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Cesarean Section and other Birth Interventions: impact on Clostridioides difficile (C. difficile) colonization in the infant gut microbiota in the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort

  • Author / Creator
    McLean, Cara
  • Abstract Background Medical interventions during childbirth are increasing, with cesarean section (CS) delivery exceeding recommended rates by 13-15 % in Canada. CS has been associated with gut dysbiosis in early life. Infants who bypass this beneficial maternal bacterial inoculation during vaginal birth have been found to be commonly colonized by opportunistic bacteria such as C. difficile, but factors leading to colonization remain unknown. This study aimed to determine the impact of medical interventions during birth on the colonization of C. difficile in infants at 3 months, 1 year and longitudinal persistent colonization throughout the first year of life.Methods This was a prospective cohort study utilizing data on 1477 mother-infant pairs at 3 months, 1836 mother-infant pairs at 1 year and 1226 mother-infant pairs longitudinally from the Canadian Healthy Infant Longitudinal Development (CHILD) population-based birth cohort. Medical interventions (i.e. cesarean delivery, anesthetics and oxytocin-like drugs to stimulate labor such as oxytocin, carbetocin, prostaglandins), and maternal and infant covariates were collected from hospital charts or maternal questionnaires. C. difficile was detected in infant fecal samples collected at 3-4 months and 1 year of age using quantitative polymerase chain reaction and classified as present/absent. Logistic regression models were run to determine whether medical interventions and mode of delivery were associated with C. difficile colonization, adjusted for covariates.Results Almost one-third of infants were colonized with C. difficile at 3 months of age which extended to almost fifty percent at 1 year of age with a fifteen percent persistence colonization rate at 3 months and 1 year of age. Overall, mode of delivery effects were most prominent at 3 months of age; C. difficile rates were 28%, 31%, 41% and 38% in infants born vaginally with no maternal intrapartum antibiotic prophylaxis (IAP), vaginally with IAP, emergency CS with IAP and elective CS with IAP, respectively. In unadjusted analysis, the risk of colonization with C. difficile was significantly increased in infants born by emergency CS and elective CS compared to vaginal birth with no IAP (OR 1.76, 95% CI: 1.27-2.44 p=0.001 and OR 1.55, 95% CI: 1.06-2.26 p=0.024, respectively). Following adjustment for maternal gravida status, birthweight, anaesthetic and oxytocin use during delivery, hospital length-of-stay, maternal ethnicity and age, prenatal depression, postnatal smoking and breastfeeding, the association remained significant for infants born by emergency CS compared to vaginal birth with no IAP (aOR 1.72, 95% CI: 1.15-2.55 p=0.007). Oxytocin-like drugs and anesthetics were used in 47% and 77% of all births, respectively. After stratification for these drugs, among mothers who received both anesthetics and oxytocin-like drugs during delivery, this increased risk of C. difficile in infants born by emergency CS was further amplified (aOR 2.29, 95% CI: 1.21-2.83 p=0.004). Mode of delivery effects persisted longitudinally to 1 year of age among first born infants and exclusively formula fed at 3 months; similarly, mode of delivery effects at 3 months were most evident in first born infants. Oxytocin and anesthetics appeared to have little effect on C. difficile colonization in early life; however, the ‘first born effect’ questions other medical interventions during birth that could disrupt the natural assembly and balance of the infant gut microbiota at birth. Conclusions Emergency cesarean delivery was significantly associated with C. difficile colonization during infancy and this did not appear to be related to oxytocin-like drugs or anesthetics during delivery.

  • Subjects / Keywords
  • Graduation date
    2019-06
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/r3-gqsn-cx78
  • License
    Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.