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Papadopoulou SK, Mentzelou M, Pavlidou E, Vasios GK, Spanoudaki M, Antasouras G, Sampani A, Psara E, Voulgaridou G, Tsourouflis G, Mantzorou M, Giaginis C. Caesarean Section Delivery Is Associated with Childhood Overweight and Obesity, Low Childbirth Weight and Postnatal Complications: A Cross-Sectional Study. Medicina (B Aires) 2023; 59:medicina59040664. [PMID: 37109623 PMCID: PMC10146198 DOI: 10.3390/medicina59040664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Background and Objectives: In the last decades, simultaneously increasing trends have been recorded for both caesarean section delivery and childhood overweight/obesity around the world, which are considered serious public health concerns, negatively affecting child health. Aim: The present study aims to investigate whether caesarean section is associated with the increased rates of childhood overweight/obesity, low childbirth anthropometric indices and postnatal complications in pre-school age. Materials and Methods: This is a cross-sectional study in which 5215 pre-school children aged 2–5 years old were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Non-adjusted and adjusted statistical analysis was performed to assess the impact of caesarean section in comparison to vaginal delivery. Results: Children delivered by caesarean section were significantly more frequently overweight or obese at the age of 2–5 years, also presenting a higher prevalence of low birth weight, length and head circumference. Caesarean section was also associated with higher incidence of asthma and diabetes type I at the age of 2–5 years. In a multivariate analysis, caesarean section increased the risk of childhood overweight/obesity and low childbirth anthropometric indices even if adjusting for several childhood and maternal confounding factors. Conclusions: Increasing trends were recorded for both caesarean section delivery and childhood overweight/obesity, which are considered serious public health concerns. Caesarean section independently increased childhood overweight/obesity in pre-school age, highlighting the emergent need to promote health policies and strategies to inform future mothers about its short and long-term risks and that this mode of delivery should preferably be performed only when there are strong medical recommendations in emergency obstetric conditions.
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Affiliation(s)
- Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Correspondence: (S.K.P.); (C.G.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Anastasia Sampani
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, 81400 Myrina, Greece
- Correspondence: (S.K.P.); (C.G.)
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Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana. J Nutr Sci 2022; 11:e43. [PMID: 35754984 PMCID: PMC9201873 DOI: 10.1017/jns.2022.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.
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Zheng X, Li R, Wang L, Yang H, Li L, Cui J, Zhao W, Yang Z, Zhang Q, Xu T, Wang Y, Chen B. The association of cesarean section with overweight and neurodevelopment of Chinese children aged 1-5 months. Front Pediatr 2022; 10:940422. [PMID: 36081630 PMCID: PMC9445438 DOI: 10.3389/fped.2022.940422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this survey was to explore the association of delivery mode with overweight and neurodevelopment of Chinese infants aged 1-5 months. MATERIALS AND METHODS This study was based on a cross-sectional survey. Data for this study were obtained from the Children's Nutrition and Health System Survey in China which was conducted from 2019 to 2020. Characteristics of parents and children and the delivery mode were obtained using interview-administered questionnaires. Body mass index-for age z-score (BMI z) was calculated using World Health Organization (WHO) child growth standards. Children's neurodevelopment was assessed by a trained child health care physician using the Child Psychological Development Scale. The association of delivery mode with infant overweight was analyzed using a multivariable logistic regression model. We conducted a multivariable linear regression model to explore the relationship between delivery modes with neurodevelopment. RESULTS In total, the present analysis included 1,347 children aged 1-5 months, 35.61% were born via cesarean section, of which 15.21% were overweight. After adjustment for infant characteristics and parental factors, the cesarean section was significantly related with the likehood of being overweight [OR = 1.95; 95% confidence interval (CI): 1.27 to 2.98]. Children born via cesarean section had a 3.41-point decrease in gross motor development (β = -3.41; 95% CI: -5.77 to -1.05), a 3.65-point decrease in fine motor development (β = -3.65; 95% CI: -6.03 to -1.28), and a 2.96-point in language development (β = -2.96; 95% CI: -5.20 to -0.73), a 1.65-point in total development (β = -1.65; 95% CI: -3.17 to -0.14) compared with those who were vaginal birth. CONCLUSION In our study population, cesarean section was associated with overweight and neurodevelopment outcomes. The cesarean section might increase the likehood of infant overweight, and might decrease the developmental scores of gross motor, fine motor and language. Further studies should be conducted to verify the associations and explore the possible mechanisms.
