The Effects of Different Modes of Delivery on the Structure
and Predicted Function of Intestinal Microbiota
in Neonates and Early Infants

Several studies have shown that an increased risk of metabolic and immune disorders associated with cesarean section mode of delivery may exist. However, such studies have not been conducted in the Chinese population. Stool sample sequencing of the gene encoding the 16S rRNA of 82 prospectively enrolled 3- and 30–42-day-old vaginal and cesarean section delivered newborns was performed to study the composition and predicted function of the intestinal microbiota. In the samples from the 3-day-old neonates, the levels of Escherichia-Shigella in the two groups were similar. The genera Bifidobacterium, Lactobacillus, and Bacteroides were more prominent in the vaginal delivery than in the cesarean section group, which showed a predominance of Staphylococcus, Streptococcus, and Corynebacterium. The differences between the two groups were statistically significant (p < 0.05). In the samples from 30- to 42-day-old infants, Bifidobacterium, Lactobacillus, Escherichia-Shigella, and Bacteroides were the main genera present in the vaginal delivery group, while in the cesarean section delivery group; the predominant genera were Escherichia-Shigella, Bifidobacterium, Bacteroides, and Staphylococcus. Predicted functions of the vaginal delivery group revealed higher metabolic and biodegradation rates of carbohydrates, vitamins, and xenobiotics than those in the cesarean section group, which contributed to the stability of the microbiota in the former. The abundance of probiotic bacteria such as Bifidobacterium and Lactobacillus, and the negative correlation between obesity and Bacteroides presence were higher in vaginally delivered infants than in cesarean-delivered infants at both studied time points.

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Prelabour Rupture of Membranes: Mode of Delivery and Outcome

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2015.037 ◽

2015 ◽

Vol 3 (2) ◽

pp. 237-240 ◽

Cited By ~ 3

Author(s):

Vlora Ademi Ibishi ◽

Rozalinda Dusan Isjanovska

Keyword(s):

Cesarean Section ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Fetal Distress ◽

Maternal Complications ◽

Cephalopelvic Disproportion ◽

Cesarean Section Delivery ◽

Clinical Center ◽

Failed Induction ◽

The University

BACKGROUND: Pre-labour Rupture of Membranes (PROM) is an important cause of maternal and fetal morbidity and increased rate of cesarean section delivery. AIM: The aim of this study is to investigate the clinical characteristics, PROM-delivery interval, mode of delivery, and early maternal neonatal outcome among pregnant patients presenting with pre-labour rupture of membranes.MATERIAL AND METHODS: This prospective case control study is implemented at the Obstetric and Gynecology Clinic of the University Clinical Center of Kosovo. The study included 100 pregnant patients presenting with prelabour rupture of membranes of which 63 were primigravida and 37 patients were multigravida.RESULTS: The incidence of cesarean section in this study is 28 % and the most common indications for cesarean delivery were fetal distress, malpresentation, cephalopelvic disproportion, and failed induction. The most common maternal complications in this study are chorioamnionitis, retained placenta and postpartum hemorrhage. Neonatal infectious morbidity was present in 16 % of cases.CONCLUSION: PROM is a significant issue for obstetricians and an important cause of maternal and neonatal morbidity and increased rate of cesarean section delivery.

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Cesarean section and offspring’s risk of multiple sclerosis: a Danish nationwide cohort study

Multiple Sclerosis Journal ◽

10.1177/1352458513480010 ◽

2013 ◽

Vol 19 (11) ◽

pp. 1473-1477 ◽

Cited By ~ 11

Author(s):

Nete M Nielsen ◽

Peter Bager ◽

Egon Stenager ◽

Bo V Pedersen ◽

Nils Koch-Henriksen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cesarean Section ◽

Cox Regression ◽

Mode Of Delivery ◽

Study Cohort ◽

Cox Regression Analysis ◽

Medical Birth Register ◽

Increased Risk ◽

Rate Ratios ◽

Log Linear

Background: Apart from a recent study reporting a 2- to 3-fold increased risk of multiple sclerosis (MS) among women and men who were delivered by Cesarean section (C-section), little attention has been given to the possible association between mode of delivery and the risk of MS. Objectives: We studied the association between C-section and risk of MS, in a cohort of 1.7 million Danes born from 1973 to 2005. Methods: Information on C-section and MS was obtained from the Danish Medical Birth Register and the Danish MS Register, respectively. The association between C-section and MS was evaluated by means of MS incidence rate ratios (RR) with 95% confidence intervals (CI) obtained in log-linear Poisson regression analyses. Results: There were 930 cases of MS in the study cohort, of whom 80 (9%) were delivered by C-section. Overall, we found there was no significant association between C-section and risk of MS (RR = 1.17; 0.92–1.46). Analyses stratified by sex revealed no unusual risk of MS for women (RR = 1.08: 0.80–1.42) nor men (RR = 1.37: 0.91–1.98). A supplementary sibling-matched Cox regression analysis likewise suggested there was no excess risk of MS in persons delivered by C-section (HR = 1.03; 0.63–1.69). Conclusions: Mode of delivery appears to be unimportant in relation to MS development in the offspring.

