Associations of caesarean delivery and the occurrence of neurodevelopmental disorders, asthma or obesity in childhood based on Taiwan birth cohort study

Long-term Risk for Type 1 Diabetes and Obesity in Early Term Born Offspring: A Systematic Review and Meta-Analysis

CONTEXT

Prematurity increases the long-term risks for endocrine and metabolic morbidity of offspring, but there is uncertainty regarding the risks for early-term deliveries (370/7-386/7 weeks of gestation).

OBJECTIVE

We aim to evaluate whether early-term deliveries increase the long-term risk for type 1 diabetes and obesity of offspring up to the age of 18 years compared with full-term children. PubMed, Medline, and EMBASE were searched. Observational cohort studies addressing the association between early-term delivery and long-term risk for type 1 diabetes and obesity, were included. Two independent reviewers extracted data and assessed risk of bias. Pooled relative risks (RRs) and heterogeneity were determined. Publication bias was assessed by funnel plots with Egger's regression line and contours, and sensitivity analyses were performed.

RESULTS

Eleven studies were included following a screen of 7500 abstracts. All studies were scored as high quality according to the Newcastle-Ottawa Quality Assessment Scale. Early-term delivery was significantly associated with an increased risk for type 1 diabetes (RR 1.19, 1.13-1.25), while the association was weaker for overweight and obesity (RR 1.05, 0.97-1.12). It is challenging to determine whether the association between early-term births and long-term morbidity represents a cause and effect relationship or is attributable to confounders. Most of the included studies adjusted for at least some possible confounders.

CONCLUSION

Compared with full-term offspring, early-term delivery poses a modest risk for long-term pediatric type 1 diabetes. Our analysis supports that, whenever medically possible, elective delivery should be avoided before 39 completed weeks of gestation.

Bridging the Mind and Gut: Uncovering the Intricacies of Neurotransmitters, Neuropeptides, and their Influence on Neuropsychiatric Disorders

BACKGROUND

The gut-brain axis (GBA) is a bidirectional signaling channel that facilitates communication between the gastrointestinal tract and the brain. Recent research on the gut-brain axis demonstrates that this connection enables the brain to influence gut function, which in turn influences the brain and its cognitive functioning. It is well established that malfunctioning of this axis adversely affects both systems' ability to operate effectively.

OBJECTIVE

Dysfunctions in the GBA have been associated with disorders of gut motility and permeability, intestinal inflammation, indigestion, constipation, diarrhea, IBS, and IBD, as well as neuropsychiatric and neurodegenerative disorders like depression, anxiety, schizophrenia, autism, Alzheimer's, and Parkinson's disease. Multiple research initiatives have shown that the gut microbiota, in particular, plays a crucial role in the GBA by participating in the regulation of a number of key neurochemicals that are known to have significant effects on the mental and physical well-being of an individual.

METHODS

Several studies have investigated the relationship between neuropsychiatric disorders and imbalances or disturbances in the metabolism of neurochemicals, often leading to concomitant gastrointestinal issues and modifications in gut flora composition. The interaction between neurological diseases and gut microbiota has been a focal point within this research. The novel therapeutic interventions in neuropsychiatric conditions involving interventions such as probiotics, prebiotics, and dietary modifications are outlined in this review.

RESULTS

The findings of multiple studies carried out on mice show that modulating and monitoring gut microbiota can help treat symptoms of such diseases, which raises the possibility of the use of probiotics, prebiotics, and even dietary changes as part of a new treatment strategy for neuropsychiatric disorders and their symptoms.

CONCLUSION

The bidirectional communication between the gut and the brain through the gut-brain axis has revealed profound implications for both gastrointestinal and neurological health. Malfunctions in this axis have been connected to a range of disorders affecting gut function as well as cognitive and neuropsychiatric well-being. The emerging understanding of the role of gut microbiota in regulating key neurochemicals opens up possibilities for novel treatment approaches for conditions like depression, anxiety, and neurodegenerative diseases.

Association of cesarean section with asthma in children/adolescents: a systematic review and meta-analysis based on cohort studies

BACKGROUND

Whether cesarean section (CS) is a risk factor for asthma in offspring is controversial. The purpose of this study was to investigate the association between CS and asthma in children/adolescents.

METHODS

Pubmed, Embase, Web of Science, and Cochrane Library electronic databases were searched for cohort studies on the relationship between mode of delivery and asthma in children/adolescents up to February 2023. Birth via CS was considered an exposure factor. Asthma incidence was taken as a result.

