Short-term and long-term effects of caesarean section on the health of women and children.

A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.

Gestational diabetes: screening for all, which test and which treatment?

Gestational diabetes mellitus is rapidly increasing in incidence, due to lifestyle changes, increasing obesity and maternal age. This increase makes universal screening mandatory; however, we are still far from it. Moreover, should we adopt rather strict oral glucose tolerance test cutoff values, resulting in a worldwide incidence of gestational diabetes mellitus of approximately 17.5%, or should we be more liberal and focus more on patients and offspring at increased risk, for example, obese women. Finally, are oral antidiabetic drugs such as glyburide and metformin safe enough to use in gestational diabetes mellitus, or should they still be considered as the 'poor man's insulin'? These issues were presented and discussed during lively debates at the Controversies in Obstetrics, Gynecology and Infertility annual meetings, but consensus was not reached.