Birth by cesarean delivery and central adiposity in adolescents from a birth cohort

Abreu, Joana D’Arc Matos França de; Abreu, Sterffeson Lamare Lucena de; Bragança, Maylla Luanna Barbosa Martins; Cavalcante, Lilian Fernanda Pereira; França, Ana Karina Teixeira da Cunha; Ribeiro, Cecília Claudia Costa; Lamy Filho, Fernando

doi:10.1590/0102-311X00033320

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ARTICLE • Cad. Saúde Pública 37 (1) • 2021 • https://doi.org/10.1590/0102-311X00033320 copy

Birth by cesarean delivery and central adiposity in adolescents from a birth cohort

Nascimento por parto cesáreo e adiposidade central em adolescentes de uma coorte de nascimentos

Nacimiento por parto con cesárea y adiposidad central en adolescentes de una cohorte de nacimientos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.

Keywords:
Cesarean Section; Adiposity; Adolescent

Variables	Weighting for loss of follow-up
Variables	OR	95%CI
Maternal schooling level (years)
5-8	1.16	0.87; 1.54
9-12	1.44	1.07; 1.95
> 12	0.95	0.54; 1.67
Ignored	0.65	0.08; 5.47
Family income at birth (minimum wage)
1-3	0.88	0.70; 1.10
Up to 1	0.76	0.56; 1.03
Ignored	0.80	0.53; 1.19
Childbirth care
Public/Private/Philanthropic health care provider	0.96	0.78; 1.18
Network-affiliated health care provider	1.03	0.71; 1.48
Autonomous health care provider	0.41	0.14; 1.22
Type of delivery	1.19	0.96; 1.47
Sex of the adolescent	0.67	0.55; 0.80
Maternal age	1.01	0.99; 1.03
Prenatal care	1.69	1.14; 2.50

Variables	Male	Female	Total
	(n = 376)	(n = 225)	(n = 601)
	Mean + SD	Mean + SD	Mean + SD
Maternal BMI (kg/m²)	21.17 + 2.85	21.08 + 3.11	21.14 + 2.95
Adolescents’ height (m)	1.73 + 0.08	1.60 + 0.06	1.68 + 0.95
Adolescents’ body weight (kg) *	64.96 + 12.30	55.72+ 11.80	61.50 + 12.90
Adolescents’ BMI (kg/m²)	21.77 + 3.64	21.70+ 4.05	21.74 + 3.79
Total fat mass (kg) *	13.94 + 7.15	19.50 + 7.40	16.04 + 7.70
Trunk fat mass (g) *	6,035.41+ 3,880.01	8,641.02 + 3,816.27	7,017.42 + 4,054.87
Limbs fat mass (g) *	7,021.72 + 3,369.96	10,049.92 + 3,677.26	8163.00 + 3782.67
Legs fat mass (g) *	5,439.16 + 2,573.86	7,894.20 + 2,877.15	6,364.43 + 2,941.57
Android fat mass (g) *	810.43 + 664.11	1,187.43+ 648.08	952.51 + 682.52
Gynoid fat mass (g) *	2,319.70 + 1,299.93	3,763.04 + 1,347.52	2,863.68 + 1,491.44
Trunk/total ratio (T/T)	0.41 + 0.05	0.43 + 0.05	0.42 + 0.05
Android/gynoid ratio (A/G)	0.32 + 0.09	0.30 + 0.08	0.31 + 0.09
Trunk/limbs (T/Lb)	0.83 + 0.20	0.85 + 0.15	0.83 + 0.18
Trunk/legs (T/Lg)	1.07 + 0.27	1.08 + 0.21	1.07 + 0.25
Fat mass index (kg/m²) *	4.69 + 2.40	7.59 + 2.73	5.79 + 2.90

Variáveis	Difference between standard averages *		Variance ratio **
Variáveis	Crude estimate	Weighted estimate	Crude estimate	Weighted estimate
Intrauterine growth restriction	-0.05	-0.020	0.90	0.96
Gestational age at birth	-0.06	0.003	0.85	1.00
Maternal education_2	-0.48	0.024	0.72	1.01
Maternal education_3	0.21	-0.013	1.01	1.00
Maternal education_4	0.45	-0.011	9.50	0.95
Maternal age	0.50	-0.061	1.35	1.02
Maternal smoking	0.01	0.005	0.94	0.97
Maternal prepregnancy BMI	0.19	-0.030	1.13	0.82
Prenatal care	0.01	0.016	0.93	0.84
Family income at birth_2	-0.25	-0.002	0.81	1.00
Family income at birth_3	-0.24	0.070	0.56	1.17
Family income at birth_4	-0.06	0.040	0.76	1.20
Maternal marital status_2	-0.35	0.028	0.94	1.00
Maternal marital status_3	-0.16	-0.007	0.78	0.99

Body fat distribution	Cesarean delivery
	Coefficient	95%CI
Trunk-to-total fat mass ratio (T/T)
Male	< -0.001	-0.013; 0.011
Female	-0.006	-0.002; 0.007
Total	-0.003	-0.013; 0.007
Android-to-gynoid fat mass ratio (A/G)
Male	0.005	-0.014; 0.024
Female	-0.009	-0.030; 0.015
Total	0.001	-0.015; 0.018
Trunk-to-limb fat mass ratio (T/Lb)
Male	-0.014	-0.050; 0.030
Female	-0.024	-0.070; 0.020
Total	-0.016	-0.048; 0.016
Trunk-to-leg fat mass ratio (T/Lg)
Male	-0.009	-0.060; 0.460
Female	-0.035	-0.090; 0.030
Total	-0.014	-0.060; 0.030
Fat mass index
Male	0.018	-0.620; 0.660
Female	-0.024	-0.830; 0.780
Total	-0.127	-0.774; 0.520
Trunk fat mass
Male	-0.003	-0.030; 0.020
Female	0.001	-0.030; 0.030
Total	-0.005	-0.030; 0.020
Android fat mass
Male	-0.002	-0.030; 0.020
Female	-0.004	-0.040; 0.030
Total	-0.007	-0.030; 0.020
Gynoid fat mass
Male	-0.002	-0.030; 0.020
Female	0.004	-0.020; 0.030
Total	-0.007	-0.036; 0.021
Total fat mass
Male	< -0.001	-0.020; 0.020
Female	0.005	-0.020; 0.030
Total	-0.003	-0.025; 0.019
Body mass index
Male	0.200	-0.670; 1.070
Female	-0.170	-1.260; 0.910
Total	-0.026	-0.800; 0.740

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[1] Correspondence
M. L. B. M. Bragança Universidade Federal do Maranhão. Rua Barão de Itapary 155, São Luís, MA 65020-070, Brasil. mayllabmartins@gmail.com