The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males

Lucas D. Ekstrom,Daniel Berglind,Viktor H. Ahlqvist,Cecilia Magnusson,Margareta Persson

doi:10.1038/s41598-020-75775-2

Lucas D. Ekstrom, Daniel Berglind + Show 3 more

Open Access

https://doi.org/10.1038/s41598-020-75775-2

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Abstract

Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. Swedish males born by cesarean section achieved lower mean Watt-maximum (− 2.32 W, 95%C.I. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. In the sub-population, males born 1982–1987, there was a greater negative association of elective cesarean section with cardiorespiratory fitness (− 4.42 W, 95%C.I. − 6.27 to − 2.57, p < 0.001) than non-elective cesarean sections (− 1.96 W, 95%C.I. − 3.77 to − 0.16, p = 0.033) as compared to vaginal births. No associations between modes of cesarean delivery and cardiorespiratory fitness levels persisted in the within-family analyses where biological male siblings were compared whilst controlling for factors shared within families. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally. These findings appear to be largely explained by factors of familial confounding.

Highlights

Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life
If cesarean section (CS) is a causal factor in such morbidities, it is possible that CS would impact cardiorespiratory fitness (CRF)
Born males achieved higher Wmax (304.0 W) compared to males born by CS (301.0 W) and were of the same median age during conscription testing (18.3 years old), Table 1

Summary

Introduction

Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally These findings appear to be largely explained by factors of familial confounding. We posited three specific research questions; (i) whether birth by CS in Swedish males born 1973–1987 are associated with lower levels of CRF later in life; (ii) whether such an association differs between elective and non-elective CS in a sub-population of males born 1982–1987 and (iii) whether any associations found robustly persist across within-family analyses

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