The incidence of respiratory diseases was not different in twin siblings when the first was born vaginally and the second was born via cesarean delivery (CD), researchers reported in Pediatric Pulmonology.
The retrospective study compared the risk for respiratory diseases up to the age of 18 years in twin siblings, where one twin was vaginally delivered (VD) and the other twin was born via CD. The analysis included all twin deliveries at a center in Israel from 1991 to 2020.
The dependent variable was offspring hospitalization with a respiratory diagnosis and time to first hospitalization. Kaplan-Meier survival analysis was used to compare the cumulative incidence of respiratory diseases between the twins.
The analysis included 184 pairs of twins (368 offspring) with the first twin (twin A) born VD (52.2% male) and the second (twin B) by CD (48.7% male). Twin B had an increased likelihood of having a nonreassuring fetal heart rate pattern compared with twin A (15.2% vs 3.3%, respectively; odds ratio [OR] 5.32; 95% CI, 2.15-13.19).
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These findings reinforce studies which found no effect of mode of delivery on long‐term respiratory disease.
Among the twin pairs, the incidence of long-term respiratory diseases for those delivered vaginally vs by cesarean was not significantly different (9.4% vs 7.6%, respectively), with no difference occurring in various respiratory diseases in twin A vs twin B. No significant difference was found in the cumulative incidence of respiratory diseases (log‐rank, P =.16).
In the multivariable survival analysis, no significant difference was observed between the twins after adjustment for birthweight and nonreassuring fetal heart rate during delivery (adjusted hazard ratio, 0.50; 95% CI, 0.21-1.18).
The investigators noted that data were unavailable for chorionicity or other exposures such as lactation.
“These findings reinforce studies which found no effect of mode of delivery on long‐term respiratory disease,” stated the study authors. “Further studies on twin A VD and twin B by CD, looking at various differences between the siblings, such as gut microbiota, are recommended to address possible mechanisms involved in respiratory morbidities risk.”
