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Wu T, Liao Z, Wang J, Liu M. The Accumulative Effect of Multiple Postnatal Risk Factors with the Risk of Being Overweight/Obese in Late Childhood. Nutrients 2024; 16:1536. [PMID: 38794774 PMCID: PMC11124345 DOI: 10.3390/nu16101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Most past studies focused on the associations of prenatal risk factors with the risks of childhood overweight/obesity. Instead, more postnatal risk factors are modifiable, with less knowledge of their cumulative effects on childhood obesity. We analyzed data of 1869 children in an Australian birth cohort. Key postnatal risk factors included: maternal and paternal overweight/obesity during the child's infancy, tobacco exposure, low family socioeconomic score, breastfeeding duration < 6 months, early introduction of solid foods, and rapid weight gain during infancy. The risk score was the sum of the number of risk factors. The primary outcome is overweight/obesity in late childhood (11-12 years); secondary outcomes are high-fat mass index (FMI), body fat percentage (BF%), and waist-to-height ratio (WHtR). Poisson regression models were used in the analyses. Children with higher risk scores had higher risks of overweight/obesity (p-for-trends < 0.001). After adjusting covariates, compared with those with 0-1 risk factors, children with 4-6 risk factors had 4.30 (95% confidence interval: 2.98, 6.21) times higher risk of being overweight/obesity; the relative risks for high FMI, BF%, and WHtR were 7.31 (3.97, 13.45), 4.41 (3.00, 6.50), and 6.52 (3.33, 12.74), respectively. Our findings highlighted that multiple postnatal risk factors were associated with increased risks of being overweight/obesity in late childhood.
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Affiliation(s)
- Ting Wu
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang 330006, China;
- Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang 330006, China
| | - Zijun Liao
- Capital Institute of Pediatrics, Beijing 100020, China;
| | - Jing Wang
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Parkville, VIC 3052, Australia;
- Department of Pediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Mengjiao Liu
- School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang 330006, China;
- Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang 330006, China
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Bridgman SL, Penfold S, Field CJ, Haqq AM, Mandhane PJ, Moraes TJ, Turvey SE, Simons E, Subbarao P, Kozyrskyj AL. Pre-labor and post-labor cesarean delivery and early childhood adiposity in the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. Int J Obes (Lond) 2024; 48:717-724. [PMID: 38302592 DOI: 10.1038/s41366-024-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND/OBJECTIVES Delivery by cesarean section (CS) compared to vaginal delivery has been associated with increased risk of overweight in childhood. Our study examined if the presence or absence of labor events in CS delivery altered risk of overweight in early childhood (1-5 years) compared to vaginal delivery and if this association differed according to infant sex. SUBJECTS/METHODS The study included 3073 mother-infant pairs from the CHILD Cohort Study in Canada. Data from birth records were used to categorize infants as having been vaginally delivered, or delivered by CS, with or without labor events. Age and sex adjusted weight-for-length (WFL) and body mass index (BMI) z scores were calculated from height and weight data from clinic visits at 1, 3 and 5 years and used to classify children as overweight. Associations between delivery mode and child overweight at each timepoint were assessed using regression models, adjusting for relevant confounding factors including maternal pre-pregnancy BMI. Effect modification by infant sex was tested. RESULTS One in four infants (24.6%) were born by CS delivery; 13.0% involved labor events and 11.6% did not. Infants born by CS without labor had an increased odds of being overweight at age 1 year compared to vaginally delivered infants after adjustment for maternal pre-pregnancy BMI, maternal diabetes, smoking, infant sex and birthweight-for-gestational age (aOR 1.68 [95% CI 1.05-2.67]). These effects did not persist to 3 or 5 years of age and, after stratification by sex, were only seen in boys (aOR at 1 year 2.21 [95% CI 1.26-3.88]). CONCLUSION AND RELEVANCE Our findings add to the body of evidence that CS, in particular CS without labor events, may be a risk factor for overweight in early life, and that this association may be sex-specific. These findings could help to identify children at higher risk for developing obesity.
