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

Table 6 Key modifiers of effects of cesarean section on infant constipation identified across studies

Modifier	Effect on constipation	Ref.	Notes
Feeding type	Formula feeding associated with higher risk; exclusive breastfeeding appears protective	Bi et al[12], 2023; Salvatore et al[11], 2019; Yoshida et al[6], 2018	Formula-fed C-section infants are more prone to delayed gut transit and reduced microbiota diversity
Antibiotic exposure	Increased constipation risk via microbiota disruption (in C-section-born, especially)	Bi et al[11], 2023; Salvatore et al[10], 2019	Antibiotics delay colonization by beneficial bacteria such as Bifidobacteria
Prematurity	Preterm C-section infants have a higher risk of functional GI disorders, including constipation	Bi et al[12], 2023; Salvatore et al[11], 2019	May reflect an immature enteric nervous system and altered motility
Probiotic use	Unexpectedly associated with increased constipation at 3 months	Ziętek et al[14], 2024	Possibly due to strain-specific effects; more research needed
Complementary feeding practices	No significant effect overall, but trends show PLW may slightly increase risk	Neves et al[20], 2023	Cultural and dietary factors may influence stool patterns
Maternal depression/smoking	Associated with increased GI symptoms and constipation in C-section-born infants	Bi et al[12], 2023; Bekem et al[15], 2021	May affect breastfeeding success and infant regulatory behavior
Age of evaluation	C-section-related constipation was not apparent at 1 year but was observed at 3 years	Yoshida et al[6], 2018; Nakamura et al[19], 2021	Suggests delayed or progressive impact of delivery mode on GI function

C-section: Cesarean section; GI: Gastrointestinal; PLW: Parent-led weaning. Clinical Pearls 2: The gastrointestinal effects of Cesarean delivery, particularly constipation, are not solely attributable to the delivery mode but are also modulated by early-life exposures, such as feeding type, antibiotics, and gestational maturity. Some effects may emerge only later in early childhood, highlighting the importance of longitudinal follow-up.