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

Table 3 Infantile colic and cesarean section delivery

Ref.	Design & number	C-section vs VD colic prevalence	Main modifiers evaluated	Key findings	Risk of bias
Sommermeyer et al[17], 2022	Cross-sectional, 195 infants	Higher fecal calprotectin in C-section colic	Type of feeding, birth mode	C-section infants had higher calprotectin & lower diagnostic accuracy for IC	Moderate (small sample, limited confounder control)
Salvatore et al[11], 2019	Prospective cohort, 934 infants	C-section: RR 1.23 for IC	Preterm, antibiotics, formula feeding	Strong C-section association with IC; antibiotics further increased the risk	Low (good sample, adjusted)
Bi et al[12], 2023	Retrospective, 988 (preterm)	Higher FGIDs (incl. IC) in C-section	Breastfeeding, smoking, hospitalization, and antibiotics	C-section is significantly associated with IC (P < 0.001)	Moderate (preterm only; confounders considered)
Ziętek et al[14], 2024	Prospective, 82 infants	↑ Colic at 3 months; ↑ regurgitation in C-section	Antibiotics, feeding pattern	GI disorders more frequent in C-section group	High (small size, short follow-up)
Akman et al[18], 2006	Prospective, 78 infants	IC in 64.7% of C-section infants	Maternal depression, attachment style	C-section, depression, and insecure attachment linked with IC	High (tiny cohort, potential bias)
Bekem et al[15], 2021	Cross-sectional, 213 infants	Infant dyschezia higher in C-section (P = 0.006)	Breastfeeding, maternal QoL, depression	IC more common in depressed mothers; C-section linked to GI symptoms	Moderate (retrospective; subjective outcomes)

C-section: Cesarean section; VD: Vaginal delivery; FGID: Functional gastrointestinal disorder; GI: Gastrointestinal; IC: Infant colic; QoL: Quality of life; RR: Relative risk.