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Comment & Response |

Cesarean Delivery on Maternal Request

Hong-tian Li, MD1; Jian-meng Liu, MD, PhD1; Jan Blustein, MD, PhD2
[+] Author Affiliations
1Institute of Reproductive and Child Health, Peking University School of Public Health, Beijing, China
2Department of Population Health, New York University School of Medicine, New York
JAMA. 2013;310(9):977-978. doi:10.1001/jama.2013.194750.
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To the Editor In the Clinical Crossroads article on cesarean delivery on maternal request (CDMR), Dr Ecker1 enumerated short- and long-term risks to maternal health, risks for future pregnancies, and short-term health risks to the infant. However, his review did not cover long-term health risks to the infant.

This is an important omission. Increasing evidence suggests that cesarean delivery jeopardizes infant, child, and even adult health. Rigorous, large-scale cohort studies and meta-analyses have consistently linked cesarean delivery to cardiometabolic disease (overweight and obesity, type 1 diabetes), autoimmune and inflammatory disorders (allergic rhinitis, food allergy and atopy, asthma, celiac disease, inflammatory bowel disease), and autism.2 The magnitudes of risk for elective cesarean delivery have been found to be greater than those for emergency cesarean delivery in some of these diseases, including celiac disease, Crohn disease, and autism. One cohort study3 showed that CDMR is associated with an increased risk of childhood overweight.

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September 4, 2013
Jeffrey Ecker, MD
1Harvard Medical School, Boston, Massachusetts
JAMA. 2013;310(9):978-979. doi:10.1001/jama.2013.194777.
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