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Affiliation(s)
- Xiaoguo Zheng
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Ruili Li
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Lihong Wang
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Huimin Yang
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Linlin Li
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Jiayin Cui
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuying Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bowen Chen
- Department of Children Health and Development, Capital Institute of Pediatrics, Beijing, China
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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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Ralphs E, Pembrey L, West J, Santorelli G. Association between mode of delivery and body mass index at 4-5 years in White British and Pakistani children: the Born in Bradford birth cohort. BMC Public Health 2021; 21:987. [PMID: 34039335 PMCID: PMC8152119 DOI: 10.1186/s12889-021-11009-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, it is becoming more common for pregnant women to deliver by caesarean section (CS). In 2020, 31% of births in England were CS, surpassing the recommended prevalence of CS. Concerns have been raised regarding potential unknown consequences of this mode of delivery. Childhood adiposity is also an increasing concern. Previous research provides inconsistent conclusions on the association between CS and childhood adiposity. More studies are needed to investigate the consequences of CS in different populations and ethnicities. Therefore, this study investigates the association between mode of delivery and BMI, in children of 4-5 years and if this differs between White British (WB) and Pakistani ethnicities, in Bradford UK. METHODS Data were obtained from the Born in Bradford (BiB) cohort, which recruited pregnant women at the Bradford Royal Infirmary, between 2007 and 2010. For these analyses, a sub-sample (n = 6410) of the BiB cohort (n = 13,858) was used. Linear regression models determined the association between mode of delivery (vaginal or CS) and BMI z-scores at 4-5 years. Children were categorised as underweight/healthy weight, overweight and obese, and logistic regression models determined the odds of adiposity. Effect modification by ethnicity was also explored. RESULTS Multivariable analysis found no evidence for a difference in BMI z-score between children of CS and vaginal delivery (0.005 kg/m2, 95% CI = - 0.062-0.072, p = 0.88). Neither was there evidence of CS affecting the odds of being overweight (OR = 1.05, 95% CI = 0.86-1.28, p = 0.65), or obese (OR = 0.98, 95% CI = 0.74-1.29, p = 0.87). There was no evidence that ethnicity was an effect modifier of these associations (p = 0.97). CONCLUSION Having CS, compared to a vaginal delivery, was not associated with greater adiposity in children of 4-5 years in this population. Concerns over CS increasing adiposity in children are not supported by the findings reported here using the BiB study population, of both WB and Pakistani families.
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Affiliation(s)
- Eleanor Ralphs
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Lucy Pembrey
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
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Mode of delivery, type of labor, and measures of adiposity from childhood to teenage: Project Viva. Int J Obes (Lond) 2020; 45:36-44. [PMID: 33199815 PMCID: PMC7755743 DOI: 10.1038/s41366-020-00709-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
Background: Cesarean delivery has been linked with childhood obesity. Few studies have examined if this association is attenuated if there is labor prior to delivery. The objective of this current analysis was to examine the association of cesarean vs. vaginal delivery with measures of childhood adiposity, and whether the association differs by labor type (spontaneous, induced, or absent) preceding cesarean delivery. Methods: We ascertained delivery mode and type of labor from medical records in 1443 mother-child dyads from Project Viva with adiposity measures from at least 1 follow-up visit (3369 total observations) in early childhood (median age 3.2y), mid-childhood (median 7.7y), or early teen (median 12.9y). Child adiposity outcomes were CDC age- and sex-specific body mass index (BMI) z-scores, sum of subscapular and triceps skinfold thicknesses (SS+TR; mm), and waist circumference (cm). We used linear regression models with generalized estimating equation estimates adjusted for maternal age, education, race/ethnicity, pre-pregnancy BMI, rate of gestational weight gain, and child sex and age at outcome. Results: A total of 333 (23%) women delivered via cesarean, including 155 (11%) with spontaneous labor, 74 (5%) with induced labor, 99 (7%) with no labor, and 5 (<1%) with unknown labor status. Compared to vaginal-delivered children, cesarean-delivered children had higher BMI-z (0.15, 95% CI: 0.04, 0.26); and non-significantly higher waist circumference (0.50 cm, 95% CI: −0.34, 1.34) and SS+TR (0.47 mm, 95% CI: −0.52, 1.46). Cesarean deliveries that were preceded by spontaneous labor were not associated with childhood BMI-z (0.08, 95% CI: −0.07, 0.23), waist circumference (−0.12 cm, 95% CI: −1.09, 0.85), or SS+TR (−0.25 mm, 95% CI: −1.44, 0.93), as compared to vaginal deliveries. Conclusion: Cesarean delivery was associated with higher childhood BMI-z, and although waist circumference and SS+TR trended in the same direction, these associations were not significant. Cesarean delivery preceded by spontaneous labor was not associated with adiposity outcomes.