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Relationship between painless delivery and postpartum depression: The Japan Environment and Children’s Study (JECS)

10.21203/rs.3.rs-135960/v1 ◽

2021 ◽

Author(s):

Nobuhiro Suzumori ◽

Takeshi Ebara ◽

Hazuki Tamada ◽

Taro Matsuki ◽

Hirotaka Sato ◽

...

Keyword(s):

Postpartum Depression ◽

Cesarean Section ◽

Epidural Analgesia ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

First Trimester ◽

Regression Analyses ◽

One Year ◽

Spinal Epidural ◽

Paracervical Block

Abstract Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with painless delivery, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without analgesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, painless vaginal delivery was associated with a higher risk of postpartum depression (aOR: 1.218, 95% confidence interval: 1.067–1.391), compared with vaginal delivery without analgesia or cesarean section. Nevertheless, the risk disappeared one year after delivery. Among the pregnant women who requested painless delivery, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.0001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%) and cesarean delivery (3.5%) groups. Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after painless vaginal delivery, compared with vaginal delivery without analgesia or cesarean section. Requests for painless delivery continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying personality characteristics, including a tendency to worry.

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The Impact of Cesarean and Vaginal Delivery on Results of Psychological Cognitive Test in 5 Year Old Children

Medicina ◽

10.3390/medicina56100554 ◽

2020 ◽

Vol 56 (10) ◽

pp. 554

Author(s):

Barbora Blazkova ◽

Anna Pastorkova ◽

Ivo Solansky ◽

Milos Veleminsky ◽

...

Keyword(s):

Secondary Education ◽

Cognitive Development ◽

Cesarean Section ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Cognitive Test ◽

Cognitive Tests ◽

Higher Secondary Education ◽

University Degree ◽

The Impact

Background and objectives: The impact of cesarean and vaginal delivery on cognitive development was analyzed in 5 year old children. Materials and Methods: Two cohorts of 5 year old children born in the years 2013 and 2014 in Karvina (Northern Moravia) and Ceske Budejovice (Southern Bohemia) were studied for their cognitive development related to vaginal (n = 117) and cesarean types of delivery (n = 51). The Bender Visual Motor Gestalt Test (BG test) and the Raven Colored Progressive Matrices (RCPM test) were used as psychological tests. Results: In the comparison of vaginal delivery vs. cesarean section, the children delivered by cesarean section scored lower and, therefore, achieved poorer performance in cognitive tests compared to those born by vaginal delivery, as shown in the RCPM (p < 0.001) and in the BG test (p < 0.001). When mothers’ education level was considered, the children whose mothers achieved a university degree scored higher in both the RCPM test (p < 0.001) and the BG test (p < 0.01) compared to the children of mothers with lower secondary education. When comparing mothers with a university degree to those with higher secondary education, there was a significant correlation between level of education and score achieved in the RCPM test (p < 0.001), but not in the BG test. Conclusions: According to our findings, the mode of delivery seems to have a significant influence on performance in psychological cognitive tests in 5 year old children in favor of those who were born by vaginal delivery. Since cesarean-born children scored notably below vaginally born children, it appears possible that cesarean delivery may have a convincingly adverse effect on children’s further cognitive development.

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Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420954284 ◽

2020 ◽

pp. 000486742095428

Author(s):

Lei Sun ◽

Su Wang ◽

Xi-Qian Li

Keyword(s):

Postpartum Depression ◽

Confidence Interval ◽

Cesarean Section ◽

Vaginal Delivery ◽

Odds Ratio ◽

Meta Analysis ◽

Mode Of Delivery ◽

Spontaneous Vaginal Delivery ◽

Emergency Cesarean Section ◽

Emergency Cesarean

Background: Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery. Methods: We searched in three electronic databases: PubMed, EMBASE and Cochrane Library. Results: This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]). Conclusion: The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

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Vaginal Delivery versus Elective Caesarean Section for Breech Presentation - Experience in Institute of Child and Mother Health (ICMH)

Medicine Today ◽

10.3329/medtoday.v31i1.40317 ◽

2019 ◽

Vol 31 (1) ◽

pp. 23-26

Author(s):

