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 For the analysis, researchers examined data on 727 infants born at
two major hospitals in Singapore. Overall, 222 deliveries were
surgical, and 74 of these procedures were elective - not done
because of medical issues with the mother or baby. The rest were
emergency surgeries.
By the time babies were 12 months old, about 12 percent of them were
on the cusp of being overweight and about 2 percent were already
overweight, the study found.
Women who had elective cesarean deliveries, also known as
C-sections, were twice as likely to have overweight infants or
babies on the cusp of becoming overweight compared to mothers who
had vaginal deliveries.
"Only elective caesarean section is significantly associated with
increased risk of early childhood obesity, while infants born via
emergency caesarean section have a similar risk to that of infants
born via vaginal delivery," said senior study author Seng Bin Ang of
KK Women's and Children's Hospital in Singapore.
"Many other studies have found that early childhood obesity has a
tendency to persist into late childhood, adolescence and even
adulthood," Ang said by email.
While C-sections have long been linked to an increased risk of
childhood obesity, the current study offers fresh evidence that the
timing of the procedure and the reason behind it may influence the
risk, Ang said.
In the study, researchers defined elective surgeries as procedures
scheduled well in advance of delivery at women's request or because
of a previous C-section. They also counted surgeries scheduled more
than 24 hours before delivery due to medical conditions that might
make labor and delivery more complicated such as mothers with
obesity or diabetes, or babies with serious health problems.
Emergency C-sections, by contrast, were scheduled within 24 hours of
delivery to protect the health of the mother or infant because of
situations like prolonged labor, fetal distress or a breech baby.
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The connection between elective surgical deliveries and overweight
babies persisted even after researchers accounted for a variety of
other factors that might lead infants to become overweight,
including mothers' age, ethnicity, education, obesity, diabetes,
high blood pressure or smoking.
Women also had a greater risk of overweight babies when the decision
to deliver by C-section was made before the start of labor compared
to when it was made after women went into labor.
One limitation of the study is that researchers lacked data on
fathers, whose weight and health habits can independently influence
weight in children, the study authors note.
It also wasn't a controlled experiment designed to prove whether or
how surgical deliveries or the timing of C-section decisions might
directly impact the risk of overweight babies.
Even so, the results add to a large and growing body of evidence
that children born by cesarean delivery are more likely to be heavy
growing up than kids born by vaginal delivery, said the coauthor of
an accompanying editorial, Dr. Jorge Chavarro of the Harvard TH Chan
School of Public Health and Harvard Medical School in Boston.
"It is difficult to tell to what extent being overweight at 12
months means in terms of long-term weight trajectories and overall
health," Chavarro said by email. "However, previous studies have
shown that the relation between cesarean delivery and childhood
weight status seems to extend to older age groups including
adolescents and young adults."
SOURCE: https://bit.ly/2Pe0S1O and https://bit.ly/2KGIRIA JAMA
Network Open, online November 21, 2018.
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