Kuhle S, Tong O S, Woolcott C G
Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada.
Obes Rev. 2015 Apr;16(4):295-303. doi: 10.1111/obr.12267. Epub 2015 Mar 5.
Birth by caesarean section has been recently implicated in the aetiology of childhood obesity, but studies examining the association have varied with regard to their settings, designs, and adjustment for potential confounders. We conducted a systematic review and meta-analysis to summarize the available evidence and to explore study characteristics as sources of heterogeneity. A search of Medline, EMBASE, and Web of Science identified 28 studies. Random effects meta-analysis was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Caesarean section had a RR of 1.34 (CI 1.18-1.51) for obesity in the child compared with vaginal birth. The RR was lower for studies that adjusted for maternal pre-pregnancy weight than for studies that did not (1.29, CI 1.16-1.44 vs. 1.55, CI 1.11-2.17). Studies that examined multiple early life factors reported lower RRs than studies that specifically examined caesarean section (1.39, CI 1.23-1.57 vs. 1.23, CI 0.97-1.56). Effect estimates did not vary by child's age at obesity assessment, study design or country income. Children born by caesarean section are at higher risk of developing obesity in childhood. Findings are limited by a moderate heterogeneity among studies and the potential for residual confounding and publication bias.
近期研究表明，剖宫产与儿童肥胖的病因有关，但相关研究在研究背景、设计以及对潜在混杂因素的调整方面存在差异。我们进行了一项系统综述和荟萃分析，以总结现有证据，并探讨作为异质性来源的研究特征。通过检索Medline、EMBASE和科学网，共识别出28项研究。采用随机效应荟萃分析计算合并风险比（RR）及95%置信区间（CI）。与阴道分娩相比，剖宫产儿童肥胖的RR为1.34（CI 1.18 - 1.51）。对母亲孕前体重进行调整的研究的RR低于未进行调整的研究（1.29，CI 1.16 - 1.44对比1.55，CI 1.11 - 2.17）。研究多个早期生活因素的研究报告的RR低于专门研究剖宫产的研究（1.39，CI 1.23 - 1.57对比1.23，CI 0.97 - 1.56）。效应估计值在肥胖评估时儿童的年龄、研究设计或国家收入方面并无差异。剖宫产出生的儿童在童年期患肥胖症的风险更高。研究结果受到研究间中等程度异质性以及潜在残留混杂和发表偏倚的限制。
