Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana

Abstract

The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.

Risk of Overweight and Obesity in Children under 6 Years Old Following Cesarean Delivery: A Systematic Review and Meta-analysis of Cohort Studies

“…Among these, 43 studies were excluded because of lacking data regarding overweight or obesity in children delivered by C-section, and 58 studies were excluded due to a lack of being without target participants. Thus, only 18 eligible studies [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were included in this final systematic review and metaanalysis.…”

“…Singapore [35], Canada [36], New Zealand [39], Turkey [40], Spain [41], Poland [43] and Ghana [44], respectively. These studies were published between 2014 and 2022 and their sample sizes ranged from 178 to 64,983 with a total of 125,042 children (33,551 delivered by C-section).…”

“…These studies were published between 2014 and 2022 and their sample sizes ranged from 178 to 64,983 with a total of 125,042 children (33,551 delivered by C-section). Three studies [35,40,44] used exclusively the WHO Child Growth Standards as a reference to identify overweight and obesity in children, eight studies [28][29]31,[33][34]36,[42][43] used the CDC standard, five studies [30,[37][38][39]41] used IOTF, and two studies [32,45] used the Chinese standard for preschool children. Two studies [29,32] reported only obesity, seven studies [28,[33][34][37][38][39]42] included data on overweight and obesity separately, nine [30][31][35][36][40][41][43][44][45] studies reported overweight and obesity as the whole data.…”

“…Three studies [35,40,44] used exclusively the WHO Child Growth Standards as a reference to identify overweight and obesity in children, eight studies [28][29]31,[33][34]36,[42][43] used the CDC standard, five studies [30,[37][38][39]41] used IOTF, and two studies [32,45] used the Chinese standard for preschool children. Two studies [29,32] reported only obesity, seven studies [28,[33][34][37][38][39]42] included data on overweight and obesity separately, nine [30][31][35][36][40][41][43][44][45] studies reported overweight and obesity as the whole data. Therefore, through calculation, sixteen studies had data on overweight combined with obesity, seven had overweight data, and nine had obesity data.…”

“…Pluymen et al (2016) [30], Huh et al (2017) [33], Tun et al (2018) [36], Ardic et al (2021) [40], Moreno et al (2021) [41] and Sulley et al (2022)[44]). …”