Caesarean section delivery and childhood obesity in a British longitudinal cohort study

Abstract

BackgroundSeveral studies reported an association between Caesarean section (CS) birth and childhood obesity. However, there are several limitations in the current literature. These include an inability to distinguish between planned and emergency CS, small study sample sizes and not adjusting for pre-pregnancy body-mass-index (BMI). We examined the association between CS delivery and childhood obesity using the United Kingdom Millennium Cohort Study (MCS).MethodsMother-infant pairs were recruited into the MCS. Use of sampling weights ensured the sample was representative of the population. The exposure was categorised as normal vaginal delivery (VD) [reference], assisted VD, planned CS and emergency CS. Childhood obesity prevalence, at age three, five, seven, eleven and fourteen years was calculated using the International Obesity Taskforce criteria. Mixed-effects linear regression models were fitted with associations adjusted for several potential confounders like maternal age, pre-pregnancy BMI, education and infant macrosomia. Linear regression models were fitted evaluating body fat percentage (BF%), at age seven and fourteen years.ResultsOf the 18,116 infants, 3872 (21.4%) were delivered by CS; 9.2% by planned CS. Obesity prevalence was 5.4%, 5.7%, 6.5%, 7.1% and 7.6% at age three, five, seven, eleven and fourteen years respectively. The mixed-effects linear regression model showed no association between planned (adjusted mean difference = 0.00; [95% confidence interval (CI) -0.10; 0.10], p-value = 0.97) or emergency CS (adjusted mean difference = 0.08; [95% CI -0.01; 0.17], p-value = 0.09) and child BMI. At age seven years, there was no association between planned CS and BF% (adjusted mean difference = 0.13; [95% CI -0.23; 0.49]); there was no association at age fourteen years.ConclusionsInfants born by planned CS did not have a significantly higher BMI or BF% compared to those born by normal VD. This may suggest that the association, described in the literature, could be due to the indications/reasons for CS birth or residual confounding.

Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis

“…Authors suggested there is no clinically relevant association between cesarean section and the development of obesity. The PIAMA study indicated an increased risk of obesity (OR = 1.7) [79] while a long-term prospective study conducted in the United Kingdom showed no significant correlation between elective cesarean section and both body mass index (BMI), as well as body fat percentage (BF%) in children [80]. The results of the remaining studies concerning the risk of developing other immune diseases are also ambiguous.…”

“…A summary of the search process is illustrated in Figure 2, as recommended by the PRISMA guidelines [90]. Due to sufficient data regarding the occurrence of respiratory tract infections, asthma, overweight/obesity as well as diabetes mellitus type 1, 16 articles [11,20,67,68,[70][71][72][73][74][75][76][77][78][79][80][81]85,86,88,89] were included in the meta-analysis. for those citations considered potentially relevant and assessed for eligibility by the two researchers.…”

Effect of Elective Cesarean Section on Children's Obesity From Birth to Adolescence: A Systematic Review and Meta-Analysis

“…After reviewing the titles and abstracts, 43 relevant studies were obtained. After reading the full text, a total of 9 studies met the inclusion criteria and were used for final meta-analysis (16)(17)(18)(20)(21)(22)(23)(24)(25) (Figure 1).…”

The Possible Contribution of being Born by Cesarean Section to Developing Childhood Overweight and Obesity in Later Life

“…Furthermore, there was no difference in body fat percentage at 7 and 14 years old between infants born by planned cesarean section and those born by vaginal delivery. 9 A very large systematic review and meta-analysis conducted to investigate associations between mode of delivery and adult BMI, overweight, and obesity found that the mean BMI was 0.44 kg.m À2 greater in subjects delivered by cesarean section compared with those delivered vaginally. The increased odds of overweight and obesity > 20% applied to both genders.…”