The DOI matches its Crossref record; 106 of the 106 references it cites were found in a registry or an index.
Cesarean section and development of the immune system in the offspring
Abstract
This review examines the relation between the mode of delivery and development of the immune system in the offspring. Recent epidemiological studies provide evidence that elective cesarean section (CS) is associated with aberrant short-term immune responses in the newborn infant, and a greater risk of developing immune diseases such as asthma, allergies, type 1 diabetes, and celiac disease. However, it is still unknown whether CS causes a long-term effect on the immune system of the offspring that contributes to compromised immune health. With the dramatic increase in the rate of CS today, a greater emphasis should be placed on the discussion among both professionals and childbearing women on potential consequences of CS on the health of the offspring.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“established links between cesarean birth and adverse child health outcomes, including asthma, type I diabetes, allergies9–11 and obesity12”
From The relation between cesarean birth and child cognitive development (2017) · cites this paper as [10]
Citations
Cites
Epigenetic programming by maternal behavior
Weaver, I. C. G., Cervoni, N., Champagne, F. A., D'Alessio, A. C., Sharma, S., Seckl, J. R., Dymov, S., Szyf, M., & Meaney, M. J. (2004) · Nature Neuroscience · doi:10.1038/nn1276 · Cited by 6,177
Hay fever, hygiene, and household size.
Strachan, D. P. (1989) · BMJ · doi:10.1136/bmj.299.6710.1259 · Cited by 5,054
Dominguez-Bello, M. G., Costello, E. K., Contreras, M., Magris, M., Hidalgo, G., Fierer, N., & Knight, R. (2010) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1002601107 · Cited by 4,774
Gut flora in health and disease
Guarner, F., & Malagelada, J. (2003) · The Lancet · doi:10.1016/s0140-6736(03)12489-0 · Cited by 3,480
Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis
Hales, C. N., & Barker, D. J. P. (1992) · Diabetologia · doi:10.1007/bf00400248 · Cited by 3,294
Fetal nutrition and cardiovascular disease in adult life
Barker, D. J. P., Godfrey, K. M., Gluckman, P. D., Harding, J. E., Owens, J. A., & Robinson, J. S. (1993) · The Lancet · doi:10.1016/0140-6736(93)91224-a · Cited by 2,753
Environmental epigenomics and disease susceptibility
Jirtle, R. L., & Skinner, M. K. (2007) · Nature Reviews Genetics · doi:10.1038/nrg2045 · Cited by 2,492
Allergy development and the intestinal microflora during the first year of life
Björkstén, B., Sepp, E., Julge, K., Voor, T., & Mikelsaar, M. (2001) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2001.118130 · Cited by 1,203
Jakobsson, H. E., Jernberg, C., Andersson, A. F., Sjölund-Karlsson, M., Jansson, J. K., & Engstrand, L. (2010) · PLoS ONE · doi:10.1371/journal.pone.0009836 · Cited by 1,160
Long-term ecological impacts of antibiotic administration on the human intestinal microbiota
Jernberg, C., Löfmark, S., Edlund, C., & Jansson, J. K. (2007) · The ISME Journal · doi:10.1038/ismej.2007.3 · Cited by 1,134
Flagged first, then by citations
Cited by
Sorted by citations
The composition of the gut microbiota throughout life, with an emphasis on early life
Rodríguez, J. M., Murphy, K., Stanton, C., Ross, R. P., Kober, O. I., Juge, N., Avershina, E., Rudi, K., Narbad, A., Jenmalm, M. C., et al. (2015) · Microbial Ecology in Health and Disease · doi:10.3402/mehd.v26.26050 · Cited by 1,414
“a risk factor for allergy development (124, 127), was asso-”
BackgroundPsychobiotics: A novel class of psychotropic
Dinan, T. G., Stanton, C., & Cryan, J. F. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.05.001 · Cited by 1,287
Minireview: Gut microbiota: The neglected endocrine organ
Clarke, G., Stilling, R. M., Kennedy, P. J., Stanton, C., Cryan, J. F., & Dinan, T. G. (2014) · Molecular Endocrinology · doi:10.1210/me.2014-1108 · Cited by 1,192
“Whether or not cesarean section delivery affects the subsequent endocrine capacity of the gut microbiota is uncertain but likely, and higher rates of diabetes in such children have been established (26).”