Mahe Jabeen ◽

Sabiha Shimul ◽

Ummay Salma ◽

Jebunnesa

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Maternal Morbidity ◽

Neonatal Outcome ◽

Elective Caesarean Section ◽

Tertiary Care ◽

Mode Of Delivery ◽

Breech Presentation ◽

Cost Of Care ◽

Increased Risk

Introduction: Compared with a fetus with cephalic presentation, a breech fetus faces increased risk during labour and delivery of asphyxia from cord compression and of traumatic injury during delivery of the shoulders and head. Caesarean section avoids most of this risk. The purpose of this study was to evaluate the feasibility of vaginal delivery of uncomplicated singleton breech presentation by evaluating early neonatal morbidity and mortality as well as maternal morbidity following vaginal and caesarean delivery for breech presentation. Materials and Methods: This is a cross sectional comparative study.104 women with singleton breech presentation at term in labour were included consequetively in labour ward of Institute of Child and Mother Health (ICMH). Informed consent was taken from them. Neonatal and maternal outcome were recorded and statistical analysis was done using SPSS version 22. Results: APGAR at 5 min and Neonatal Intensive Care Unite (NICU) admission were not affected by mode of delivery. Long term neonatal outcome is similar in either mode of delivery. Maternal morbidity and duration of hospital stay is increased in caesarean births. Conclusion: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill & confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. Medicine Today 2019 Vol.31(1): 23-26

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Comparison of Melatonin Levels in the Colostrum between Vaginal Delivery and Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0037-1608681 ◽

2017 ◽

Vol 35 (05) ◽

pp. 481-485 ◽

Cited By ~ 1

Author(s):

Ziya Kalem ◽

Tuncay Yuce ◽

Batuhan Bakırarar ◽

Feride Söylemez ◽

Müberra Namlı Kalem

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Elective Cesarean Section ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional ◽

Emergency Cesarean ◽

Study Results ◽

Elective Cesarean

Objective This study aims to compare melatonin levels in colostrum between vaginal and cesarean delivery. Study Design This cross-sectional study was conducted with 139 mothers who gave live births between February 2016 and December 2016. The mothers were divided into three groups according to the mode of delivery: 60 mothers (43.2%) in the vaginal delivery group, 47 mothers (33.8%) in the elective cesarean delivery, and 32 mothers (23.0%) in the emergency cesarean delivery group. Colostrum of the mothers was taken between 01:00 and 03:00 a.m. within 48 to 72 hours following the delivery, and the melatonin levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the groups. Results The melatonin levels in the colostrum were the highest in the vaginal delivery group, lower in the elective cesarean section group, and the lowest in the emergency cesarean group (265.7 ± 74.3, 204.9 ± 55.6, and 167.1 ± 48.1, respectively; p < 0.001). The melatonin levels in the colostrum did not differ according to the demographic characteristics of the mothers, gestational age, birth weight, newborn sex, the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores, and for the requirement for neonatal intensive care. Conclusion Our study results showed that melatonin levels in the colostrum of the mothers who delivered vaginally were higher than those who delivered by cesarean section. Considering the known benefits of melatonin for the newborns, we believe that vaginal delivery poses an advantage.

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Cesarean delivery may increase the risk of multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458511424904 ◽

2011 ◽

Vol 18 (4) ◽

pp. 468-471 ◽

Cited By ~ 17

Author(s):

Amir-Hadi Maghzi ◽

Masoud Etemadifar ◽

Kiyan Heshmat-Ghahdarijani ◽

Safieh Nonahal ◽

Alireza Minagar ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cesarean Section ◽

Birth Order ◽

Vaginal Delivery ◽

Conditional Logistic Regression ◽

Mode Of Delivery ◽

Age At Onset ◽

Significant Risk ◽

Significant Difference ◽

Healthy Siblings

Background: Prenatal and perinatal factors are believed to contribute to the risk of developing multiple sclerosis (MS). Objective: This study was designed to evaluate whether mode of delivery (vaginal versus cesarean section), as a perinatal factor, affects susceptibility to MS. Methods: MS patients were recruited from the MS registry of Isfahan Multiple Sclerosis Society (IMSS) and were compared with their healthy siblings. Data regarding mode of delivery, birth order, and gestation week of birth were obtained through a specially designed questionnaire. Preterm or post term deliveries were excluded. We used conditional logistic regression statistics and adjusted for gender and birth order. Results: This study included 1349 participants (449 MS patients and 900 controls). Subjects who were born by cesarean section had significant risk of MS (odds ratio, OR = 2.51; 95% confidence interval, CI: 1.43–4.41; p = 0.001). There was significant MS risk for females who were born by cesarean section (OR = 2.69, 95% CI: 1.30–5.58; p = 0.008), but not for males (OR = 2.25, 95% CI: 0.90–5.63; p = 0.082). The mean age at onset was lower in MS patients born by cesarean section (24.58 ± 6.33) compared with that of patients born by vaginal delivery (27.59 ± 7.97; p = 0.041). There was no significant difference between the two groups for birth order ( p = 0.417). Conclusion: Our results suggest that those born by vaginal delivery are at a lower risk of subsequent MS. These preliminary findings will need to be addressed in a much larger and preferably prospective study.

