Association Between Elective Cesarean Section And Children’s Body Fat-related Trajectory: A Prospective Birth Cohort Study

Objectives: Based on a large sample birth cohort,we aims to examine the effect of ECS with or without medical indications on children’s physical development by using repeated anthropometric data from birth to 6 years of age.Methods: A total of 2304 mother-child pairs with complete data on delivery mode and children’s anthropometric measurement were recruited from the Ma’anshan-Anhui Birth Cohort(MABC)in China.ECS was the main exposure in this study,and the primary outcomes were children’s growth trajectories and early adiposity rebound(AR).Children’s BMI trajectories were fitted by using group-based trajectory models and fractional polynomial mixed-effects models.The association between elective cesarean section(ECS)and children’s growth trajectories and early AR was performed using multiple logistic regression models.Results: Among 2304 mother-child pairs(1199 boys and 1105 girls),1088(47.2%)children were born by CS,including 61(5.6%)emergency CS,441(40.5%)ECS with medical indications,and 586(53.9%)ECS without medical indications.After adjusting for potential confounders,it was found that ECS without medical indications was associated with a “high level” of BMI trajectory(OR=1.777;95% CI:1.096-2.881),and ECS without medical indications was associated with early AR(OR=1.517;95% CI:1.123-2.050)in girls.We have not found that ECS was associated with “high level” body fat-related growth trajectory in boys.Conclusions: ECS may be relate with girls’ high level BMI trajectories and early AR.If causal,the findings will provide an evidence-based reference for early life interventions for childhood obesity.