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O. Gorman T, Maher GM, Al Khalaf S, Khashan AS. The association between caesarean section delivery and obesity at age 17 years. Evidence from a longitudinal cohort study in the United Kingdom. PLoS One 2024; 19:e0301684. [PMID: 38820521 PMCID: PMC11142666 DOI: 10.1371/journal.pone.0301684] [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: 11/16/2023] [Accepted: 03/20/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Childhood and adolescent obesity are major, preventable public health concerns. Studies to date are inconclusive regarding an association between caesarean section (CS) delivery and offspring obesity, with fewer studies conducted in late adolescence. This study examined the association between CS delivery, with a specific focus on planned CS, and induction of labour and adolescent body mass index (BMI) and body fat percentage (BF%) at age 17 years. METHODS Data on 8,880 mother-child pairs from the United Kingdom Millennium Cohort Study were analysed. The exposures were mode of delivery (normal vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS) and mode of delivery by induction of labour status. Crude and adjusted binary logistic regression and linear regression models were fitted examining BMI and BF% at age 17 years respectively, adjusting for several potential confounders. RESULTS Adolescents born by CS did not have an elevated BMI or BF% compared to those born by normal VD. The fully adjusted results for overweight and obesity in children born by planned CS, compared to VD, were 1.05 (95% CI: 0.86-1.28) and 0.94 (95% CI: 0.72-1.23), respectively. The results were similar for the associations between CS and BF%, and between induction of labour and BMI. CONCLUSION Overall, this large longitudinal study did not support an association between CS or induction of labour and overweight, obesity or BF%. It is possible that previously reported associations are due to residual or unmeasured confounding and/or underlying indications for CS delivery.
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Affiliation(s)
- Tessa O. Gorman
- School of Public Health, University College Cork, Cork, Ireland
- Department of Public Health South West, St. Finbarr’s Hospital, Cork, Ireland
| | - Gillian M. Maher
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Sukainah Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland
- Mohammed Al-Mana College for Medical Sciences, Dammam, Saudi Arabia
| | - Ali S. Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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Mashak B, Pouryaghobi SM, Hashemnejad M, Farahani M, Rahimi S, Ataee M. The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial. Ann Med Surg (Lond) 2024; 86:2708-2714. [PMID: 38694343 PMCID: PMC11060214 DOI: 10.1097/ms9.0000000000001821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/01/2024] [Indexed: 05/04/2024] Open
Abstract
Objective One of the common methods of anaesthesia for caesarean sections (CSs) involves the use of spinal anaesthesia in mothers. Various positions are utilized in this method. This study aims to compare the evaluation of two positions, Trendelenburg and reverse Trendelenburg, in candidates for CS to assess the duration of anaesthesia and changes in vital signs in women. Methods This study was a randomized clinical trial in which 60 pregnant mothers who met the inclusion criteria entered the study. These mothers were randomly allocated into two equal groups using block randomization. One group of patients received spinal anaesthesia in the Trendelenburg position, while the other group received it in the Reverse Trendelenburg position. Vital signs (systolic and diastolic blood pressure, heart rate, Apgar score, and SPO2) of participants from both groups were evaluated for 1 h after the induction of anaesthesia. Additionally, sensory level and duration of anaesthesia were measured. Finally, the data from both groups were subjected to statistical analysis using SPSS version 26 software. Results The mean (SD) age of participating mothers in the Reverse Trendelenburg and Trendelenburg groups was 28.93 (5.82) and 30.97 (4.94), respectively. The two study groups did not significantly differ in baseline characteristics such as age, BMI, which could potentially impact vital sign outcomes or anaesthesia duration, and education (P>0.05). The mean (SD) duration of anaesthesia in the Trendelenburg position was significantly higher than in the Reverse Trendelenburg position [221.57(min) vs. 159.00(min)] (P<0.0001). There was no significant difference between the two positions, Trendelenburg and Reverse Trendelenburg, in terms of sensory level and its extent (P=0.08). The two study groups did not significantly differ in hemodynamic changes measured 13 times, including heart rate, systolic and diastolic blood pressure, and Apgar score (P>0.05). Conclusion In spinal anaesthesia with the Trendelenburg position compared to the Reverse Trendelenburg position, there is a longer duration of anaesthesia. This is while the two positions did not differ in terms of hemodynamic changes and sensory level.
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Affiliation(s)
| | | | | | | | | | - Mina Ataee
- Department of Obstetrics and Gynecology, Social Determinants of Health, Research Center School of Medical Sciences, Alborz University of Medical Sciences, Karaj
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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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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4
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Yunitawati D, Latifah L, Suryaputri IY, Laksono AD. A Higher Maternal Education Level Could Be a Critical Factor in the Exceeded Cesarean Section Delivery in Indonesia. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:219-227. [PMID: 38694861 PMCID: PMC11058373 DOI: 10.18502/ijph.v53i1.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/05/2023] [Indexed: 05/04/2024]
Abstract
Background Cesarean section (CS) could be life-saving with medically indicated, but without it, both women and children could be at risk. The maximum rate for CS is 15%, but it tends to exceed globally. Objective We aimed to analyze the education level's role in the delivery of CS in Indonesia. Methods We used the 2017 Indonesia Demographic and Health Survey data. The study sampled 15,357 women who delivered in five last years. Besides delivery mode and education level, the study also used nine control variables: residence, age, marital, employment, parity, wealth, insurance, antenatal care, and birth type. The study employed a binary logistics regression. Results The results show women with secondary education (16.5% CS) are 2.174 times (AOR 2.174; 95% CI 1.095-4.316), and higher education (33% CS) are 3.241 (AOR 3.241; 95% CI 1.624-6.469) times more likely to deliver by CS than no-school education (4.4% CS). There was no significant difference between primary (9.1%) and no-education women. Apart from education, primiparous women, age 34-34 yr, attending antenatal care ≥4 times, non-poorest, having insurance, living in the city, and being unemployed also related to higher risk of CS. Conclusion Exceeded CS in Indonesia occurs mostly in higher education women. Higher education women were more likely to access more information and technology, therefore health promotion on healthy normal birth on social media or m-Health (mobile device-based health promotion) and involving health authorities at every level were suitable to reduce the overuse of the CS.
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Affiliation(s)
- Diah Yunitawati
- Public Health and Nutrition Research Center, National Research and Innovation Agency, Jakarta, Indonesia
| | - Leny Latifah
- Public Health and Nutrition Research Center, National Research and Innovation Agency, Jakarta, Indonesia
| | - Indri Yunita Suryaputri
- Public Health and Nutrition Research Center, National Research and Innovation Agency, Jakarta, Indonesia
| | - Agung Dwi Laksono
- Public Health and Nutrition Research Center, National Research and Innovation Agency, Jakarta, Indonesia
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Miyayama C, Morisaki N, Ogawa K, Tanaka H, Shoji H, Shimizu T, Sago H, Horikawa R, Urayama KY. Evaluating the association between caesarean delivery and weight status in early childhood in a Japanese birth cohort study. Sci Rep 2023; 13:19612. [PMID: 37949883 PMCID: PMC10638261 DOI: 10.1038/s41598-023-45316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
To examine whether the prevailing hypothesis of an association between caesarean section (CS) delivery method and increased weight status in early childhood is observed in Japanese. A total of 1277 mother-infant pairs from a prospective hospital-based mother-infant birth cohort that recruited women in their first trimester from May 2010 to November 2013 were included. We assessed the relationship between delivery method and weight status of delivered children at 1, 3 and 6 years of age. In total, 366 children (28.7%) were delivered by CS. Delivery by CS was not associated with body mass index (BMI) z-score (≥ 75 percentile) at age 1 year, (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.69-1.36), 3 years (OR 0.98, 95% CI 0.67-1.42), and 6 years (OR 0.71, 95% CI 0.45-1.12), and also showed no association with low weight status (< 25th percentile). Supplemental evaluations addressing the influence of preterm births, pre-pregnancy BMI, emergency CS, and modification by breastfeeding were consistent with the primary analyses. Our findings do not support the hypothesis that children born by CS are at risk of being overweight in childhood among the Japanese population.