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Cesarean Section or Vaginal Delivery to Prevent Possible Vertical Transmission From a Pregnant Mother Confirmed With COVID-19 to a Neonate: A Systematic Review

Frontiers in Medicine ◽

10.3389/fmed.2021.634949 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jianghui Cai ◽

Mi Tang ◽

Yu Gao ◽

Hongxi Zhang ◽

Yanfeng Yang ◽

...

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Vertical Transmission ◽

Mode Of Delivery ◽

Biomedical Literature ◽

Sufficient Evidence ◽

Cochrane Library ◽

Pregnant Mother ◽

Maternal Deaths ◽

Neonatal Deaths

Background: The impact of delivery mode on the infection rates of Coronavirus disease 2019 (COVID-19) in the newborn remains unknown. We aimed to summarize the existing literature on COVID-19 infection during pregnancy to evaluate which mode of delivery is better for preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate.Methods: We performed a comprehensive literature search of PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, and the Chinese Biomedical Literature database (CBM) from 31 December 2019 to 18 June 2020. We applied no language restrictions. We screened abstracts for relevance, extracted data, and assessed the risk of bias in duplicate. We rated the certainty of evidence using the GRADE approach. The primary outcome was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity in neonates born to mothers with confirmed COVID-19 following different delivery modes. Secondary outcomes were neonatal deaths and maternal deaths. This study is registered with PROSPERO, CRD42020194049.Results: Sixty-eight observational studies meeting inclusion criteria were included in the current study, with no randomized controlled trials. In total, information on the mode of delivery, detailed neonatal outcomes, and SARS-CoV-2 status were available for 1,019 pregnant women and 1,035 neonates. Six hundred and eighteen (59.71%) neonates were born through cesarean section and 417(40.29%) through vaginal delivery. Probable congenital SARS-CoV-2 infections were reported in 34/1,035 (3.29%) neonates. Of babies born vaginally, 9/417 (2.16%) were tested positive compared with 25/618 (4.05%) born by cesarean. Of babies born vaginally, 0/417 (0.00%) neonatal deaths were reported compared with 6/618 (0.97%) born by cesarean. Of women who delivered vaginally, 1/416 (0.24%) maternal deaths were reported compared with 11/603 (1.82%) delivered by cesarean. Two women died before delivery. Sensitivity analyses and subgroup analyses showed similar findings.Conclusions: The rate of neonatal COVID-19 infection, neonatal deaths, and maternal deaths are no greater when the mother gave birth through vaginal delivery. Based on the evidence available, there is no sufficient evidence supporting that the cesarean section is better than vaginal delivery in preventing possible vertical transmission from a pregnant mother confirmed with COVID-19 to a neonate. The mode of birth should be individualized and based on disease severity and obstetric indications. Additional good-quality studies with comprehensive serial tests from multiple specimens are urgently needed.Study registration: PROSPERO CRD42020194049.

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Influence of severity of total bile acids and mode of delivery on the perinatal outcomes in intrahepatic cholestasis of pregnancy

10.21203/rs.3.rs-267237/v1 ◽

2021 ◽

Author(s):

Chengcai Kong ◽

Fenglin Mei ◽

Pingping Xue ◽

Jingyun Cao ◽

Yong Li ◽

...

Keyword(s):

Bile Acids ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Intrahepatic Cholestasis ◽

Mode Of Delivery ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Fetal Outcomes ◽

Increased Risk ◽

Total Bile Acids ◽

Cholestasis Of Pregnancy

Abstract To assess the associations between mode of delivery and pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) based on the severity of maternal hypercholanemia. A hospital-based retrospective cohort study was performed between January 1, 2015, and December 31, 2019. Among the 177 women with mild total bile acids, 123 (69.5%) had a vaginal delivery and 54 (30.5%) underwent a cesarean delivery, of which 42 (23.7%) were planned and 12 (6.8%) were unplanned. Among the 50 severe ICP women, 13 (26.0%) had a vaginal delivery and 37 (74.0%) underwent a cesarean delivery, of which 26 (52.0%) were planned and 11 (22.0%) were unplanned. Severe ICP was associated with an increased risk of preterm delivery (P < 0.001), low birthweight (P=0.001), and neonatal intensive care unit admission (P < 0.001). Women with severe ICP (aOR, 5.017; 95% CI 1.848–13.622), planned cesarean delivery (aOR, 5.444; 95%CI 1.723–17.203), or unplanned cesarean delivery (aOR, 5.792; 95%CI 1.384–24.236) had increased risks of adverse fetal outcomes compared to controls. Both planned and unplanned cesarean delivery are associated with a higher incidence of adverse fetal outcomes and severe ICP than vaginal delivery.

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