RESULTS

Thirty-five cohort studies (thirteen prospective and twenty-two retrospective cohort studies) were included. The results showed that the incidence of asthma was higher in CS offspring (odds ratio (OR) = 1.18, P < 0.001) than in the vaginal delivery (VD) group. Partial subgroup analyses showed a higher incidence of asthma in female offspring born via CS (OR = 1.26, P < 0.001) compared with the VD group, while there was no difference in males (OR = 1.07, P = 0.325). Asthma incidence was higher in CS offspring than in the VD group in Europe (OR = 1.20, P < 0.001), North America (OR = 1.15, P < 0.001), and Oceania (OR = 1.06, P = 0.008). This trend was not found in the Asian population (OR = 1.17, P = 0.102). The incidence of atopic asthma was higher in offspring born via CS (OR = 1.14, P < 0.001) compared to the VD group. The CS group had a higher incidence of persistent asthma, but the difference did not reach statistical significance (OR = 1.15, P = 0.063).

CONCLUSION

In this meta-analysis, CS may be a risk factor for asthma in offspring children/adolescents compared with VD. The relationship between CS and asthma was influenced by sex and region.

Association between Gut Dysbiosis and the Occurrence of SIBO, LIBO, SIFO and IMO

Gut microbiota is the aggregate of all microorganisms in the human digestive system. There are 1014 CFU/mL of such microorganisms in the human body, including bacteria, viruses, fungi, archaea and protozoa. The Firmicutes and Bacteroidetes bacteria phyla comprise 90% of the human gut microbiota. The microbiota support the healthy functioning of the human body by helping with digestion (mainly via short-chain fatty acids and amino acids) and producing short-chain fatty acids. In addition, it exhibits many physiological functions, such as forming the intestinal epithelium, intestinal integrity maintenance, the production of vitamins, and protection against pathogens. An altered composition or the number of microorganisms, known as dysbiosis, disrupts the body's homeostasis and can lead to the development of inflammatory bowel disease, irritable bowel syndrome, and metabolic diseases such as diabetes, obesity and allergies. Several types of disruptions to the gut microbiota have been identified: SIBO (Small Intestinal Bacterial Overgrowth), LIBO (Large Intestinal Bacterial Overgrowth), SIFO (Small Intestinal Fungal Overgrowth), and IMO (Intestinal Methanogen Overgrowth). General gastrointestinal problems such as abdominal pain, bloating, gas, diarrhoea and constipation are the main symptoms of dysbiosis. They lead to malabsorption, nutrient deficiencies, anaemia and hypoproteinaemia. Increased lipopolysaccharide (LPS) permeability, stimulating the inflammatory response and resulting in chronic inflammation, has been identified as the leading cause of microbial overgrowth in the gut. The subject literature is extensive but of limited quality. Despite the recent interest in the gut microbiome and its disorders, more clinical research is needed to determine the pathophysiology, effective treatments, and prevention of small and large intestinal microbiota overgrowth. This review was designed to provide an overview of the available literature on intestinal microbial dysbiosis (SIBO, LIBO, SIFO and IMO) and to determine whether it represents a real threat to human health.

Risks of attention-deficit/hyperactivity disorder, autism spectrum disorder, and intellectual disability in children delivered by caesarean section: A population-based cohort study

This population-based study investigated the risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disabilities among children delivered by Cesarean section (CS) in comparison with those who were delivered by vaginal delivery (VD). The Taiwan Maternal and Child Health Database from 2004 to 2016 registered 675,718 and 1,208,983 children delivered by CS and by VD, respectively. The results of Cox proportional hazards regression model demonstrated that children delivered by CS had significantly higher risks of ADHD, ASD, and intellectual disability than those delivered by VD after the confounding effects of maternal and child factors were controlled for.

Childhood overweight and obesity and abnormal birth anthropometric measures are associated with a higher prevalence of childhood asthma in pre-school age

OBJECTIVES

Childhood asthma is one of the most common non-communicable diseases in the world. Several perinatal and postnatal factors have been associated with increased risk of developing childhood asthma. The present study aims to assess whether childhood overweight and obesity and abnormal birth anthropometric measures affect the risk of developing childhood asthma in preschool age.

METHODS

In this study, 5215 preschool children at the age of 2-5 years were enrolled after applying several inclusion and exclusion criteria and they examined whether they present asthma symptoms. Non-adjusted and adjusted statistical analysis was performed to assess whether perinatal and postnatal factors increase the risk of developing childhood asthma.

