title: Mode of delivery and risk of allergic rhinitis and asthma.
abstract: BACKGROUND
  It has been hypothesized that cesarean section might increase the risk of developing allergic disease by depriving the fetus and newborn of exposure to maternal microflora. Furthermore, it has been suggested that complicated modes of delivery might be associated with an increased risk of asthma.
  
  
  OBJECTIVE
  The purpose of this investigation was to study whether cesarean section and other complicated modes of delivery are associated with an increased risk of allergic rhinitis or asthma.
  
  
  METHODS
  Information on self-reported allergic rhinitis, asthma ever, current asthma, and occupation was obtained from 9722 singleton women born in Denmark during the period 1973-1977 who participated in a national cohort study during the period 1997-2001. For these women, information was available on mode of delivery (spontaneous delivery, cesarean section, vacuum extraction, or other complicated mode of delivery, such as rotation/traction or use of forceps), gestational age, birth weight, and length at birth from the Danish Medical Birth Register. Information on parity and maternal age was obtained from the Danish Civil Registration System.
  
  
  RESULTS
  The odds ratios (ORs) of allergic rhinitis were 1.16 (95% CI, 0.90-1.49) for cesarean section and 1.06 (95% CI, 0.85-1.32) for other complicated modes of delivery in comparison with spontaneous delivery. The corresponding ORs of asthma ever were 1.33 (95% CI, 1.02-1.74) and 1.18 (95% CI, 0.94-1.49) for cesarean section and other complicated modes of delivery, respectively, and the ORs of current asthma were 1.22 (95% CI, 0.87-1.73) and 1.26 (95% CI, 0.94-1.68), respectively, in comparison with spontaneous delivery.
  
  
  CONCLUSIONS
  Our findings do not support the hypothesis that cesarean section or other complicated modes of delivery are associated with the development of allergic rhinitis. However, there might be a positive association with development of asthma--in particular, for cesarean section--that was not explained by gestational age, birth weight, ponderal index, smallness for gestational age, parity, maternal age, or occupation.
authors.affiliation: Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Bager
authors.forename: Mads
authors.initials: M
authors.lastname: Melbye
authors.forename: Klaus
authors.initials: K
authors.lastname: Rostgaard
authors.forename: Christine Stabell
authors.initials: CS
authors.lastname: Benn
authors.forename: Tine
authors.initials: T
authors.lastname: Westergaard
mesh_terms: D000328:Adult; D001249:Asthma / Q000276:immunology*; D001724:Birth Weight; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D016017:Odds Ratio; D011247:Pregnancy; D012130:Respiratory Hypersensitivity / Q000453:epidemiology*; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology*; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology*; D012307:Risk Factors