BackgroundCesarean Section and Chronic Immune Disorders
Sevelsted, A., Stokholm, J., Bønnelykke, K., & Bisgaard, H. (2015) · PEDIATRICS · doi:10.1542/peds.2014-0596 · Cited by 482
The microbiome: stress, health and disease
Moloney, R. D., Desbonnet, L., Clarke, G., Dinan, T. G., & Cryan, J. F. (2014) · Mammalian Genome · doi:10.1007/s00335-013-9488-5 · Cited by 430
“…of microbiota composition, infants delivered by Caesareansection are more likely to suffer from allergies, asthma and diabetes later in life (Cho and Norman 2013; Relman 2012; Romero and Korzeniewski 2013), highlighting that the early life environment is fundamental in the development of a…”
BackgroundThe gut microbiome and diet in psychiatry: focus on depression
Dash, S., Clarke, G., Berk, M., & Jacka, F. N. (2015) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000117 · Cited by 369
The Impact of Microbiota on Brain and Behavior: Mechanisms & Therapeutic Potential
Borre, Y. E., Moloney, R. D., Clarke, G., Dinan, T. G., & Cryan, J. F. (2014) · Advances in Experimental Medicine and Biology · doi:10.1007/978-1-4939-0897-4_17 · Cited by 329
Wilson, R. D., Caughey, A. B., Wood, S. L., Macones, G. A., Wrench, I. J., Huang, J., Norman, M., Pettersson, K., Fawcett, W. J., Shalabi, M. M., et al. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.09.015 · Cited by 315
Self-citationYang, I. H., Corwin, E. J., Brennan, P. A., Jordan, S., Murphy, J. R., & Dunlop, A. L. (2015) · Nursing Research · doi:10.1097/nnr.0000000000000133 · Cited by 310
“All rights reserved. cesarean section are more likely to have been exposed to antibiotics in utero (Cho & Norman, 2013), which may significantly alter their enteric microflora (Jakobsson et al., 2010; Jernberg, Löfmark, Edlund, & Jansson, 2010).”
BackgroundCurran, E. A., O'Neill, S. M., Cryan, J. F., Kenny, L. C., Dinan, T. G., Khashan, A. S., & Kearney, P. M. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12351 · Cited by 250
Early life microbial exposures and allergy risks: opportunities for prevention
Renz, H. E., & Skevaki, C. L. (2020) · Nature reviews. Immunology · doi:10.1038/s41577-020-00420-y · Cited by 266
Amabebe, E., & Anumba, D. O. C. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.02184 · Cited by 247
“Because vertical mother-to-infant transmission of microbiota is important for host metabolism and immune development, infants born by C-section are at increased risk of chronic immune disorders including neonatal respiratory morbidity, bronchiolitis, respiratory syncytial virus infection, allergies (asthma, hay fever,…”
BackgroundRomero, R. J., Miranda, J., Kusanovic, J. P., Chaiworapongsa, T., Chaemsaithong, P., Martinez, A., Gotsch, F., Dong, Z., Ahmed, A. I., Shaman, M., et al. (2015) · Journal of Perinatal Medicine · doi:10.1515/jpm-2014-0249 · Cited by 235
“This has clinical implications, as all of these patients and their neonates receive antibiotics [113–120] which can change the neonatal microbiota [121–129] and may have long-term effects in their immune response [130, 131].”
BackgroundZhang, T., Sidorchuk, A., Sevilla‐Cermeño, L., Vilaplana-Pérez, A., Chang, Z., Larsson, H., Mataix‐Cols, D., & de la Cruz, L. F. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.10236 · Cited by 216
Impact of Early-Life Exposures on Immune Maturation and Susceptibility to Disease
Gollwitzer, E. S., & Marsland, B. J. (2015) · Trends in Immunology · doi:10.1016/j.it.2015.09.009 · Cited by 207
“Labor specifically alters neutrophil, monocyte, and NK cell numbers and function [4].”
BackgroundInfluentialYuan, C., Gaskins, A. J., Blaine, A. I., Zhang, C., Gillman, M. W., Missmer, S. A., Field, A. E., & Chavarro, J. E. (2016) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2016.2385 · Cited by 200
Do bacteria shape our development? Crosstalk between intestinal microbiota and HPA axis
de Weerth, C. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.09.016 · Cited by 189
“Interestingly, cesarean-born infants are more likely than vaginally born infants to develop immune diseases (Cho and Norman, 2013; Sevelsted et al., 2014).”
Priming for health: gut microbiota acquired in early life regulates physiology, brain and behaviour
Clarke, G., O'Mahony, S., Dinan, T., & Cryan, J. (2014) · Acta Paediatrica · doi:10.1111/apa.12674 · Cited by 179
“Epidemiological data show that allergies, asthma and diabetes later in life are all more common in these infants (31).”
