BACKGROUND
Medical (i.e. induction/augmentation) and surgical interventions (i.e. instrumental birth, caesarean section) during labour and birth are increasing globally, even though there is emerging evidence that these interventions may have a negative effect on children’s health in the long term. The EPIgenetic Impact of Childbirth (EPICC) hypothesis and Extended Hygiene Hypothesis (EHH) propose possible explanations: one through epigenetic priming and the other through seeding of the microbiome. Epidemiological studies have reported that children born by caesarean section have more adverse health outcomes (e.g. immune-related conditions, metabolic syndrome) compared with children born vaginally. However, most of these studies did not include the effect of medical interventions in their analyses. The aim of the present study is to gain a clearer understanding of the effect of both medical and surgical birth interventions on long-term child health.
METHODS
New South Wales (Australia) population linked datasets were analysed, including data on maternal characteristics, child characteristics, mode of birth, interventions during labour and birth, and adverse health outcomes of the children (ICD-10-AM) in the neonatal period (28 days) and early childhood (5 years). Women were included in the analyses if they were aged between 20-35 years, had a singleton pregnancy without obstetric/medical risk factors. Children were included with a gestational age between 37-41+6 weeks, and had a vertex presentation before birth.
Associations between mode of labour and birth and adverse health outcomes (i.e. jaundice, feeding problems, reduced thermogenic response, respiratory infections, gastritis and duodenitis, other infections, metabolic syndrome, and eczema) were calculated with Odds Ratios (OR) with 95% Confidence Intervals (95% CI). All results were adjusted for maternal characteristics (i.e. maternal age, country of birth, socio economic status, parity and pain relief during birth) and infant characteristics (i.e. gender, gestational age, birthweight, small for gestational age, large for gestational age and birth trauma).
PRELIMINARY RESULTS
A total of 491 590 low risk pregnant women and their children were included in this study. They had a mean age of 29 (SD 4) years, and 45% were nulliparous. Thirty eight percent (n=185 883) gave birth spontaneously, 28% (n=136 651) had a vaginal birth with induction/augmentation, 4% (n=19 865) had an instrumental birth, and 8% (n=41 631) had an instrumental birth with induction/augmentation. Eleven percent (n=55 499) had an elective caesarean section, 4% (n=17 216) an emergency caesarean section following spontaneous labour onset and 7% (n=34 845) had an emergency caesarean section after induction/augmentation. Compared with children born vaginally following spontaneous labour onset, children born with medical and/or surgical interventions showed higher incidence and/or significant higher associations with jaundice, feeding problems, reduced thermogenic response, respiratory infections, other infections, metabolic syndrome and eczema. Values of the OR (95% CI) will be presented at the NLBC 2017.
DISCUSSION AND CONCLUSION
The preliminary results support the EPIIC and EHH and hypothesis since it showed that medical and surgical interventions during birth appeared to be associated with several adverse health outcomes in children up till 5 years of age
1. Studies that integrate knowledge from a range of scientific approaches and/or perspecti , Basic science studies of the physiology, biochemistry, psychology, and sociology of normal , The identification and examination of relevant outcomes relating to labour and birth
