title: Delivery Mode, Duration of Labor, and Cord Blood Adiponectin, Leptin, and C-Reactive Protein: Results of the Population-Based Ulm Birth Cohort Studies.
abstract: BACKGROUND
  Numerous studies have reported associations between delivery mode and health outcomes in infancy and later life. Previous smaller studies indicated a relationship between delivery mode and newborn inflammation potentially constituting a mediating factor. We aimed to determine the influence of delivery mode and duration of labor on cord blood concentrations of adiponectin, leptin, and high-sensitivity C-reactive protein (hs-CRP).
  
  
  METHODS
  In the Ulm SPATZ Health Study, 934 singleton newborns and their mothers were recruited during their hospital stay in the University Medical Center Ulm, Southern Germany, from 04/2012-05/2013. Inflammatory biomarkers were measured by ELISAs (n = 836). Delivery mode was analyzed categorically (elective cesarean (reference), active labor delivery: emergency cesarean, assisted vaginal, and spontaneous vaginal); duration of labor continuously. Following log-transformation, linear regression was used to estimate geometric means ratios (GMR) adjusted for potential confounders for the effects of delivery mode and duration of labor on each biomarker separately. Independent replication was sought in the similarly conducted Ulm Birth Cohort Study recruited from 11/2000-11/2001.
  
  
  RESULTS
  Individually, active labor delivery modes as well as increasing duration of labor were associated with higher leptin and hs-CRP concentrations. After mutual adjustment, the associations with delivery modes were attenuated but those for duration of labor remained statistically significant (GMR (95%CI) 1.10 (1.00; 1.21) and 1.15 (1.04; 1.27) for leptin and hs-CRP per hour of labor, respectively). No significant adjusted associations were observed between delivery modes and adiponectin concentrations. These findings were replicated in an independent birth cohort study.
  
  
  CONCLUSIONS
  Cord blood leptin and hs-CRP concentrations were associated with duration of labor rather than delivery mode. Further research is warranted to investigate these associations with additional cytokines involved in inflammatory response to delineate the inflammatory profile. Subsequently, research on determinants of these associations and their role in development of chronic disease is needed.
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Logan
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors.forename: Larissa
authors.initials: L
authors.lastname: Thiel
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bornemann
authors.affiliation: Department of Internal Medicine II-Cardiology, University Medical Center Ulm, Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Department of Gynecology and Obstetrics, University Medical Center Ulm, Ulm, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Reister
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.|'In-FLAME' the International Inflammation Network, World Universities Network (WUN), Ulm, Germany.
authors.forename: Jon
authors.initials: J
authors.lastname: Genuneit
mesh_terms: D052242:Adiponectin / Q000378:metabolism*; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D005858:Germany; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D020738:Leptin / Q000378:metabolism*; D008875:Middle Aged; D011247:Pregnancy
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D020738:Leptin; D002097:C-Reactive Protein