Associations Between Delivery Mode and Early Childhood Body Mass Index Z-Score Trajectories: A Retrospective Analysis of 2,685 Children From Mothers Aged 18 to 35 Years at Delivery

Abstract

Objective: To investigate the association between cesarean delivery (CD) and trajectory patterns of age- and sex-specific body mass index (BMI) z-score in early childhood.Methods: A retrospective cohort study was conducted among 2,685 children whose maternal age at the time of birth was between 18 and 35 years, and birth data and anthropometric measurement data during their ages 3–60 months were collected. A group-based trajectory modeling approach was used to identify distinct BMI z-score trajectories, and multinomial logistic regressions were applied to estimate the associations among CD (both elective and non-elective combined), elective and non-selective CD, and BMI z-score trajectory classes.Results: Of the 2,685 participants, 46.5% (N = 1,248) were born by vaginal delivery (VD), 20.7% (N = 556) by elective CD, and 32.8% (N = 881) by non-elective CD. Five BMI z-score trajectory patterns were identified, and they were “increasing from moderate to high” (10.1%, n = 270), “increasing from mild to moderate” (34.2%, n = 919), “increasing from low to high” (10.5%, n = 283), “stable mild” (30.1%, n = 808), and “stable low” (15.1%, n = 405) groups. Compared with children delivered by VD, those who delivered by CD (both elective and non-elective combined), elective CD, and non-elective CD were associated with the “increasing from moderate to high” trajectory [odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.13–2.29; OR = 1.64, 95%CI: 1.06–2.54; and OR = 1.59, 95%CI: 1.05–2.39, respectively] and were also associated with the “increasing from low to high” trajectory (OR = 1.60, 95%CI: 1.17–2.19, OR = 1.75, 95%CI: 1.16–2.63; and OR = 1.53, 95%CI: 1.00–2.34, respectively).Conclusion: Both elective and non-elective CD were associated with the risk of accelerated weight gain in early childhood.

Sex-specific association between elective cesarean section and growth trajectories in preschool children: A prospective birth cohort study

“…Begum et al ( 31 )showed that the pooled OR of “high level” trajectory in offspring delivered by CS was 1.72 (95% CI: 1.28–2.31) compared with those born via VD. Zhang et al ( 32 ) found that children delivered by CS (without distinguishing ECS and non-ECS) more possibly had a “medium to high increase” trajectory from 3 to 60 months of age and a “low to high increase” trajectory from 3 to 60 months of age. Similar to previous studies, we found an increased possibility of “high level” BMI trajectory in children born via ECS with medical indicators.…”

Impact of short-term change of adiposity on risk of high blood pressure in children: Results from a follow-up study in China

“…(5) We also used BMI standard deviation score (BMI SDS) instead of BMI to compare the risk of HBP in different groups with multivariate logistic models. Age-and sex-specific BMI SDS was calculated using the World Health Organization (WHO) child growth charts [25][26][27].…”