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Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: A call to action. Health Sci Rep 2023; 6:e1274. [PMID: 37216058 PMCID: PMC10196217 DOI: 10.1002/hsr2.1274] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Over the years; global caesarian section (CS) rates have significantly increased from around 7% in 1990 to 21% today surpassing the ideal acceptable CS rate which is around 10%-15% according to the WHO. However, currently, not all CS are done for medical reasons with rapidly increasing rate of nonmedically indicated CS and the so-called "caesarian on maternal request." These trends are projected to continue increasing over this current decade where both unmet needs and overuse are expected to coexist with the projected global rate of 29% by 2030. CS reduces both maternal and neonatal morbidity and mortality significantly when it is done under proper indications while at the same time, it can be of harm to the mother and the child when performed contrary. The later exposes both the mother and the baby to a number of unnecessary short and long-term complications and increase the chances of developing different noncommunicable diseases and immune-related conditions among babies later in life. The implications of lowering SC rate will ultimately lower healthcare expenditures. This challenge can be addressed by several ways including provision of intensive public health education regarding public health implications of increased CS rate. Assisted vaginal delivery approaches like the use of vacuum and forceps and other methods should be considered and encouraged during delivery as long as their indications for implementation are met. Conducting frequent external review and audits to the health facilities and providing feedback regarding the rates of CS deliveries can help to keep in check the rising CS trends as well as identifying the settings with unmet surgical needs. Moreover, the public especially expectant mothers during clinic visits and clinicians should be educated and be informed on the WHO recommendations on nonclinical interventions towards reduction of unnecessary CS procedures.
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Affiliation(s)
- Cornel M. Angolile
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Medicine, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Obstetrics and GynaecologyKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Baraka L. Max
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Justice Mushemba
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Medicine, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Obstetrics and GynaecologyKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Harold L. Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Medicine, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Obstetrics and GynaecologyKilimanjaro Christian Medical University CollegeMoshiTanzania
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Flatt S, Velez MP. The cost of preterm birth and cesarean section as a result of infertility and its treatment: A review. Best Pract Res Clin Obstet Gynaecol 2023; 86:102304. [PMID: 36681599 DOI: 10.1016/j.bpobgyn.2022.102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
Infertility, irrespective of receipt of fertility treatment, is associated with an increased risk of adverse pregnancy outcomes, including cesarean section (CS) and preterm birth (PTB). These complications are associated with significant physical, mental, emotional, social, and financial costs to individuals, healthcare systems, and society at large. Although multiple pregnancy is one of the most significant contributors to the elevated CS and PTB rates in women receiving fertility treatment, singleton pregnancy is also at an increased risk of these outcomes. Single embryo transfer policies through publicly funded in vitro fertilization programs have demonstrated beneficial health outcomes and cost savings. Low-dose aspirin prophylaxis may be considered for PTB reduction in patients with infertility. Finally, upstream prevention strategies such as lifestyle modification and social policies to address the underlying needs for fertility treatment may also beneficially impact both CS and PTB rates.
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Affiliation(s)
- Sydney Flatt
- Queen's University, School of Medicine, Kingston, K7L 3L4, Canada
| | - Maria P Velez
- Queen's University, Obstetrics and Gynecology, Kingston, K7L 2V7, Canada.
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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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Videira-Silva A, Manco L, Sardinha LB, Fonseca H. Vigorous physical activity: a potential ally in adolescent obesity management. Eur J Sport Sci 2022; 23:607-616. [PMID: 35084276 DOI: 10.1080/17461391.2022.2035437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Individual variability may contribute to the modest and inconsistent results reported in obesity-management interventions. This study aimed to investigate the impact of non-modifiable as well as modifiable factors on body mass index (BMI) and body fat variance in adolescents with obesity followed in a clinical obesity-management program, in order to better understand individual variability. Non-modifiable factors (i.e., socio-economic status, pregnancy BMI, weight progression across pregnancy, BMI at time of delivery, way of delivery, birth weight, breastfeeding duration, age at overweight onset, overweight duration, and FTO rs9939609 polymorphism) and modifiable factors data (i.e., self-determination level, self-efficacy and perception of importance to lose weight, energy intake, physical activity, and sedentary behaviors) from 63 adolescents (93.7% Caucasian, 55.6% girls), with a median age of 15.0 (2.5) years, and a median BMI z-score of 2.88 (0.70), followed for 6 months were analyzed. BMI z-score variance was predicted by vigorous physical activity (VPA) (F(1,57)= 4.55, p=.039), overweight duration (F(1,59)= 5.61, p=.022), way of delivery (F(2,58)= 6.55, p=.003) and self-determination level (F(1,59)= 4.75, p=.034). VPA further predicted body fat mass (%) (F(1,57)= 9.99, p=.003) as well as trunk fat mass variance (F(1,57)= 8.94, p=.006). This study suggests that although both non-modifiable and modifiable factors influence BMI and body fat variance to some extent, in adolescents with obesity, VPA (modifiable factor) stands out as the factor with the best association with both outcomes. VPA may be a potential ally in the success of clinical obesity management in adolescents, and so should be emphasized in this population.Trial registration: ClinicalTrials.gov identifier: NCT02941770..
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Affiliation(s)
- Antonio Videira-Silva
- Pediatric University Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Licínio Manco
- Research Centre for Anthropology and Health (CIAS), Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - Luis B Sardinha
- Exercise and Health Laboratory, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Helena Fonseca
- Rheumatology Research Unit, Molecular Medicine Institute, Faculty of Medicine, University of Lisbon; Pediatric Obesity Clinic, Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal
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Lopes AF, Machado TC, Nascimento VG, Bertoli CJ, Leone C. Cesarean Delivery and Risk of Excess Weight Among Brazilian Preschool Children. Matern Child Health J 2022; 26:1305-1311. [PMID: 34982336 DOI: 10.1007/s10995-021-03295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the relationship between cesarean Delivery (CD) and overweight in preschool children, considering the presence of birth aspects and demographic characteristics that have been associated with the risk of excess weight. METHODS This retrospective cross-sectional analysis used representative data of children from 2 to 6 years of age at municipal daycare centers in Taubaté, São Paulo, Brazil. The sample included 752 preschoolers. Weight and height were collected in daycare centers, and the nutritional status classification was performed using z scores of Body Mass Index (zBMI). Data analysis was performed in the bivariate and multivariate manner, the latter with the inclusion of another possible risk factor. Adjustments were made for daycare centers time, sex, birth length and weight and maternal schooling. RESULTS The mean age of preschool children was 4.7 years, and 53.8% were boys. The prevalence of overweight children was 21.7%. The median zBMI of the children born by CD was higher than that of vaginal Delivery (p = 0.0194). The prevalence of overweight showed association with CD (p = 0.0196; PR = 1.397 with 95% CI of 1065-1831). Logistic binary multivariate regression analysis confirmed the association, even in the presence of other possible risk factors (CR: 1.580, 95% CI: 1.072-2.330). CONCLUSION FOR PRACTICE Birth by CD is one of the factors that are associated with the early development of overweight in preschoolers.
