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

Table 5 Summary of key findings on constipation and cesarean section in infants

Ref.	Sample size	Age evaluated	Prevalence of FC	C-section vs VD comparison	Significance	Modifiers	Risk of bias
Yoshida et al[6], 2018	83019	1 year	1.37%	No significant difference (AOR = 0.94)	No	Breastfeeding, GA, BW	Low (large national dataset; adjusted)
Nakamura et al[19], 2021	71878	3 years	12.3%	Higher in C-section (13.1% vs 12.1%; AOR = 1.064)	Yes	Breastfeeding, solid food, maternal BMI	Low (population-based; confounders addressed)
Bi et al[12], 2023	988 (preterm)	0-12 months	19.2%	Strong C-section association (67.1% vs 40.3%)	Yes	Antibiotics, FF, maternal smoking	Moderate (limited to preterms; good stats)
Ziętek et al[14], 2024	82	3, 6, 12 months	Not isolated	C-section is linked to regurgitation only	No	Probiotics ↑ risk (P = 0.045)	High (small sample; limited power)
Salvatore et al[11], 2019	934	0-12 months	26.6%	C-section linked to dyschezia, not FC	No	Preterm, antibiotics, FF	Low (good design and adjustment)
Neves et al[20], 2023	135	12 months	49.6%	C-section infants had more FC, but not significant	No	Feeding method (PLW)	Moderate (small sample; not powered)
Hierink et al[21], 2024	2643 (mothers)	Adults	24.6% maternal constipation	More common in VD mothers	Yes	Perineal trauma	Moderate (maternal outcome; subjective reporting)

AOR: Adjusted odds ratio; BMI: Body mass index; BW: Birth weight; C-section: Cesarean section; FC: Functional constipation; FF: Formula feeding; GA: Gestational age; IC: Infant colic; PLW: Parent-led weaning; VD: Vaginal delivery.