Changzheng Yuan, ScD et al
JAMA Pediatr. Published online September 06, 2016.
Reviewed by Virginia Hatton
In 2013 the film Microbirthdrew attention to the growing research on caesarean birth and obesity. Now a study published in July 2016 in the Journal of the American Medical Association Pediatrics provides more evidence to support this association. Researchers used data from the Growing Up Today Study, a prospective cohort study conducted from 1996-2012. The study included 22068 children born to 15271 women.,Information was collected from the women via questionnaire when children were aged 9–14 through ages 20–28. The study used a larger sample size than similar previous studies in Germany and Canada which failed to demonstrate a statistical significance in the increased risk of obesity after caesarean birth.
This study was designed to account for potential confounders which had not been included in previous studies on this subject, particularly maternal pregnancy BMI, but also pre-pregnancy smoking and duration of breastfeeding. The study did not investigate lifestyle and behaviour factors for obesity because none precede both exposure (in this case birth by caesarean) and outcome (risk of obesity). Importantly, the study data lacked details of the specific reasons for caesareans, whether women laboured at all, what other interventions were used during labour and birth, such as artificial rupture of membranes, and antibiotic use during pregnancy or labour and delivery. It is also difficult to apply the findings of the study to the general population as the mothers were all nurses participating in a long-term health study (Nurses’ Health Study II) and the authors noted that minorities were underrepresented.
The study found that individuals born by caesarean were 15% more likely to become obese during follow-up than those born vaginally. This association was stronger (30% increased risk) among individuals without known risk factors for caesarean section (risk factors included maternal pre-pregnancy raised BMI, gestational diabetes, hypertensive disorders, smoking, advanced maternal age, gestational age at birth, and birth weight). Vaginal birth after caesarean birth was associated with a 31% lower risk of individuals being obese compared with those born via repeat caesarean delivery. The within-family analysis showed that those born via caesarean had 64% higher odds of obesity compared with their siblings born vaginally.
This study was limited to examining the association between caesarean birth and obesity, however it did point to the growing evidence that higher risk of obesity associated with caesarean birth may be a consequence of differences in gastro-intestinal microbiota established at birth. Whether differences in microbiota in individuals are sustained long-term remains to be evaluated.
Additional research is still necessary to address whether increased rates of obesity translate to increased risk of adverse cardio-metabolic outcomes such as diabetes, heart disease or stroke among individuals born by caesarean.
AIMS Journal, 2017, Vol 29 No 3 A huge welcome to readers old and new! The AIMS Journal, the backbone of our work for nearly 60 years, is now entirely available online, t…Read more
AIMS Journal, 2017, Vol 29 No 3 Jo Dagustun reports on the INFANT trial study day in October 2017 This national (central Birmingham based) free-to-attend study day on the…Read more
AIMS Journal, 2017, Vol 29 No 3 Ann Roberts shares her story of how AIMS helped her back in 1983 I first contacted AIMS 34 years ago (1983), when I was pregnant with my s…Read more
To register your interest please email firstname.lastname@example.org or keep an eye on our website https://www.npeu.ox.ac.uk/mbrrace-uk/bookings . Earlybird bookings will open…Read more
17–21 October 2018 Further DetailsRead more
AIMS AGM 2018 All members welcome! Please email email@example.com if you plan to attend to help us to judge numbers, or if you wish to send apologies 10 for 10.30 sta…Read more
Dr. Ágnes Geréb is a Hungarian obstetrician and midwife who has been under house arrest following her support for women outside of the obstetric system. March 2018: ENCA…Read more
AIMS submitted our response to this consultation on the 23 January 2018. A number of regulators, including the Care Quality Commission (CQC), the Professional Standards A…Read more
Beverley Lawrence Beech At an AIMS AGM it is customary for the Chair to give an account of the activities of the Committee during the year. I am not going to do that this…Read more