title: Cesarean delivery and metabolic risk factors in young adults: a Brazilian birth cohort study.
abstract: BACKGROUND
  Cesarean delivery (CD) perturbs the assembly of the neonatal gut microbiome and has been associated with child and adult obesity. However, it is still unknown whether CD is associated with metabolic risk factors in young adults.
  
  
  OBJECTIVE
  We investigated the association of CD and metabolic risk factors in young adults in a cohort study who were 23-25 y of age at follow-up.
  
  
  METHODS
  We used data from a cohort study in Ribeirão Preto, Brazil. Baseline data on 6827 singleton pregnancies were collected in 1978-1979, and a sample of 2063 subjects were followed up 23-25 y later (2002-2004). Information on the type of delivery, birth weight, maternal age, parity, maternal schooling, and maternal smoking was obtained after birth. Anthropometric data, biochemical measurements, and information on participant schooling and smoking history were collected at 23-25 y of age. A linear regression was performed to assess the association between CD and biochemical measurements in early adulthood, controlling for a minimum set of confounders that were identified in a directed acyclic graph.
  
  
  RESULTS
  The mean ± SD age of the subjects was 23.9 ± 0.71 y, and 51.8% of the sample were women. The CD rate was 32.0% and was more common in older (P < 0.001) and more educated mothers (P < 0.001). Compared with vaginal delivery, CD was associated with higher body mass index (BMI) after multivariable adjustment (P < 0.001) but not with glucose, homeostasis model assessment of insulin resistance, the quantitative insulin-sensitivity check index, total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides (all P > 0.05).
  
  
  CONCLUSIONS
  In our sample of Brazilian adults, CD was associated with higher BMI but not with other metabolic risk factors.
authors.affiliation: Biological and Health Sciences Center, University of Caxias do Sul, Caxias do Sul, Brazil; Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil;
authors.forename: Juliana Rombaldi
authors.initials: JR
authors.lastname: Bernardi
authors.affiliation: Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil;
authors.forename: Tanara Vogel
authors.initials: TV
authors.lastname: Pinheiro
authors.affiliation: Department of Epidemiology, Columbia University, New York, NY;
authors.forename: Noel Theodore
authors.initials: NT
authors.lastname: Mueller
authors.affiliation: Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil;
authors.forename: Helena Ayako Sueno
authors.initials: HA
authors.lastname: Goldani
authors.affiliation: Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil; and.
authors.forename: Manoel Romeu Pereira
authors.initials: MR
authors.lastname: Gutierrez
authors.affiliation: Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil; and.
authors.forename: Heloisa
authors.initials: H
authors.lastname: Bettiol
authors.affiliation: Department of Public Health, University of Maranhão, São Luis, Brazil.
authors.forename: Antônio Augusto
authors.initials: AA
authors.lastname: Moura da Silva
authors.affiliation: Department of Pediatrics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil; and.
authors.forename: Marco Antônio
authors.initials: MA
authors.lastname: Barbieri
authors.affiliation: Department of Pediatrics, Porto Alegre Clinical Hospital, Faculty of Medicine, University of Rio Grande do Sul, Porto Alegre, Brazil; mgoldani@hcpa.ufrgs.br.
authors.forename: Marcelo Zubaran
authors.initials: MZ
authors.lastname: Goldani
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D050177:Overweight / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: cesarean delivery; cohort study; metabolic diseases; microbiome; obesity; vaginal delivery