BackgroundDelivery mode and gut microbial changes correlate with an increased risk of childhood asthma
Stokholm, J., Thorsen, J., Blaser, M. J., Rasmussen, M. A., Hjelmsø, M. H., Shah, S. A., Christensen, E. D., Chawes, B., Bønnelykke, K., Brix, S., et al. (2020) · Science Translational Medicine · doi:10.1126/scitranslmed.aax9929 · Cited by 169
“However, most countries have a higher prevalence, suggesting less strict medical indications for performing the procedure (3, 4).”
BackgroundCurran, E. A., Dalman, C., Kearney, P. M., Kenny, L. C., Cryan, J. F., Dinan, T. G., & Khashan, A. S. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.0846 · Cited by 146
Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis
Słabuszewska-Jóźwiak, A., Szymański, J. K., Ciebiera, M., Sarecka‐Hujar, B., & Jakiel, G. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17218031 · Cited by 162
Microbiota at the crossroads of autoimmunity
Shamriz, O., Mizrahi, H., Werbner, M., Shoenfeld, Y., Avni, O., & Koren, O. (2016) · Autoimmunity Reviews · doi:10.1016/j.autrev.2016.07.012 · Cited by 153
“Higher risk for allergy and celiac disease was also related to Cesarean section [161].”
BackgroundThe Effects of Delivery Mode on the Gut Microbiota and Health: State of Art
Zhang, C., Li, L., Jin, B.-Y., Xu, X., Zuo, X., Li, Y., & Li, Z. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2021.724449 · Cited by 155
The first microbial environment of infants born by C-section: the operating room microbes
Shin, H., Pei, Z., Martinez, K. A., Rivera-Viñas, J. I., Méndez, K., Cavallín, H., & Domínguez-Bello, M. G. (2015) · Microbiome · doi:10.1186/s40168-015-0126-1 · Cited by 141
“This might be relevant to the increased risk of immune diseases observed in C-section born infants [28, 29].”
Violência obstétrica e prevenção quaternária: o que é e o que fazer
Tesser, C. D., Knobel, R., Andrezzo, H. F. D. A., & Diniz, S. G. (2015) · Revista Brasileira de Medicina de Família e Comunidade · doi:10.5712/rbmfc10(35)1013 · Cited by 138
Early-life origins of chronic respiratory diseases: understanding and promoting healthy ageing
Carraro, S., Scheltema, N. M., Bont, L., & Baraldi, E. (2014) · European Respiratory Journal · doi:10.1183/09031936.00084114 · Cited by 142
Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood
Papathoma, E., Triga, M., Fouzas, S., & Dimitriou, G. (2016) · Pediatric Allergy and Immunology · doi:10.1111/pai.12552 · Cited by 129
“Cesarean section may also influence the maturation of the immune system by altering the level of stress at birth (21).”
BackgroundCesarean Delivery and Risk of Childhood Obesity
Pei, Z., Heinrich, J., Fuertes, E., Flexeder, C., Hoffmann, B. H., Lehmann, I., Schaaf, B., Berg, A. V., & Koletzko, S. (2014) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2013.12.044 · Cited by 121
The relation between cesarean birth and child cognitive development
Polidano, C., Zhu, A., & Bornstein, J. C. (2017) · Scientific Reports · doi:10.1038/s41598-017-10831-y · Cited by 119
Selma‐Royo, M., Calatayud, M., García‐Mantrana, I., Llorca, A. P., Escuriet, R., Martínez‐Costa, C., & Collado, M. C. (2020) · Microbiome · doi:10.1186/s40168-020-00940-8 · Cited by 125
“Many researchers have discussed the possible relationship between CS and altered immune system development [26].”
BackgroundMarcotte, E. L., Thomopoulos, T., Infante-Rivard, C., Clavel, J., Petridou, E., Schüz, J., Ezzat, S., Dockerty, J., Metayer, C., Magnani, C., et al. (2016) · The Lancet Haematology · doi:10.1016/s2352-3026(16)00002-8 · Cited by 110
Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care
Buckley, S. J. (2015) · Issue Lab (Candid) · Cited by 113
Romero, R. J., Chaemsaithong, P., Korzeniewski, S. J., Kusanovic, J. P., Docheva, N., Martínez‐Varea, A., Ahmed, A. I., Yoon, B. H., Hassan, S. S., Chaiworapongsa, T., et al. (2015) · Journal of Perinatal Medicine · doi:10.1515/jpm-2015-0044 · Cited by 104
Fetal programming of overweight through the microbiome: boys are disproportionately affected
Kozyrskyj, A. L., Kalu, R. N., Koleva, P. T., & Bridgman, S. L. (2015) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s2040174415001269 · Cited by 104
“Changes in maternal intestinal permeability during pregnancy and delivery may play a key role in bacterial translocation.(64) Maternal obesity may also affect placental function through greater placental infiltration of macrophages and pro-inflammatory cytokines, which facilitates transfer of internalized microbes.”
