Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood

Abstract

Importance: Cesarean birth has been associated with higher risk of obesity in offspring, but previous studies have focused primarily on childhood obesity and have been hampered by limited control for confounders.

Objective: To investigate the association between cesarean birth and risk of obesity in offspring.

Design, setting, and participants: A prospective cohort study was conducted from September 1, 1996, to December 31, 2012, among participants of the Growing Up Today Study, including 22 068 offspring born to 15 271 women, followed up via questionnaire from ages 9 to 14 through ages 20 to 28 years. Data analysis was conducted from October 10, 2015, to June 14, 2016.

Exposure: Birth by cesarean delivery.

Main outcomes and measures: Risk of obesity based on International Obesity Task Force or World Health Organization body mass index cutoffs, depending on age. Secondary outcomes included risks of obesity associated with changes in mode of delivery and differences in risk between siblings whose modes of birth were discordant.

Results: Of the 22 068 offspring (20 950 white; 9359 male and 12 709 female), 4921 individuals (22.3%) were born by cesarean delivery. The cumulative risk of obesity through the end of follow-up was 13% among all participants. The adjusted risk ratio for obesity among offspring delivered via cesarean birth vs those delivered via vaginal birth was 1.15 (95% CI, 1.06-1.26; P = .002). This association was stronger among women without known indications for cesarean delivery (adjusted risk ratio, 1.30; 95% CI, 1.09-1.54; P = .004). Offspring delivered via vaginal birth among women who had undergone a previous cesarean delivery had a 31% (95% CI, 17%-47%) lower risk of obesity compared with those born to women with repeated cesarean deliveries. In within-family analysis, individuals born by cesarean delivery had 64% (8%-148%) higher odds of obesity than did their siblings born via vaginal delivery.

Conclusions and relevance: Cesarean birth was associated with offspring obesity after accounting for major confounding factors. Although additional research is needed to clarify the mechanisms underlying this association, clinicians and patients should weigh this risk when considering cesarean delivery in the absence of a clear indication.

Figure 1. Adjusted Risk Ratios (RR) and 95% Confidence Intervals (CI) for Cesarean section and Offspring Obesity

Multivariate model was adjusted for maternal age at delivery, race (white, other), maternal pre-pregnancy BMI group (<18.5, 18.5–24.99, 25–29.99, 30+ kg/m2), previous cesarean (yes/no), maternal height, gestational diabetes (yes, no), preeclampsia (yes, no), pregnancy induced hypertension(yes, no), child sex (male, female), year of birth (<=1984, 1985–1989, >1989), gestational age at delivery (<37, 37–39, 40–42, 43+ weeks), birth order, birth weight group (<5, 5–6.9, 7–8.4,8.5–9.9, 10+ lbs), pre-pregnancy smoking (never, past, current) and region of residence at birth (Northeast, Midwest, West, South). Data from the Growing Up Today Study, 1996–2011