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Updated: May 11, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Association of caesarean delivery with child adiposity from age 6 weeks to 15 years
1Department of Health Policy, Medicine, and Population Health, NYU School of Medicine, New York, NY 10012, USA. jan.blustein@wagner.nyu.edu
Insights
Caesarean birth is linked to higher body mass in children and adolescents. This association is stronger in offspring of overweight mothers, suggesting potential microbiome involvement.
Area of Science:
- Pediatric Health
- Epidemiology
- Public Health
Background:
- Caesarean section rates have increased globally.
- Understanding the long-term health implications of birth mode is crucial.
- Previous studies suggest a link between caesarean delivery and childhood obesity.
Purpose of the Study:
- To assess the association between caesarean section and body mass from birth through adolescence.
- To investigate if maternal pre-pregnancy weight modifies this association.
Main Methods:
- A longitudinal birth cohort study of 10,219 children in the UK (ALSPAC).
- Standardized measures of body mass (weight-for-length z-scores and BMI z-scores) were collected up to age 15.
- Mixed multivariable models were used to adjust for confounding factors.
Main Results:
- Caesarean delivery was associated with increased adiposity from 6 weeks through 15 years.
- Children born via caesarean had higher odds of being overweight or obese by age 11 (1.83 times).
- The association was stronger and more persistent in children born to overweight or obese mothers.
Conclusions:
- Caesarean delivery is associated with increased body mass during childhood and adolescence.
- Further research is needed to understand the mechanisms, potentially involving the gut microbiome.
- The association may differ based on maternal pre-pregnancy weight.
Objectives:
o assess associations of caesarean section with body mass from birth through adolescence.
Design:
ongitudinal birth cohort study, following subjects up to 15 years of age.
Setting And Participants:
Children born in 1991-1992 in Avon, UK who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) (n=10 219).
Primary Outcome:
standardized measures of body mass (weight-for length z-scores at 6 weeks, 10 and 20 months; and body mass index (BMI) z-scores at 38 months, 7, 9, 11 and 15 years). Secondary outcome: categorical overweight or obese (BMI: 85th percentile) for age and gender, at 38 months, 7, 9, 11 and 15 years.
Results:
Of the 10 219 children, 926 (9.06%) were delivered by caesarean section. Those born by caesarean had lower-birth weights than those born vaginally (-46.1 g, 95% confidence interval(CI): 14.6-77.6 g; P=0.004). In mixed multivariable models adjusting for birth weight, gender, parental body mass, family sociodemographics, gestational factors and infant feeding patterns, caesarean delivery was consistently associated with increased adiposity, starting at 6 weeks (+0.11 s.d. units, 95% CI: 0.03-0.18; P=0.005), through age 15 (BMI z-score increment+0.10 s.d. units, 95% CI: 0.001-0.198; P=0.042). By age 11 caesarean-delivered children had 1.83 times the odds of overweight or obesity (95% CI: 1.24-2.70; P=0.002). When the sample was stratified by maternal pre-pregnancy weight, the association among children born of overweight/obese mothers was strong and long-lasting. In contrast, evidence of an association among children born of normal-weight mothers was weak.
Conclusion:
Cesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.
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