Prevalence of Allergic Diseases in Children according to Mode of Delivery

Yong Ju Lee; Hye Mi Jee; Byoung Ju Kim; Hyo Bin Kim; Jinho Yu; So Yeon Lee; Woo Kyung Kim; Myung Hyun Sohn; Kyu-Earn Kim; Soo-Jong Hong; Kyung Won Kim

doi:10.7581/pard.2011.21.3.197

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Lee, Jee, Kim, Kim, Yu, Lee, Kim, Sohn, Kim, Hong, and Kim: Prevalence of Allergic Diseases in Children according to Mode of Delivery

Abstract

Pediatr Allergy Respir Dis 2011;21(3):197-206.

Published online: 20 January 2011

DOI: https://doi.org/10.7581/pard.2011.21.3.197

Prevalence of Allergic Diseases in Children according to Mode of Delivery

Yong Ju Lee, MD¹, Hye Mi Jee, MD², Byoung Ju Kim, MD³, Hyo Bin Kim, MD, PhD⁴, Jinho Yu, MD, PhD⁵, So Yeon Lee, MD, PhD⁶, Woo Kyung Kim, MD, PhD⁷, Myung Hyun Sohn, MD, PhD⁸, Kyu-Earn Kim, MD, PhD⁸, Soo-Jong Hong, MD, PhD⁵, Kyung Won Kim, MD, PhD^8,

¹Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

²Department of Pediatrics, Bundang CHA Hospital, CHA University School of Medicine, Seongnam, Korea

³Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

⁴Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

⁵Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

⁶Department of Pediatrics, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

⁷Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

⁸Department of Pediatrics, Institute of Allergy, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea

책임저자: 김경원, 서울시 서대문구 성산로 250 연세대학교 의과대학 소아과학교실 Tel: 02)2228-2050 Fax: 02)393-9118 E-mail: kwkim@yuhs.ac

Received 28 June 2011 Revised 19 July 2011 Accepted 25 July 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

It has been suggested that caesarean section is a risk factor for allergic diseases under the ‘hygiene hypothesis', but it remains controversial. In this study, we examined the association between mode of delivery and development of allergic diseases.

Methods

The Korean International Study of Asthma and Allergies in Childhood questionnaire was used to survey 8,404 elementary and middle-school students in Seoul between April and October 2008. We categorized children into a caesarean section group and a vaginal delivery group, and surveyed the prevalence of asthma, allergic rhinitis, and atopic dermatitis

Results

No differences in the prevalence of “wheeze ever” (P=0.418), “wheezing the last 12 months” (P=0.152), and “diagnosis of asthma ever” (P=0.382) were observed between the caesarean section group and the vaginal delivery group. The prevalence of “rhinitis ever” (P=0.609), “rhinitis the last 12 months” (P=0.788), and “diagnosis of allergic rhinitis ever” (P=0.700) was also similar between the two groups. The prevalence of “itchy eczema ever” (P=0.065), “itchy eczema last 12 months” (P=0.381), and a “diagnosis of atopic dermatitis ever” (P=0.162) also did not show any differences between the two groups. However, in subjects with a family history of allergic disease, the caesarean section group had the higher prevalence of “diagnosis of asthma ever” (11.3% vs. 9.2%, P=0.032) than that in the vaginal delivery group.

Conclusion:

We found an association between mode of delivery and the subsequent development of asthma in children with a family history of allergic disease in Seoul, Korea.

Keywords: Caesarean section, Mode of delivery, Children, Asthma, Allergic rhinitis, Atopic dermatitis

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Table 1.

Characteristics of the Subjects by Mode of Delivery (continue)

	Vaginal delivery	Caesarean section	Total	P -value^∗
All	5,177 (61.6)	3,227 (38.4)	8,404 (100)
Sex
Male	2,268 (43.8)	1,452 (45.0)	3,720 (44.3)	0.360
Female	2,721 (52.6)	1,670 (51.8)	4,391 (52.2)
Missing	188 (3.6)	105 (3.3)	293 (3.5)
Pre-term delivery, wk
<37	167 (3.2)	166 (5.1)	333 (4.0)	<0.001
≥37	4,885 (94.4)	2,965 (91.9)	7,850 (93.4)
Missing	125 (2.4)	96 (3.0)	221 (2.6)
Birth weight, kg
<2.5	139 (2.7)	152 (4.7)	291 (3.5)	<0.001
2.5–4.0	4,554 (88.0)	2,709 (83.9)	7,263 (89.8)
>4.0	303 (5.9)	234 (7.3)	537 (6.4)
Missing	181 (3.5)	132 (4.1)	313 (3.7)
Duration of breastfeeding, months
Never	1,892 (36.5)	1,565 (48.5)	3,457 (41.1)	<0.001
1–6	1,831 (35.4)	921 (28.5)	2,752 (32.7)
6–12	882 (17.0)	427 (13.2)	1,309 (15.6)
>12	541 (10.5)	296 (9.2)	837 (10.0)
Missing	31 (0.6)	18 (0.6)	49 (0.6)
Number of siblings in household, n				0.006
0	2,991 (57.8)	1,851 (57.4)	4,842 (57.6)
1	1,750 (33.8)	1,158 (35.9)	2,908 (34.6)
2	364 (7.0)	193 (6.0)	557 (6.6)
≥3	72 (1.4)	25 (0.8)	97 (1.2)
Household income, million won in a month				0.002
<2.00	571 (11.1)	421 (13.1)	992 (11.8)
2.00–2.99	920 (17.8)	620 (19.2)	1,540 (18.3)
3.00–3.99	1,321 (25.5)	771 (23.9)	2,092 (24.9)
4.00–4.99	1,345 (26.0)	845 (26.2)	2,190 (26.1)
≥5.00	740 (14.3)	398 (12.3)	1,138 (13.5)
Missing	280 (5.4)	172 (5.3)	452 (5.4)
Antibiotics use in the first year of life, n
Never	3,516 (67.9)	2,201 (68.2)	5,717 (68.0)	0.152
1–2	951 (18.4)	539 (16.7)	1,490 (17.7)
3–4	289 (5.6)	203 (6.3)	492 (5.9)
≥5	308 (5.9)	204 (6.3)	512 (6.1)
Missing	113 (2.2)	80 (2.5)	193 (2.3)
Bronchiolitis in the first 2 years of life, n
Yes	501 (9.7)	296 (9.2)	797 (9.5)	0.377
No	4,296 (83.0)	2,725 (84.4)	7,021 (83.5)
Missing	380 (7.3)	206 (6.4)	586 (7.0)
Day care attendance, n
Yes	4,368 (84.4)	2,782 (86.2)	7,150 (85.1)	0.014
No	671 (13.0)	360 (11.2)	1,031 (12.3)
Missing	138 (2.7)	85 (2.6)	223 (2.7)
Household pets
Dog	450 (8.7)	291 (9.0)	741 (8.8)	0.348
Cat	19 (0.4)	12 (0.4)	31 (0.4)
Nothing	4,708 (90.9)	2,924 (90.6)	7,632 (90.2)
Parental history of allergy
Yes	2,725 (52.6)	1,620 (50.2)	4,345 (51.7)	0.160
No	1,257 (24.3)	808 (25.0)	2,065 (24.6)
Missing	1,195 (23.1)	799 (24.8)	1,994 (23.7)
ETS
Yes	2,472 (47.7)	1,644 (50.9)	4,116 (49.0)	0.008
No	2,436 (47.1)	1,434 (44.4)	3,870 (46.0)
Missing	269 (5.2)	149 (4.6)	418 (5.0)