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Affiliation(s)
- Sarah L Bridgman
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- London School of Hygiene and Tropical Medicine, University of London, London, UK.
| | - Suzanne Penfold
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Catherine J Field
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Elinor Simons
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Kenkel WM, Ahmed S, Partie M, Rogers K. Delivery by cesarean section leads to heavier adult bodyweight in prairie voles (Microtus ochrogaster). Horm Behav 2024; 160:105499. [PMID: 38350334 PMCID: PMC10961198 DOI: 10.1016/j.yhbeh.2024.105499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
Delivery by cesarean section now makes up 32.1 % of all births in the United States. Meta-analyses have estimated that delivery by cesarean section is associated with a > 50 % increased risk for childhood obesity by 5 years of age. While this association is independent of maternal obesity, breastfeeding, and heritable factors, studies in humans have been unable to test for a causal role of cesarean delivery in this regard. Here, we set out to use an animal model to experimentally test whether delivery by cesarean section would increase offspring weight in adulthood. Delivery by cesarean section may exert neurodevelopmental consequences by impacting hormones that are important at birth as well as during metabolic regulation in later life, such as oxytocin and vasopressin. The prairie vole (Microtus ochrogaster) has long been studied to investigate the roles of oxytocin and vasopressin in brain development and social behavior. Here, we establish that prairie voles tolerate a range of ambient temperatures, including conventional 22° housing, which makes them translationally appropriate for studies of diet-induced obesity. We also studied vole offspring for their growth, sucrose preference, home cage locomotor activity, and food consumption after birth by either cesarean section or vaginal delivery. At sacrifice, we collected measures of weight, length, and adipose tissue to analyze body composition in adulthood. Voles delivered by cesarean section had consistently greater bodyweights than those born vaginally, despite having lower food consumption and greater locomotive activity. Cesarean-delivered animals were also longer, though this did not explain their greater body weights. While cesarean delivery had no effect on vasopressin, it resulted in less oxytocin immunoreactivity within the hypothalamus in adulthood. These results support the case that cesarean section delivery plays a causal role in increasing offspring body weight, potentially by affecting the oxytocin system.
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Affiliation(s)
- William M Kenkel
- Department of Psychological and Brain Sciences, University of Delaware, United States of America.
| | - Sabreen Ahmed
- Department of Psychological and Brain Sciences, University of Delaware, United States of America
| | - Miranda Partie
- Department of Psychological and Brain Sciences, University of Delaware, United States of America
| | - Katelyn Rogers
- Department of Psychological and Brain Sciences, University of Delaware, United States of America
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Yang M, Zhang S, Teng Y, Ru X, Zhu L, Han Y, Tao X, Cao H, Yan S, Tao F, Huang K. Association of Maternal TSH, FT4 With Children's BMI Trajectories, and Obesity: A Birth Cohort Study. J Clin Endocrinol Metab 2023; 109:e190-e199. [PMID: 37526290 DOI: 10.1210/clinem/dgad441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To investigate the association between maternal TSH, free thyroxine (FT4), and children's body mass index (BMI) trajectories and obesity. METHOD Based on the Ma'anshan Birth Cohort in China, we repeatedly assayed maternal thyroid functions in 3 trimesters of pregnancy. Children's height and weight were measured 15 times before they were age 6 years. Body fat was assessed when children were aged 6 years. Mplus software was used to fit maternal thyroid hormone trajectories and BMI trajectories. Multivariate logistic regression models and generalized linear models were used in data analysis. RESULTS Low maternal FT4 trajectory was observed to be related to an increased risk of a high children's BMI trajectory and overweight, with an odds ratio and 95% CI of 1.580 (1.169-2.135) and 1.505 (1.064-2.129), respectively. Increased maternal FT4 concentrations in the first, second, and third trimesters were associated with a decreased risk of high children's BMI trajectories and obesity. There was a positive association between low maternal FT4 trajectory and 6-year-old children's body fat ratio with β and 95% CI of 0.983 (0.138-1.829). Furthermore, negative correlations between maternal FT4 concentration in the first, second, and third trimesters of pregnancy and body fat ratio were observed. CONCLUSIONS Low maternal FT4 trajectory during pregnancy may predict a high BMI trajectory in children and relate to overweight and high body fat ratio in 6-year-old children. High maternal FT4 concentrations throughout pregnancy may be associated with the decreasing risk of obesity and low body fat ratio in 6-year-old children.
