Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2020 Apr 1;3(4):e202605. doi: 10.1001/jamanetworkopen.2020.2605.
Cesarean delivery is associated with an increased risk of childhood obesity in offspring. However, whether this increased risk also includes obesity-associated conditions remains unclear.
To evaluate the association of birth by cesarean delivery with offspring's risks of obesity and type 2 diabetes in adulthood.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study compared the incidence of obesity and type 2 diabetes between birth by cesarean delivery and vaginal delivery among 33 226 women participating in the Nurses' Health Study II who were born between 1946 and 1964, with follow-up through the end of the 2013-2015 follow-up cycle. Participants' mothers provided information on mode of delivery and pregnancy characteristics. Participants provided information every 2 years on weight and diagnosis of type 2 diabetes. Relative risks of obesity and type 2 diabetes were estimated using log-binomial and proportional hazards regression accounting for maternal body mass index and other confounding factors. Statistical analysis was performed from June 2017 to December 2019.
Birth by cesarean delivery compared with birth by vaginal delivery.
Risk of obesity and incidence of type 2 diabetes.
At baseline, the participants' mean (SD) age was 33.8 (4.6) years (range, 24.0-44.0 years). A total of 1089 of the 33 226 participants (3.3%) were born by cesarean delivery. After 1 913 978 person-years of follow-up, 12 156 (36.6%) women were obese and 2014 (6.1%) had received a diagnosis of type 2 diabetes. Women born by cesarean delivery were more likely to be classified as obese and to have received a diagnosis of type 2 diabetes during follow-up. The multivariable-adjusted relative risk of obesity among women born by cesarean vs vaginal delivery was 1.11 (95% CI, 1.03-1.19). The multivariable-adjusted hazard ratio for type 2 diabetes among women born by cesarean vs vaginal delivery was 1.46 (95% CI, 1.18-1.81); this association remained significant after additional adjustment for participant's own body mass index (relative risk, 1.34 [95% CI, 1.08-1.67]). These associations persisted when analyses were restricted to women at low risk of cesarean delivery based on maternal characteristics.
This study suggests that women born by cesarean delivery may have a higher risk than women born by vaginal delivery of being obese and developing type 2 diabetes during adult life.
剖宫产与后代儿童肥胖的风险增加有关。然而，这种风险增加是否也包括与肥胖相关的疾病仍不清楚。
评估剖宫产与成年后代肥胖和 2 型糖尿病风险之间的关系。
设计、设置和参与者：这项前瞻性队列研究比较了 33226 名参加护士健康研究 II 的女性的剖宫产和阴道分娩的肥胖和 2 型糖尿病发病率，这些女性出生于 1946 年至 1964 年之间，随访至 2013-2015 年随访周期结束。参与者的母亲提供了分娩方式和妊娠特征的信息。参与者每 2 年报告一次体重和 2 型糖尿病的诊断情况。使用对数二项式和比例风险回归，根据母体体重指数和其他混杂因素，估计肥胖和 2 型糖尿病的相对风险。统计分析于 2017 年 6 月至 2019 年 12 月进行。
剖宫产与阴道分娩。
肥胖风险和 2 型糖尿病发病率。
在基线时，参与者的平均（SD）年龄为 33.8（4.6）岁（范围，24.0-44.0 岁）。共有 33226 名参与者中的 1089 名（3.3%）为剖宫产。经过 1913978 人年的随访，12156 名（36.6%）女性肥胖，2014 名（6.1%）患有 2 型糖尿病。与阴道分娩相比，剖宫产出生的女性更有可能被归类为肥胖，并在随访期间被诊断为 2 型糖尿病。与阴道分娩相比，剖宫产出生的女性肥胖的多变量调整后相对风险为 1.11（95%CI，1.03-1.19）。与阴道分娩相比，剖宫产出生的女性患 2 型糖尿病的多变量调整后风险比为 1.46（95%CI，1.18-1.81）；在进一步调整参与者自身体重指数后，这种关联仍然显著（相对风险，1.34[95%CI，1.08-1.67]）。当根据母体特征将分析限制在剖宫产低风险的女性中时，这些关联仍然存在。
这项研究表明，与阴道分娩相比，剖宫产出生的女性在成年后肥胖和患 2 型糖尿病的风险可能更高。
