Cesarean Delivery of Breeched Fetuses May Increase Long-Term Hospitalizations for Gastrointestinal Morbidities

newborn in hospital
Investigators assessed the effects of mode of delivery on overall long-term gastrointestinal health in fetuses born in the breech position.

Cesarean delivery of a breeched fetus was associated with long-term increased risk for hospitalization during childhood due to inflammatory bowel disease (IBD) and total gastrointestinal (GI) morbidity. These findings were published in the Journal of Clinical Gastroenterology.

This retrospective population-based cohort study was conducted at Soroka University Medical Center in Israel between 1991 and 2014. Outcomes in patients until 18 years of age were assessed on the basis of cesarean (n=6376) or vaginal (n=961) delivery of fetuses presenting in a breech position.

The cesarean and vaginal delivery cohorts included mothers aged mean 29.2±6.0 and 28.4±6.2 years (P <.001), 7.5% and 3.7% had gestational diabetes (P <.001), the gestational age was 37.9±2.3 and 38.4±2.6 weeks at delivery (P <.001), 47.0% and 47.6% of babies were boys, and 13.5% and 21.2% had low Apgar score (<7) at 1 minute, respectively.

Among the selected long-term GI-related hospitalization outcomes, IBD-related (1.8% vs 0.7%; P =.012) and total GI morbidity (6.6% vs 4.9%; P =.047) hospitalizations were more common among the cesarean delivery cohort. A Kaplan-Meier survival curve found a higher cumulative incidence of IBD-related (P =.004) and total GI morbidity (P <.001) hospitalizations.

Compared with the vaginal delivery cohort, risk for IBD-related hospitalizations was increased for mode of delivery (adjusted hazard ratio [aHR], 3.18; 95% CI, 1.47-6.87; P =.003) and gestational age at birth (aHR, 0.90; 95% CI, 0.83-0.98; P =.026). For total GI morbidity hospitalizations, cesarean delivery was also an independent predictor (aHR, 1.94; 95% CI, 1.39-2.71; P <.001).

These results were limited by the relatively low occurrence of GI conditions among the study cohort; additionally, this study was not designed to assess causality.

“In conclusion, while evidence suggests that cesarean delivery is preferable in lowering neonatal morbidity, our study does not provide the support that these associations continue beyond the neonatal period, as reflected by elevated GI morbidly among those delivered by cesarean delivery,” concluded the study authors.

Reference

Zamstein O, Bendersky AG, Sheiner E, Landau D, Levy A. Association between mode of delivery of the breech fetus and hospitalizations due to inflammatory bowel disease during childhood. J Clin Gastroenterol. 2022;56(2):e161-e165. doi:10.1097/MCG.0000000000001565