RESULTS

A prevalence of 4.5% of childhood asthma was recorded. Among children diagnosed with asthma, 19.4% were affected by overweight and 13.9% were obese. Childhood overweight/obesity was indepedently associated with a 76% higher risk of childhood asthma than normal weight. Abnormal birth anthropometric measures, i.e. birth weight, length, and head circumference, were independently associated with higher odds (87%, 29%, and 23%, respectively) of childhood asthma than normal ranges.

CONCLUSIONS

This is a cross-sectional, nationally representative study which supported evidence that childhood overweight/obesity and abnormal birth anthropometric measures may independently increase the risk of childhood asthma in preschool age. Emergent health policies and strategies are recommended to promote a healthy lifestyle, preventing childhood obesity at the early stages of life.

Role of Gut Microbiome in Autism Spectrum Disorder and Its Therapeutic Regulation

Autism spectrum disorder (ASD) is a neurological disorder that affects normal brain development. The recent finding of the microbiota–gut–brain axis indicates the bidirectional connection between our gut and brain, demonstrating that gut microbiota can influence many neurological disorders such as autism. Most autistic patients suffer from gastrointestinal (GI) symptoms. Many studies have shown that early colonization, mode of delivery, and antibiotic usage significantly affect the gut microbiome and the onset of autism. Microbial fermentation of plant-based fiber can produce different types of short-chain fatty acid (SCFA) that may have a beneficial or detrimental effect on the gut and neurological development of autistic patients. Several comprehensive studies of the gut microbiome and microbiota–gut–brain axis help to understand the mechanism that leads to the onset of neurological disorders and find possible treatments for autism. This review integrates the findings of recent years on the gut microbiota and ASD association, mainly focusing on the characterization of specific microbiota that leads to ASD and addressing potential therapeutic interventions to restore a healthy balance of gut microbiome composition that can treat autism-associated symptoms.

Maternal and Neonatal Risk Factors Affecting the Occurrence of Neurodevelopmental Disorders: A Population-Based Nationwide Study

To investigate the maternal and neonatal risk factors related to pregnancy and birth affecting the occurrence of neurodevelopmental disorders to their children using the medical claim data for the whole population. The study was conducted on all the babies born in Korea from 2005 to 2009 based on data from the National Health Information Database. All birth records were tracked from birth to December 31, 2015. To analyze factors related to the mother, data related to the mother of the newborn were collected. Increased maternal age was found to increase the risk of cerebral palsy (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] [1.22, 1.75]) and autism spectrum disorder (aOR = 1.48, 95% CI [1.25, 1.76]), while lowering the risk of intellectual disability (aOR = 1.83, 95% CI [1.33, 2.53]) and speech and language impairment (aOR = 1.41, 95% CI [1.08, 1.83]) compared with the reference group aged 25 to 29 years old. The incidence affected by socioeconomic factors varied according to the types of disorders. Among various risk factors, prematurity or low birth weight, problems associated with amniotic fluid or amniotic membrane, preeclampsia or eclampsia, and cesarean section affect the incidence of neurodevelopmental disorders. To reduce the incidence or severity of neurodevelopmental disorders, a better understanding of the risk factors of neurodevelopmental disorders is important. The results of this study can be used as basic data to help such understanding.

Risk factors of asthma in the Asian population: a systematic review and meta-analysis

Background and objective

An increasing trend of asthma prevalence was observed in Asia; however, contributions of environmental and host-related risk factors to the development of this disease remain uncertain. This study aimed to perform a systematic review and meta-analysis for asthma-associated risk factors reported in Asia.

Methods

We systematically searched three public databases (Web of Science, PubMed, and Scopus) in Feb 2021. We only included articles that reported environmental and host-related risk factors associated with asthma in the Asian population. Random-effect meta-analyses were conducted for frequently reported asthma-associated risk factors to provide an overall risk estimate of asthma development.

Results

Of 4030 records obtained from public databases, 289 articles were selected for review. The most frequently reported asthma-associated risk factor was the family history of allergy-related conditions. The random-effect asthma risk estimates (pooled odds ratio, OR) were 4.66 (95% confidence interval (CI): 3.73–5.82) for the family history of asthma, 3.50 (95% CI: 2.62–4.67) for the family history of atopy, 3.57 (95% CI: 3.03–4.22) for the family history of any allergic diseases, 1.96 (95% CI: 1.47–2.61) for the family history of allergic rhinitis, and 2.75 (95% CI: 1.12–6.76) for the family history of atopic dermatitis. For housing-related factors, including the presence of mold, mold spots, mold odor, cockroach, water damage, and incense burning, the random-effect pooled OR ranged from 1.43 to 1.73. Other risk factors with significant pooled OR for asthma development included male gender (1.30, 95% CI: 1.23–1.38), cigarette smoke exposure (1.44, 95% CI: 1.30–1.60), cigarette smoking (1.66, 95% CI: 1.44–1.90), body mass index (BMI)–related parameters (pooled OR ranged from 1.06 to 2.02), various types of air pollution (NO₂, PM10, and O₃; pooled OR ranged from 1.03 to 1.22), and pre- and perinatal factors (low birth weight, preterm birth, and cesarean section; pooled OR ranged from 1.14 to 1.32).