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Affiliation(s)
- Amanda Forster Lopes
- Health and Biotechnology Institute, Federal University of Amazonas, Manaus, Brazil.
| | - Thais Costa Machado
- Department of Health, Life Cycles and Society of the Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Viviane Gabriela Nascimento
- Department of Health, Life Cycles and Society of the Faculty of Public Health, University of São Paulo, São Paul, Brazil.,Paulista University, São Paul, Brazil
| | | | - Claudio Leone
- Department of Health, Life Cycles and Society-FSP-USP, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP 01246-904, Brazil
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Sbaraini M, Cureau FV, Ritter JDA, Schuh DS, Madalosso MM, Zanin G, Goulart MR, Pellanda LC, Schaan BD. Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis. Public Health Nutr 2021; 24:6415-6426. [PMID: 33821783 PMCID: PMC11148597 DOI: 10.1017/s1368980021001464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To estimate the burden of excess weight in Brazilian adolescents. DESIGN Systematic review with meta-analysis. SETTING We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI. PARTICIPANTS Brazilian adolescents (10 to 19 years old). RESULTS One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000. CONCLUSIONS The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.
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Affiliation(s)
- Mariana Sbaraini
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
| | - Felipe Vogt Cureau
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Julianna do Amaral Ritter
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Daniela Schneid Schuh
- Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariana Migliavacca Madalosso
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Gabriella Zanin
- Universidade Luterana do Brasil (ULBRA), Porto Alegre, RS, Brazil
| | - Maíra Ribas Goulart
- Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucia Campos Pellanda
- Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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de Jesus Sousa Lima T, Dos Prazeres TMP, Dos Santos Henrique R, da Rocha Queiroz D, Bezerra J, de Barros MVG, Dos Santos MAM. Inter-individual variability in children's physical growth and body composition: Findings of longitudinal ELOS-Pré study. Am J Hum Biol 2021; 34:e23697. [PMID: 34757666 DOI: 10.1002/ajhb.23697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's physical growth (PG) and body composition (BC) can be influenced by birth weight and type of delivery. AIM To longitudinally analyze the dynamics of PG and BC of children from 5 to 9 years; to investigate the inter-individual differences according to age, sex, BW, and type of delivery across the following years of the study. SUBJECTS AND METHODS A total of 1236 children (597 boys) were evaluated at 5-years of age and followed annually until 9-years. PG and BC measurements were evaluated. Multilevel modeling was used. RESULTS Annual increments were observed (p < .001). Girls presented lower height and fat-free-mass but higher %BF (p < .001). Distinct trajectories between the sexes were observed for height (p < .001). Low-birth-weight children presented lower height, body mass, and fat-free-mass (p < .001), but the interaction between velocity of growth and BC was significant only in height (p < .05). Children born by had lower height, body mass, and %BF, and gained less body mass per year than those born by vaginal delivery (p < .05). Significant inter-individual differences were observed at 5-years of age and in their trajectories, except for fat-free-mass (p < .01). CONCLUSION There are differences in the dynamics of PG and BC, low-birth-weight and type of delivery influence the dynamics of PG during this interval of ages.
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Affiliation(s)
| | | | | | | | - Jorge Bezerra
- School of Physical Education, University of Pernambuco, Recife, Brazil
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Rifas-Shiman SL, Huh SY, Martin RM, Kramer M, Patel R, Bogdanovich N, Vilchuck K, Thompson J, Oken E. Delivery by caesarean section and offspring adiposity and cardio-metabolic health at ages 6.5, 11.5 and 16 years: results from the PROBIT cohort in Belarus. Pediatr Obes 2021; 16:e12783. [PMID: 33660413 DOI: 10.1111/ijpo.12783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Caesarean delivery has been associated with later adiposity, perhaps via early programming or perhaps because of residual confounding by maternal or birth characteristics. OBJECTIVES Examine associations of caesarean delivery with adiposity and cardio-metabolic biomarkers. METHODS Observational analysis of 15 069 children in the PROBIT cohort in Belarus. We examined measures of child anthropometry and blood pressure at 6.5, 11.5 and 16 years and fasting blood (11.5 years). RESULTS Caesarean-delivered children were slightly heavier at 6.5 (mean BMI 15.8 vs. 15.6 kg/m2 ), 11.5 (18.4 vs. 18.2) and 16 years (21.5 vs. 21.3). After adjustment for prenatal characteristics including maternal third trimester BMI, however, we observed no association of caesarean versus vaginal delivery with child BMI (β 0.05 kg/m2 ; 95%CI: -0.03, 0.14), sum of skinfolds (0.14 mm; -0.13, 0.42), waist circumference (-0.07 cm; -0.23, 0.10), obesity (OR 0.99; 0.76, 1.29), or systolic (-0.20 mmHg; -0.70, 0.30) or diastolic (-0.17 mmHg, -0.60, 0.26) blood pressure at 6.5 years; results were similar at 11.5 and 16 years. At 11.5 years, we observed a modest association of caesarean delivery with fasting insulin (0.33 mU/L; 0.00, 0.65). CONCLUSIONS Caesarean delivery had little or no association with adiposity or related cardio-metabolic biomarkers in childhood. Adjustment for maternal BMI attenuated all outcome effect estimates.
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Affiliation(s)
- Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Susanna Y Huh
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard M Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Michael Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Patel
- Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalia Bogdanovich
- Department of Obstetrics, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Konstanin Vilchuck
- Department of Obstetrics, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Jennifer Thompson
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Abreu JDMFD, Abreu SLLD, Bragança MLBM, Cavalcante LFP, França AKTDC, Ribeiro CCC, Lamy Filho F. Birth by cesarean delivery and central adiposity in adolescents from a birth cohort. CAD SAUDE PUBLICA 2021; 37:e00033320. [PMID: 33503161 DOI: 10.1590/0102-311x00033320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/16/2020] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.
