Elsevier

The Journal of Pediatrics

Volume 164, Issue 5, May 2014, Pages 1068-1073.e2
The Journal of Pediatrics

Original Article
Cesarean Delivery and Risk of Childhood Obesity

https://doi.org/10.1016/j.jpeds.2013.12.044Get rights and content

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/m2 vs 22.5 kg/m2), 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.

Section snippets

Methods

Data were analyzed from the ongoing German birth cohort LISAplus (Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood plus Air Pollution and Genetics). The design of this birth cohort study has been described previously.28 Between November 1997 and January 1999, a total of 3097 healthy full-term neonates (gestational age >37 weeks and birth weight >2500 g) were recruited from Munich, Leipzig, Wesel, and Bad Honnef. Infants with congenital

Results

Participant characteristics at each time point are summarized in the Table (available at www.jpeds.com). Approximately 17% of the children were delivered by cesarean (range at different time points, 17.01%-17.44%). At the age 2 year evaluation, the mothers who delivered by cesarean had higher mean prepregnancy BMI (23.7 kg/m2 vs 22.5 kg/m2; P < .05), mean gestational weight gain during pregnancy (15.3 kg vs 14.5 kg; P < .05), and proportion of smoking during pregnancy (19.4% vs 14.3%; P < .05),

Discussion

In a previous study, data from a birth cohort of 1255 US children suggested that cesarean delivery compared with vaginal delivery increases the risk of obesity at age 3 years (OR, 2.10; 95% CI, 1.36-3.23).10 That birth cohort was similar to ours with respect to duration of the recruitment period, inclusion criteria, and confounders considered. The OR for obesity at age 3 years in that US study is comparable with our result at 2 years (OR, 1.74; 95% CI, 1.12-2.70); however, no follow-up data

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  • Cited by (0)

    The LISAplus Study was supported by the Federal Ministry for Education, Science, Research, and Technology (01GI1121A), Kompetenznetz Adipositas (Competence Network Obesity), Helmholtz Zentrum Munich (former GSF), Helmholtz Centre for Environmental Research - UFZ, Leipzig, and Research Institute at Marien-Hospital Wesel, Pediatric Practice, Bad Honnef (for the first 2 years). The 4-year, 6-year, and 10-year follow-up examinations of the LISAplus Study supported by Helmholtz Zentrum Munich (former GSF), Helmholtz Centre for Environmental Research - UFZ, Leipzig, Research Institute at Marien-Hospital Wesel, Pediatric Practice, Bad Honnef, IUF – Leibniz-Research Institute for Environmental Medicine at the University of Düsseldorf, and the Federal Ministry for Environment ( IUF Düsseldorf, FKZ 20462296). This study was co-funded by the German Network of Competency on Adiposity. The authors declare no conflicts of interest.

    List of additional members of the LISAplus Study Group are available at www.jpeds.com (Appendix).

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