Association of caesarean delivery with child adiposity from age 6 weeks to 15 years

Abstract

Objectives To assess associations of caesarean section with body mass from birth through adolescence. Design Longitudinal birth cohort study, following subjects up to 15 years of age. Setting and Participants Children born in 1991–1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children [ALSPAC] (n = 10,219). Outcome measures Primary outcome: standardized measures of body mass (weight-for length z-scores at 6 weeks, 10, and 20 months; and Body Mass Index [BMI] z-scores at 38 months, 7, 9, 11, and 15 years). Secondary outcome: Categorical overweight or obese (BMI >= 85th percentile) for age and gender, at 38 months, 7, 9, 11, and 15 years. Results Of the 10,219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower birth weights than those born vaginally (−46.1g, 95% CI: 14.6 to 77.6 g; p = 0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at six weeks (+0.11 SD units, 95% CI 0.03 to 0.18; p=0.005), through age 15 (BMI z-score increment + 0.10 SD units, 95% CI 0.001 to 0.198; p=0.042). By age 11 caesarean–delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24 to 2.70; p=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal weight mothers was weak. Conclusion Caesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

Prenatal exposure to systemic antibacterials and overweight and obesity in Danish schoolchildren: a prevalence study

“…14 Exposure to antimicrobials during gestation 15 and in early life 43 may affect the postnatal metabolism by altering the composition of the 'pioneer' microbiota, ultimately leading, in some persons, to overweight or obesity. 40,44 In addition, use of antibiotics in childhood was associated with an increased risk of obesity in a recent large cohort study. 43,44 Prenatal antibacterial exposure impacts intergenerational transfer of microbiota to infants, which leads to persistent alteration in host immunity 45 and can make newborns more susceptible to infections and results in early exposure to antibiotics.…”

Intestinal microbiota and faecal transplantation as treatment modality for insulin resistance and type 2 diabetes mellitus

“…[9]. In this regard, it is interesting to note that mode of delivery (caesarean) is associated with increased risk of obesity later in life [10]. Other than the delivery mode, gestational age at birth, diet composition and antibiotic use by the infant may have significant impacts to determine the composition of the infant's intestinal microbial communities and body mass index (BMI) [11].…”

Sex differences in the gut microbiome–brain axis across the lifespan

“…As the Bifidobacterium genome contains a large cluster of genes involved in the utilization and metabolism of maternal breast milk oligosaccharides, delayed colonization by these bacteria may alter nutrient and energy availability necessary for normal growth and development [9,101,102]. The resulting differences in colonizing microbiota for vaginally and caesarean delivered children persist well into childhood and are associated with increased body mass and childhood obesity [103]. In addition, children born by caesarean section exhibit increased risk of allergies, such as allergic rhinoconjunctivitis, and this risk is highest in females born after multiple caesarean sections, paralleling well-established observations of female-biased risk in the development of allergies [104,105].…”