title: The long-term effects of birth by caesarean section: the case for a randomised controlled trial.
abstract: Birth by caesarean section is rising rapidly around the world and is associated with a range of adverse short and long-term outcomes in offspring. The latter include features of the metabolic syndrome, type-1 diabetes, and asthma. Though there are several plausible candidate biological mechanisms, evidence of a causal relationship between mode of delivery and long-term outcomes remains lacking. Here we review the evidence to date, and examine ways in which future studies might advance understanding. We conclude that a randomised controlled trial of mode of delivery for the healthy term, cephalic pregnancy, is neither unethical nor unfeasible and should be seriously considered as the optimum means of addressing a question of great relevance to public health.
authors.affiliation: Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London, SW10 9NH, United Kingdom. matthew.hyde02@imperial.ac.uk
authors.forename: Matthew James
authors.initials: MJ
authors.lastname: Hyde
authors.forename: Neena
authors.initials: N
authors.lastname: Modi
mesh_terms: D001249:Asthma / Q000209:etiology; D002585:Cesarean Section / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology; D005260:Female; D006801:Humans; D024821:Metabolic Syndrome / Q000209:etiology; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013995:Time