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Estimating the effect of cesarean delivery on long-term childhood health across two countries

Assessing the impact of cesarean delivery (CD) on long-term childhood outcomes is challenging as conducting a randomized controlled trial is rarely feasible and inferring it from observational data may be confounded. Utilizing data from electronic health records of 737,904 births, we defined and emu...

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Autores principales: Keshet, Ayya, Rossman, Hagai, Shilo, Smadar, Barbash-Hazan, Shiri, Amit, Guy, Bivas-Benita, Maytal, Yanover, Chen, Girshovitz, Irena, Akiva, Pinchas, Ben-Haroush, Avi, Hadar, Eran, Wiznitzer, Arnon, Segal, Eran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578586/
https://www.ncbi.nlm.nih.gov/pubmed/36256630
http://dx.doi.org/10.1371/journal.pone.0268103
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author Keshet, Ayya
Rossman, Hagai
Shilo, Smadar
Barbash-Hazan, Shiri
Amit, Guy
Bivas-Benita, Maytal
Yanover, Chen
Girshovitz, Irena
Akiva, Pinchas
Ben-Haroush, Avi
Hadar, Eran
Wiznitzer, Arnon
Segal, Eran
author_facet Keshet, Ayya
Rossman, Hagai
Shilo, Smadar
Barbash-Hazan, Shiri
Amit, Guy
Bivas-Benita, Maytal
Yanover, Chen
Girshovitz, Irena
Akiva, Pinchas
Ben-Haroush, Avi
Hadar, Eran
Wiznitzer, Arnon
Segal, Eran
author_sort Keshet, Ayya
collection PubMed
description Assessing the impact of cesarean delivery (CD) on long-term childhood outcomes is challenging as conducting a randomized controlled trial is rarely feasible and inferring it from observational data may be confounded. Utilizing data from electronic health records of 737,904 births, we defined and emulated a target trial to estimate the effect of CD on predefined long-term pediatric outcomes. Causal effects were estimated using pooled logistic regression and standardized survival curves, leveraging data breadth to account for potential confounders. Diverse sensitivity analyses were performed including replication of results in an external validation set from the UK including 625,044 births. Children born in CD had an increased risk to develop asthma (10-year risk differences (95% CI) 0.64% (0.31, 0.98)), an average treatment effect of 0.10 (0.07–0.12) on body mass index (BMI) z-scores at age 5 years old and 0.92 (0.68–1.14) on the number of respiratory infection events until 5 years of age. A positive 10-year risk difference was also observed for atopy (10-year risk differences (95% CI) 0.74% (-0.06, 1.52)) and allergy 0.47% (-0.32, 1.28)). Increased risk for these outcomes was also observed in the UK cohort. Our findings add to a growing body of evidence on the long-term effects of CD on pediatric morbidity, may assist in the decision to perform CD when not medically indicated and paves the way to future research on the mechanisms underlying these effects and intervention strategies targeting them.
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spelling pubmed-95785862022-10-19 Estimating the effect of cesarean delivery on long-term childhood health across two countries Keshet, Ayya Rossman, Hagai Shilo, Smadar Barbash-Hazan, Shiri Amit, Guy Bivas-Benita, Maytal Yanover, Chen Girshovitz, Irena Akiva, Pinchas Ben-Haroush, Avi Hadar, Eran Wiznitzer, Arnon Segal, Eran PLoS One Research Article Assessing the impact of cesarean delivery (CD) on long-term childhood outcomes is challenging as conducting a randomized controlled trial is rarely feasible and inferring it from observational data may be confounded. Utilizing data from electronic health records of 737,904 births, we defined and emulated a target trial to estimate the effect of CD on predefined long-term pediatric outcomes. Causal effects were estimated using pooled logistic regression and standardized survival curves, leveraging data breadth to account for potential confounders. Diverse sensitivity analyses were performed including replication of results in an external validation set from the UK including 625,044 births. Children born in CD had an increased risk to develop asthma (10-year risk differences (95% CI) 0.64% (0.31, 0.98)), an average treatment effect of 0.10 (0.07–0.12) on body mass index (BMI) z-scores at age 5 years old and 0.92 (0.68–1.14) on the number of respiratory infection events until 5 years of age. A positive 10-year risk difference was also observed for atopy (10-year risk differences (95% CI) 0.74% (-0.06, 1.52)) and allergy 0.47% (-0.32, 1.28)). Increased risk for these outcomes was also observed in the UK cohort. Our findings add to a growing body of evidence on the long-term effects of CD on pediatric morbidity, may assist in the decision to perform CD when not medically indicated and paves the way to future research on the mechanisms underlying these effects and intervention strategies targeting them. Public Library of Science 2022-10-18 /pmc/articles/PMC9578586/ /pubmed/36256630 http://dx.doi.org/10.1371/journal.pone.0268103 Text en © 2022 Keshet et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Keshet, Ayya
Rossman, Hagai
Shilo, Smadar
Barbash-Hazan, Shiri
Amit, Guy
Bivas-Benita, Maytal
Yanover, Chen
Girshovitz, Irena
Akiva, Pinchas
Ben-Haroush, Avi
Hadar, Eran
Wiznitzer, Arnon
Segal, Eran
Estimating the effect of cesarean delivery on long-term childhood health across two countries
title Estimating the effect of cesarean delivery on long-term childhood health across two countries
title_full Estimating the effect of cesarean delivery on long-term childhood health across two countries
title_fullStr Estimating the effect of cesarean delivery on long-term childhood health across two countries
title_full_unstemmed Estimating the effect of cesarean delivery on long-term childhood health across two countries
title_short Estimating the effect of cesarean delivery on long-term childhood health across two countries
title_sort estimating the effect of cesarean delivery on long-term childhood health across two countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578586/
https://www.ncbi.nlm.nih.gov/pubmed/36256630
http://dx.doi.org/10.1371/journal.pone.0268103
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