Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age
Association of Elective and Emergency Cesarean Delivery With Early Childhood Overweight at 12 Months of Age
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DOI：
10.1001/jamanetworkopen.2018.5025
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发表时间：
2018-11-01
影响因子：
13.8
通讯作者：
Ang, Seng Bin
中科院分区：
文献类型：
--
作者：
Cai, Meijin;Loy, See Ling;Ang, Seng Bin
重要性 过去 20 年来，全球剖腹产 (CD) 率增加了一倍以上，其中择期剖宫产的贡献不断增加。剖腹产与儿童早期超重和肥胖有关，但单独检查选择性和紧急 CD 的研究有限。 目的 调查选择性或紧急 CD 是否与儿童早期超重风险相关。 设计、环境和参与者 数据来自新加坡成长走向健康结果 (GUSTO) 研究，这是一项正在进行的前瞻性母子出生队列研究。参与者是 2009 年 6 月至 2010 年 9 月期间在新加坡两家主要公立医院招募的 18 岁或以上、父母种族背景相同的孕妇（n = 1237）。患有1型糖尿病或正在接受化疗或精神药物治疗的患者被排除在外。数据分析于 2017 年 10 月开始。暴露 分娩模式从临床记录中获得。选择性和紧急 CD 分别以阴道分娩为参考进行检查。 主要结果和测量 12 个月时的年龄体重指数 z 得分，根据 2006 年世界卫生组织儿童生长标准，根据 2010 年 12 月至 2012 年 4 月期间测量的婴儿体重和卧位头跟长度测量值计算得出。超重风险的高体重指数状态定义为 z 得分大于 1 SD 且小于或等于 2 SD。超重定义为 z 得分超过 2 个标准差。 结果 在分析的 727 名婴儿中（51.2% [372] 男性），30.5% (222) 通过 CD 出生，其中 33.3% (74) 是选择性出生。 12 个月龄时超重风险和超重患病率分别为 12.2% (89) 和 2.3% (17)。在调整母亲种族、年龄、教育程度、产次、体重指数、产前吸烟、妊娠期高血压疾病后，选择性 CD 与超重或 12 个月时超重的风险显着相关。妊娠糖尿病和性别调整胎龄出生体重（比值比，2.05；95% CI，1.08-3.90；P = .03）。在进一步调整产时抗生素和前 6 个月婴儿喂养（幼儿超重和肥胖的 2 个潜在介质）后，这种关联仍然存在（比值比，2.02；95% CI，1.05-3.89；P = 0.04）。没有发现与紧急 CD 存在显着关联。对缺失协变量的多重插补分析得出了相似的结果。 结论和相关性 分娩方式的选择可能会影响儿童早期超重的风险。鼓励临床医生与打算生育的患者讨论选择性 CD 对儿童代谢结果的潜在长期影响。
IMPORTANCE Global cesarean delivery (CD) rates have more than doubled over the past 2 decades, with an increasing contribution from elective CDs. Cesarean delivery has been linked to early childhood overweight and obesity, but limited studies have examined elective and emergency CDs separately.OBJECTIVE To investigate whether elective or emergency CD was associated with risk of early childhood overweight.DESIGN, SETTING, AND PARTICIPANTS Data were drawn from the Growing Up in Singapore Toward Healthy Outcomes (GUSTO) study, an ongoing prospective mother-child birth cohort study. Participants were pregnant women aged 18 years or older with homogeneous parental ethnic background in their first trimester recruited between June 2009 and September 2010 (n = 1237) at 2 major public hospitals in Singapore. Those with type 1 diabetes or undergoing chemotherapy or psychotropic drug treatment were excluded. Data analysis commenced in October 2017.EXPOSURES Delivery mode obtained from clinical records. Elective and emergency CD examined separately against vaginal delivery as reference.MAIN OUTCOMES AND MEASURES Body mass index-for-age z scores at age 12 months calculated based on 2006 World Health Organization Child Growth Standards from infant weight and recumbent crown-heel length measurements taken between December 2010 and April 2012. High body mass index status at risk of overweight was defined as a z score of more than 1 SD and less than or equal to 2 SDs. Overweight was defined as a z score of more than 2 SDs.RESULTS Among 727 infants analyzed (51.2% [372] male), 30.5% (222) were born via CD, of which 33.3% (74) were elective. Prevalence of at risk of overweight and overweight at age 12 months was 12.2% (89) and 2.3%(17), respectively. Elective CD was significantly associated with at risk of overweight or overweight at age 12 months after adjusting for maternal ethnicity, age, education, parity, body mass index, antenatal smoking, hypertensive disorders of pregnancy. gestational diabetes, and sex-adjusted birth weight-for-gestational age (odds ratio, 2.05; 95% CI, 1.08-3.90; P = .03). The association persisted after further adjustment for intrapartum antibiotics and first 6 months infant feeding, 2 potential mediators of early childhood overweight and obesity (odds ratio, 2.02; 95% CI, 1.05-3.89; P = .04). No significant associations were found for emergency CD. Analysis with multiple imputation for missing covariates yielded similar results.CONCLUSIONS AND RELEVANCE Choice of delivery mode may influence risk of early childhood overweight. Clinicians are encouraged to discuss potential long-term implications of elective CD on child metabolic outcomes with patients who intend to have children.