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Affiliation(s)
- Mengting Yang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Shanshan Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Yuzhu Teng
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Xue Ru
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Linlin Zhu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Yan Han
- School of Public Health, Xuzhou Medical University, Xuzhou 221000, China
| | - Xingyong Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Hui Cao
- Maternal and Child Health Center in Ma'anshan, Ma'anshan 243000, China
| | - Shuangqin Yan
- Maternal and Child Health Center in Ma'anshan, Ma'anshan 243000, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230000, China
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230000, China
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Ruiz-Triviño J, Álvarez D, Cadavid J. ÁP, Alvarez AM. From gut to placenta: understanding how the maternal microbiome models life-long conditions. Front Endocrinol (Lausanne) 2023; 14:1304727. [PMID: 38161976 PMCID: PMC10754986 DOI: 10.3389/fendo.2023.1304727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
The microbiome -defined as the microbiota (bacteria, archaea, lower and higher eukaryotes), their genomes, and the surrounding environmental conditions- has a well-described range of physiological functions. Thus, an imbalance of the microbiota composition -dysbiosis- has been associated with pregnancy complications or adverse fetal outcomes. Although there is controversy about the existence or absence of a microbiome in the placenta and fetus during healthy pregnancy, it is known that gut microbiota can produce bioactive metabolites that can enter the maternal circulation and may be actively or passively transferred through the placenta. Furthermore, the evidence suggests that such metabolites have some effect on the fetus. Since the microbiome can influence the epigenome, and modifications of the epigenome could be responsible for fetal programming, it can be experimentally supported that the maternal microbiome and its metabolites could be involved in fetal programming. The developmental origin of health and disease (DOHaD) approach looks to understand how exposure to environmental factors during periods of high plasticity in the early stages of life (e.g., gestational period) influences the program for disease risk in the progeny. Therefore, according to the DOHaD approach, the influence of maternal microbiota in disease development must be explored. Here, we described some of the diseases of adulthood that could be related to alterations in the maternal microbiota. In summary, this review aims to highlight the influence of maternal microbiota on both fetal development and postnatal life, suggesting that dysbiosis on this microbiota could be related to adulthood morbidity.
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Affiliation(s)
- Jonathan Ruiz-Triviño
- Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia - UdeA, Medellín, Colombia
- Semillero de Investigación en Alteraciones de la Gestación y Autoinmunidad (SIAGA), Universidad de Antioquia - UdeA, Medellín, Colombia
| | - Daniel Álvarez
- Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia - UdeA, Medellín, Colombia
- Semillero de Investigación en Alteraciones de la Gestación y Autoinmunidad (SIAGA), Universidad de Antioquia - UdeA, Medellín, Colombia
| | - Ángela P. Cadavid J.
- Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia - UdeA, Medellín, Colombia
- Semillero de Investigación en Alteraciones de la Gestación y Autoinmunidad (SIAGA), Universidad de Antioquia - UdeA, Medellín, Colombia
- Grupo de Investigación en Trombosis, Facultad de Medicina, Universidad de Antioquia - UdeA, Medellín, Colombia
| | - Angela M. Alvarez
- Grupo Reproducción, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia - UdeA, Medellín, Colombia
- Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad de Antioquia - UdeA, Medellín, Colombia
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6
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de Wit DF, Hanssen NMJ, Wortelboer K, Herrema H, Rampanelli E, Nieuwdorp M. Evidence for the contribution of the gut microbiome to obesity and its reversal. Sci Transl Med 2023; 15:eadg2773. [PMID: 37992156 DOI: 10.1126/scitranslmed.adg2773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/27/2023] [Indexed: 11/24/2023]
Abstract
Obesity has become a worldwide pandemic affecting more than 650 million people and is associated with a high burden of morbidity. Alongside traditional risk factors for obesity, the gut microbiome has been identified as a potential factor in weight regulation. Although rodent studies suggest a link between the gut microbiome and body weight, human evidence for causality remains scarce. In this Review, we postulate that existing evidence remains to establish a contribution of the gut microbiome to the development of obesity in humans but that modified probiotic strains and supraphysiological dosages of microbial metabolites may be beneficial in combatting obesity.
