Pediatric Original Article

International Journal of Obesity (2013) 37, 900–906; doi:10.1038/ijo.2013.49; published online 14 May 2013

Association of caesarean delivery with child adiposity from age 6 weeks to 15 years

J Blustein1, T Attina2, M Liu3, A M Ryan4, L M Cox5, M J Blaser6 and L Trasande7

  1. 1Department of Health Policy, Medicine, and Population Health, NYU School of Medicine, NYU/Wagner School of Public Service, New York, NY, USA
  2. 2Department of Pediatrics, NYU School of Medicine, New York, NY, USA
  3. 3Department of Population Health and Environmental Medicine, NYU School of Medicine, New York, NY, USA
  4. 4Department of Public Health, Weill-Cornell Medical School, New York, NY, USA
  5. 5NYU Sackler Institute of Graduate Biomedical Studies, New York, NY, USA
  6. 6Department of Medicine and Microbiology, NYU School of Medicine, New York, NY, USA
  7. 7Department of Pediatrics and Environmental Medicine, NYU School of Medicine, NYU/Wagner School of Public Service, New York, NY, USA

Correspondence: Dr J Blustein, Department of Health Policy, Medicine, and Population Health, NYU School of Medicine, Wagner School of Public Service, 295 Lafayette St, New York, NY 10012, USAE-mail: jan.blustein@wagner.nyu.edu

Received 31 October 2012; Revised 6 March 2013; Accepted 10 March 2013
Accepted article preview online 8 April 2013; Advance online publication 14 May 2013

Top

Abstract

Objectives:

 

To assess associations of caesarean section with body mass from birth through adolescence.

Design:

 

Longitudinal birth cohort study, following subjects up to 15 years of age.

Setting and participants:

 

Children born in 1991–1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n=10219).

Outcome measures:

 

Primary outcome: standardized measures of body mass (weight-for length z-scores at 6 weeks, 10 and 20 months; and body mass index (BMI) z-scores at 38 months, 7, 9, 11 and 15 years). Secondary outcome: categorical overweight or obese (BMI greater than or equal to85th percentile) for age and gender, at 38 months, 7, 9, 11 and 15 years.

Results:

 

Of the 10219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower-birth weights than those born vaginally (−46.1g, 95% confidence interval(CI): 14.6–77.6g; P=0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at 6 weeks (+0.11s.d. units, 95% CI: 0.03–0.18; P=0.005), through age 15 (BMI z-score increment+0.10s.d. units, 95% CI: 0.001–0.198; P=0.042). By age 11 caesarean-delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24–2.70; P=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal-weight mothers was weak.

Conclusion:

 

Caesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

Keywords:

childhood obesity; adiposity; caesarean delivery; microbiome; ALSPAC

Extra navigation

.

natureevents

ADVERTISEMENT