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Affiliation(s)
- Chiharu Miyayama
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
- Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kohei Ogawa
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
- Collaborative Departments of Advanced Pediatric Medicine, Tohoku University, Miyagi, Japan
| | - Hisako Tanaka
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
- Collaborative Departments of Advanced Pediatric Medicine, Tohoku University, Miyagi, Japan
| | - Reiko Horikawa
- Department of Endocrinology, National Center for Child Health and Development, Tokyo, Japan
| | - Kevin Y Urayama
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
- Graduate School of Public Health, St. Luke's International University, 3-6-2 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
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Zhang C, Lin H, Liu L, Liu J, Li Y. Functional data analysis with covariate-dependent mean and covariance structures. Biometrics 2023; 79:2232-2245. [PMID: 36065564 DOI: 10.1111/biom.13744] [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: 07/29/2021] [Accepted: 08/11/2022] [Indexed: 11/27/2022]
Abstract
Functional data analysis has emerged as a powerful tool in response to the ever-increasing resources and efforts devoted to collecting information about response curves or anything that varies over a continuum. However, limited progress has been made with regard to linking the covariance structures of response curves to external covariates, as most functional models assume a common covariance structure. We propose a new functional regression model with covariate-dependent mean and covariance structures. Particularly, by allowing variances of random scores to be covariate-dependent, we identify eigenfunctions for each individual from the set of eigenfunctions that govern the variation patterns across all individuals, resulting in high interpretability and prediction power. We further propose a new penalized quasi-likelihood procedure that combines regularization and B-spline smoothing for model selection and estimation and establish the convergence rate and asymptotic normality of the proposed estimators. The utility of the developed method is demonstrated via simulations, as well as an analysis of the Avon Longitudinal Study of Parents and Children concerning parental effects on the growth curves of their offspring, which yields biologically interesting results.
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Affiliation(s)
- Chenlin Zhang
- Center of Statistical Research and School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Huazhen Lin
- Center of Statistical Research and School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Li Liu
- School of Mathematics and Statistics, Wuhan University, Wuhan, China
| | - Jin Liu
- Centre for Quantitative Medicine, Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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7
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Terashita S, Yoshida T, Matsumura K, Hatakeyama T, Inadera H. Caesarean section and childhood obesity at age 3 years derived from the Japan Environment and Children's Study. Sci Rep 2023; 13:6535. [PMID: 37085536 PMCID: PMC10121560 DOI: 10.1038/s41598-023-33653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
Caesarean section (CS) birth is widely reported to be a risk factor for childhood obesity. Although susceptibility to childhood obesity is influenced by race and ethnicity, it is unclear whether this risk of childhood obesity with CS birth also applies in the Japanese population. We investigated the impact of CS birth on obesity at 3 years of age in Japanese children. We obtained data from 60,769 mother-toddler pairs in the Japan Environment and Children's Study, a large-scale birth cohort study. Obesity was determined by body mass index measured at 3 years of age. Analysis revealed that 11,241 toddlers (18.5%) had a CS birth and that 4912 toddlers (8.1%) were obese. The adjusted risk ratio for obesity at 3 years of age when born by CS compared with vaginal delivery, estimated using inverse probability of treatment weighting, was 1.16 (95% confidence interval 1.08-1.25). These results suggest that CS birth modestly increases the risk of obesity at 3 years of age in Japanese children.
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Affiliation(s)
- Shintaro Terashita
- Department of Pediatrics, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, Toyama, Japan
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | | | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
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8
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Sassin AM, Johnson GJ, Goulding AN, Aagaard KM. Crucial nuances in understanding (mis)associations between the neonatal microbiome and Cesarean delivery. Trends Mol Med 2022; 28:806-822. [PMID: 36085277 PMCID: PMC9509442 DOI: 10.1016/j.molmed.2022.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 12/12/2022]
Abstract
As rates of Cesarean delivery and common non-communicable disorders (NCDs), such as obesity, metabolic disease, and atopy/asthma, have concomitantly increased in recent decades, investigators have attempted to discern a causal link. One line of research has led to a hypothesis that Cesarean birth disrupts the presumed normal process of colonization of the neonatal microbiome with vaginal microbes, yielding NCDs later in life. However, a direct link between a disrupted microbiota transfer at time of delivery and acute and/or chronic illness in infants born via Cesarean has not been causally established. Microbiota seeding from maternal vaginal or stool sources has been preliminarily evaluated as an intervention designed to compensate for the lack of (or limited) exposure to such sources among Cesarean-delivered neonates. However, to date, clinical trials have yet to show a clear health benefit with neonatal 'vaginal seeding' practices. Until the long-term effects of these microbiome alterations can be fully determined, it is paramount to conduct parallel meaningful and mechanistic-minded interrogations of the impact of clinically modifiable maternal, nutritional, or environmental exposure on the functional microbiome over the duration of pregnancy and lactation to determine their role in the mitigation of childhood and adult NCDs.
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Affiliation(s)
- Alexa M Sassin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Grace J Johnson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alison N Goulding
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kjersti M Aagaard
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX 77030, USA; Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
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9
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Cavalcante LFP, Carvalho CAD, Padilha LL, Viola PCDAF, Silva AAMD, Simões VMF. Cesarean section and body mass index in children: is there a causal effect? CAD SAUDE PUBLICA 2022; 38:e00344020. [PMID: 35442262 DOI: 10.1590/0102-311x00344020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Obesity is considered a global public health problem. Cesarean section has been associated with high body mass index (BMI) and increased obesity throughout life. However, this association has been challenged by some studies. This study aims to assess the causal effect of cesarean section on the BMI of children aged 1-3 years. This is a cohort study of 2,181 children aged 1-3 years, born in 2010, obtained from the BRISA Birth Cohort, in São Luís, state of Maranhão, Brazil. Sociodemographic variables, maternal characteristics, type of childbirth, morbidity, anthropometric measurements, and BMI were assessed. Marginal structural models with a counterfactual approach were used to check the causal effect of the type of childbirth on obesity, weighted by the inverse probability of selection and exposure. Out of the 2,181 children assessed (52% female), 50.6% were born by cesarean section, 5.9% of the newborn infants were large for gestational age, and 10.7% of them had excess weight. No causal effect of cesarean section on BMI was observed (coefficient = -0.004; 95%CI: -0.136; 0.127; p = 0.948). Cesarean section did not have a causal effect on the BMI of children aged 1-3 years.
