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.

Sheryl L Rifas-Shiman, Susanna Y Huh, Richard M Martin, Michael Kramer, Rita Patel, Natalia Bogdanovich, Konstanin Vilchuck, Jennifer Thompson, Emily Oken

Journal: Pediatric obesity 2021;16(9):e12783

PMID: 33660413

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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/m ), 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/m ; 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.

Address: Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.; 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.; Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.; Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.; Department of Obstetrics, National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus.

DOI: 10.1111/ijpo.12783