Elective and nonelective cesarean section and obesity among young adult male offspring: A Swedish population–based cohort study

Ahlqvist, Viktor H.; Persson, Margareta; Magnusson, Cecilia; Berglind, Daniel

doi:10.1371/journal.pmed.1002996

Cited by 31 publications

(46 citation statements)

References 68 publications

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“…Basing on the obtained results the issue of the participation of the microbiota in the development of obesity should be further discussed [51]. Ahlqvist, et al [78] found no evidence of an association between elective or nonelective cesarean section and young adulthood obesity in young male conscripts when accounting for maternal and paternal factors (relative risk ratio RRR = 0.96; CI 95% 0.83-1.10). Authors suggested there is no clinically relevant association between cesarean section and the development of obesity.…”

Section: Discussionmentioning

confidence: 97%

“…A summary of the search process is illustrated in Figure 2, as recommended by the PRISMA guidelines [90]. Due to sufficient data regarding the occurrence of respiratory tract infections, asthma, overweight/obesity as well as diabetes mellitus type 1, 16 articles [11,20,67,68,[70][71][72][73][74][75][76][77][78][79][80][81]85,86,88,89] were included in the meta-analysis. for those citations considered potentially relevant and assessed for eligibility by the two researchers.…”

Section: Study Selection Processmentioning

confidence: 99%

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Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis

Słabuszewska-Jóźwiak

Szymański

Ciebiera

et al. 2020

IJERPH

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Background: Cesarean section is a surgical procedure, which is the most frequently performed in gynecology and obstetrics. It is commonly believed that an operative delivery is a less painful and safer mode of delivery, which translates into an increasing number of the procedures performed without medical indications. The maternal sequelae of cesarean sections are well elucidated and widely discussed in the literature, while long-term neonatal consequences still remain the issue of research and scientific dispute. The aim of the present paper was to perform a systematic review of current literature regarding pediatrics consequences of cesarean section. Methods: We reviewed available data from PubMed, Science Direct as well as Google Scholar bases concerning early and long-term neonatal sequelae of operative deliveries. The following key words were used: “cesarean section”, “caesarean section”, “neonatal outcomes”, “respiratory disorders”, “asthma”, “obesity”, “overweight”, and “neurological disorders”. A total of 1636 papers were retrieved out of which 27 were selected for the final systematic review whereas 16 articles provided data for meta-analysis. Statistical analyses were performed using RevMan 5.4. To determine the strength of association between the caesarean section and respiratory tract infections, asthma, diabetes type 1 as well as obesity the pooled odds ratios (OR) with the 95% confidence intervals (CI) were calculated. Results: Conducted meta-analyses revealed that caesarean section is a risk factor for respiratory tract infections (pooled OR = 1.30 95%CI 1.06–1.60, p = 0.001), asthma (pooled OR = 1.23 95%CI 1.14–1.33, p < 0.00001) as well as obesity (pooled OR = 1.35 95%CI 1.29–1.41, p < 0.00001) in offspring. Conclusions: The results of the studies included indicated that children delivered by cesarean section more commonly developed respiratory tract infections, obesity and the manifestations of asthma than children delivered vaginally. The risk of developing diabetes mellitus type 1 or neurological disorders in offspring after caesarean section is still under discussion.

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Section: Discussionmentioning

confidence: 97%

Section: Study Selection Processmentioning

confidence: 99%

Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis

Słabuszewska-Jóźwiak

Szymański

Ciebiera

et al. 2020

IJERPH

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“…Two previous studies were conducted with male individuals in late adolescence, verifying an association among cesarean delivery and obesity measured by BMI: Bar-Meir et al 27 evaluated 17,003 17-year-olds individuals in West Jerusalem, and Svensson et al 28 studied 21,051 18-year-old individuals in Denmark. Two other studies were found that did not verify this association: Barros et al 5 who studied fat mass index assessed by DXA in 3961 adolescents aged 18 years in the city of Pelotas in Rio Grande do Sul, Brazil, and the study by Ahlqvist et al 29 who studied BMI in 97,291 men with an average age of 18 years from Sweden. These studies do not point to a consensus.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies on the association between cesarean delivery and obesity have been done including children 4,5,6,17,32,33,34,35,36,37,38 and adults 5,16,39,40,41 . Some studies have been carried out including adolescent individuals 4,5,6,17,42 , but there are few studies conducted with individuals in their late adolescence 4,5,27,29 . This study was carried out with people in this age group because they have already gone through the growth stage and are no longer under the hormonal effects of adolescence, which provide greater deposition of adipose tissue 43 .…”

Section: Discussionmentioning

confidence: 99%

Birth by cesarean delivery and central adiposity in adolescents from a birth cohort

Abreu

Bragança

et al. 2021

Cad. Saúde Pública

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The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.

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“…On the other, maternal medical histories of CS are associated with persistent severe obstetric risks in later pregnancies as well as with an excess maternal morbidity burden 9 – 17 . Epidemiological studies have shown associations between birth by CS with excess risks of a range of offspring morbidities each capable of adversely impacting cardiorespiratory fitness (CRF) later in life 10 , 18 – 23 . If CS is a causal factor in such morbidities, it is possible that CS would impact CRF.…”

Section: Introductionmentioning

confidence: 99%

The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males

Ekström

Ahlqvist

Persson

et al. 2020

Sci Rep

Self Cite

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Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. Swedish males born by cesarean section achieved lower mean Watt-maximum (− 2.32 W, 95%C.I. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. In the sub-population, males born 1982–1987, there was a greater negative association of elective cesarean section with cardiorespiratory fitness (− 4.42 W, 95%C.I. − 6.27 to − 2.57, p < 0.001) than non-elective cesarean sections (− 1.96 W, 95%C.I. − 3.77 to − 0.16, p = 0.033) as compared to vaginal births. No associations between modes of cesarean delivery and cardiorespiratory fitness levels persisted in the within-family analyses where biological male siblings were compared whilst controlling for factors shared within families. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally. These findings appear to be largely explained by factors of familial confounding.

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Elective and nonelective cesarean section and obesity among young adult male offspring: A Swedish population–based cohort study

Cited by 31 publications

References 68 publications

Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis

Pediatrics Consequences of Caesarean Section—A Systematic Review and Meta-Analysis

Birth by cesarean delivery and central adiposity in adolescents from a birth cohort

The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males

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