Conclusions

The family history of asthma was the most frequently reported risk factor for asthma development in Asia with the highest risk estimate for asthma development. This suggests a major role of the genetic component in asthma pathogenesis. Further study on asthma genetics is required to improve the current understanding of asthma etiology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-021-00273-x.

Does cesarean delivery increase the occurrence of neurodevelopmental disorders in childhood?

OBJECTIVE

This study aimed to investigate whether cesarean delivery (CD) is associated with the occurrence of neurodevelopmental disorders (NDDs) at the age of 8 years.

METHODS

A total of 19 142 children were included from the Taiwan Birth Cohort Study (TBCS) database. Associations between modes of delivery or modalities of CD and NDDs were evaluated before and after controlling for gestational age (GA) and clinical condition at birth, children's characteristics, maternal socioeconomic status and maternal clinical condition at childbirth.

RESULTS

The odds ratio (OR) of occurrence of NDDs in children born via CD was 1.15 and the 95% confidence interval (CI) was 1.00-1.32. Emergency CD had a higher occurrence of NDDs (OR: 1.38; 95% CI: 1.16-1.65) compared with vaginal delivery. These associations were attenuated after controlling for children's and maternal characteristics and GA at birth. GA at birth had a significant reverse dose-effect on the occurrence of NDDs in children born via vaginal delivery and CD.

CONCLUSION

Modes of delivery and GA could influence the occurrence of NDDs in childhood. However, association of risk of NDDs and modes of delivery or modalities of CD might be modified by males, lower socioeconomic status and mothers with gestational diabetes mellitus.

Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil

The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.

Cesarean delivery and early childhood diseases in Bangladesh: An analysis of Demographic and Health Survey (BDHS) and Multiple Indicator Cluster Survey (MICS)

Introduction

The rate of cesarean delivery (C-section) has been increasing worldwide, including Bangladesh, and it has a negative impact on the mother and child's health. Our aim was to examine the association between C-section and childhood diseases and to identify the key factors associated with childhood diseases.

Methods

We used four nationally representative data sets from multiple indicator cluster survey (MICS, 2012 and 2019) and Bangladesh Demographic and Health Survey (BDHS, 2011and 2014) and analyzed 25,270 mother-child pairs. We used the frequency of common childhood diseases (fever, short or rapid breaths, cough, blood in stools, and diarrhea) as our outcome variable and C-section as exposure variable. We included mother’s age, place of residence, division, mother’s education, wealth index, child age, child sex, and child size at birth as confounding variables. Negative binomial regression model was used to analyze the data.

Results

In the BDHS data, the prevalence of C-section increased from 17.95% in 2011 to 23.33% in 2014. Also, in MICS, the prevalence almost doubled over an eight-year period (17.74% in 2012 to 35.41% in 2019). We did not observe any significant effect of C-section on childhood diseases in both surveys. Only in 2014 BDHS, we found that C-section increases the risk of childhood disease by 5% [Risk Ratio (RR): 1.05, 95% CI: 0.95, 1.17, p = 0.33]. However, the risk of childhood disease differed significantly in all survey years by division, child's age, and child’s size at birth after adjusting for important confounding variables. For example, children living in Chittagong division had a higher risk [(2011 BDHS RR: 1.22, 95% CI: 1.08, 1.38) and (2019 MICS RR: 1.21, 95% CI: 1.08, 1.35)] of having disease compared to Dhaka division. Maternal age, education, and wealth status showed significant differences with the outcome in some survey years.

Conclusion

Our study shows that C-section in Bangladesh continued to increase over time, and we did not find significant association between C-section and early childhood diseases. High C-section rate has a greater impact on maternal and child health as well as the burden on the health care system. We recommend raising public awareness of the negative impact of unnecessary C-section in Bangladesh.

