Infant, born by cesarean section: possible health risks and opportunities to mitigate them


The article comprises some of modern scientific literature review, dedicated to potential health risks for infants, born by cesarean section without medical indications. Possible mechanisms of such risks are discussed along with strategies to mitigate them - with a focus on the importance of optimal nutrition from birth.

Keywords:cesarean section, risks for infant, immune-mediated diseases, gut microbiota, infant nutrition, human milk oligosaccharides

Funding. The study had no sponsor support.

Conflict of interests. Ukraintsev S.E. is medical director of Netsle Russia LLC.

For citation: Ukraintsev S.E., Zakharova I.N., Zaplatnikov A.L., Belousova T.V., Belotserkovtseva L.D., Ovsyannikov D.Yu., Gorev V.V., Rozhko Yu.V. Infant, born by cesarean section: possible health risks and opportunities to mitigate them. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2020; 8 (2): 28-38. DOI: 10.33029/2308-2402-2020-8-2-28-38 (in Russian)


1. Losev A.F. Mythology of the Greeks and Romans. Сompiled by A.A. Takho-Godi; edited by A.A. Takho-Godi, 1.1. Makhankova. Moscow: Mysl’, 1996: 975 p. (in Russian)

2. Gorelova L.E. Pages of the Caesarean Section History. RMZH Mat’ i ditya [RMJ. Mother and Child]. 2008; (19): 1292. (in Russian)

3. Boerma T., Ronsmas C., Melesse D.Y., et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018; 392: 1341-8.

4. Occhi G.M., de Lamare F.N.T., Neri M.A., et al. Strategic measures to reduce the caesarean section rate in Brazil. Lancet. 2018; 392 (10 155): 1290-1. DOI: 10.1016/S0140-6736(18)32407-3

5. Betran A.P., Ye L., Moller A.-B., et al. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016; 11 (2): e0148343.

6. Kostin I.N. Reserves for reducing reproductive losses in the Russian Federation: Diss. Moscow, 2012. (in Russian)

7. Malgina G.B., Bashmakova N.V., Kovalev V.V. Cesarean Section effectiveness ratio in leaders perinathal centres of the Ural Federal District. Ural’skiy meditsinskiy zhurnal [Ural Medical Journal]. 2012: (11): 2. (in Russian)

8. Mikhailova L.E., Gorkoltseva E.I., Demkina Yu.O. Structure and analysis of indications for operative abdominal delivery in the Nizhnevartovsk District Clinical Perinatal Center in the Khanty-Mansi Autonomous Okrug-Ugra for the period 2013 - 9 months 2016. Robson M. Classification Cesarean Section Efficiency. Zdravookhranenie Yugry: Opyt i innovatsii [Healthcare of Ugra: Experience and Innovation]. 2016; (4): 6-8. (in Russian)

9. WHO. Statement on Caesarean Section Rates. Geneva: World Health Organization, 2015. URL: (date of access March, 2019)

10. Mascarello K.C., Horta B.L., Silveira M.F. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Rev Saude Publica. 2017; 51: 105.

11. Neu D., Rushing J. Cesarean versus vaginal delivery: long term infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011; 38 (2): 321-31.

12. Sevelsted A., Stokholm J., Bonnelykke K. Cesarean section and chronic immune disorders. Pediatrics. 2015; 135 (1): e92-8. DOI: 10.1542/ peds.2014-0596

13. Matteo M.R., Morton S.C., Lepper H.S., et al. Caesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychol. 1996; 15: 303-14.

14. Clement S. Psychological aspects of caesarean section. Best Pract Res Clin Obstet Gynaecol. 2001; 15 (1): 109-26.

15. Hobbs A.J., Mannion C.A., McDonald S.W., et al. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childb. 2016; 16: 90.

16. Evans K.C., Evans R.G., Royal R., et al. Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life. Arch Dis Child Fetal Neonatal Ed. 2003; 88: F380-2.

17. Mitselou N., Hallberg J., Stephansos O., et al. Cesarean delivery, preterm birth and risk of food allergy: nationwide Swedish cohort study of over 1 million children. J Allergy Clin Immunol. 2019; 143 (5): 1972.

18. Bager P., Wohlfahrt J., Westergaard T., et al. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy. 2008; 38: 634-42.

