Association between mode of delivery and body mass index at 4-5 years in White British and Pakistani children: the Born in Bradford birth cohort

Abstract

Background Globally, it is becoming more common for pregnant women to deliver by caesarean section (CS). In 2020, 31% of births in England were CS, surpassing the recommended prevalence of CS. Concerns have been raised regarding potential unknown consequences of this mode of delivery. Childhood adiposity is also an increasing concern. Previous research provides inconsistent conclusions on the association between CS and childhood adiposity. More studies are needed to investigate the consequences of CS in different populations and ethnicities. Therefore, this study investigates the association between mode of delivery and BMI, in children of 4–5 years and if this differs between White British (WB) and Pakistani ethnicities, in Bradford UK. Methods Data were obtained from the Born in Bradford (BiB) cohort, which recruited pregnant women at the Bradford Royal Infirmary, between 2007 and 2010. For these analyses, a sub-sample (n = 6410) of the BiB cohort (n = 13,858) was used. Linear regression models determined the association between mode of delivery (vaginal or CS) and BMI z-scores at 4–5 years. Children were categorised as underweight/healthy weight, overweight and obese, and logistic regression models determined the odds of adiposity. Effect modification by ethnicity was also explored. Results Multivariable analysis found no evidence for a difference in BMI z-score between children of CS and vaginal delivery (0.005 kg/m2, 95% CI = − 0.062–0.072, p = 0.88). Neither was there evidence of CS affecting the odds of being overweight (OR = 1.05, 95% CI = 0.86–1.28, p = 0.65), or obese (OR = 0.98, 95% CI = 0.74–1.29, p = 0.87). There was no evidence that ethnicity was an effect modifier of these associations (p = 0.97). Conclusion Having CS, compared to a vaginal delivery, was not associated with greater adiposity in children of 4–5 years in this population. Concerns over CS increasing adiposity in children are not supported by the findings reported here using the BiB study population, of both WB and Pakistani families.

Analysis of the Influence of Pre-Pregnancy BMI and Weight Gain during Pregnancy on the Weight of Healthy Children during the First 2 Years of Life: A Prospective Study

“…We conducted a correlation matrix analysis calculating Spearman’s R, first among all quantitative variables, then separately for the child’s mass in different time points with the mother’s pBMI. Multiple Linear Models were used to compare the differences in child’s body mass according to different categories of maternal pBMI and GWG, adjusted by smoking, gender, breastfeeding and delivery type, because all these factors can affect children’s body weight [ 27 , 28 , 29 , 30 ]. Cohen’s f2 was used as an effect size for multiple linear models.…”

Risk of Overweight and Obesity in Children under 6 Years Old Following Cesarean Delivery: A Systematic Review and Meta-analysis of Cohort Studies

“…Among these, 43 studies were excluded because of lacking data regarding overweight or obesity in children delivered by C-section, and 58 studies were excluded due to a lack of being without target participants. Thus, only 18 eligible studies [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were included in this final systematic review and metaanalysis.…”

“…Of the 18 cohort studies included, two were from China [32,45], two from the United Kingdom (UK) [29,42], two from the United States of America (USA) [31,33], two from Ireland [37,38], one from Germany [28], Netherlands [30], Denmark [34],…”

“…These studies were published between 2014 and 2022 and their sample sizes ranged from 178 to 64,983 with a total of 125,042 children (33,551 delivered by C-section). Three studies [35,40,44] used exclusively the WHO Child Growth Standards as a reference to identify overweight and obesity in children, eight studies [28][29]31,[33][34]36,[42][43] used the CDC standard, five studies [30,[37][38][39]41] used IOTF, and two studies [32,45] used the Chinese standard for preschool children. Two studies [29,32] reported only obesity, seven studies [28,[33][34][37][38][39]42] included data on overweight and obesity separately, nine [30][31][35][36][40][41][43][44][45] studies reported overweight and obesity as the whole data.…”

“…Three studies [35,40,44] used exclusively the WHO Child Growth Standards as a reference to identify overweight and obesity in children, eight studies [28][29]31,[33][34]36,[42][43] used the CDC standard, five studies [30,[37][38][39]41] used IOTF, and two studies [32,45] used the Chinese standard for preschool children. Two studies [29,32] reported only obesity, seven studies [28,[33][34][37][38][39]42] included data on overweight and obesity separately, nine [30][31][35][36][40][41][43][44][45] studies reported overweight and obesity as the whole data. Therefore, through calculation, sixteen studies had data on overweight combined with obesity, seven had overweight data, and nine had obesity data.…”