title: Cesarean delivery and risk of childhood obesity.
abstract: OBJECTIVE
  To investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity.
  
  
  METHODS
  Healthy, full-term infants were recruited. Overweight and obesity were defined using measured weight and height according to World Health Organization reference data. Associations between cesarean delivery and being overweight or obese were investigated at age 2, 6, and 10 years (n = 1734, 1244, and 1170, respectively) by multivariate logistic regression models adjusted for socioeconomic status, child characteristics, and maternal prepregnancy characteristics.
  
  
  RESULTS
  Mothers who gave birth by cesarean delivery (∼17%) had a higher mean prepregnancy body mass index (23.7 kg/m(2) vs 22.5 kg/m(2)), greater mean gestational weight gain (15.3 kg vs 14.5 kg), and shorter mean duration of exclusive breastfeeding (3.4 months vs 3.8 months) compared with those who delivered vaginally. The proportion of obese children was greater in the cesarean delivery group compared with the vaginal delivery group at age 2 years (13.6% vs 8.3%), but not at older ages. Regression analyses revealed a greater likelihood of obesity at age 2 years in the cesarean delivery group compared with the vaginal delivery group at age 2 years (aOR, 1.68; 95% CI, 1.10-2.58), but not at age 6 years (aOR, 1.49; 95% CI, 0.55-4.05) or age 10 years (aOR, 1.16; 95% CI, 0.59-2.29).
  
  
  CONCLUSIONS
  Cesarean delivery may increase the risk of obesity in early childhood. Our results do not support the hypothesis that an increasing rate of cesarean delivery contributes to obesity in childhood.
authors: Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany; Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany.
authors: Zhengcun
authors: Z
authors: Pei
authors: Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany.
authors: Joachim
authors: J
authors: Heinrich
authors: Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Elaine
authors: E
authors: Fuertes
authors: Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany.
authors: Claudia
authors: C
authors: Flexeder
authors: Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Düsseldorf, Germany; Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
authors: Barbara
authors: B
authors: Hoffmann
authors: Department of Environmental Immunology, Helmholz Center for Environmental Research, Leipzig, Germany; Department of Pediatrics, Technical University Munich, Munich, Germany.
authors: Irina
authors: I
authors: Lehmann
authors: Medical Practice for Pediatrics, Bad Honnef, Germany.
authors: Beate
authors: B
authors: Schaaf
authors: Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
authors: Andrea
authors: A
authors: von Berg
authors: Division of Pediatric, Gastroenterology, and Hepatology, Dr von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany. Electronic address: sibylle.koletzko@med.uni-muenchen.de.
authors: Sibylle
authors: S
authors: Koletzko
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D050177:Overweight / Q000209:etiology; D063766:Pediatric Obesity / Q000209:etiology*; D011247:Pregnancy; D012307:Risk Factors