New research has shown that babies born via Caesarean section have a greater risk of incurring the development of cardiovascular diseases and obesity and has launched an appeal to limit the increasingly widespread practice.
The results of the study have been published in the scientific journal Journal of Public Health Australia and New Zealand.
Caesarean section: what are the disadvantages?
The doctor Yaqoot Fatima of the Murtupuni Center for Rural and Remote Health of James Cook University together with the Doctor Tahmina Begum of the University of Queensland were part of a research group that used data from the longitudinal study of Australian babies to analyze the health outcomes of babies delivered by caesarean section.
“Caesarean section births have increased worldwide with a disproportionately higher rate in developed countries. In Australia, the caesarean section birth rate has increased from 18.5% in 1990 to 36% in 2019 and nearly half of Australian babies are expected to be born by caesarean section by 2045, ”said Dr Begum.
The researchers argued that the study found a relationship between caesarean section births and risk factors for cardiac disease exposure (CVD) in children: “Four out of six individual CVD risk components and the composite index of five risk components CVD showed a positive association with caesarean delivery. Our study also provided a direct relationship between caesarean section and increased overweight and obesity among 10-10 year olds. 12 years of age, ”said Dr. Fatima.
Dr. Begum also explained there was a biologically plausible reason for linking caesarean section to CVD risk factors and obesity: “There is an altered microbial load from cesarean delivery compared to vaginal delivery. This altered microbial ecosystem hinders the gut-brain axis and releases some pathogenic toxins that cause metabolic damage, ”he said.
Dr Fatima added that it was also possible that fetal stress due to physiological or pharmacological induction of labor during a caesarean section could have an effect: “In Australia in 2020, approximately 26% of deaths per year in the adult population were the result of CVD. Globally, the spectrum of chronic diseases of CVD costs trillions due to expenses related to health services and the loss of economic productivity ”.
The researcher said the study provides important insights into health policy and strategic direction towards reducing the risk of chronic disease: “Rising rates of caesarean sections conducted for non-clinical reasons is a major public health concern that requires a reduction of the rate of unnecessary caesarean sections and of the association’s human and economic costs, ”said Dr. Begum.
Another study, on the other hand, has identified the possibility that children born by caesarean section may be at a greater risk of developing Crohn’s disease later in life.
The results of the Research have been published in the scientific journal Acta Obstetrics et Gynecologica Scandinavian.
In the national population study, all people included in the medical birth register in Sweden between 1990 and 2000 were followed up until 2017. Among 1,102,468 people, of whom 11.6% were delivered by caesarean section and 88.4% were delivered vaginally, Caesarean section was associated with a 14% higher risk of developing Crohn’s disease after adjustment for confounding factors. No associations were found between delivery modes and appendicitis, ulcerative colitis, cholecystitis or diverticulosis.
“Our study is the largest in this field, and shows interesting new associations between caesarean section and increased risk later in life of incurring the Crohn’s disease. We hypothesize that the underlying mechanism could be the gut microbiome, but further studies will have to confirm this, ”said senior author Anna Löf Granström, of the Karolinska Institute in Sweden.
As for Italy, according to the Istituto Superiore Della Sanità: “In the last twenty years the frequency of caesarean section has increased greatly in Italy: it went from 11.2% in 1980 to 33.2% in 2000. This value is much higher than the values of other European countries (for example 21.5% in England and Wales, 17.8% in Spain, 15.9% in France) and 10-15% compared to what is recommended by the World Health Organization “.
“There is also a considerable regional variability, with a minimum of 18.7% in the Province of Bolzano and a maximum of 53.4% in Campania in 2000. Also within the regions there is a wide variability between structures. The greatest increases were observed in Southern Italy (from 8.5% in 1980 to 53.4% in 2000 in Campania and from 7.1% to 37.6% in Calabria). Higher values of recourse to caesarean section and greater increases over the years have been found in private clinics “.
