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Pediatrics

Pre-labor and post-labor cesarean delivery and early childhood adiposity in the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study

International Journal of Obesity (2024)Cite this article

Subjects

Abstract

Background/Objectives

Delivery by cesarean section (CS) compared to vaginal delivery has been associated with increased risk of overweight in childhood. Our study examined if the presence or absence of labor events in CS delivery altered risk of overweight in early childhood (1–5 years) compared to vaginal delivery and if this association differed according to infant sex.

Subjects/Methods

The study included 3073 mother-infant pairs from the CHILD Cohort Study in Canada. Data from birth records were used to categorize infants as having been vaginally delivered, or delivered by CS, with or without labor events. Age and sex adjusted weight-for-length (WFL) and body mass index (BMI) z scores were calculated from height and weight data from clinic visits at 1, 3 and 5 years and used to classify children as overweight. Associations between delivery mode and child overweight at each timepoint were assessed using regression models, adjusting for relevant confounding factors including maternal pre-pregnancy BMI. Effect modification by infant sex was tested.

Results:

One in four infants (24.6%) were born by CS delivery; 13.0% involved labor events and 11.6% did not. Infants born by CS without labor had an increased odds of being overweight at age 1 year compared to vaginally delivered infants after adjustment for maternal pre-pregnancy BMI, maternal diabetes, smoking, infant sex and birthweight-for-gestational age (aOR 1.68 [95% CI 1.05–2.67]). These effects did not persist to 3 or 5 years of age and, after stratification by sex, were only seen in boys (aOR at 1 year 2.21 [95% CI 1.26–3.88]).

Conclusion and relevance

Our findings add to the body of evidence that CS, in particular CS without labor events, may be a risk factor for overweight in early life, and that this association may be sex-specific. These findings could help to identify children at higher risk for developing obesity.

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Fig. 1
Fig. 2: Odds of overweight/obesity and difference in mean WFL z scores at age 1 year according to type of CS delivery stratified by infant sex.

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Data availability

Restrictions apply to the availability of these data. They were obtained from the CHILD Cohort Study and are available via childcohort.ca (http://childcohort.ca/ (accessed on September 26, 2023)) with the permission of Anita Kozyrskyj and the Child Cohort Study National Coordinating Center.

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Acknowledgements

We thank the CHILD Cohort Study (CHILD) participant families for their dedication and commitment to advancing health research as well as the whole CHILD study team, which includes interviewers, nurses, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, and receptionists.

Funding

The Canadian Institutes of Health Research (CIHR) and the Allergy, Genes and Environment Network of Centres of Excellence provided core funding for the Canadian Healthy Infant Longitudinal Development (CHILD) Study. This research was specifically funded by CIHR Microbiome Initiative team grant 227312.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Sarah L. Bridgman, Andrea M. Haqq, Piushkumar J. Mandhane & Anita L. Kozyrskyj

  2. London School of Hygiene and Tropical Medicine, University of London, London, UK

    Sarah L. Bridgman & Suzanne Penfold

  3. Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada

    Catherine J. Field & Andrea M. Haqq

  4. Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Theo J. Moraes

  5. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Stuart E. Turvey

  6. BC Children’s Hospital, Vancouver, BC, Canada

    Stuart E. Turvey

  7. Manitoba Interdisciplinary Lactation Centre, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

    Elinor Simons

  8. Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Padmaja Subbarao

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  1. Sarah L. Bridgman
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Contributions

ALK, SLB, CJF, AMH, PJM, TJM, SET, ES, PS were involved in the study concept and design. PJM, TJM, ES, SET, PS were involved in the acquisition of data. SLB conducted the data cleaning and statistical analysis and drafted the manuscript. All authors provided critical revision of the manuscript for important intellectual content and approved the final submitted manuscript.

Corresponding author

Correspondence to Sarah L. Bridgman.

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Bridgman, S.L., Penfold, S., Field, C.J. et al. Pre-labor and post-labor cesarean delivery and early childhood adiposity in the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01480-z

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