Caesarean delivery is associated with increased blood pressure in young adult offspring

Amaraporn Rerkasem,Sarah E Maessen,Antika Wongthanee,José G B Derraik,Kittipan Rerkasem,Ampica Mangklabruks,Sakda Pruenglampoo,Patumrat Sripan

doi:10.1038/s41598-021-89438-3

Abstract

We examined the associations between caesarean section (CS) delivery and cardiovascular risk factors in young adults in Thailand. Participants were 632 offspring from a birth cohort in Chiang Mai (Northern Thailand), born in 1989–1990 and assessed in 2010 at a mean age of 20.6 years, including 57 individuals (9.0%) born by CS and 575 born vaginally. Clinical assessments included anthropometry, blood pressure (BP), carotid intima-media thickness, and fasting blood glucose, insulin, and lipid profile. Young adults born by CS had systolic BP (SBP) 6.2 mmHg higher (p < 0.001), diastolic BP 3.2 mmHg higher (p = 0.029), and mean arterial pressure (MAP) 4.1 mmHg higher (p = 0.003) than those born vaginally. After covariate adjustments, SBP and MAP remained 4.1 mmHg (p = 0.006) and 2.9 mmHg (p = 0.021) higher, respectively, in the CS group. The prevalence of abnormal SBP (i.e., pre-hypertension or hypertension) in the CS group was 2.5 times that of those born vaginally (25.0% vs 10.3%; p = 0.003), with an adjusted relative risk of abnormal SBP 1.9 times higher (95% CI 1.15, 2.98; p = 0.011). There were no differences in anthropometry (including obesity risk) or other metabolic parameters. In this birth cohort in Thailand, CS delivery was associated with increased blood pressure in young adulthood.

Highlights

We examined the associations between caesarean section (CS) delivery and cardiovascular risk factors in young adults in Thailand
This prospective cohort study found that young adults born by CS had higher blood pressure than peers born vaginally, with nearly twice the likelihood of elevated systolic BP (SBP)
Consistent with our findings, in a Brazilian birth cohort, young adults born by CS were 1.5 times more likely to have hypertension than those born vaginally; the authors did not report a difference in mean SBP or diastolic BP (DBP) by birth mode[29]

Summary

Introduction

We examined the associations between caesarean section (CS) delivery and cardiovascular risk factors in young adults in Thailand. Several studies have shown that compared to individuals born vaginally, those born by CS have an increased risk of adverse health outcomes, including overweight/obesity and hypertension in childhood, adolescence, and a dulthood[3,4,5,6] These findings are far from universal, with some studies showing no such associations when CS is e lective[7] or for all CS c ases[8]. The gut microbiome has been associated with hypertension in animal models, and there is evidence that this may apply to humans[14] In this context, we aimed to examine the associations between CS and long-term cardiometabolic outcomes in a cohort of young adults in Thailand. To our knowledge, such associations have never been previously examined in this country

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Conclusion