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



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


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=10 219).

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 85th percentile) for age and gender, at 38 months, 7, 9, 11 and 15 years.


Of the 10 219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower-birth weights than those born vaginally (−46.1 g, 95% confidence interval(CI): 14.6–77.6 g; 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 (+0.11 s.d. units, 95% CI: 0.03–0.18; P=0.005), through age 15 (BMI z-score increment+0.10 s.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.


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.

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We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The UK Medical Research Council, the Wellcome Trust (Grant ref: 092731) and the University of Bristol provide core support for ALSPAC. Additional financial support was provided through a pilot grant from the NYU Global Public Health Research Challenge Fund, by NIH grants RO1DK090989 and 1UL1RR029893, and by the Diane Belfer Program in Human Microbial Ecology.


This publication is the work of the authors and Drs Blustein and Trasande will serve as guarantors for the contents of this paper and does not reflect the views of the ALSPAC executive.

Data sharing statement

The authors were granted access to the ALSPAC data through an agreement with the University of Bristol, and are not authorized to share data with other investigators.

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Correspondence to J Blustein.

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All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: all authors had financial support from the NYU Global Public Health Research Fund for the submitted work, and MJB/LMK had financial support from the National Institutes of Health (NIH), as described in the acknolwedgements and the Diane Belfer Program in Human Microbial Ecology; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Blustein, J., Attina, T., Liu, M. et al. Association of caesarean delivery with child adiposity from age 6 weeks to 15 years. Int J Obes 37, 900–906 (2013).

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  • childhood obesity
  • adiposity
  • caesarean delivery
  • microbiome

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