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

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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/m2), 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/m2; 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.
Original languageEnglish
Article numbere12783
Number of pages9
JournalPediatric Obesity
Volume16
Issue number9
Early online date3 Mar 2021
DOIs
Publication statusPublished - Sep 2021

Bibliographical note

Funding Information:
We thank the staff and participants of PROBIT. We thank Tom Palmer (Warwick Medical School, University of Warwick, U.K.) for statistical advice. This study was supported by grants from: the European Union, Early Nutrition Programming Long-term Efficacy and Safety Trials (FOODDT-2005-007036); Canadian Institutes of Health Research (MOP-53155); and US National Institutes of Health (R01 HD050758). Dr. Oken was supported by the US National Institutes of Health (K24 HD069408 and P30 DK092924). Dr. Martin works within the Integrative Epidemiology Unit, which is supported by the Medical Research Council and the University of Bristol. The NIHR Bristol Biomedical Research Centre is funded by the National Institute for Health Research (NIHR) and is a partnership between University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The sponsors of the study had no role in the study design, recruitment of participants, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication. Sheryl Rifas-Shiman, Susanna Huh, Jennifer Thompson and Emily Oken report grants from U.S. National Institutes of Health during the conduct of the study. Natalia Bogdanovich, and Konstanin Vilchuck report grants from U.S. National Institutes of Health and Canadian Institute for Health Research during the conduct of the study.

Publisher Copyright:
© 2021 World Obesity Federation

Keywords

  • body mass index
  • caesarean section
  • child
  • mode of delivery
  • obesity

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