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Abstract
BACKGROUND Caesarean section birth may be associated with overweight in childhood; however, findings to date have been inconsistent. This study explored the association of caesarean section vs. vaginal birth with childhood overweight in Vietnam. METHODS This longitudinal cohort study explored the association of delivery mode with overweight, obesity, and overweight/or obesity at 8 years of age in children (n = 1937) across 20 sites in Vietnam, using Young Lives longitudinal cohort study data. Categories were defined using BMI z-scores in relationship to the World Health Organization (WHO) reference median: overweight >1 and <2 standard deviations (SD) above WHO reference median, obese >2 SD, and overweight/or obese >1 SD. Individual questionnaire data collected sociodemographic information and pregnancy/birth information through face-to-face interviews with mothers/caregivers. Anthropometric measurements for mother and child were collected at baseline and at 8 years for children. RESULTS Adjusted multivariable logistic models revealed a twofold increase in odds at age 8 years of overweight [odds ratio (OR) = 1.8, 95% confidence interval (95% CI) 1.03-3.2, p = 0.039], obese (OR = 2.2, 95% CI 1.2-4.0, p = 0.014), or overweight/or obese (OR = 2.1, 95% CI 1.3-3.3, p = 0.002) for children born through caesarean section compared with vaginal birth. Children born through planned caesarean section (adjusted OR = 2.3, 95% CI 1.2-4.1, p < 0.001) and unplanned caesarean section (adjusted OR = 1.9, 95% CI 1.1-3.5, p = 0.03) had similar increased odds of overweight/or obesity compared with children born through vaginal birth. CONCLUSIONS These findings suggest that there may be an association between caesarean section and childhood overweight even after adjustment for confounders. Further research is needed to explore the underlying mechanisms of this finding.
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Affiliation(s)
- Tina Lavin
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia , Crawley, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia , Crawley, Australia
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Thompson AL, Houck KM, Jahnke JR. Pathways linking caesarean delivery to early health in a dual burden context: Immune development and the gut microbiome in infants and children from Galápagos, Ecuador. Am J Hum Biol 2019; 31:e23219. [PMID: 30693586 PMCID: PMC6661198 DOI: 10.1002/ajhb.23219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/29/2018] [Accepted: 12/28/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Global increases in caesarean deliveries are exposing more infants to perinatal environments that are evolutionarily novel and potentially increasing their risks for inflammatory conditions. Yet, the pathways linking caesareans to later health outcomes are not well understood, particularly in dual burden contexts. We test two of the hypothesized pathways, altered immune function and gut microbiota, which may link delivery mode to later health outcomes and test whether these associations persist when controlling for postnatal nutritional and pathogenic exposures. METHODS Data come from infants, aged 0 to 2 (n = 41), and young children, aged 2 to 11 (n = 135), from the Galápagos, Ecuador. Differences in morbidity, C-reactive protein (CRP), and gut microbiota by delivery type were tested using linear and logistic regression models adjusted for nutritional and pathogenic exposures and infant age. RESULTS Over half of infants and over 40% of children were delivered by caesarean. Morbidity and CRP did not differ between infants or children born by caesarean or vaginally. Microbial taxa abundance differed by delivery mode. Infants born by caesarean had a higher abundance of Firmicutes and a lower relative abundance of Bacteroidales. Children born by caesarean had a higher abundance of Proteobacteria and Enterobacteriales. These differences remained after adjustment for environmental exposure. CONCLUSIONS Caesarean delivery is associated with differences in gut microbiota across childhood even in this dual burden context. Our results highlight the importance of examining caesarean delivery across diverse contexts to better understand the impact of perinatal interventions on short- and longer-term health outcomes.