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Affiliation(s)
| | | | - Luana Lopes Padilha
- Instituto Federal de Educação, Ciência e Tecnologia do Maranhão, São Luís, Brasil
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Zheng X, Li R, Wang L, Yang H, Li L, Cui J, Zhao W, Yang Z, Zhang Q, Xu T, Wang Y, Chen B. The association of cesarean section with overweight and neurodevelopment of Chinese children aged 1-5 months. Front Pediatr 2022; 10:940422. [PMID: 36081630 PMCID: PMC9445438 DOI: 10.3389/fped.2022.940422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this survey was to explore the association of delivery mode with overweight and neurodevelopment of Chinese infants aged 1-5 months. MATERIALS AND METHODS This study was based on a cross-sectional survey. Data for this study were obtained from the Children's Nutrition and Health System Survey in China which was conducted from 2019 to 2020. Characteristics of parents and children and the delivery mode were obtained using interview-administered questionnaires. Body mass index-for age z-score (BMI z) was calculated using World Health Organization (WHO) child growth standards. Children's neurodevelopment was assessed by a trained child health care physician using the Child Psychological Development Scale. The association of delivery mode with infant overweight was analyzed using a multivariable logistic regression model. We conducted a multivariable linear regression model to explore the relationship between delivery modes with neurodevelopment. RESULTS In total, the present analysis included 1,347 children aged 1-5 months, 35.61% were born via cesarean section, of which 15.21% were overweight. After adjustment for infant characteristics and parental factors, the cesarean section was significantly related with the likehood of being overweight [OR = 1.95; 95% confidence interval (CI): 1.27 to 2.98]. Children born via cesarean section had a 3.41-point decrease in gross motor development (β = -3.41; 95% CI: -5.77 to -1.05), a 3.65-point decrease in fine motor development (β = -3.65; 95% CI: -6.03 to -1.28), and a 2.96-point in language development (β = -2.96; 95% CI: -5.20 to -0.73), a 1.65-point in total development (β = -1.65; 95% CI: -3.17 to -0.14) compared with those who were vaginal birth. CONCLUSION In our study population, cesarean section was associated with overweight and neurodevelopment outcomes. The cesarean section might increase the likehood of infant overweight, and might decrease the developmental scores of gross motor, fine motor and language. Further studies should be conducted to verify the associations and explore the possible mechanisms.
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Affiliation(s)
- Xiaoguo Zheng
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Ruili Li
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Lihong Wang
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Huimin Yang
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Linlin Li
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Jiayin Cui
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuying Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bowen Chen
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
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11
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de Cuevillas B, Milagro FI, Tur JA, Gil-Campos M, de Miguel-Etayo P, Martínez JA, Navas-Carretero S. Fecal microbiota relationships with childhood obesity: A scoping comprehensive review. Obes Rev 2022; 23 Suppl 1:e13394. [PMID: 34913242 DOI: 10.1111/obr.13394] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022]
Abstract
Childhood obesity is a costly burden in most regions with relevant and adverse long-term health consequences in adult life. Several studies have associated excessive body weight with a specific profile of gut microbiota. Different factors related to fecal microorganism abundance seem to contribute to childhood obesity, such as gestational weight gain, perinatal diet, antibiotic administration to the mother and/or child, birth delivery, and feeding patterns, among others. This review reports and discusses diverse factors that affect the infant intestinal microbiota with putative or possible implications on the increase of the obesity childhood rates as well as microbiota shifts associated with excessive body weight in children.
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Affiliation(s)
- Begoña de Cuevillas
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology. School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Fermín I Milagro
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology. School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA, Health Research Institute of Navarra, Pamplona, Spain
| | - Josep A Tur
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands-IUNICS & IDISBA, Palma de Mallorca, Spain
| | - Mercedes Gil-Campos
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Pilar de Miguel-Etayo
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Universidad de Zaragoza. Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - J Alfredo Martínez
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology. School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA, Health Research Institute of Navarra, Pamplona, Spain.,Precision Nutrition Program, Research Institute on Food and Health Sciences IMDEA Food. CSIC-UAM, Madrid, Spain
| | - Santiago Navas-Carretero
- Center for Nutrition Research, Department of Nutrition, Food Sciences and Physiology. School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,IdiSNA, Health Research Institute of Navarra, Pamplona, Spain
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12
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Nandy D, Craig SJC, Cai J, Tian Y, Paul IM, Savage JS, Marini ME, Hohman EE, Reimherr ML, Patterson AD, Makova KD, Chiaromonte F. Metabolomic profiling of stool of two-year old children from the INSIGHT study reveals links between butyrate and child weight outcomes. Pediatr Obes 2022; 17:e12833. [PMID: 34327846 PMCID: PMC8647636 DOI: 10.1111/ijpo.12833] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Metabolomic analysis is commonly used to understand the biological underpinning of diseases such as obesity. However, our knowledge of gut metabolites related to weight outcomes in young children is currently limited. OBJECTIVES To (1) explore the relationships between metabolites and child weight outcomes, (2) determine the potential effect of covariates (e.g., child's diet, maternal health/habits during pregnancy, etc.) in the relationship between metabolites and child weight outcomes, and (3) explore the relationship between selected gut metabolites and gut microbiota abundance. METHODS Using 1 H-NMR, we quantified 30 metabolites from stool samples of 170 two-year-old children. To identify metabolites and covariates associated with children's weight outcomes (BMI [weight/height2 ], BMI z-score [BMI adjusted for age and sex], and growth index [weight/height]), we analysed the 1 H-NMR data, along with 20 covariates recorded on children and mothers, using LASSO and best subset selection regression techniques. Previously characterized microbiota community information from the same stool samples was used to determine associations between selected gut metabolites and gut microbiota. RESULTS At age 2 years, stool butyrate concentration had a significant positive association with child BMI (p-value = 3.58 × 10-4 ), BMI z-score (p-value = 3.47 × 10-4 ), and growth index (p-value = 7.73 × 10-4 ). Covariates such as maternal smoking during pregnancy are important to consider. Butyrate concentration was positively associated with the abundance of the bacterial genus Faecalibacterium (p-value = 9.61 × 10-3 ). CONCLUSIONS Stool butyrate concentration is positively associated with increased child weight outcomes and should be investigated further as a factor affecting childhood obesity.
