Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study
- Susanna Y Huh1,
- Sheryl L Rifas-Shiman2,
- Chloe A Zera3,
- Janet W Rich Edwards4,
- Emily Oken2,
- Scott T Weiss5,
- Matthew W Gillman2,6
- 1Department of Pediatrics, Harvard Medical School, and Division of Gastroenterology and Nutrition, Children's Hospital Boston, Massachusetts, USA
- 2Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
- 3Division of Maternal–Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- 4The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School and the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- 5Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- 6Department of Nutrition, Harvard School of Public Health, Boston, USA
- Correspondence to Susanna Y Huh, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA;
Contributors All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. SYH designed the research question, led data analysis and wrote the first draft of the manuscript. CAZ participated in data collection. SRS conducted the statistical analysis. MWG participated in the study design, obtained funding, and directed study operations. All authors contributed to data interpretation and to critical revision of the manuscript and approved the final version. SYH is the guarantor.
- Accepted 26 March 2012
- Published Online First 23 May 2012
Objective To examine whether delivery by caesarean section is a risk factor for childhood obesity.
Design Prospective prebirth cohort study (Project Viva).
Setting Eight outpatient multi-specialty practices based in the Boston, Massachusetts area.
Participants We recruited women during early pregnancy between 1999 and 2002, and followed their children after birth. We included 1255 children with body composition measured at 3 years of age.
Main outcome measures BMI score, obesity (BMI for age and sex ≥95th percentile), and sum of triceps plus subscapular skinfold thicknesses at 3 years of age.
Results 284 children (22.6%) were delivered by caesarean section. At age 3, 15.7% of children delivered by caesarean section were obese compared with 7.5% of children born vaginally. In multivariable logistic and linear regression models adjusting for maternal prepregnancy BMI, birth weight, and other covariates, birth by caesarean section was associated with a higher odds of obesity at age 3 (OR 2.10, 95% CI 1.36 to 3.23), higher mean BMI z-score (0.20 units, 95% CI 0.07 to 0.33), and higher sum of triceps plus subscapular skinfold thicknesses (0.94 mm, 95% CI 0.36 to 1.51).
Conclusions Infants delivered by caesarean section may be at increased risk of childhood obesity. Further studies are needed to confirm our findings and to explore mechanisms underlying this association.
Competing interests None.
Funding This work was supported by NIH grants R01HD034568, R01HD064925 and K24HL068041. 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.
Provenance and peer review Not commissioned; externally peer reviewed.