Caesarean section delivery and childhood obesity: evidence from the growing up in New Zealand cohort

BackgroundEpidemiological studies have reported conflicting results in the association between Caesarean section (CS) birth and childhood obesity. Many of these studies had small sample sizes, were unable to distinguish between elective/planned and emergency CS, and did not adjust for the key confounder maternal pre-pregnancy body mass index (BMI). We investigated the association between CS delivery, particularly elective/planned and childhood obesity, using the Growing Up in New Zealand prospective longitudinal cohort study.MethodsPregnant women planning to deliver their babies on the New Zealand upper North Island were invited to participate. Mode of delivery was categorised into spontaneous vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS. The main outcome was childhood obesity defined according to the International Obesity Taskforce criteria at age 24 and 54 months. Multinomial logistic regression and mixed-effects linear regression models were fitted with associations adjusted for several potential confounders.ResultsOf the 6599 infants, 1532 (23.2%) were delivered by CS. At age 24 months, 478 (9.3%) children were obese. There was a statistically significant association between planned CS adjusted relative risk ratio (aRRR=1.59; (95% CI 1.09 to 2.33)) and obesity but not for emergency CS (aRRR=1.27; (95% CI 0.89 to 1.82)). At age 54 months there was no association between planned CS (aRRR=0.89; (95% CI 0.54 to 1.45)) and obesity as well as for emergency CS (aRRR=1.19; (95% CI 0.80 to 1.77)). At all-time points those born by planned CS had a higher mean BMI (adjusted mean difference=0.16; (95% CI 0.00 to 0.31), p=0.046).ConclusionsPlanned CS was an independent predictor of obesity in early childhood. This suggests that birth mode influences growth, at least in the short term. This association occurred during a critical phase of human development, the first 2 years of life, and if causal might result in long-term detrimental cardiometabolic changes.

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Association between caesarean section delivery and obesity in childhood: a longitudinal cohort study in Ireland

BMJ Open ◽

10.1136/bmjopen-2018-025051 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025051 ◽

Cited By ~ 9

Author(s):

Gwinyai Masukume ◽

Fergus P McCarthy ◽

Philip N Baker ◽

Louise C Kenny ◽

Susan MB Morton ◽

...

Keyword(s):

Cohort Study ◽

Caesarean Section ◽

Mode Of Delivery ◽

Longitudinal Cohort Study ◽

Relative Risk Ratio ◽

Delivery Mode ◽

Longitudinal Impact ◽

Adjusted Relative Risk ◽

Longitudinal Cohort ◽

Prospective Longitudinal

ObjectivesTo investigate the association between caesarean section (CS) birth and body fat percentage (BF%), body mass index (BMI) and being overweight or obese in early childhood.DesignProspective longitudinal cohort study.SettingBabies After Screening for Pregnancy Endpoints: Evaluating the Longitudinal Impact on Neurological and Nutritional Endpoints cohort.ParticipantsInfants born to mothers recruited from the Screening for Pregnancy Endpoints study, Cork University Maternity Hospital between November 2007 and February 2011.Outcome measureOverweight or obese defined according to the International Obesity Task Force criteria.ResultsOf the 1305 infants, 362 (27.8%) were delivered by CS. On regression analysis, BF% at 2 months did not differ significantly by delivery mode. Infants born by CS had a higher mean BMI at 6 months compared with those born vaginally (adjusted mean difference=0.24; 95% CI 0.06 to 0.41, p value=0.009). At 2 years, no difference was seen across the exposure groups in the risk of being overweight or obese. At 5 years, the association between prelabour CS and the risk of overweight or obesity was not statistically significant (adjusted relative risk ratio, aRRR=1.37; 95% CI 0.69 to 2.69) and the association remained statistically nonsignificant when children who were macrosomic at birth were excluded from the model (aRRR=0.86; 95% CI 0.36 to 2.08).ConclusionAt 6 months of age, children born by CS had a significantly higher BMI but this did not persist into future childhood. There was no evidence to support an association between mode of delivery and long-term risk of obesity in the child.

