Mode of Delivery and Childhood Obesity

Abstract

Despite the consistency of this literature, a key question remains: are these results reflective of a causal relation or are they due to residual confounding? In the absence of a randomized trial to answer this question, clever study design and analysis of observational studies must be leveraged to address this important problem. Three main strategies have been used to address this issue: statistical adjustment for shared risk factors for cesarean delivery and childhood obesity, most critically prepregnancy body mass index; comparison of weight status of siblings discordant in mode of delivery; and comparison of weight status of individuals born by vaginal delivery with those born by cesarean delivery after differentiating between elective and nonelective procedures and/or procedures performed before or after the onset of labor. Separating elective procedures performed before the onset of labor from other cesarean deliveries can also provide insights into one of the proposed mechanisms underlying this association: differences in infant gut microbiome resulting from differences in exposure to maternal vaginal secretions.