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Affiliation(s)
- Debmalya Nandy
- Department of StatisticsPenn State UniversityUniversity ParkPAUSA,Present address:
Department of Biostatistics and Informatics, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sarah J. C. Craig
- Department of BiologyPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA
| | - Jingwei Cai
- Department of Molecular ToxicologyPenn State UniversityUniversity ParkPAUSA,Present address:
Department of Drug Metabolism and PharmacokineticsGenentech Inc.South San FranciscoCaliforniaUSA
| | - Yuan Tian
- Department of Molecular ToxicologyPenn State UniversityUniversity ParkPAUSA
| | - Ian M. Paul
- Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA,Department of PediatricsPenn State College of MedicineHersheyPAUSA
| | - Jennifer S. Savage
- Department of Nutritional SciencesPenn State UniversityUniversity ParkPAUSA,Center for Childhood Obesity ResearchPenn State UniversityUniversity ParkPAUSA
| | - Michele E. Marini
- Center for Childhood Obesity ResearchPenn State UniversityUniversity ParkPAUSA
| | - Emily E. Hohman
- Center for Childhood Obesity ResearchPenn State UniversityUniversity ParkPAUSA
| | - Matthew L. Reimherr
- Department of StatisticsPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA
| | - Andrew D. Patterson
- Department of Molecular ToxicologyPenn State UniversityUniversity ParkPAUSA,Department of Biochemistry & Molecular BiologyPenn State UniversityUniversity ParkPAUSA
| | - Kateryna D. Makova
- Department of BiologyPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA
| | - Francesca Chiaromonte
- Department of StatisticsPenn State UniversityUniversity ParkPAUSA,Center for Medical GenomicsPenn State UniversityUniversity ParkPAUSA,Institute of EconomicsEMbeDS, Sant'Anna School of Advanced StudiesPisaItaly
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13
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Li J, Gu H. Paeonol suppresses lipid formation and promotes lipid degradation in adipocytes. Exp Ther Med 2021; 23:78. [PMID: 34938364 PMCID: PMC8688932 DOI: 10.3892/etm.2021.11001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/23/2021] [Indexed: 12/14/2022] Open
Abstract
Paeonol can regulate a variety of physiological and pathological processes such as thrombosis, oxidative stress, inflammation and atherosclerosis. However, its potential role and underlying mechanisms in obesity and lipid metabolism remain to be elucidated. In the present study, 3T3-L1 cells were differentiated and collected on days 4, 6 and 8. The expression levels of fatty-acid-binding protein 4 (FABP4) and microRNA (miR)-21 were detected using reverse transcription-quantitative PCR and western blot analyses. Cell viability was assessed using a Cell Counting Kit-8 assay. A miR-21 mimic was constructed and transfected into 3T3-L1 preadipocytes. Adipocyte differentiation was detected using Oil Red O staining. The proteins CD36, glucose transporter 4, peroxisome proliferator-activated receptor γ (PPAR-γ) and adipocyte protein 2 (Ap2) were detected using western blot analysis. The expression levels of FABP4 and miR-21 were increased in differentiated 3T3-L1 cells. Paeonol exhibited no effects on cell activity, whereas it inhibited the expression levels of miR-21 in the 3T3-L1 differentiated adipocytes. Paeonol suppressed the differentiation of 3T3-L1 adipocytes and its effect was partially reversed by the overexpression of miR-21. In addition, paeonol promoted the lipid degradation of 3T3-L1 adipocytes, increased the expression levels of PPAR-γ and Ap2, and suppressed triglyceride synthesis in these cells. These effects were partially reversed by the overexpression of miR-21. In conclusion, the findings of the present study indicated that paeonol may exert protective effects against lipid formation and promote lipid degradation in adipocytes. These data provide evidence of the regulatory effect of paeonol on adipocyte differentiation and highlight its pathological significance.
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Affiliation(s)
- Ji Li
- Department of Pediatrics, Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100053, P.R. China
| | - Huan Gu
- Department of Cardiology of Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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14
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Jian C, Carpén N, Helve O, de Vos WM, Korpela K, Salonen A. Early-life gut microbiota and its connection to metabolic health in children: Perspective on ecological drivers and need for quantitative approach. EBioMedicine 2021; 69:103475. [PMID: 34256346 PMCID: PMC8324810 DOI: 10.1016/j.ebiom.2021.103475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022] Open
Abstract
The colonisation and development of the gut microbiota has been implicated in paediatric metabolic disorders via its powerful effect on host metabolic and immune homeostasis. Here we summarise the evidence from human studies on the early gut microbiota and paediatric overweight and obesity. Manipulation of the early gut microbiota may represent a promising target for countering the burgeoning metabolic disorders in the paediatric population, provided the assembly patterns of microbiota and their health consequences can be decoded. Therefore, in this review, we pay particular attention to the important ecological drivers affecting the community dynamics of the early gut microbiota. We then discuss the knowledge gaps in commonly studied exposures linking the gut microbiota to metabolic disorders, especially regarding maternal factors and antibiotic use. This review also attempts to give directions for future studies aiming to identify predictive and corrective measures for paediatric metabolic disorders based on the gut microbiota. Gut microbiota; Metabolism; Paediatric overweight and obesity; Ecological driver; Dynamics; Infants.
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Affiliation(s)
- Ching Jian
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Noora Carpén
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Otto Helve
- Children's Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Department of Health Security, Helsinki, Finland
| | - Willem M de Vos
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Laboratory of Microbiology, Wageningen University & Research, Wageningen, Netherlands
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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15
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Oral administration of maternal vaginal microbes at birth to restore gut microbiome development in infants born by caesarean section: A pilot randomised placebo-controlled trial. EBioMedicine 2021; 69:103443. [PMID: 34186487 PMCID: PMC8254083 DOI: 10.1016/j.ebiom.2021.103443] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background Birth by caesarean section (CS) is associated with aberrant gut microbiome development and greater disease susceptibility later in life. We investigated whether oral administration of maternal vaginal microbiota to infants born by CS could restore their gut microbiome development in a pilot single-blinded, randomised placebo-controlled trial (Australian New Zealand Clinical Trials Registry, ACTRN12618000339257). Methods Pregnant women scheduled for a CS underwent comprehensive antenatal pathogen screening. At birth, healthy neonates were randomised to receive a 3 ml solution of either maternal vaginal microbes (CS-seeded, n = 12) or sterile water (CS-placebo, n = 13). Vaginally-born neonates were used as the reference control (VB, n = 22). Clinical assessments occurred within the first 2 h of birth, and at 1 month and 3 months of age. Infant stool samples and maternal vaginal extracts from CS women underwent shotgun metagenomic sequencing. The primary outcome was gut microbiome composition at 1 month of age. Secondary outcomes included maternal strain engraftment, functional potential of the gut microbiome, anthropometry, body composition, and adverse events. Findings Despite the presence of viable microbial cells within transplant solutions, there were no observed differences in gut microbiome composition or functional potential between CS-seeded and CS-placebo infants at 1 month or 3 months of age. Both CS groups displayed the characteristic signature of low Bacteroides abundance, which contributed to a number of biosynthesis pathways being underrepresented when compared with VB microbiomes. Maternal vaginal strain engraftment was rare. Vaginal seeding had no observed effects on anthropometry or body composition. There were no serious adverse events associated with treatment. Interpretation Our pilot findings question the value of vaginal seeding given that oral administration of maternal vaginal microbiota did not alter early gut microbiome development in CS-born infants. The limited colonisation of maternal vaginal strains suggest that other maternal sources, such as the perianal area, may play a larger role in seeding the neonatal gut microbiome. Funding Health Research Council of New Zealand, A Better Start – National Science Challenge.