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Incidence and Determinants of Caesarean Section in Shiraz, Iran

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165632 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5632

Author(s):

Mahnaz Zarshenas ◽

Yun Zhao ◽

Colin W. Binns ◽

Jane A. Scott

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Financial Incentives ◽

Multinomial Logistic Regression ◽

Mode Of Delivery ◽

Alternative Methods ◽

Relative Risk Ratio ◽

Healthy Weight ◽

Natural Childbirth ◽

Maternity Hospitals

The rate of Caesarean section (CS) without medical indication has increased markedly worldwide in the past decades. This study reports the incidence of CS and identifies the determinants of elective and emergency CS as separate pregnancy outcomes in a cohort of Iranian women. Mothers (n = 700) of healthy, full-term infants were recruited from five maternity hospitals in Shiraz. The association between maternal socio-demographic and biomedical factors with mode of delivery was explored using multivariable, multinomial logistic regression. Most mothers underwent either an elective (35.4%) or emergency (34.7%) CS. After adjustment, women were more likely to deliver by elective CS than vaginally if they were older (≥30 year) compared to younger mothers (<25 year) (Relative Risk Ratio (RRR) 2.22; 95% Confidence Interval (CI) 1.28, 3.84), and had given birth at a private hospital (RRR 3.64; 95% CI 1.79, 7.38). Compared to those educated to primary or lower secondary level, university educated women were more likely to have undergone an elective (RRR 2.65; 95% CI 1.54, 4.58) or an emergency CS (RRR 3.92; 95% CI 2.27, 6.78) than a vaginal delivery. Similarly, overweight or obese women were more likely than healthy weight women to have undergone an elective (RRR 1.91; 95% CI 1.27, 2.87) or an emergency CS (RRR 2.02; 95% CI 1.35, 3.02) than a vaginal delivery. Specialist education of obstetricians and midwives along with financial incentives paid to private hospitals to encourage natural delivery may help in the reduction of unnecessary CS in Iran. In addition, to increase their childbirth knowledge and self-efficacy, pregnant women need to have the opportunity to attend purposefully designed antenatal childbirth preparation classes where they receive evidence-based information on natural childbirth and alternative methods of pain control, as well as the risks and indications for CS.

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Chronic hepatitis B prognostic markers other than pre-treatment viral load predicted composite treatment outcome

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2759 ◽

2013 ◽

Vol 7 (07) ◽

pp. 541-549

Author(s):

Myo Nyein Aung ◽

Wattana Leowattana ◽

Khine Nwe Win ◽

Noppadon Tangpukdee ◽

Sant Muangnoicharoen

Keyword(s):

Chronic Hepatitis ◽

Treatment Outcome ◽

Viral Load ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Multinomial Logistic Regression ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Response Predictors ◽

Pre Treatment

Introduction: Chronic hepatitis B (CHB) is a globally common infectious disease. Its clinical course is complicated. In Southeast Asia, nucleos(t)ide analogues (NA) are commonly used drugs for CHB treatment. Composite treatment outcome has often been used in CHB clinical practice, but rarely predicted epidemiologically. This study aimed to compare the composite treatment outcome between CHB patients with low and high treatment-naïve viral load, and to identify its predictors Methodology: This retrospective cohort study followed up 95 CHB patients on NA treatment for a year. Composite treatment outcome was defined as undetectable HBV DNA level, ALT normalization and, HBeAg clearance in the case of HBeAg-positive patients. Multinomial logistic regression analysis was applied to analyze the significant treatment response predictors. Results: Complete composite treatment outcome was achieved by 52% of CHB patients with an initial viral load < 6.5 log 10 copies /ml, but 31% of those had an initial viral load ≥ log 6.5 log 10 copies /ml. Outcome was predicted by HBeAg negativity (adjusted relative risk ratio, aRRR = 11.1, 95 % confidence interval, CI 3-41.3) and ALT normalization within the sixth month of therapy (aRRR = 6.7, CI 1.8-24.9). An elevation of ALT to more than 1.5 times the normal value (40 IU/ml) can lead to an incomplete response on NA therapy (aRRR = 6.2, CI 1.5-26.6.) Conclusion: Routine clinical markers other than pre-treatment viral load predicted composite CHB outcome on NA Therapy.

