No Link Found Between Caesarean Delivery and Childhood Obesity Interview with:
Sheryl L. Rifas-Shiman, MPH
Lead Research Analyst
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Health Care Institute
Landmark Center
Boston, MA 02215 What is the background for this study?

Response: Caesarean delivery rates remain high and variable across hospitals, regions, and countries.
Caesarean delivery may be a risk factor for childhood obesity, possibly because delivery route can influence the intestinal microbiomes, which may influence energy regulation.

Previously reported associations of caesarean delivery with childhood obesity may be confounded by maternal BMI and sociocultural factors. To address this possibility, we studied sibling pairs from the Linked CENTURY Study, a longitudinal clinical database of well-child visits in Massachusetts linked to each child’s birth certificate, to isolate the effect of caesarean delivery from most other factors. What are the main findings? 

Response: Among 16,140 siblings, we found that compared with siblings born vaginally, those born via caesarean delivery did not have higher BMI z-scores at 5 years.

This null finding suggests that confounding by unmeasured variables such as lifestyle and sociocultural factors account for observed associations between caesarean delivery and BMI z-scores in some previous studies. What should readers take away from your report?

Response: While caesarean delivery may be life-saving in some circumstances, adverse maternal and short-term offspring health consequences of cesarean delivery are also well-established and include greater risk of cardiac arrest, emergency hysterectomy, and newborn respiratory complications. Thus, cesarean deliveries should only be performed if there is a medical indication, not by request. Our data, however, do not suggest that reducing caesarean delivery rates will have a big impact on the ongoing obesity epidemic. What recommendations do you have for future research as a result of this work?

Response: An important next step is for researchers to examine the effects of cesarean delivery on other outcomes such as cardio-metabolic biomarkers and asthma or allergies. Is there anything else you would like to add? 

Response: Childhood obesity is widespread and is hard to treat. So, it’s important to identify modifiable factors that occur prenatally and during infancy so that prevention can start early 

No disclosures. 


Rifas-Shiman SL, Gillman MW, Hawkins SS, Oken E, Taveras EM, Kleinman KP. Association of Cesarean Delivery With Body Mass Index z Score at Age 5 Years. JAMA Pediatr. Published online June 11, 2018. doi:10.1001/jamapediatrics.2018.0674

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