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16
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Rerkasem A, Maessen SE, Wongthanee A, Pruenglampoo S, Mangklabruks A, Sripan P, Derraik JGB, Rerkasem K. Caesarean delivery is associated with increased blood pressure in young adult offspring. Sci Rep 2021; 11:10201. [PMID: 33986334 PMCID: PMC8119414 DOI: 10.1038/s41598-021-89438-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
We examined the associations between caesarean section (CS) delivery and cardiovascular risk factors in young adults in Thailand. Participants were 632 offspring from a birth cohort in Chiang Mai (Northern Thailand), born in 1989–1990 and assessed in 2010 at a mean age of 20.6 years, including 57 individuals (9.0%) born by CS and 575 born vaginally. Clinical assessments included anthropometry, blood pressure (BP), carotid intima-media thickness, and fasting blood glucose, insulin, and lipid profile. Young adults born by CS had systolic BP (SBP) 6.2 mmHg higher (p < 0.001), diastolic BP 3.2 mmHg higher (p = 0.029), and mean arterial pressure (MAP) 4.1 mmHg higher (p = 0.003) than those born vaginally. After covariate adjustments, SBP and MAP remained 4.1 mmHg (p = 0.006) and 2.9 mmHg (p = 0.021) higher, respectively, in the CS group. The prevalence of abnormal SBP (i.e., pre-hypertension or hypertension) in the CS group was 2.5 times that of those born vaginally (25.0% vs 10.3%; p = 0.003), with an adjusted relative risk of abnormal SBP 1.9 times higher (95% CI 1.15, 2.98; p = 0.011). There were no differences in anthropometry (including obesity risk) or other metabolic parameters. In this birth cohort in Thailand, CS delivery was associated with increased blood pressure in young adulthood.
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Affiliation(s)
- Amaraporn Rerkasem
- NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sarah E Maessen
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Antika Wongthanee
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakda Pruenglampoo
- NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Ampica Mangklabruks
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - José G B Derraik
- NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. .,Liggins Institute, University of Auckland, Auckland, New Zealand. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Kittipan Rerkasem
- NCD Center of Excellence, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. .,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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17
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Aljassim H, Jradi H. Childhood overweight and obesity among the Saudi population: a case-control study among school children. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:15. [PMID: 33827702 PMCID: PMC8025524 DOI: 10.1186/s41043-021-00242-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Childhood obesity is a global public health concern with major consequences. In Saudi Arabia, the percentage of children who are overweight or obese has significantly increased in the past two decades, raising concerns about the physical and psychosocial consequences of this burden. This study aimed at investigating the different risk factors contributing to childhood obesity in Saudi Arabia. METHODS A case-control study was conducted among 492 school children (246 overweight/obese children, and 246 normal weight control children aged 5-9 years). Using valid and reliable instruments, parental and child characteristics, behavioral practices, screen use, and other activities were assessed as risk factors for childhood obesity using logistic regression analysis. RESULTS An unemployed father (OR=11.90; 95% CI: 7.47-18.93), a father with overweight/obesity (OR=2.04; 95% CI: 1.40-2.96), an incorrect parental perception of child's weight status (OR=2.54; 95% CI: 1.75-3.68), cesarean delivery (OR=2.52; 95% CI: 1.56-4.09), daily time in active play for less than 30 min (OR=2.18; 95% CI: 1.44-3.28), frequent snacking (OR=1.74; 95% CI: 1.05-2.93), and screen time use for more than 2 h per day outside of school (OR=1.62; 95% CI: 1.12-2.34) were all independent risk factors for being overweight or obese among the selected cases. CONCLUSION Efforts to prevent childhood overweight and obesity in this population should focus primarily on the early identification and confrontation of risk factors. Such risk factors include parental characteristics and awareness of the magnitude of the burden obesity poses, behavioral practices such as frequent snacking, screen time use, and physical activity.
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Affiliation(s)
- Hanan Aljassim
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Prince Sultan Military Medical City, Health Education Administration, Riyadh, Saudi Arabia
| | - Hoda Jradi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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18
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Kenkel W. Birth signalling hormones and the developmental consequences of caesarean delivery. J Neuroendocrinol 2021; 33:e12912. [PMID: 33145818 PMCID: PMC10590550 DOI: 10.1111/jne.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
Rates of delivery by caesarean section (CS) are increasing around the globe and, although several epidemiological associations have already been observed between CS and health outcomes in later life, more are sure to be discovered as this practice continues to gain popularity. The components of vaginal delivery that protect offspring from the negative consequences of CS delivery in later life are currently unknown, although much attention to date has focused on differences in microbial colonisation. Here, we present the case that differing hormonal experiences at birth may also contribute to the neurodevelopmental consequences of CS delivery. Levels of each of the 'birth signalling hormones' (oxytocin, arginine vasopressin, epinephrine, norepinephrine and the glucocorticoids) are lower following CS compared to vaginal delivery, and there is substantial evidence for each that manipulations in early life results in long-term neurodevelopmental consequences. We draw from the research traditions of neuroendocrinology and developmental psychobiology to suggest that the perinatal period is a sensitive period, during which hormones achieve organisational effects. Furthermore, there is much to be learned from research on developmental programming by early-life stress that may inform research on CS, as a result of shared neuroendocrine mechanisms at work. We compare and contrast the effects of early-life stress with those of CS delivery and propose new avenues of research based on the links between the two bodies of literature. The research conducted to date suggests that the differences in hormone signalling seen in CS neonates may produce long-term neurodevelopmental consequences.
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Affiliation(s)
- William Kenkel
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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19
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Delivery mode and altered infant growth at 1 year of life in India. Pediatr Res 2021; 90:1251-1257. [PMID: 33654288 PMCID: PMC8671090 DOI: 10.1038/s41390-021-01417-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cesarean section (C-section) delivered infants are more likely to be colonized by opportunistic pathogens, resulting in altered growth. We examined whether C-section (elective/emergency) vs vaginal delivery was associated with altered weight and linear growth at 1 year of life. METHODS A total of 638 mother-infant pairs were included from MAASTHI cohort 2016-2019. Information on delivery mode was obtained from medical records. Based on WHO child growth standards, body mass index-forage z-score (BMI z) and length-for-age z-score (length z) were derived. We ran multivariable linear and Poisson regression models before and after multiple imputation. RESULTS The rate of C-section was 43.4% (26.5%: emergency, 16.9%: elective). Percentage of infant overweight was 14.9%. Compared to vaginal delivery, elective C-section was associated with β = 0.57 (95% CI 0.20, 0.95) higher BMI z. Also infants born by elective C-section had RR = 2.44 (95% CI 1.35, 4.41) higher risk of being overweight; no such association was found for emergency C-section. Also, elective C-section delivery was associated with reduced linear growth at 1 year after multiple imputation (β = -0.38, 95% CI -0.76, -0.01). CONCLUSIONS Elective C-section delivery might contribute to excess weight and also possibly reduced linear growth at 1 year of age in children from low- and middle-income countries. IMPACT Our study, in a low-income setting, suggests that elective, but not emergency, C-section is associated with excess infant BMI z at 1 year of age and elective C (C-section) was also associated with altered linear growth but only in multiple imputation analyses. Elective C-section was associated with a higher risk of being overweight at 1 year of age. Our results indicate that decreasing medically unnecessary elective C-section deliveries may help limit excess weight gain and stunted linear growth among infants.