BackgroundCurran, E. A., Cryan, J. F., Kenny, L. C., Dinan, T. G., Kearney, P. M., & Khashan, A. S. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2616-1 · Cited by 94
“2009), exposure to altered microbiota (Cho and Norman 2013; Cryan and Dinan 2012; Desbonnet et al. 2014; Hsiao et al. 2013; Salminen et al. 2004), or possibly through changes in maternal–child attachment (Brumariu and Kerns 2010; Olza Fernandez et al.”
BackgroundAcquisition of microbiota according to the type of birth: an integrative review
Coelho, G. D. P., Ayres, L. F. A., Barreto, D. S., Henriques, B. D., do Prado, M. R. M. C., & dos Passos, C. M. (2021) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518.8345.4466.3446 · Cited by 111
“Dysbiosis may prolong immunological immaturity and, consequently, increase the risk of autoimmune disorders(11,34,40,49-54).”
BackgroundThe mother–offspring dyad: microbial transmission, immune interactions and allergy development
Jenmalm, M. C. (2017) · Journal of Internal Medicine · doi:10.1111/joim.12652 · Cited by 95
“CS delivery, which is performed with increasing rates worldwide and may increase the risk of development of allergy and other immune-mediated diseases [20, 120, 121], thus disrupts these opportunities for the microbiota to be transferred from the mother to her baby [31, 61, 74, 76–85].”
Almgren, M., Schlinzig, T., Gómez-Cabrero, D., Gunnar, A., Sundin, M., Johansson, S., Norman, M., & Ekström, T. J. (2014) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2014.05.014 · Cited by 96
“Several studies have identified differences in immune biomarkers following CS compared with vaginal birth, and experimental data suggest that delivery mode can alter gene expression with a functional significance for the immune system.(12,33-37) However, the main idea of our hypothesis is that altered methylation may…”
Self-citationThe connection between microbiome and schizophrenia
Golofast, B., & Vales, K. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.12.011 · Cited by 92
Gut microbiota: a source of novel tools to reduce the risk of human disease?
Collado, M. C., Rautava, S., Isolauri, E., & Salminen, S. (2015) · Pediatric Research · doi:10.1038/pr.2014.173 · Cited by 93
“These challenges are thought to result from lack of stress signals induced by labor in the fetus and the mother which is also reflected in immune markers measured from cord blood or in the neonatal period (43).”
BackgroundTribe, R. M., Taylor, P. D., Kelly, N., Rees, D., Sandall, J., & Kennedy, H. P. (2018) · The Journal of Physiology · doi:10.1113/jp275429 · Cited by 93
Mode of Delivery Shapes Gut Colonization Pattern and Modulates Regulatory Immunity in Mice
Hansen, C. H. F., Andersen, L. S. F., Krych, Ł., Metzdorff, S. B., Hasselby, J. P., Skov, S., Nielsen, D. S., Buschard, K., Hansen, L. H., & Hansen, A. K. (2014) · The Journal of Immunology · doi:10.4049/jimmunol.1400085 · Cited by 95
“more, it is speculated that altered epigenetic regulation of genes during C-section may modify the immune response (43).”
BackgroundResultMontoya‐Williams, D., Lemas, D. J., Spiryda, L. B., Patel, K., Carney, O. O., Neu, J., & Carson, T. L. (2018) · Neonatology · doi:10.1159/000487102 · Cited by 94
Gut microbiota development across the lifespan: Disease links and health‐promoting interventions
Schoultz, I., Claesson, M. J., Domínguez-Bello, M. G., Hållenius, F. F., Konturek, P. C., Korpela, K., Laursen, M. F., Penders, J., Roager, H. M., Vatanen, T., et al. (2025) · Journal of Internal Medicine · doi:10.1111/joim.20089 · Cited by 108
“Birth by CS has been associated with the development of immune-mediated diseases, including allergy, asthma, Type 1 diabetes, and celiac disease [224–228].”
