{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:16:44Z","timestamp":1790191004663,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T00:00:00Z","timestamp":1503964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T00:00:00Z","timestamp":1503964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Caesarean section (CS) may increase the risk of asthma and allergic diseases in children, but previous studies could not preclude the potential confounding effect of underlying medical indications for CS. We aim to assess the association between CS itself (without indications) and risks of asthma and allergic rhinitis in children. The 2014 Shanghai Children\u2019s Health, Education and Lifestyle Evaluation was a large population-based survey with cluster random probability sampling in 26 primary schools in Shanghai, China, in 2014. The mode of delivery and child history of asthma and allergic rhinitis were reported by parents. We included 12639 children in our analysis. CS without medical indication was associated with an increased risk of childhood asthma. CS without medical indication and CS for fetal complications were associated with increased risks of childhood allergic rhinitis, respectively. In children fed by exclusive breastfeeding or mixed feeding in the first four months after birth, these risks were not significant. In contrast, in children fed by exclusive formula milk, CS was highly significantly associated with childhood asthma and allergic rhinitis. In conclusion, CS without medical indication was associated with increased risks of both childhood asthma and allergic rhinitis. Breastfeeding in early infancy may attenuate these risks.<\/jats:p>","DOI":"10.1038\/s41598-017-10206-3","type":"journal-article","created":{"date-parts":[[2017,8,23]],"date-time":"2017-08-23T09:21:27Z","timestamp":1503480087000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Cesarean section without medical indication and risks of childhood allergic disorder, attenuated by breastfeeding"],"prefix":"10.1038","volume":"7","author":[{"given":"Shuyuan","family":"Chu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunting","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanrui","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanqi","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2017,8,29]]},"reference":[{"key":"10206_CR1","doi-asserted-by":"publisher","first-page":"251","DOI":"10.4168\/aair.2013.5.5.251","volume":"5","author":"GW Wong","year":"2013","unstructured":"Wong, G. W., Leung, T. F. & Ko, F. W. Changing prevalence of allergic diseases in the Asia-pacific region. Allergy Asthma Immunol Res \n                           5, 251\u2013257 (2013).","journal-title":"Allergy Asthma Immunol Res"},{"key":"10206_CR2","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1111\/j.1365-2222.2008.02939.x","volume":"38","author":"P Bager","year":"2008","unstructured":"Bager, P., Wohlfahrt, J. & Westergaard, T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy \n                           38, 634\u201342 (2008).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR3","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1111\/j.1365-2222.2007.02780.x","volume":"38","author":"S Thavagnanam","year":"2008","unstructured":"Thavagnanam, S., Fleming, J., Bromley, A., Shields, M. D. & Cardwell, C. R. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy \n                           38, 629\u2013633 (2008).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114022","volume":"10","author":"Y Li","year":"2015","unstructured":"Li, Y. et al. Pre- and postnatal risk factors in relation to allergic rhinitis in school-aged children in China. PLoS One \n                           10, e0114022 (2015).","journal-title":"PLoS One"},{"key":"10206_CR5","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1136\/thx.2008.111385","volume":"65","author":"SW Turner","year":"2010","unstructured":"Turner, S. W. et al. Associations between fetal size, maternal {alpha}-tocopherol and childhood asthma. Thorax \n                           65, 391\u2013397 (2010).","journal-title":"Thorax"},{"key":"10206_CR6","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1111\/j.1365-2222.2012.03997.x","volume":"42","author":"SG Tedner","year":"2012","unstructured":"Tedner, S. G., \u00d6rtqvist, A. K. & Almqvist, C. Fetal growth and risk of childhood asthma and allergic disease. Clin Exp Allergy \n                           42, 1430\u20131447 (2012).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR7","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1056\/NEJM200008243430803","volume":"343","author":"TM Ball","year":"2000","unstructured":"Ball, T. M. et al. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood. N Engl J Med \n                           343, 538\u2013543 (2000).","journal-title":"N Engl J Med"},{"key":"10206_CR8","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1111\/cea.12349","volume":"45","author":"DP Strachan","year":"2015","unstructured":"Strachan, D. P. et al. Siblings, asthma, rhinoconjunctivitis and eczema: a worldwide perspective from the International Study of Asthma and Allergies in Childhood. Clin Exp Allergy \n                           45, 126\u2013136 (2015).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR9","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1111\/cea.12380","volume":"45","author":"SM Collin","year":"2015","unstructured":"Collin, S. M. et al. Pet ownership is associated with increased risk of non-atopic asthma and reduced risk of atopy in childhood: findings from a UK birth cohort. Clin Exp Allergy \n                           45, 200\u2013210 (2015).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR10","doi-asserted-by":"crossref","unstructured":"Feng, X. L., Xu, L., Guo, Y. & Ronsmans, C. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ \n                           90, 30\u201339, 39A (2012).","DOI":"10.2471\/BLT.11.090399"},{"key":"10206_CR11","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1097\/AOG.0b013e31816e349e","volume":"111","author":"J Zhang","year":"2008","unstructured":"Zhang, J. et al. Cesarean delivery on maternal request in southeast China. Obstet Gynecol \n                           111, 1077\u20131082 (2008).","journal-title":"Obstet Gynecol"},{"key":"10206_CR12","doi-asserted-by":"crossref","unstructured":"Fuller, W. A. Sampling Statistics. Wiley series in survey methodology. John Wiley & Sons, Inc., New Jersey. 455\u2013456 (2009).","DOI":"10.1002\/9780470523551.scard"},{"key":"10206_CR13","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1080\/01621459.1994.10476818","volume":"89","author":"JM Robins","year":"1994","unstructured":"Robins, J. M., Rotnitzky, A. & Zhao, L. P. Estimation of regression coefficients when some regressors are not always observed. J Am Stat Assoc \n                           89, 846\u2013866 (1994).","journal-title":"J Am Stat Assoc"},{"key":"10206_CR14","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.1001\/jama.2015.16176","volume":"314","author":"M Black","year":"2015","unstructured":"Black, M., Bhattacharya, S., Philip, S., Norman, J. E. & McLernon, D. J. Planned cesarean delivery at term and adverse outcomes in childhood health. JAMA \n                           314, 2271\u20132279 (2015).","journal-title":"JAMA"},{"key":"10206_CR15","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1111\/cea.12548","volume":"45","author":"JY Leung","year":"2015","unstructured":"Leung, J. Y., Li, A. M., Leung, G. M. & Schooling, C. M. Mode of delivery and childhood hospitalizations for asthma and other wheezing disorders. Clin Exp Allergy \n                           45, 1109\u20131117 (2015).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR16","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1203\/PDR.0b013e318217638a","volume":"69","author":"JL Kaplan","year":"2011","unstructured":"Kaplan, J. L., Shi, H. N. & Walker, W. A. The role of microbes in developmental immunologic programming. Pediatr Res \n                           69, 465\u2013472 (2011).","journal-title":"Pediatr Res"},{"key":"10206_CR17","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1038\/nm.4039","volume":"22","author":"MG Dominguez-Bello","year":"2016","unstructured":"Dominguez-Bello, M. G. et al. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nat Med \n                           22, 250\u2013253 (2016).","journal-title":"Nat Med"},{"issue":"5","key":"10206_CR18","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/ACI.0000000000000303","volume":"16","author":"D Munblit","year":"2016","unstructured":"Munblit, D. & Verhasselt, V. Allergy prevention by breastfeeding: possible mechanisms and evidence from human cohorts. Curr Opin Allergy Clin Immunol \n                           16(5), 427\u2013433 (2016).","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"10206_CR19","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1111\/j.1365-2222.2012.04021.x","volume":"42","author":"C Almqvist","year":"2012","unstructured":"Almqvist, C., Cnattingius, S., Lichtenstein, P. & Lundholm, C. The impact of birth mode of delivery on childhood asthma and allergic diseases\u2013a sibling study. Clin Exp Allergy \n                           42, 1369\u20131376 (2012).","journal-title":"Clin Exp Allergy"},{"key":"10206_CR20","first-page":"42","volume":"4","author":"L Bao","year":"2007","unstructured":"Bao, L. Ratio of only children and age model of childcare pattern. China Youth Study \n                           4, 42\u201347 (2007).","journal-title":"China Youth Study"},{"key":"10206_CR21","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.jclinepi.2005.08.010","volume":"59","author":"SC Sou","year":"2006","unstructured":"Sou, S. C., Chen, W. J., Hsieh, W. S. & Jeng, S. F. Severe obstetric complications and birth characteristics in preterm or term delivery were accurately recalled by