Caesarean delivery, caesarean delivery on maternal request and childhood overweight: a Chinese birth cohort study of 181 380 children

ObjectivesTo assess the impact of caesarean delivery including non-medically indicated maternal request caesarean delivery on childhood overweight. MethodsWe conducted a prospective investigation of a Chinese birth cohort involving 181380 children, who were born during 1993-1996 to mothers registered in a perinatal care surveillance system and whose weight and height were measured in 2000. Information on delivery mode and covariates was obtained from the surveillance system. Overweight was defined according to the International Obesity Task Force body mass index (BMI) cutoffs. Multivariable logistic regression was used to estimate adjusted odds ratios. Stratified analyses were done to test whether the association between caesarean section and overweight persisted across subgroups. ResultsThe adjusted odds ratio of overweight for children born by caesarean compared with vaginal delivery was 1.13 [95% confidence interval {CI}: 1.08, 1.18]. The association persisted in subgroups stratified by gender, maternal education, maternal BMI, weight gain during pregnancy and child birthweight (all P values for interaction test 0.30). The adjusted odds ratio of overweight for children born by non-medically indicated caesarean delivery compared with vaginal delivery was 1.18 (95% CI: 1.00, 1.41). ConclusionCaesarean delivery including non-medically indicated maternal request caesarean delivery compared with vaginal delivery modestly increases childhood overweight risk.