Values are presented as number (%).

ETS, environmental tobacco smoke exposure at least once per week.

^∗ Chi-square test based on non-missing data.

Table 2.

Prevalence of Allergic Diseases according to the Mode Of Delivery

Variables	Caesarean section (n=3,227)		Vaginal delivery (n=5,177)		P -value^∗
Variables	n	%	n	%	P -value^∗
Asthma
Wheeze, ever	323/2,667	12.1	550/3,665	12.9	0.418
Wheezing, last 12 mo	197/2,826	6.5	351/4,481	7.2	0.152
Diagnosis of asthma, ever	241/2,806	7.9	357/4,495	7.4	0.382
Allergic rhinitis
Rhinitis, ever	1,143/1,723	39.9	1,793/2,772	39.3	0.609
Rhinitis, last 12 mo	1,051/1,941	35.1	1,662/3,111	34.8	0.788
Diagnosis of AR, ever	873/2,065	29.7	1,403/3,251	30.1	0.700
Atopic dermatitis
Itchy eczema, ever	585/2,385	19.7	1,022/3,739	21.5	0.065
Itchy eczema, last 12 mo	440/2,618	14.4	739/4,148	15.1	0.381
Diagnosis of AD, ever	811/2,239	26.6	1,363/3,498	28.0	0.162

AD, atopic dermatitis.

^∗ Chi-square test based on non-missing data.

Table 3.

Prevalence of Allergic Diseases according to the Mode of Delivery in Subjects with a Family History of Allergic Diseases

Variables	Cesarean section (n=1,620)		Vaginal delivery (n=2,725)		P -value^∗
Variables	N	%	N	%	P -value^∗
Asthma
Wheeze, ever	193/1,157	14.3	340/1,880	15.3	0.438
Wheezing, last 12 mo	212/2,338	7.3	112/1,415	8.3	0.257
Diagnosis of asthma, ever	175/1,368	11.3	236/2,316	9.2	0.032
Allergic rhinitis
Rhinitis, ever	680/777	46.7	1,127/1,274	46.9	0.894
Rhinitis, last 12 mo	643/879	42.2	1,055/1,457	42.0	0.895
Diagnosis of AR, ever	608/885	40.7	1,032/1,438	41.8	0.527
Atopic dermatitis
Itchy eczema, ever	399/1,117	26.3	722/1,790	28.7	0.102
Itchy eczema, last 12 mo	291/1,263	18.7	538/2,049	20.8	0.109
Diagnosis of AD, ever	549/985	35.8	959/1,609	37.3	0.332

AD, atopic dermatitis

^∗ Chi-square test based on non-missing data.

Table 4.

Association between the Mode of Delivery and Allergic Disease in Subjects with a Family History of Allergic Diseases

Outcomes	No. of cesarean section	No. of vaginal deliveries	Crude OR [95% CI]	Adjusted OR^∗ [95% CI]
Asthma
Yes	175/1,543 (11.3)	236/2,552 (9.2)	1.26 [1.02,1.54]	1.24 [0.99,1.56]
No	1,368/1,543 (88.7)	2,316/2,552 (80.8)
Allergic rhinitis
Yes	608/1,493 (40.7)	1,032/2,470 (41.8)	0.96 [0.84,1.09]	0.95 [0.83,1.10]
No	885/1,493 (59.3)	1,438/2,470 (58.2)
Atopic dermatitis
Yes	549/1,534 (35.8)	959/2,568 (37.3)	0.94 [0.82,1.07]	0.89 [0.77,1.03]
No	985/1,534 (64.2)	1,609/2,568 (62.7)

OR, odds ratio; CI, confidence interval.

^∗ Adjusted for gender, age, sibling number, exposure to smoking, prematurity, birth weight, breast milk feeding, antibiotics use during the first year, house income, and daycare.

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