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原标题：剖腹产与儿童特应性皮炎的风险
背景：剖腹产可能会破坏母婴微生物的转移，并改变免疫系统的发育以及随后发生特应性皮炎的风险。 
方法：母婴信息是通过美国凯撒健康计划和医疗集团（KPNC）集成医疗系统收集的。数据来源包括电子医疗记录、药房数据库、州出生记录和前瞻性收集的母乳喂养调查。如果儿童在2005年至2014年之间出生于KPNC或其承包医院并且连续至少四年入选KPNC的系统，则符合资格（n = 173105）。
结果：尽管未经校正的分析显示，剖腹产与特应性皮炎之间存在正相关性[RR（95%CI）：1.06（1.03，1.10）]，但这种影响在校正后减弱为零[aRR（95%CI）：1.02（0.99），1.05）]。在分层分析中，有证据表明，剖腹产在某些亚组（例如，第一胎，BMI超重/肥胖的孕妇）中增加了特应性皮炎的风险，但关联性较弱。剖腹产分娩条件表明与母体微生物组的接触最少（膜破裂和分娩之间的间隔很短），但没有证据表明与这与特应性皮炎有关。估计的相关性并没有受到产时抗生素、母乳喂养、缺失数据或家庭因素的强烈影响。
结论：在这个大型的美国队列中，剖腹产与儿童4岁时的特应性皮炎无关。这种关联似乎没有受到产时抗生素、母乳喂养行为、剖腹产指征、缺失协变量或家族因素的影响。
延伸阅读
Clinical & Experimental Allergy                                              
Caesarean delivery and the risk of atopic dermatitis in children
DOI: org/10.1111/cea.13668
Abstract:
Background: Caesarean delivery (C‐section) may disrupt maternal‐infant microbial transfer and alter immune system development and subsequent risk for atopic dermatitis.
Methods: P
Maternal and child information was collected through Kaiser Permanente Northern California's (KPNC) integrated healthcare system. Data sources included electronic medical records, pharmacy databases, state birth records, and prospectively collected breastfeeding surveys. Children were eligible if they were born in a KPNC or contracting hospital between 2005 and 2014 and had continuous enrolment in the KPNC system for at least four years (n=173105). Modified Poisson regression with robust variance estimation was used to estimate the association between C‐section and atopic dermatitis overall and when stratified by demographic and labour and delivery characteristics.
Results: Although unadjusted analyses showed a positive association between C‐section and atopic dermatitis [RR(95%CI): 1.06(1.03, 1.10)], this effect was attenuated towards the null after adjustment [aRR(95%CI): 1.02(0.99, 1.05)]. In stratified analyses, there was evidence that C‐section increased atopic dermatitis risk among certain subgroups (eg firstborns, overweight/obese pre‐pregnancy BMI), but associations were weak. C‐section delivery conditions indicative of the least exposure to maternal microbiome (ie no labour, short interval between membrane rupture and delivery) showed no evidence of association with atopic dermatitis. Estimated associations were not strongly influenced by intrapartum antibiotics, breastfeeding, missing data, or familial factors.
Conclusion: Caesarean delivery was not associated with atopic dermatitis by age four in this large US cohort. This association did not appear to be biased by intrapartum antibiotics, breastfeeding behaviour, C‐section indication, missing covariates, or familial factors.
First Author:
Megan Richards
Correspondence:
Megan Richards, School of Community Health Sciences 1664 N Virginia St, m/s 0275, Reno, NV 89557, USA.
All Authors:
Megan Richards, Jeannette Ferber, Hong Chen, Erin Swor, Charles P. Quesenberry, De‐Kun Li, Lyndsey A. Darrow
　　创建过敏性疾病的科研、科普知识交流平台，为过敏患者提供专业诊断、治疗、预防的共享平台。