The microbiome during pregnancy and early postnatal life
Neu, J. (2016) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2016.05.001 · Cited by 88
Inchingolo, F., Inchingolo, A. D., Palumbo, I., Trilli, I., Guglielmo, M., Mancini, A., Palermo, A., Inchingolo, A. M., & Dipalma, G. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25021055 · Cited by 112
“Consequently, understanding the implications of CS delivery on the infant’s GM holds profound significance for maternal and child health outcomes [38–51].”
BackgroundAssociation of Birth by Cesarean Delivery With Obesity and Type 2 Diabetes Among Adult Women
Chavarro, J. E., Martín‐Calvo, N., Yuan, C., Arvizu, M., Rich-Edwards, J. W., Michels, K. B., & Sun, Q. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.2605 · Cited by 80
Dietert, R. R. (2014) · Advances in Medicine · doi:10.1155/2014/867805 · Cited by 78
“[103–105]).”
BackgroundObstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study
Curran, E. A., Khashan, A. S., Dalman, C., Kenny, L. C., Cryan, J. F., Dinan, T. G., & Kearney, P. M. (2016) · International Journal of Epidemiology · doi:10.1093/ije/dyw001 · Cited by 74
Evolutionary perspectives on cesarean section
Rosenberg, K. E., & Trevathan, W. R. (2018) · Evolution Medicine and Public Health · doi:10.1093/emph/eoy006 · Cited by 79
The impact of Caesarean section on the infant gut microbiome
Hoang, D. M., Levy, E. I., & Vandenplas, Y. (2020) · Acta Paediatrica · doi:10.1111/apa.15501 · Cited by 70
Romero, R. J., & Korzeniewski, S. J. (2012) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2012.12.026 · Cited by 65
Romero, R. J., Chaemsaithong, P., Docheva, N., Korzeniewski, S. J., Tarca, A. L., Bhatti, G., Xu, Z., Kusanovic, J. P., Chaiyasit, N., Dong, Z., et al. (2015) · Journal of Perinatal Medicine · doi:10.1515/jpm-2015-0121 · Cited by 67
Kingsbury, M. A., & Bilbo, S. D. (2019) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2019.100794 · Cited by 68
Birth delivery mode alters perinatal cell death in the mouse brain
Castillo-Ruiz, A., Mosley, M., Jacobs, A. J., Hoffiz, Y. C., & Forger, N. G. (2018) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1811962115 · Cited by 67
“Interestingly, a greater risk of autism (4), impaired immune responses (56), and dampening of the stress response (57) have been linked to C-section birth in humans.”
BackgroundIn utero Programming of Allergic Susceptibility
Grieger, J. A., Clifton, V. L., Tuck, A., Wooldridge, A. L., Robertson, S. A., & Gatford, K. L. (2016) · International Archives of Allergy and Immunology · doi:10.1159/000443961 · Cited by 59
Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study
O’Neill, S. M., Curran, E. A., Dalman, C., Kenny, L. C., Kearney, P. M., Clarke, G. A., Cryan, J. F., Dinan, T. G., & Khashan, A. S. (2015) · Schizophrenia Bulletin · doi:10.1093/schbul/sbv152 · Cited by 59
Mode of Delivery and Asthma at School Age in 9 European Birth Cohorts
Rusconi, F., Zugna, D., Annesi‐Maesano, I., Baïz, N., Barros, H., Correia, S., Duijts, L., Forastiere, F., Inskip, H. M., Kelleher, C. C., et al. (2017) · American Journal of Epidemiology · doi:10.1093/aje/kwx021 · Cited by 57
“Nowadays women who undergo cesarean section are typically pretreated with antibiotics (44), which can perturb the intestinal microflora of their infants (31).”
BackgroundInfluentialChen, G., Chiang, W., Shu, B., Guo, Y. L., Chiou, S.-T., & Chiang, T. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017086 · Cited by 55
Interpreting Behavior Genetic Models: Seven Developmental Processes to Understand
Briley, D. A., Livengood, J., Derringer, J. L., Tucker–Drob, E. M., Fraley, R. C., & Roberts, B. W. (2018) · Behavior Genetics · doi:10.1007/s10519-018-9939-6 · Cited by 59
Hygiene Hypothesis in Asthma Development: Is Hygiene to Blame?
