Abstract
BackgroundConflicting findings on the risk of obesity among subjects born by caesarean section have been published. Caesarean section should also increase the risk of obesity related cardiovascular risk factors if type of delivery is associated with obesity later in life. This study was aimed at assessing the effect of type of delivery on metabolic cardiovascular risk factors in early adulthood.Methodology and Principal FindingsIn 1982, maternity hospitals in Pelotas, southern Brazil, were visited and those livebirths whose family lived in the urban area of the city have been followed. In 2000, when male subjects undertook the Army entrance examination (n=2200), fat mass and fat free mass were estimated through bioimpedance. In 2004–2005, we attempted to follow the whole cohort (n=4297), and the following outcomes were studied: blood pressure; HDL cholesterol; triglycerides; random blood glucose, C-reactive protein, waist circumference and body mass index. The estimates were adjusted for the following confounders: family income at birth; maternal schooling; household assets index in childhood; maternal skin color; birth order; maternal age; maternal prepregnancy weight; maternal height; maternal smoking during pregnancy; birthweight and family income at early adulthood.ResultsIn the crude analyses, blood pressure (systolic, diastolic and mean arterial pressure) and body mass index were higher among subjects who were delivered through caesarean section. After controlling for confounders, systolic blood pressure was 1.15 mmHg (95% confidence interval: 0.05; 2.25) higher among subjects delivered by caesarean section, and BMI 0.40 kg/m2 (95% confidence interval: 0.08; 0.71). After controlling for BMI the effect on systolic blood pressure dropped to 0.60 mmHg (95% confidence interval: -0.47; 1.67). Fat mass at 18 years of age was also higher among subjects born by caesarean section.ConclusionCaesarean section was associated with a small increased in systolic blood pressure, body mass index and fat mass.
Highlights
There is growing evidence that the development of noncommunicable diseases may be programmed by exposures in early life [1,2]
In the crude analyses, blood pressure and body mass index were higher among subjects who were delivered through caesarean section
After controlling for confounders, systolic blood pressure was 1.15 mmHg (95% confidence interval: 0.05; 2.25) higher among subjects delivered by caesarean section, and body mass index (BMI) 0.40 kg/m2 (95% confidence interval: 0.08; 0.71)
Summary
There is growing evidence that the development of noncommunicable diseases may be programmed by exposures in early life [1,2]. Studies from developed countries suggest that subjects born by caesarean section present increased risk of immune-related diseases in later life such as allergies [7], asthma [8], celiac disease [9], and type 1 diabetes [10]. The intestinal flora of infants born through caesarean section is less diverse in terms of bacterial species, and Bifidobacteria spp. are absent [12,13]. Caesarean section should increase the risk of obesity related cardiovascular risk factors if type of delivery is associated with obesity later in life. This study was aimed at assessing the effect of type of delivery on metabolic cardiovascular risk factors in early adulthood
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