Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen, Denmark.
Int J Obes (Lond). 2018 Jan;42(1):15-19. doi: 10.1038/ijo.2017.175. Epub 2017 Jul 31.
Birth by Cesarean section (C-section) may increase the risk for non-communicable diseases. We aimed to examine the relation of birth by C-section with offspring overweight and markers of cardiometabolic risk in a prospective observational cohort with 20 years of follow-up.
The Danish Fetal Origins Cohort enrolled 965 pregnant women in 1988-1989. In 2008, a follow-up study of the offspring was completed. The offspring were invited to participate in a clinical examination with measurements of anthropometry and a fasting blood sample (n=443). In addition, 252 offspring completed a self-administered questionnaire with questions on height and weight, leaving us with a study sample of 695 offspring. Offspring overweight at 20 years was defined as body mass index (BMI)⩾25 kg m. We also analyzed blood pressure and fasting blood samples for cardiometabolic risk factors including insulin, leptin and adiponectin, and lipid concentrations.
In the cohort, 7% were born by C-section, and at age 20 years, 18% of the offspring had a BMI ⩾25 kg m. Birth by C-section was associated with increased odds of overweight or obesity at 20 years (Odds ratio=2.17 (95% confidence interval (CI): 1.10, 4.27)) after adjustment for potential confounders. Birth by C-section was also associated with higher serum concentrations of total cholesterol (8.5%, 95% CI: 1.1-16.5), low-density lipoprotein cholesterol (12.6%, 95% CI: 1.0, 25.5), leptin (73.1%, 95% CI: 5.9, 183.1) and Apolipoprotein B (0.08 g l, 95% CI: 0.04, 0.15). In contrast, birth by C-section was not related to blood pressure or serum concentrations of insulin, adiponectin, triglycerides, high-density lipoprotein or Apolipoprotein A.
Birth by C-section was associated with higher frequency of dysmetabolic traits in offspring independently of shared risk factors. Further research aimed at replicating these findings and elucidating the underlying biological mechanisms of this relation is needed.
剖宫产（C -section）分娩可能会增加非传染性疾病的风险。我们旨在通过一项前瞻性观察队列研究，对 20 年随访的剖宫产与后代超重和心血管代谢风险标志物的关系进行检验。
丹麦胎儿起源队列于 1988-1989 年招募了 965 名孕妇。2008 年，对后代进行了随访研究。邀请后代参加临床检查，测量人体测量学和空腹血样（n=443）。此外，252 名后代完成了一份自我管理的问卷，其中包括身高和体重的问题，这使得我们的研究样本中有 695 名后代。20 岁时超重的后代定义为体重指数（BMI）≥25kg/m。我们还分析了血压和空腹血样中的心血管代谢危险因素，包括胰岛素、瘦素和脂联素以及脂质浓度。
在该队列中，7%的婴儿为剖宫产，20 岁时，18%的后代 BMI≥25kg/m。在调整了潜在混杂因素后，剖宫产与 20 岁时超重或肥胖的几率增加有关（优势比=2.17（95%置信区间（CI）：1.10，4.27））。剖宫产也与总胆固醇（8.5%，95%CI：1.1-16.5）、低密度脂蛋白胆固醇（12.6%，95%CI：1.0，25.5）、瘦素（73.1%，95%CI：5.9，183.1）和载脂蛋白 B（0.08g/l，95%CI：0.04，0.15）的血清浓度升高有关。相比之下，剖宫产与血压或胰岛素、脂联素、甘油三酯、高密度脂蛋白或载脂蛋白 A 的血清浓度无关。
剖宫产与后代代谢异常的发生频率增加有关，而与共同的危险因素无关。需要进一步的研究来复制这些发现，并阐明这种关系的潜在生物学机制。