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Abstract
Introduction: The health implications of Caesarean section are a significant factor in evaluating the use of Caesarean section as a method of completing childbirth. The increased rate of Cesarean section augmenting in a statistical way the health implications of the use of Cesarean section as a way of operative technique of childbirth finalization. Aim: To investigate the incidence of health implications on mother and child after Cesarian section in comparison to vaginal delivery. Methods: In our study, which was conducted as a retrospective-prospective and targeted study, the observed research period is from 2007 to 2019. The data sources are: medical histories, birth protocols and neonatal medical histories. Group A: represents the number of surveyed patients with a Cesarean section in a one-year period (2018) in General Hospital „Prim.dr A. Nakaš“. Group B: represents a control group of the same number of patients born by Caesarean section in 2007 in General Hospital „Prim.dr A.Nakaš“ with all parameters and variables detected in the research group. Evaluation of the examinee’s findings includes: anamnestic data, sonographic data, gynecological finding, colposcopic finding. PAPA test, HPV typing and laboratory findings due to the extensiveness of the study. Results: A comparison of the number of Caesarean sections in BiH before and now shows a statistically significant increase from about 6 caesareans per year to almost 21 Cesarean section per year (p<0.05). This increase led to a statistically significant decrease in perinatal mortality from 30 per thousand per year to only 6 per thousand per year (p<0.05). Complications after Cesarean section during both observed periods are dominated by subjective problems, followed by early complications after Cesarean section. According to the types of complications after Caesarean section, hemorrhages were the most numerous during both examined years, with 1 case of other complications and without a statistically significant difference between the observed years. There were no statistically significant differences in the duration of hospitalization, although in 2007 somewhat longer stay in the hospital after Caesarean section was recorded. Conclusion: Our study has shown that one of the most visible trends in modern perinatology is a significant increase in number of Cesarean sections. This is the basis of long-term side effects of Caesarean section, the frequency of which correlates with the increase in this surgical procedure.
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Affiliation(s)
- Nenad Miseljic
- Department of Gynecology and Obstetrics, General Hospital "Prim.dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
| | - Sead Ibrahimovic
- Department of Gynecology and Obstetrics, General Hospital "Prim.dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
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Zhang L, Huang L, Zhao Z, Ding R, Liu H, Qu W, Jia X. Associations Between Delivery Mode and Early Childhood Body Mass Index Z-Score Trajectories: A Retrospective Analysis of 2,685 Children From Mothers Aged 18 to 35 Years at Delivery. Front Pediatr 2020; 8:598016. [PMID: 33392117 PMCID: PMC7774081 DOI: 10.3389/fped.2020.598016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the association between cesarean delivery (CD) and trajectory patterns of age- and sex-specific body mass index (BMI) z-score in early childhood. Methods: A retrospective cohort study was conducted among 2,685 children whose maternal age at the time of birth was between 18 and 35 years, and birth data and anthropometric measurement data during their ages 3-60 months were collected. A group-based trajectory modeling approach was used to identify distinct BMI z-score trajectories, and multinomial logistic regressions were applied to estimate the associations among CD (both elective and non-elective combined), elective and non-selective CD, and BMI z-score trajectory classes. Results: Of the 2,685 participants, 46.5% (N = 1,248) were born by vaginal delivery (VD), 20.7% (N = 556) by elective CD, and 32.8% (N = 881) by non-elective CD. Five BMI z-score trajectory patterns were identified, and they were "increasing from moderate to high" (10.1%, n = 270), "increasing from mild to moderate" (34.2%, n = 919), "increasing from low to high" (10.5%, n = 283), "stable mild" (30.1%, n = 808), and "stable low" (15.1%, n = 405) groups. Compared with children delivered by VD, those who delivered by CD (both elective and non-elective combined), elective CD, and non-elective CD were associated with the "increasing from moderate to high" trajectory [odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.13-2.29; OR = 1.64, 95%CI: 1.06-2.54; and OR = 1.59, 95%CI: 1.05-2.39, respectively] and were also associated with the "increasing from low to high" trajectory (OR = 1.60, 95%CI: 1.17-2.19, OR = 1.75, 95%CI: 1.16-2.63; and OR = 1.53, 95%CI: 1.00-2.34, respectively). Conclusion: Both elective and non-elective CD were associated with the risk of accelerated weight gain in early childhood.
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Affiliation(s)
- Lihong Zhang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Shandong Maternal and Child Health Development Research Center, Maternal and Child Health Care Hospital, Shandong University, Jinan, China
| | - Liuxia Huang
- Department of Pediatrics, The Huangdao Maternal and Child Health Care Hospital, Qingdao, China
| | - Zhiyuan Zhao
- Department of Pharmacy, The Binhai Central Health Center of Huangdao, Qingdao, China
| | - Renjuan Ding
- Department of Pharmacy, The Huangdao Maternal and Child Health Care Hospital, Qingdao, China
| | - Hongnian Liu
- Department of Orthopedic, The Binhai Central Health Center of Huangdao, Qingdao, China
| | - Wenchao Qu
- Department of Pediatrics, The Huangdao Maternal and Child Health Care Hospital, Qingdao, China
| | - Xiao Jia
- Department of Traditional Chinese Medicine, The Huangdao Maternal and Child Health Care Hospital, Qingdao, China
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12
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Sogunle E, Masukume G, Nelson G. The association between caesarean section delivery and later life obesity in 21-24 year olds in an Urban South African birth cohort. PLoS One 2019; 14:e0221379. [PMID: 31725725 PMCID: PMC6855451 DOI: 10.1371/journal.pone.0221379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity is an important public health problem and rates have reached epidemic proportions in many countries. Studies have explored the association between infants delivered by caesarean section and their later life risk of obesity, in many countries outside Africa. As a result of the increasing caesarean section and obesity rates in South Africa, we investigated the association in this country. METHODS This was a retrospective analysis of data that were collected from a prospective South African birth cohort (Birth to Twenty Plus), established in 1990. A total of 889 young adults aged 21-24 years were included in the analysis. Poisson regression models were fitted to assess the association between mode of delivery and early adulthood obesity. RESULTS Of the 889 young adults, 106 (11.9%) were obese while 72 (8.1%) were delivered by caesarean section; of which 14 (19.4%) were obese. Caesarean section delivery was significantly associated with obesity in young adults after adjusting for potential confounders like young adults' sex and birth weight, mothers' parity, and education (incidence rate ratio 1.64, 95% CI 1.01-2.68, p = 0.045). CONCLUSION The association of caesarean section with early adulthood obesity should be interpreted with caution because data on certain key confounding factors such as mothers' pre-pregnancy body mass index and gestational diabetes were not available. Further research from Africa, with larger sample sizes and databases with useful linking of maternal and infant data, should be conducted.
