title: The lack of natural processes of delivery and neonatal intensive care treatment lead to impaired cytokine responses later in life.
abstract: OBJECTIVE
  Birth-related factors and neonatal treatments could affect the maturation of immune system and thus have lasting effects on immune responses. We investigated the effect of obstetric factors other than being born by cesarean section on immune responses later in life.
  
  
  METHODS
  Regulatory, inflammatory, TH1 and TH2 cytokines, and a chemokine were analyzed in unstimulated and Toll-like receptors (TLRs) 2-, 3-, and 4-stimulated PBMCs of teenagers born by cesarean delivery (CD; N=79). Data on obstetric factors were collected from patient data archives.
  
  
  RESULTS
  Advanced cervical dilatation at the time of CD associated with higher unstimulated production of cytokines compared to adolescents who were delivered before the onset of labor. Neonatal intensive care treatment associated with lower unstimulated production of cytokines. Similar associations were found following TLR stimulations.
  
  
  CONCLUSIONS
  The lack of natural processes of delivery and neonatal intensive care treatment might lead to long-lasting impairment of immune responses.
authors.affiliation: Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Maria-Viola
authors.initials: MV
authors.lastname: Martikainen
authors.affiliation: Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.|Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Leea
authors.initials: L
authors.lastname: Keski-Nisula
authors.affiliation: Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Hermina
authors.initials: H
authors.lastname: Jakupović
authors.affiliation: Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Karvonen
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Pekkanen
authors.affiliation: Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.|Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland.
authors.forename: Maija-Riitta
authors.initials: MR
authors.lastname: Hirvonen
authors.affiliation: Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Marjut
authors.initials: M
authors.lastname: Roponen
mesh_terms: D000293:Adolescent; D002478:Cells, Cultured; D002585:Cesarean Section; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D007107:Immune System; D015931:Intensive Care, Neonatal; D007963:Leukocytes, Mononuclear / Q000276:immunology*; D008297:Male; D011247:Pregnancy; D018417:Th1 Cells / Q000276:immunology*; D018418:Th2 Cells / Q000276:immunology*; D051193:Toll-Like Receptors / Q000378:metabolism; D014599:Uterus / Q000378:metabolism*
chemical_list: D016207:Cytokines; D051193:Toll-Like Receptors
keywords: 
  TLR
  ; cesarean; innate immunity; microbes; obstetric factors