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. 2020 Apr 1;3(4):e202605.
doi: 10.1001/jamanetworkopen.2020.2605.

Association of Birth by Cesarean Delivery With Obesity and Type 2 Diabetes Among Adult Women

Jorge E Chavarro  1   2   3 , Nerea Martín-Calvo  4   5   6 , Changzheng Yuan  1 , Mariel Arvizu  1 , Janet W Rich-Edwards  2   7 , Karin B Michels  8   9 , Qi Sun  1   2   3
Affiliations

Association of Birth by Cesarean Delivery With Obesity and Type 2 Diabetes Among Adult Women

Jorge E Chavarro et al. JAMA Netw Open. .

Abstract

Importance: Cesarean delivery is associated with an increased risk of childhood obesity in offspring. However, whether this increased risk also includes obesity-associated conditions remains unclear.

Objective: To evaluate the association of birth by cesarean delivery with offspring's risks of obesity and type 2 diabetes in adulthood.

Design, setting, and participants: This prospective cohort study compared the incidence of obesity and type 2 diabetes between birth by cesarean delivery and vaginal delivery among 33 226 women participating in the Nurses' Health Study II who were born between 1946 and 1964, with follow-up through the end of the 2013-2015 follow-up cycle. Participants' mothers provided information on mode of delivery and pregnancy characteristics. Participants provided information every 2 years on weight and diagnosis of type 2 diabetes. Relative risks of obesity and type 2 diabetes were estimated using log-binomial and proportional hazards regression accounting for maternal body mass index and other confounding factors. Statistical analysis was performed from June 2017 to December 2019.

Exposure: Birth by cesarean delivery compared with birth by vaginal delivery.

Main outcomes and measures: Risk of obesity and incidence of type 2 diabetes.

Results: At baseline, the participants' mean (SD) age was 33.8 (4.6) years (range, 24.0-44.0 years). A total of 1089 of the 33 226 participants (3.3%) were born by cesarean delivery. After 1 913 978 person-years of follow-up, 12 156 (36.6%) women were obese and 2014 (6.1%) had received a diagnosis of type 2 diabetes. Women born by cesarean delivery were more likely to be classified as obese and to have received a diagnosis of type 2 diabetes during follow-up. The multivariable-adjusted relative risk of obesity among women born by cesarean vs vaginal delivery was 1.11 (95% CI, 1.03-1.19). The multivariable-adjusted hazard ratio for type 2 diabetes among women born by cesarean vs vaginal delivery was 1.46 (95% CI, 1.18-1.81); this association remained significant after additional adjustment for participant's own body mass index (relative risk, 1.34 [95% CI, 1.08-1.67]). These associations persisted when analyses were restricted to women at low risk of cesarean delivery based on maternal characteristics.

Conclusions and relevance: This study suggests that women born by cesarean delivery may have a higher risk than women born by vaginal delivery of being obese and developing type 2 diabetes during adult life.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chavarro reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Sun reported receiving ad hoc consulting fees from Emavant Solutions GmbH. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Incidence of Type 2 Diabetes Among Women Born by Vaginal vs Cesarean Delivery
Figure 2.
Figure 2.. Associations of Birth by Cesarean Delivery With Risks of Offspring Obesity and Type 2 Diabetes Among Women in Low-Risk Categories for Cesarean Delivery Based on Maternal Characteristics
A, Risk of obesity among offspring in adulthood. B, Risk of type 2 diabetes among offspring in adulthood. BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); HR, hazard ratio; and RR, relative risk.
See this image and copyright information in PMC

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