Skip to main content
SpringerLink
Log in

Cesarean section and the risk of overweight in grade 6 children

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

We examined the relationship between cesarean section (C-section) and the risk of overweight and obesity in children in grade 6 (mean age, 11.92 years; standard deviation = 0.34). Data from phase I through phase III of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used. Children with complete data from 1991 through 2004 were included in this study (n = 917). Multiple logistic regression analyses were used to adjust for potential confounding and to evaluate the association of C-section and childhood overweight and obesity. Compared to children delivered vaginally, children delivered by C-section had approximately twice the likelihood of being overweight (odds ratio (OR) = 1.86, 95 % confidence interval (CI) = 1.27–2.73) or obese (OR = 1.87, 95 % CI = 1.19–2.95). However, when examined according to sex, males delivered by C-section had an increased risk for being overweight (OR = 1.78, 95 % CI = 1.01–3.12) and obese (OR = 2.58, 95 % CI = 1.36–4.88), while females had an increased risk only for being overweight (OR = 1.99, 95 % CI = 1.17–3.39). Conclusion: C-section was associated with an increased risk of overweight and obesity in children in grade 6, but the relationship differed according to gender. Further longitudinal studies are warranted to examine the long-term effect of delivery mode on the risk of childhood overweight.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CATCH:

Child and Adolescent Trial for Cardiovascular Health

CDC:

Centers for Disease Control and Prevention

CI:

Confidence interval

C section:

Cesarean section

NICHD:

National Institute of Child Health and Human Development

OR:

Odds ratio

SAPAC:

Self-Administered Physical Activity Checklist

SECCYD:

Study of Early Child Care and Youth Development

References

  1. Agras WS, Hammer LD, McNicholas F, Kraemer HC (2004) Risk factors for childhood overweight: a prospective study from birth to 9.5 years. J Pediatr 145:20–25

    Article  PubMed  Google Scholar 

  2. Ajslev TA, Andersen CS, Gamborg M, Sørensen TI, Jess T (2011) Childhood overweight after establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early administration of antibiotics. Int J Obes 35:522–529

    Article  CAS  Google Scholar 

  3. Barros FC, Matijasevich A, Hallal PC et al (2012) Cesarean section and risk of obesity in childhood, adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts. Am J Clin Nutr 95:465–470

    Article  PubMed  CAS  Google Scholar 

  4. Betrán AP, Merialdi M, Lauer JA et al (2007) Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 21:98–113

    Article  PubMed  Google Scholar 

  5. Cardwell CR, Stene LC, Joner G et al (2008) Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 51:726–735

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control and Prevention (2011) National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. U.S. Department of Health and Human Services, Atlanta

  7. Daniels SR, Arnett DK, Eckel RH et al (2005) Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 111:1999–2002

    Article  PubMed  Google Scholar 

  8. Decker E, Engelmann G, Findeisen A et al (2010) Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 125:e1433–e1440

    Article  PubMed  Google Scholar 

  9. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241

    Article  PubMed  CAS  Google Scholar 

  10. Freedman DS, Khan LK, Serdula MK et al (2005) The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics 115:22–27

    PubMed  Google Scholar 

  11. Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH (2007) Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 150:12–17

    Article  PubMed  Google Scholar 

  12. Gillman MW, Rifas-Shiman SL, Kleinman K, Oken E, Rich-Edwards JW, Taveras EM (2008) Developmental origins of childhood overweight: potential public health impact. Obesity (Silver Spring) 16:1651–1656

    Article  Google Scholar 

  13. Goldani HA, Bettiol H, Barbieri MA et al (2011) Cesarean delivery is associated with an increased risk of obesity in adulthood in a Brazilian birth cohort study. Am J Clin Nutr 93:1344–1347

    Article  PubMed  CAS  Google Scholar 

  14. Grönlund MM, Lehtonen OP, Eerola E, Kero P (1999) Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr 28:19–25

    Article  PubMed  Google Scholar 

  15. Hamilton BE, Martin JA, Ventura SJ (2010) Births: preliminary data for 2009. National vital statistics report. National Center for Health, Hyattsville

    Google Scholar 

  16. Huh SY, Rifas-Shiman SL, Zera CA et al (2012) Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study. Arch Dis Child 97:610–616

    Article  PubMed  Google Scholar 

  17. Huurre A, Kalliomaki M, Rautava S, Rinne M, Salminen S, Isolauri E (2008) Mode of delivery effects on gut microbiota and humoral immunity. Neonatol 93:236–240

    Article  Google Scholar 

  18. Kalliomäki M, Collado MC, Salminen S, Isolauri E (2008) Early differences in fecal microbiota composition in children may predict overweight. Am J Clin Nutr 87:534–538

    PubMed  Google Scholar 

  19. Kamath BD, Todd JK, Glazner JE, Lezotte D, Lynch AM (2009) Neonatal outcomes after elective cesarean delivery. Obstet Gynecol 113:1231–1238

    PubMed  Google Scholar 

  20. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D (2007) Assessment of child and adolescent overweight and obesity. Pediatrics 120(Suppl 4):S193–228

    Article  PubMed  Google Scholar 

  21. Kuczmarski RJ, Ogden CL, Guo SS et al (2002) 2000 CDC growth charts for the United States: methods and development. Natl Cent Health Stat Vital Health Stat 11(246):1–190