19. Gil F., Amezqueta A., Martinez D. Association between caesarean delivery and isolated doses of formula feeding in cow milk allergy. Int Arch Allergy Immunol. 2017; 173: 147-52.

20. Cardwell C.R., et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a metaanalysis of observational studies. Diabetologia. 2008; 51: 726-35.

21. Bonifacio E., Warncke K., Winkler C., Wallner M., Ziegler A.G. Cesarean section and interferon-induced helicase gene polymorphisms combine to increase childhood type 1 diabetes risk. Diabetes. 2011; 60: 3300-6.

22. Wen L., Ley R.W., Volchkov P.Y., et al. Innate immunity and intestinal microbiota in the development of Type 1 diabetes. Nature. 2008; 455 (7216): 1109-13.

23. Laimighofer M., Lickert R., Fuerst R., et al. Common patterns of gene regulation associated with Cesarean section and the development of islet autoimmunity - indications of immune cell activation. Sci Rep. 2019; 9 (1): 6250.

24. Jakobsson H.E., Abrahamsson T.R., Jenmalm M.C., Harris K., Quince C., Jernberg C., et al. Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section. Gut. 2014; 63 (4): 559-66.

25. Stokholm J., Thorsen J., Chawes B.L., Schjorring S., Krogfelt K.A., Bonnelykke K., et al. Cesarean section changes neonatal gut colonization. J Allergy Clin Immunol. 2016; 138 (3): 881-9.e2.

26. Dominguez-Bello M.G., Costello E.K., Contreras M., Magris M., Hidalgo G., Fierer N., et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci USA. 2010; 107 (26): 11 971-5.

27. Huure A., Kalliomaki M., Ruatava S., et al. Mode of delivery - effects on gut microbiota and humoral immunity. Neonatology. 2008; 93: 236-40.

28. Sevelsted A., Stokholm J., Bonnelykke K., Bisgaard H. Cesarean section and chronic immune disorders. Pediatrics. 2015; 135 (1): e92-8.

29. Lagercrantz H. Stress, arousal, and gene activation at birth. Physiology. 1996; 11 (5): 214-8.

30. Vogl S.E., Worda C., Egarter C., et al. Mode of delivery is associated with maternal and fetal endocrine stress response. BJOG. 2006; 113: 441-5.

31. Lagercrantz H., Slotkin T. The «stress» of being born. Sci Am. 1986; 254 (4): 100-7.

32. Lagerkrantz H. Stress, arousal, and gene activation at birth. News Physiol Sci. 1996; 11: 214-8.

33. Gitau R., Menson E., Pickles V., Fisk N.M., Glover V., MacLachlan N. Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2001; 98: 14-7.

34. Siggers R.H., Thymann T., Jensen B.B., et al. Elective cesarean delivery affects gut maturation and delays microbial colonization but does not increase necrotizing enterocolitis in preterm pigs. Am J Physiol Regul Integr Comp Physiol. 2008; 294: R929-38.

35. Steinborn A., Sohn C., Sayehli C., Baudendistel A., Huwelmeier D., Solbach C., et al. Spontaneous labour at term is associated with fetal monocyte activation. Clin Exp Immunol. 1999; 117: 147-52.

36. Lim F.T., Scherjon S.A., van Beckhoven J.M., Brand A., Kanhai H.H., Hermans J.M., et al. Association of stress during delivery with increased numbers of nucleated cells and hematopoietic progenitor cells in umbilical cord blood. Am J Obstet Gynecol. 2000; 183: 1144-52.

37. Nandanan B., Chua M.C., Chiang W.C., et al. Influence of mode of delivery on cytokine expression in cord blood. Hum Immunol. 2019; 80: 533-6.

38. Renz-Polster H., David M.R., Buist A.S., et al Caesarean section delivery and the risk of allergic disorders in childhood. Clin Exp Allergy. 2005; 35: 1466-72.

39. Schlinzig T., Johansson S., Gunnar A., et al. Epigenetic modulation at birth - altered DNA-methylation in white blood cells after Caesarean section. Acta Paediatr. 2009; 98: 1096-9.

40. Martino D.J., Prescott S.L. Silent mysteries: epigenetic paradigms could hold the key to conquering the epidemic of allergy and immune disease. Allergy. 2010; 65: 7-15.

