The University of Southampton
University of Southampton Institutional Repository

Association of elective and emergency cesarean delivery with early childhood overweight at 12 months of age

Association of elective and emergency cesarean delivery with early childhood overweight at 12 months of age
Association of elective and emergency cesarean delivery with early childhood overweight at 12 months of age
Importance Global cesarean delivery (CD) rates have more than doubled over the past 2 decades, with an increasing contribution from elective CDs. Cesarean delivery has been linked to early childhood overweight and obesity, but limited studies have examined elective and emergency CDs separately.

Objective To investigate whether elective or emergency CD was associated with risk of early childhood overweight.

Design, Setting, and Participants Data were drawn from the Growing Up in Singapore Toward Healthy Outcomes (GUSTO) study, an ongoing prospective mother-child birth cohort study. Participants were pregnant women aged 18 years or older with homogeneous parental ethnic background in their first trimester recruited between June 2009 and September 2010 (n = 1237) at 2 major public hospitals in Singapore. Those with type 1 diabetes or undergoing chemotherapy or psychotropic drug treatment were excluded. Data analysis commenced in October 2017.

Exposures Delivery mode obtained from clinical records. Elective and emergency CD examined separately against vaginal delivery as reference.

Main Outcomes and Measures Body mass index–for–age z scores at age 12 months calculated based on 2006 World Health Organization Child Growth Standards from infant weight and recumbent crown-heel length measurements taken between December 2010 and April 2012. High body mass index status at risk of overweight was defined as a z score of more than 1 SD and less than or equal to 2 SDs. Overweight was defined as a z score of more than 2 SDs.

Results Among 727 infants analyzed (51.2% [372] male), 30.5% (222) were born via CD, of which 33.3% (74) were elective. Prevalence of at risk of overweight and overweight at age 12 months was 12.2% (89) and 2.3% (17), respectively. Elective CD was significantly associated with at risk of overweight or overweight at age 12 months after adjusting for maternal ethnicity, age, education, parity, body mass index, antenatal smoking, hypertensive disorders of pregnancy, gestational diabetes, and sex-adjusted birth weight–for–gestational age (odds ratio, 2.05; 95% CI, 1.08-3.90; P = .03). The association persisted after further adjustment for intrapartum antibiotics and first 6 months infant feeding, 2 potential mediators of early childhood overweight and obesity (odds ratio, 2.02; 95% CI, 1.05-3.89; P = .04). No significant associations were found for emergency CD. Analysis with multiple imputation for missing covariates yielded similar results.

Conclusions and Relevance Choice of delivery mode may influence risk of early childhood overweight. Clinicians are encouraged to discuss potential long-term implications of elective CD on child metabolic outcomes with patients who intend to have children.
1-14
Cai, Meijin
a2f46884-0166-4d3f-88ca-9c9ebe21f6fa
Loy, See Ling
6fd10b64-1de2-419e-a5f4-b505be233e6e
Tan, Kok Hian
4714c94d-334a-42ad-b879-f3aa3a931def
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Gluckman, Peter D.
e916630e-5ae2-437c-a1d1-8e24c0e05589
Chong, Yap-Seng
7043124b-e892-4d4b-8bb7-6d35ed94e136
Shek, Lynette Pei-Chi
9a77403c-0e0c-4536-a5ad-628ce94b279a
Cheung, Yin Bun
c9beaf35-87d8-47f0-b41e-729e7820f991
Lek, Ngee
517c4b9b-b6c9-4625-9db4-fd2b228b1755
Lee, Yung Seng
0e28a8d6-3085-4086-9fa1-ac0684783bcf
Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293
Chan, Jerry Kok Yen
42e59d61-c3d1-486b-b33a-22c4645acf12
Yap, Fabian
22f6b954-31fc-4696-a52b-e985a424b95b
Ang, Seng Bin
db42a488-097c-4ead-9f06-ee37a47436b4
Cai, Meijin
a2f46884-0166-4d3f-88ca-9c9ebe21f6fa
Loy, See Ling
6fd10b64-1de2-419e-a5f4-b505be233e6e
Tan, Kok Hian
4714c94d-334a-42ad-b879-f3aa3a931def
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Gluckman, Peter D.
e916630e-5ae2-437c-a1d1-8e24c0e05589
Chong, Yap-Seng
7043124b-e892-4d4b-8bb7-6d35ed94e136
Shek, Lynette Pei-Chi
9a77403c-0e0c-4536-a5ad-628ce94b279a
Cheung, Yin Bun
c9beaf35-87d8-47f0-b41e-729e7820f991
Lek, Ngee
517c4b9b-b6c9-4625-9db4-fd2b228b1755
Lee, Yung Seng
0e28a8d6-3085-4086-9fa1-ac0684783bcf
Chan, Shiao-Yng
3c9d8970-2cc4-430a-86a7-96f6029a5293
Chan, Jerry Kok Yen
42e59d61-c3d1-486b-b33a-22c4645acf12
Yap, Fabian
22f6b954-31fc-4696-a52b-e985a424b95b
Ang, Seng Bin
db42a488-097c-4ead-9f06-ee37a47436b4

