• Zhengcun Pei, Joachim Heinrich, Elaine Fuertes, Claudia Flexeder, Barbara Hoffmann, Irina Lehmann, Beate Schaaf, Andrea von Berg, Sibylle Koletzko, and Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood plus Air Pollution and Genetics (LISAplus) Study Group.
• Institute of Epidemiology I, German Research Center for Environmental Health, Neuherberg, Germany; Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany.
• J. Pediatr. 2014 May 1; 164 (5): 1068-1073.e2.

ObjectiveTo investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity.Study DesignHealthy, 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.ResultsMothers 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).ConclusionCesarean 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.Copyright © 2014 Elsevier Inc. All rights reserved.

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