The association between caesarean section delivery and later life obesity in 21-24 year olds in an Urban South African birth cohort.
ABSTRACT: BACKGROUND:Obesity is an important public health problem and rates have reached epidemic proportions in many countries. Studies have explored the association between infants delivered by caesarean section and their later life risk of obesity, in many countries outside Africa. As a result of the increasing caesarean section and obesity rates in South Africa, we investigated the association in this country. METHODS:This was a retrospective analysis of data that were collected from a prospective South African birth cohort (Birth to Twenty Plus), established in 1990. A total of 889 young adults aged 21-24 years were included in the analysis. Poisson regression models were fitted to assess the association between mode of delivery and early adulthood obesity. RESULTS:Of the 889 young adults, 106 (11.9%) were obese while 72 (8.1%) were delivered by caesarean section; of which 14 (19.4%) were obese. Caesarean section delivery was significantly associated with obesity in young adults after adjusting for potential confounders like young adults' sex and birth weight, mothers' parity, and education (incidence rate ratio 1.64, 95% CI 1.01-2.68, p = 0.045). CONCLUSION:The association of caesarean section with early adulthood obesity should be interpreted with caution because data on certain key confounding factors such as mothers' pre-pregnancy body mass index and gestational diabetes were not available. Further research from Africa, with larger sample sizes and databases with useful linking of maternal and infant data, should be conducted.
Project description:Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and family-related (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36-3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02-2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.
Project description:OBJECTIVE:To examine the impact of caesarean section on breastfeeding indicators-early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once)-in sub-Saharan Africa. DESIGN:Secondary analysis of Demographic and Health Surveys (DHS). SETTING:Thirty-three low-income and middle-income countries with a survey conducted between 2010 and 2017/2018. PARTICIPANTS:Women aged 15-49 years with a singleton live last birth during the 2 years preceding the survey. MAIN OUTCOME MEASURES:We analysed the DHS data to examine the impact of caesarean section on breastfeeding indicators using the modified Poisson regression models for each country adjusted for potential confounders. For each breastfeeding indicator, the within-country adjusted prevalence ratios (aPR) were pooled in random-effects meta-analysis. RESULTS:The within-country analyses showed, compared with vaginal birth, caesarean section was associated with aPR for early initiation of breastfeeding that ranged from 0.24 (95% CI 0.17 to 0.33) in Tanzania to 0.89 (95% CI 0.78 to 1.00) in South Africa. The aPR for exclusive breastfeeding under 6 months ranged from 0.58 (95% CI 0.34 to 0.98) in Angola to 1.93 (95% CI 0.46 to 8.10) in Cote d'Ivoire, while the aPR for children ever breastfed ranged from 0.91 (95% CI 0.82 to 1.02) in Gabon to 1.02 (95% CI 0.99 to 1.04) in Gambia. The meta-analysis showed caesarean section was associated with a 46% lower prevalence of early initiation of breastfeeding (pooled aPR, 0.54 (95% CI 0.48 to 0.60)). However, meta-analysis indicated little association with exclusive breastfeeding under 6 months (pooled aPR, 0.94 (95% CI 0.88 to 1.01)) and children ever breastfed (pooled aPR, 0.98 (95% CI 0.98 to 0.99)) among caesarean versus vaginally born children. CONCLUSIONS:Caesarean section had a negative influence on early initiation of breastfeeding but showed little difference in exclusive breastfeeding under 6 months and children ever breastfed in sub-Saharan Africa.
Project description:OBJECTIVE:To examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016. DESIGN:Secondary analysis of Ethiopian Demographic and Health Surveys. SETTING:All administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016. PARTICIPANTS:Women aged 15-49 years with a live birth during the 5 years preceding the survey. MAIN OUTCOME MEASURES:We analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the 'Three Delays Model' to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia. RESULTS:The adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths. CONCLUSIONS:A naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.