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20
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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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21
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Baldassarre ME, Di Mauro A, Caroli M, Schettini F, Rizzo V, Panza R, De Giorgi A, Capozza M, Fanelli M, Laforgia N. Premature Birth is an Independent Risk Factor for Early Adiposity Rebound: Longitudinal Analysis of BMI Data from Birth to 7 Years. Nutrients 2020; 12:nu12123654. [PMID: 33261215 PMCID: PMC7760942 DOI: 10.3390/nu12123654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Adiposity rebound (AR) refers to the second rise of the body mass index (BMI) curve that usually occurs physiologically between five and seven years of age. AR timing has a great impact on patients’ health, since early adiposity rebound (EAR) is associated with the development of metabolic syndrome later in life. We aimed to investigate the prevalence of EAR in a cohort of inborn preterm infants admitted to the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Secondarily, we assessed whether some determinants such as (1) gender; (2) delivery mode; (3) birth weight and classification into small, normal, or large for gestational age; (4) type of feeding; (5) breastfeeding duration; (6) timing of introduction of solid food; (7) parental education; and (8) parental pre-pregnancy body mass index (BMI) influenced EAR in this cohort. The tertiary aim was to evaluate the prevalence of obesity or being overweight at seven years of age in children according to early versus timely AR. This is a prospective, population-based longitudinal study conducted at the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Inborn preterm infants admitted to the neonatal ward between 2009 and 2011 were eligible. Enrolled preterm infants were evaluated at birth and at 1, 3, 6, 9, 12, 15, 18, and 24 months and 3, 4, 5, 6, and 7 years of age. Weight and height data were analyzed, and BMI was calculated. AR was assessed in the growth trajectory in a body mass index (BMI) plot. Of the 250 preterm newborns included, 100 completed the seven-year follow-up and entered the final analysis, 138 were lost during the seven-year follow-up, and in 12 cases parents withdrew over the course of the study. The prevalence of EAR in our cohort of preterm newborns was 54% at seven years of age. Early adiposity rebound was associated with being large for gestational age (LGA) at birth. No other factors were associated with EAR. Early adiposity rebounders had a significantly higher BMI at seven years compared to children with timely AR (17.2 ± 2.7 vs. 15.6 ± 2.05, p = 0.021). No significant differences were found in the prevalence of obesity or being overweight at seven years of age in children with early or timely AR (29% vs. 14%, p = 0.202). Ex-preterm infants have an increased risk of EAR. Since EAR may lead to long-term detrimental health effects with the onset of various chronic diseases (e.g., obesity, metabolic syndrome, etc.), healthcare providers should be prepared to counteract its occurrence, especially in delicate sub-populations of infants.
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Affiliation(s)
- Maria Elisabetta Baldassarre
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
- Correspondence:
| | - Antonio Di Mauro
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
| | | | - Federico Schettini
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
| | - Valentina Rizzo
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
| | - Raffaella Panza
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
| | - Alessia De Giorgi
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
| | - Manuela Capozza
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
| | - Margherita Fanelli
- Department of Interdisciplinary Medicine, “Aldo Moro” University of Bari, 70100 Bari, Italy;
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, 70100 Bari, Italy; (A.D.M.); (F.S.); (V.R.); (R.P.); (A.D.G.); (M.C.); (N.L.)
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22
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Słabuszewska-Jóźwiak A, Szymański JK, Ciebiera M, Sarecka-Hujar B, Jakiel G. Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8031. [PMID: 33142727 PMCID: PMC7662709 DOI: 10.3390/ijerph17218031] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cesarean section is a surgical procedure, which is the most frequently performed in gynecology and obstetrics. It is commonly believed that an operative delivery is a less painful and safer mode of delivery, which translates into an increasing number of the procedures performed without medical indications. The maternal sequelae of cesarean sections are well elucidated and widely discussed in the literature, while long-term neonatal consequences still remain the issue of research and scientific dispute. The aim of the present paper was to perform a systematic review of current literature regarding pediatrics consequences of cesarean section. METHODS We reviewed available data from PubMed, Science Direct as well as Google Scholar bases concerning early and long-term neonatal sequelae of operative deliveries. The following key words were used: "cesarean section", "caesarean section", "neonatal outcomes", "respiratory disorders", "asthma", "obesity", "overweight", and "neurological disorders". A total of 1636 papers were retrieved out of which 27 were selected for the final systematic review whereas 16 articles provided data for meta-analysis. Statistical analyses were performed using RevMan 5.4. To determine the strength of association between the caesarean section and respiratory tract infections, asthma, diabetes type 1 as well as obesity the pooled odds ratios (OR) with the 95% confidence intervals (CI) were calculated. RESULTS Conducted meta-analyses revealed that caesarean section is a risk factor for respiratory tract infections (pooled OR = 1.30 95%CI 1.06-1.60, p = 0.001), asthma (pooled OR = 1.23 95%CI 1.14-1.33, p < 0.00001) as well as obesity (pooled OR = 1.35 95%CI 1.29-1.41, p < 0.00001) in offspring. CONCLUSIONS The results of the studies included indicated that children delivered by cesarean section more commonly developed respiratory tract infections, obesity and the manifestations of asthma than children delivered vaginally. The risk of developing diabetes mellitus type 1 or neurological disorders in offspring after caesarean section is still under discussion.
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Affiliation(s)
- Aneta Słabuszewska-Jóźwiak
- First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Żelazna 90 Street, 01-004 Warsaw, Poland; (J.K.S.); (G.J.)
| | - Jacek Krzysztof Szymański
- First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Żelazna 90 Street, 01-004 Warsaw, Poland; (J.K.S.); (G.J.)
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Cegłowska 80 Street, 01-809 Warsaw, Poland;
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa 3 Street, 41-200 Sosnowiec, Poland;
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynaecology, Centre of Postgraduate Medical Education, Żelazna 90 Street, 01-004 Warsaw, Poland; (J.K.S.); (G.J.)
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23
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Ekstrom LD, Ahlqvist VH, Persson M, Magnusson C, Berglind D. The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males. Sci Rep 2020; 10:18661. [PMID: 33122786 PMCID: PMC7596509 DOI: 10.1038/s41598-020-75775-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/19/2020] [Indexed: 01/13/2023] Open
Abstract
Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. Swedish males born by cesarean section achieved lower mean Watt-maximum (− 2.32 W, 95%C.I. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. In the sub-population, males born 1982–1987, there was a greater negative association of elective cesarean section with cardiorespiratory fitness (− 4.42 W, 95%C.I. − 6.27 to − 2.57, p < 0.001) than non-elective cesarean sections (− 1.96 W, 95%C.I. − 3.77 to − 0.16, p = 0.033) as compared to vaginal births. No associations between modes of cesarean delivery and cardiorespiratory fitness levels persisted in the within-family analyses where biological male siblings were compared whilst controlling for factors shared within families. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally. These findings appear to be largely explained by factors of familial confounding.
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Affiliation(s)
- Lucas D Ekstrom
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | | | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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24
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Butler ÉM, Chiavaroli V, Derraik JG, Grigg CP, Wilson BC, Walker N, O'Sullivan JM, Cutfield WS. Maternal bacteria to correct abnormal gut microbiota in babies born by C-section. Medicine (Baltimore) 2020; 99:e21315. [PMID: 32791721 PMCID: PMC7387037 DOI: 10.1097/md.0000000000021315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION There is evidence that caesarean section (CS) is associated with increased risk of childhood obesity, asthma, and coeliac disease. The gut microbiota of CS-born babies differs to those born vaginally, possibly due to reduced exposure to maternal vaginal bacteria during birth. Vaginal seeding is a currently unproven practice intended to reduce such differences, so that the gut microbiota of CS-born babies is similar to that of babies born vaginally. Our pilot study, which uses oral administration as a novel form of vaginal seeding, will assess the degree of maternal strain transfer and overall efficacy of the procedure for establishing normal gut microbiota development. METHODS AND ANALYSIS Protocol for a single-blinded, randomized, placebo-controlled pilot study of a previously untested method of vaginal seeding (oral administration) in 30 CS-born babies. A sample of maternal vaginal bacteria is obtained prior to CS, and mixed with 5 ml sterile water to obtain a supernatant. Healthy babies are randomized at 1:1 to receive active treatment (3 ml supernatant) or placebo (3 ml sterile water). A reference group of 15 non-randomized vaginal-born babies are also being recruited. Babies' stool samples will undergo whole metagenomic shotgun sequencing to identify potential differences in community structure between CS babies receiving active treatment compared to those receiving placebo at age 1 month (primary outcome). Secondary outcomes include differences in overall gut community between CS groups (24 hours, 3 months); similarity of CS-seeded and placebo gut profiles to vaginally-born babies (24 hours, 1 and 3 months); degree of maternal vaginal strain transfer in CS-born babies (24 hours, 1 and 3 months); anthropometry (1 and 3 months) and body composition (3 months). ETHICS AND DISSEMINATION Ethics approval by the Northern A Health and Disability Ethics Committee (18/NTA/49). Results will be published in peer-reviewed journals and presented at international conferences. REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12618000339257).