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Affiliation(s)
- Eniola Sogunle
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gwinyai Masukume
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gill Nelson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Ferraro AA, Barbieri MA, da Silva AAM, Goldani MZ, Fernandes MTB, Cardoso VC, Stein AD, Bettiol H. Cesarean Delivery and Hypertension in Early Adulthood. Am J Epidemiol 2019; 188:1296-1303. [PMID: 31111861 DOI: 10.1093/aje/kwz096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
The rate of cesarean delivery (CD) is high in many parts of the world. Birth via CD has been associated with adverse later health outcomes, such as obesity, asthma, and type 1 diabetes mellitus. Few studies have focused on hypertension. We investigated the associations of CD with hypertension, systolic blood pressure (BP), and diastolic BP and tested whether body mass index (BMI; weight (kg)/height (m)2) was a mediator of these associations in a birth cohort (n = 2,020) assembled in 1978-1979 and followed up in 2002-2004 in Ribeirão Preto, Brazil. The CD rate was 32.0%. Hypertension was present in 11.7% of persons born via CD and 7.7% of those born vaginally. Being born by CD increased the odds of hypertension by 51% (odds ratio = 1.51, 95% confidence interval (CI): 1.10, 2.07). After adjustment for confounders, this estimate changed little (odds ratio = 1.49, 95% CI: 1.07, 2.06). In a mediation analysis, odds ratios for the indirect and direct effects were 1.18 (95% CI: 1.11, 1.25) and 1.31 (95% CI: 0.97, 1.65), respectively. CD also had indirect effects on both systolic and diastolic BP via BMI. Our findings suggest that CD is associated with young-adult hypertension and that this association is at least partially mediated by BMI. This has implications for countries struggling with the burden of noncommunicable diseases and where CD rates are high.
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Affiliation(s)
| | - Marco Antônio Barbieri
- Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Marcelo Zubaran Goldani
- Department of Pediatrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Viviane Cunha Cardoso
- Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Aryeh David Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Heloisa Bettiol
- Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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14
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Veile A, Valeggia C, Kramer KL. Cesarean birth and the growth of Yucatec Maya and Toba/Qom children. Am J Hum Biol 2019; 31:e23228. [PMID: 30815932 DOI: 10.1002/ajhb.23228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Cesarean delivery is often epidemiologically associated with childhood obesity. However, little attention is paid to post-birth modulatory environments, and most studies are conducted in settings where obesity arises for a number of reasons in addition to birth mode. We therefore assess population differences in the relationship between birth mode and childhood growth using data from rural and peri-urban Latin American indigenous populations, and test predictions developed using life history theory. METHODS Child height and weight were measured monthly in 80 Yucatec Maya and 58 Toba/Qom children aged 1-48 months (2007-2014, 3812 observations). Random-effects linear mixed models were used to compare children's growth by population, sex, and birth mode, accounting for potential confounders. RESULTS Cesarean delivery rates were 47% (Toba/Qom) and 20% (Yucatec Maya). Childhood obesity and overweight rates were low in both populations. Cesarean-delivered children had significantly greater weight gain (but similar height grain) compared to vaginally-delivered children. By age 4, cesarean delivered Yucatec Maya girls and boys, and Toba/Qom boys (not girls), had significantly higher weight-for-age compared to vaginally-delivered children from their own sex and population. CONCLUSIONS This provides one of the first attempts to document differences in children's growth patterns according to mode of birth in modernizing indigenous populations. Cesarean delivery is associated with young children's growth patterns, even in the absence of many obesity-inducing factors. There are also population, age, and sex differences in the relationship between birth mode and childhood weight trajectories that warrant future investigation.
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Affiliation(s)
- Amanda Veile
- Department of Anthropology, Purdue University, West Lafayette, Indiana
| | - Claudia Valeggia
- Department of Anthropology, Yale University, New Haven, Connecticut
| | - Karen L Kramer
- Department of Anthropology, University of Utah, Salt Lake City, Utah
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15
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Kananikandeh S. Persuading Iranian Women toward Normal Vaginal Delivery: Using Pictorial Perception of the Labour Process. Open Access Maced J Med Sci 2018; 6:1145-1152. [PMID: 29983818 PMCID: PMC6026440 DOI: 10.3889/oamjms.2018.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Pictorial education could provide an innovative approach for health educators which help to increase health-related information, the attention of individuals, comprehension, and recall. AIM: The purpose of this study was to determine the effect of pictorial perception of labour process by persuading Iranian women toward normal vaginal delivery. MATERIALS AND METHODS: The pre and post non-randomized trial with control group carried out on non-probability sample consisted of 76 pregnant women during the third trimester of pregnancy in the four urban health care centres in Pars-Abad city, Iran, during 2014. Demographic, knowledge, attitude, subjective norms, outcome expectations, self-efficacy, and intention to do normal vaginal delivery variables were measured by using self-administered questionnaire and via the self-report method. Data analysis was performed using SPSS-21 software by Independent t-test, repeated measure, paired T-test, ANOVA, chi-square, Cochran’s Q, and McNemar test. Manipulation included a pictorial education program to persuade pregnant women toward selecting normal vaginal delivery. RESULTS: The results showed significant improvement in mean scores of knowledge, attitudes, self-efficacy and behavioural intention of labour after manipulation in the intervention group (P < 0.001). It was found about 60% changes for intending to choose normal vaginal delivery, and 27/06% of women in the intervention group reported normal vaginal delivery versus the control group. And 10/81% of women did a cesarean section because of medical reasons during of delivery. Reduction of cesarean section was evident. Additionally, the annual rate of cesarean section decreased about 7% in comparison to the previous year. CONCLUSION: Pictorial education could be effective on the intention of women to choose natural vaginal delivery among pregnant women, and it can be used as an effective training technique for developing health literacy, enhancing self-efficacy and decision-making power of women in the delivery.
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Affiliation(s)
- Safieh Kananikandeh
- Sarab Faculty, Tabriz University of Medical Sciences, Research Vice Chancellor of Tabriz University of Medical Sciences, Tabriz, Iran
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16
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Abstract
Introduction: The increase in the percentage of the Cesarean sections has got an important place in determination of modern obstetrics. The evaluation of that needs actual, modern opinion for obstetrics and transformation actual obstetric science than investigating the best situation for the mother and child in the actual moment. All medical, organizational, economic and ethical capacities with support of modern diagnostic and therapeutic procedures present a reason for the access in modern obstetrics. It takes the descriptive and analytic method at work. In our country the percentage of the Caesarean section is 15% (according to WHO data), with large variations in frequency depending on the writer and the investigated time. Aim: To investigate the prevalence of Cesarean section in Bosnia and Herzegovina until 2017. Patients and Methods: In our investigation made prospective and target analysis is investigated at 2017 as a target year. Sources are: patient charts, notes and charts of new born. Group A presents number investigated patients with made Cesarean section in time at one year (2017) in General hospital „Prim.dr A.Nakaš“. Group B presents control group with identical number of deliveries with Cesarean section in 2007 in General hospital „Prim.dr A. Nakaš“ with all variables who detected in investigation group. Results: Analysis the number of deliveries finished Cesarean section in time from 2007 to 2017 in General hospital „Prim.dr Abdulah Nakaš “Sarajevo presents augmentation frequency from 15,5 % in 2007 year to 21,7 % in 2011; smaller number in 2012 to 20,3% and finally 22.9% in 2017 for all deliveries. Conclusion: Our investigation shows an important number of Cesarean section and is still working because of clearer obstetric indication but they make a vital indication for the mother and baby. It worries percent of poorly described indications, that are something important for the comfort of doctor and any patients that wants natural delivery. It worries the public because the more important short term and long-term unwanted effects; Cesarean delivery in correlation with augmentation of this operation.