Project description:It is relatively less known whether pre-pregnancy obesity and excess gestational weight gain (GWG) are associated with caesarean delivery, pregnancy complications, preterm birth, birth and placenta weights and increased length of postnatal hospital stay.We used a population-based cohort of 6632 women who gave birth in Brisbane, Australia, between 1981 and 1983. The independent associations of pre-pregnancy obesity, GWG and institute of medicine (IOM) categories of combined pre-pregnancy BMI and GWG with outcomes were examined using multivariable regression (for continuous outcomes) and multivariable multinomial regression (for categorical outcomes) models.We found women who were obese prior to pregnancy and women who gained excess weight during pregnancy were at greater risk for a pregnancy complications (OR: 2.10; 1.74, 2.54; age adjusted model), caesarean section (OR 1.29; 1.09, 1.54), higher birth weight difference (206.45 gm; 178.82, 234.08) and greater placental weight difference (41.16 gm; 33.83, 48.49) and longer length of hospital stay. We also found that mothers who gained inadequate weight or were underweight before pregnancy were at greater risk of preterm birth (2.27; 1.71, 3.00), lower risk of pregnancy complications (0.58; 0.44, 0.77) and had lower birth (-190.63;-221.05,-160.20) and placental (-37.16; -45.23,-29.09) weights. Results indicate that all associations remain consistent after adjustment for a range of potential confounding factors with the exception of the association between pre-pregnancy obesity and hospital stay.Pre-pregnancy obesity or excessive GWG are associated with greater risk of pregnancy complications, caesarean delivery and greater birth and placenta weight. Excess GWG is associated with a longer stay in hospital after delivery, independent of pre-pregnancy BMI, pregnancy complications and caesarean delivery. In addition to pre-pregnancy obesity, it is vital that clinical practice considers excess GWG as another indicator of adverse pregnancy outcomes.
Project description:BACKGROUND:Previous studies have suggested that cesarean section (CS) is associated with offspring overweight and obesity. However, few studies have been able to differentiate between elective and nonelective CS, which may differ in their maternal risk profile and biological pathway. Therefore, we aimed to examine the association between differentiated forms of delivery with CS and risk of obesity in young adulthood. METHODS AND FINDINGS:Using Swedish population registers, a cohort of 97,291 males born between 1982 and 1987 were followed from birth until conscription (median 18 years of age) if they conscripted before 2006. At conscription, weight and height were measured and transformed to World Health Organization categories of body mass index (BMI). Maternal and infant data were obtained from the Medical Birth Register. Associations were evaluated using multinomial and linear regressions. Furthermore, a series of sensitivity analyses were conducted, including fixed-effects regressions to account for confounders shared between full brothers. The mothers of the conscripts were on average 28.5 (standard deviation 4.9) years old at delivery and had a prepregnancy BMI of 21.9 (standard deviation 3.0), and 41.5% of the conscripts had at least one parent with university-level education. Out of the 97,291 conscripts we observed, 4.9% were obese (BMI ? 30) at conscription. The prevalence of obesity varied slightly between vaginal delivery, elective CS, and nonelective CS (4.9%, 5.5%, and 5.6%, respectively), whereas BMI seemed to be consistent across modes of delivery. We found no evidence of an association between nonelective or elective CS and young adulthood obesity (relative risk ratio 0.96, confidence interval 95% 0.83-1.10, p = 0.532 and relative risk ratio 1.02, confidence interval 95% 0.88-1.18, p = 0.826, respectively) as compared with vaginal delivery after accounting for prepregnancy maternal BMI, maternal diabetes at delivery, maternal hypertension at delivery, maternal smoking, parity, parental education, maternal age at delivery, gestational age, birth weight standardized according to gestational age, and preeclampsia. We found no evidence of an association between any form of CS and overweight (BMI ? 25) as compared with vaginal delivery. Sibling analysis and several sensitivity analyses did not alter our findings. The main limitations of our study were that not all conscripts had available measures of anthropometry and/or important confounders (42% retained) and that our cohort only included a male population. CONCLUSIONS:We found no evidence of an association between elective or nonelective CS and young adulthood obesity in young male conscripts when accounting for maternal and prenatal factors. This suggests that there is no clinically relevant association between CS and the development of obesity. Further large-scale studies are warranted to examine the association between differentiated forms of CS and obesity in young adult offspring. TRIAL REGISTRATION:Registered as observational study at ClinicalTrials.gov Identifier: NCT03918044.
