Cesarean section and increased body mass index in school children: two cohort studies from distinct socioeconomic background areas in Brazil

Author(s)

Goldani, Marcelo Zubaran ^[1] ; Barbieri, Marco Antonio ^[2] ; Moura da Silva, Antonio Augusto ^[3] ; Pereira Gutierrez, Manoel Romeu ^[2] ; Bettiol, Heloisa ^[2] ; Sueno Goldani, Helena Ayako ^[1]

Affiliation

^[1] Univ Fed Rio Grande do Sul, Dept Pediat, Fac Med, BR-90035903 Porto Alegre, RS - Brazil

^[2] Univ Sao Paulo, Dept Pediat, Fac Med Ribeirao Preto, BR-14049900 Ribeirao Preto, SP - Brazil

^[3] Univ Maranhao, Dept Publ Hlth, BR-65020070 Sao Luis, MA - Brazil

• Document type: Journal article
• Source: NUTRITION JOURNAL; v. 12, JUL 25 2013.
• Web of Science Citations: 17

Abstract

Background: Recent studies have raised controversy regarding the association between cesarean section and later obesity in the offspring. The purpose of this study was to assess the association of cesarean section with increased body mass index (BMI) and obesity in school children from two Brazilian cities with distinct socioeconomic backgrounds. Methods: Two birth cohorts respectively born in 1994 in Ribeirao Preto, a wealthy city in Southeast, and in 1997/98 in Sao Luis, a less wealthy city in Northeast of Brasil, were evaluated. After birth, 2,846 pairs of mothers-newborns were evaluated in Ribeirao Preto and 2,542 in Sao Luis. In 2004/05, 790 children aged 10/11 years were randomly reassessed in Ribeirao Preto and 673 at 7/9 years in Sao Luis. Information on type of delivery, maternal and child characteristics, socioeconomic position and anthropometric measurements were collected after birth and at school age. Obesity was defined as BMI >= 95th percentile at school age. Results: Obesity rate was 13.0% in Ribeirao Preto and 2.1% in Sao Luis. Cesarean section was associated with obesity and remained significant after adjustment only in Ribeirao Preto {[}OR = 1.74 (95% CI: 1.04; 2.92)]. The association between cesarean section and BMI remained significant after adjustment for maternal schooling, maternal smoking during pregnancy, duration of breastfeeding, gender, birth weight and gestational age, type of school and, only in Sao Luis, pre-pregnancy maternal weight. In Ribeirao Preto children born by cesarean section had BMI 0.31 kg/m(2) (95% CI: 0.11; 0.51) higher than those born by vaginal delivery. In Sao Luis BMI of children born by cesarean section was 0.28 kg/m(2) higher (95% CI: 0.08; 0.49) than those born by vaginal delivery. Conclusion: A positive association between cesarean section and increased BMI z-score was demonstrated in areas with different socioeconomic status in a middle-income country. (AU)

• FAPESP's process: 00/09508-7 - From perinatal health to health of the young adult: study of cohort born in 1978/79 in the hospitals of Ribeirão Preto, SP
• Grantee: Marco Antonio Barbieri
• Support Opportunities: Research Projects - Thematic Grants