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Affiliation(s)
- Nenad Miseljic
- General Hospital "Prim. dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Ejub Basic
- Department Ginecology, General Hospital «Prim.dr. Abdulah Nakas», Sarajevo, Bosnia and Herzegovina
| | - Sanja Miseljic
- Department for Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases. Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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17
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Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018; 15:e1002494. [PMID: 29360829 PMCID: PMC5779640 DOI: 10.1371/journal.pmed.1002494] [Citation(s) in RCA: 410] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/18/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. METHODS AND FINDINGS Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with increased risk of miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies), but not perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies). Pregnancy following cesarean delivery was associated with increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies). This is a comprehensive review adhering to a registered protocol, and guidelines for the Meta-analysis of Observational Studies in Epidemiology were followed, but it is based on predominantly observational data, and in some meta-analyses, between-study heterogeneity is high; therefore, causation cannot be inferred and the results should be interpreted with caution. CONCLUSIONS When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery.
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Affiliation(s)
- Oonagh E. Keag
- NHS Lothian Department of Obstetrics and Gynaecology, Simpson’s Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jane E. Norman
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen’s Medical Research Institute, Edinburgh, United Kingdom
| | - Sarah J. Stock
- Tommy’s Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen’s Medical Research Institute, Edinburgh, United Kingdom
- School of Women’s and Infants’ Health, University of Western Australia, Crawley, Australia
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18
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Barros AJD, Santos LP, Wehrmeister F, Motta JVDS, Matijasevich A, Santos IS, Menezes AMB, Gonçalves H, Assunção MCF, Horta BL, Barros FC. Caesarean section and adiposity at 6, 18 and 30 years of age: results from three Pelotas (Brazil) birth cohorts. BMC Public Health 2017; 17:256. [PMID: 28292278 PMCID: PMC5351260 DOI: 10.1186/s12889-017-4165-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 03/02/2017] [Indexed: 11/16/2022] Open
Abstract
Background Association between caesarian section (C-section) and obesity is controversial and mostly based on body mass index (BMI), which has inherent limitations. Using direct estimates of body fat mass, we aimed to assess the association between C-section and adiposity using fat mass index and BMI z-score in three birth cohort studies from Pelotas, Brazil. Methods We measured weight, height and fat mass (using dual X-ray absorptiometry (DXA)) at ages 6, 18 and 30 years among participants in the 2004, 1993 and 1982 population-based Pelotas Birth Cohort Studies, respectively. We used multiple linear regression analysis to examine the crude and adjusted association between C-section and the body composition indicators. We also modelled height as an outcome to explore the presence of residual confounding. Results We observed that fat mass index and BMI z-score were strongly and positively associated with C-section in the crude analysis. However, when we adjusted for socioeconomic characteristics, maternal BMI, parity, age and smoking during pregnancy, effect estimates were attenuated towards the null, except for 30-year-old women. In those women from the 1982 cohort, C-section remained associated with fat mass index (β = 0.82; CI95% 0.32;1.32) and BMI z-score (β = 0.15; CI95% 0.03;0.28), even after adjusting for all potential confounders, suggesting an increase in fat mass index and BMI at 30 years among those born by C-section. Conclusion We found no consistent association of C-section with fat mass index measured by DXA and BMI z-score in individuals aged 6, 18 and 30 years, except for women in the latter group, which might be explained by residual confounding. Confounding by socioeconomic and maternal characteristics accounted for all the other associations.
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Affiliation(s)
- Aluisio J D Barros
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil.
| | - Leonardo Pozza Santos
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil.,Federal University of Pampa, Itaqui, Brazil
| | - Fernando Wehrmeister
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil
| | | | - Alicia Matijasevich
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil.,Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ina S Santos
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil
| | - Ana M B Menezes
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil
| | - Helen Gonçalves
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil
| | - Maria Cecília Formoso Assunção
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil
| | - Bernardo L Horta
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil
| | - Fernando C Barros
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3o piso, 96020-220, Pelotas, Brazil.,Post-graduate Program in Health and Behaviour, Catholic University of Pelotas, Itaqui, Brazil
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19
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Yuan C, Gaskins AJ, Blaine AI, Zhang C, Gillman MW, Missmer SA, Field AE, Chavarro JE. Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood. JAMA Pediatr 2016; 170:e162385. [PMID: 27599167 PMCID: PMC5854473 DOI: 10.1001/jamapediatrics.2016.2385] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Cesarean birth has been associated with higher risk of obesity in offspring, but previous studies have focused primarily on childhood obesity and have been hampered by limited control for confounders. OBJECTIVE To investigate the association between cesarean birth and risk of obesity in offspring. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted from September 1, 1996, to December 31, 2012, among participants of the Growing Up Today Study, including 22 068 offspring born to 15 271 women, followed up via questionnaire from ages 9 to 14 through ages 20 to 28 years. Data analysis was conducted from October 10, 2015, to June 14, 2016. EXPOSURE Birth by cesarean delivery. MAIN OUTCOMES AND MEASURES Risk of obesity based on International Obesity Task Force or World Health Organization body mass index cutoffs, depending on age. Secondary outcomes included risks of obesity associated with changes in mode of delivery and differences in risk between siblings whose modes of birth were discordant. RESULTS Of the 22 068 offspring (20 950 white; 9359 male and 12 709 female), 4921 individuals (22.3%) were born by cesarean delivery. The cumulative risk of obesity through the end of follow-up was 13% among all participants. The adjusted risk ratio for obesity among offspring delivered via cesarean birth vs those delivered via vaginal birth was 1.15 (95% CI, 1.06-1.26; P = .002). This association was stronger among women without known indications for cesarean delivery (adjusted risk ratio, 1.30; 95% CI, 1.09-1.54; P = .004). Offspring delivered via vaginal birth among women who had undergone a previous cesarean delivery had a 31% (95% CI, 17%-47%) lower risk of obesity compared with those born to women with repeated cesarean deliveries. In within-family analysis, individuals born by cesarean delivery had 64% (8%-148%) higher odds of obesity than did their siblings born via vaginal delivery. CONCLUSIONS AND RELEVANCE Cesarean birth was associated with offspring obesity after accounting for major confounding factors. Although additional research is needed to clarify the mechanisms underlying this association, clinicians and patients should weigh this risk when considering cesarean delivery in the absence of a clear indication.