Modification of caesarean section on the associations between air pollution and childhood asthma in seven Chinese cities

It is unknown whether giving birth via caesarean section (c-section) is a modifier for the association between air pollution and asthma. From 2012 to 2013, 59,754 children between the ages of 2 and 17 were randomly selected from 94 middle schools, elementary schools and kindergartens in seven Chinese cities for a cross-sectional study. The children's parents or guardians completed questionnaires, from which data on asthma as well as asthma-related symptoms were obtained. Participants' exposure to particles with an aerodynamic diameter ≤1.0 μm (PM₁), ≤2.5 μm (PM_2.5), and ≤10 μm (PM₁₀) and exposure to nitrogen dioxide (NO₂) were estimated using random forest models. We used mixed effects logistic regression models and added an interaction term between mode of delivery and ambient air pollution into the model to estimate effect modification from c-sections after appropriate adjustments for potential confounding variables. Among children delivered by c-section, the adjusted ORs for asthma and its symptoms per interquartile range (IQR) increase of PM₁, PM_2.5, PM₁₀ and NO₂ (1.20 95% CI: 1.07-1.34 to 2.04 95% CI: 1.87-2.24) were significantly higher than those of children delivered vaginally (1.05 95% CI: 0.92-1.19 to 1.33 95%CI: 1.21-1.47). The interactions between c-sections and ambient air pollution were statistically significant for all studied respiratory disorders, except current wheeze. Delivery via c-section may increase the risks of air pollution on asthma and its symptoms in Chinese children.

Hand Function at 18-22 Months Is Associated with School-Age Manual Dexterity and Motor Performance in Children Born Extremely Preterm

OBJECTIVES

To determine associations between hand function at age 18-22 months (early) and scores on the Movement Assessment Battery for Children, 2nd edition (MABC) at 6-7 years of age (school age) in extremely preterm children.

STUDY DESIGN

Prospective multicenter cohort of 313 extremely preterm children with early hand function assessment and school-age MABC testing. Early hand function was compared with "definite deficits" (MABC <5th percentile) and MABC standard scores. Early hand function was categorized as "no deficit" vs "any deficit." Mixed-effects regression models were used to evaluate the association of early hand function with MABC deficits, controlling for multiple demographic, neonatal, and childhood factors.

RESULTS

Children with early hand function deficits were more likely to have definite school-age deficits in all MABC subtests (Manual Dexterity, Aiming and Catching, and Balance) and to have received physical or occupational therapy (45% vs 26%; P < .001). Children with early hand function deficits had lower Manual Dexterity (P = .006), Balance (P = .035), and Total Test (P = .039) scores. Controlling for confounders, children with early hand function deficits had higher odds of definite school-age deficits in Manual Dexterity (aOR, 2.78; 95% CI, 1.36-5.68; P = .005) and lower Manual Dexterity (P = .031) and Balance (P = .027) scores. When excluding children with cerebral palsy and those with an IQ <70, hand function deficits remained significantly associated with manual dexterity.

CONCLUSION

Hand function deficits at age 18-22 months are associated with manual dexterity deficits and motor difficulties at school age, independent of perinatal-neonatal factors and the use of occupational or physical therapy. This has significant implications for school success, intervention, and rehabilitative therapy development.

The mediating effect of dietary patterns on the association between mother's education level and the physical aggression of five-year-old children: a population-based cohort study

BACKGROUND

Relatively few studies have investigated the effects of diet on behavior problems among preschoolers, particularly, physical aggression. In addition, children raised by poorly educated mothers usually have a higher probability of developing negative outcomes. Additionally, highly educated mothers have a higher probability of providing more healthy foods for their children. Thus, mothers providing healthy foods might mitigate children's behavior problems. The study aims to examine whether preschoolers' dietary pattern, as a manipulable factor, mediates the association between maternal education level and physical aggression.

METHODS

Data came from the Taiwan Birth Cohort Study (TBCS), a nationally representative population-based cohort study, which included 18,513 five-year-old Taiwanese children. Mothers and primary caregivers reported the information on preschoolers' physical aggression and food consumption at age 5 and maternal education level at age 6 months. Two dietary patterns, namely a healthy diet and a high-fat-sugar-salt (HFSS) diet, were retrieved by exploratory factor analysis. Mediation hypotheses were tested by a series of multiple regression models conducted using the PROCESS macro of SAS 9.4. All models were adjusted for children's sex, parental marital status, household income, mental distress at age 5 and children's physical aggression at age 3.

