Non-indicated scheduled caesarean deliveries in low-risk pregnancies have harmful effects on gene expression and immune function

Abstract

Medicalised birth is increasing on a global scale. Scheduled caesarean deliveries have become the most common delivery mode in the South African private sector despite evidence that a vaginal delivery is the safest delivery mode in low risk pregnancies. Interventions at childbirth occur at a critical time for epigenetic influence, the assembly of the neonatal microbiome and downstream immune development. The perinatal events that may affect epigenetic influence include iatrogenic premature delivery, distress, bypassing of the vagina, separation of the mother-infant dyad, formula feeds, admission to a neonatal intensive care unit and antibiotics. Caesarean section delivery is associated with a list of long-term immune consequences. A scheduled caesarean section delivery often represents the initial event that will precipitate a domino-effect of altered early life exposures. The purpose of this review is to emphasise the roles of the fetal epigenome and microbiome in long term health and to highlight the harmful effects of a scheduled caesarean delivery on their integrity.