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Affiliation(s)
- Douwe F de Wit
- Amsterdam UMC location University of Amsterdam, Experimental Vascular Medicine, 1105AZ Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes and Metabolism, 1105AZ Amsterdam, Netherlands
| | - Nordin M J Hanssen
- Amsterdam UMC location University of Amsterdam, Experimental Vascular Medicine, 1105AZ Amsterdam, Netherlands
| | - Koen Wortelboer
- Amsterdam UMC location University of Amsterdam, Experimental Vascular Medicine, 1105AZ Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes and Metabolism, 1105AZ Amsterdam, Netherlands
| | - Hilde Herrema
- Amsterdam UMC location University of Amsterdam, Experimental Vascular Medicine, 1105AZ Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes and Metabolism, 1105AZ Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1105AZ Amsterdam, Netherlands
| | - Elena Rampanelli
- Amsterdam UMC location University of Amsterdam, Experimental Vascular Medicine, 1105AZ Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes and Metabolism, 1105AZ Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, 1105AZ Amsterdam, Netherlands
| | - Max Nieuwdorp
- Amsterdam UMC location University of Amsterdam, Experimental Vascular Medicine, 1105AZ Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes and Metabolism, 1105AZ Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Medical Center, Department of Internal Medicine, Diabetes Center, 1105AZ Amsterdam, Netherlands
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Sitarik AR, Wegienka G, Johnson CC, Joseph CLM. Impact of Spirometry Race-Correction on Preadolescent Black and White Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3097-3106. [PMID: 37301437 PMCID: PMC10592501 DOI: 10.1016/j.jaip.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Race-correction for Black patients is standard practice in spirometry testing. History suggests that these corrections are at least partially a result of racist assumptions regarding lung anatomy among Black individuals, which can potentially lead to less frequent diagnoses of pulmonary diseases in this population. OBJECTIVE To evaluate the impact of race-correction in spirometry testing among Black and White preadolescents, and examine the frequency of current asthma symptoms in Black children who were differentially classified depending on whether race-corrected or race-uncorrected reference equations were deployed. METHODS Data from Black and White children who completed a clinical examination at age 10 years from a Detroit-based unselected birth cohort were analyzed. Global Lung Initiative 2012 reference equations were applied to spirometry data using both race-corrected and race-uncorrected (ie, population-average) equations. Abnormal results were defined as values less than the fifth percentile. Asthma symptoms were assessed concurrently using the International Study of Asthma and Allergies in Childhood questionnaire, while asthma control was assessed using the Asthma Control Test. RESULTS The impact of race-correction on forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio was minimal, but abnormal classification of FEV1 results more than doubled among Black children when race-uncorrected equations were used (7% vs 18.1%) and were almost 8 times greater based on forced vital capacity classification (1.5% vs 11.4%). More than half of Black children differentially classified on FEV1 (whose FEV1 was classified as normal with race-corrected equations but abnormal with race-uncorrected equations) experienced asthma symptoms in the past 12 months (52.6%), which was significantly higher than the percentage of Black children consistently classified as normal (35.5%, P = .049), but similar to that of Black children consistently classified as abnormal using both race-corrected and race-uncorrected equations (62.5%, P = .60). Asthma Control Test scores were not different based on classification. CONCLUSIONS Race-correction had an extensive impact on spirometry classification in Black children, and differentially classified children had a higher rate of asthma symptoms than children consistently classified as normal. Spirometry reference equations should be reevaluated to be aligned with current scientific perspectives on the use of race in medicine.
