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

Table 7 Summary of gastroesophageal reflux findings in cesarean section-born infants

Ref.	Population	Key findings	C-section association	Modifiable factors	Risk of bias
Dahlen et al[22], 2018	869188 infants	1.1% diagnosed with GER/GERD; higher in C-section births	AOR: 1.13 (P < 0.001)	Maternal psychiatric illness, prematurity, NICU stay	Low (large national dataset, adjusted for multiple confounders)
Pantazi et al[13], 2025	134 infants	Reduced Lactobacillus and Bifidobacterium in GER infants; ↑ E. coli	GER strongly linked with C-section and dysbiosis	Artificial feeding, C-section, antibiotic use	Moderate (small cohort, microbial focus, controlled analysis)
Ziętek et al[14], 2024	82-term infants	Higher regurgitation in C-section group (P = 0.0434)	Significant increase in GER symptoms	Formula feeding, antibiotic use	High (small sample size, limited adjustment)
Salvatore et al[11], 2019	934 infants	40% had regurgitation in year one; C-section increased FGID risk	Associated with dyschezia and diarrhea	Exclusive formula, prolonged hospital stays	Low (well-designed, prospective, controlled)
Bi et al[12], 2023	988 preterm infants	41.6% had GER; C-section among strongest risk factors	Yes (χ2 = 33.13, P < 0.001)	Lack of breastfeeding, antibiotic/probiotic use	Moderate (preterm focus, retrospective, good confounder control)
Guo et al[23], 2002	496 neonates (C-section only)	GER/aspiration prevented with manual intervention	None reported	Early postnatal intervention	High (no comparison group, limited external validity)

A P value less than 0.05 is considered significant. Clinical Pearls 3: Gastroesophageal reflux is reported more frequently in infants born via cesarean section, particularly during the first months of life. The association is likely linked to delayed gut microbiota maturation and reduced exposure to labor-induced hormonal and physiological adaptations. Contributing factors include formula feeding, antibiotic use, and preterm birth. Supporting early breastfeeding and gut microbiota development may help reduce gastroesophageal reflux symptoms in cesarean section-born infants. AOR: Adjusted odds ratio; C-section: Cesarean section; E. coli: Escherichia coli; GER/GERD: Gastroesophageal reflux/Gastroesophageal reflux disease; NICU: Neonatal intensive care unit.