title: Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study.
abstract: OBJECTIVE
  To examine whether delivery by caesarean section is a risk factor for childhood obesity.
  
  
  METHODS
  Prospective prebirth cohort study (Project Viva).
  
  
  METHODS
  Eight outpatient multi-specialty practices based in the Boston, Massachusetts area.
  
  
  METHODS
  We recruited women during early pregnancy between 1999 and 2002, and followed their children after birth. We included 1255 children with body composition measured at 3 years of age.
  
  
  METHODS
  BMI score, obesity (BMI for age and sex ≥95th percentile), and sum of triceps plus subscapular skinfold thicknesses at 3 years of age.
  
  
  RESULTS
  284 children (22.6%) were delivered by caesarean section. At age 3, 15.7% of children delivered by caesarean section were obese compared with 7.5% of children born vaginally. In multivariable logistic and linear regression models adjusting for maternal prepregnancy BMI, birth weight, and other covariates, birth by caesarean section was associated with a higher odds of obesity at age 3 (OR 2.10, 95% CI 1.36 to 3.23), higher mean BMI z-score (0.20 units, 95% CI 0.07 to 0.33), and higher sum of triceps plus subscapular skinfold thicknesses (0.94 mm, 95% CI 0.36 to 1.51).
  
  
  CONCLUSIONS
  Infants delivered by caesarean section may be at increased risk of childhood obesity. Further studies are needed to confirm our findings and to explore mechanisms underlying this association.
authors.affiliation: Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. susanna.huh@childrens.harvard.edu
authors.forename: Susanna Y
authors.initials: SY
authors.lastname: Huh
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Chloe A
authors.initials: CA
authors.lastname: Zera
authors.forename: Janet W Rich
authors.initials: JW
authors.lastname: Edwards
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
authors.forename: Scott T
authors.initials: ST
authors.lastname: Weiss
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008404:Massachusetts / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D050177:Overweight / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012885:Skinfold Thickness; D012959:Socioeconomic Factors