Project description:INTRODUCTION:Multiple chemical sensitivity (MCS) is characterized by recurrent nonspecific symptoms that are attributed to exposure to trace levels of environmental agents. Although the clinical symptoms of MCS have been described in several studies, the risk factors for this condition remain unclear. Our aim was to clarify the risk factors for MCS and the association between MCS and birth by caesarean section. METHODS:We conducted a nationwide case-control study of Japanese individuals (aged 20-65?years) with physician-diagnosed MCS (183 cases) and without MCS (345 controls). The study participants were selected from among 150,000 people in a web-based research panel with approximately 1,000,000 registrants. They completed an online survey including questions on their sociodemographic characteristics, birth history (i.e., birth by caesarean section), and other potential risk factors for MCS. Multivariate logistic regression analysis was employed to determine the association between sociodemographic characteristics and the risk of MCS. RESULTS:The proportions of case and control subjects who were born by caesarean section were 39.9 and 7.0%, respectively. The association between birth by caesarean section and MCS was significant even after adjusting for potential confounders (adjusted odds ratio: 6.15; 95% confidence interval: 3.13-12.1). A history of agricultural work, mouth breathing, ?11 vaccinations in the past 10?years, and residing in a new home (<?1?year-old) ?3 times were also significantly associated with MCS. CONCLUSION:Our data indicate an epidemiological link between MCS and birth by caesarean section. Moreover, we show that factors other than chemical exposure may be associated with the development of MCS.
Project description:Negative birth experiences can lead to symptoms of post-traumatic stress disorder in new mothers but have received much less attention in new fathers. A sample of 314 first-time expectant couples rated their symptoms of anxiety and depression in the third trimester and at 4-month post birth (227 vaginal delivery, 87 caesarean section), when they also completed the emotional memories subscale of the BirthMARQ (Foley et al. BMC Pregnancy Childbirth, 14, 211, 2014). We first examined mode of delivery (vaginal birth versus caesarean section) as a predictor of mothers' and fathers' BirthMARQ scores. Next, we used actor-partner interdependence model (APIM) to investigate intra- and interpersonal associations between birth experiences and maternal/paternal latent factors for antenatal and postnatal depression/anxiety. Reports of negative birth experiences were more common for mothers than fathers and for parents of babies born by caesarean section than by vaginal delivery. Within-couple agreement was moderately strong and, for both parents at both time-points, individual differences in negative birth memories were associated with symptoms of depression and anxiety. Negative birth memories also played a mediating role in the association between birth via caesarean section and reduced postnatal maternal wellbeing. Given the striking similarities between mothers and fathers in links between birth experiences and wellbeing, our findings highlight the need for partner-inclusive intervention strategies.
Project description:OBJECTIVE: Obesity and increases in body weight in adults are considered to be among the most important risk factors for type 2 diabetes. Low birth weight is also associated with a higher diabetes incidence. We aimed to examine to what extent the evolution of body shape, from childhood to adulthood, is related to incident diabetes in late adulthood. RESEARCH DESIGN AND METHODS: Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) is a cohort study of French women born in 1925-1950 and followed by questionnaire every 2 years. At baseline, in 1990, women were asked to report their current weight, height, and body silhouette at various ages. Birth weight was recorded in 2002. Cases of diabetes were self-reported or obtained by drug reimbursement record linkage and further validated. RESULTS: Of the 91,453 women who were nondiabetic at baseline, 2,534 developed diabetes over the 15 years of follow-up. Birth weight and body silhouette at 8 years, at menarche, and in young adulthood (20-25 years) were inversely associated with the risk of diabetes, independently of adult BMI during follow-up (all P(trend) < 0.001). In mid-adulthood (35-40 years), the association was reversed, with an increase in risk related to a larger body silhouette. An increase in body silhouette from childhood to mid-adulthood amplified the risk of diabetes. CONCLUSIONS: Low birth weight and thinness until young adulthood may increase the risk of diabetes, independently of adult BMI during follow-up. Young women who were lean children should be especially warned against weight gain.
Project description:This study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes. Population-based register study. National registers of Denmark and Sweden. A total of 5 523 365 children born in Denmark (1977-2008) and Sweden (1973-2006).Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively. In this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95%?CI 1.64 to 1.90); low birth weight (RRR 1.84, 95%?CI 1.69 to 2.01); low Apgar score (OR 1.36, 95%?CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95%?CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95%?CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95%?CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95%?CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95%?CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95%?CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95%?CI 0.91 to 0.98). Results suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.
Project description:BACKGROUND: Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. METHODS: Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. DISCUSSION: This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.