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Underweight and overweight/obesity among adults in Afghanistan: Prevalence and correlates from a national survey in 2018

10.21203/rs.3.rs-366120/v1 ◽

2021 ◽

Author(s):

Supa Pengpid ◽

Karl Peltzer

Keyword(s):

Logistic Regression ◽

Multinomial Logistic Regression ◽

Normal Weight ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Dual Burden ◽

Male Sex

Abstract Background The study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among adults in Afghanistan. Methods National cross-sectional survey data of 3,779 persons aged 18–69 years were analysed. Multinomial logistic regression was used to estimate factors associated with underweight and overweight/obesity relative to normal weight. Results In all, 7.8% of the study sample was underweight (BMI < 18.5 kg/m²), 49.5% had normal weight (BMI 18.5–24.9 kg/m²), 25.5% overweight (25.0-29.9 kg/m²), and 17.2% obesity. In adjusted multinomial logistic regression, factors negatively associated with underweight were male sex (Adjusted Relative Risk Ratio-ARRR: 0.55, Confidence Interval-CI: 0.32–0.95). Factors positively associated with overweight/obesity were aged 30–44 years (ARRR: 1.92, CI: 1.46–2.53) and aged 45–69 years (ARRR: 1.49, CI: 1.05–2.11) (compared to 18–29 years) (ARRR: 1.28, CI: 1.14–2.18), hypertension (ARRR: 2.69, CI: 1.88–3.85), type 2 diabetes (ARRR: 1.81, CI: 1.15–2.86), and raised cholesterol (ARRR: 2.04, CI: 1.41–2.95). Conclusion Almost one in ten adult respondents were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in Afghanistan.

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Overweight and Obesity Among Adults in Iraq: Prevalence and Correlates From a National Survey in 2015

10.20944/preprints202011.0489.v1 ◽

2020 ◽

Author(s):

Supa Pengpid ◽

Karl Peltzer

Keyword(s):

Logistic Regression ◽

Multinomial Logistic Regression ◽

Normal Weight ◽

Overweight And Obesity ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Adult Participants ◽

Nationally Representative

The study aimed to estimate the prevalence and correlates of overweight and obesity among adults in Iraq. Data from a 2015 nationally representative cross-sectional survey of 3,916 persons 18 years and older were analysed that responded to a questionnaire, physical and biochemical measures. Multinomial logistic regression was utilized to predict determinants of overweight and obesity relative to under or normal weight. Results indicate that 3.6% of the participants were underweight (BMI <18.5 kg/m²), 30.8% had normal weight (BMI 18.5-24.9 kg/m²), 31.8% were overweight (25.0-29.9 kg/m²), and 33.9% had obesity (BMI ≥ 30.0 kg/m²). In adjusted multinomial logistic regression, aged 40-49 years (Adjusted Relative Risk Ratio-ARRR: 4.47, Confidence Interval-CI: 3.39-5.91), urban residence (ARRR: 1.28, CI: 1.14-2.18), hypertension (ARRR: 3.13, CI: 2.36-4.17) were positively, and male sex (ARRR: 0.47, CI: 0.33-0.68), having more than primary education (ARRR: 0.69, CI: 0.50-0.94), and larger household size (≥5 members) (ARRR: 0.45, CI: 0.33-0.60) were negativey associated with obesity. About two in three adult participants were overweight/obese, and sociodemographic and health risk factors were found that can be utilized in targeting interventions.

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Association Between Parental HPV Knowledge and Intentions to Have Their Daughters Vaccinated

Western Journal of Nursing Research ◽

10.1177/0193945916682953 ◽

2016 ◽

Vol 40 (4) ◽

pp. 481-501 ◽

Cited By ~ 3

Author(s):

Lisa N. Mansfield ◽

Elijah O. Onsomu ◽

Elizabeth Merwin ◽

Naomi M. Hall ◽

Alfreda Harper-Harrison

Keyword(s):

Health Care Providers ◽

School Attendance ◽

Multinomial Logistic Regression ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Care Providers ◽

Cross Sectional ◽

Data Set ◽

Cervical Cancers ◽

Hpv Knowledge

Human papillomavirus (HPV) 16 and 18 causes 66% of cervical cancers (Dunne et al., 2014). Vaccination during adolescence can prevent HPV-associated cervical cancers, yet less than half of adolescent girls are vaccinated. This study examined the association between HPV knowledge and parental intentions to vaccinate daughters against HPV. A retrospective, cross-sectional, national data set from the 2006-2007 Health Information National Trends Survey (HINTS) was used. A multivariate multinomial logistic regression analysis was used to estimate the association between intent to vaccinate and HPV knowledge. After controlling for other covariates, parents who were knowledgeable were more likely to intend to have their daughters vaccinated compared with those who were not knowledgeable (adjusted relative risk ratio [aRRR] = 3.96, p = .004). Having HPV knowledge would significantly increase parents’ intent for vaccination against the disease for their daughters. Health care providers should integrate HPV-related education for parents within their services, and policymakers should consider requiring HPV vaccination for school attendance.

