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Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics



To investigate whether delivery mode (vaginal versus by caesarean section), maternal pre-pregnancy body mass index (BMI) and early exposure to antibiotics (<6 months of age) influence child's risk of overweight at age 7 years, hence supporting the hypotheses that environmental factors influencing the establishment and diversity of the gut microbiota are associated with later risk of overweight.


Longitudinal, prospective study with measure of exposures in infancy and follow-up at age 7 years.


A total of 28 354 mother–child dyads from the Danish National Birth Cohort, with information on maternal pre-pregnancy BMI, delivery mode and antibiotic administration in infancy, were assessed. Logistic regression analyses were performed with childhood height and weight at the 7-year follow-up as outcome measures.


Delivery mode was not significantly associated with childhood overweight (odds ratio (OR):1.18, 95% confidence interval (CI): 0.95–1.47). Antibiotics during the first 6 months of life led to increased risk of overweight among children of normal weight mothers (OR: 1.54, 95% CI: 1.09–2.17) and a decreased risk of overweight among children of overweight mothers (OR: 0.54, 95% CI: 0.30–0.98). The same tendency was observed among children of obese mothers (OR: 0.85, 95% CI: 0.41–1.76).


The present cohort study revealed that a combination of early exposures, including delivery mode, maternal pre-pregnancy BMI and antibiotics in infancy, influences the risk of overweight in later childhood. This effect may potentially be explained by an impact on establishment and diversity of the microbiota.

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The study was financed through a Female Research Leader grant (no. 09-066323) from the Danish Council of Independent Research to Dr Tine Jess. Additional support for the DNBC ( was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation and the Health Foundation. The 7-year follow-up study within the DNBC has received financial support from the Lundbeck Foundation (195/04) and the Danish Medical Research Council (SSVF 0646). We acknowledge all the families who are represented in the cohort for their thorough contribution in completing questionnaires. This work was also carried out as a part of the research programme of the Danish Obesity Research Centre (DanORC, see, granted by the Danish Council for Strategic Research (grant no. 2101-06-0005), and as part of the TORNADO collaboration (

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Correspondence to T A Ajslev.

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Ajslev, T., Andersen, C., Gamborg, M. et al. Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics. Int J Obes 35, 522–529 (2011).

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  • gut microbiota
  • childhood overweight
  • antibiotics
  • delivery mode
  • pre-pregnancy BMI

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