Cai, Meijin, Loy, See Ling, Tan, Kok Hian, Godfrey, Keith, Gluckman, Peter D., Chong, Yap-Seng, Shek, Lynette Pei-Chi, Cheung, Yin Bun, Lek, Ngee, Lee, Yung Seng, Chan, Shiao-Yng, Chan, Jerry Kok Yen, Yap, Fabian and Ang, Seng Bin (2018) Association of elective and emergency cesarean delivery with early childhood overweight at 12 months of age. JAMA Network Open, 1 (7), 1-14, [e185025]. (doi:10.1001/jamanetworkopen.2018.5025).

Record type: Article

Abstract

Importance Global cesarean delivery (CD) rates have more than doubled over the past 2 decades, with an increasing contribution from elective CDs. Cesarean delivery has been linked to early childhood overweight and obesity, but limited studies have examined elective and emergency CDs separately.

Objective To investigate whether elective or emergency CD was associated with risk of early childhood overweight.

Design, Setting, and Participants Data were drawn from the Growing Up in Singapore Toward Healthy Outcomes (GUSTO) study, an ongoing prospective mother-child birth cohort study. Participants were pregnant women aged 18 years or older with homogeneous parental ethnic background in their first trimester recruited between June 2009 and September 2010 (n = 1237) at 2 major public hospitals in Singapore. Those with type 1 diabetes or undergoing chemotherapy or psychotropic drug treatment were excluded. Data analysis commenced in October 2017.

Exposures Delivery mode obtained from clinical records. Elective and emergency CD examined separately against vaginal delivery as reference.

Main Outcomes and Measures Body mass index–for–age z scores at age 12 months calculated based on 2006 World Health Organization Child Growth Standards from infant weight and recumbent crown-heel length measurements taken between December 2010 and April 2012. High body mass index status at risk of overweight was defined as a z score of more than 1 SD and less than or equal to 2 SDs. Overweight was defined as a z score of more than 2 SDs.

Results Among 727 infants analyzed (51.2% [372] male), 30.5% (222) were born via CD, of which 33.3% (74) were elective. Prevalence of at risk of overweight and overweight at age 12 months was 12.2% (89) and 2.3% (17), respectively. Elective CD was significantly associated with at risk of overweight or overweight at age 12 months after adjusting for maternal ethnicity, age, education, parity, body mass index, antenatal smoking, hypertensive disorders of pregnancy, gestational diabetes, and sex-adjusted birth weight–for–gestational age (odds ratio, 2.05; 95% CI, 1.08-3.90; P = .03). The association persisted after further adjustment for intrapartum antibiotics and first 6 months infant feeding, 2 potential mediators of early childhood overweight and obesity (odds ratio, 2.02; 95% CI, 1.05-3.89; P = .04). No significant associations were found for emergency CD. Analysis with multiple imputation for missing covariates yielded similar results.

Conclusions and Relevance Choice of delivery mode may influence risk of early childhood overweight. Clinicians are encouraged to discuss potential long-term implications of elective CD on child metabolic outcomes with patients who intend to have children.

Text
Cai 2018 oi 180216 (1) - Version of Record
Available under License Creative Commons Attribution.
Download (1MB)

More information

Accepted/In Press date: 2 October 2018
e-pub ahead of print date: 21 November 2018

Identifiers

Local EPrints ID: 426520
URI: http://eprints.soton.ac.uk/id/eprint/426520
PURE UUID: 72089ed3-955c-4d5b-b280-e720f1881013
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

Catalogue record

Date deposited: 29 Nov 2018 17:30
Last modified: 16 Mar 2024 02:42

Export record

Altmetrics

Contributors

Author: Meijin Cai
Author: See Ling Loy
Author: Kok Hian Tan
Author: Keith Godfrey ORCID iD
Author: Peter D. Gluckman
Author: Yap-Seng Chong
Author: Lynette Pei-Chi Shek
Author: Yin Bun Cheung
Author: Ngee Lek
Author: Yung Seng Lee
Author: Shiao-Yng Chan
Author: Jerry Kok Yen Chan
Author: Fabian Yap
Author: Seng Bin Ang

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×