Elective Cesarean-section delivery might contribute to excess weight and also possibly reduced linear growth at one year of age in children, according to a study published in Paediatric Research, a monthly peer-reviewed medical journal.

The study authored by a team of researchers led by Giridhara R. Babu, head of Lifecourse Epidemiology at the Indian Institute of Public Health (IIPH), analysed data from the Maternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycaemia and Insulin (MAASTHI) prospective birth cohort.

The MAASTHI cohort, led by Dr. Babu and his team, was designed to study maternal risk factors associated with childhood overweight and obesity.

A total of 638 mother–infant pairs from public hospitals in South Bengaluru were included from MAASTHI cohort during 2016 to 2019 and information on delivery mode was obtained from medical records. Based on WHO child growth standards, body mass index-for age z-score (BMI z) and length-for-age z-score (length z) were derived.

“Our results indicate that decreasing medically unnecessary elective C-section deliveries may help limit excess weight gain and stunted linear growth among infants,” Dr. Babu told The Hindu on Wednesday.

The study found that the rate of C-section was 43.4% (26.5% emergency, 16.9% elective) among the 638 mothers. While 14.9% of the overall infants were overweight at one year of age, among the 108 babies delivered by elective C-section, 25% became overweight.

“Babies delivered by elective C-section had 2.44 times higher risk of being overweight compared to those born by vaginal delivery. However, no such association was found for emergency C-section,” explained Deepa R., researcher from IIPH, who is the co-author of the study.

According to the study, one exposure in the first 1,000 days that has been associated with excess infant weight gain and childhood overweight and obesity is C-section delivery. While several mechanisms may explain this association, the leading hypothesis is that interruption of mother-to-newborn microbiota transfer drives the association of C-section with overweight and obesity. Consistent with this hypothesis, studies have found that gut microbiota may play an etiologic role in the development of overweight, as well as under-nutrition and C-section is highly deterministic of the infant gut microbiota development.

Dr. Babu said the prevalence of C-section delivery is on the rise globally, including countries such as India that have a high burden of malnutrition.