Bernardes, E. V. T., & Arrieta, M. (2017) · Archives of Medical Research · doi:10.1016/j.arcmed.2017.11.009 · Cited by 59
“Additionally, epidemiological studies have shown that several factors known to alter the microbiome, such as Caesarean sections (68,23,82), formula feeding (24), obesity (25), smoking exposure/habits (83,26), antibiotic treatments (27) and unhealthy diet (18,69), significantly correlate with an increased incidence or…”
BackgroundChaiyasit, N., Romero, R. J., Chaemsaithong, P., Docheva, N., Bhatti, G., Kusanovic, J. P., Dong, Z., Yeo, L., Pacora, P., Hassan, S. S., et al. (2017) · Journal of Perinatal Medicine · doi:10.1515/jpm-2016-0344 · Cited by 51
Jahnke, H. R., Roach, J. M., Azcárate-Peril, M. A., & Thompson, A. L. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251782 · Cited by 56
“However, environmental disturbances, including changes in the immune system, diet, stress, and exposures to xenobiotics (antibiotics and anti-cancer medications), among other exposures, can induce dysbiosis [8], which has been associated with risk for obesity, metabolic disease, autoimmune disease and allergy, and int…”
BackgroundRintala, A., Riikonen, I., Toivonen, A., Pietilä, S., Munukka, E., Pursiheimo, J., Elo, L. L., Arikoski, P., Luopajärvi, K., Schwab, U., et al. (2018) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2018.1444788 · Cited by 52
“For example, epidemiological studies have reported that children born by CS have an increased risk for CD compared to the vaginally delivered infants [33-35].”
BackgroundNeu, J. (2015) · Maternal Health Neonatology and Perinatology · doi:10.1186/s40748-015-0007-4 · Cited by 49
“obesity and other disorders in infants born by cesarean section [29], this raises the question of whether increasing levels of cesarean section may become a public health issue in areas where C-sections are highly prevalent.”
BackgroundWang, R., Wiemels, J. L., Metayer, C., Morimoto, L. M., Francis, S. S., Kadan‐Lottick, N. S., DeWan, A. T., Zhang, Y., & Ma, X. (2016) · American Journal of Epidemiology · doi:10.1093/aje/kww153 · Cited by 48
Samuel, M. H., Meiri, G., Dinstein, I., Flusser, H., Michaelovski, A., Bashiri, A., & Menashe, I. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04034-9 · Cited by 48
Lee, H., Lu, C., Chen, H.-F., Su, H.-F., & Li, C. (2015) · European Journal of Public Health · doi:10.1093/eurpub/ckv059 · Cited by 46
Schüler, I. M., Haberstroh, S., Dawczynski, K., Lehmann, T., & Heinrich‐Weltzien, R. (2017) · Caries Research · doi:10.1159/000480124 · Cited by 48
“Furthermore, the activity of leukocytes as well as their release of proinflammatory cytokines, such as interleukin (IL)-4r, IL-1β, IL-6, and tumor necrosis factor (TNF)-α, were lower after C-section compared to vaginal delivery, thereby hampering immune cell functions [Cho and Norman, 2013].”
BackgroundBirth signalling hormones and the developmental consequences of caesarean delivery
Kenkel, W. M. (2020) · Journal of Neuroendocrinology · doi:10.1111/jne.12912 · Cited by 47
The influence of mode of delivery on neonatal and maternal short and longterm outcomes
Prado, D. S., Mendes, R. B., Gurgel, R. Q., Barreto, Í. D. D. C., Cipolotti, R., & Gurgel, R. Q. (2018) · Revista de Saúde Pública · doi:10.11606/s1518-8787.2018052000742 · Cited by 44
Cesarean delivery on maternal request and its influencing factors in Chongqing, China
Deng, R., Tang, X., Liu, J., Gao, Y., & Zhong, X. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03866-7 · Cited by 44
Logan, C. A., Thiel, L., Bornemann, R., Köenig, W., Reister, F., Brenner, H., Rothenbacher, D., & Genuneit, J. (2016) · PLoS ONE · doi:10.1371/journal.pone.0149918 · Cited by 44
Antibiotic exposure in pregnancy and risk of coeliac disease in offspring: a cohort study
Mårild, K., Ludvigsson, J., Sanz, Y., & Ludvigsson, J. F. (2014) · BMC Gastroenterology · doi:10.1186/1471-230x-14-75 · Cited by 43
“In addition, several epidemiological studies have shown that prenatal exposures to antibiotics are associated with the development of childhood asthma, a disease that shares potential etiological traits with CD [19-21].”
