Cesarean delivery on maternal request and common child health outcomes: A prospective cohort study in China

• Published in: Journal of global health Vol. 12; p. 11001
• Main Authors: Si, Ke-Yi, Li, Hong-Tian, Zhou, Yu-Bo, Li, Zhi-Wen, Zhang, Le, Zhang, Ya-Li, Ye, Rong-Wei, Liu, Jian-Meng
• Format: Journal Article
• Language: English
• Published: Scotland Edinburgh University Global Health Society 01.01.2022; International Society of Global Health
• Subjects: Acids; Anemia; Associations; Birth weight; Body mass index; Caregivers; Cesarean Section; Child; Child Health; Childbirth & labor; Children & youth; Childrens health; Cohort analysis; Delivery, Obstetric; Female; Gestational age; Global health; Health insurance; Hemoglobin; Humans; Infant; Obesity; Pediatric Obesity - epidemiology; Pneumonia; Pregnancy; Pregnancy complications; Prospective Studies; Research Theme 7: Health Transitions in China; Standard deviation; Vagina; Vitamin B; Womens health; China
• ISSN: 2047-2978; 2047-2986
• DOI: 10.7189/jogh.12.11001

Cesarean delivery vs vaginal delivery was reported to increase the risks of childhood obesity, pneumonia, anemia, and neurobehavioral disorders, but few studies were able to deal with the confounding biases associated with medical conditions indicating cesareans. This prospective cohort study aims to investigate the associations of non-medically indicated cesarean delivery on maternal request (CDMR) with these child health outcomes. Among 17 748 liveborn infants whose mothers (primiparas) participated in a randomized controlled trial on micronutrient supplementation and pregnancy outcomes during 2006-2009 in 5 rural counties in Hebei Province, China, 6972 singletons born by full-term spontaneous vaginal delivery (SVD) and 3626 by CDMR were extracted for the assessments of obesity (weight-for-height z-score >3) and pneumonia (self-reported) at 1.5-5 years in 2011. Some children were further randomly selected from these two groups for the assessments of anemia (hemoglobin <110 g/L, 2341 SVD and 2417 CDMR) and neurobehavioral disorders (raw score of Child Behavior Checklist larger than the 90th percentile of the normative sample, 1257 SVD and 1060 CDMR). Compared with SVD, CDMR was associated with increased risks of obesity (adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.14-1.75,  = 0.002) and anemia (aOR = 1.65, 95% CI = 1.28-2.12,  < 0.001), but not with the risk of pneumonia (aOR = 1.16, 95% CI = 0.94-1.45,  = 0.17) or neurobehavioral disorders (aORs varied from 0.82 to 0.91,  > 0.05) in childhood. Cesarean delivery, independent of cesarean indications, is likely associated with childhood obesity and anemia, indicating a need to keep pregnant women informed, especially those seeking CDMR, a need to explore possible improvement on obstetric service, and even a need for main stakeholders to reach a compromise in making a cesarean decision. ClinicalTrials.gov: NCT00133744 and NCT01404416.