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Affiliation(s)
- Amanda L. Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly M Houck
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Johanna R. Jahnke
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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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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Caesarean delivery, immune function and inflammation in early life among Ecuadorian infants and young children. J Dev Orig Health Dis 2019; 10:555-562. [PMID: 30728087 DOI: 10.1017/s2040174419000047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Caesarean delivery has been linked to a number of inflammatory conditions in childhood and adolescence. Yet the mechanisms underlying these associations and their generalizability across contexts with different postnatal feeding and pathogenic exposures remain unclear. This study tests the association between delivery type and three measures of immune function, inflammation, morbidity and leukocyte proportions, in Ecuadorian infants and children aged 6 months to 2 years. Data were collected from mother-child pairs participating in a nationally representative health and nutrition survey Encuesta Nacional de Salud y Nutricion (ENSANUT-ECU) conducted in 2012. The analytic sample includes 828 mothers and infants with delivery information and measured biomarkers. Poisson regression models were used to examine the association between delivery type and markers of immune function, controlling for maternal and infant characteristics, including age, sex, sociodemographic characteristics and medical indications. 40.8% (n=338) of sample infants and children were delivered by caesarean. Compared to those born vaginally, infants born by caesarean were less likely to have elevated C-reactive protein (CRP) [CRP>2 mg/l; risk ratio (RR): 0.76, 95% confidence interval (CI): 0.58-1.00] and more likely to have illness symptoms (RR: 1.22, 95% CI: 1.01-1.46) and elevated basophils (RR: 1.83, 95% CI: 1.03-3.25). No other immune cell proportions differed by delivery type. The results suggest that differences in the perinatal exposures accompanying caesarean delivery may alter immune development and function, particularly in the inflammatory response to infection and in cells involved in the allergic response, across infancy and early childhood. Understanding the pathways linking perinatal exposures to immune development is important for preventing the development of inflammatory conditions.
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Chu S, Zhang Y, Jiang Y, Sun W, Zhu Q, Liu S, Chen C, Zhang Z, Huang B, Jiang F, Zhang J. Cesarean section and risks of overweight and obesity in school-aged children: a population-based study. QJM 2018; 111:859-865. [PMID: 30184122 DOI: 10.1093/qjmed/hcy195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obesity puts a great health burden in the world. Previous studies suggest that caesarean section (CS) may increase the risk of obesity in children, but it is still uncertain whether this association is causal or due to residual confounding by medical indication. AIM To assess the association between CS, CS without medical indications in particular and the risk of overweight and obesity in school-aged children. DESIGN Cross-sectional survey. METHODS The 2014 Shanghai Child Health, Education and Lifestyle Evaluation was a large population-based survey with cluster random probability sampling in 26 primary schools in Shanghai, China, in 2014. The mode of delivery was reported by parents. The height, weight and waist circumference of the children were measured. Logistic regression models with SURVEYLOGISTIC procedure were used to estimate the risk of childhood obesity. Pupils delivered vaginally were served as the reference group. RESULTS A total of 17 571 pupils completed this survey, and 13 724 of them who were singleton, born term and between 5 and 13 years old were included in our analysis. CS was associated with increased risks of overweight and obesity (BMI: adjusted OR = 1.28 [95%CI 1.13-1.45] and 1.44 [1.26-1.66], respectively; weight for height ratio [WHtR] >0.46: 1.33 [1.20-1.48]). Similar results were found in CS without medical indication (BMI: overweight = 1.24 [1.05-1.47], obesity = 1.43 [1.19-1.72]; WHtR > 0.46: 1.30 [1.13-1.50]). CONCLUSIONS CS overall and CS without medical indications were associated with increased risks of overweight and obesity in primary school children.
