Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Environmental Health Sciences

Content Description

1 online resource (ii, xi, 167 pages) : illustrations (some color)

Dissertation/Thesis Chair

Erin M Bell

Committee Members

David Lawrence, Shao Lin, Alexander McLain, Edwina Yeung


Food allergy in infants, Wheeze, Cesarean-born children

Subject Categories

Environmental Health


This dissertation sought to assess the effect of cesarean delivery (CD) on the risk of developing wheezing or food allergies in early childhood; and whether breastfeeding mediates the association between CD and the outcomes. We also aimed to highlight the differences in immunoglobulin concentrations by mode of delivery (MOD) in newborn dried blood spots (DBS), and the subsequent development of wheezing and food allergies in infants during the first three years of life. Data from the Upstate KIDS cohort was analyzed. Modified Poisson regression was used to compare the risks for wheezing and food allergies by MOD. We used a directed acyclic graph (DAG) approach to identify the model covariates. Marginal structural models with inverse-probability weighting were used to estimate the controlled direct effects of cesarean delivery on wheezing and food allergy outcomes, independent of breastfeeding in the first year of life. The non-linear associations between MOD and immunoglobulin concentrations were assessed using multinomial logistic regression while the relationship between immunoglobulins and wheezing or food allergies was assessed using modified Poisson regression with generalized estimating equations.