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Affiliation(s)
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
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8
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Sitarik AR, Johnson CC, Levin AM, Lynch SV, Ownby DR, Rundle AG, Straughen JK, Wegienka G, Woodcroft KJ, Cassidy-Bushrow AE. Progression of C-reactive protein from birth through preadolescence varies by mode of delivery. Front Pediatr 2023; 11:1155852. [PMID: 37388285 PMCID: PMC10304017 DOI: 10.3389/fped.2023.1155852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Delivery via caesarean section (C-section) has been associated with an increased risk of childhood chronic diseases such as obesity and asthma, which may be due to underlying systemic inflammation. However, the impact of specific C-section types may be differential, as emergency C-sections typically involve partial labor and/or membrane rupture. Our objectives were to determine if mode of delivery associates with longitudinal profiles of high sensitivity CRP (hs-CRP) -a marker of systemic inflammation-from birth through preadolescence, and to examine if CRP mediates the association between mode of delivery and preadolescent body mass index (BMI). Methods Data from the WHEALS birth cohort (N = 1,258) were analyzed; 564 of the 1,258 children in the cohort had data available for analysis. Longitudinal plasma samples (birth through 10-years of age) from 564 children from were assayed for hs-CRP levels. Maternal medical records were abstracted to obtain mode of delivery. Growth mixture models (GMMs) were used to determine classes of hs-CRP trajectories. Poisson regression with robust error variance was used to calculate risk ratios (RRs). Results Two hs-CRP trajectory classes were identified: class 1 (76% of children) was characterized by low hs-CRP, while class 2 (24% of children) was characterized by high and steadily increasing hs-CRP. In multivariable models, children delivered via planned C-section had 1.15 times higher risk of being in hs-CRP class 2, compared to vaginal deliveries (p = 0.028), while no association was found for unplanned C-section deliveries [RR (95% CI) = 0.96 (0.84, 1.09); p = 0.49]. Further, the effect of planned C-section on BMI z-score at age 10 was significantly mediated by hs-CRP class (percent mediated = 43.4%). Conclusions These findings suggest potentially beneficial effects of experiencing partial or full labor, leading to a lower trajectory of systemic inflammation throughout childhood and decreased BMI during preadolescence. These findings may have implications for chronic disease development later in life.
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Affiliation(s)
- Alexandra R. Sitarik
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Christine C. Johnson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Albert M. Levin
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Susan V. Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, United States
| | - Dennis R. Ownby
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA, United States
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | | | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
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9
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Kenkel WM, Kingsbury MA, Reinhart JM, Cetinbas M, Sadreyev RI, Carter CS, Perkeybile AM. Lasting consequences on physiology and social behavior following cesarean delivery in prairie voles. Horm Behav 2023; 150:105314. [PMID: 36731301 PMCID: PMC10023354 DOI: 10.1016/j.yhbeh.2023.105314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
Cesarean delivery is associated with diminished plasma levels of several 'birth-signaling' hormones, such as oxytocin and vasopressin. These same hormones have been previously shown to exert organizational effects when acting in early life. For example, our previous work found a broadly gregarious phenotype in prairie voles exposed to oxytocin at birth. Meanwhile, cesarean delivery has been previously associated with changes in social behavior and metabolic processes related to oxytocin and vasopressin. In the present study, we investigated the long-term neurodevelopmental consequences of cesarean delivery in prairie voles. After cross-fostering, vole pups delivered either via cesarean or vaginal delivery were studied throughout development. Cesarean-delivered pups responded to isolation differently in terms of their vocalizations (albeit in opposite directions in the two experiments), huddled in less cohesive groups under warmed conditions, and shed less heat. As young adults, we observed no differences in anxiety-like or alloparental behavior. However, in adulthood, cesarean-delivered voles of both sexes failed to form partner preferences with opposite sex conspecifics. In a follow-up study, we replicated this deficit in partner-preference formation among cesarean-delivered voles and were able to normalize pair-bonding behavior by treating cesarean-delivered vole pups with oxytocin (0.25 mg/kg) at delivery. Finally, we detected minor differences in regional oxytocin receptor expression within the brains of cesarean-delivered voles, as well as microbial composition of the gut. Gene expression changes in the gut epithelium indicated that cesarean-delivered male voles have altered gut development. These results speak to the possibility of unintended developmental consequences of cesarean delivery, which currently accounts for 32.9 % of deliveries in the U.S. and suggest that further research should be directed at whether hormone replacement at delivery influences behavioral outcomes in later life.
