Grand Rounds

Is There a Link Between Cesarean Delivery and Obesity in Young Adulthood?

BACKGROUND AND PURPOSE:

Ahlqvist et al. (PLoS Medicine, 2019) investigated the possible association between cesarean section and risk of obesity in young adulthood

Retrospective cohort study
Participants
- Swedish males born between 1982 and 1987
Data sources
- Swedish population registers
- Medical Birth Register
Study design
- Participants were followed from birth until conscription (median 18 years of age) if they conscripted before 2006
- At conscription: Weight and height were measured and transformed to WHO categories based on BMI
Data analysis
- Associations were evaluated using linear regression
- Adjustments made for potential confounders, including
  - Prepregnancy maternal BMI | Maternal diabetes at delivery | Maternal hypertension at delivery | Maternal smoking | Parity | Parental education | Maternal age at delivery | Gestational age | Birth weight standardized according to gestational age | Preeclampsia

97,291 men were included
- Average maternal age at delivery: 28.5 years
- Average prepregnancy BMI: 21.9
- 41.5% of the conscripts had at least one parent with university-level education
Obesity (BMI ≥ 30) of conscripts: 4.9%
Slight difference in prevalence of obesity based on mode of delivery
- Vaginal delivery: 4.9%
- Elective cesarean: 5.5%
- Nonelective cesarean: 5.6%
After accounting for potential confounders, when compared with vaginal delivery, there was no evidence of an association between nonelective or elective CS and young adulthood obesity
- Nonelective cesarean (p = 0.532)
  - Relative risk ratio 0.96 (95% CI, 0.83 to 1.10)
- Elective cesarean (p = 0.826)
  - Relative risk ratio 1.02 (95% CI, 0.88 to 1.18)
Likewise, compared with vaginal delivery, there was no evidence for an association between any form of CS and overweight (BMI ≥ 25)

This study did not find evidence of a link between overweight or obesity based on mode of delivery in young adulthood
The authors point out that one limitation of their study was that the cohort only included a male population

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