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Elective cesarean delivery at term and the long-term risk for endocrine and metabolic morbidity of the offspring

Published online by Cambridge University Press:  27 December 2018

R. Moshkovsky Open the ORCID record for R. Moshkovsky [Opens in a new window] ,
T. Wainstock ,
E. Sheiner ,
D. Landau  and
A. Walfisch
R. Moshkovsky*
Affiliation:
The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
T. Wainstock
Affiliation:
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
E. Sheiner
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
D. Landau
Affiliation:
Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
A. Walfisch
Affiliation:
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Address for correspondence: Ran Moshkovsky, The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel. E-mail: ranmos7@gmail.com
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Abstract

Other than obesity, no definitive insights have been gained regarding the apparent association between mode of delivery and long-term endocrine and metabolic outcomes in the offspring. We aimed to determine whether elective cesarean delivery (CD) impacts on long-term endocrine and metabolic morbidity of the offspring. A population-based cohort analysis was performed including all singleton-term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via a non-emergent CD and those delivered vaginally (VD). Hospitalizations of the offspring up to the age of 18 years involving endocrine morbidity were evaluated. A Kaplan–Meier survival curve was used to compare cumulative morbidity incidence. Cox and a Weibull regression models were used to control for confounders. During the study period 131,880 term deliveries met the inclusion criteria; 8.9% were elective non-urgent CDs (n=11,768) and 91.1% (n=120,112) were VDs. The survival curve demonstrated a significantly higher cumulative incidence of endo-metabolic morbidity in offspring born via CD (P=0.010). In the regression models, adjusted for maternal obesity, CD was not noted as an independent risk factor for long-term pediatric endocrine and metabolic morbidity of the offspring while maternal obesity emerged as a strong predictor. We therefore conclude that CD per-se does not appear to increase the risk for long-term pediatric endo-metabolic morbidity of the offspring.

Keywords

cesarean deliveryendocrinefollow-upmorbiditypediatric morbidity
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 10 , Issue 4 , August 2019 , pp. 429 - 435
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2018 

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Footnotes

Presented in part at the 38th annual SMFM meeting, Dallas, Texas, USA, January 2017.

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