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Affiliation(s)
- William M Kenkel
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States of America.
| | - Marcy A Kingsbury
- Department of Pediatrics, Massachusetts General Hospital, Cambridge, MA, United States of America
| | - John M Reinhart
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States of America
| | - Murat Cetinbas
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, United States of America; Department of Genetics, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ruslan I Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Department of Pathology, Massachusetts General Hospital, Boston, MA, United States of America
| | - C Sue Carter
- Department of Psychology, University of Virginia, Charlottesville, VA, United States of America
| | - Allison M Perkeybile
- Department of Psychology, University of Virginia, Charlottesville, VA, United States of America
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Tang M, Marroquin E. The role of the gut microbiome in the intergenerational transmission of the obesity phenotype: A narrative review. Front Med (Lausanne) 2022; 9:1057424. [PMID: 36619646 PMCID: PMC9812955 DOI: 10.3389/fmed.2022.1057424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Obesity is considered an epidemic by the World Health Organization. In particular, maternal obesity can affect the development of obesity and other related metabolic disorders in infants. Recently, both animal and human studies have pointed to the importance of the gut microbiome in facilitating the transmission of the obesity phenotype from mother to offspring. The gut microbiome changes significantly during the progression of pregnancy, and the microbiota of the amniotic fluid and placenta have recently been shown to colonize the infant gut in utero. Microbial composition, diversity, and richness are significantly altered by maternal obesity, which in turn affects the infant's acquisition of the gut microbiome and their risk to develop metabolic disorders. C-section has also been shown to affect the colonization of the infant gut and offspring metabolic and immune health. This narrative review seeks to discuss the role of the gut microbiome in the transmission of the obesity phenotype from mother to child, as well as how birth delivery, breastfeeding, and probiotic interventions may modulate this relationship.
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Affiliation(s)
- Mabel Tang
- Department of BioSciences, Rice University, Houston, TX, United States
| | - Elisa Marroquin
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, United States,*Correspondence: Elisa Marroquin,
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Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana. J Nutr Sci 2022; 11:e43. [PMID: 35754984 PMCID: PMC9201873 DOI: 10.1017/jns.2022.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.
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12
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Cho NA, Sales KM, Sampsell K, Wang W, Noye Tuplin EW, Lowry DE, Reimer RA. C-section birth increases offspring obesity risk dependent on maternal diet and obesity status in rats. Obesity (Silver Spring) 2021; 29:1664-1675. [PMID: 34464518 DOI: 10.1002/oby.23258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The gut microbiota is a complex ecosystem that shapes host metabolism, especially in early life. Maternal vaginal and gut microbiota is vertically transmitted to offspring during natural birth. Offspring born by cesarean section (CS) do not receive these bacteria and exhibit higher obesity risk later in life. The objective of this study was to examine differences in obesity risk between offspring born naturally (NB) or by CS to lean/obese dams. METHODS Lean and obese rat dams gave birth to offspring naturally or by CS. Offspring obesity risk was analyzed via body weight/composition, food intake, sucrose preference, gut microbiota, and gene expression in gut and brain tissues. RESULTS Obese (O)+CS offspring showed greater weight gain and caloric intake but a reduction in hypothalamic agouti related neuropeptide, neuropeptide Y, and interleukin 1β expression compared with O+NB offspring. Lean (L)+CS offspring had higher serum corticosterone concentration and reduced liver peroxisome proliferator-activated receptor γ expression compared with L+NB. O+CS offspring had long-term alterations to gut microbiota, including increased relative abundance of Faecalibaculum and reduced Muribaculaceae. CONCLUSIONS Overall, CS alters obesity risk differentially based on maternal obesity status. Further studies looking at the risks of obesity associated with CS are needed, with special attention paid to maternal obesity status and gut microbiota.