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Affiliation(s)
- Changzheng Yuan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Audrey J. Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Arianna I. Blaine
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH
| | - Cuilin Zhang
- Epidemiology Branch. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Matthew W. Gillman
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Obstetrics, Gynecology, and Reproductive Biology; Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA
| | - Alison E. Field
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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20
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Veile A, Kramer KL. Childhood body mass is positively associated with cesarean birth in Yucatec Maya subsistence farmers. Am J Hum Biol 2016; 29. [PMID: 27699897 DOI: 10.1002/ajhb.22920] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/07/2016] [Accepted: 08/20/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The epidemiologic link between cesarean birth and childhood obesity is unresolved, partly because most studies come from industrialized settings where many post-birth factors affect the risk for obesity. We take advantage of an unusual ethnographic situation where hospital and cesarean birth modes have recently been introduced among Yucatec Maya subsistence farmers, but young children have had minimal exposure to the nutritional transition. While we expect to find very low rates of childhood obesity, we predict that cesarean-born children will be larger and heavier than vaginally born children. METHODS Weight and height were collected monthly on 108 children aged 0-5 (3576 observations total). Birth mode and birthweight were collected by maternal interview. Data were analyzed using linear mixed models that compare child growth [Maya population-specific Z-scores for weight-for-age and body mass index-for-age (WAZ and BMIZ)] in cesarean and vaginally born children aged 0-5 years. RESULTS The cesarean rate was 20%, no children were obese, and 5% were overweight. Cesarean birth was a significant predictor of child WAZ and BMIZ after accounting for maternal effects, child birthweight, and sex. Children who were born by cesarean to mothers with high BMI had the highest WAZ of all children by 5 years of age, and the highest BMIZ of all children at all ages. CONCLUSION Cesarean-born Maya children had higher BMI than vaginally born children, even in the absence of many known confounding factors that contribute to childhood obesity. Child growth was most sensitive to birth mode when mothers had high BMI.
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Affiliation(s)
- Amanda Veile
- Department of Anthropology, Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, 47907-2050
| | - Karen L Kramer
- Department of Anthropology, University of Utah, Salt Lake City, Utah, 84112
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21
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Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med 2016; 50:761-779. [PMID: 26916261 DOI: 10.1016/j.amepre.2015.11.012] [Citation(s) in RCA: 563] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/27/2022]
Abstract
CONTEXT Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years. EVIDENCE ACQUISITION PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015. EVIDENCE SYNTHESIS Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity. CONCLUSIONS Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.
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Affiliation(s)
- Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
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Influence of metabolic-linked early life factors on the eruption timing of the first primary tooth. Clin Oral Investig 2015; 20:1871-1879. [PMID: 26620731 DOI: 10.1007/s00784-015-1670-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 11/18/2015] [Indexed: 01/22/2023]
Abstract
AIM Early eruption of permanent teeth has been associated with childhood obesity and diabetes mellitus, suggesting links between tooth eruption and metabolic conditions. This longitudinal study aimed to identify pre-, peri- and postnatal factors with metabolic consequences during infancy that may affect the eruption timing of the first primary tooth (ETFT) in children from an ethnically heterogeneous population residing within the same community. MATERIAL AND METHODS Participants were recruited (n = 1033) through the GUSTO (Growing Up in Singapore Towards healthy Outcomes) birth cohort (n = 1237). Oral examinations were performed at 3-month intervals from 6 to 18 months of age. Crude and adjusted analyses, with generalized linear modelling, were conducted to link ETFT to potential determinants occurring during pregnancy, delivery/birth and early infancy. RESULTS Overall mean eruption age of the first primary tooth was 8.5 (SD 2.6) months. Earlier tooth eruption was significantly associated with infant's rate of weight gain during the first 3 months of life and increased maternal childbearing age. Compared to their Chinese counterparts, Malay and Indian children experienced significantly delayed tooth eruption by 1.2 and 1.7 months, respectively. CONCLUSIONS Infant weight gain from birth to 3 months, ethnicity and maternal childbearing age were significant determinants of first tooth eruption timing. Early life influences can affect primary tooth development, possibly via metabolic pathways. CLINICAL RELEVANCE Timing of tooth eruption is linked to general growth and metabolic function. Therefore, it has potential in forecasting oral and systemic conditions such as caries and obesity.
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Sutharsan R, Mannan M, Doi SA, Mamun AA. Caesarean delivery and the risk of offspring overweight and obesity over the life course: a systematic review and bias-adjusted meta-analysis. Clin Obes 2015; 5:293-301. [PMID: 26286021 DOI: 10.1111/cob.12114] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/07/2015] [Accepted: 07/16/2015] [Indexed: 12/15/2022]
Abstract
A causal role of Caesarean delivery (CD) on developing overweight and obesity in the life course of offspring has been postulated. However, the true strength of this association is not clear and the potential for confounding has not been adequately addressed. A systematic review and meta-analysis were conducted to evaluate the strength of this association, this time using a bias-adjusted model in addition to conventional methods. Our search yielded 32 estimates from 14 publications (n = 261,000) for meta-analysis. The pooled analysis of seven estimates (n = 194,463) demonstrated a trend only towards a risk increase (RR = 1.15; 95% CI:0.94, 1.40) in overweight and obesity combined (ow+ob) due to CD in early childhood (0-5 years) and a similar trend was observed for mid-childhood and adolescence (5-18 years). In adulthood, a moderate increase in risk for ow+ob due to CD was observed (n = 30,200) (RR = 1.28; 95% CI 1.02, 1.34). Results for obesity and overweight separately were stronger for obesity and demonstrated a decreasing effect across the three life stages. Conventional methods of analysis suggested less uncertainty than we report and publication bias assessment was strongly suggestive of a bias in favour of positive studies. The current analysis therefore suggests that the small effects seen with CD in this and previous meta-analyses are probably a cumulative consequence of several biases we have outlined, including confounding effect and publication bias.
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Affiliation(s)
- R Sutharsan
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- Eskitis Institute, Griffith University, Brisbane, QLD, Australia
| | - M Mannan
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - S A Doi
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - A A Mamun
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
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Abstract
The DOHaD research field has successfully associated adult non-communicable diseases with inadequate nutrition in early periods of life. More recently, different types of exposure have been linked with impaired developmental outcomes and later health consequences, such as cesarean section at delivery, air pollution and domestic violence during pregnancy. The aim of this work is to bring up this issue looking at the published evidence on these three highly prevalent hazards in Latin American countries.
