：
--
作者：
Almqvist C;Cnattingius S;Lichtenstein P;Lundholm C
据报道，剖腹产（CS）会增加后代患哮喘的风险。根据“卫生假说”，这可能是由于CS分娩的婴儿未暴露于阴道植物群。我们的目的是调查CS是否增加儿童哮喘的风险，以及使用同胞设计校正家族混杂因素后风险增加是否仍然存在。对87500对瑞典同胞进行了一项基于登记的队列研究。哮喘结果变量是从国家健康登记处收集的，作为诊断或哮喘药物（ICD-10 J 45-J 46; ATC代码R 03），在生命的第10年或第13年（随访年）。分娩方式和混杂因素从医学出生登记册中检索。这些数据作为一个队列进行分析，并与同胞对照分析，调整未测量的家族混杂。在队列分析中，CS患儿在随访期间接受哮喘药物治疗和哮喘诊断的风险增加（校正OR，95%CI分别为1.13，1.04-1.24和1.10，1.03-1.18）。当区分急诊和择期CS时，急诊CS对哮喘药物的影响仍然存在，但择期CS则没有，而与阴道分娩相比，两组对哮喘诊断均有显著影响。在同胞对照分析中，选择性CS对哮喘的影响消失，而紧急CS获得了相似但不显著的药物OR。在紧急CS出生的人群中，哮喘药物治疗的风险增加，但不是选择性的，这表明阴道微生物菌群没有因果关系。应在急诊CS的适应症中寻找更可能的解释。
Caesarean section (CS) has been reported to increase the risk of asthma in offspring. This may be due to that infants delivered by CS are unexposed to vaginal flora, according to the ‘hygiene hypothesis’. Our aim was to investigate if CS increases risk of childhood asthma, and if the risk increase remains after adjustment for familial confounding using sibling design. A register-based cohort study with 87 500 Swedish sibling pairs was undertaken. Asthma outcome variables were collected from national health registers as diagnosis or asthma medication (ICD-10 J45-J46; ATC code R03) during the 10th or 13th year of life (year of follow-up). Mode of delivery and confounders were retrieved from the Medical Birth Register. The data were analysed both as a cohort and with sibling control analysis which adjusts for unmeasured familial confounding. In the cohort analyses, there was an increased risk of asthma medication and asthma diagnosis during year of follow-up in children born with CS (adjusted ORs, 95% CI 1.13, 1.04–1.24 and 1.10, 1.03–1.18 respectively). When separating between emergency and elective CS the effect on asthma medication remained for emergency CS, but not for elective CS, while both groups had significant effects on asthma diagnosis compared with vaginal delivery. In sibling control analyses, the effect of elective CS on asthma disappeared, while similar but non-significant ORs of medication were obtained for emergency CS. An increased risk of asthma medication in the group born by emergency CS, but not elective, suggests that there is no causal effect due to vaginal microflora. A more probable explanation should be sought in the indications for emergency CS.
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影响因子：
6.1
作者：
Håkansson, S;Källén, K
通讯作者：
Källén, K
影响因子：
5.1
作者：
Tollanes, Mette C.;Moster, Dag;Irgens, Lorentz M.
通讯作者：
Irgens, Lorentz M.
影响因子：
6.1
作者：
Lundholm, C.;Ortqvist, A. K.;Almqvist, C.
通讯作者：
Almqvist, C.
影响因子：
8
作者：
Ortqvist, Anne Kristina;Lundholm, Cecilia;Almqvist, Catarina
通讯作者：
Almqvist, Catarina
影响因子：
6.1
作者：
Thavagnanam, S.;Fleming, J.;Cardwell, C. R.
通讯作者：
Cardwell, C. R.