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  • Original Article
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Birth by cesarean section in relation to adult offspring overweight and biomarkers of cardiometabolic risk

Abstract

Background:

Birth by Cesarean section (C-section) may increase the risk for non-communicable diseases. We aimed to examine the relation of birth by C-section with offspring overweight and markers of cardiometabolic risk in a prospective observational cohort with 20 years of follow-up.

Methods:

The Danish Fetal Origins Cohort enrolled 965 pregnant women in 1988–1989. In 2008, a follow-up study of the offspring was completed. The offspring were invited to participate in a clinical examination with measurements of anthropometry and a fasting blood sample (n=443). In addition, 252 offspring completed a self-administered questionnaire with questions on height and weight, leaving us with a study sample of 695 offspring. Offspring overweight at 20 years was defined as body mass index (BMI)25 kg m−2. We also analyzed blood pressure and fasting blood samples for cardiometabolic risk factors including insulin, leptin and adiponectin, and lipid concentrations.

Results:

In the cohort, 7% were born by C-section, and at age 20 years, 18% of the offspring had a BMI 25 kg m−2. Birth by C-section was associated with increased odds of overweight or obesity at 20 years (Odds ratio=2.17 (95% confidence interval (CI): 1.10, 4.27)) after adjustment for potential confounders. Birth by C-section was also associated with higher serum concentrations of total cholesterol (8.5%, 95% CI: 1.1–16.5), low-density lipoprotein cholesterol (12.6%, 95% CI: 1.0, 25.5), leptin (73.1%, 95% CI: 5.9, 183.1) and Apolipoprotein B (0.08 g l−1, 95% CI: 0.04, 0.15). In contrast, birth by C-section was not related to blood pressure or serum concentrations of insulin, adiponectin, triglycerides, high-density lipoprotein or Apolipoprotein A.

Conclusion:

Birth by C-section was associated with higher frequency of dysmetabolic traits in offspring independently of shared risk factors. Further research aimed at replicating these findings and elucidating the underlying biological mechanisms of this relation is needed.

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Acknowledgements

Dr Hansen was responsible for analysis and interpretation of data, wrote the first draft of the manuscript and had primary responsibility for the final content. Dr Halldorsson was responsible for data acquisition, designed the research, analyzed and interpreted data, and critically reviewed the manuscript. Dr Olsen was responsible for the original pregnancy study, initiated the follow-up of the offspring, and critically reviewed the manuscript. Drs Rytter and Bech conducted the follow-up study and critically reviewed the manuscript. Ms. Granström and Dr Henriksen contributed to data interpretation and critically reviewed the manuscript. Dr Chavarro designed the research, contributed to data interpretation, and critically reviewed the manuscript. All authors read and approved the final manuscript. Funding for this study was provided by the Danish Agency for Science, Technology and Innovation (DSF: 09-067124 (Centre for Fetal Programming), and DSF: 09-063072 (Danish Obesity Research Centre), DFS: 2101-06-0005, FSS: 09-065631) and the National Institutes of Health (P30 DK046200).

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Correspondence to S Hansen.

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Hansen, S., Halldorsson, T., Olsen, S. et al. Birth by cesarean section in relation to adult offspring overweight and biomarkers of cardiometabolic risk. Int J Obes 42, 15–19 (2018). https://doi.org/10.1038/ijo.2017.175

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