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Overweight and Obesity among Adults in Iraq: Prevalence and Correlates from a National Survey in 2015

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084198 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4198

Author(s):

Supa Pengpid ◽

Karl Peltzer

Keyword(s):

Logistic Regression ◽

Multinomial Logistic Regression ◽

Normal Weight ◽

Overweight And Obesity ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Adult Participants ◽

Nationally Representative

This study aimed to estimate the prevalence and correlates of overweight and obesity among adults in Iraq. Data from a 2015 nationally representative cross-sectional survey of 3916 persons 18 years or older (M (median) age = 40 years, IQR (interquartile range) age = 29–52 years; men: M = 41 years, IQR = 29–54 years; women: M = 40 years, IQR = 30–51 years) who responded to a questionnaire, and physical and biochemical measures were analysed. Multinomial logistic regression was utilised to predict the determinants of overweight and obesity relative to under or normal weight. The results indicate that 3.6% of the participants were underweight (body mass index (BMI) <18.5 kg/m2), 30.8% had normal weight (BMI 18.5–24.9 kg/m2), 31.8% were overweight (25.0–29.9 kg/m2), and 33.9% had obesity (BMI ≥30.0 kg/m2). In the adjusted multinomial logistic regression, being aged 40–49 years (compared to 18–39 years old) (adjusted relative risk ratio (ARRR): 4.47, confidence interval (CI): 3.39–5.91), living in an urban residence (ARRR: 1.28, CI: 1.14–2.18), and having hypertension (ARRR: 3.13, CI: 2.36–4.17) were positively associated with obesity. Being male (ARRR: 0.47, CI: 0.33–0.68), having more than primary education (ARRR: 0.69, CI: 0.50–0.94), and having a larger household size (five members or more) (ARRR: 0.45, CI: 0.33–0.60) were negatively associated with obesity. Approximately two in three adult participants were overweight/obese, and sociodemographic and health risk factors were found that can be utilised in targeting interventions.

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Underweight and overweight/obesity among adults in Afghanistan: prevalence and correlates from a national survey in 2018

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00251-0 ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Supa Pengpid ◽

Karl Peltzer

Keyword(s):

Logistic Regression ◽

Multinomial Logistic Regression ◽

Normal Weight ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Negatively Associated ◽

Dual Burden

Abstract Background The study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among adults in Afghanistan. Methods National cross-sectional survey data of 3779 persons aged 18–69 years were analysed. Multinomial logistic regression was used to estimate factors associated with underweight and overweight/obesity relative to normal weight. Results In all, 7.8% of the study sample was underweight (BMI < 18.5 kg/m2), 49.5% had normal weight (BMI 18.5–24.9 kg/m2), 25.5% overweight (25.0–29.9 kg/m2), and 17.2% obesity. In adjusted multinomial logistic regression, factors negatively associated with underweight were male sex (adjusted relative risk ratio (ARRR): 0.30, 95% confidence interval (CI): 0.15–0.58) and hypertension (ARRR: 0.51, 95% CI: 0.27–0.95) and factors positively associated with underweight were sedentary behaviour (ARRR: 1.85, 95% CI: 1.11–3.10) and current tobacco use (ARRR: 2.58, 95% CI: 1.08–6.16). Factors positively associated with overweight/obesity were aged 30–44 years (ARRR: 2.00, CI: 1.51–2.66) and aged 45–69 years (ARRR: 1.58, CI: 1.09–2.31) (compared to 18–29 years) (ARRR: 1.28, CI: 1.14–2.18), hypertension (ARRR: 2.74, CI: 1.89–3.96), and type 2 diabetes (ARRR: 1.82, CI: 1.13–2.94), and high physical activity (ARRR: 0.70, CI: 0.50–0.98) was negatively associated with overweight/obesity. Conclusion Almost one in ten adult respondents were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in Afghanistan.