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Affiliation(s)
- S Chu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Laboratory of Respiratory Disease, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Y Zhang
- Child Health Advocacy Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Y Jiang
- Department of Developmental and Behavioral Pediatrics, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - W Sun
- Department of Developmental and Behavioral Pediatrics, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Q Zhu
- Department of Developmental and Behavioral Pediatrics, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - S Liu
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - C Chen
- Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Z Zhang
- School of Public Health, Guilin Medical University, Guilin, China
| | - B Huang
- School of Public Health, Guilin Medical University, Guilin, China
| | - F Jiang
- Department of Developmental and Behavioral Pediatrics, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - J Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Guilin Medical University, Guilin, China
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Cai M, Loy SL, Tan KH, Godfrey KM, Gluckman PD, Chong YS, Shek LPC, Cheung YB, Lek N, Lee YS, Chan SY, Chan JKY, Yap F, Ang SB. Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age. JAMA Netw Open 2018; 1:e185025. [PMID: 30646378 PMCID: PMC6324378 DOI: 10.1001/jamanetworkopen.2018.5025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Global cesarean delivery (CD) rates have more than doubled over the past 2 decades, with an increasing contribution from elective CDs. Cesarean delivery has been linked to early childhood overweight and obesity, but limited studies have examined elective and emergency CDs separately. OBJECTIVE To investigate whether elective or emergency CD was associated with risk of early childhood overweight. DESIGN, SETTING, AND PARTICIPANTS Data were drawn from the Growing Up in Singapore Toward Healthy Outcomes (GUSTO) study, an ongoing prospective mother-child birth cohort study. Participants were pregnant women aged 18 years or older with homogeneous parental ethnic background in their first trimester recruited between June 2009 and September 2010 (n = 1237) at 2 major public hospitals in Singapore. Those with type 1 diabetes or undergoing chemotherapy or psychotropic drug treatment were excluded. Data analysis commenced in October 2017. EXPOSURES Delivery mode obtained from clinical records. Elective and emergency CD examined separately against vaginal delivery as reference. MAIN OUTCOMES AND MEASURES Body mass index-for-age z scores at age 12 months calculated based on 2006 World Health Organization Child Growth Standards from infant weight and recumbent crown-heel length measurements taken between December 2010 and April 2012. High body mass index status at risk of overweight was defined as a z score of more than 1 SD and less than or equal to 2 SDs. Overweight was defined as a z score of more than 2 SDs. RESULTS Among 727 infants analyzed (51.2% [372] male), 30.5% (222) were born via CD, of which 33.3% (74) were elective. Prevalence of at risk of overweight and overweight at age 12 months was 12.2% (89) and 2.3% (17), respectively. Elective CD was significantly associated with at risk of overweight or overweight at age 12 months after adjusting for maternal ethnicity, age, education, parity, body mass index, antenatal smoking, hypertensive disorders of pregnancy, gestational diabetes, and sex-adjusted birth weight-for-gestational age (odds ratio, 2.05; 95% CI, 1.08-3.90; P = .03). The association persisted after further adjustment for intrapartum antibiotics and first 6 months infant feeding, 2 potential mediators of early childhood overweight and obesity (odds ratio, 2.02; 95% CI, 1.05-3.89; P = .04). No significant associations were found for emergency CD. Analysis with multiple imputation for missing covariates yielded similar results. CONCLUSIONS AND RELEVANCE Choice of delivery mode may influence risk of early childhood overweight. Clinicians are encouraged to discuss potential long-term implications of elective CD on child metabolic outcomes with patients who intend to have children.
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Affiliation(s)
- Meijin Cai
- Duke-NUS Medical School, Singapore, Singapore
| | - See Ling Loy
- Duke-NUS Medical School, Singapore, Singapore
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Peter D. Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yap-Seng Chong
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Yin Bun Cheung
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Ngee Lek
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Shiao-Yng Chan
- Brenner Centre for Molecular Medicine, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Seng Bin Ang
- Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Family Medicine Service, KK Women’s and Children’s Hospital, Singapore, Singapore
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Chi DL, Luu M, Chu F. A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research. J Public Health Dent 2017; 77 Suppl 1:S8-S31. [PMID: 28600842 DOI: 10.1111/jphd.12221] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/06/2017] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTIONS What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children? OBJECTIVES Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children. METHODS The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed. RESULTS Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health). CONCLUSIONS Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.
