Association Between Cesarean Birth and Risk of Obesity

http://archpedi.jamanetwork.com/article.aspx?articleid=2548440

by Mz • 10 years ago

33 42 10 years ago

archpedi.jamanetwork.com

RA_Fisher2• 10 years ago

It's so disappointing to see studies like these relied on when reported by news outlets. To start, we don't have the data or statistical code used to generate the results. Consider this a basic unit test. Of course we'd want to further scrutinize the code and methodology, but we're not even there. :-(

I'd suggest a marker for quantitative research posted to HN along the lines of: runnable?

porejide• 10 years ago

Code: totally agreed.

Data: tricky, because of privacy and HIPPA.

basseq3• 10 years ago

You could make this complaint about pretty much every academic study ever. Rarely is the underlying data, statistical models, etc. shared publicly.

Should they be (for repeatability and peer review)? Sure, I buy that argument. But it's not a valid reason to criticize this particular study.

And at least it's the source journal article, not a media post!

RA_Fisher2• 10 years ago

I do make this argument for pretty much every quantitative study.

AWildDHHAppears• 10 years ago

Why would a person who had had a "Cesarean Birth" choose to eat more? This raises more questions than it answers.

asksol• 10 years ago

Definitely questionable, but maybe it's related to germs transferred during birth: http://well.blogs.nytimes.com/2016/02/01/post-cesarean-bacte...

phormula• 10 years ago

It's speculated that cesarian births do not get exposure the the mother's vaginal flora and their microbiome does not get properly seeded.

I wonder if manually exposing the child to the mother's flora would be of any benefit.

flurie• 10 years ago

A pilot study on this was published pretty recently with some success in terms of passing the mother's microbiome on to the infant, though that's still a long way off from determining the benefits.

http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html

firstworldman• 10 years ago

Before my son was born, we tried to persuade our OB to allow us to do this, or at least to look at the research herself. She wouldn't budge.

As an aside, my son was born 12 lb 1 oz, he now weighs 31 lbs at 5 months. The same weight as my 3 1/2 year old daughter.

dragonwriter• 10 years ago

Why would a person who had had a "Cesarean Birth" choose to eat more?

The described relation isn't between Cesarean Birth and choosing to eat more.

seizethecheese4• 10 years ago

Wild speculation: perhaps those that chose c-section are on average less able to tolerate pain, and therefore lacking in self control (to a degree) and therefore their progeny have a higher likelihood of overeating.

basseq3• 10 years ago

Disclaimer: There's a really bad stigma about c-sections and mothers who have them being "less" or "worse" because of it. I'm careful to point this out before we dive into a discussion on making accusations of "poor self-control". That said...

If you remove those c-sections that are medically necessary or recommended ("known indicators for cesarean delivery" is the language used in the abstract), then you're left with that population that truly "chose" to have a c-section. The association is stronger in this population.

I'd want to tie this back to those demographics. What kind of people truly choose a c-section? Is there something about that demographic that correlates to obesity for other reasons? Are obese women more likely to be counseled towards c-sections? Again, why? It's unclear if they normalized for this.

Incidentally, I think your speculation is probably wrong. You assume that c-sections are (or are regarded as) the lower-pain option. You can have a painless "natural" birth with an epidural, and post-birth recovery is going to be "painful"--in different ways--with either path. In other words, don't think people choose c-section for pain management in the first place, which invalidates the rest of your logic chain.

seizethecheese4• 10 years ago

Interesting, and I think you may be right. I do think women choose c-sections because the are scared of natural birth for whatever reason.

It's probably true that there is some demographic component to this correlation, though I would assume the would control for that.

tonfa• 10 years ago

If you read the article, the study was done in context of other studies showing that most of the gut bacteria comes from vaginal birth, e.g http://www.mdpi.com/2076-0817/3/3/769/htm

Correlation between healthy gut bacteria and lower obesity rate are not that surprising.

gohrt3• 10 years ago

That's a tautology -- what does "healthy" mean?

fragola• 10 years ago

I am speechless. Just in case anyone reads this and thinks having a C-section is painless: it's not. It's really not for the faint of heart, and it almost always happens after hours in labor anyway.

Before leaping to insulting conclusions about why women get C-sections, consider the most obvious explanation: this whole thing is just due to gestational diabetes -> higher risk of c-section AND gestational diabetes -> higher risk of obesity later in life for infant.[0]

[0] http://www.webmd.com/baby/gestational-diabetes-you#1

seizethecheese4• 10 years ago

My only knowledge here is personal experience having talked to women swearing they will only ever have C-sections.

ginko• 10 years ago

Couldn't it be the other way round? Children that tend to obesity are more likely to require a cesarean section? One common reason to use a cesarean is with unusually large babies, for instance.

te• 10 years ago

Yes. The paper's abstract only notes an 'association', not a causal arrow. Readers simply infer the causal arrow.

midnitewarrior2• 10 years ago

Cesarean birth in the US is something mothers push for because they don't want the cosmetic consequences of a natural birth. I think technically they need a medical reason for it, but I'm guessing it's not too tough to qualify for it.

I have a guess here, in that children who don't travel down the birth canal aren't inoculated with certain bacteria from the mother that may be important in digestive and possible immune function. Just a guess assuming causation, but the mother's birth canal bacteria may play a role in child development.

GFischer• 10 years ago

Doctors also push for it because they get paid more (according to Freakonomics).

A source:

http://www.wired.com/2005/05/realestate/

"consider these findings of a 1996 medical study: Obstetricians in areas with declining birthrates are much more likely to perform cesarean section deliveries than obstetricians in growing areas – suggesting that when business is tough, doctors may try to ring up more expensive procedures."

randomdrake• 10 years ago

This is so factually incorrect and full of opinion that I felt no choice but to downvote.

No, mothers don't just push it because they are concerned about cosmetics. What an overreaching and insulting generalization.

paulddraper• 10 years ago

They don't want they cosmetic consequences of a NATURAL birth?!?

Have you even seen someone who's had a C-section?

Two-piece outfits are usually not a part of their wardrobe afterward.

C-sections are terrible: scarring, risky, expensive, and having a far longer recovery period. Natural birth is no picnic, but compared to a C-section, it nearly is.

It's hard for me to believe anyone would prefer a C-section if it wasn't medically recommended.

mobilefriendly3• 10 years ago

Also, moms that are less healthy are more likely candidates for c-sections.

jwdunne• 10 years ago

Yes. Obesity in the mother can increase birth weight. Increased birth weight can require a C-section. There is a strong link between obesity in parents and children regardless of delivery method.

xherberta• 10 years ago

1) Cesarean birth is a risk factor for developing a less-than-optimal microbiome. (http://jn.nutrition.org/content/138/9/1796S.full)

2) Prevalence of certain species in the microbiome is highly correlated with obesity. (http://go.nature.com/1sksCA6) "Our results indicate that the obese microbiome has an increased capacity to harvest energy from the diet."

gohrt3• 10 years ago

Those two facts seem to stand in opposition, unless "optimal" is used in a tautological sense.

Splendor• 10 years ago

What options currently exist to improve a person's microbiome?

Mz3• 10 years ago

Yogurt, probiotic supplements, dietary changes.

Association Between Cesarean Birth and Risk of Obesity

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