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Patterns of risk exposure in first 1,000 days of life and health, behavior, and education-related problems at age 4.5: evidence from Growing Up in New Zealand, a longitudinal cohort study

BMC Pediatrics ◽

10.1186/s12887-021-02652-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jan L. Wallander ◽

Sarah Berry ◽

Polly Atatoa Carr ◽

Elizabeth R. Peterson ◽

Karen E. Waldie ◽

...

Keyword(s):

Risk Factors ◽

New Zealand ◽

Health Behavior ◽

Early Development ◽

Externalizing Behavior ◽

Cumulative Risk ◽

Growing Up ◽

Eligibility Criteria ◽

Prospective Longitudinal Study ◽

Prospective Longitudinal

Abstract Background Children who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development. Those exposed to multiple risk factors are more likely to exhibit problems in development than those exposed to a single or no risk factor. We examined the longitudinal associations between persistence and timing of exposure to cumulative risk (CR) on three occasions by age 2 and problems in development at age 4.5 in health, behavior, and education-related domains. Methods Data are from Growing Up in New Zealand (NZ), a prospective longitudinal study of a birth cohort first assessed during their last trimester in 2009–10 and followed at ages 9 months and 2 and 4.5 years. All women with an expected delivery date in a 12-month period who resided within a defined region were invited to participate, with no additional eligibility criteria. Exposure was measured for 12 sociodemographic and maternal health risk factors at third trimester and ages 9 months and 2 years, from which developmental trajectories were constructed capturing persistence and timing of CR exposure. Ten developmental outcomes were measured at age 4.5 to classify problems in overall health status, obesity, and injuries; internalizing and externalizing behavior problems; and letter naming, counting forward and backward, and expectations for starting school and completing education. Results Analyses of data from 6156 children (49% female, 33% Non-European ethnicity) who participated in the 4.5-age assessment uniformly showed associations between exposure to more than consistently zero CR across early development and higher prevalence of being classified with problems for 9 of 10 outcomes. Persistent exposure to a CR ≥ 4 was generally associated with a higher prevalence of problems for 7 of 10 outcomes, whereas the timing of first exposure to CR ≥ 4 showed a less consistent association with problem outcomes. Conclusions These findings are concerning because over 50% of NZ children are exposed to at least one of these risk factors at some point in early development. Routine screening of most of these risk factors during pregnancy is feasible and can identify priority candidates for intervention.

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Prospective longitudinal study investigating predictors of childhood injuries from Growing Up in New Zealand cohort: study protocol

Injury Prevention ◽

10.1136/injuryprev-2021-044414 ◽

2021 ◽

pp. injuryprev-2021-044414

Author(s):

Luam Ghebreab ◽

Bridget Kool ◽

Arier Lee ◽

Susan Morton

Keyword(s):

New Zealand ◽

Unintentional Injury ◽

Emergency Department Visits ◽

Family Characteristics ◽

Health Concern ◽

Growing Up ◽

Prospective Longitudinal Study ◽

Childhood Injuries ◽

Increased Risk ◽

Prospective Longitudinal

BackgroundInjury is one of the leading causes of mortality and morbidity worldwide and yet preventable and predictable. In New Zealand (NZ), unintentional injury is the leading cause of emergency department visits, hospitalisations and death among children, making it a significant public health concern.ObjectiveTo identify the factors that place young children in NZ at an increased risk of unintentional injury.MethodsThis study will investigate injuries among children from the prospective Growing Up in NZ birth cohort of 6853 children and their families. The primary outcome of interest is injury events where medical treatment was sought. The data sources include parental reports of child injury and Accident Compensation Corporation—NZ’s no-fault injury compensation system—injury claims. The linked datasets will be utilised to examine the distribution of life course exposures and outcome data using descriptive statistics. A temporal multilevel model will then be developed to examine relationships between neighbourhood, child and family characteristics and injury from birth to 5 years of age for all children for whom parental consent to link data were obtained.DiscussionThe findings of this research will help to identify how the multiplicity of influences between children, family and their broader societal context acting across time affect their risk of experiencing a preschool injury. This information will provide an evidence base to inform context-relevant strategies to reduce and prevent childhood injuries.

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