CoChat
Sign Up
Cited by 211Maternal and Perinatal Health InterventionsObesity, Physical Activity, DietBirth, Development, and Health

Association of caesarean delivery with child adiposity from age 6 weeks to 15 years

Open access
Blustein, J, Attina, T, Liu, M, Ryan, A M, Cox, L M, Blaser, M J, Trasande, L·2013·International Journal of Obesity
DOI 10.1038/ijo.2013.49PMC PMC5007946
Open this paper in CoChat — free accountOpen PDF

Abstract

Objectives o assess associations of caesarean section with body mass from birth through adolescence. Design ongitudinal birth cohort study, following subjects up to 15 years of age. Setting and participants Children born in 1991-1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n=10 219). Outcome measures Primary outcome standardized measures of body mass (weight-for length z-scores at 6 weeks, 10 and 20 months; and body mass index (BMI) z-scores at 38 months, 7, 9, 11 and 15 years). Secondary outcome: categorical overweight or obese (BMI: 85th percentile) for age and gender, at 38 months, 7, 9, 11 and 15 years. Results Of the 10 219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower-birth weights than those born vaginally (-46.1 g, 95% confidence interval(CI): 14.6-77.6 g; P=0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at 6 weeks (+0.11 s.d. units, 95% CI: 0.03-0.18; P=0.005), through age 15 (BMI z-score increment+0.10 s.d. units, 95% CI: 0.001-0.198; P=0.042). By age 11 caesarean-delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24-2.70; P=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal-weight mothers was weak. Conclusion Cesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1038/ijo.2013.49

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Despite the transient nature of delivery-mode differences, early life differential colonization has a long-lasting effect and several studies show a correlation between birth by C-section and increased risk of developing obesity, type 1 diabetes, and immune disorders such as asthma or allergies.

    “despite this transient nature, early life differential colonization has a long-lasting effect and several studies show a correlation between birth by C-section and increased risk of developing a variety of disorders including obesity, type 1 diabetes, as well as immune disorders such as asthma or allergies (Bisgaard et al., 2011;Blustein et al., 2013;Jakobsson et al., 2014;Montoya-Williams et al.,”

    From The Microbiota-Gut-Brain Axis (2019) · cites this paper as Blustein et al., 2013

