Chiavarini Manuela, De Socio Benedetta, Giacchetta Irene, Fabiani Roberto
Department of Medicine and Surgery, Section of Public Heath (Dr Chiavarini), Nursing and Midwifery Science (Ms De Socio), Department of Chemistry, Biology and Biotechnology (Dr Fabiani), and Department of Medicine and Surgery, Section of Public Heath, School of Hygiene and Preventive Medicine (Dr Giacchetta), University of Perugia, Perugia, Italy.
J Public Health Manag Pract. 2023;29(2):128-141. doi: 10.1097/PHH.0000000000001687.
Overweight/obesity is one of the most important health problems. Birth by cesarean section has been shown to influence long-term health outcomes including obesity.
The aim of this systematic review-meta-analysis is to update acknowledgment of the increased risk of cesarean section on offspring's overweight/obesity.
This study follows the PRISMA guidelines. A systematic literature search was conducted on Scopus, PubMed, and Web of Science; we have selected all the articles published until January 2, 2022. For inclusion, studies must have reported either (i) both birth by cesarean section and adult (≥18 years) offspring's body mass index; (ii) cohort or case-control study design; and (iii) a risk estimate. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by the Egger test and the Begg test. Meta-analysis was performed through a random-effects model.
Twelve studies with a combined population of 180 065 subjects were included in the meta-analysis. The overall analysis (N = 19) yielded a combined risk estimate for overweight/obesity of 1.19 (95% CI, 1.08-1.30) and the test of heterogeneity resulted into Q = 57.44 ( I2 = 68.67%, P ≤ .001). The risk of offspring obesity is 1.23 (95% CI, 1.09-1.39) and the test of heterogeneity resulted into Q = 39.55 ( I2 = 69.66%, P ≤ .001). Children born by cesarean section have an increased risk of obesity in adulthood.
超重/肥胖是最重要的健康问题之一。剖宫产已被证明会影响包括肥胖在内的长期健康结果。
本系统评价-荟萃分析的目的是更新对剖宫产增加后代超重/肥胖风险的认识。
本研究遵循PRISMA指南。在Scopus、PubMed和Web of Science上进行了系统的文献检索；我们选择了截至2022年1月2日发表的所有文章。纳入标准为：研究必须报告（i）剖宫产和成年（≥18岁）后代的体重指数；（ii）队列或病例对照研究设计；（iii）风险估计。使用Cochran's Q和I2统计量进行异质性检验。通过Egger检验和Begg检验评估发表偏倚。通过随机效应模型进行荟萃分析。
荟萃分析纳入了12项研究，合并人群为180065名受试者。总体分析（N = 19）得出超重/肥胖的合并风险估计值为1.19（95%CI，1.08 - 1.30），异质性检验结果为Q = 57.44（I2 = 68.67%，P≤.001）。后代肥胖的风险为1.23（95%CI，1.09 - 1.39），异质性检验结果为Q = 39.55（I2 = 69.66%，P≤.001）。剖宫产出生的儿童成年后患肥胖症的风险增加。
