New York, June 10 -- A new paper in the British Medical Journal by Jan Blustein, M.D., Ph.D., of New York University's Wagner School and a professor of Medicine and Population Health at NYU School of Medicine and Jianmeng Liu, M.D., Ph.D., of Peking University examines the evidence as to whether newborns delivered by Cesarean section are more likely to develop chronic diseases later in life. While the jury is still out and research is ongoing, recent studies underscore the need for health care providers to discuss with expectant parents the risk of babies born through cesarean section developing obesity, asthma, and diabetes, according to the paper by Blustein and Liu.
Cesarean section is sometimes a medical necessity, or even an emergency. But it is increasingly a choice made in cooler moments. C-section on mothers' request is growing globally. At the same time, while repeat cesarean is not necessarily medically indicated for women with otherwise low obstetrical risk, there is a 90 percent repeat cesarean rate among women giving birth who have had a prior cesarean, in the U.S.
While cesarean and vaginal deliveries are both associated with well-known acute risks, recent studies link C-section to long-term child chronic disease. The authors review this evidence from a variety of sources. These include observational studies where researchers locate large samples of children, assess the extent of disease, and look back to see how the children were delivered. They also include a clinical trial, in which mothers were prospectively randomized to undergo cesarean or vaginal delivery. The authors find that the evidence warrants concerns that C-section may lead to worse long-term child health.
These risks have yet to be mentioned in clinical guidelines, which are the official documents that are used to educate doctors and midwives. 'It's time to update the guidelines to include information about possible risks to long-term child health,' comments Blustein.
She acknowledges that the evidence linking cesarean to worse child health is not unequivocal. 'It is clear that cesarean-born children have worse health, but further research is needed to establish whether it is the cesarean that causes disease, or whether other factors are at play,' Blustein says. 'Getting definitive answers will take many years of further research. In the interim, we must make decisions based on the evidence that we have. To me, that evidence says that it is reasonable to believe that cesarean has the potential for long-term adverse health consequences for children.'
'It takes awhile for research findings to reach clinicians and patients,' says Blustein. 'This research isn't widely known. It is time for that to change, so that doctors, midwives and patients can weigh the risks and benefits of elective cesarean, and decide accordingly.'
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As already noted, the paper is embargoed for release on June 10 at 5:00 a.m. EST. It will be published in the British Medical Journal on June 13. Blustein is available for interview. To reach her, please contact the press officer listed with this press release.
Contributors and sources: JB and JL have conducted epidemiological research on the long term consequences of caesarean delivery on child health. JL is the senior author of a meta-analysis on the relation between caesarean delivery and child obesity. The authors have collaborated on epidemiological analyses of caesarean delivery in China. The concept for this paper grew out of their collaboration. JB wrote the first draft, and they both contributed to the development and final version of the piece.
Provenance and peer review: Not commissioned; externally peer reviewed.
Competing interests: JB and JL have read and understood BMJ policy on declaration of interests and declare JB was supported in part by the NYU CTSA grant UL1TR000038 from the National Center for the Advancement of Translational Science (NCATS), NIH, and JL receives support from the National Natural Science Foundation of China (No 81273163).
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