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Bernardi JR, Pinheiro TV, Mueller NT, Goldani HAS, Gutierrez MRP, Bettiol H, Moura da Silva AA, Barbieri MA, Goldani MZ. Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study. Am J Clin Nutr 2015; 102:295-301. [PMID: 26085513 PMCID: PMC6546227 DOI: 10.3945/ajcn.114.105205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/13/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cesarean delivery (CD) perturbs the assembly of the neonatal gut microbiome and has been associated with child and adult obesity. However, it is still unknown whether CD is associated with metabolic risk factors in young adults. OBJECTIVE We investigated the association of CD and metabolic risk factors in young adults in a cohort study who were 23-25 y of age at follow-up. DESIGN We used data from a cohort study in Ribeirão Preto, Brazil. Baseline data on 6827 singleton pregnancies were collected in 1978-1979, and a sample of 2063 subjects were followed up 23-25 y later (2002-2004). Information on the type of delivery, birth weight, maternal age, parity, maternal schooling, and maternal smoking was obtained after birth. Anthropometric data, biochemical measurements, and information on participant schooling and smoking history were collected at 23-25 y of age. A linear regression was performed to assess the association between CD and biochemical measurements in early adulthood, controlling for a minimum set of confounders that were identified in a directed acyclic graph. RESULTS The mean ± SD age of the subjects was 23.9 ± 0.71 y, and 51.8% of the sample were women. The CD rate was 32.0% and was more common in older (P < 0.001) and more educated mothers (P < 0.001). Compared with vaginal delivery, CD was associated with higher body mass index (BMI) after multivariable adjustment (P < 0.001) but not with glucose, homeostasis model assessment of insulin resistance, the quantitative insulin-sensitivity check index, total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides (all P > 0.05). CONCLUSION In our sample of Brazilian adults, CD was associated with higher BMI but not with other metabolic risk factors.
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Affiliation(s)
- Juliana Rombaldi Bernardi
- Biological and Health Sciences Center, University of Caxias do Sul, Caxias do Sul, Brazil; Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Tanara Vogel Pinheiro
- Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Helena Ayako Sueno Goldani
- Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Heloisa Bettiol
- Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil; and
| | | | - Marco Antônio Barbieri
- Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil; and
| | - Marcelo Zubaran Goldani
- Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil;
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Carrillo-Larco RM, Miranda JJ, Bernabé-Ortiz A. Delivery by caesarean section and risk of childhood obesity: analysis of a Peruvian prospective cohort. PeerJ 2015; 3:e1046. [PMID: 26137427 PMCID: PMC4485704 DOI: 10.7717/peerj.1046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022] Open
Abstract
Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and family-related (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; School of Medicine, Department of Medicine, Universidad Peruana Cayetano Heredia , Lima , Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; School of Medicine, Department of Medicine, Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru ; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas , Lima , Peru
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Piedimonte A, Mercurio R, Mosca A, De Lucia I, Roma I, Franzelletti P, Vania A. Childhood weight excess. Does the delivery affect it? Appetite 2015. [DOI: 10.1016/j.appet.2014.12.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kanani S, Allahverdipour H, AsghariJafarabadi M. Modeling the intention to choose natural vaginal delivery: using reasoned action and social cognitive theories. Health Promot Perspect 2015; 5:24-33. [PMID: 26000243 DOI: 10.15171/hpp.2015.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/30/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Behavioral Intention Model is one of the best and most widely models used regarding attitude of behavioral of pregnancy and decrease the rate of cesarean section (CS) among pregnant women, except effect of attitude and subjective norms on behavioral intention. Two variables of self-efficacy, and outcome expectation, relate to individual's behavior in an upcoming situation, and both of them are important at the development of behavior. The purpose of the present study was to develop a model to explain women's inten-tion to choose natural vaginal delivery (NVD). The variables of self-efficacy and outcome expectations, derived from Bandura's Social Cognitive Theory, and Behavioral Intention Model constructs were used to define the model. METHODS The study was descriptive and cross-sectional in nature and took place in Pars Abad, Iran in 2014. The non-probability sample consisted of 200 pregnant women who voluntarily participated in the study and provided the data. SPSS 21 and MPLUS 6.8 were employed to analyze the data. RESULTS Self-efficacy, outcome expectations, and attitude toward NVD were associated with intention to choose the NVD. CONCLUSION The study findings may play a role in designing educational interventions aimed at influencing the NVD and improving childbirth programs.
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Affiliation(s)
- Safieh Kanani
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
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Kuhle S, Tong OS, Woolcott CG. Association between caesarean section and childhood obesity: a systematic review and meta-analysis. Obes Rev 2015; 16:295-303. [PMID: 25752886 DOI: 10.1111/obr.12267] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/07/2015] [Accepted: 01/14/2015] [Indexed: 12/15/2022]
Abstract
Birth by caesarean section has been recently implicated in the aetiology of childhood obesity, but studies examining the association have varied with regard to their settings, designs, and adjustment for potential confounders. We conducted a systematic review and meta-analysis to summarize the available evidence and to explore study characteristics as sources of heterogeneity. A search of Medline, EMBASE, and Web of Science identified 28 studies. Random effects meta-analysis was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Caesarean section had a RR of 1.34 (CI 1.18-1.51) for obesity in the child compared with vaginal birth. The RR was lower for studies that adjusted for maternal pre-pregnancy weight than for studies that did not (1.29, CI 1.16-1.44 vs. 1.55, CI 1.11-2.17). Studies that examined multiple early life factors reported lower RRs than studies that specifically examined caesarean section (1.39, CI 1.23-1.57 vs. 1.23, CI 0.97-1.56). Effect estimates did not vary by child's age at obesity assessment, study design or country income. Children born by caesarean section are at higher risk of developing obesity in childhood. Findings are limited by a moderate heterogeneity among studies and the potential for residual confounding and publication bias.
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Affiliation(s)
- S Kuhle
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada
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30
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Salehi-Abargouei A, Shiranian A, Ehsani S, Surkan PJ, Esmaillzadeh A. Caesarean delivery is associated with childhood general obesity but not abdominal obesity in Iranian elementary school children. Acta Paediatr 2014; 103:e383-7. [PMID: 24903542 DOI: 10.1111/apa.12711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/03/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
Abstract
AIM This study examined the association between Caesarean delivery and general and abdominal obesity among children. METHODS In a cross-sectional study, 635 children aged from 6 to 12 years of age (476 girls and 159 boys) were randomly selected from Isfahan elementary schools. Weight, height and waist circumference were measured. General obesity and abdominal obesity were defined based on World Health Organization growth charts and Iranian national cut-off points, respectively. Parents were asked about delivery type and other factors potentially related to childhood obesity using a self-administered questionnaire. The association between delivery type and obesity was examined using univariate and multivariate logistic regression models. RESULTS The overall prevalence of general and central obesity was 17.6% and 17.1%, respectively, and Caesarean delivery was significantly associated with general obesity after controlling for potential confounders (OR: 2.46; 95% CI: 1.30-4.63, p = 0.005). We observed a significant association between Caesarean delivery and abdominal obesity in crude analyses (OR: 1.66; 1.02-2.69, p = 0.04), but this disappeared after adjusting for covariates (OR: 1.96; 0.82-4.69, p = 0.13). CONCLUSION Our results suggest that Caesarean delivery is adversely associated with general childhood obesity, but not abdominal obesity. This provides support for recommending vaginal births, unless contraindicated. Further research in large populations is required to confirm these findings.