    Google Scholar 

  22. Kushi LH, Byers T, Doyle C et al (2006) American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 56:254–281

    Article  PubMed  Google Scholar 

  23. Li C, Ford ES, Zhao G, Mokdad AH (2009) Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among US adolescents: NHANES 2005–2006. Diabetes Care 32:342–347

    Article  PubMed  Google Scholar 

  24. Luoto R, Kalliomäki M, Laitinen K et al (2011) Initial dietary and microbiological environments deviate in normal-weight compared to overweight children at 10 years of age. J Pediatr Gastroenterol Nutr 52:90–95

    Article  PubMed  Google Scholar 

  25. Modi N, Steer P (2009) Elective caesarean sections—risks to infants. Lancet 374:665–667

    Article  Google Scholar 

  26. National Institute of Child Health and Human Development Early Child Care Research Network (2001) Child care and common communicable illnesses: results from the National Institute of Child Health and Human Development Study of Early Child Care. Arch Pediatr Adolesc Med 155(4):481–488

    Article  Google Scholar 

  27. Neu J, Rushing J (2011) Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clin Perinatol 38:321–331

    Article  PubMed  Google Scholar 

  28. Office of the Surgeon General (2010) The surgeon general's vision for a healthy and fit nation. U.S. Department of Health and Human Services, Rockville

    Google Scholar 

  29. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM (2010) Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 303:242–249

    Article  PubMed  CAS  Google Scholar 

  30. Ogden CL, Kuczmarski RJ, Flegal KM et al (2002) Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45–60

    Article  PubMed  Google Scholar 

  31. Oken E, Gillman MW (2003) Fetal origins of obesity. Obes Res 11:496–506

    Article  PubMed  Google Scholar 

  32. Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW (2007) Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol 196(4):e1–8, 322

    Article  PubMed  Google Scholar 

  33. Penders J, Thijs C, Vink C et al (2006) Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118:511–521

    Article  PubMed  Google Scholar 

  34. Perry CL, Stone EJ, Parcel GS et al (1990) School-based cardiovascular health promotion: child and adolescent trial for cardiovascular health. J Sch Health 60:406–413

    Article  PubMed  CAS  Google Scholar 

  35. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  36. Reilly JJ, Armstrong J, Dorosty AR et al (2005) Early life risk factors for obesity in childhood: cohort study. BMJ 330:1357

    Article  PubMed  Google Scholar 

  37. Reilly JJ, Methven E, McDowell Z et al (2003) Health consequences of obesity. Arch Dis Child 88:748–752

    Article  PubMed  CAS  Google Scholar 

  38. Reinhardt C, Reigstad CS, Bäckhed F (2009) Intestinal microbiota during infancy and its implications for obesity. J Pediatr Gastroenterol Nutr 48:249–256

    Article  PubMed  Google Scholar 

  39. Rhodes SK, Shimoda KC, Waid LR et al (1995) Neurocognitive deficits in morbidly obese children with obstructive sleep apnea. J Pediatr 127:741–744

    Article  PubMed  CAS  Google Scholar 

  40. Salminen S, Gibson GR, McCartney AL, Isolauri E (2004) Influence of mode of delivery on gut microbiota composition in seven year old children. Gut 53:1388–1389

    Article  PubMed  CAS  Google Scholar 

  41. Tanentsapf I, Heitmann BL, Adeqboye AR (2011) Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight, and obese women. BMC Pregnancy Childbirth 26:81

    Article  Google Scholar 

  42. Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR (2008) A meta-analysis of the association between caesarean section and childhood asthma. Clin Exp Allergy 38:629–633

    Article  PubMed  CAS  Google Scholar 

  43. Wang Y (2001) Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol 30:1129–1136

    Article  PubMed  CAS  Google Scholar 

  44. Whitaker RC, Dietz WH (1998) Role of the prenatal environment in the development of obesity. J Pediatr 132:768–776

    Article  PubMed  CAS  Google Scholar 

  45. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH (1997) Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 337:869–873

    Article  PubMed  CAS  Google Scholar 

  46. Zhou L, He G, Zhang J, Xie R, Walker M, Wen SW (2011) Risk factors of obesity in preschool children in an urban area in China. Eur J Pediatr 170:1401–1406

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was conducted by the NICHD Early Child Care Research Network supported by NICHD through a cooperative agreement that calls for scientific collaboration between the grantees and the NICHD staff. The East Tennessee State University have restricted data use agreements to analyze the SECCYD data.

Conflict of interest

The authors have no disclosures of competing interests.

Author information

Authors and Affiliations

  1. Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, P.O. Box 70259, Johnson City, TN, 37614, USA

    Liang Wang, Arsham Alamian, Kesheng Wang, James Anderson & Marc Stevens

  2. Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, 37614, USA

    Jodi Southerland

Authors
  1. Liang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arsham Alamian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jodi Southerland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kesheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Liang Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, L., Alamian, A., Southerland, J. et al. Cesarean section and the risk of overweight in grade 6 children. Eur J Pediatr 172, 1341–1347 (2013). https://doi.org/10.1007/s00431-013-2043-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-013-2043-2

Keywords

Search

Navigation