41. Nolan A., Lawrence C. A pilot study of a nursing intervention protocol to minimize maternal-infant separation after cesarean birth. J Obstet Gynecol Neonatal Nurs. 2009; 38: 430-42.

42. Hung K., Berg 0. Early skin-to-skin after cesarean to improve breastfeeding. MCN. Am J Matern Child Nurs. 2011; 36: 318-26.

43. Stevens J., Schimed V., Burns E., Dahlen H. Immediate or early skin-to-skin contact after a caesarean section: a review of the literature. Matern Child Nutr. 2014; 10: 456-73.

44. Erlandsson K., Dsilna A., et al. Skin-to-skin care with the father after cesarean birth and its effects on newborn crying and prefeeding behavior. Birth. 2007; 34 (2): 105-14.

45. Cunnington A.J., Sim K., Deierl A., et al. «Vaginal seeding» of infants born by caesarean section. BMJ. 2016; 352: i227. D0I: 10.1136/bmj.i227

46. Campbell J.R., Hillier S.L., Krohn M.A., et al. Group B streptococcal colonization and serotype-specific immunity in pregnant women at delivery. Obstet Gynecol. 2000; 96: 498-503.

47. O’Connor D.I., Unger S. Post-discharge nutrition of the breastfed preterm infant. Semin Fetal Neonatal Med. 2013; 18: 124-8.

48. Walker W., Iyengar R. Breast milk, microbiota, and intestinal immune homeostasis. Pediatr Res. 2015; 77: 220-8.

49. Pannaraj P.S., Li F., Cerini C., et al. Association between breast milk bacterial communities and establishment and development of the infant gut microbiome. JAMA Pediatr. 2017; 171 (7): 647-54.

50. Goldman A.S. Future research in the immune system of human milk. J Pediatr. 2019; 206: 274-9.

51. Makarova E.G., Netrebenko O.K., Ukraintsev S.E.. Breast milk oligosaccharides: the history of discovery, structure and protective functions. Pediatriya. Zhurnal im. G.N. Speranskogo [Pediatrics Journal named after G.N. Speranskiy]. 2018; 97 (4): 152-60. (in Russian)

52. Bode L. Human milk oligosaccharides: prebiotics and beyond. Nutr Rev. 2009; 67 (2): S183-91.

53. Triantis V., Bode L., Joost van Neerven R.J. Immunological effects of human milk oligosaccharides. Front Pediatr. 2018; 6: 190.

54. Cabrera-Rubio R., Kunz C., Rudloff S., et al. Association of maternal secretor status and human milk oligosaccharides with milk microbiota: an observational pilot study. J Pediatr Gastroenterol Nutr. 2019; 68: 256-63.

55. Korpela K., Salonen A., Hickman B. Fucosylated oligosaccharides in mother’s milk alleviate the effects of caesarean birth on infant gut microbiota. Sci Rep. 2018; 8: 13757.

56. Thomson P., Medina D.A., Garrido D. Human milk oligosaccharides and infant gut bifidobacteria: molecular strategies for their utilization. Food Microbiol. 2018; 75: 37-46.

57. Sprenger N., Odenwald H., Kukkonen A.K., Kuitunen M., Savilahti E., Kunz C. FUT2-dependent breast milk oligosaccharides and allergy at 2 and 5 years of age in infants with high hereditary allergy risk. Eur J Nutr. 2017; 56: 1293-301.

58. Goldman A.S. Future research in the immune system of human milk // J. Pediatr. 2019; 206: 274-9.

59. Federal state statistics service, 2019. URL: (in Russian)

60. Puccio G., Alliet P., Cajozzo C., et al. Effects of infant formula with human milk oligosaccharides on growth and morbidity: a randomized multicenter trial. J Pediatr Gastroenterol Nutr. 2017; 64 (4): 624-31.

61. Risnes K.R., Belanger K., Murk W., Bracken M.B. Antibiotic exposure by 6 months and asthma and allergy at 6 years findings in a cohort of 1401 US children. Am J Epidemiol. 2011; 173 (3): 310-8.

62. Rodenas C.L.G., Lepage M., Ngom-Bru C. Effect of formula containing Lactobacillus reuteri DSM 17938 on fecal microbiota of infants born by cesarean-section. J Pediatr Gastroenterol Nutr. 2016; 63: 681-7.

Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

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