Luigi Frigerio, Head of Obstetrics and Gynecology at the Papa Giovanni XXIII Hospital in Bergamo, said: “First of all the Caesarean section it is a full-blown surgical procedure that is not without risks for both mother and baby. In the vast majority of cases it has no consequences, but it cannot be ruled out that surgical, haemorrhagic, thrombo-embolic, infectious complications or related to local or total anesthesia may occur during the operation. In addition, surgery can increase the risk of uterus rupture and placentation errors in subsequent pregnancies. Or, again, it can lead to the formation of adhesions and cause chronic pelvic pain ”.
“As for the baby, the surgery exposes him to an increased risk of respiratory complications, being deprived of the pulmonary squeezing that occurs during the passage through the birth canal. Furthermore, being born with a caesarean section rather than vaginally involves differences in the composition of the microbiota: the set of bacteria that colonize the intestine, which can affect the maturation of the immune system and predispose to autoimmune diseases “.
However, there are cases for which intervening with a caesarean section is essential: “There are absolute indications for caesarean section: for example, in cases of placenta previa, abnormal presentation of the fetus, a narrow maternal pelvis, an excessively large child, in the presence of serious maternal diseases or a previo fibroma. And then, in all emergency situations: in cases of fetal distress, placental abruption, cervical abnormalities, bleeding from placenta previa or complications of gestosis ”, explained Professor Frigerio.
There is also the possibility that they are twins, one of which is breech: “There is a widespread idea that, in these cases, since a first child has already come out, it is easier for the second to make their way. However, there are no data in the literature that can guarantee sufficient safety in this regard. In America, this eventuality is not considered an absolute indication for caesarean section. On the other hand, there is a 2 – 4% risk of incarceration of the child’s head which must be taken into account. If it occurs, there is no room for maneuver. In the evaluation of the risk-benefit ratio, therefore, in Italy there is a tendency to prefer a caesarean to natural childbirth ”, specified Frigerio.
“As for the twin pregnancies, 85% of cases opt for a caesarean, due to prematurity, chorionicity – that is, when the twins share only one placenta, a situation that involves greater risks – or the presentation of one of the two fetuses in the breech position. Only in 10-15% of bigeminal pregnancies proceeds with the natural birth: when the amniotic sacs and the placentas are two and the twins present themselves in the cephalic position, that is with the head turned downwards ”.
The doctor Chiara Riviello he added: “During natural childbirth and especially in the period of labor, some complications may emerge (for which the health – or life – of the mother or fetus is really put at risk) that require immediate intervention by the medical team in the operating room with the indication of a emergency caesarean section. This can occur due to the detachment of the placenta, the prolapse of the umbilical cord, the alteration of the fetal heartbeat, the mother’s preenclapsia “.
As a gynecologist and more often in the exercise of my function as a forensic doctor, I find myself increasingly evaluating cases that deal with the aspect of correct assessment of the severity of complications and related management of emergency response times. To define these times, we doctors and health professionals refer to the international guidelines (NICE, ACOG) [note 1,2,3] which recite: “When acute fetal compromise is suspected or confirmed, a caesarean section should be performed as soon as possible and ideally within 30 minutes, taking into account fetal and maternal factors.”
“The history of the timing of caesarean section in emergency urgency sees a modification of the times established between the decision and the birth by caesarean. In fact, if starting from 1982 it was established that an obstetric service in the presence of high-risk patients would have to guarantee the execution of the caesarean section in 15 minutes, subsequent studies have shown on an analysis of over 500 hospitals, that most of these were able to perform an emergency caesarean section within 30 minutes, but not in 15, considering the time needed to set up the operating room, to the surgical preparation of the patient and from which the general anesthesia took effect. For this reason the adequate time of performing caesarean section in urgency in the interval of 30 minutes”.
“The timing of 30 minutes it can be excessively long in some emergency situations, which require immediate caesarean surgery, as in the example of a fetal suffering condition due to lack of oxygen (anoxic condition), due to the possible neurological repercussions on the baby’s brain. In fact, the published studies show that in this case the neurological damage is created in the first 5-6 minutes of absence of oxygen (see Myers experiments on primates which caused the interruption of the cerebral circulation) ”.
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