BackgroundThe Role of Fatty Acid Metabolites in Vaginal Health and Disease: Application to Candidiasis
Baldewijns, S., Sillen, M., Palmans, I., Vandecruys, P., Van Dijck, P., & Demuyser, L. (2021) · Frontiers in Microbiology · doi:10.3389/fmicb.2021.705779 · Cited by 44
Factors associated with increased odds of cesarean delivery in ART pregnancies
Stern, J. E., Liu, C.-L., Cabral, H., Richards, E. G., Coddington, C. C., Missmer, S. A., & Diop, H. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.04.032 · Cited by 41
“This choice occurs in spite of the fact that cesarean delivery is associated with an increased incidence of maternal morbidity, particularly in subsequent deliveries (14,17) as well as possible negative consequences for the infant born via cesarean (18).”
Protective environmental factors for neuromyelitis optica
Graves, J. S., Grandhe, S., Weinfurtner, K. M., Krupp, L., Belman, A. L., Chitnis, T., Ness, J., Weinstock‐Guttman, B., Gorman, M., Patterson, M. C., et al. (2014) · Neurology · doi:10.1212/wnl.0000000000001001 · Cited by 38
“The significance of a nonvaginal birth and autoimmune disease has been previously postulated to relate to early differences in infant gut flora.(35,36) Similar to recent findings in adults, we observed demographic differences in AQP4-IgG-positive and -negative subjects with NMO.”
ResultEkéus, C., Norman, M., Åberg, K., Winberg, S., Stolt, K., & Aronsson, A. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1378328 · Cited by 38
“why children and adults born with elective CS exhibit an increased risk of developing immune diseases [5].”
BackgroundSelf-citationLiao, S., Tsai, M., Yao, T., Hua, M., Yeh, K., Chiu, C., Su, K., Huang, S., Kao, C., Lai, S., et al. (2017) · Scientific Reports · doi:10.1038/s41598-017-07894-2 · Cited by 37
Birth by caesarean section and school performance in Swedish adolescents- a population-based study
Curran, E. A., Kenny, L. C., Dalman, C., Kearney, P. M., Cryan, J. F., Dinan, T. G., & Khashan, A. S. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1304-x · Cited by 34
“It has been hypothesised that birth by CS leads to changes in psychological development, due to “early term” birth [4, 5] or alterations in microbiota or stress response [6].”
Cesarean delivery and infant cortisol regulation
Martinez, L. D., Glynn, L. M., Sandman, C. A., Wing, D. A., & Davis, E. P. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104862 · Cited by 32
“Empirical and metaanalytic evidence indicates that offspring delivered by cesarean are at increased risk for metabolic disease and immune dysfunction later in life, including obesity, diabetes, asthma, allergies, and celiac disease (Cardwell et al., 2008; Cho and Norman, 2013; Darmasseelane et al., 2014; Sevelsted et…”
BackgroundNo. 361-Caesarean Delivery on Maternal Request
Alsayegh, E., Bos, H., Campbell, K., & Barrett, J. F. R. (2018) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2017.12.009 · Cited by 31
Microbial orchestra in juvenile idiopathic arthritis: Sounds of disarray?
Arvonen, M., Vänni, P., Sarangi, A. N., Tejesvi, M. V., Vähäsalo, P., Aggarwal, A., & Stoll, M. L. (2019) · Immunological Reviews · doi:10.1111/imr.12826 · Cited by 34
“2019;7(18):2734–2745) has been published while the current manuscript was in proofs and is thus not discussed.”
BackgroundTerm Elective Cesarean Delivery and Offspring Infectious Morbidity
Wainstock, T., Walfisch, A., Shoham‐Vardi, I., Segal, I., Sergienko, R., Landau, D., & Sheiner, E. (2018) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0000000000002197 · Cited by 31
Eide, K. T., & Bærøe, K. (2020) · Journal of Medical Ethics · doi:10.1136/medethics-2020-106071 · Cited by 35
Factors affecting the early establishment of neonatal intestinal flora and its intervention measures
Ma, G., Shi, Y., Meng, L., Fan, H., Tang, X., Luo, H., Wang, D., Zhou, J., & Xiao, X. (2023) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2023.1295111 · Cited by 30
Schlinzig, T., Johansson, S., Stephansson, O., Hammarström, L. L. G., Zetterström, R. H., von Döbeln, U., Cnattingius, S., & Norman, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0184748 · Cited by 29
Self-citationAssociation between cesarean delivery types and obesity in preadolescence
Sitarik, A. R., Havstad, S. L., Johnson, C. C., Jones, K. J., Levin, A. M., Lynch, S. V., Ownby, D. R., Rundle, A., Straughen, J. K., Wegienka, G., et al. (2020) · International Journal of Obesity · doi:10.1038/s41366-020-00663-8 · Cited by 29
Preconception Care: A New Standard of Care within Maternal Health Services
Genuis, S. J., & Genuis, R. A. (2016) · BioMed Research International · doi:10.1155/2016/6150976 · Cited by 30
“Other studies have reported higher rates of celiac disease [154], type 1 diabetes [155], and allergic disease [152, 154] among those born by Caesarean delivery.”
