Abstract
BackgroundCesarean section (C-section) delivered infants are more likely to be colonized by opportunistic pathogens, resulting in altered growth. We examined whether C-section (elective/emergency) vs vaginal delivery was associated with altered weight and linear growth at 1 year of life.MethodsA total of 638 mother–infant pairs were included from MAASTHI cohort 2016–2019. Information on delivery mode was obtained from medical records. Based on WHO child growth standards, body mass index-forage z-score (BMI z) and length-for-age z-score (length z) were derived. We ran multivariable linear and Poisson regression models before and after multiple imputation.ResultsThe rate of C-section was 43.4% (26.5%: emergency, 16.9%: elective). Percentage of infant overweight was 14.9%. Compared to vaginal delivery, elective C-section was associated with β = 0.57 (95% CI 0.20, 0.95) higher BMI z. Also infants born by elective C-section had RR = 2.44 (95% CI 1.35, 4.41) higher risk of being overweight; no such association was found for emergency C-section. Also, elective C-section delivery was associated with reduced linear growth at 1 year after multiple imputation (β = −0.38, 95% CI −0.76, −0.01).ConclusionsElective C-section delivery might contribute to excess weight and also possibly reduced linear growth at 1 year of age in children from low- and middle-income countries.ImpactOur study, in a low-income setting, suggests that elective, but not emergency, C-section is associated with excess infant BMI z at 1 year of age and elective C (C-section) was also associated with altered linear growth but only in multiple imputation analyses.Elective C-section was associated with a higher risk of being overweight at 1 year of age.Our results indicate that decreasing medically unnecessary elective C-section deliveries may help limit excess weight gain and stunted linear growth among infants.
Highlights
The double burden of overweight and obesity and undernutrition continues to rise globally, affecting one-third of low and middle-income countries (LMICs).[1]
Infants delivered by elective C-section had a 0.57 unit (95% confidence interval (CI) 0.20, 0.95) higher body mass index-forage z-score (BMI z) compared to infants that were vaginally delivered after adjusting for covariates, and this finding was similar after imputation (β = 0.58, 95% CI 0.24, 0.91)
Emergency Csection, on the other hand, was not associated with infant Body mass index (BMI) z score (β = 0.20, 95% CI −0.13, 0.53) (Table 2)
Summary
The double burden of overweight and obesity and undernutrition (e.g., stunting) continues to rise globally, affecting one-third of low and middle-income countries (LMICs).[1]. We examined whether C-section (elective/emergency) vs vaginal delivery was associated with altered weight and linear growth at 1 year of life. Infants born by elective C-section had RR = 2.44 (95% CI 1.35, 4.41) higher risk of being overweight; no such association was found for emergency C-section. Elective C-section delivery was associated with reduced linear growth at 1 year after multiple imputation (β = −0.38, 95% CI −0.76, −0.01). CONCLUSIONS: Elective C-section delivery might contribute to excess weight and possibly reduced linear growth at 1 year of age in children from low- and middle-income countries
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