RESULTS

Maternal education positively linked to healthy dietary patterns (B = 0.014, p = 0.002) which was negatively associated with preschoolers' physical aggression (B = -0.096, p = 0.013), and it is negatively related to the HFSS dietary pattern (B = -0.042, p = 0.002) which was directly positively associated with preschoolers' physical aggression (B = 0.123, p = 0.008). The association between maternal education and preschoolers' physical aggression was partially mediated by preschoolers' healthy (B = -0.001, p < .001) and HFSS (B = -0.005, p = <.001) dietary patterns, respectively. The R-square of the mediation model is 0.178.

CONCLUSIONS

Preschoolers' dietary patterns directly associate with their physical aggression. In addition, mothers with poor education may provide less healthy foods and more unhealthy foods to their children, which may increase the level of physical aggression. The results imply partial mediating effects of dietary patterns between maternal education and physical aggression. It is suggested that a parent-based nutritional education program focusing on healthy meal preparation for poor educated mothers might be beneficial for preschoolers' healthy development.

Interaction between delivery mode and maternal age in predicting overweight and obesity in 1,123 Chinese preschool children

Background

Pediatric overweight/obesity has escalated to epidemic proportions worldwide. In this study, we aimed to assess the association of delivery mode and maternal age, both individually and interactively, with the risk of being overweight or obese among Chinese preschool children.

Methods

We cross-sectionally recruited 1,123 preschool children from five kindergartens in Beijing. Data were collected by a pre-validated self-developed questionnaire. Overweight and obesity are defined according to the World Health Organization (WHO), International Obesity Task Force (IOTF), and China criteria, respectively.

Results

Cesarean delivery was significantly associated with pediatric overweight/obesity under the WHO [adjusted odds ratio (aOR), 95% confidence interval (CI): 1.60, 1.12-2.29], IOTF (1.77, 1.23-2.53), and China (1.43, 1.06-1.94) criteria, respectively. Maternal age <28 years reached statistical significance under both WHO (1.69, 1.09-2.61) and IOTF (1.69, 1.09-2.61) criteria in predicting pediatric overweight/obesity. The interaction between cesarean delivery and maternal age <28 years was remarkably significant under the WHO (2.26, 1.10-4.67), IOTF (2.92, 1.43-5.96), and China (2.36, 1.24-4.50) criteria.

Conclusions

Our findings indicate that the interaction between cesarean delivery and maternal age <28 years can remarkably increase the risk of overweight/obesity among Chinese preschool children.

Exploring Mediation Roles of Child Screen-Viewing between Parental Factors and Child Overweight in Taiwan

Children's screen-viewing behavior is influenced by parents' own screen-viewing hours and the parental rules set for screen-viewing time. However, whether childhood obesity is associated with these three factors has not been widely investigated in Chinese populations. We examined the relationships between parental rules, parental screen-viewing, child screen-viewing and child overweight. Questionnaires were distributed to 1300 parents who had children studying in two elementary schools in an eastern Taiwanese City (Yi-Lan). We collected the data (the final response rate was 77.7%) on children's health states, the length of screen-viewing time, and whether parental rules of screen-viewing time have been set (n = 1005). Models using structural equation modeling, with controlling of age, gender, and physical activity of the participants, were carried out, to examine the mediated effect of child screen-viewing. The results of model testing showed that child screen-viewing could be a mediator in the associations between parental rule and child overweight (parental rule: coefficient = -0.18, p < 0.001); and between parent screen-viewing and child overweight (parent screen-viewing: coefficient = 0.072, p < 0.001). These findings suggested that parental factors (rules and little screen viewing time) effectively decreased the level of children's screen-viewing time, and the child screen-viewing time could mediate the association between parental factors and child overweight in the Chinese population.

The role of Caesarean section in childhood asthma

OBJECTIVE

As indicated by previous studies, children born via Caesarean section may have an increased risk of developing asthma compared with those born via vaginal delivery. The aim of this study is to assess the association between a Caesarean section and the risk of childhood asthma. Methods: This was a case-control study carried out in Basrah, Iraq including 952 children aged 3-12 years. Four hundred and seven asthmatic cases and a control group of 545 age-matched non-asthmatic children were enrolled. Binary logistic regression was used to assess the relationship between asthma and birth via Caesarean section.

RESULTS

The mean age of the children was 6.7±2.5 years. Two-hundred eighty-three children (29.7%) were delivered via Caesarean section. The binary logistic regression analysis showed that delivery via Caesarean section was found to be an independent significant risk factor for asthma (OR=3.37; 95% CI=1.76-6.46; p<0.001). In addition, many other risk factors were found to be significant predictors of asthma, including bottlefeeding (OR=27.29; 95% CI=13.54-54.99; p<0.001) and low birth weight (OR=16.7; 95% CI=6.97-37.49; p<0.001).

