Background and Goals: 

While evidence suggests short-term benefits in neonatal morbidity and mortality from cesarean delivery of the fetus in breech presentation, the long-term implications for the offspring are less clear. To assess the implications of the mode of delivery on offspring’s health, we have evaluated the long-term gastrointestinal (GI) morbidity of offspring with a breech presentation delivered in either way.

Materials and Methods: 

A population-based retrospective cohort study including singleton deliveries in breech presentation occurring between 1991 and 2014 at a tertiary referral hospital. Incidence of hospitalizations of the offspring up to the age of 18 years involving GI morbidity was compared between those delivered via cesarean section or vaginally. A Kaplan-Meier survival curve compared cumulative GI morbidity. A Weibull parametric survival model controlled for confounders while accounting for repeated occurrence of mothers and dependence among siblings.

Results: 

Overall, 86.9% (n=6376) of the 7337 fetuses in breech presentation, were delivered abdominally. Hospitalizations involving GI morbidity were higher in offspring delivered by cesarean section, specifically due to inflammatory bowel disease (IBD). Kaplan-Meier survival curve revealed the higher cumulative incidence of total GI morbidity and IBD specifically in the cesarean delivery group (P<0.001 and P=0.004, respectively). Using a Weibull parametric while controlling for relevant confounders, cesarean delivery emerged as an independent risk factor for long-term IBD-related morbidity of the offspring delivered in breech presentation (adjusted hazard ratio=3.18, 95% confidence interval: 1.47-6.87, P=0.003).

Conclusion: 

Cesarean delivery is associated with higher rates of hospitalizations due to IBD and total GI morbidity during childhood in term singleton in breech presentation.

中文翻译：

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臀位胎儿的分娩方式与儿童期炎症性肠病住院之间的关系

背景和目标： 

虽然有证据表明臀位剖腹产对新生儿发病率和死亡率有短期好处，但对后代的长期影响尚不清楚。为了评估分娩方式对后代健康的影响，我们评估了无论哪种方式臀位分娩的后代的长期胃肠道（GI）发病率。

材料和方法： 

一项基于人群的回顾性队列研究，包括 1991 年至 2014 年在三级转诊医院进行的臀位单胎分娩。对剖腹产或阴道分娩的后代 18 岁以下因胃肠道发病率住院的发生率进行了比较。Kaplan-Meier 生存曲线比较了累积胃肠道发病率。威布尔参数生存模型控制了混杂因素，同时考虑了母亲的重复出现和兄弟姐妹之间的依赖性。

结果： 

总体而言，7337 名臀位胎儿中，86.9%（n=6376）是经腹分娩的。剖宫产后代的胃肠道发病率较高，特别是由于炎症性肠病（IBD）。Kaplan-Meier 生存曲线显示，特别是在剖腹产组中，胃肠道总发病率和 IBD 累积发生率较高（分别为P <0.001 和P = 0.004）。使用威布尔参数，同时控制相关混杂因素，剖腹产成为臀位分娩后代长期 IBD 相关发病率的独立风险因素（调整后风险比 = 3.18，95% 置信区间：1.47-6.87，P =0.003）。

结论： 

剖腹产与臀位足月单胎儿童期因 IBD 和总胃肠道发病率较高的住院率相关。