Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study

Bernardi, Juliana Rombaldi; Pinheiro, Tanara Vogel; Mueller, Noel T.; Goldani, Helena Ayako Sueno; Gutierrez, Manoel Romeu Pereira; Bettiol, Heloísa; Silva, Antônio Augusto Moura da; Barbieri, Marco Antônio; Goldani, Marcelo Zubarán

doi:10.3945/ajcn.114.105205

Cited by 26 publications

(25 citation statements)

References 62 publications

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“…Our findings on the association of delivery mode with childhood OWOB are consistent with a growing body of literature 9,13,15 . A meta-analysis that found Cesarean delivery increases odds of childhood overweight or obesity by approximately 30% 9 —a magnitude of association comparable to our study.…”

Section: Discussionsupporting

confidence: 92%

Does vaginal delivery mitigate or strengthen the intergenerational association of overweight and obesity? Findings from the Boston Birth Cohort

et al. 2016

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Background/Objectives The intergenerational association of obesity may be driven by mother-to-newborn transmission of microbiota at birth. Yet Cesarean delivery circumvents newborn acquisition of vaginal microbiota, and has been associated with greater childhood adiposity. Here we examined the independent and joint associations of maternal pre-pregnancy BMI (kg/m2) and delivery mode with childhood overweight or obesity. Subjects/Methods We prospectively followed 1,441 racially and ethnically diverse mother-child dyads in the Boston Birth Cohort until age 5y (range 2.0—8.0y). We used logistic regression to examine the independent and joint associations of delivery mode (Cesarean and vaginal delivery) and pre-pregnancy BMI with childhood overweight or obesity (age-sex specific BMI≥85th percentile). Results Of 1,441 mothers, 961 delivered vaginally and 480 by Cesarean. Compared to vaginally delivered children, Cesarean delivered children had 1.4 (95% CI 1.1–1.8) times greater odds of becoming overweight or obese in childhood, after adjustment for maternal age at delivery, race/ethnicity, education, air pollution exposure, pre-pregnancy BMI, pregnancy weight gain, and birth weight. Compared to children born vaginally to normal weight mothers, after multivariable adjustment, odds of childhood overweight or obesity were highest in children born by Cesarean delivery to obese mothers (OR 2.8, 95% CI 1.9–4.1), followed by children born by Cesarean delivery to overweight mothers (OR 2.2, 95% CI 1.5–3.2), then children born vaginally to obese mothers (OR 1.8, 95% CI 1.3–2.6), and finally children born vaginally to overweight mothers (OR 1.7, 95% CI, 1.2–2.3). Conclusions In our racially and ethnically diverse cohort, Cesarean delivery and pre-pregnancy overweight and obesity were associated with childhood overweight or obesity. Needed now are prospective studies that integrate measures of the maternal and infant microbiome, and other potentially explanatory covariates, to elucidate the mechanisms driving this association and to explore whether exposure to vaginal microbiota in Cesarean delivered newborns may be an innovative strategy to combat the intergenerational cycle of obesity.

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Section: Discussionsupporting

confidence: 92%

Does vaginal delivery mitigate or strengthen the intergenerational association of overweight and obesity? Findings from the Boston Birth Cohort

et al. 2016

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“…(2013) and Bernardi et al . (2015) reported increase in fat accumulation due to delivery by CS: measured by either waist-hip ratio (IRR 1.45, 95% CI 1.18-1.79) [23] or BMI (β coefficient 0.12, 95% CI 0.01-0.03) [24]. More recently, Yuan et al (2016) and Barros et al (2017) reported increased risks of obesity in CS-delivered YAs (RR 1.15, 95% CI 1.06-1.26, n= 8 486; β coefficient 0.15, 95% CI 0.08-0.23, n= 1 794, respectively) in Boston (USA) and Pelotas (Brazil) [19,26].…”

Section: Discussionmentioning

confidence: 99%

The association between caesarean section delivery and later life obesity in 21-24 year olds in an Urban South African birth cohort

