Birth by c-section: a risk for childhood obesity?

Both Travis and I are at that age when our Facebook feed is becoming dominated by photos of our friends’ babies; many of my close friends have added an adorable member to their family over the past few years.

A while back, my partner Marina and I watched a fascinating documentary by ex-talk show host, Ricki Lake, entitled “The Business of Being Born.”The documentary exposes the many changes have occurred surrounding the way women give birth in US hospitals, namely the increased use of drugs and increased rates of caesarean sections – two factors that expedite the process. Here is a small clip from the documentary which I highly recommend watching:

Although I am no expert in gynecology and obstetrics, I have long-wondered what these changes in hospital procedures can have on the health of the mother and baby. Sadly, a recent study I came across  suggests that babies born by c-section are at higher risk of obesity in early childhood compared to those born vaginally.

In the study, the authors assessed a total of 1255 children at age 3 and compared the body weights and body composition of those born via c-section (284 births or 22.6%) to those born naturally.

Here’s what’s interesting: at age 3, 15.7% of children delivered by c-section were obese compared with 7.5% of children born vaginally. The obesity rates were more than doubled for c-sections!

Of course, there could be a number of confounders to this relationship. For example, maybe the women that received c-sections tended to be heavier, and thus the relationship was merely one of heavy women having heavy babies. However, the authors performed further analysis where they took into consideration the following factors: maternal age, education, race/ethnicity, pre-pregnancy body mass index (BMI), and child age, sex, and birth weight. All things being equal, a baby born via a c-section had double the risk of being obese by age 3 by comparison to a baby born vaginally.

While the authors speculated on a few possible reasons for this observation, the cause remains unknown.

What does appear to be possible is that birth by c-section may be yet another risk factor for obesity that we have no control over – much like the genetics handed down to us by our parents.

Peter

Reference:

Huh SY, Rifas-Shiman SL, Zera CA, Edwards JW, Oken E, Weiss ST, Gillman MW. Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study. Arch Dis Child. 2012 Jul;97(7):610-6.

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15 Responses to Birth by c-section: a risk for childhood obesity?

  1. Cindy Marsch says:

    I’m a mother of four who fought for and had natural, drug-free births for each, when the first and the third would have been typical C-section candidates and the others naturally C-section candidates once I’d had one that way. I would suggest that many who might be typical C-section candidates are highly motivated to avoid the surgery, as I was, in an approach to birth, and life in general, that is more natural and health-oriented. I bet more of the vaginal-birth children were breastfed, too. Call me an Earth Mother–my grown kids are healthy and enjoy vegetables, though I am heavy and see the tendency in three of my children.

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  2. bsci says:

    This seems like a really weak study to me. If you have a significant population difference, you can’t simply assume a well-modeled function and regress out that difference. To give an extreme case, if you are studying the lung cancer of having beer and Cheerios for breakfast where your population also happens to smoke much more, you can just include smoking as a confounding variable.

    The study showed significant population differences in maternal and paternal BMI, maternal age, birthweight corrected for gestational age, and breast feeding initiation and duration. There was also a non-significant increase in glucose tolerance / gestational diabetes in the c-section group. There is no statical method that can remotely isolate all of these differences to confirm that the Cesarean was the causal variable. Another way of thinking about this if if they flip their study & call parental BMI or breast feeding duration the effect of interest and use Cesarean rates as a confounding variable, they’d probably show the same child obesity effect.

    In addition, the basic assumption of this study seems to be that there was no reason for the C sections. (i.e. they were done on otherwise healthy deliveries). A full-term baby who got an emergency c-section because of lack of oxygen or dozens of other causes, was delivered blue & unresponsive, but recovered, was called the same as other babies as long has its weight was normal. The authors did not list any early measure of baby health, like an Apgar score.

    This paper, but might an ok preliminary finding worth more study, but until better studies are done that has better patient matching, it’s not worth much.

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    • Violet in Twilight says:

      I agree that Gestational Diabetes (GD) is one of the primary risk factors for having C-sections. Also, there is an higher chance for the induced labour cases to end up with C-section. Without controlling for the prenatal stress factors (High Blood Pressure, GD, weak placenta in overdue pregnancy), how can one say C-section alone is the factor for obesity?

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  3. Noadi says:

    Did the authors control for birth weight? One of the indications for c section is an overly large baby. It wouldn’t surprise me if birth weight was highly correlated to obesity.

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    • Travis says:

      That’s what immediately jumped to my mind as well. However, it looks like the relationship was significant even after control for pre-pregnancy BMI and birthweight, both of which would affect c-section rates. A colleague pointed out to me that they didn’t control for weight gain during pregnancy though, which could have an influence as well.

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  4. Gwen says:

    I cannot believe that you just cited Ricki Lake and pimped her film. Who next, Jenny McCarthy? Suzanne Somers? As regards the study -

    http://cesareandebate.blogspot.com/2012/06/two-weeks-following-submission-my.html#more

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  5. Ceridwen says:

    I have to agree with Gwen. You are pimping the Business of Being Born? Really? You need to use a more critical eye on this one. The BoBB presents a lot of half truths along with a pretty good number of outright lies. I’m disappointed that you appear to have swallowed them.

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  6. My husband went to a private catholic school and the gym was named after Coach Muff. Muff Gymnasium. I’m so glad you were born. You’re funny and smart and you’re a good rapper.

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  7. Cara says:

    It seems that in order to prove a direct link between childhood obesity and the act of having a c-section (rather than the reasons for having one) the study should focus more on biological and medicinal chemicals transferred to the baby via stress and drugs that go along with having a c-section.

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  9. Johan says:

    This is consistent with a earlier result I’ve seen suggesting the method of delivery may affect the intestinal bacteria of the child when you combine it the the research showing a link between intestinal bacteria and obesity.

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  12. Andrea says:

    I’ve heard (and experienced) that mothers who give birth via c-section have a harder time breast feeding. And babies who are breast fed have a lower rate of obesity. Perhaps this explains the results.

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