Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Am J Epidemiol. 2019 Jul 1;188(7):1296-1303. doi: 10.1093/aje/kwz096.
The rate of cesarean delivery (CD) is high in many parts of the world. Birth via CD has been associated with adverse later health outcomes, such as obesity, asthma, and type 1 diabetes mellitus. Few studies have focused on hypertension. We investigated the associations of CD with hypertension, systolic blood pressure (BP), and diastolic BP and tested whether body mass index (BMI; weight (kg)/height (m)2) was a mediator of these associations in a birth cohort (n = 2,020) assembled in 1978-1979 and followed up in 2002-2004 in Ribeirão Preto, Brazil. The CD rate was 32.0%. Hypertension was present in 11.7% of persons born via CD and 7.7% of those born vaginally. Being born by CD increased the odds of hypertension by 51% (odds ratio = 1.51, 95% confidence interval (CI): 1.10, 2.07). After adjustment for confounders, this estimate changed little (odds ratio = 1.49, 95% CI: 1.07, 2.06). In a mediation analysis, odds ratios for the indirect and direct effects were 1.18 (95% CI: 1.11, 1.25) and 1.31 (95% CI: 0.97, 1.65), respectively. CD also had indirect effects on both systolic and diastolic BP via BMI. Our findings suggest that CD is associated with young-adult hypertension and that this association is at least partially mediated by BMI. This has implications for countries struggling with the burden of noncommunicable diseases and where CD rates are high.
在世界上许多地方，剖宫产率（CD）都很高。通过 CD 分娩与肥胖、哮喘和 1 型糖尿病等不良后期健康结果有关。很少有研究关注高血压。我们调查了 CD 与高血压、收缩压（BP）和舒张压的关系，并测试了体重指数（BMI；体重（kg）/身高（m）2）是否在巴西里贝朗普雷托的一个出生队列（n = 2020）中对这些关联起中介作用，该队列于 1978-1979 年组建，并于 2002-2004 年进行了随访。CD 率为 32.0%。经 CD 分娩的人群中高血压的患病率为 11.7%，经阴道分娩的人群中高血压的患病率为 7.7%。通过 CD 分娩会使高血压的几率增加 51%（优势比 = 1.51，95%置信区间（CI）：1.10，2.07）。调整混杂因素后，这一估计值变化不大（优势比 = 1.49，95% CI：1.07，2.06）。在中介分析中，间接和直接效应的优势比分别为 1.18（95% CI：1.11，1.25）和 1.31（95% CI：0.97，1.65）。CD 还通过 BMI 对收缩压和舒张压产生间接影响。我们的研究结果表明，CD 与青年期高血压有关，而这种关联至少部分是由 BMI 介导的。这对正在努力应对非传染性疾病负担且 CD 率较高的国家具有重要意义。