Sogunle

Masukume

Nelson

2019

Preprint

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27Background: Obesity is an important public health problem and rates have reached epidemic 28 proportions in many countries. Studies have explored the association between infants delivered 29 by caesarean section and their later life risk of obesity, in many countries outside Africa. As a 30 result of the increasing caesarean section and obesity rates in South Africa, we investigated the 31 association in this country. 32Methods: This was a retrospective analysis of data that were collected from a prospective 33 South African birth cohort (Birth to Twenty Plus), established in 1990. A total of 889 young 34 adults aged 21-24 years were included in the analysis. Multiple logistic regression models were 35 fitted to assess the association between mode of delivery and early adulthood obesity. 36Results: Of the 889 young adults, 106 (11.9%) were obese while 72 (8.1%) were delivered by 37 CS; of which 14 (19.4%) were obese. Caesarean section delivery was significantly associated 38 with obesity in young adults after adjusting for potential confounders like gestational age (at 39 delivery), birth weight, sex, maternal age, parity and education (OR 1.99, 95% CI 1.00-3.94, 40 p=0.049). 41 Conclusion: The association of caesarean section with early adulthood obesity should be 42 interpreted with caution because data on certain key confounding factors such as mothers' pre-43 pregnancy body mass index and gestational diabetes were not available. Further research from 44 Africa, with larger sample sizes and databases with useful linking of maternal and infant data, 45 should be conducted.46 47 48 49 50 3 51 Introduction 52Obesity is an important public health problem and rates have reached epidemic proportions in 53 many countries -one in every five young people was estimated to be obese in 2012 in high and 54 middle income countries [1]. Globally, 39% and 13% of individuals aged 18 years and older 55 were overweight and obese, respectively, in 2016 [2]. In South Africa, the rates of overweight 56 or obesity in 2016 were higher among women (61% in women and 31% in men) [3]. Obesity 57 has been associated with adverse health outcomes such as type 2 diabetes, cardiovascular 58 disease cancer, and premature mortality, in both adults and children [4][5][6][7][8] . Diet (high energy 59 foods), physical inactivity, birth weight, genetics, and parity are commonly explored risk 60 factors of obesity [9][10][11]. Mode of delivery at birth has also been suggested to be associated 61 with obesity in later life. 63Due to the rising rates of obesity, any hypothesized risk factor, such as caesarean section (CS) 64 as a mode of child delivery, is worth exploring. Acknowledging that CSs are sometimes 65 performed to prevent birth complications, biased motives have been identified [12,13] and the 66 use of the procedure is increasing globally [14]. As many as one in three births was reported to 67 be by CS in high-income countries such as the United States of America (USA) in 2017 [15]. 68The rates of CS in South Africa in 2014, re...

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“…Children born via cesarean compared to those born vaginally are more likely to develop immune-related disorders like asthma/allergies (Black, Bhattacharya, Philip, Norman, & McLernon, 2016; Kristensen & Henriksen, 2016), inflammatory bowel disease (Kristensen & Henriksen, 2016), and obesity (Bernardi et al, 2015; Li, Zhou, & Liu, 2013; Mueller et al, 2015). Although not all of these associations are shown consistently in all studies (Bernstein et al, 2016; Black et al, 2016), these findings have led some researchers to speculate that alterations in microbiome seeding of newborns following cesarean birth may play some role in these associations between chronic disease and route of birth (Dominguez-Bello et al, 2016; Goedert, Hua, Yu, & Shi, 2014).…”

Section: Implications Of Route Of Birthmentioning

confidence: 99%

The Maternal Infant Microbiome

Dunn

Jordan

Baker

et al. 2017

McN: The American Journal of Maternal/Child Nursing

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The human microbiome plays a role in maintaining health, but is also thought to attenuate and/or exacerbate risk factors for adverse maternal-child health outcomes. The development of the microbiome begins in utero, however factors related to the labor and birth environment have been shown to influence the initial colonization process of the newborn microbiome. This “seeding” or transfer of microbes from the mother to newborn may serve as an early inoculation process with implications for the long-term health outcomes of newborns. Studies have shown that there are distinct differences in the microbiome profiles of newborns born vaginally compared to those born by cesarean. Antibiotic exposure has been shown to alter the microbial profiles of women and may influence the gut microbial profiles of their newborns. Considering that the first major microbial colonization occurs at birth, it is essential that labor and birth nurses be aware of factors that may alter the composition of the microbiome during the labor and birth process. The implications of various activities and factors unique to the labor and birth environment that may influence the microbiome of women and newborns during the labor and birth process (e.g. route of birth, antibiotic use, nursing procedures) are presented with a focus on the role of labor nurses and the potential influence of nursing activities on this process.

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Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study

Abstract: In our sample of Brazilian adults, CD was associated with higher BMI but not with other metabolic risk factors.

Cited by 26 publications

References 62 publications

Does vaginal delivery mitigate or strengthen the intergenerational association of overweight and obesity? Findings from the Boston Birth Cohort

Does vaginal delivery mitigate or strengthen the intergenerational association of overweight and obesity? Findings from the Boston Birth Cohort

The association between caesarean section delivery and later life obesity in 21-24 year olds in an Urban South African birth cohort

The Maternal Infant Microbiome

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