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Affiliation(s)
- Amin Salehi-Abargouei
- Food Security Research Center; Isfahan University of Medical Sciences; Isfahan Iran
- Department of Community Nutrition; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
- Student Research Committee; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
| | - Afshin Shiranian
- Food Security Research Center; Isfahan University of Medical Sciences; Isfahan Iran
- Department of Community Nutrition; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
- Student Research Committee; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
| | - Simin Ehsani
- Food Security Research Center; Isfahan University of Medical Sciences; Isfahan Iran
- Department of Community Nutrition; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
- Student Research Committee; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
| | - Pamela J. Surkan
- Department of International Health; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Ahmad Esmaillzadeh
- Food Security Research Center; Isfahan University of Medical Sciences; Isfahan Iran
- Department of Community Nutrition; School of Nutrition and Food Science; Isfahan University of Medical Sciences; Isfahan Iran
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Arabin B, Stupin JH. Overweight and Obesity before, during and after Pregnancy: Part 2: Evidence-based Risk Factors and Interventions. Geburtshilfe Frauenheilkd 2014; 74:646-655. [PMID: 25100879 PMCID: PMC4119107 DOI: 10.1055/s-0034-1368462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 12/21/2022] Open
Abstract
Overweight and obesity have become a global health problem. Obesity and excessive weight gain during pregnancy have a serious impact on maternal, fetal and neonatal outcomes. Pre-conceptional obesity and excessive weight gain during pregnancy are associated with weight gain in women following childbirth leading to associated risks such as metabolic syndrome, cardiovascular disease and diabetes. Long-term risks for the offspring are an increased risk for early cardiovascular events, metabolic syndrome and decreased life expectancy as adults. German health care has not yet adequately responded to this development. There are no clinical guidelines for obesity before, during or after pregnancy, there are no concerted actions amongst midwives, obstetricians, health advisors, politicians and the media. Research projects on effective interventions are lacking although health care concepts would be urgently needed to reduce future metabolic and cardiovascular risks for women and children as well as to minimize the associated costs for the society.
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Affiliation(s)
- B. Arabin
- Clara Angela Foundation, Witten and Berlin
- Phillips University Marburg, Centre for Mother and Child
- Department of Obstetrics, University Hospital Charité Berlin
| | - J. H. Stupin
- Clara Angela Foundation, Witten and Berlin
- Department of Obstetrics, University Hospital Charité Berlin
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Pei Z, Heinrich J, Fuertes E, Flexeder C, Hoffmann B, Lehmann I, Schaaf B, von Berg A, Koletzko S. Cesarean delivery and risk of childhood obesity. J Pediatr 2014; 164:1068-1073.e2. [PMID: 24508442 DOI: 10.1016/j.jpeds.2013.12.044] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity. STUDY DESIGN Healthy, full-term infants were recruited. Overweight and obesity were defined using measured weight and height according to World Health Organization reference data. Associations between cesarean delivery and being overweight or obese were investigated at age 2, 6, and 10 years (n = 1734, 1244, and 1170, respectively) by multivariate logistic regression models adjusted for socioeconomic status, child characteristics, and maternal prepregnancy characteristics. RESULTS Mothers who gave birth by cesarean delivery (∼17%) had a higher mean prepregnancy body mass index (23.7 kg/m(2) vs 22.5 kg/m(2)), greater mean gestational weight gain (15.3 kg vs 14.5 kg), and shorter mean duration of exclusive breastfeeding (3.4 months vs 3.8 months) compared with those who delivered vaginally. The proportion of obese children was greater in the cesarean delivery group compared with the vaginal delivery group at age 2 years (13.6% vs 8.3%), but not at older ages. Regression analyses revealed a greater likelihood of obesity at age 2 years in the cesarean delivery group compared with the vaginal delivery group at age 2 years (aOR, 1.68; 95% CI, 1.10-2.58), but not at age 6 years (aOR, 1.49; 95% CI, 0.55-4.05) or age 10 years (aOR, 1.16; 95% CI, 0.59-2.29). CONCLUSION Cesarean delivery may increase the risk of obesity in early childhood. Our results do not support the hypothesis that an increasing rate of cesarean delivery contributes to obesity in childhood.
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Affiliation(s)
- Zhengcun Pei
- Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany; Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Joachim Heinrich
- Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany
| | - Elaine Fuertes
- Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudia Flexeder
- Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Hoffmann
- Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany; Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Irina Lehmann
- Department of Environmental Immunology, Helmholz Center for Environmental Research, Leipzig, Germany; Department of Pediatrics, Technical University Munich, Munich, Germany
| | - Beate Schaaf
- Medical Practice for Pediatrics, Bad Honnef, Germany
| | - Andrea von Berg
- Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Sibylle Koletzko
- Division of Pediatric, Gastroenterology, and Hepatology, Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany.
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Kulas T, Bursac D, Zegarac Z, Planinic-Rados G, Hrgovic Z. New Views on Cesarean Section, its Possible Complications and Long-Term Consequences for Children's Health. Med Arch 2013; 67:460-3. [PMID: 25568522 PMCID: PMC4272489 DOI: 10.5455/medarh.2013.67.460-463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/08/2013] [Indexed: 11/26/2022] Open
Abstract
Historical developments and advancements in cesarean section techniques and logistics have reduced the maternal and neonatal risks associated with the procedure, while increasing the number of operatively completed pregnancies for medically unjustifiable reasons. The uncritical attitude towards cesarean section and the fast emergence of ‘modern’ diseases such as obesity at a young age, asthma, type 1 diabetes mellitus and various forms of dermatitis have stimulated researches associating cesarean section with these diseases. Intestinal flora of the children born by cesarean section contains less bifidobacteria, i.e. their intestinal flora is similar to the intestinal flora in diabetic individuals. In children born by cesarean section, the ‘good’ maternal bacterial that are normally found in the maternal birth canal and rectum are lacking, while the ‘bad’ bacteria that may endanger the child’s immune system are frequently present. In children born by vaginal delivery, the ‘good’ maternal bacteria stimulate the newborn’s white blood cells and other components of the immune system, which has been taken as a basis for the hypotheses explaining the evident association of the above morbidities and delivery by cesarean section.
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Affiliation(s)
- Tomislav Kulas
- University Department of Gynecology and Obstetrics, Merkur University Hospital, Zagreb, Croatia
| | - Danijel Bursac
- University Department of Gynecology and Obstetrics, Merkur University Hospital, Zagreb, Croatia
| | - Zana Zegarac
- University Department of Gynecology and Obstetrics, Merkur University Hospital, Zagreb, Croatia
| | - Gordana Planinic-Rados
- University Department of Gynecology and Obstetrics, Merkur University Hospital, Zagreb, Croatia
| | - Zlatko Hrgovic
- University Department of Gynecology and Obstetrics, Merkur University Hospital, Zagreb, Croatia
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