Is cesarean section a cause of affective disorders?-A national cohort study using sibling designs.
Cesarean section
Depression
Epidemiologic research design
Microbiota
Mood disorders
Proportional hazards models
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
15 03 2020
15 03 2020
Historique:
received:
02
07
2019
revised:
16
11
2019
accepted:
12
01
2020
entrez:
25
2
2020
pubmed:
25
2
2020
medline:
16
2
2021
Statut:
ppublish
Résumé
The gut microbiota of children delivered by cesarean section differs from that of children delivered vaginally. In light of the gut-brain axis hypothesis, cesarean section may influence risk of affective disorders. Population based prospective cohort study included Danish children born 1982 through 2001, with follow-up until 2015. The effect of delivery mode on the risk of affective disorders was assessed using a standard Cox model and two types of Cox sibling models. Diagnostic codes or prescriptions for antidepressants and lithium were used to define cases of affective disorders. 1,009,444 children were followed for 8,880,794 person-years from the age of 13 years, with relevant covariates available from birth. There are strong calendar time trends in the occurrence of affective disorders with an increasingly younger age at first diagnosis and with a hotspot between the years 2007-2012. Fully adjusted standard Cox models showed an increased risk of affective disorders for both pre-labor (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.08-1.15) and intrapartum (HR, 1.07; 95% CI, 1.05-1.10) cesarean section, compared to vaginal delivery. This effect disappeared in the between-within sibling model for pre-labor (HR, 1.00; 95% CI, 0.94-1.07) but not intrapartum (HR, 1.05; 95% CI, 1.00-1.12) cesarean section. Interpretation of results from sibling models may not be relevant to children without siblings. These results do not support the hypothesis that a delivery-mode dependent change in gut microbiota is a cause of subsequent affective disorders, despite an apparent association with delivery mode.
Sections du résumé
BACKGROUND
The gut microbiota of children delivered by cesarean section differs from that of children delivered vaginally. In light of the gut-brain axis hypothesis, cesarean section may influence risk of affective disorders.
METHODS
Population based prospective cohort study included Danish children born 1982 through 2001, with follow-up until 2015. The effect of delivery mode on the risk of affective disorders was assessed using a standard Cox model and two types of Cox sibling models. Diagnostic codes or prescriptions for antidepressants and lithium were used to define cases of affective disorders.
RESULTS
1,009,444 children were followed for 8,880,794 person-years from the age of 13 years, with relevant covariates available from birth. There are strong calendar time trends in the occurrence of affective disorders with an increasingly younger age at first diagnosis and with a hotspot between the years 2007-2012. Fully adjusted standard Cox models showed an increased risk of affective disorders for both pre-labor (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.08-1.15) and intrapartum (HR, 1.07; 95% CI, 1.05-1.10) cesarean section, compared to vaginal delivery. This effect disappeared in the between-within sibling model for pre-labor (HR, 1.00; 95% CI, 0.94-1.07) but not intrapartum (HR, 1.05; 95% CI, 1.00-1.12) cesarean section.
LIMITATIONS
Interpretation of results from sibling models may not be relevant to children without siblings.
CONCLUSIONS
These results do not support the hypothesis that a delivery-mode dependent change in gut microbiota is a cause of subsequent affective disorders, despite an apparent association with delivery mode.
Identifiants
pubmed: 32090777
pii: S0165-0327(19)31703-3
doi: 10.1016/j.jad.2020.01.046
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
496-504Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest All the authors declare no conflicts of interest.