哮喘联盟

   摘要
   目的: 评估我们的前瞻性母-婴队列和国家登记数据，以分析分娩方式中哮喘的风险以及是否在胎膜破裂前或后进行剖宫产会对此风险产生不同的影响。
   研究设计：本次哥本哈根儿童期哮喘的前瞻性队列研究是一项411名高出生风险丹麦儿童的队列研究。在研究所在地，医生诊断为哮喘，然后采用Cox比例风险模型，将哮喘与剖宫产的相关性进行分析。根据丹麦国家预先的登记，我们总结了1997-2010的数据。儿童期哮喘的定义为反复使用药店里的吸入性糖皮质激素。剖宫产分为胎膜破裂前和胎膜破裂后进行的剖宫产，并将其哮喘的风险与阴道分娩哮喘风险进行比较。结果根据年龄、出生年月、性别、出生时体重、胎龄、多胎、奇偶校验和产妇因素（年龄，吸烟/孕期使用抗生素，就业状况，以及哮喘）进行逐步校正。
   结果: 在本次哥本哈根前瞻性儿童期哮喘队列研究中，与阴道分娩相比，剖宫产哮喘的标准化风险比增加了2.18（1.27-3.73）。登记的数据重复了这些结果。与胎膜破裂后剖宫产相比（阴道分娩的1.12倍[1.09-1.16]），破膜前进行剖宫产有更高的哮喘风险（阴道分娩的1.2倍[1.16-1.23]）。
   结论：我们证实剖宫产是儿童哮喘的危险因素。胎膜破前就进行剖宫产手术则哮喘的风险更为显著。

 

（苏欣 审校）
J Pediatr. 2016 Jan26.pii:S0022-3476(15)01656-X.doi:10.1016/j.jpeds.2015.12.066. [Epub ahead of print]
 

Risk of Asthma from Cesarean Delivery Depends on Membrane Rupture.
 

Sevelsted A1, Stokholm J2, Bisgaard H3.
 

Abstract
OBJECTIVE:To assess our prospective mother-child cohort and the national registry data to analyze the risk of asthma by delivery mode and whether cesarean delivery before or after membrane rupture affects this risk differently.
STUDY DESIGN:The Copenhagen Prospective Studies on Asthma in Childhood2000 is a high-risk birth cohort of 411 Danish children. Asthma was diagnosed prospectively by physicians at the research site, and associations with cesarean delivery were investigated using Cox proportional hazard models. From the Danish national prospective registry we included data from 1997-2010. Childhood asthma was defined from recurrent use of inhaled corticosteroids filled at pharmacies. Cesarean delivery was classified as either before or after rupture of membranes, and the risk of asthma was compared with vaginal delivery. Results were adjusted stepwise for age and calendar year, sex, birth weight, gestational age, multiple births, parity, and maternal factors (age, smoking/antibiotics during pregnancy, employment status, and asthma).
RESULTS:In the Copenhagen Prospective Studies on Asthma in Childhood2000 cohort, the adjusted hazard ratio for asthma was increased by cesarean delivery relative to vaginal birth 2.18 (1.27-3.73). Registry data replicated these findings. Cesarean delivery performed before rupture of membranes carried significantly higher risk of asthma, (incidence rate ratio to vaginal delivery 1.20 [1.16-1.23]) than cesarean delivery after rupture of membranes (incidence rate ratio to vaginal delivery 1.12 [1.09-1.16]).
CONCLUSIONS:We confirmed cesarean delivery to be a risk factor for childhood asthma. This effect was more pronounced for cesarean delivery performed before rupture of membranes.
 

J Pediatr. 2016 Jan26.pii:S0022-3476(15)01656-X.doi:10.1016/j.jpeds.2015.12.066. [Epub ahead of print]