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Affiliation(s)
- Nicole A Cho
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kate M Sales
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kara Sampsell
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Weilan Wang
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Dana E Lowry
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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King J. Are there adverse outcomes for child health and development following caesarean section delivery? Can we justify using elective caesarean section to prevent obstetric pelvic floor damage? Int Urogynecol J 2021; 32:1963-1969. [PMID: 33877375 DOI: 10.1007/s00192-021-04781-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Elective pre-labour Caesarean section (CS) delivery is widely regarded as the panacea for all pelvic floor dysfunction despite substantial epidemiological evidence that it is only partially protective. To demand a CS is also considered a right for the well-counselled patient, even without an elevated risk of incontinence or prolapse. In recent years there has been increasing data on possible adverse health outcomes for children delivered by CS over those delivered vaginally. This includes respiratory illness, atopic conditions, obesity, diabetes and other severe auto-immune diseases. Concern has also been raised over possible impacts on cognitive and neuropsychological development in these children. Often the response has been to dismiss these outcomes as a result of the indication for the CS birth such as antenatal compromise or maternal disease. However the marked increase in non-medical Caesarean delivery throughout many regions of the world has allowed us to better distinguish these contributing factors. METHODS This narrative review looks at some of the more recent evidence on adverse health and developmental outcomes associated with CS, particularly pre-labour CS and the implications for the long term health of our society. RESULTS Epidemiological studies and animal research indicate an increased risk of negative impacts on child physical health and neuro-cognitive development aftercaesarean section delivery, particularly pre-labour Caesarean section, compared with vaginal delivery. This elevated risk persists after correction forobstetric and maternal factors. CONCLUSION Caesarean section delivery can result in adverse outcomes for infant, maternal and societal wellbeing. Elective Caesarean section, purely to potentially minimise pelvic floor dysfunction, cannot be justified.
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Affiliation(s)
- Jennifer King
- Pelvic Floor Unit, Westmead Hospital, Sydney, Australia.
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14
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Zhang S, Qin X, Li P, Huang K. Effect of Elective Cesarean Section on Children's Obesity From Birth to Adolescence: A Systematic Review and Meta-Analysis. Front Pediatr 2021; 9:793400. [PMID: 35155315 PMCID: PMC8829565 DOI: 10.3389/fped.2021.793400] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Elective cesarean section (ECS) is the most common reason for the increasing cesarean section rate worldwide, and it is reported to be related to adverse short-term and long-term outcomes in both mothers and infants. Findings on the association between ECS and overweight and obesity in children are controversial in recent studies. Therefore, we conducted a systematic review and meta-analysis to examine the effect of ECS on offspring's overweight and obesity. METHODS PubMed, Science Direct, Web of Science, CNKI (China National Knowledge Infrastructure), Wanfang Database (in Chinese), and China Biology Medicine disc databases were searched using different combinations of three groups of keywords: "elective cesarean section," "overweight/obesity," and "children." Nine cohort studies and 11 independent risk estimates were finally identified. RESULTS We have observed significant association between ECS and children's obesity, the total pooled risk ratio (RR) being 1.10 (95% CI: 1.01-1.18; I 2 = 32.4%). In subgroup analysis, ECS was found to be associated with the occurrence of obesity in preschoolers (RR = 1.12, 95% CI: 1.02-1.22; I 2 = 16.8%). Furthermore, it revealed that ECS was related with the high risk of children's obesity where the rate of ECS exceeded 10%. No significant association was observed between ECS and children's overweight, and the RR was 1.12 (95% CI: 0.94-1.30; I 2 = 55.6%). CONCLUSIONS Overall, it indicated that children born via ECS had an increased risk of later-life obesity. Given the global increase in childhood obesity, our findings would provide evidence-based reference for early life intervention on children's obesity. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267211, identifier: CRD42021267211.
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Affiliation(s)
- Shanshan Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Xiaoyun Qin
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Peixuan Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, Hefei, China.,National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.,Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China
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