Caesarean section, also known as C-section, is a surgical procedure for delivering a baby through incisions in the mother’s abdomen and uterus.
While C-section can be life-saving in many cases, recent studies suggest that it may increase the risk of asthma in children. Let’s take a closer look at the link between C-section and asthma.
What is Asthma?
Asthma is a chronic respiratory condition that affects millions of people worldwide. It causes inflammation and narrowing of the airways, leading to symptoms such as wheezing, coughing, chest tightness, and shortness of breath.
Asthma can be triggered by various factors, including allergies, pollution, exercise, and respiratory infections. In severe cases, asthma attacks can be life-threatening.
The Rise of C-Section
In recent decades, the rate of C-section has increased rapidly in many countries, particularly in developed nations.
According to the World Health Organization (WHO), around 21% of births worldwide are delivered by C-section, with rates ranging from 5% to 40% depending on the country. In the United States, the C-section rate was 32% in 2018, up from 21% in 1996.
Why C-Section is Done?
C-section is typically done for medical reasons, such as:.
- Fetal distress (abnormal heart rate or oxygen supply)
- Breech presentation (baby’s bottom or feet first instead of head down)
- Placenta previa (placenta covering the cervix)
- Multiple pregnancy (twins, triplets, or more)
- Previous C-section or other uterine surgery
- Maternal health conditions, such as high blood pressure, diabetes, or HIV
The Hypothesis on the Link between C-Section and Asthma
The exact mechanism behind the association between C-section and asthma is unclear, but some theories suggest that the delivery method may affect the development and function of the immune and respiratory systems in the fetus.
During a vaginal birth, the baby is exposed to the mother’s vaginal and gut bacteria, which can help colonize the newborn’s own gut and skin microbiome. This early exposure may also boost the baby’s immune system and reduce the risk of allergic and autoimmune diseases, including asthma.
In contrast, babies born by C-section are deprived of this microbial transfer, as they bypass the birth canal and are instead exposed to the skin and gut microbiome of the mother and the hospital environment.
Moreover, C-section may cause changes in lung mechanics and surfactant production in the baby, which can alter the lung development and increase the risk of respiratory problems, including asthma.
What Do the Studies Say?
Several studies have investigated the link between C-section and asthma, but the results are mixed and sometimes conflicting.
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The Blame Game: C-Section and Asthma
Some studies have reported a significant association between C-section and asthma, while others have found no or weak correlation.
For example, a meta-analysis of 22 studies published in the American Journal of Obstetrics and Gynecology in 2014 found that children born by C-section had a 22% higher risk of asthma compared to those delivered by vaginal birth after adjusting for other factors. The study also showed that the risk was greater in children without any family history of asthma or allergies.
Similarly, a study published in JAMA Pediatrics in 2018 analyzed data from more than 1.2 million children born in Sweden between 1998 and 2012 and found that those born by C-section had a 15% higher risk of asthma compared to those born vaginally.
The risk was slightly higher in children born by pre-labor C-section than in those born by emergency C-section.
On the other hand, a study published in the European Respiratory Journal in 2018 analyzed data from over 6,000 Danish children and found no significant difference in asthma prevalence between those born by C-section and those born vaginally after adjusting for confounding factors. However, the study did find that children born by C-section had a slightly higher risk of hospitalization for asthma, suggesting that C-section may increase the severity of asthma but not the incidence.
The Importance of Breastfeeding
Regardless of the delivery method, breastfeeding has been shown to provide numerous health benefits for both the mother and the baby, including boosting the immune system, reducing the risk of infections, and improving cognitive and emotional development. Breast milk also contains probiotics and other beneficial components that can help establish a healthy gut and lung microbiome in the baby.
Several studies have suggested that exclusive breastfeeding for at least six months can modulate the effect of C-section on asthma risk.
For example, a study published in JAMA Pediatrics in 2013 analyzed data from over 1,200 Brazilian children and found that those born by C-section had a twofold higher risk of asthma at age six compared to those born vaginally, but the risk was reduced by almost half in children who were exclusively breastfed for the first six months of life.
The Bottom Line
While the link between C-section and asthma is not fully understood, the evidence suggests that C-section may increase the risk of asthma in children, especially those without a family history of asthma or allergies.
However, C-section may be necessary to save the life or health of the mother or the baby in certain situations, and the benefits and risks should be weighed carefully by the healthcare providers and the parents.
Moreover, breastfeeding for at least six months can help mitigate the effect of C-section on asthma risk and provide numerous other health benefits.
Therefore, promoting and supporting breastfeeding should be a priority for public health initiatives worldwide.