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Affiliation(s)
- Éadaoin M. Butler
- A Better Start – National Science Challenge
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Valentina Chiavaroli
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Neonatal Intensive Care Unit, Pescara Public Hospital, Pescara, Italy
| | - José G.B. Derraik
- A Better Start – National Science Challenge
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Celia P. Grigg
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Brooke C. Wilson
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Nicholas Walker
- Department of Obstetrics and Gynaecology, Auckland City Hospital, Auckland District Health Board, New Zealand
| | | | - Wayne S. Cutfield
- A Better Start – National Science Challenge
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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25
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Saaka M, Hammond AY. Caesarean Section Delivery and Risk of Poor Childhood Growth. J Nutr Metab 2020; 2020:6432754. [PMID: 32399289 PMCID: PMC7211263 DOI: 10.1155/2020/6432754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/10/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Though emerging evidence indicates caesarean section (CS) brings about late initiation of breastfeeding, early cessation of breastfeeding, and a higher risk of developing obesity, little is documented on the association between CS birth and stunted growth. This study assessed caesarean section delivery and the risk of poor postnatal childhood growth. METHODS A retrospective cohort study design was used to collect the requisite data on a sample of 528 mothers having children between the ages of 6 to 24 months. An interviewer-administered questionnaire was used to collect the data. RESULTS After controlling for potential confounding factors, linear growth as measured by height-for-age Z-score (HAZ) was significantly higher by 0.121 standard units in children born through normal vaginal delivery, compared to their counterparts born through caesarean section (beta coefficients (β) = 0.121, p=0.002). The mode of delivery also had a statistically significant impact on infant feeding practices. Whereas 70.4% of babies delivered via vagina initiated breastfeeding within one hour of delivery, only 52.7% of babies born through CS did the same. Vaginally delivered babies were 2.1 times more likely to initiate breastfeeding within one hour of delivery ((Crude odds ratio (COR) = 2.13, p < 0.001). Compared to CS babies, vaginally delivered babies were 3.2 times more likely not to have been fed with prelacteal feeds such as water and sugar solutions. Vagina delivered babies were 1.8 times more likely to receive adequate neonatal feeding than their counterparts who were delivered through CS (COR = 1.76, p=0.003). CONCLUSIONS This study has found an association between CS delivery and stunting, an adverse outcome that clinicians and patients should weigh when considering in particular elective CS that seeks to avoid the pain associated with a vaginal birth.
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Affiliation(s)
- Mahama Saaka
- University for Development Studies, School of Allied Health Sciences, P.O. Box TL 1883, Tamale, Ghana
| | - Addae Yaw Hammond
- University for Development Studies, School of Allied Health Sciences, P.O. Box TL 1883, Tamale, Ghana
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26
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Raspini B, Porri D, De Giuseppe R, Chieppa M, Liso M, Cerbo RM, Civardi E, Garofoli F, Monti MC, Vacca M, De Angelis M, Cena H. Prenatal and postnatal determinants in shaping offspring's microbiome in the first 1000 days: study protocol and preliminary results at one month of life. Ital J Pediatr 2020; 46:45. [PMID: 32293504 PMCID: PMC7158098 DOI: 10.1186/s13052-020-0794-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fetal programming during in utero life defines the set point of physiological and metabolic responses that lead into adulthood; events happening in "the first 1,000 days" (from conception to 2-years of age), play a role in the development of non-communicable diseases (NCDs). The infant gut microbiome is a highly dynamic organ, which is sensitive to maternal and environmental factors and is one of the elements driving intergenerational NCDs' transmission. The A.MA.MI (Alimentazione MAmma e bambino nei primi MIlle giorni) project aims at investigating the correlation between several factors, from conception to the first year of life, and infant gut microbiome composition. We described the study design of the A.MA.MI study and presented some preliminary results. METHODS A.MA.MI is a longitudinal, prospective, observational study conducted on a group of mother-infant pairs (n = 60) attending the Neonatal Unit, Fondazione IRCCS Policlinico San Matteo, Pavia (Italy). The study was planned to provide data collected at T0, T1, T2 and T3, respectively before discharge, 1,6 and 12 months after birth. Maternal and infant anthropometric measurements were assessed at each time. Other variables evaluated were: pre-pregnancy/gestational weight status (T0), maternal dietary habits/physical activity (T1-T3); infant medical history, type of feeding, antibiotics/probiotics/supplements use, environment exposures (e.g cigarette smoking, pets, environmental temperature) (T1-T3). Infant stool samples were planned to be collected at each time and analyzed using metagenomics 16S ribosomal RNA gene sequence-based methods. RESULTS Birth mode (cesarean section vs. vaginal delivery) and maternal pre pregnancy BMI (BMI < 25 Kg/m2 vs. BMI ≥ 25 Kg/m2), significant differences were found at genera and species levels (T0). Concerning type of feeding (breastfed vs. formula-fed), gut microbiota composition differed significantly at genus and species level (T1). CONCLUSION These preliminary and explorative results confirmed that pre-pregnancy, mode of delivery and infant factors likely impact infant microbiota composition at different levels. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04122612.
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Affiliation(s)
- Benedetta Raspini
- Dietetics and Clinical Nutrition Laboratory - Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, 27100, Pavia, Italy.
| | - Debora Porri
- Dietetics and Clinical Nutrition Laboratory - Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Rachele De Giuseppe
- Dietetics and Clinical Nutrition Laboratory - Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, 27100, Pavia, Italy
| | - Marcello Chieppa
- National Institute of Gastroenterology "S. de Bellis", Institute of Research, Castellana, 70013, Grotte, BA, Italy.,European Biomedical Research Institute of Salerno EBRIS, 84125, Salerno, Italy
| | - Marina Liso
- National Institute of Gastroenterology "S. de Bellis", Institute of Research, Castellana, 70013, Grotte, BA, Italy
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Civardi
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Garofoli
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine - Unit of Biostatistics and Clinical Epidemiology, University of Pavia, 27100, Pavia, Italy
| | - Mirco Vacca
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, Bari, Italy
| | - Maria De Angelis
- Department of Soil, Plant and Food Science, University of Bari Aldo Moro, Bari, Italy
| | - Hellas Cena
- Dietetics and Clinical Nutrition Laboratory - Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Bassi 21, 27100, Pavia, Italy.,Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy
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27
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Maher GM, O’Keeffe GW, O’Keeffe LM, Matvienko-Sikar K, Dalman C, Kearney PM, McCarthy FP, Khashan AS. The Association Between Preeclampsia and Childhood Development and Behavioural Outcomes. Matern Child Health J 2020; 24:727-738. [DOI: 10.1007/s10995-020-02921-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Panda BK, Nayak I, Mishra US. Determinant of inequality in cesarean delivery in India: A decomposition analysis. Health Care Women Int 2020; 41:817-832. [PMID: 31928373 DOI: 10.1080/07399332.2020.1711757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In India, Cesarean Section (CS) rate had got doubled in the last decade, with widespread diversity across the population subgroup. Hence, this study examined the pattern, inequality and driving correlates of CS in India. The attributes that shape the inequality in CS were private health facility, followed by the richest economic status, southern region, highest education level. A substantial rise in CS in private sectors and richer section raises the apprehension as to whether commercial motive of private providers contributes to the undue rise in CS that need not necessarily be genuine.
