Gastrointestinal consequences of cesarean section birth: A systematic review of short- and long-term effects in infancy and beyond

Abstract

BACKGROUND

Cesarean section (C-section) delivery rates are rising globally, raising concern about their potential long-term health consequences on offspring. Emerging evidence suggests that C-section, by bypassing the physiological and microbial exposures of vaginal birth, may adversely affect neonatal gastrointestinal (GI) development and immune regulation.

AIM

To evaluate the short- and long-term gastrointestinal outcomes in infants born via C-section, compared to those born vaginally.

METHODS

A systematic literature search was conducted across PubMed, Scopus, and Web of Science for studies published from inception to 2024. Studies were included if they reported gastrointestinal outcomes among C-section-born infants and included a vaginal delivery comparison group. Outcomes of interest included short-term disorders (infantile colic, gastroesophageal reflux, constipation, dyschezia, and functional gastrointestinal disorders) and long-term conditions (inflammatory bowel disease, food allergies including cow's milk protein allergy, celiac disease, and microbiota dysbiosis). Data extraction and synthesis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

C-section -born infants demonstrated a higher risk of several short-term GI disturbances, including infantile colic, reflux, and constipation. These outcomes were consistently associated with early gut microbiota dysbiosis, characterized by reduced microbial diversity and delayed colonization by Bifidobacteria and Bacteroides. Long-term associations with C-section included a modest increase in the risk of Crohn’s disease, cow’s milk protein allergy, and food sensitization, while the links with ulcerative colitis and celiac disease were inconsistent. Breastfeeding, probiotic/synbiotic supplementation, and limited antibiotic exposure emerged as protective modifiable factors.

CONCLUSION

C-section delivery is associated with a higher risk of adverse gastrointestinal outcomes in infancy and childhood, driven in part by early-life gut microbial disruption. Preventive strategies targeting microbial restoration and immune modulation, particularly breastfeeding and probiotic interventions, may help mitigate these risks. Clinicians should be aware of these associations to guide personalized care and parental counseling, particularly in elective C-section deliveries.

Keywords: Cesarean section; Gut microbiota; Infantile colic; Functional gastrointestinal disorders; Food allergy; Inflammatory bowel disease; Dysbiosis; Probiotics; Breastfeeding

Core Tip: Cesarean section (C-section) delivery is associated with altered neonatal gut microbiota and a higher risk of both short- and long-term gastrointestinal (GI) disorders. This systematic review summarizes evidence linking C-section to infantile colic, gastroesophageal reflux, constipation, food allergies, inflammatory bowel disease, and celiac disease. The review highlights gut dysbiosis as a central mechanism and identifies modifiable factors—including breastfeeding, probiotic use, and reduced antibiotic exposure—that can mitigate risks. Understanding these associations enables clinicians to provide personalized postnatal care and early interventions that may prevent chronic GI outcomes in C-section-born infants.