Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Int J Obes (Lond). 2021 Jan;45(1):36-44. doi: 10.1038/s41366-020-00709-x. Epub 2020 Nov 16.
Cesarean delivery has been linked with childhood obesity. Few studies have examined if this association is attenuated if there is labor prior to delivery. The objective of this current analysis was to examine the association of cesarean vs. vaginal delivery with measures of childhood adiposity, and whether the association differs by labor type (spontaneous, induced, or absent) preceding cesarean delivery.
We ascertained delivery mode and type of labor from medical records in 1443 mother-child dyads from Project Viva with adiposity measures from at least one follow-up visit (3369 total observations) in early childhood (median age 3.2 y), mid-childhood (median 7.7 y), or early teen (median 12.9 y). Child adiposity outcomes were CDC age- and sex-specific body mass index (BMI) z-scores, sum of subscapular and triceps skinfold thicknesses (SS + TR; mm), and waist circumference (cm). We used linear regression models with generalized estimating equation estimates and adjusted for maternal age, education, race/ethnicity, prepregnancy BMI, rate of gestational weight gain, and child sex and age at outcome.
A total of 333 (23%) women delivered via cesarean, including 155 (11%) with spontaneous labor, 74 (5%) with induced labor, 99 (7%) with no labor, and 5 (<1%) with unknown labor status. Compared to vaginal-delivered children, cesarean-delivered children had higher BMI-z (0.15, 95% CI: 0.04, 0.26); and non-significantly higher waist circumference (0.50 cm, 95% CI: -0.34, 1.34) and SS + TR (0.47 mm, 95% CI: -0.52, 1.46). Cesarean deliveries that were preceded by spontaneous labor were not associated with childhood BMI-z (0.08, 95% CI: -0.07, 0.23), waist circumference (-0.12 cm, 95% CI: -1.09, 0.85), or SS + TR (-0.25 mm, 95% CI: -1.44, 0.93), as compared to vaginal deliveries.
Cesarean delivery was associated with higher childhood BMI-z, and although waist circumference and SS + TR trended in the same direction, these associations were not significant. Cesarean delivery preceded by spontaneous labor was not associated with adiposity outcomes.
剖宫产与儿童肥胖有关。很少有研究调查如果在分娩前有劳动，这种关联是否会减弱。本研究的目的是检查剖宫产与阴道分娩与儿童肥胖指标的关系，以及剖宫产前劳动类型（自然、诱导或无）是否会影响这种关系。
我们从 Viva 项目的 1443 对母婴对中从医疗记录中确定了分娩方式和劳动类型，并且在儿童早期（中位年龄 3.2 岁）、中期（中位年龄 7.7 岁）或青少年早期（中位年龄 12.9 岁）有至少一次随访时测量了儿童肥胖的指标。儿童肥胖的结果是根据 CDC 的年龄和性别特异性身体质量指数（BMI）z 分数、肩胛下和肱三头肌皮褶厚度总和（SS+TR；mm）和腰围（cm）。我们使用广义估计方程估计的线性回归模型进行分析，并调整了母亲的年龄、教育程度、种族/民族、孕前 BMI、孕期体重增加率以及儿童的性别和结局时的年龄。
共有 333 名（23%）女性行剖宫产术，其中 155 名（11%）为自然分娩，74 名（5%）为诱导分娩，99 名（7%）为无劳动，5 名（<1%）劳动状态未知。与阴道分娩的儿童相比，剖宫产分娩的儿童 BMI-z 更高（0.15，95% CI：0.04，0.26）；腰围（0.50cm，95% CI：-0.34，1.34）和 SS+TR（0.47mm，95% CI：-0.52，1.46）非显著更高。与阴道分娩相比，有自然分娩史的剖宫产术与儿童 BMI-z（0.08，95% CI：-0.07，0.23）、腰围（-0.12cm，95% CI：-1.09，0.85）或 SS+TR（-0.25mm，95% CI：-1.44，0.93）无关。
剖宫产与儿童 BMI-z 较高有关，尽管腰围和 SS+TR 呈相同趋势，但这些关联没有统计学意义。有自然分娩史的剖宫产术与肥胖结局无关。