CONCLUSION

Caesarean section is significantly associated with an increased risk of childhood asthma.

Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis

Importance

Birth by cesarean delivery is increasing globally, particularly cesarean deliveries without medical indication. Children born via cesarean delivery may have an increased risk of negative health outcomes, but the evidence for psychiatric disorders is incomplete.

Objective

To evaluate the association between cesarean delivery and risk of neurodevelopmental and psychiatric disorders in the offspring.

Data Sources

Ovid MEDLINE, Embase, Web of Science, and PsycINFO were searched from inception to December 19, 2018. Search terms included all main mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

Study Selection

Two researchers independently selected observational studies that examined the association between cesarean delivery and neurodevelopmental and psychiatric disorders in the offspring.

Data Extraction and Synthesis

Two researchers independently extracted data according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines and assessed study quality using the Newcastle-Ottawa Scale. Random-effects meta-analyses were used to pool odds ratios (ORs) with 95% CIs for each outcome. Sensitivity and influence analyses tested the robustness of the results.

Main Outcomes and Measures

The ORs for the offspring with any neurodevelopmental or psychiatric disorder who were born via cesarean delivery compared with those were born via vaginal delivery.

Results

A total of 6953 articles were identified, of which 61 studies comprising 67 independent samples were included, totaling 20 607 935 deliveries. Compared with offspring born by vaginal delivery, offspring born via cesarean delivery had increased odds of autism spectrum disorders (OR, 1.33; 95% CI, 1.25-1.41; I2 = 69.5%) and attention-deficit/hyperactivity disorder (OR, 1.17; 95% CI, 1.07-1.26; I2 = 79.2%). Estimates were less precise for intellectual disabilities (OR, 1.83; 95% CI, 0.90-3.70; I2 = 88.2%), obsessive-compulsive disorder (OR, 1.49; 95% CI, 0.87-2.56; I2 = 67.3%), tic disorders (OR, 1.31; 95% CI, 0.98-1.76; I2 = 75.6%), and eating disorders (OR, 1.18; 95% CI, 0.96-1.47; I2 = 92.7%). No significant associations were found with depression/affective psychoses or nonaffective psychoses. Estimates were comparable for emergency and elective cesarean delivery. Study quality was high for 82% of the cohort studies and 50% of the case-control studies.

Conclusions and Relevance

The findings suggest that cesarean delivery births are associated with an increased risk of autism spectrum disorder and attention-deficit/hyperactivity disorder, irrespective of cesarean delivery modality, compared with vaginal delivery. Future studies on the mechanisms behind these associations appear to be warranted.

What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases

Each individual is provided with a unique gut microbiota profile that plays many specific functions in host nutrient metabolism, maintenance of structural integrity of the gut mucosal barrier, immunomodulation, and protection against pathogens. Gut microbiota are composed of different bacteria species taxonomically classified by genus, family, order, and phyla. Each human's gut microbiota are shaped in early life as their composition depends on infant transitions (birth gestational date, type of delivery, methods of milk feeding, weaning period) and external factors such as antibiotic use. These personal and healthy core native microbiota remain relatively stable in adulthood but differ between individuals due to enterotypes, body mass index (BMI) level, exercise frequency, lifestyle, and cultural and dietary habits. Accordingly, there is not a unique optimal gut microbiota composition since it is different for each individual. However, a healthy host⁻microorganism balance must be respected in order to optimally perform metabolic and immune functions and prevent disease development. This review will provide an overview of the studies that focus on gut microbiota balances in the same individual and between individuals and highlight the close mutualistic relationship between gut microbiota variations and diseases. Indeed, dysbiosis of gut microbiota is associated not only with intestinal disorders but also with numerous extra-intestinal diseases such as metabolic and neurological disorders. Understanding the cause or consequence of these gut microbiota balances in health and disease and how to maintain or restore a healthy gut microbiota composition should be useful in developing promising therapeutic interventions.

Gut microbiota and pediatric obesity/non-alcoholic fatty liver disease

Huge amount microorganisms resides in human intestine, and many contribute to the maturation and homeostasis of immune system. The diversity of gut ecology are affected by the gestational age, delivery type, feeding sources, and antibiotics use in neonates. Recent studies pointed out that disturbance of gut microbiota, so called dysbiosis, could result in several pediatric diseases including obesity, non-alcoholic fatty liver disease (NAFLD), metabolic syndromes, allergic diseases, and inflammatory bowel diseases. However, there are no single species can be proven to play a key factor in pediatric obesity and NAFLD at present. Various probiotics may confer benefit to these gut microbiota-related pediatric diseases. The clinical application is still limited. This review article aimed to elucidate evidently the relationship between gut microbiota and pediatric obesity/NAFLD and to discuss the potential probiotics use in pediatric obesity and NAFLD.

Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age

IMPORTANCE

Global cesarean delivery (CD) rates have more than doubled over the past 2 decades, with an increasing contribution from elective CDs. Cesarean delivery has been linked to early childhood overweight and obesity, but limited studies have examined elective and emergency CDs separately.

OBJECTIVE

To investigate whether elective or emergency CD was associated with risk of early childhood overweight.

DESIGN, SETTING, AND PARTICIPANTS

Data were drawn from the Growing Up in Singapore Toward Healthy Outcomes (GUSTO) study, an ongoing prospective mother-child birth cohort study. Participants were pregnant women aged 18 years or older with homogeneous parental ethnic background in their first trimester recruited between June 2009 and September 2010 (n = 1237) at 2 major public hospitals in Singapore. Those with type 1 diabetes or undergoing chemotherapy or psychotropic drug treatment were excluded. Data analysis commenced in October 2017.

EXPOSURES

Delivery mode obtained from clinical records. Elective and emergency CD examined separately against vaginal delivery as reference.

MAIN OUTCOMES AND MEASURES

Body mass index-for-age z scores at age 12 months calculated based on 2006 World Health Organization Child Growth Standards from infant weight and recumbent crown-heel length measurements taken between December 2010 and April 2012. High body mass index status at risk of overweight was defined as a z score of more than 1 SD and less than or equal to 2 SDs. Overweight was defined as a z score of more than 2 SDs.

RESULTS

Among 727 infants analyzed (51.2% [372] male), 30.5% (222) were born via CD, of which 33.3% (74) were elective. Prevalence of at risk of overweight and overweight at age 12 months was 12.2% (89) and 2.3% (17), respectively. Elective CD was significantly associated with at risk of overweight or overweight at age 12 months after adjusting for maternal ethnicity, age, education, parity, body mass index, antenatal smoking, hypertensive disorders of pregnancy, gestational diabetes, and sex-adjusted birth weight-for-gestational age (odds ratio, 2.05; 95% CI, 1.08-3.90; P = .03). The association persisted after further adjustment for intrapartum antibiotics and first 6 months infant feeding, 2 potential mediators of early childhood overweight and obesity (odds ratio, 2.02; 95% CI, 1.05-3.89; P = .04). No significant associations were found for emergency CD. Analysis with multiple imputation for missing covariates yielded similar results.

CONCLUSIONS AND RELEVANCE

Choice of delivery mode may influence risk of early childhood overweight. Clinicians are encouraged to discuss potential long-term implications of elective CD on child metabolic outcomes with patients who intend to have children.

Association of vitamin D receptor expression with inflammatory changes and prognosis of asthma

The expression level of vitamin D receptor in patients with asthma was investigated to study the association between vitamin D receptor and inflammatory changes in asthma. Thirty patients with bronchial asthma treated in the Tianjin Hospital of ITCWM Nankai Hospital were selected as the experimental group, while 30 healthy individuals were selected as the control group. The mRNA expression level of vitamin D receptor in blood was detected via reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The protein expression level of vitamin D receptor in blood was detected via western blot analysis and the levels of inflammatory factors were detected via enzyme-linked immune sorbent assay (ELISA). Correlations between the expression level of vitamin D and inflammatory factors were studied via Pearsons analysis. Finally, the prognoses of patients were recorded and analyzed. The results showed that the mRNA and protein expression levels of vitamin D receptor in the experimental group were significantly lower than those in control group (P<0.01). The content of 25-(OH) D₃ in serum in the experimental group was significantly lower than that in the control group (P<0.01). The contents of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum in the experimental group were obviously higher than those in the control group, but the contents of IL-10 and transforming growth factor-β (TGF-β) were obviously lower than those in the control group (P<0.01). Moreover, the correlation analysis revealed that IL-6 and TNF-α were negatively correlated with the expression of vitamin D receptor (P<0.05), whereas IL-10 and TGF-β were positively correlated with the expression of vitamin D receptor (P<0.05). In conclusion, the expression of vitamin D receptor is positively correlated with the levels of pro-inflammatory factors. Moreover, the vitamin D receptor affects the prognosis and recovery of lung function of patients with asthma.