Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul;37(7):900-6.
doi: 10.1038/ijo.2013.49. Epub 2013 Apr 8.

Association of caesarean delivery with child adiposity from age 6 weeks to 15 years

J Blustein  1 , T Attina, M Liu, A M Ryan, L M Cox, M J Blaser, L Trasande
Affiliations

Association of caesarean delivery with child adiposity from age 6 weeks to 15 years

J Blustein et al. Int J Obes (Lond). 2013 Jul.

Abstract

Objectives: o assess associations of caesarean section with body mass from birth through adolescence.

Design: ongitudinal birth cohort study, following subjects up to 15 years of age.

Setting and participants: Children born in 1991-1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n=10 219).

Primary outcome: standardized measures of body mass (weight-for length z-scores at 6 weeks, 10 and 20 months; and body mass index (BMI) z-scores at 38 months, 7, 9, 11 and 15 years). Secondary outcome: categorical overweight or obese (BMI: 85th percentile) for age and gender, at 38 months, 7, 9, 11 and 15 years.

Results: Of the 10 219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower-birth weights than those born vaginally (-46.1 g, 95% confidence interval(CI): 14.6-77.6 g; P=0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at 6 weeks (+0.11 s.d. units, 95% CI: 0.03-0.18; P=0.005), through age 15 (BMI z-score increment+0.10 s.d. units, 95% CI: 0.001-0.198; P=0.042). By age 11 caesarean-delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24-2.70; P=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal-weight mothers was weak.

Conclusion: Cesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

PubMed Disclaimer

Conflict of interest statement

Competing interest. All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: all authors had financial support from the NYU Global Public Health Research Fund for the submitted work, and MJB/LMK had financial support from the National Institutes of Health [NIH], as described in the acknowledgements and the Diane Belfer Program in Human Microbial Ecology; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Association of delivery mode (caesarean vs. vaginal) and child’s body mass, ages 6 weeks to 15 years
Mean predicted age- and sex-adjusted z-score weight-for-length (wfl) and Body Mass Index (BMI) for children born by caesarean section and vaginal delivery. Mean predicted values are derived from mixed multivariable models, as described in the text. P-values correspond to a two-tailed test of the difference of means for the modes of delivery, at each time point. Panel A. All children; n = 10,219. Panel B. Children of normal weight mothers; n = 7,603. Panel C. Children of overweight/obese mothers; n =1,874. Panels B and C. Mothers with missing pre-pregnancy weights do not appear.
Figure 1
Figure 1. Association of delivery mode (caesarean vs. vaginal) and child’s body mass, ages 6 weeks to 15 years
Mean predicted age- and sex-adjusted z-score weight-for-length (wfl) and Body Mass Index (BMI) for children born by caesarean section and vaginal delivery. Mean predicted values are derived from mixed multivariable models, as described in the text. P-values correspond to a two-tailed test of the difference of means for the modes of delivery, at each time point. Panel A. All children; n = 10,219. Panel B. Children of normal weight mothers; n = 7,603. Panel C. Children of overweight/obese mothers; n =1,874. Panels B and C. Mothers with missing pre-pregnancy weights do not appear.
Figure 1
Figure 1. Association of delivery mode (caesarean vs. vaginal) and child’s body mass, ages 6 weeks to 15 years
Mean predicted age- and sex-adjusted z-score weight-for-length (wfl) and Body Mass Index (BMI) for children born by caesarean section and vaginal delivery. Mean predicted values are derived from mixed multivariable models, as described in the text. P-values correspond to a two-tailed test of the difference of means for the modes of delivery, at each time point. Panel A. All children; n = 10,219. Panel B. Children of normal weight mothers; n = 7,603. Panel C. Children of overweight/obese mothers; n =1,874. Panels B and C. Mothers with missing pre-pregnancy weights do not appear.
Figure 2
Figure 2. Association of delivery mode (elective caesarean vs emergency caesarean vs vaginal) and body mass, ages 6 weeks to 15 years
Mean predicted age- and sex-adjusted z-score weight-for-length (wfl) and Body Mass Index (BMI) for children born by elective caesarean section, emergency caesarean section, and vaginal delivery. Mean predicted values are derived from mixed multivariable models, as described in the text. P-values correspond to two-tailed tests of the difference of means for each of the two modes of caesarean delivery, versus vaginal delivery, at each time point. The upper value is for elective caesarean versus vaginal delivery, and the lower value is for emergency caesarean section.
See this image and copyright information in PMC

References

    1. Keeler EB, Brodie M. Economic incentives in the choice between vaginal delivery and cesarean section. Milbank Q. 1993;71:365–404. - PubMed
    1. Lauer JA, Betran AP, Merialdi M, Wojdyla D. Determinants of caesarean section rates in developed countries: supply, demand and opportunities for control. 2010 Available at http://www.who.int/healthsystems/topics/financing/healthreport/29Determi... (Accessed 2 July 2012)
    1. Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends. 2011;5:139–150. - PubMed
    1. Yang YT, Mello MM, Subramanian SV, Studdert DM. Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section. Med Care. 2009;47:234–242. - PMC - PubMed
    1. National Institutes of Health. State-of-the-Science Conference Statement: Cesarean Delivery on Maternal Request March 27–29, 2006. Obestrics & Gynecology. 107:1386–1397. - PubMed

Publication types

MeSH terms