mothers. J Clin Epidemiol \n                           59, 429\u2013435 (2006).","journal-title":"J Clin Epidemiol"},{"key":"10206_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-285","volume":"14","author":"W Deng","year":"2014","unstructured":"Deng, W. et al. Cesarean section in Shanghai: women\u2019s or healthcare provider\u2019s preferences? BMC Pregnancy Childbirth \n                           14, 285 (2014).","journal-title":"BMC Pregnancy Childbirth"},{"key":"10206_CR23","unstructured":"National Cooperative Group on Childhood Asthma; Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention; Chinese Center for Disease Control and Prevention. Third nationwide survey of childhood asthma in urban areas of China. Zhonghua Er Ke Za Zhi \n                           51, 729\u2013735 (2013)."},{"key":"10206_CR24","unstructured":"Respiratory Disease Group, Pediatric Committee of Shanghai Medical Association. Epidemiological survey of asthma in children aged 0\u201314 years in seven districts of Shanghai. Zhonghua Er Ke Za Zhi \n                           52, 17\u201322 (2014)."},{"key":"10206_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-437","volume":"11","author":"F Li","year":"2011","unstructured":"Li, F. et al. Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: a multicenter study. BMC Public Health \n                           11, 437 (2011).","journal-title":"BMC Public Health"},{"key":"10206_CR26","first-page":"708","volume":"31","author":"C Niu","year":"2010","unstructured":"Niu, C., Wu, J., Zhuang, Z., Lu, G. & Tang, C. Prevalence of Respiratory Symptoms and Diseases Among Children and Adolescent in Urban Shanghai. Chinese Journal of School Health \n                           31, 708\u2013710 (2010).","journal-title":"Chinese Journal of School Health"},{"key":"10206_CR27","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-568","volume":"12","author":"JQ Ma","year":"2012","unstructured":"Ma, J. Q. et al. A summary index of infant and child feeding practices is associated with child growth in urban Shanghai. BMC Public Health \n                           12, 568 (2012).","journal-title":"BMC Public Health"},{"key":"10206_CR28","doi-asserted-by":"publisher","DOI":"10.1186\/s40413-015-0068-x","volume":"8","author":"MN Danansuriya","year":"2015","unstructured":"Danansuriya, M. N., Rajapaksa, L. C. & Weerasinghe, A. Genetic, familial and environmental correlates of asthma among early adolescents in Sri Lanka: a case control study. World Allergy Organ J \n                           8, 19 (2015).","journal-title":"World Allergy Organ J"},{"issue":"1","key":"10206_CR29","first-page":"5","volume":"25","author":"R Huang","year":"2009","unstructured":"Huang, R. China\u2019s Only Children: The Quantity, Structure and Risk. Journal of Nanjing College for Population Programme Management \n                           25(1), 5\u201310 (2009).","journal-title":"Journal of Nanjing College for Population Programme Management"},{"issue":"2","key":"10206_CR30","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1111\/j.1728-4457.2005.00067.x","volume":"31","author":"Y Nie","year":"2005","unstructured":"Nie, Y. & Wyman, R. J. The One-Child Policy in Shanghai: Acceptance and Internalization. Population and Development Review \n                           31(2), 313\u2013336 (2005).","journal-title":"Population and Development Review"},{"key":"10206_CR31","doi-asserted-by":"publisher","first-page":"4203","DOI":"10.1007\/s11434-013-5679-4","volume":"34","author":"C Huang","year":"2013","unstructured":"Huang, C., Hu, Y., Liu, W., Zou, Z. J. & Jan, S. Pet-keeping and its impact on asthma and allergies among preschool children in Shanghai, China. Chinese Science Bulletin \n                           34, 4203\u20134210 (2013).","journal-title":"Chinese Science Bulletin"},{"key":"10206_CR32","unstructured":"National Cooperative Group on Childhood Asthma; Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention; Chinese Center for Disease Control and Prevention. Third nationwide survey of childhood asthma in urban areas of China. Zhonghua Er Ke Za Zhi \n                           51, 729\u2013735 (2013)."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-10206-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-10206-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-10206-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T09:43:34Z","timestamp":1671788614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-017-10206-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,29]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,12]]}},"alternative-id":["10206"],"URL":"https:\/\/doi.org\/10.1038\/s41598-017-10206-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,29]]},"assertion":[{"value":"2 May 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2017","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2017","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"9762"}}