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The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis.
Int J Obes (Lond) 2013; 37(7):893-9IJ

Abstract

Studies have reported inconsistent results concerning the association of cesarean section with offspring obesity. We performed a systematic review and meta-analysis to examine whether cesarean section increases the risk of later overweight and obesity. Pubmed, Embase and Web of Science were searched using different combinations of two groups of keywords: 'cesarean' and 'overweight/obesity'. Cohort or case-control studies that reported the association of cesarean section with childhood (3-8 years), adolescence (9-18 years) and/or adult (>19 years) overweight/obesity were eligible. Where possible, adjusted risk estimates were pooled using a random effects model; otherwise unadjusted estimates were pooled. Statistical heterogeneity was assessed with I(2) statistics; the values of 25%, 50% and 75% were considered to indicate low, medium and high heterogeneity, respectively. We conducted a subgroup analysis to identify the sources of heterogeneity according to study quality defined on the basis of the Newcastle-Ottawa Scale. In total, two case-control and seven cohort studies were identified for the literature review and 15 separate risk estimates were included in the meta-analysis. The overall pooled odds ratio (OR) of overweight/obesity for offspring delivered by cesarean section compared with those born vaginally was 1.33 (95% confidence interval (CI) 1.19, 1.48; I(2)=63%); the OR was 1.32 (1.15, 1.51) for children, 1.24 (1.00, 1.54) for adolescents and 1.50 (1.02, 2.20) for adults. In subgroup analysis, the overall pooled OR was 1.18 (1.09, 1.27; I(2)=29%) for high-quality studies and 1.78 (1.43, 2.22; I(2)=24%) for medium-quality (P for interaction=0.0005); no low-quality studies were identified. The ORs for children, adolescents and adults all tended to be lower for high-quality studies compared with medium-quality studies. Our results indicated that cesarean section was moderately associated with offspring overweight and obesity. This finding has public health implications, given the increase in cesarean births in many countries.

Authors+Show Affiliations

Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, School of Public Health, Peking University Health Science Center, Beijing, China.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23207407

Citation

Li, H-t, et al. "The Impact of Cesarean Section On Offspring Overweight and Obesity: a Systematic Review and Meta-analysis." International Journal of Obesity (2005), vol. 37, no. 7, 2013, pp. 893-9.
Li HT, Zhou YB, Liu JM. The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2013;37(7):893-9.
Li, H. T., Zhou, Y. B., & Liu, J. M. (2013). The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. International Journal of Obesity (2005), 37(7), pp. 893-9. doi:10.1038/ijo.2012.195.
Li HT, Zhou YB, Liu JM. The Impact of Cesarean Section On Offspring Overweight and Obesity: a Systematic Review and Meta-analysis. Int J Obes (Lond). 2013;37(7):893-9. PubMed PMID: 23207407.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysis. AU - Li,H-t, AU - Zhou,Y-b, AU - Liu,J-m, Y1 - 2012/12/04/ PY - 2012/06/21/received PY - 2012/10/01/revised PY - 2012/10/29/accepted PY - 2012/12/5/entrez PY - 2012/12/5/pubmed PY - 2014/3/29/medline SP - 893 EP - 9 JF - International journal of obesity (2005) JO - Int J Obes (Lond) VL - 37 IS - 7 N2 - Studies have reported inconsistent results concerning the association of cesarean section with offspring obesity. We performed a systematic review and meta-analysis to examine whether cesarean section increases the risk of later overweight and obesity. Pubmed, Embase and Web of Science were searched using different combinations of two groups of keywords: 'cesarean' and 'overweight/obesity'. Cohort or case-control studies that reported the association of cesarean section with childhood (3-8 years), adolescence (9-18 years) and/or adult (>19 years) overweight/obesity were eligible. Where possible, adjusted risk estimates were pooled using a random effects model; otherwise unadjusted estimates were pooled. Statistical heterogeneity was assessed with I(2) statistics; the values of 25%, 50% and 75% were considered to indicate low, medium and high heterogeneity, respectively. We conducted a subgroup analysis to identify the sources of heterogeneity according to study quality defined on the basis of the Newcastle-Ottawa Scale. In total, two case-control and seven cohort studies were identified for the literature review and 15 separate risk estimates were included in the meta-analysis. The overall pooled odds ratio (OR) of overweight/obesity for offspring delivered by cesarean section compared with those born vaginally was 1.33 (95% confidence interval (CI) 1.19, 1.48; I(2)=63%); the OR was 1.32 (1.15, 1.51) for children, 1.24 (1.00, 1.54) for adolescents and 1.50 (1.02, 2.20) for adults. In subgroup analysis, the overall pooled OR was 1.18 (1.09, 1.27; I(2)=29%) for high-quality studies and 1.78 (1.43, 2.22; I(2)=24%) for medium-quality (P for interaction=0.0005); no low-quality studies were identified. The ORs for children, adolescents and adults all tended to be lower for high-quality studies compared with medium-quality studies. Our results indicated that cesarean section was moderately associated with offspring overweight and obesity. This finding has public health implications, given the increase in cesarean births in many countries. SN - 1476-5497 UR - https://www.unboundmedicine.com/medline/citation/23207407/The_impact_of_cesarean_section_on_offspring_overweight_and_obesity:_a_systematic_review_and_meta_analysis_ L2 - http://dx.doi.org/10.1038/ijo.2012.195 DB - PRIME DP - Unbound Medicine ER -