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Affiliation(s)
- Basant Kumar Panda
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Itishree Nayak
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Udaya S Mishra
- Centre for Development Studies, Trivandrum, Kerala, India
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29
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Ahlqvist VH, Persson M, Magnusson C, Berglind D. Elective and nonelective cesarean section and obesity among young adult male offspring: A Swedish population-based cohort study. PLoS Med 2019; 16:e1002996. [PMID: 31809506 PMCID: PMC6897402 DOI: 10.1371/journal.pmed.1002996] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous studies have suggested that cesarean section (CS) is associated with offspring overweight and obesity. However, few studies have been able to differentiate between elective and nonelective CS, which may differ in their maternal risk profile and biological pathway. Therefore, we aimed to examine the association between differentiated forms of delivery with CS and risk of obesity in young adulthood. METHODS AND FINDINGS Using Swedish population registers, a cohort of 97,291 males born between 1982 and 1987 were followed from birth until conscription (median 18 years of age) if they conscripted before 2006. At conscription, weight and height were measured and transformed to World Health Organization categories of body mass index (BMI). Maternal and infant data were obtained from the Medical Birth Register. Associations were evaluated using multinomial and linear regressions. Furthermore, a series of sensitivity analyses were conducted, including fixed-effects regressions to account for confounders shared between full brothers. The mothers of the conscripts were on average 28.5 (standard deviation 4.9) years old at delivery and had a prepregnancy BMI of 21.9 (standard deviation 3.0), and 41.5% of the conscripts had at least one parent with university-level education. Out of the 97,291 conscripts we observed, 4.9% were obese (BMI ≥ 30) at conscription. The prevalence of obesity varied slightly between vaginal delivery, elective CS, and nonelective CS (4.9%, 5.5%, and 5.6%, respectively), whereas BMI seemed to be consistent across modes of delivery. We found no evidence of an association between nonelective or elective CS and young adulthood obesity (relative risk ratio 0.96, confidence interval 95% 0.83-1.10, p = 0.532 and relative risk ratio 1.02, confidence interval 95% 0.88-1.18, p = 0.826, respectively) as compared with vaginal delivery after accounting for prepregnancy maternal BMI, maternal diabetes at delivery, maternal hypertension at delivery, maternal smoking, parity, parental education, maternal age at delivery, gestational age, birth weight standardized according to gestational age, and preeclampsia. We found no evidence of an association between any form of CS and overweight (BMI ≥ 25) as compared with vaginal delivery. Sibling analysis and several sensitivity analyses did not alter our findings. The main limitations of our study were that not all conscripts had available measures of anthropometry and/or important confounders (42% retained) and that our cohort only included a male population. CONCLUSIONS We found no evidence of an association between elective or nonelective CS and young adulthood obesity in young male conscripts when accounting for maternal and prenatal factors. This suggests that there is no clinically relevant association between CS and the development of obesity. Further large-scale studies are warranted to examine the association between differentiated forms of CS and obesity in young adult offspring. TRIAL REGISTRATION Registered as observational study at ClinicalTrials.gov Identifier: NCT03918044.
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Affiliation(s)
- Viktor H. Ahlqvist
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Cecilia Magnusson
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Daniel Berglind
- Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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30
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Masukume G, Khashan AS, Morton SMB, Baker PN, Kenny LC, McCarthy FP. Caesarean section delivery and childhood obesity in a British longitudinal cohort study. PLoS One 2019; 14:e0223856. [PMID: 31665164 PMCID: PMC6821069 DOI: 10.1371/journal.pone.0223856] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background Several 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). Methods Mother-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. Results Of 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. Conclusions Infants 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.
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Affiliation(s)
- Gwinyai Masukume
- INFANT Research Centre, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S. Khashan
- INFANT Research Centre, Cork, Ireland
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Susan M. B. Morton
- Centre for Longitudinal Research–He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Philip N. Baker
- College of Life Sciences, University of Leicester, Leicester, England, United Kingdom
| | - Louise C. Kenny
- Department of Women’s and Children’s Health, Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England, United Kingdom
| | - Fergus P. McCarthy
- INFANT Research Centre, Cork, Ireland
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, England, United Kingdom
- * E-mail:
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Masukume G, McCarthy FP, Russell J, Baker PN, Kenny LC, Morton SMB, Khashan AS. Caesarean section delivery and childhood obesity: evidence from the growing up in New Zealand cohort. J Epidemiol Community Health 2019; 73:1063-1070. [DOI: 10.1136/jech-2019-212591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/06/2019] [Accepted: 09/20/2019] [Indexed: 11/04/2022]
Abstract
BackgroundEpidemiological studies have reported conflicting results in the association between Caesarean section (CS) birth and childhood obesity. Many of these studies had small sample sizes, were unable to distinguish between elective/planned and emergency CS, and did not adjust for the key confounder maternal pre-pregnancy body mass index (BMI). We investigated the association between CS delivery, particularly elective/planned and childhood obesity, using the Growing Up in New Zealand prospective longitudinal cohort study.MethodsPregnant women planning to deliver their babies on the New Zealand upper North Island were invited to participate. Mode of delivery was categorised into spontaneous vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS. The main outcome was childhood obesity defined according to the International Obesity Taskforce criteria at age 24 and 54 months. Multinomial logistic regression and mixed-effects linear regression models were fitted with associations adjusted for several potential confounders.ResultsOf the 6599 infants, 1532 (23.2%) were delivered by CS. At age 24 months, 478 (9.3%) children were obese. There was a statistically significant association between planned CS adjusted relative risk ratio (aRRR=1.59; (95% CI 1.09 to 2.33)) and obesity but not for emergency CS (aRRR=1.27; (95% CI 0.89 to 1.82)). At age 54 months there was no association between planned CS (aRRR=0.89; (95% CI 0.54 to 1.45)) and obesity as well as for emergency CS (aRRR=1.19; (95% CI 0.80 to 1.77)). At all-time points those born by planned CS had a higher mean BMI (adjusted mean difference=0.16; (95% CI 0.00 to 0.31), p=0.046).ConclusionsPlanned CS was an independent predictor of obesity in early childhood. This suggests that birth mode influences growth, at least in the short term. This association occurred during a critical phase of human development, the first 2 years of life, and if causal might result in long-term detrimental cardiometabolic changes.
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