Abstract
Objective: To investigate the association between cesarean delivery (CD) and trajectory patterns of age- and sex-specific body mass index (BMI) z-score in early childhood.Methods: A retrospective cohort study was conducted among 2,685 children whose maternal age at the time of birth was between 18 and 35 years, and birth data and anthropometric measurement data during their ages 3–60 months were collected. A group-based trajectory modeling approach was used to identify distinct BMI z-score trajectories, and multinomial logistic regressions were applied to estimate the associations among CD (both elective and non-elective combined), elective and non-selective CD, and BMI z-score trajectory classes.Results: Of the 2,685 participants, 46.5% (N = 1,248) were born by vaginal delivery (VD), 20.7% (N = 556) by elective CD, and 32.8% (N = 881) by non-elective CD. Five BMI z-score trajectory patterns were identified, and they were “increasing from moderate to high” (10.1%, n = 270), “increasing from mild to moderate” (34.2%, n = 919), “increasing from low to high” (10.5%, n = 283), “stable mild” (30.1%, n = 808), and “stable low” (15.1%, n = 405) groups. Compared with children delivered by VD, those who delivered by CD (both elective and non-elective combined), elective CD, and non-elective CD were associated with the “increasing from moderate to high” trajectory [odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.13–2.29; OR = 1.64, 95%CI: 1.06–2.54; and OR = 1.59, 95%CI: 1.05–2.39, respectively] and were also associated with the “increasing from low to high” trajectory (OR = 1.60, 95%CI: 1.17–2.19, OR = 1.75, 95%CI: 1.16–2.63; and OR = 1.53, 95%CI: 1.00–2.34, respectively).Conclusion: Both elective and non-elective CD were associated with the risk of accelerated weight gain in early childhood.
Highlights
The cesarean delivery (CD) rate has increased significantly in the past decades worldwide [1]
Compared with children delivered by vaginal delivery (VD), those who delivered by CD, elective CD, and non-elective CD were associated with the “increasing from moderate to high” trajectory [odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.13–2.29; OR = 1.64, 95%CI: 1.06–2.54; and OR = 1.59, 95%CI: 1.05–2.39, respectively] and were associated with the “increasing from low to high” trajectory (OR = 1.60, 95%CI: 1.17–2.19, OR = 1.75, 95%CI: 1.16–2.63; and OR = 1.53, 95%CI: 1.00–2.34, respectively)
Delivery Mode and body mass index (BMI) Trajectories. Both elective and non-elective CD were associated with the risk of accelerated weight gain in early childhood
Summary
The cesarean delivery (CD) rate has increased significantly in the past decades worldwide [1]. CD could be life-saving for both the mothers and their offspring if appropriately performed and medically indicated, which should only be performed when a vaginal delivery (VD) places the mothers or newborns at risk because of medical reasons [3]. Given the high rate of CD, especially elective CD, the potential adverse impact of CD on mother and offspring has been concerning, and in comparison with VD, higher risk of maternal death or infection, neonatal respiratory morbidity, and adverse effects to subsequent pregnancies have been identified [6]. CD may result in altered neonatal gut microbiota and pre-dispose offspring to an increased risk of childhood overweight and obesity [7]
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