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 32

  1. [1]Keeler EB Brodie M Economic incentives in the choice between vaginal delivery and cesarean section Milbank Q 1993 71 365 404 8413067
  2. [3]Niino Y The increasing cesarean rate globally and what we can do about it Biosci Trends 2011 5 139 150 21914948
  3. [4]Yang YT Mello MM Subramanian SV Studdert DM Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section Med Care 2009 47 234 242 19169125 PMC3096673
  4. [5]National Institutes of Health State-of-the-Science Conference Statement: Cesarean Delivery on Maternal Request March 27–29, 2006 Obestrics & Gynecology 107 1386 1397 16738168
  5. [6]Fuglenes D Aas E Botten G Oian P Kristiansen IS Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear Am J Obstet Gynecol 2011 205 45 e41 49 21620366
  6. [7]National Institute for Health and Clinical Excellence (NICE) Caesarean section (update). (Clinical guideline 132) 2011 http://guidance.nice.org.uk/CG132 31886991
  7. [8]Dominguez-Bello MG Costello EK Contreras M Magris M Hidalgo G Fierer N Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns Proc Natl Acad Sci U S A 2010 107 11971 11975 20566857 PMC2900693
  8. [9]Huurre A Kalliomaki M Rautava S Rinne M Salminen S Isolauri E Mode of delivery – effects on gut microbiota and humoral immunity Neonatology 2008 93 236 240 18025796
  9. [10]Dominguez-Bello MG Costello EK Contreras M Magris M Hidalgo G Fierer N Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns Proceedings of the National Academy of Sciences 2010 107 11971 11975 PMC2900693 20566857
  10. [11]Koenig JE Spor A Scalfone N Fricker AD Stombaugh J Knight R Succession of microbial consortia in the developing infant gut microbiome Proceedings of the National Academy of Sciences 2010 PMC3063592 20668239
  11. [12]Palmer C Bik EM DiGiulio DB Relman DA Brown PO Development of the Human Infant Intestinal Microbiota PLoS Biol 2007 5 e177 17594176 PMC1896187
  12. [13]Penders J Thijs C Vink C Stelma FF Snijders B Kummeling I Factors Influencing the Composition of the Intestinal Microbiota in Early Infancy Pediatrics 2006 118 511 521 16882802
  13. [15]Cho I Yamanishi S Cox L Methe BA Zavadil J Li K Antibiotics in early life alter the murine colonic microbiome and adiposity Nature 2012 488 621 626 22914093 PMC3553221
  14. [17]Barros FC Matijasevich A Hallal PC Horta BL Barros AJ Menezes AB Cesarean section and risk of obesity in childhood, adolescence, and early adulthood: evidence from 3 Brazilian birth cohorts Am J Clin Nutr 2012 95 465 470 22237058 PMC3260073
  15. [18]Goldani HA Bettiol H Barbieri MA Silva AA Agranonik M Morais MB Cesarean delivery is associated with an increased risk of obesity in adulthood in a Brazilian birth cohort study Am J Clin Nutr 2011 93 1344 1347 21508088
  16. [19]Huh SY Rifas-Shiman SL Zera CA Edwards JW Oken E Weiss ST Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study Arch Dis Child 2012 97 610 616 22623615 PMC3784307
  17. [21]Golding J Pembrey M Jones R ALSPAC–the Avon Longitudinal Study of Parents and Children. I. Study methodology Paediatr Perinat Epidemiol 2001 15 74 87 11237119
  18. [22]Bragg F Cromwell DA Edozien LC Gurol-Urganci I Mahmood TA Templeton A Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study BMJ 2010 341 c5065 20926490 PMC2950923
  19. [23]Castro LC Avina RL Maternal obesity and pregnancy outcomes Curr Opin Obstet Gynecol 2002 14 601 606 12441699
  20. [24]Hillier TA Pedula KL Schmidt MM Mullen JA Charles MA Pettitt DJ Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia Diabetes Care 2007 30 2287 2292 17519427
  21. [25]Howe LD Tilling K Lawlor DA Accuracy of height and weight data from child health records Arch Dis Child 2009 94 950 954 19689966
  22. [26]de Onis M WHO Multicentre Growth Reference Study Group WHO Child Growth Standards based on length/height, weight and age Acta Paediatrica 2006 95 76 85 16817681
  23. [27]Grummer-Strawn LM Reinold C Krebs NF Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States MMWR Recomm Rep 2010 59 1 15 20829749
  24. [28]Ogden CL Kuczmarski RJ Flegal KM Mei Z Guo S Wei R Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version Pediatrics 2002 109 45 60 11773541
  25. [29]Fraser A Tilling K Macdonald-Wallis C Hughes R Sattar N Nelson SM Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC) Am J Clin Nutr 2011 93 1285 1292 21471282 PMC3095501
  26. [33]Golding J Pembrey M Jones R ALSPAC-the Avon longitudinal study of parents and children. I. Study methodology Paediatric and Perinatal Epidemiology 2001 15 74 87 11237119
  27. [34]Reilly JJ Armstrong J Dorosty AR Emmett PM Ness A Rogers I Early life risk factors for obesity in childhood: cohort study BMJ 2005 330 1357 15908441 PMC558282
  28. [35]Wolke D Waylen A Samara M Steer C Goodman R Ford T Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders Br J Psychiatry 2009 195 249 256 19721116 PMC2802508
  29. [36]Cho I Blaser MJ The human microbiome: at the interface of health and disease Nat Rev Genet 2012 13 260 270 22411464 PMC3418802
  30. [37]Mugford M Kingston J Chalmers I Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources BMJ 1989 299 1003 1006 2511938 PMC1837925
  31. [38]Trasande L Blustein J Liu M Corwin E Cox LM Blaser MJ Infant antibiotic exposures and early-life body mass Int J Obes (Lond) 2012 PMC3798029 22907693
  32. [39]Friedemann C Heneghan C Mahtani K Thompson M Perera R Ward AM Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis BMJ 2012 345 e4759 23015032 PMC3458230

Cited by

Sorted by citations

Authors
Blustein, J., Attina, T., Liu, M., Ryan, A. M., Cox, L. M., Blaser, M. J., & Trasande, L.
Affiliations
  • NYU Langone Health (US)
  • Cornell University (US)
  • New York University (US)
Corresponding author
Blustein, J
ORCID
Venue
International Journal of Obesity
Publisher
Springer Science and Business Media LLC
Published
2013-04-08
Volume
37
Issue
7
Pages
900-906
ISSN
  • 0307-0565 (ISSN-L)
  • 1476-5497
DOI
10.1038/ijo.2013.49
PMC
PMC5007946
OpenAlex
W2074833261
Cited by
211
References
3
Citations by year
2026: 3 · 2025: 5 · 2024: 5 · 2023: 11 · 2022: 15 · 2021: 20 · 2020: 16 · 2019: 24 · 2018: 15 · 2017: 26 · 2016: 29 · 2015: 17 · 2014: 18 · 2013: 7
FWCI
26.54
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • International Journal of Obesity (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
Funders
  • Wellcome Trust (092731)
  • University of Bristol (092731)
  • National Institutes of Health (092731)
  • Medical Research Council (092731)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK090989)
  • National Center for Research Resources (UL1RR029893)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
cesarean section, childhood obesity, childhood adiposity, body mass index, birth weight, maternal pre-pregnancy weight, overweight, adolescence, birth cohort, Avon Longitudinal Study of Parents and Children, infant feeding, gestational factors, sociodemographic factors, family factors, sex differences, maternal alcohol use
MeSH terms
Adolescent, Birth Weight, Breast Feeding, Cesarean Section, Child, Child, Preschool, Decision Making, Female, United Kingdom, Humans, Infant, Longitudinal Studies, Male, Mothers, Pregnancy, Risk Factors, Socioeconomic Factors, Body Mass Index, Age of Onset, Delivery, Obstetric, Adiposity, Pediatric Obesity, Microbiota

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review