ResultBai, L., Zhao, D., Cheng, Q., Zhang, Y., Wang, S., Zhang, H., Xie, M., He, R., & Su, H. (2018) · Annals of Epidemiology · doi:10.1016/j.annepidem.2018.10.003 · Cited by 28
Cesarean Delivery and Body Mass Index at 6 Months and Into Childhood
Vinding, R., Sejersen, T. S., Chawes, B., Bønnelykke, K., Buhl, T., Bisgaard, H. F., & Stokholm, J. (2017) · PEDIATRICS · doi:10.1542/peds.2016-4066 · Cited by 28
Cesarean Delivery and Childhood Malignancies: A Single-Center, Population-Based Cohort Study
Greenbaum, S., Sheiner, E., Wainstock, T., Segal, I., Ben‐Harush, M., Sergienko, R., & Walfisch, A. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2017.12.049 · Cited by 28
Gabbianelli, R., Bordoni, L., Morano, S., Calleja‐Agius, J., & Lalor, J. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21145032 · Cited by 36
Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison
Thornton, P. D., McFarlin, B. L., Park, C. G., Rankin, K., Schorn, M. N., Finnegan, L., & Stapleton, S. R. (2016) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.12553 · Cited by 28
Liao, Z., Lamb, K. E., Burgner, D. P., Ranganathan, S., Miller, J. E., Koplin, J. J., Dharmage, S. C., Lowe, A. J., Ponsonby, A., Tang, M. L. K., et al. (2020) · Archives of Disease in Childhood · doi:10.1136/archdischild-2019-317485 · Cited by 27
Atopic dermatitis is associated with Caesarean sections in Korean adolescents, but asthma is not
Yu, M., Han, K., Kim, D., & Nam, G. E. (2015) · Acta Paediatrica · doi:10.1111/apa.13212 · Cited by 27
Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study
Bernardi, J. R., Pinheiro, T. V., Mueller, N. T., Goldani, H. A. S., Gutierrez, M. R. P., Bettiol, H., da Sílva, A. A. M., Barbieri, M. A., & Goldani, M. Z. (2015) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.114.105205 · Cited by 27
“Emerging literature supports the hypothesis that CD is associated with immune-mediated diseases such as asthma (9), celiac disease, allergic rhinitis, gastroenteritis (10, 11), and type 1 diabetes (12).”
Chojnacki, M. R., Holscher, H. D., Balbinot, A., Raine, L. B., Biggan, J. R., Walk, A. M., Kramer, A. F., Cohen, N. J., Hillman, C. H., & Khan, N. A. (2019) · Early Human Development · doi:10.1016/j.earlhumdev.2018.12.021 · Cited by 26
“As the rates of CS have increased, so too have the rates of type I diabetes mellitus (23% higher (31)), Crohn’s disease, multiple sclerosis, asthma (20% higher (31)), allergic rhinitis, and atopic dermatitis (31).”
BackgroundWomen Are Designed to Deliver Vaginally and Not by Cesarean Section: An Obstetrician's View
Visser, G. H. A. (2014) · Neonatology · doi:10.1159/000365164 · Cited by 26
Delivery by caesarean section and childhood cancer: a nationwide follow‐up study in three countries
Momen, N., Olsen, J. H., Gissler, M., Cnattingius, S., & Li, J. (2014) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12667 · Cited by 25
Metadata
- Authors
- Cho, C. E., & Norman, M.
- Affiliations
- University of Toronto (CA)
- Karolinska Institutet (SE)
- Corresponding author
- Cho, Clara E.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 208
- Issue
- 4
- Pages
- 249-254
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2069680673
- Cited by
- 301
- References
- 105
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 17 · 2023: 11 · 2022: 15 · 2021: 26 · 2020: 28 · 2019: 28 · 2018: 40 · 2017: 27 · 2016: 26 · 2015: 29 · 2014: 21 · 2013: 10
- FWCI
- 3.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- cesarean section, mode of delivery, immune system development, asthma, allergy, type 1 diabetes, celiac disease, immune disorders, offspring health
- MeSH terms
- Adult, Animals, Cesarean Section, Child, Child, Preschool, Female, Humans, Immune System, Immune System Diseases, Infant, Infant, Newborn, Pregnancy, Risk Factors, Rats
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
