Association between Cesarean section delivery and increased risk of childhood Kawasaki disease

Chih-Fu Wei; Mei-Huei Chen; Ching-Chun Lin; Meng-Shan Tsai; Yueliang Leon Guo; Shio-Jean Lin; Mei-Hwan Wu; Wu-Shiun Hsieh; Pau-Chung Chen

doi:10.1016/j.jfma.2023.12.006

Association between Cesarean section delivery and increased risk of childhood Kawasaki disease

J Formos Med Assoc. 2024 Aug;123(8):843-848. doi: 10.1016/j.jfma.2023.12.006. Epub 2023 Dec 14.

Authors

Chih-Fu Wei¹, Mei-Huei Chen², Ching-Chun Lin³, Meng-Shan Tsai³, Yueliang Leon Guo⁴, Shio-Jean Lin⁵, Mei-Hwan Wu⁶, Wu-Shiun Hsieh⁷, Pau-Chung Chen⁸

Affiliations

¹ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
³ Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.
⁴ Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁵ Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan.
⁶ Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
⁷ Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
⁸ Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan. Electronic address: [email protected].

PMID: 38097429
DOI: 10.1016/j.jfma.2023.12.006

Abstract

Aim: Cesarean section delivery is associated with microbiota disruption and immuno-dysregulation during childhood, but the association with Kawasaki disease remains uncertain. We aimed to evaluate the association between Cesarean section and Kawasaki disease.

Methods: We examined the association between Kawasaki disease between six and eighteen months and Cesarean section within a birth cohort of 15,796 mother-infant pairs in Taiwan. The associations were assessed with Poisson regression in the study population, in the 1:2 propensity score-matched subpopulation, and compared with febrile convulsion, trauma and accidents during the same interval as negative control outcomes.

Results: Cesarean section was found to increase the risk of Kawasaki disease among overall population (adjusted relative risk [aRR]: 2.22, 95 % confidence interval (CI): 1.14-4.34) and the matched subpopulation (aRR: 2.29, 95 % CI: 1.14-4.68 in PS-matched subpopulation). Meanwhile, there was no association between Cesarean section and the clinic visits for febrile convulsion, trauma and accidents.

Conclusion: In conclusion, this study identified a potential association between Cesarean section delivery and a higher risk of Kawasaki disease during six-to eighteen months of the prospective birth cohort in Taiwan.

Keywords: Cesarean section; Epidemiology; Kawasaki disease; Population-based cohort study.

MeSH terms

Adult
Cesarean Section* / adverse effects
Cesarean Section* / statistics & numerical data
Female
Humans
Infant
Male
Mucocutaneous Lymph Node Syndrome* / epidemiology
Poisson Distribution
Pregnancy
Propensity Score
Prospective Studies
Risk Factors
Taiwan / epidemiology