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Association between cesarean delivery types and obesity in preadolescence



The association between mode of delivery and childhood obesity remains inconclusive. Because few studies have separated C-section types (planned or unplanned C-section), our objective was to assess how these subtypes relate to preadolescent obesity.


The study consisted of 570 maternal–child pairs drawn from the WHEALS birth cohort based in Detroit, Michigan. Children were followed-up at 10 years of age where a variety of anthropometric measurements were collected. Obesity was defined based on BMI percentile (≥95th percentile), as well as through Gaussian finite mixture modeling on the anthropometric measurements. Risk ratios (RRs) and 95% confidence intervals (CIs) for obesity comparing planned and unplanned C-sections to vaginal deliveries were computed, which utilized inverse probability weights to account for loss to follow-up and multiple imputation for covariate missingness. Mediation models were fit to examine the mediation role of breastfeeding.


After adjusting for marital status, maternal race, prenatal tobacco smoke exposure, maternal age, maternal BMI, any hypertensive disorders during pregnancy, gestational diabetes, prenatal antibiotic use, child sex, parity, and birthweight z-score, children born via planned C-section had 1.77 times higher risk of obesity (≥95th percentile), relative to those delivered vaginally ((95% CI) = (1.16, 2.72); p = 0.009). No association was found comparing unplanned C-section to vaginal delivery (RR (95% CI) = 0.75 (0.45, 1.23); p = 0.25). The results were similar but slightly stronger when obesity was defined by anthropometric class (RR (95% CI) = 2.78 (1.47, 5.26); p = 0.002). Breastfeeding did not mediate the association between mode of delivery and obesity.


These findings indicate that children delivered via planned C-section—but not unplanned C-section—have a higher risk of preadolescent obesity, suggesting that partial labor or membrane rupture (typically experienced during unplanned C-section delivery) may offer protection. Additional research is needed to understand the biological mechanisms behind this effect, including whether microbiological differences fully or partially account for the association.

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Fig. 1: Description of anthropometric classes at age 10.
Fig. 2: The mediating effect of breastfeeding in the association between planned C-section vs. vaginal delivery and 10-year anthropometric outcomes.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Code availability

Code is available from the corresponding author upon reasonable request.


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We would like to acknowledge the continued dedicated participation of the WHEALS families in this long-standing birth cohort study.


The WHEALS study was supported by the National Institutes of Health (R01 HD082147; R01 AI050681; R01 HL-113010; P01 AI089473) and the Fund for Henry Ford Hospital. The authors take full responsibility of the content, which does not necessarily represent the official views of the funding bodies.

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Correspondence to Alexandra R. Sitarik.

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Sitarik, A.R., Havstad, S.L., Johnson, C.C. et al. Association between cesarean delivery types and obesity in preadolescence. Int J Obes 44, 2023–2034 (2020).

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