Table 2.
Mode of delivery and changes in the immune system of neonates (authors ordered by year and then alphabetically).
| Author, Year [Ref.] | Location Study Design N |
Outcomes Assessed | Mode of Delivery | Statistically Significant Main Findings | |
|---|---|---|---|---|---|
| Immune Cells Frequency | Cytokine Patterns/Ig | ||||
| Samelson et al. 1992 [92] | USA Cross-sectional N = 12 |
Lymphocytes (%) | Vaginal delivery | ↓ T and Th cells ↑ NK cells |
|
| Thilaganathan et al. 1994 [80] | UK Cross-sectional N = 40 |
Leukocytes Lymphocytes (counts) |
Vaginal delivery | ↑ Leukocytes, neutrophils, monocytes and NK cells | |
| Nikischin et al. 1997 [81] | Germany Cross-sectional N = 121 |
Leukocytes (counts) | Vaginal delivery | ↑ Leukocytes | |
| Chirico et al. 1999 [82] | Italy Cross-sectional N = 203 |
Leukocytes (counts) | Vaginal delivery | ↑ Leukocytes and neutrophils | |
| Grönlund et al. 1999 [83] | Finland Cross-sectional N = 64 |
Leukocytes (counts and %) |
Vaginal delivery | ↑ Leukocytes and neutrophils ↓ Lymphocytes |
|
| Kotiranta-Ainamo et al. 1999 [91] | Finland Cross-sectional N = 50 |
Lymphocytes Macrophages (%) | Cesarean section | ↓ CD14+ cells | |
| Steinborn et al. 1999 [97] | Germany Cross-sectional N = 84 |
Cytokine production | Vaginal delivery | ↑ IL-6 in myelomonocytic cord blood cells | |
| Brown et al. 2003 [101] | USA Cross-sectional N = 16 |
Cytokine response | Vaginal delivery | ↑ ConA-induced IFN-γ ↑ LPS-induced IFN-γ and IL-12 ↑ PHA-induced IFN-γ |
|
| Gessler et al. 2003 [90] | Switzerland Cross-sectional N = 30 |
Neutrophils (counts) | Vaginal delivery | ↑ Neutrophils ↑ E.Coli-induced phagocytic respiratory burst |
|
| Thornton et al. 2003 [96] | UK Cross-sectional N = 27 |
Leukocytes (%) Lymphocytes (%) |
Cytokine response | Cesarean section | ↑ CD62L+ Th cells |
| Malamitsi-Puchner et al. 2005 [98] | Greece Cohort N = 78 |
Cytokine production | Vaginal delivery | ↑ IFN-γ and IL-1β levels ↑ IL-6 and TNF-α levels |
|
| Ly et al. 2006 [102] | USA Cohort N = 37 |
Cytokine response | Cesarean section | ↑ IFN-γ baseline secretion ↑ PHA-induced IFN-γ response ↑ cat dander allergen-induced IFN-γ response ↑ induced IL-13 response |
|
| Yektaei-Karin et al. 2007 [86] | Sweden Cross-sectional N = 168 |
Leukocytes | Cytokine production | Vaginal delivery (compared to C-section) |
↑ IL-8 ↑ Leukocytes, neutrophils and monocytes |
| Assisted delivery (compared to C-section) | ↑ IFN-γ ↑ IL-8 ↑ Leukocytes, neutrophils, lymphocytes and monocytes |
||||
| Gold et al. 2009 [78] | USA Cohort N = 609 |
Cytokine response | Cesarean section | ↓ LPS-induced IL-8 response ↓ PG-induced IL-8 response ↓ CpG-induced IL-12p40 response ↑ Respiratory syncytial virus-induced IL-12p40 response ↓ PHA-induced IL-13 response |
|
| Shen et al. 2009 [87] |
Taiwan Cross-sectional N = 62 |
Leukocytes (counts) | Cesarean section | ↓ Leukocytes, neutrophils, lymphocytes and monocytes ↓ TLR2 and TLR4 surface expression on monocytes |
|
| Keski-Nisula et al. 2010 [79] | Finland Cohort N = 423 |
Leukocytes (counts) | Cytokine response | Cesarean section | ↓ Leukocytes ↓ induced IL-5 response |
| Long labour | ↑ Leukocytes ↑ induced IFN-α and IL-5 response |
||||
| Prostaglandin induction | ↓ induced IFN-γ response | ||||
| Steinborn et al. 2010 [95] | Germany Cross-sectional N = 96 |
Lymphocytes | Vaginal delivery | ↓ FoxP3 expression in Tregs cells | |
| Bili et al. 2011 [93] | Greece Cross-sectional N = 81 |
Lymphocytes (%) | Vaginal delivery | ↑ NK cells | |
| Yildiran et al. 2011 [94] | Turkey Cross-sectional N = 39 |
Lymphocytes (counts) | Vaginal delivery | ↑ Treg cells | |
| Almanzar et al. 2015 [84] | Austria Cohort N = 120 |
Lymphocytes (counts and %) | Cytokine production | Vaginal delivery | ↑ Leukocytes (counts) ↑ Neutrophils and NK cells (%) ↓ Lymphocytes and T cells (%) ↑ IFN-γ, IL-2 and IL-8 |
| Birle et al. 2015 [85] | Germany Cohort N = 66 |
Leukocytes (counts) | Vaginal delivery | ↑ Leukocytes | |
| Treviño-Garza et al. 2016 [99] | Mexico Cross-sectional N = 125 |
Cytokine production | Vaginal delivery | ↑ IL-6 | |
| Liao et al. 2017 [23] | Taiwan Cohort N = 487 |
Cytokine response | Cesarean section | ↓ TLR1-stimulated TNF-α and IL-6 | |
| Lurà et al. 2018 [88] | Switzerland Cohort N = 289 |
Leukocytes (counts) | Cesarean section | ↓ Leukocytes, basophilic granulocytes ↓ Plasmacytoid dendritic cells |
|
| Werlang et al. 2018 [89] | Brazil Cross-sectional N = 64 |
Leukocytes (counts) | Cytokine production | Cesarean section | ↓ Leukocytes ↓ GM-CSF |
| Nandanan et al. 2019 [100] | Singapore Cohort N = 98 |
Cytokine production | Vaginal delivery | ↑ IL-6 and IL-8 ↓ TNF-α and G-CSF levels |
|
CD: cluster of differentiation; ConA: Concanavalin A; G-CSF: Granulocyte-colony stimulating Factor; CpG: Immunostimulatory CpG oligonucleotides; E.Coli: Escherichia coli; GM-CSF: Granulocyte-macrophage colony-stimulating factor; IL: interleukin; IFN: interferon; LPS: Lipopolysaccharide; NK: natural killer; PHA: P Phytohemagglutinin; PG: Peptidoglycan; Th: T helper cell; Treg: T regulatory cells; TLR: Toll-like receptor; TNF: tumor necrosis factor.