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Affiliation(s)
- Donald L Chi
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Monique Luu
- Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - Frances Chu
- Oral Health Sciences, University of Washington, Seattle, WA, USA
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Greathouse KL, Faucher MA, Hastings-Tolsma M. The Gut Microbiome, Obesity, and Weight Control in Women's Reproductive Health. West J Nurs Res 2017; 39:1094-1119. [PMID: 28303750 DOI: 10.1177/0193945917697223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The microbes residing in the human gut, referred to as the microbiome, are intricately linked to energy homeostasis and subsequently obesity. Integral to the origins of obesity, the microbiome is believed to affect not only health of the human gut but also overall health. This microbiome-obesity association is mediated through the process of energy extraction, metabolism, and cross talk between the brain and the gut microbiome. Host exposures, including diet, that potentially modify genetic predisposition to obesity and affect weight management are reviewed. The higher prevalence of obesity among women and recent evidence linking obesity during pregnancy with offspring health make this topic particularly relevant. Current limitations in microbiome research to address obesity and future advances in this field are described. Applications of this science with respect to applied nursing and overall health care in general are included, with emphasis on the reproductive health of women and their offspring.
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Affiliation(s)
- K Leigh Greathouse
- 1 Robbins College of Health and Human Science, Baylor University, Waco, TX, USA
| | - Mary Ann Faucher
- 2 Louise Harrington School of Nursing, Baylor University, Dallas, TX, USA
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Rutayisire E, Wu X, Huang K, Tao S, Chen Y, Tao F. Cesarean section may increase the risk of both overweight and obesity in preschool children. BMC Pregnancy Childbirth 2016; 16:338. [PMID: 27809806 PMCID: PMC5094065 DOI: 10.1186/s12884-016-1131-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022] Open
Abstract
Background The increase rates of cesarean section (CS) occurred at the same period as the dramatic increase of childhood overweight/obesity. In China, cesarean section rates have exponentially increased in the last 20 years and they now exceed World Health Organization (WHO) recommendation. Such high rates demand an understanding to the long-term consequences on child health. We aim to examine the association between CS and risk of overweight and obesity among preschool children. Method We recruited 9103 children from 35 kindergartens in 4 cities located in East China. Children anthropometric measurements were taken in person by trained personnel. The mode of delivery was classified as vaginal or CS, in sub-analyses we divided cesarean delivery into elective or non-elective. The mode of delivery and other parental information were self-reported by parents. Multivariate logistic regression analysis was used to examine the associations. Results In our cross-sectional study of 8900 preschool children aged 3–6 years, 67.3 % were born via CS, of whom 15.7 % were obese. Cesarean delivery was significantly associated with the risk of overweight [OR 1.24; (95 % CI 1.07–1.44); p = 0.003], and the risk of obesity [OR 1.29; (95 % CI 1.13–1.49); p < 0.001] in preschool children. After adjusted for child characteristics, parental factors and family income, the odd of overweight was 1.35 and of obesity was 1.25 in children delivered by elective CS. Conclusion The associations between CS and overweight/obesity in preschool children are influenced by potential confounders. Both children delivered by elective or non-elective CS are at increased risk of overweight/obesity. Potential consequences of CS on the health of the children should be discussed among both health care professionals and childbearing women.
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Affiliation(s)
- Erigene Rutayisire
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, 230032, China
| | - Xiaoyan Wu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, 230032, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, 230032, China
| | - Kun Huang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, 230032, China.,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, 230032, China
| | - Shuman Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, 230032, China
| | - Yunxiao Chen
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui Province, 230032, China. .,Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, 230032, China.
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Lopomo A, Burgio E, Migliore L. Epigenetics of Obesity. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2016; 140:151-84. [DOI: 10.1016/bs.pmbts.2016.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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